Lancet Planetary Health最新文献

Ambitious policies are urgently needed to protect human health from the impacts of climate change. Civil society, including researchers and advocates, can help advance such policies by communicating with policy makers. In this scoping review, we examined what is known about effectively communicating with policy makers to encourage them to act on public health, climate change, or their nexus. We analysed 139 studies published in the literature on health, climate, and their intersection that focused on strategies for communicating with policy makers. Among many other recommendations, the most frequently recommended communication strategies were to tailor messaging to target audiences; share accessible, concise, and timely evidence; and build coalitions and trusted relationships. The studies were largely about health communication to policy makers, were predominantly based in high-income countries, and most frequently used case studies, interviews, and surveys as methods. Further experimental research is needed to test the findings generated by non-experimental methods. Additionally, future research should seek to generate and test communication strategies in more low-income and middle-income countries. Based on this literature, we have produced a list of strategic questions that communicators might wish to consider as they prepare to communicate with policy makers.

Despite increasing emphasis being placed on the inclusion of upstream ecological and social perspectives for zoonotic disease control, few guidelines exist for practitioners and decision makers to work with communities in identifying suitable, locally relevant interventions and integrating these into public health action plans. With an interdisciplinary group of Kenyan stakeholders, we designed and tested a comprehensive framework for the co-design, evaluation, and prioritisation of beneficiary-oriented, ecologically and socially informed interventions for preventing and controlling outbreaks of wildlife-borne zoonoses. Our approach used four globally important wildlife-borne pathogens-Rift Valley fever virus, Congo-Crimean haemorrhagic fever virus, and the causative agents of anthrax and rabies-enabling stakeholders to develop a shared understanding of complex transmission pathways, identify a broad array of measures targeting ecological, biological, and social processes governing outbreaks of these pathogens, and explore trade-offs for specific interventions. The framework can be applied early in the decision-making process to encourage broader, cross-sectoral co-production of knowledge, ideas, and consensus on the control of complex zoonotic diseases.

Sand and dust storms increasingly threaten global environmental and public health. To date, 150 countries are directly affected, with more than 100 classified as non-dust source regions. With climate change, these storms are expected to become more frequent and severe. Despite international awareness and initiatives, such as those led by the UN, crucial knowledge gaps continue to hinder effective, evidence-based public responses to sand and dust storms. In this Viewpoint, we review existing gaps in health research and highlight four key research priorities: the comprehensive health effects of sand and dust storms, including short-term and long-term exposures, diseases, regions, and health outcomes; the key particle sizes and toxic components of particles during sand and dust storms; the design of multicentre studies accounting for region-specific exposure patterns; and research on health outcomes attributable to particulate matter mixtures dominated by windblown dust versus other sources. We urgently call for international, collaborative, and multidisciplinary health studies considering sand and dust storm exposure characteristics and for the adoption of scientifically robust epidemiological methods in these studies.

Background: Weather extremes are predicted to influence pathogen exposure but their effects on specific faecal-oral transmission pathways are not well investigated. We evaluated associations between extreme rain and temperature during different antecedent periods (0-14 days) and Escherichia coli along eight faecal-oral pathways in rural Bangladeshi households.

Methods: We used data from the WASH Benefits Bangladesh cluster-randomised controlled trial (NCT01590095). E coli was enumerated in hand rinses from children younger than 5 years and their mothers, food, stored drinking water, tubewells, captured flies, ponds, and courtyard soil using IDEXX Quanti-Tray/2000 in nine rounds over 3·5 years and spatiotemporally matched to daily weather data. We used generalised linear models with robust standard errors to estimate E coli count ratios (ECRs) associated with extreme rain and temperature, defined as greater than the 90th percentile of daily values during the study period.

Findings: A total of 26 659 samples were collected during the study period. Controlling for temperature, extreme rain on the sampling day was associated with increased E coli in food (ECR=3·13 [95% CI 1·63-5·99], p=0·0010), stored drinking water (ECR=1·98 [1·36-2·88], p=0·0004), and ponds (ECR=3·46 [2·34-5·11], p<0·0001), and reduced E coli in soil (ECR=0·36 [0·24-0·53], p<0·0001). Extreme rain the day before sampling was associated with reduced E coli in tubewells (ECR=0·10 [0·02-0·62], p=0·014). Associations were similar for rainfall 1-7 days before sampling and slightly attenuated for rainfall 14 days before sampling. Controlling for rainfall, extreme temperature on the sampling day was associated with increased E coli in stored drinking water (ECR=1·49 [1·05-2·12], p=0·025) and food (ECR=3·01 [1·51-6·01], p=0·0020). Associations with temperature were similar for all antecedent periods and particularly pronounced for food. Neither rainfall nor temperature were consistently associated with E coli on hands and flies.

Interpretation: In rural Bangladesh, measures to control enteric infections following weather extremes should focus on water treatment and safe storage to reduce contamination of drinking water and food stored at home and on reducing exposure to surface waters.

Funding: Bill & Melinda Gates Foundation, National Institutes of Health, World Bank.

Shifting to dietary patterns rich in plants and low in animal-source foods could substantially lower emissions from the food sector while reducing the global burden of non-communicable diseases. The EAT-Lancet Commission proposed the planetary health diet (PHD) to emphasise plant-forward diets and set global targets to guide an urgently needed food-system transformation. However, the PHD's meat-reduction approach has attracted criticism and prompted debate on the potential micronutrient shortfalls of the plant-forward dietary approach. Since the planet simply cannot sustain human diets defaulting towards animal-based solutions, the objective of this Viewpoint is to provide recommendations that address the shortfalls of the PHD, with an emphasis on plant-based sourcing of food. Using a socioecological approach, along with an Integrative Sustainability Framework to evaluate dietary guidelines, in this Viewpoint we recommend seven key thematic areas for further development of the PHD. These themes relate to the bioavailability of micronutrients from plant-based foods, the inclusion of indigenous foods and practices, fortification and supplementation, cultural inclusiveness, and gender-based differences, a broader perspective on processed foods, and strengthening the concept by integrating the One Health approach.

Background: An increase in pandemics of zoonotic origin has led to a growing interest in using statistical prediction to identify hotspots of zoonotic emergence. However, the rare nature of pathogen emergence requires modellers to impose simplifying assumptions, which limit the model's validity. We present a novel approach to hotspot mapping that aims to improve validity by combining model-based insights with expert knowledge.

Methods: We conducted a systematic literature review to identify predictors for zoonotic emergence events in three priority virus families (Filoviridae, Coronaviridae, and Paramyxoviridae). We searched PubMed, Web of Science, Agricola, medRxiv, bioRxiv, Embase, CAB Global Health, and Google Scholar on Oct 14-28, 2021, with no restrictions on language or the date of publication. Articles suggested by subject matter experts and those identified by a review of reference lists were also included. We used regularised regression to fit a model to the data extracted from the literature and produced maps of ranked risk. In a series of workshops in five countries (Kenya, Peru, Senegal, Thailand, and Viet Nam), experts in zoonotic diseases produced qualitative hotspot maps based on their expertise, which were compared with the model-derived maps.

Findings: 425 articles were analysed, from which 19 predictors and 1068 outcome events were identified. The in-sample misclassification error was 0·365, and 89% of participant-selected zones were ranked as moderate or high risk by the model. Participant-selected zones were too large to be actionable without further refinement. Discordance was probably due to missing predictors for which no valid data exist, and homogeneity imposed by our global model.

Interpretation: Concordance between the two sets of maps supports the validity of each. Because model-based and participatory strategies have non-overlapping limitations, the results can be harmonised to minimise bias, and model-based results could be used to refine participant-selected zones. This approach shows potential for refining deployment of countermeasures to prevent future pandemics.

Funding: US Agency for International Development.

There are increasing concerns that continued economic growth in high-income countries might not be environmentally sustainable, socially beneficial, or economically achievable. In this Review, we explore the rapidly advancing field of post-growth research, which has evolved in response to these concerns. The central idea of post-growth is to replace the goal of increasing GDP with the goal of improving human wellbeing within planetary boundaries. Key advances discussed in this Review include: the development of ecological macroeconomic models that test policies for managing without growth; understanding and reducing the growth dependencies that tie social welfare to increasing GDP in the current economy; and characterising the policies and provisioning systems that would allow resource use to be reduced while improving human wellbeing. Despite recent advances in post-growth research, important questions remain, such as the politics of transition, and transformations in the relationship between the Global North and the Global South.