Pub Date : 2025-02-01DOI: 10.1016/S2542-5196(24)00330-9
Léo Moutet PharmD , Paquito Bernard PhD , Prof Rosemary Green PhD , James Milner PhD , Prof Andy Haines FMedSci , Rémy Slama PhD , Prof Laura Temime PhD , Kévin Jean PhD
Moving towards net-zero emission societies is projected to provide human health co-benefits. However, the magnitude of these co-benefits is poorly documented and might be context specific. Synthesising the evidence on these co-benefits could enhance the engagement of decision makers and populations in climate mitigation actions. We performed database searches of PubMed, Web of Science, and Scopus for studies published between database inception and Jan 1, 2024, identifying 3976 papers. Of these, 58 quantitative studies met our inclusion criteria and were included in this systematic review. These 58 papers explored 125 net-zero emission scenarios and considered various pathways by which climate policies can affect human health. Pathways addressing air quality, physical activity, and dietary changes found substantial health co-benefits, with a median mortality reduction of 1·5%. National or sub-national studies showed that net-zero policies would yield substantial local air quality benefits, independently of the actions taken in neighbouring countries. However, these co-benefits varied with explored emission sector, decarbonisation levers, modelling approach, and location. Studies that included a cost–benefit analysis estimated that monetised benefits outweighed the costs of implementing climate policies. This systematic review highlights the need for a standardised framework to assess and compare health impacts of climate mitigation actions across sectors and confirms that achieving net-zero goals supports far-reaching public health policies.
Translation
For the French translation of the abstract see Supplementary Materials section.
{"title":"The public health co-benefits of strategies consistent with net-zero emissions: a systematic review","authors":"Léo Moutet PharmD , Paquito Bernard PhD , Prof Rosemary Green PhD , James Milner PhD , Prof Andy Haines FMedSci , Rémy Slama PhD , Prof Laura Temime PhD , Kévin Jean PhD","doi":"10.1016/S2542-5196(24)00330-9","DOIUrl":"10.1016/S2542-5196(24)00330-9","url":null,"abstract":"<div><div>Moving towards net-zero emission societies is projected to provide human health co-benefits. However, the magnitude of these co-benefits is poorly documented and might be context specific. Synthesising the evidence on these co-benefits could enhance the engagement of decision makers and populations in climate mitigation actions. We performed database searches of PubMed, Web of Science, and Scopus for studies published between database inception and Jan 1, 2024, identifying 3976 papers. Of these, 58 quantitative studies met our inclusion criteria and were included in this systematic review. These 58 papers explored 125 net-zero emission scenarios and considered various pathways by which climate policies can affect human health. Pathways addressing air quality, physical activity, and dietary changes found substantial health co-benefits, with a median mortality reduction of 1·5%. National or sub-national studies showed that net-zero policies would yield substantial local air quality benefits, independently of the actions taken in neighbouring countries. However, these co-benefits varied with explored emission sector, decarbonisation levers, modelling approach, and location. Studies that included a cost–benefit analysis estimated that monetised benefits outweighed the costs of implementing climate policies. This systematic review highlights the need for a standardised framework to assess and compare health impacts of climate mitigation actions across sectors and confirms that achieving net-zero goals supports far-reaching public health policies.</div></div><div><h3>Translation</h3><div>For the French translation of the abstract see Supplementary Materials section.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 2","pages":"Pages e145-e156"},"PeriodicalIF":24.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426372","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 : 2025-02-01DOI: 10.1016/S2542-5196(25)00023-3
Andy Haines , Jemilah Mahmood
{"title":"The imperative for actions to protect and promote human health within Earth-system boundaries","authors":"Andy Haines , Jemilah Mahmood","doi":"10.1016/S2542-5196(25)00023-3","DOIUrl":"10.1016/S2542-5196(25)00023-3","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 2","pages":"Pages e80-e82"},"PeriodicalIF":24.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445167","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 : 2025-02-01DOI: 10.1016/S2542-5196(24)00331-0
Douglas A Colquhoun MB ChB , David Hovord MB BChir , Robyn Rachel MHSA , Yuan Yuan MS , Graciela B Mentz PhD , Prabhat Koppera MD , Timur Z Dubovoy MD , Prof Paul Picton MB ChB , Prof George A Mashour MD
Background
Inhaled anaesthetics are greenhouse gases. However, changes in the delivery of inhaled anaesthetics can mitigate environmental impact. We hypothesised that system-wide changes to the delivery of anaesthesia care would reduce environmental harm without compromising patient outcomes.
Methods
We launched the Green Anesthesia Initiative (GAIA) in March, 2022, with the aims of reducing the use of nitrous oxide, using less environmentally harmful inhaled fluorinated ethers, and increasing intravenous anaesthetic use. In this retrospective cohort study, we used electronic health record data from general anaesthetics performed on all patients older than 1 year between March 1, 2021, and Feb 28, 2023, at a single US academic medical centre across multiple sites, collecting data from before and after the introduction of GAIA. Patients with missing or invalid data recorded by the anaesthesia machine, patients given general anaesthetics for electroconvulsive therapy, and patients who met American Society of Anesthesiologists Physical Status Classification 6 were excluded. Using multivariable modelling, we compared estimated CO2, equivalents and, secondarily, anaesthetic dose, postoperative nausea and vomiting, pain scores on a 0–10 scale, and reports of intraoperative awareness with explicit recall.
Findings
We recorded 45 692 patients pre-intervention (23 193 [50·8%] female, 22 494 [49·2%] male, five [<0·1%] unknown) and 47 199 post-intervention (23 981 [50·8%] female, 23 209 [49·2%] male, nine [<0·1%] unknown). After the implementation of GAIA, CO2, equivalents were reduced by 14·38 kg per patient (95% CI –14·68 to –14·07; p<0·0001). There was no clinically meaningful difference in median anaesthetic delivered (minimum alveolar concentration –0·02 [95% CI –0·02 to –0·01]; p<0·0001) nor pain scores (–0·34 [–0·39 to –0·29]; p<0·0001). Postoperative nausea and vomiting was unchanged (odds ratio 0·98 [95% CI 0·94–1·02]; p=0·26). A small number of definite intraoperative awareness events were reported in both periods (one pre-intervention and two post-intervention).
Interpretation
A health-system wide intervention reduces greenhouse gas emissions attributable to anaesthesia care without detriment to patient outcomes.
Funding
University of Michigan Medical School and National Institutes of Health.
{"title":"Environmental and patient safety outcomes of a health-system Green Anesthesia Initiative (GAIA): a retrospective observational cohort study","authors":"Douglas A Colquhoun MB ChB , David Hovord MB BChir , Robyn Rachel MHSA , Yuan Yuan MS , Graciela B Mentz PhD , Prabhat Koppera MD , Timur Z Dubovoy MD , Prof Paul Picton MB ChB , Prof George A Mashour MD","doi":"10.1016/S2542-5196(24)00331-0","DOIUrl":"10.1016/S2542-5196(24)00331-0","url":null,"abstract":"<div><h3>Background</h3><div>Inhaled anaesthetics are greenhouse gases. However, changes in the delivery of inhaled anaesthetics can mitigate environmental impact. We hypothesised that system-wide changes to the delivery of anaesthesia care would reduce environmental harm without compromising patient outcomes.</div></div><div><h3>Methods</h3><div>We launched the Green Anesthesia Initiative (GAIA) in March, 2022, with the aims of reducing the use of nitrous oxide, using less environmentally harmful inhaled fluorinated ethers, and increasing intravenous anaesthetic use. In this retrospective cohort study, we used electronic health record data from general anaesthetics performed on all patients older than 1 year between March 1, 2021, and Feb 28, 2023, at a single US academic medical centre across multiple sites, collecting data from before and after the introduction of GAIA. Patients with missing or invalid data recorded by the anaesthesia machine, patients given general anaesthetics for electroconvulsive therapy, and patients who met American Society of Anesthesiologists Physical Status Classification 6 were excluded. Using multivariable modelling, we compared estimated CO<sub>2</sub>, equivalents and, secondarily, anaesthetic dose, postoperative nausea and vomiting, pain scores on a 0–10 scale, and reports of intraoperative awareness with explicit recall.</div></div><div><h3>Findings</h3><div>We recorded 45 692 patients pre-intervention (23 193 [50·8%] female, 22 494 [49·2%] male, five [<0·1%] unknown) and 47 199 post-intervention (23 981 [50·8%] female, 23 209 [49·2%] male, nine [<0·1%] unknown). After the implementation of GAIA, CO<sub>2</sub>, equivalents were reduced by 14·38 kg per patient (95% CI –14·68 to –14·07; p<0·0001). There was no clinically meaningful difference in median anaesthetic delivered (minimum alveolar concentration –0·02 [95% CI –0·02 to –0·01]; p<0·0001) nor pain scores (–0·34 [–0·39 to –0·29]; p<0·0001). Postoperative nausea and vomiting was unchanged (odds ratio 0·98 [95% CI 0·94–1·02]; p=0·26). A small number of definite intraoperative awareness events were reported in both periods (one pre-intervention and two post-intervention).</div></div><div><h3>Interpretation</h3><div>A health-system wide intervention reduces greenhouse gas emissions attributable to anaesthesia care without detriment to patient outcomes.</div></div><div><h3>Funding</h3><div>University of Michigan Medical School and National Institutes of Health.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 2","pages":"Pages e124-e133"},"PeriodicalIF":24.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445172","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}
Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are prevalent neurodegenerative disorders, posing a critical worldwide public health challenge. Ambient air pollution has been identified as a potential risk factor for AD progression based on toxicological and epidemiological studies. We aimed to evaluate the impacts of air pollution—including fine particulate matter (PM2·5), nitrogen dioxide (NO2), summer ozone (O3), and oxidant—on readmission or death among Medicare enrollees previously hospitalised with an AD/ADRD diagnosis code.
Methods
We constructed a population-based nationwide retrospective cohort including all Medicare fee-for-service beneficiaries (aged ≥65 years) in the contiguous USA (2000–16) hospitalised with AD/ADRD, and followed them up from the year after their first hospitalisation until (1) year of death (mortality cohort) and (2) year of second hospitalisation for any cause (readmission cohort). We calculated annual average PM2·5, NO2, summer O3, and oxidant concentrations for each individual at their residential ZIP code in each year after their first hospitalisation with AD/ADRD. We applied Cox proportional hazard models for the mortality and readmission cohorts stratifying on individual risk factors and adjusting for socioeconomic status, seasonal temperatures, and relative humidity.
Findings
Our cohort consisted of 5 544 118 individuals, of whom 4 543 759 (82·0%) died and 3 880 894 (70·0%) were readmitted to the hospital during the study period. The average follow-up times were 3·34 years (SD 2·60) for the mortality cohort and 1·98 years (SD 1·65) for the readmission cohort. In both the mortality and readmission cohorts we found significant associations with each pollutant. For an IQR increase in NO2, we found a hazard ratio (HR) for mortality of 1·012 (95% CI 1·009–1·015) and an HR for readmission of 1·110 (1·104–1·117). In the readmission cohort, we found an HR of 1·084 (1·079–1·089) for an IQR increase (3·87 μg/m3) in PM2·5. The results slightly decreased in multi-pollutant models. The results of effect modification for mortality and readmission varied by pollutant, but higher risks were found among Black males and among those eligible for Medicaid in general.
Interpretation
We provide new evidence that among a susceptible population with previous AD/ADRD-related hospitalisations, annual air pollution exposure since first hospitalisation is associated with risk of readmission and death.
Funding
National Institute on Aging.
{"title":"The impacts of air pollution on mortality and hospital readmission among Medicare beneficiaries with Alzheimer's disease and Alzheimer's disease-related dementias: a national retrospective cohort study in the USA","authors":"Shuxin Dong SM , Danielle Braun PhD , Xiao Wu PhD , Maayan Yitshak-Sade PhD , Prof Deborah Blacker PhD , Marianthi-Anna Kioumourtzoglou PhD , Prof Joel Schwartz PhD , Daniel Mork PhD , Prof Francesca Dominici PhD , Antonella Zanobetti PhD","doi":"10.1016/S2542-5196(25)00001-4","DOIUrl":"10.1016/S2542-5196(25)00001-4","url":null,"abstract":"<div><h3>Background</h3><div>Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are prevalent neurodegenerative disorders, posing a critical worldwide public health challenge. Ambient air pollution has been identified as a potential risk factor for AD progression based on toxicological and epidemiological studies. We aimed to evaluate the impacts of air pollution—including fine particulate matter (PM<sub>2·5</sub>), nitrogen dioxide (NO<sub>2</sub>), summer ozone (O<sub>3</sub>), and oxidant—on readmission or death among Medicare enrollees previously hospitalised with an AD/ADRD diagnosis code.</div></div><div><h3>Methods</h3><div>We constructed a population-based nationwide retrospective cohort including all Medicare fee-for-service beneficiaries (aged ≥65 years) in the contiguous USA (2000–16) hospitalised with AD/ADRD, and followed them up from the year after their first hospitalisation until (1) year of death (mortality cohort) and (2) year of second hospitalisation for any cause (readmission cohort). We calculated annual average PM<sub>2·5</sub>, NO<sub>2</sub>, summer O<sub>3</sub>, and oxidant concentrations for each individual at their residential ZIP code in each year after their first hospitalisation with AD/ADRD. We applied Cox proportional hazard models for the mortality and readmission cohorts stratifying on individual risk factors and adjusting for socioeconomic status, seasonal temperatures, and relative humidity.</div></div><div><h3>Findings</h3><div>Our cohort consisted of 5 544 118 individuals, of whom 4 543 759 (82·0%) died and 3 880 894 (70·0%) were readmitted to the hospital during the study period. The average follow-up times were 3·34 years (SD 2·60) for the mortality cohort and 1·98 years (SD 1·65) for the readmission cohort. In both the mortality and readmission cohorts we found significant associations with each pollutant. For an IQR increase in NO<sub>2</sub>, we found a hazard ratio (HR) for mortality of 1·012 (95% CI 1·009–1·015) and an HR for readmission of 1·110 (1·104–1·117). In the readmission cohort, we found an HR of 1·084 (1·079–1·089) for an IQR increase (3·87 μg/m<sup>3</sup>) in PM<sub>2·5</sub>. The results slightly decreased in multi-pollutant models. The results of effect modification for mortality and readmission varied by pollutant, but higher risks were found among Black males and among those eligible for Medicaid in general.</div></div><div><h3>Interpretation</h3><div>We provide new evidence that among a susceptible population with previous AD/ADRD-related hospitalisations, annual air pollution exposure since first hospitalisation is associated with risk of readmission and death.</div></div><div><h3>Funding</h3><div>National Institute on Aging.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 2","pages":"Pages e114-e123"},"PeriodicalIF":24.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445171","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 : 2025-02-01DOI: 10.1016/S2542-5196(24)00332-2
Elena Litchman PhD
Ongoing global climate change is affecting all aspects of life on Earth, including human health. The gut microbiota is an important determinant of health in humans and other organisms, but how climate change affects gut microbiota remains largely unexplored. In this Review, I discuss how the changing climate might affect gut microbiota by altering the quantity and quality of food, as well as environmental microbiomes, such as enteric pathogen pressure and host physiology. Climate change-induced variability in food supply, shifts in elemental and macromolecular composition of plant and animal food, the proliferation of enteric pathogens, and the direct effects of high temperatures on gut physiology might alter gut microbiota in undesirable ways, increasing the health burden of climate change. The importance of different pathways might depend on many geographical, economic, and ecological factors. Microbiomes of populations in low-income countries might be disproportionally affected through greater climate change effects and poor mitigation on diet, pathogen burden, and host physiology.
{"title":"Climate change effects on the human gut microbiome: complex mechanisms and global inequities","authors":"Elena Litchman PhD","doi":"10.1016/S2542-5196(24)00332-2","DOIUrl":"10.1016/S2542-5196(24)00332-2","url":null,"abstract":"<div><div>Ongoing global climate change is affecting all aspects of life on Earth, including human health. The gut microbiota is an important determinant of health in humans and other organisms, but how climate change affects gut microbiota remains largely unexplored. In this Review, I discuss how the changing climate might affect gut microbiota by altering the quantity and quality of food, as well as environmental microbiomes, such as enteric pathogen pressure and host physiology. Climate change-induced variability in food supply, shifts in elemental and macromolecular composition of plant and animal food, the proliferation of enteric pathogens, and the direct effects of high temperatures on gut physiology might alter gut microbiota in undesirable ways, increasing the health burden of climate change. The importance of different pathways might depend on many geographical, economic, and ecological factors. Microbiomes of populations in low-income countries might be disproportionally affected through greater climate change effects and poor mitigation on diet, pathogen burden, and host physiology.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 2","pages":"Pages e134-e144"},"PeriodicalIF":24.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445173","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 : 2025-02-01DOI: 10.1016/S2542-5196(24)00335-8
Thomas K Bauer , Christiane Wuckel
{"title":"The association between PM2.5 and clinical antibiotic resistance","authors":"Thomas K Bauer , Christiane Wuckel","doi":"10.1016/S2542-5196(24)00335-8","DOIUrl":"10.1016/S2542-5196(24)00335-8","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 2","pages":"Page e90"},"PeriodicalIF":24.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445328","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 : 2025-02-01DOI: 10.1016/S2542-5196(24)00311-5
Mylan Evrard BA , Alicia Rieckhoff MSc , Leah Shipton MA , Peter Søgaard Jørgensen PhD , Jean-Luc Falcone PhD , Roland Bouffanais PhD , Prof Bastien Chopard PhD , Prof Nicolas Levrat PhD , Didier Wernli PhD
Background
The concept of planetary health underscores the intricate relationship between environmental concerns and global health. This interconnection raises an important question related to cross-sectoral policy development: to what extent are environmental issues integrated into global health governance? To address this question, this study examines resolutions adopted by the World Health Assembly (WHA) from 1948 to 2023.
Methods
Based on a systematic text search for environmental issues, this study examines the evolution of the occurrence and content of resolutions adopted by the WHA and the structure and pattern of connectivity of the normative network of resolutions regarding environment-related resolutions from 1948 to 2023. Environment-related resolutions were processed in the Python environment using relevant packages, such as Pandas, Numpy, and Matplotlib. Regular expressions were employed to identify citations among resolutions and construct a directed citation network. The network was then examined using NetworkX and Graph-Tool.
Findings
Despite important variations in the attention dedicated to environmental issues in resolutions adopted by the WHA, the proportion of environment-related resolutions adopted each year has increased. The number of topics and their diversity have also expanded. Although environment-specific resolutions are well connected to each other, they are more weakly connected to environment-related resolutions, and not well connected to non-environment-related resolutions, suggesting potential silos in policy development. This study shows that several topical entry points exist for a deeper integration of environmental concerns in global health governance.
Interpretation
The findings of this study indicate not only the growing reference to environmental concerns in global health governance, but also an evolution of the understanding of the environment as a key driver of the health of the people. However, there remains room for more comprehensive integration across all areas of global health policy. The study emphasises both the need for active participation in global environmental governance processes that affect health and the importance of minimising the health sector's contribution to environmental problems.
{"title":"The environment in global health governance: an analysis of environment-related resolutions adopted at the World Health Assembly from 1948 to 2023","authors":"Mylan Evrard BA , Alicia Rieckhoff MSc , Leah Shipton MA , Peter Søgaard Jørgensen PhD , Jean-Luc Falcone PhD , Roland Bouffanais PhD , Prof Bastien Chopard PhD , Prof Nicolas Levrat PhD , Didier Wernli PhD","doi":"10.1016/S2542-5196(24)00311-5","DOIUrl":"10.1016/S2542-5196(24)00311-5","url":null,"abstract":"<div><h3>Background</h3><div>The concept of planetary health underscores the intricate relationship between environmental concerns and global health. This interconnection raises an important question related to cross-sectoral policy development: to what extent are environmental issues integrated into global health governance? To address this question, this study examines resolutions adopted by the World Health Assembly (WHA) from 1948 to 2023.</div></div><div><h3>Methods</h3><div>Based on a systematic text search for environmental issues, this study examines the evolution of the occurrence and content of resolutions adopted by the WHA and the structure and pattern of connectivity of the normative network of resolutions regarding environment-related resolutions from 1948 to 2023. Environment-related resolutions were processed in the Python environment using relevant packages, such as Pandas, Numpy, and Matplotlib. Regular expressions were employed to identify citations among resolutions and construct a directed citation network. The network was then examined using NetworkX and Graph-Tool.</div></div><div><h3>Findings</h3><div>Despite important variations in the attention dedicated to environmental issues in resolutions adopted by the WHA, the proportion of environment-related resolutions adopted each year has increased. The number of topics and their diversity have also expanded. Although environment-specific resolutions are well connected to each other, they are more weakly connected to environment-related resolutions, and not well connected to non-environment-related resolutions, suggesting potential silos in policy development. This study shows that several topical entry points exist for a deeper integration of environmental concerns in global health governance.</div></div><div><h3>Interpretation</h3><div>The findings of this study indicate not only the growing reference to environmental concerns in global health governance, but also an evolution of the understanding of the environment as a key driver of the health of the people. However, there remains room for more comprehensive integration across all areas of global health policy. The study emphasises both the need for active participation in global environmental governance processes that affect health and the importance of minimising the health sector's contribution to environmental problems.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 2","pages":"Pages e103-e113"},"PeriodicalIF":24.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445170","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 : 2025-02-01DOI: 10.1016/S2542-5196(25)00003-8
Peninah Murage PhD , Blanca Anton MSc , Faraja Chiwanga MD , Roberto Picetti PhD , Tabby Njunge MSc , Syreen Hassan MD PhD , Sarah Whitmee PhD , Jane Falconer MA , Hugh Sharma Waddington PhD , Prof Rosemary Green PhD
The impact of nature-based solutions on human health is increasingly recognised; however, our understanding of the strength of evidence and the extent to which it supports policy and practice is insufficient. We aimed to assess the health and wellbeing impacts of solutions in low-income and middle-income settings in which trees are a central feature in the protection, restoration, and sustainable management of landscapes. For this systematic review and meta-analysis, we searched Web of Science, Embase, APA PsycInfo, MEDLINE ALL, Global Health, Global Index Medicus, GreenFILE, SciELO, EconLit, and Africa-Wide Information for studies that evaluated the impacts of relevant interventions on health and wellbeing. Searches were limited to records published from Jan 1, 2000, to the search date; an initial search was conducted on Nov 23, 2021, and was updated on Feb 27–28, 2023. We extracted data from studies comparing interventions with matched controls, calculated standardised mean differences, and pooled the effects using random-effects meta-analysis with adjustments for potential effect dependence. Studies were assessed for quality using seven risk-of-bias domains. Our search identified 23 402 studies, of which 54 were included in the meta-analysis. We found significant positive pooled effects for agricultural yields (standardised mean difference 0·41 [95% CI 0·11 to 0·70]), dietary diversity (0·10 [0·02 to 0·18]), total household income (0·21 [0·09 to 0·33]), poverty reduction (0·17 [0·07 to 0·27]), child growth (0·11 [0·00 to 0·22]), and self-reported wellbeing (0·21 [0·00 to 0·43]). Loss of income from timber production could be a negative outcome (−0·13 [−0·29 to 0·02]); however, these effects might be partially offset by increased income from non-timber forest products (0·32 [0·04 to 0·61]). Effects varied substantially by intervention type, with more positive effects associated with interventions in which the primary target was livelihood improvement than with interventions that targeted biodiversity or carbon mitigation. However, cautious interpretation is urged owing to the low certainty of the evidence. In conclusion, evidence suggests that tree-based solutions can support the health and wellbeing of the implementing communities. Such evidence strengthens the case for aligning health objectives with the goals of nature-based solutions by making community wellbeing an integral component of conservation programmes. Future studies should examine a wider range of outcomes that have direct relevance for health.
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