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AbstractClimate change is one of the major global health threats to the world's population. It is brought on by global warming due in large part to increasing levels of greenhouse gases resulting from human activity, including burning fossil fuels (carbon dioxide), animal husbandry (methane from manure), industry emissions (ozone, nitrogen oxides, sulfur dioxide), vehicle/factory exhaust, and chlorofluorocarbon aerosols that trap extra heat in the earth's atmosphere. Resulting extremes of weather give rise to wildfires, air pollution, changes in ecology, and floods. These in turn result in displacement of populations, family disruption, violence, and major impacts on water quality and availability, food security, public health and economic infrastructures, and limited abilities for civil society to maintain citizen safety. Climate change also has direct impacts on human health and well‐being. Particularly vulnerable populations are affected, including women, pregnant women, children, the disabled, and the elderly, who comprise the majority of the poor globally. Additionally, the effects of climate change disproportionally affect disadvantaged communities, including low income and communities of color, and lower‐income countries that are at highest risk of adverse impacts when disasters occur due to inequitable distribution of resources and their socioeconomic status. The climate crisis is tilting the risk balance unfavorably for women's sexual and reproductive health and rights as well as newborn and child health. Obstetrician/gynecologists have the unique opportunity to raise awareness, educate, and advocate for mitigation strategies to reverse climate change affecting our patients and their families. This article puts climate change in the context of women's reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue that needs our attention now for the health and well‐being of this and future generations. FIGO joins a broad coalition of international researchers and the medical community in stating that the current climate crisis presents an imminent health risk to pregnant people, developing fetuses, and reproductive health, and recognizing that we need society‐wide solutions, government policies, and global cooperation to address and reduce contributors, including fossil fuel production, to climate change.

National and international assessments have drawn attention to the substantial economic risks of climate change. The costs of climate-sensitive health outcomes responsive to meteorological or seasonal patterns are among the least studied of those risks. In this article we describe how cost valuation analyses that relate climate-sensitive health outcomes to damages in economic terms can illuminate the costs of inaction on the climate crisis and the economic savings of addressing this problem. We identify major challenges to expanding the application of climate-health valuation research and suggest solutions to overcome these obstacles to better characterize the burden of climate-sensitive health outcomes and health disparities. The projected health and economic harms of climate-sensitive risks could be enormous if climate change continues to accelerate and communities are not prepared to reduce or prevent their impact. Expanded valuation of climate-sensitive health outcomes can inform policies that slow climate change and promote stronger investments in health-protective climate change adaptation efforts.

Abstract Climate change poses a multifaceted, complex, and existential threat to human health and well-being, but efforts to communicate these threats to the public lag behind what we know how to do in communication research. Effective communication about climate change’s health risks can improve a wide variety of individual and population health-related outcomes by: (1) helping people better make the connection between climate change and health risks and (2) empowering them to act on that newfound knowledge and understanding. The aim of this manuscript is to highlight communication methods that have received empirical support for improving knowledge uptake and/or driving higher-quality decision making and healthier behaviors and to recommend how to apply them at the intersection of climate change and health. This expert consensus about effective communication methods can be used by healthcare professionals, decision makers, governments, the general public, and other stakeholders including sectors outside of health. In particular, we argue for the use of 11 theory-based, evidence-supported communication strategies and practices. These methods range from leveraging social networks to making careful choices about the use of language, narratives, emotions, visual images, and statistics. Message testing with appropriate groups is also key. When implemented properly, these approaches are likely to improve the outcomes of climate change and health communication efforts.

Interventions to reduce household air pollution (HAP) are key to reducing associated morbidity and mortality in low- and middle- income countries (LMICs); especially among pregnant women and young children. This systematic review aims to determine the effectiveness of interventions aimed to reduce HAP exposure associated with domestic solid biomass fuel combustion, compared to usual cooking practices, for improving health outcomes in pregnant women and children under five in LMIC settings. A systematic review and meta-analysis was undertaken with searches undertaken in MEDLINE, EMBASE, CENTRAL, GIM, ClinicalTrials.gov, and Greenfile in August 2020. Inclusion criteria were experimental, non-experimental, or quasi-experimental studies investigating the impact of interventions to reduce HAP exposure and improve associated health outcomes among pregnant women or children under 5 years. Study selection, data extraction, and quality assessment using the Effective Public Health Practice Project tool were undertaken independently by two reviewers. Seventeen out of 7293 retrieved articles (seven pregnancy, nine child health outcome; 13 studies) met the inclusion criteria. These assessed improved cookstoves (ICS; n = 10 studies), ethanol stoves (n = 1 study), and Liquefied Petroleum Gas (LPG; n = 2 studies) stoves interventions. Meta-analysis showed no significant effect of ICS interventions compared to traditional cooking for risk of preterm birth (n = 2 studies), small for gestational age (n = 2 studies), and incidence of acute respiratory infections (n = 6 studies). Although an observed increase in mean birthweight was observed, this was not statistically significant (n = 4). However, ICS interventions reduced the incidence of childhood burns (n = 3; observations = 41 723; Rate Ratio: 0.66 [95% CI: 0.45-0.96]; I2 : 46.7%) and risk of low birth weight (LBW; n = 4; observations = 3456; Odds Ratio: 0.73 [95% CI: 0.61-0.87]; I2 : 21.1%). Although few studies reported health outcomes, the data indicate that ICS interventions were associated with reduced risk of childhood burns and LBW. The data highlight the need for the development and implementation of robust, well-reported and monitored, community-driven intervention trials with longer-term participant follow-up.

In Latin America, where climate change and rapid urbanization converge, non-optimal ambient temperatures contribute to excess mortality. However, little is known about area-level characteristics that confer vulnerability to temperature-related mortality.Explore city-level socioeconomic and demographic characteristics associated with temperature-related mortality in Latin American cities.The dependent variables quantify city-specific associations between temperature and mortality: heat- and cold-related excess death fractions (EDF, or percentages of total deaths attributed to cold/hot temperatures), and the relative mortality risk (RR) associated with 1 °C difference in temperature in 325 cities during 2002-2015. Random effects meta-regressions were used to investigate whether EDFs and RRs associated with heat and cold varied by city-level characteristics, including population size, population density, built-up area, age-standardized mortality rate, poverty, living conditions, educational attainment, income inequality, and residential segregation by education level.We find limited effect modification of cold-related mortality by city-level demographic and socioeconomic characteristics and several unexpected associations for heat-related mortality. For example, cities in the highest compared to the lowest tertile of income inequality have all-age cold-related excess mortality that is, on average, 3.45 percentage points higher (95% CI: 0.33, 6.56). Higher poverty and higher segregation were also associated with higher cold EDF among those 65 and older. Large, densely populated cities, and cities with high levels of poverty and income inequality experience smaller heat EDFs compared to smaller and less densely populated cities, and cities with little poverty and income inequality.Evidence of effect modification of cold-related mortality in Latin American cities was limited, and unexpected patterns of modification of heat-related mortality were observed. Socioeconomic deprivation may impact cold-related mortality, particularly among the elderly. The findings of higher levels of poverty and income inequality associated with lower heat-related mortality deserve further investigation given the increasing importance of urban adaptation to climate change.

To investigate relationships between ambient temperatures and violent crimes to determine whether those relationships are consistent across different crime categories and whether they are best described as increasing linear functions, or as curvilinear functions that decrease beyond some temperature threshold. A secondary objective was to consider the implications of the observed relationships for injuries and deaths from violent crimes in the context of a warming climate. To address these questions, we examined the relationship between daily ambient temperatures and daily incidents of violent crime in Dallas, Texas from 1993-1999.We analyzed the relationships between daily fluctuations in ambient temperature, other meteorological and temporal variables, and rates of daily violent crime using time series piece-wise regression and plots of daily data. Violent crimes, including aggravated assault, homicide, and sexual assault, were analyzed.We found that daily mean ambient temperature is related in a curvilinear fashion to daily rates of violent crime with a positive and increasing relationship between temperature and aggravated crime that moderates beyond temperatures of 80°F and then turns negative beyond 90°F.While some have characterized the relationship between temperature and violent crime as a continually increasing linear function, leaving open the possibility that aggravated crime will increase in a warmer climate, we conclude that the relationship in Dallas is not linear, but moderates and turns negative at high ambient temperatures. We posit that higher temperatures may encourage people to seek shelter in cooler indoor spaces, and that street crime and other crimes of opportunity are subsequently decreased. This finding suggests that the higher ambient temperatures expected with climate change may result in marginal shifts in violent crime in the short term, but are not likely to be accompanied by markedly higher rates of violent crime and associated increased incidence of injury and death. Additional studies are indicated, across cities at varying latitudes that experience a range of daily ambient temperatures.

Le paludisme est une maladie à transmission vectorielle très préoccupante pour la santé publique. Malgré le succès généralisé de nombreuses initiatives d'élimination, les efforts d'élimination dans certaines régions du monde sont au point mort. Les obstacles à l'élimination du paludisme comprennent les changements climatiques et d'utilisation des terres, tels que le réchauffement des températures et l'urbanisation, qui peuvent altérer les habitats des moustiques. Les facteurs socio-économiques, tels que l'instabilité politique et les migrations régionales, menacent également les objectifs d'élimination. Cela est particulièrement pertinent dans les zones où l'élimination locale a été réalisée et où, par conséquent, les efforts de surveillance et de contrôle diminuent et ne sont plus une priorité. Comprendre l'impact des changements environnementaux sur l'élimination du paludisme a des implications pratiques importantes pour les stratégies de lutte antivectorielle et de surveillance des maladies. Il est important de tenir compte du changement climatique lors de la surveillance de la menace de résurgence du paludisme en raison d'influences socio-économiques. Cependant, l'évaluation de la manière dont la combinaison des variations climatiques, des interventions et des pressions socio-économiques influence les tendances à long terme des efforts de transmission et d'élimination du paludisme est limitée. Dans cette étude, nous avons utilisé des modèles hiérarchiques bayésiens mixtes et des données sur les cas de paludisme pour une période de 29 ans afin de démêler les impacts des variations climatiques et des efforts de lutte contre le paludisme sur le risque de paludisme dans la province équatorienne d'El Oro, qui a atteint l'élimination locale en 2011. Nous avons constaté une évolution des schémas de paludisme entre les zones rurales et urbaines, avec une augmentation relative de P. vivax dans les zones urbanisées. La température minimale était un facteur important de la saisonnalité du paludisme et l'association entre les températures minimales plus chaudes et l'incidence du paludisme était plus grande pour P. falciparum que pour P. vivax. Il y avait une hétérogénéité considérable dans l'impact de trois mesures de lutte contre les vecteurs chimiques sur le paludisme à P. falciparum et à P. vivax. Nous avons trouvé des associations statistiquement significatives entre deux des trois mesures (pulvérisation à effet rémanent à l'intérieur et pulvérisation dans l'espace) et une réduction de l'incidence du paludisme, qui variait selon le type de paludisme. Nous avons également constaté que l'aptitude environnementale à la transmission du paludisme augmente à El Oro, ce qui pourrait limiter les futurs efforts d'élimination si le paludisme est autorisé à se rétablir. Nos résultats ont des implications importantes pour comprendre les obstacles environnementaux à l'élimination du paludisme et soulignent l'importance de concevoir et de soutenir les efforts d'élimination dans les zones qui restent vulnérables à la résurgence. La malaria es una enfermedad transmitida por vectores de gran preocupación para la salud pública. A pesar del éxito generalizado de muchas iniciativas de eliminación, los esfuerzos de eliminación en algunas regiones del mundo se han estancado. Las barreras para la eliminación de la malaria incluyen cambios en el clima y el uso de la tierra, como el calentamiento de las temperaturas y la urbanización, que pueden alterar los hábitats de los mosquitos. Los factores socioeconómicos, como la inestabilidad política y la migración regional, también amenazan los objetivos de eliminación. Esto es particularmente relevante en áreas donde se ha logrado la eliminación local y, en consecuencia, los esfuerzos de vigilancia y control están disminuyendo y ya no son una prioridad. Comprender cómo el cambio ambiental afecta la eliminación de la malaria tiene importantes implicaciones prácticas para el control de vectores y las estrategias de vigilancia de enfermedades. Es importante considerar el cambio climático al monitorear la amenaza del resurgimiento de la malaria debido a las influencias socioeconómicas. Sin embargo, hay una evaluación limitada de cómo la combinación de la variación climática, las intervenciones y las presiones socioeconómicas influyen en las tendencias a largo plazo en los esfuerzos de transmisión y eliminación de la malaria. En este estudio, utilizamos modelos mixtos jerárquicos bayesianos y datos de casos de malaria durante un período de 29 años para desentrañar los impactos de la variación climática y los esfuerzos de control de la malaria en el riesgo de malaria en la provincia ecuatoriana de El Oro, que logró la eliminación local en 2011. Encontramos patrones cambiantes de malaria entre áreas rurales y urbanas, con un aumento relativo de P. vivax en áreas urbanizadas. La temperatura mínima fue un importante impulsor de la estacionalidad de la malaria y la asociación entre las temperaturas mínimas más cálidas y la incidencia de la malaria fue mayor para P. falciparum en comparación con la malaria por P. vivax. Hubo una considerable heterogeneidad en el impacto de tres medidas de control de vectores químicos tanto en la malaria por P. falciparum como por P. vivax. Encontramos asociaciones estadísticamente significativas entre dos de las tres medidas (fumigación residual en interiores y fumigación en espacios) y una reducción en la incidencia de malaria, que varió según el tipo de malaria. También encontramos que la idoneidad ambiental para la transmisión de la malaria está aumentando en El Oro, lo que podría limitar los esfuerzos futuros de eliminación si se permite que la malaria se restablezca. Nuestros hallazgos tienen implicaciones importantes para comprender los obstáculos ambientales para la eliminación de la malaria y resaltan la importancia de diseñar y mantener los esfuerzos de eliminación en áreas que siguen siendo vulnerables al resurgimiento. Malaria is a vector-borne disease of significant public health concern. Despite widespread success of many elimination initiatives, elimination efforts in some regions of the world have stalled. Barriers to malaria elimination include climate and land use changes, such as warming temperatures and urbanization, which can alter mosquito habitats. Socioeconomic factors, such as political instability and regional migration, also threaten elimination goals. This is particularly relevant in areas where local elimination has been achieved and consequently surveillance and control efforts are dwindling and are no longer a priority. Understanding how environmental change impacts malaria elimination has important practical implications for vector control and disease surveillance strategies. It is important to consider climate change when monitoring the threat of malaria resurgence due to socioeconomic influences. However, there is limited assessment of how the combination of climate variation, interventions and socioeconomic pressures influence long-term trends in malaria transmission and elimination efforts. In this study, we used Bayesian hierarchical mixed models and malaria case data for a 29-year period to disentangle the impacts of climate variation and malaria control efforts on malaria risk in the Ecuadorian province of El Oro, which achieved local elimination in 2011. We found shifting patterns of malaria between rural and urban areas, with a relative increase of P. vivax in urbanized areas. Minimum temperature was an important driver of malaria seasonality and the association between warmer minimum temperatures and malaria incidence was greater for P. falciparum compared to P. vivax malaria. There was considerable heterogeneity in the impact of three chemical vector control measures on both P. falciparum and P. vivax malaria. We found statistically significant associations between two of the three measures (indoor residual spraying and space spraying) and a reduction in malaria incidence, which varied between malaria type. We also found environmental suitability for malaria transmission is increasing in El Oro, which could limit future elimination efforts if malaria is allowed to re-establish. Our findings have important implications for understanding environmental obstacles to malaria elimination and highlights the importance of designing and sustaining elimination efforts in areas that remain vulnerable to resurgence. الملاريا مرض ينتقل عن طريق النواقل ويشكل مصدر قلق كبير على الصحة العامة. على الرغم من النجاح الواسع النطاق للعديد من مبادرات القضاء على الملاريا، فقد توقفت جهود القضاء على الملاريا في بعض مناطق العالم. تشمل العوائق التي تحول دون القضاء على الملاريا تغيرات المناخ واستخدام الأراضي، مثل ارتفاع درجات الحرارة والتحضر، والتي يمكن أن تغير موائل البعوض. كما تهدد العوامل الاجتماعية والاقتصادية، مثل عدم الاستقرار السياسي والهجرة الإقليمية، أهداف القضاء على المرض. هذا مهم بشكل خاص في المناطق التي تم فيها تحقيق القضاء المحلي وبالتالي تضاءلت جهود المراقبة والسيطرة ولم تعد أولوية. إن فهم كيفية تأثير التغير البيئي على القضاء على الملاريا له آثار عملية مهمة على استراتيجيات مكافحة ناقلات الأمراض ومراقبة الأمراض. من المهم مراعاة تغير المناخ عند رصد خطر عودة الملاريا بسبب التأثيرات الاجتماعية والاقتصادية. ومع ذلك، هناك تقييم محدود لكيفية تأثير مزيج من التباين المناخي والتدخلات والضغوط الاجتماعية والاقتصادية على الاتجاهات طويلة الأجل في جهود انتقال الملاريا والقضاء عليها. في هذه الدراسة، استخدمنا نماذج مختلطة هرمية بايزية وبيانات حالة الملاريا لمدة 29 عامًا لفصل آثار تغير المناخ وجهود مكافحة الملاريا على خطر الملاريا في مقاطعة إل أورو الإكوادورية، والتي حققت القضاء المحلي في عام 2011. وجدنا أنماطًا متغيرة من الملاريا بين المناطق الريفية والحضرية، مع زيادة نسبية في P. vivax في المناطق الحضرية. كانت درجة الحرارة الدنيا محركًا مهمًا لموسمية الملاريا وكان الارتباط بين درجات الحرارة الدنيا الأكثر دفئًا وحدوث الملاريا أكبر بالنسبة لداء المتصورة المنجلية مقارنة بداء المتصورة النشيطة. كان هناك عدم تجانس كبير في تأثير ثلاثة تدابير لمكافحة النواقل الكيميائية على كل من P. falciparum و P. vivax malaria. وجدنا ارتباطات ذات دلالة إحصائية بين اثنين من التدابير الثلاثة (الرش الداخلي المتبقي والرش المكاني) وانخفاض في الإصابة بالملاريا، والتي اختلفت بين نوع الملاريا. كما وجدنا أن الملاءمة البيئية لانتقال الملاريا آخذة في الازدياد في إل أورو، مما قد يحد من جهود القضاء على الملاريا في المستقبل إذا سُمح للملاريا بالعودة. للنتائج التي توصلنا إليها آثار مهمة على فهم العقبات البيئية التي تحول دون القضاء على الملاريا وتسلط الضوء على أهمية تصميم جهود القضاء على الملاريا واستدامتها في المناطق التي لا تزال عرضة للظهور من جديد.

Author(s): Riggs, William | Abstract: A review of the recent book by Dannenberg, Frumkin, and Jackson which proposes a “toolbox” of solutions to reshape the built environment for posterity.

Environmental and social factors influencing resource allocation in rural, developing regions are critical social determinants of health that necessitate cross-sector collaboration to improve health opportunities. Thus, we sought to evaluate the spatial distribution and accessibility of medical resources to assess existing disparities, identify best practices for resource allocation, and inform regional health planning policies. In this study, inequality in the frequency distribution of medical resources in Wenzhou, China, was measured using the Gini coefficient and agglomeration degree. We evaluated the spatial accessibility of medical institutions throughout the city using the modified hierarchical two-step floating catchment area (H2SFCA) method. Using the Spearman correlation analysis, we investigated the factors influencing accessibility differences. The results indicate that Wenzhou’s spatial distribution of medical resources is unbalanced and unequal. According to the population and geographic distribution, the distribution of medical resources in Wenzhou is unequal. Wenzhou’s overall spatial accessibility is poor. The east region is more accessible than the west region, and the accessibility of medical institutions at different levels varies greatly. The correlation between accessibility and the number of institutions, doctors, population density, road density, and GDP is positive. There is a need for policies and initiatives to enhance the geographical distribution of resources, construct interconnected road networks, and improve residents’ access to medical resources.

BackgroundMost studies of the climate footprint of diets have been conducted in countries in the global north, but the majority of the world population lives in global south countries. We estimated total dietary greenhouse gas emissions (GHGE) in Mexico, examined the contribution of major food and beverage groups, and assessed variation across social groups.MethodsWe linked individual-level dietary data from the Mexican National Health and Nutrition Survey 2018 to the SHARP Indicators Database, containing GHGE estimates for 182 primary food and beverages.ResultsMean dietary GHGE was 3.9 kg of carbon dioxide equivalent per person per day. Dietary GHGE is highest among those in young adulthood and middle age versus adolescents and older adults, and among males, those with higher educational attainment, higher socioeconomic status, that do not speak an indigenous language, and that live in urban areas.ConclusionThe Mexican diet has a much lower carbon footprint than diets in other Latin American countries for which such estimates are available. In contrast to patterns observed in Argentina and Brazil, dietary GHGE was lowest in those in lower socioeconomic and educational strata and in rural areas. A better understanding of the differences in diet sustainability between and within countries will be needed for developing global and local strategies that meet the environmental sustainability goals.