Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00245-6
Background
Hospitals contribute substantially to greenhouse gas emissions and face a moral obligation to prioritise emission reduction. Drugs constitute an important component of the greenhouse gas emissions of hospitals. Alternative dosing strategies (ADS) have been implemented to improve the cost-effectiveness of pembrolizumab and nivolumab. However, the impact of these ADS on greenhouse gas emissions remains unknown. Therefore, we aimed to analyse the effect of ADS implementation on the carbon emissions of treatment with pembrolizumab and nivolumab.
Methods
We used a process-based lifecycle assessment to quantify the environmental impact of pembrolizumab and nivolumab, focused on equivalent carbon dioxide emissions (CO2e). Lifecycle inventory and impact data from Erasmus University Medical Center (Rotterdam, Netherlands) were used to calculate the CO2e for pembrolizumab and nivolumab, their dosing intervals, and the impact of ADS on CO2e. The functional unit of the study was the administration of a single dose of pembrolizumab or nivolumab.
Findings
In 2022, the annual carbon emissions related to pembrolizumab and nivolumab treatment in the Erasmus University Medical Center were 445 tons of CO2e, averaging 94 kg of CO2e per dose. Pharmaceutical production was the main driver of treatment-related carbon emissions (mean 92·9% of total emissions). Applying ADS resulted in 21–26% and 9–11% CO2e reductions for pembrolizumab and nivolumab, respectively.
Interpretation
This study shows the environmental impact of pembrolizumab and nivolumab treatment and calls for further implementation of ADS for pembrolizumab, nivolumab, and other anti-PD-(L)1 monoclonal antibodies, and more sustainable pharmaceutical production processes. Our findings create environmental awareness and contribute to the promotion and understanding of health-care practices with lower carbon emissions.
{"title":"Effect of alternative dosing strategies of pembrolizumab and nivolumab on health-care emissions in the Netherlands: a carbon footprint analysis","authors":"","doi":"10.1016/S2542-5196(24)00245-6","DOIUrl":"10.1016/S2542-5196(24)00245-6","url":null,"abstract":"<div><h3>Background</h3><div>Hospitals contribute substantially to greenhouse gas emissions and face a moral obligation to prioritise emission reduction. Drugs constitute an important component of the greenhouse gas emissions of hospitals. Alternative dosing strategies (ADS) have been implemented to improve the cost-effectiveness of pembrolizumab and nivolumab. However, the impact of these ADS on greenhouse gas emissions remains unknown. Therefore, we aimed to analyse the effect of ADS implementation on the carbon emissions of treatment with pembrolizumab and nivolumab.</div></div><div><h3>Methods</h3><div>We used a process-based lifecycle assessment to quantify the environmental impact of pembrolizumab and nivolumab, focused on equivalent carbon dioxide emissions (CO<sub>2</sub>e). Lifecycle inventory and impact data from Erasmus University Medical Center (Rotterdam, Netherlands) were used to calculate the CO<sub>2</sub>e for pembrolizumab and nivolumab, their dosing intervals, and the impact of ADS on CO<sub>2</sub>e. The functional unit of the study was the administration of a single dose of pembrolizumab or nivolumab.</div></div><div><h3>Findings</h3><div>In 2022, the annual carbon emissions related to pembrolizumab and nivolumab treatment in the Erasmus University Medical Center were 445 tons of CO<sub>2</sub>e, averaging 94 kg of CO<sub>2</sub>e per dose. Pharmaceutical production was the main driver of treatment-related carbon emissions (mean 92·9% of total emissions). Applying ADS resulted in 21–26% and 9–11% CO<sub>2</sub>e reductions for pembrolizumab and nivolumab, respectively.</div></div><div><h3>Interpretation</h3><div>This study shows the environmental impact of pembrolizumab and nivolumab treatment and calls for further implementation of ADS for pembrolizumab, nivolumab, and other anti-PD-(L)1 monoclonal antibodies, and more sustainable pharmaceutical production processes. Our findings create environmental awareness and contribute to the promotion and understanding of health-care practices with lower carbon emissions.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00239-0
<div><h3>Background</h3><div>Being unhoused can increase vulnerability to adverse health effects due to air pollution. We aimed to quantify changes in emergency-department visits during and after exposure to wildfire-specific and non-wildfire particulate matter 2·5 μm or less in diameter (PM<sub>2·5</sub>) in San Diego County (CA, USA) in people who were both unhoused and housed.</div></div><div><h3>Methods</h3><div>For this time-stratified case–crossover study, we used data on exposure to wildfire-specific PM<sub>2·5</sub> in California and individual-level data for people admitted to the emergency departments of two hospitals (UC San Diego Health emergency departments at La Jolla and Hillcrest, San Diego) in San Diego County between July 1, 2012, and Dec 31, 2020. People with a postcode outside of San Diego County were excluded. Demographic information was age group, race or ethnicity, and transport to the emergency department. Wildfire-specific PM<sub>2·5</sub> concentration at the postcode level was previously estimated using an ensemble model that combined multiple machine-learning algorithms and explanatory variables obtained via data on 24-h mean PM<sub>2·5</sub> concentrations from the US Environmental Protection Agency Air Quality System. Conditional logistic regression models were applied, adjusting for specific humidity, wind velocity, and maximum temperature extracted from the US Gridded Surface Meteorological Dataset. Housing status was established by registration staff or triage nurses on arrival at the emergency department. For people who were unhoused, exposure was defined based on the weighted mean PM<sub>2·5</sub> concentration at the city level proportional to the number of people who were unhoused in each specific city across urban centres in San Diego County. For people who were housed, we used residence postcode to measure exposure. We assessed the association between PM<sub>2·5</sub> from wildfire and non-wildfire sources and emergency-department visits in people who were housed and unhoused.</div></div><div><h3>Findings</h3><div>There were 587 562 emergency-department visits at the two hospitals, 76 407 (13·0%) of which were by people who were unhoused. People who were housed had a higher exposure to overall PM<sub>2·5</sub> (24-h mean over the study period of 9·904 mg/m<sup>3</sup>, SD 3·445) and non-wildfire PM<sub>2·5</sub> (9·663, 2·977) than people who were unhoused (9·863, 3·221; 9·557, 2·599). However, people who were unhoused had a higher exposure to wildfire-specific PM<sub>2·5</sub> (0·305, 1·797) than people who were housed (0·240, 1·690). Overall PM<sub>2·5</sub> exposure was associated with increased odds of emergency-department visits for both people who were housed (odds ratio 1·003, 95% CI 1·001–1·004 per 1 μg/m<sup>3</sup> PM<sub>2·5</sub> for 0–3 days after exposure) and people who were unhoused (1·004, 1·000–1·008 for 0–3 days after exposure). We found that non-wildfire PM<sub>2·5</sub> was associated wi
{"title":"Effects of fine particulate matter from wildfire and non-wildfire sources on emergency-department visits in people who were housed and unhoused in San Diego County (CA, USA) during 2012–20: a time-stratified case–crossover study","authors":"","doi":"10.1016/S2542-5196(24)00239-0","DOIUrl":"10.1016/S2542-5196(24)00239-0","url":null,"abstract":"<div><h3>Background</h3><div>Being unhoused can increase vulnerability to adverse health effects due to air pollution. We aimed to quantify changes in emergency-department visits during and after exposure to wildfire-specific and non-wildfire particulate matter 2·5 μm or less in diameter (PM<sub>2·5</sub>) in San Diego County (CA, USA) in people who were both unhoused and housed.</div></div><div><h3>Methods</h3><div>For this time-stratified case–crossover study, we used data on exposure to wildfire-specific PM<sub>2·5</sub> in California and individual-level data for people admitted to the emergency departments of two hospitals (UC San Diego Health emergency departments at La Jolla and Hillcrest, San Diego) in San Diego County between July 1, 2012, and Dec 31, 2020. People with a postcode outside of San Diego County were excluded. Demographic information was age group, race or ethnicity, and transport to the emergency department. Wildfire-specific PM<sub>2·5</sub> concentration at the postcode level was previously estimated using an ensemble model that combined multiple machine-learning algorithms and explanatory variables obtained via data on 24-h mean PM<sub>2·5</sub> concentrations from the US Environmental Protection Agency Air Quality System. Conditional logistic regression models were applied, adjusting for specific humidity, wind velocity, and maximum temperature extracted from the US Gridded Surface Meteorological Dataset. Housing status was established by registration staff or triage nurses on arrival at the emergency department. For people who were unhoused, exposure was defined based on the weighted mean PM<sub>2·5</sub> concentration at the city level proportional to the number of people who were unhoused in each specific city across urban centres in San Diego County. For people who were housed, we used residence postcode to measure exposure. We assessed the association between PM<sub>2·5</sub> from wildfire and non-wildfire sources and emergency-department visits in people who were housed and unhoused.</div></div><div><h3>Findings</h3><div>There were 587 562 emergency-department visits at the two hospitals, 76 407 (13·0%) of which were by people who were unhoused. People who were housed had a higher exposure to overall PM<sub>2·5</sub> (24-h mean over the study period of 9·904 mg/m<sup>3</sup>, SD 3·445) and non-wildfire PM<sub>2·5</sub> (9·663, 2·977) than people who were unhoused (9·863, 3·221; 9·557, 2·599). However, people who were unhoused had a higher exposure to wildfire-specific PM<sub>2·5</sub> (0·305, 1·797) than people who were housed (0·240, 1·690). Overall PM<sub>2·5</sub> exposure was associated with increased odds of emergency-department visits for both people who were housed (odds ratio 1·003, 95% CI 1·001–1·004 per 1 μg/m<sup>3</sup> PM<sub>2·5</sub> for 0–3 days after exposure) and people who were unhoused (1·004, 1·000–1·008 for 0–3 days after exposure). We found that non-wildfire PM<sub>2·5</sub> was associated wi","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00246-8
In the summer of 2024, there were higher temperatures than usual in several parts of India. Temperatures in Delhi, a huge city with millions of residents, broke several previous records. Low-income households have dwellings that do not offer much protection from the heat, and individuals struggle to access basic amenities, such as water. With accumulating evidence on consequent impacts for mortality and morbidity, governance structures are seeking to respond in a timely and efficient manner. There is a need to recognise that heat-related illnesses and deaths are not best addressed merely as an acute disaster but as public health and economic challenges that require planned responses. Responses that are sustainable and equitable combine long-term structural efforts at resilience building with emergency preparedness and prove to be most effective in averting the largely preventable deaths, morbidities, and economic shocks arising from heat-related health risks among exposed and vulnerable communities. Joint action on climate and health enhances achievement of multiple developmental goals with multistakeholder participation. Diverse sectors, including medical care, surveillance, risk communication, disaster preparedness, livelihoods and jobs, and adaptation and urban planning, are needed to raise public awareness and engagement, induce behavioural change, and focus resources for the much-needed structural changes in urban planning and health systems that can save lives and avert damages. To reduce heat-related health risks, vulnerability, inequity, and climate action in the Indian context must be urgently addressed.
{"title":"Responding to heat-related health risks: the urgency of an equipoise between emergency and equity","authors":"","doi":"10.1016/S2542-5196(24)00246-8","DOIUrl":"10.1016/S2542-5196(24)00246-8","url":null,"abstract":"<div><div>In the summer of 2024, there were higher temperatures than usual in several parts of India. Temperatures in Delhi, a huge city with millions of residents, broke several previous records. Low-income households have dwellings that do not offer much protection from the heat, and individuals struggle to access basic amenities, such as water. With accumulating evidence on consequent impacts for mortality and morbidity, governance structures are seeking to respond in a timely and efficient manner. There is a need to recognise that heat-related illnesses and deaths are not best addressed merely as an acute disaster but as public health and economic challenges that require planned responses. Responses that are sustainable and equitable combine long-term structural efforts at resilience building with emergency preparedness and prove to be most effective in averting the largely preventable deaths, morbidities, and economic shocks arising from heat-related health risks among exposed and vulnerable communities. Joint action on climate and health enhances achievement of multiple developmental goals with multistakeholder participation. Diverse sectors, including medical care, surveillance, risk communication, disaster preparedness, livelihoods and jobs, and adaptation and urban planning, are needed to raise public awareness and engagement, induce behavioural change, and focus resources for the much-needed structural changes in urban planning and health systems that can save lives and avert damages. To reduce heat-related health risks, vulnerability, inequity, and climate action in the Indian context must be urgently addressed.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00234-1
Food systems contribute to multiple crises while failing to deliver healthy, nutritious food for all. A substantial amount of research suggests that the root cause of this issue lies in the complete integration of food systems within global capitalism and the consequent subordination of fairness and sustainability to profit accumulation. We draw on critical political economy to explore how the integration of food systems within global capitalism and their subordination to profit occur. Subsequently, we illustrate how this subordination erodes the autonomy of food producers, with strong environmental and social consequences for consumers and society at large. Lastly, we discuss how agroecology could transform food systems and enhance producers' autonomy, while mitigating environmental and social dysfunction. We stress how the transformative power of agroecology lies in its double nature: concrete (technical) and social (political). By acting in both dimensions, agroecology can help reorient food systems away from profit accumulation and towards better meeting community needs, in line with the tenets of food sovereignty.
{"title":"Transforming food systems through agroecology: enhancing farmers' autonomy for a safe and just transition","authors":"","doi":"10.1016/S2542-5196(24)00234-1","DOIUrl":"10.1016/S2542-5196(24)00234-1","url":null,"abstract":"<div><div>Food systems contribute to multiple crises while failing to deliver healthy, nutritious food for all. A substantial amount of research suggests that the root cause of this issue lies in the complete integration of food systems within global capitalism and the consequent subordination of fairness and sustainability to profit accumulation. We draw on critical political economy to explore how the integration of food systems within global capitalism and their subordination to profit occur. Subsequently, we illustrate how this subordination erodes the autonomy of food producers, with strong environmental and social consequences for consumers and society at large. Lastly, we discuss how agroecology could transform food systems and enhance producers' autonomy, while mitigating environmental and social dysfunction. We stress how the transformative power of agroecology lies in its double nature: concrete (technical) and social (political). By acting in both dimensions, agroecology can help reorient food systems away from profit accumulation and towards better meeting community needs, in line with the tenets of food sovereignty.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00243-2
Background
In 2015, the Chinese Government launched the coal to clean heating policy (CHP), designed to improve air quality and health in China. The CHP banned household coal burning and provided subsidies for clean electric or gas-powered heating for millions of peri-urban and rural households. We aimed to investigate whether the CHP affected the incidence of acute myocardial infarction in Beijing townships.
Methods
In this quasi-experimental study, we obtained township data on acute myocardial infarction hospital admissions and deaths, exposure to the CHP (yes vs no), and a range of covariates for periods before (Jan 1, 2013, to Dec 31, 2014) and after the CHP began (Jan 1, 2016, to Dec 31, 2017; and Jan 1, 2018, to Dec 31, 2019). The policy was gradually rolled out across villages, and townships in our study were considered exposed to the policy in periods when more than 50% of their villages were assigned into the CHP. We estimated the effect of the CHP on township incidence of acute myocardial infarction for all adults (aged ≥35 years) and separately for sex and older adults (aged ≥65 years) using a difference-in-differences approach that accommodates the progressive roll-out of the policy.
Findings
Of 307 townships in Beijing, we excluded 156 (51%) urban townships where most villages had central heating and were thus ineligible for the CHP. Of the 151 peri-urban and rural Beijing townships considered eligible for the CHP, 75 (50%) townships were exposed to the CHP by the end of 2017 and 92 (61%) by the end of 2019. We estimated an overall reduction of 6·6% (95% CI –12·3 to –0·8) in the incidence of acute myocardial infarction from before to after roll-out of the CHP in exposed townships relative to those not exposed to the policy, with some evidence of larger effects in women (–11·7% [–19·0 to –4·1%]), older adults (–10·7% [–17·4 to –3·6%]), and in townships exposed for longer (–3·5% [–9·5 to 2·8%] after <2 years and –9·7% [–18·3 to –0·5%] after 2–4 years).
Interpretation
Our results provide among the first empirical evidence of possible cardiovascular benefits from a household clean energy policy, and support efforts to implement and assess such policies in China and globally.
Funding
Wellcome Trust, the Canadian Institutes for Health Research, and the National Natural Science Foundation of China.
{"title":"Effects of a coal to clean heating policy on acute myocardial infarction in Beijing: a difference-in-differences analysis","authors":"","doi":"10.1016/S2542-5196(24)00243-2","DOIUrl":"10.1016/S2542-5196(24)00243-2","url":null,"abstract":"<div><h3>Background</h3><div>In 2015, the Chinese Government launched the coal to clean heating policy (CHP), designed to improve air quality and health in China. The CHP banned household coal burning and provided subsidies for clean electric or gas-powered heating for millions of peri-urban and rural households. We aimed to investigate whether the CHP affected the incidence of acute myocardial infarction in Beijing townships.</div></div><div><h3>Methods</h3><div>In this quasi-experimental study, we obtained township data on acute myocardial infarction hospital admissions and deaths, exposure to the CHP (yes <em>vs</em> no), and a range of covariates for periods before (Jan 1, 2013, to Dec 31, 2014) and after the CHP began (Jan 1, 2016, to Dec 31, 2017; and Jan 1, 2018, to Dec 31, 2019). The policy was gradually rolled out across villages, and townships in our study were considered exposed to the policy in periods when more than 50% of their villages were assigned into the CHP. We estimated the effect of the CHP on township incidence of acute myocardial infarction for all adults (aged ≥35 years) and separately for sex and older adults (aged ≥65 years) using a difference-in-differences approach that accommodates the progressive roll-out of the policy.</div></div><div><h3>Findings</h3><div>Of 307 townships in Beijing, we excluded 156 (51%) urban townships where most villages had central heating and were thus ineligible for the CHP. Of the 151 peri-urban and rural Beijing townships considered eligible for the CHP, 75 (50%) townships were exposed to the CHP by the end of 2017 and 92 (61%) by the end of 2019. We estimated an overall reduction of 6·6% (95% CI –12·3 to –0·8) in the incidence of acute myocardial infarction from before to after roll-out of the CHP in exposed townships relative to those not exposed to the policy, with some evidence of larger effects in women (–11·7% [–19·0 to –4·1%]), older adults (–10·7% [–17·4 to –3·6%]), and in townships exposed for longer (–3·5% [–9·5 to 2·8%] after <2 years and –9·7% [–18·3 to –0·5%] after 2–4 years).</div></div><div><h3>Interpretation</h3><div>Our results provide among the first empirical evidence of possible cardiovascular benefits from a household clean energy policy, and support efforts to implement and assess such policies in China and globally.</div></div><div><h3>Funding</h3><div>Wellcome Trust, the Canadian Institutes for Health Research, and the National Natural Science Foundation of China.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00283-3
{"title":"Planetary Health Research Digest","authors":"","doi":"10.1016/S2542-5196(24)00283-3","DOIUrl":"10.1016/S2542-5196(24)00283-3","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00241-9
Hospitals use many single-use devices that produce more waste and greenhouse gas emissions than reusable devices; operating theatres alone are responsible for up to a third of hospital waste. We explored barriers and enablers to replacing disposable devices with reusable alternatives in operating theatres by use of interviews, the Theoretical Domains Framework, and theory-informed behaviour change techniques. 19 stakeholders were interviewed at a large tertiary hospital in Melbourne, Australia, and 53 barriers and 44 experience-based or intuition-based enablers were identified. 30 strategies were identified across six topics: external purchasing (two strategies); internal purchasing (seven strategies); incentivisation and standardised environmental decision making (three strategies); successful practical introduction of reusable devices (five strategies); identification of goals and facilitation of leadership (two strategies); and a community of practice and knowledge building (11 strategies). We present these 30 implementation strategies, from the individual to the policy level, which consist of evidence-based behaviour change techniques aimed at addressing the identified barriers to replacing single-use devices with reusable alternatives.
{"title":"A qualitative exploration of barriers, enablers, and implementation strategies to replace disposable medical devices with reusable alternatives","authors":"","doi":"10.1016/S2542-5196(24)00241-9","DOIUrl":"10.1016/S2542-5196(24)00241-9","url":null,"abstract":"<div><div>Hospitals use many single-use devices that produce more waste and greenhouse gas emissions than reusable devices; operating theatres alone are responsible for up to a third of hospital waste. We explored barriers and enablers to replacing disposable devices with reusable alternatives in operating theatres by use of interviews, the Theoretical Domains Framework, and theory-informed behaviour change techniques. 19 stakeholders were interviewed at a large tertiary hospital in Melbourne, Australia, and 53 barriers and 44 experience-based or intuition-based enablers were identified. 30 strategies were identified across six topics: external purchasing (two strategies); internal purchasing (seven strategies); incentivisation and standardised environmental decision making (three strategies); successful practical introduction of reusable devices (five strategies); identification of goals and facilitation of leadership (two strategies); and a community of practice and knowledge building (11 strategies). We present these 30 implementation strategies, from the individual to the policy level, which consist of evidence-based behaviour change techniques aimed at addressing the identified barriers to replacing single-use devices with reusable alternatives.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00250-X
Limited reporting of Indigenous-led planetary health education programmes has constrained efforts to expand planetary health education, in Indigenous communities and beyond, despite urgent need. Although incorporation of Indigenous knowledge and cultures cannot be standardised, showcasing successful programmes could reveal good practices and aid replicability. In this Personal View, we highlight how shellfish toxin education programmes, designed and organised by the Sitka Tribe of Alaska, reduce local environmental health risks and support youth in pathways towards careers in planetary health. We describe how programmes build awareness and understanding of the local environment, environmental and health risks, and context-appropriate adaptation strategies by centring Tlingit culture and using hands-on activities that integrate Tlingit culture with western science. Lesson plans and resources created by Sitka Tribe of Alaska staff for these programmes are available in the US National Institute for Environmental Health Sciences Partnerships for Environmental Public Health resources web database.
{"title":"Tribally led planetary health education in southeast Alaska","authors":"","doi":"10.1016/S2542-5196(24)00250-X","DOIUrl":"10.1016/S2542-5196(24)00250-X","url":null,"abstract":"<div><div>Limited reporting of Indigenous-led planetary health education programmes has constrained efforts to expand planetary health education, in Indigenous communities and beyond, despite urgent need. Although incorporation of Indigenous knowledge and cultures cannot be standardised, showcasing successful programmes could reveal good practices and aid replicability. In this Personal View, we highlight how shellfish toxin education programmes, designed and organised by the Sitka Tribe of Alaska, reduce local environmental health risks and support youth in pathways towards careers in planetary health. We describe how programmes build awareness and understanding of the local environment, environmental and health risks, and context-appropriate adaptation strategies by centring Tlingit culture and using hands-on activities that integrate Tlingit culture with western science. Lesson plans and resources created by Sitka Tribe of Alaska staff for these programmes are available in the US National Institute for Environmental Health Sciences Partnerships for Environmental Public Health resources web database.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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