Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101376
Erin Coughlan de Perez , Ahmed Ishtiaque Amin Chowdhury , Glecy Atienza , Sonia Binte Murshed , Ramon Christopher A Caballero , Dennis De La Torre , Aira Joy Delos Angeles , Desderius Haufiku , Alexa Samantha R Hernandez , Md. Monirul Islam , Kenneth Lekatsa , Selma Lendelvo , Tandi Litwayi , Makoala V Marake , Joalane Marunye , Mashfiqus Salehin , Kebitsamang Mothibe , Elena Naumova , Mothusi Nyofane , Garimoi Christopher Orach , Carolyn Van Sant
{"title":"Beyond the narrow lens: the power of an interdisciplinary approach to climate and health research and training","authors":"Erin Coughlan de Perez , Ahmed Ishtiaque Amin Chowdhury , Glecy Atienza , Sonia Binte Murshed , Ramon Christopher A Caballero , Dennis De La Torre , Aira Joy Delos Angeles , Desderius Haufiku , Alexa Samantha R Hernandez , Md. Monirul Islam , Kenneth Lekatsa , Selma Lendelvo , Tandi Litwayi , Makoala V Marake , Joalane Marunye , Mashfiqus Salehin , Kebitsamang Mothibe , Elena Naumova , Mothusi Nyofane , Garimoi Christopher Orach , Carolyn Van Sant","doi":"10.1016/j.lanplh.2025.101376","DOIUrl":"10.1016/j.lanplh.2025.101376","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101376"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101377
Peninah Murage PhD , Charlotte Hicks MA , Valerie Kapos PhD , Santhuri Naidoo MSc , Syreen Hassan PhD , Sarah Whitmee PhD
Human health stands to benefit from a deeper understanding of the mechanisms by which ecosystems affect health and wellbeing. However, achieving this understanding requires overcoming conceptual and practical challenges in both public health and ecology. Despite growing recognition of the importance of natural ecosystems for human health, the health sector has yet to fully integrate this ever-growing body of evidence to inform policy and practice. Substantial conceptual differences underpin the disciplinary divide between health and ecology. For example, environmental health research disciplines, such as epidemiology, emphasise the adverse effects of environmental exposures, such as water and air pollutants, as well as naturally occurring hazards, such as radon or arsenic. By contrast, ecology focuses on nature’s contributions to people through ecosystem services, including food provision, climate regulation, or disaster management. These conceptual differences create a misalignment in evidence generation, in setting priorities for policy, and in the implementation of solutions. Methodological differences further complicate the alignment of health and ecology datasets, particularly when exposures and outcomes occur across different spatiotemporal scales. The disciplines also differ on how to define pathways from exposure to health and how to quantify and communicate effects. Consequently, each discipline often reinforces its existing views instead of leveraging the combined knowledge base for a broader understanding. This Personal View outlines practical steps to bridging the divide and fostering transdisciplinary collaboration by recognising the dynamic interactions between health and natural ecosystems, integrating conceptual frameworks across disciplines, and addressing methodological challenges in assessing impacts.
{"title":"Safeguarding natural ecosystems can protect population health: advancing approaches to bridge the health–ecology divide","authors":"Peninah Murage PhD , Charlotte Hicks MA , Valerie Kapos PhD , Santhuri Naidoo MSc , Syreen Hassan PhD , Sarah Whitmee PhD","doi":"10.1016/j.lanplh.2025.101377","DOIUrl":"10.1016/j.lanplh.2025.101377","url":null,"abstract":"<div><div>Human health stands to benefit from a deeper understanding of the mechanisms by which ecosystems affect health and wellbeing. However, achieving this understanding requires overcoming conceptual and practical challenges in both public health and ecology. Despite growing recognition of the importance of natural ecosystems for human health, the health sector has yet to fully integrate this ever-growing body of evidence to inform policy and practice. Substantial conceptual differences underpin the disciplinary divide between health and ecology. For example, environmental health research disciplines, such as epidemiology, emphasise the adverse effects of environmental exposures, such as water and air pollutants, as well as naturally occurring hazards, such as radon or arsenic. By contrast, ecology focuses on nature’s contributions to people through ecosystem services, including food provision, climate regulation, or disaster management. These conceptual differences create a misalignment in evidence generation, in setting priorities for policy, and in the implementation of solutions. Methodological differences further complicate the alignment of health and ecology datasets, particularly when exposures and outcomes occur across different spatiotemporal scales. The disciplines also differ on how to define pathways from exposure to health and how to quantify and communicate effects. Consequently, each discipline often reinforces its existing views instead of leveraging the combined knowledge base for a broader understanding. This Personal View outlines practical steps to bridging the divide and fostering transdisciplinary collaboration by recognising the dynamic interactions between health and natural ecosystems, integrating conceptual frameworks across disciplines, and addressing methodological challenges in assessing impacts.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101377"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101391
Anand Bhopal MBChB PhD , Martin Hensher PhD , Andrea J MacNeill MD , Ole F Norheim MD PhD , Jodi D Sherman MD , Craig Mitton PhD
Priority setting in health care is a research and practice area at the intersection of medicine, ethics, and economics, which aims to systematically and transparently evaluate the value for money of health services to support fair resource allocation. Three widely accepted principles for fair priority setting are cost-effectiveness, priority to the worse off, and financial risk protection, with a wide range of other contested criteria. Conceptualising and navigating potential synergies and trade-offs between competing goals, and clearly communicating the values at stake, are the central tasks of priority setting. It is now increasingly clear that health care systems have substantial environmental effects that have been largely overlooked, and that the growing movement towards high-quality, low-polluting, and climate-resilient health systems has potentially far-reaching implications for resource allocation. This Personal View explores how priority setting tools can facilitate the transition to environmentally sustainable health care. We outline the key principles of priority setting in health care and explore how environmental sustainability can be incorporated into resource allocation tools, such as health technology assessment and multicriteria decision analysis, as well as budgetary processes, such as programme budgeting and marginal analysis. We conclude with some implications for wider health system transformation.
{"title":"Priority setting for environmentally sustainable health care: emerging approaches to fair resource allocation","authors":"Anand Bhopal MBChB PhD , Martin Hensher PhD , Andrea J MacNeill MD , Ole F Norheim MD PhD , Jodi D Sherman MD , Craig Mitton PhD","doi":"10.1016/j.lanplh.2025.101391","DOIUrl":"10.1016/j.lanplh.2025.101391","url":null,"abstract":"<div><div>Priority setting in health care is a research and practice area at the intersection of medicine, ethics, and economics, which aims to systematically and transparently evaluate the value for money of health services to support fair resource allocation. Three widely accepted principles for fair priority setting are cost-effectiveness, priority to the worse off, and financial risk protection, with a wide range of other contested criteria. Conceptualising and navigating potential synergies and trade-offs between competing goals, and clearly communicating the values at stake, are the central tasks of priority setting. It is now increasingly clear that health care systems have substantial environmental effects that have been largely overlooked, and that the growing movement towards high-quality, low-polluting, and climate-resilient health systems has potentially far-reaching implications for resource allocation. This Personal View explores how priority setting tools can facilitate the transition to environmentally sustainable health care. We outline the key principles of priority setting in health care and explore how environmental sustainability can be incorporated into resource allocation tools, such as health technology assessment and multicriteria decision analysis, as well as budgetary processes, such as programme budgeting and marginal analysis. We conclude with some implications for wider health system transformation.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101391"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101334
Yijing Feng MHS , Tingfan Jin MS , Yaguang Wei PhD , Prof Kyle Steenland PhD , Prof Joel Schwartz PhD
<div><h3>Background</h3><div>The health burden from cancer has markedly increased over the past 20 years. Total PM<sub>2·5</sub> has been identified as an environmental risk factor for cancer. However, how each constituent of PM<sub>2·5</sub> contributes to the development of cancer is largely unknown. We aimed to investigate the association between 15 PM<sub>2·5</sub> constituents, sources of PM<sub>2·5</sub>, and the incidence of five common cancers among adults aged 65 years and older in the USA.</div></div><div><h3>Methods</h3><div>For this national cohort study, we included beneficiaries of Medicare in the USA, aged 65 or older, who were followed for various time periods between Jan 1, 2000, and Dec 31, 2018. The concentrations of 15 PM<sub>2·5</sub> constituents in the contiguous USA were estimated using ensemble machine learning models, and the sources of PM<sub>2·5</sub> were identified from the PM<sub>2·5</sub> constituent data using non-negative matrix factorisation. The outcomes were incident lung, colorectal, prostate, breast, and endometrial cancers, for which information was extracted from the Medicare Chronic Conditions Data Warehouse database. Associations between PM<sub>2·5</sub> constituents and the outcomes were investigated using a generalised weighted-quantile sum regression model with the Cox-approximate Poisson method, and associations between PM<sub>2·5</sub> sources and outcomes were investigated using Cox-approximate Poisson regression models.</div></div><div><h3>Findings</h3><div>15 138 652 Medicare beneficiaries were included in the study, with a median follow-up period of 9 years (IQR 5–15). The incidences per 1000 person-years were 15·9 for lung cancer, 18·9 for colorectal cancer, 73·5 for prostate cancer, 50·7 for breast cancer, and 11·4 for endometrial cancer. Each one-decile increase in exposure to the PM<sub>2·5</sub> mixture was associated with incident rate increases of 6·4% (95% CI 5·9 to 6·9) for lung cancer, 4·3% (3·8 to 4·8) for colorectal cancer, 3·6% (3·1 to 3·9) for prostate cancer, and 2·0% (1·7 to 2·4) for breast cancer. No association was observed for endometrial cancer (0·4% [−0·4 to 1·1]). Of the PM<sub>2·5</sub> constituents, vanadium contributed the largest relative weight in the observed associations (ranging from 23·7–36·1%). Increased incidence of all five cancers was associated with PM<sub>2·5</sub> sourced from fuel oil combustion (14·1% [95% CI 6·5–22·3] for lung cancer, 15·6% [7·5–24·2] for colorectal cancer, 18·4% [5·2–33·4] for prostate cancer, 9·2% [7·9–10·5] for breast cancer, and 5·6% [2·9–8·3] for endometrial cancer for each 1 μg/m<sup>3</sup> increase in concentration) and with PM<sub>2·5</sub> sourced from coal combustion (6·9% [3·3–10·7] for lung cancer, 9·2% [6·6–11·9] for colorectal cancer, 7·3% [3·6–11·1] for prostate cancer, 6·2% [3·2–9·3] for breast cancer, and 3·3% [2·2–4·3] for endometrial cancer).</div></div><div><h3>Interpretation</h3><div>PM<sub>2·5</sub> exposure was ass
{"title":"Long-term exposure to PM2·5 constituents and incident cancer among Medicare beneficiaries in the USA: a national cohort study","authors":"Yijing Feng MHS , Tingfan Jin MS , Yaguang Wei PhD , Prof Kyle Steenland PhD , Prof Joel Schwartz PhD","doi":"10.1016/j.lanplh.2025.101334","DOIUrl":"10.1016/j.lanplh.2025.101334","url":null,"abstract":"<div><h3>Background</h3><div>The health burden from cancer has markedly increased over the past 20 years. Total PM<sub>2·5</sub> has been identified as an environmental risk factor for cancer. However, how each constituent of PM<sub>2·5</sub> contributes to the development of cancer is largely unknown. We aimed to investigate the association between 15 PM<sub>2·5</sub> constituents, sources of PM<sub>2·5</sub>, and the incidence of five common cancers among adults aged 65 years and older in the USA.</div></div><div><h3>Methods</h3><div>For this national cohort study, we included beneficiaries of Medicare in the USA, aged 65 or older, who were followed for various time periods between Jan 1, 2000, and Dec 31, 2018. The concentrations of 15 PM<sub>2·5</sub> constituents in the contiguous USA were estimated using ensemble machine learning models, and the sources of PM<sub>2·5</sub> were identified from the PM<sub>2·5</sub> constituent data using non-negative matrix factorisation. The outcomes were incident lung, colorectal, prostate, breast, and endometrial cancers, for which information was extracted from the Medicare Chronic Conditions Data Warehouse database. Associations between PM<sub>2·5</sub> constituents and the outcomes were investigated using a generalised weighted-quantile sum regression model with the Cox-approximate Poisson method, and associations between PM<sub>2·5</sub> sources and outcomes were investigated using Cox-approximate Poisson regression models.</div></div><div><h3>Findings</h3><div>15 138 652 Medicare beneficiaries were included in the study, with a median follow-up period of 9 years (IQR 5–15). The incidences per 1000 person-years were 15·9 for lung cancer, 18·9 for colorectal cancer, 73·5 for prostate cancer, 50·7 for breast cancer, and 11·4 for endometrial cancer. Each one-decile increase in exposure to the PM<sub>2·5</sub> mixture was associated with incident rate increases of 6·4% (95% CI 5·9 to 6·9) for lung cancer, 4·3% (3·8 to 4·8) for colorectal cancer, 3·6% (3·1 to 3·9) for prostate cancer, and 2·0% (1·7 to 2·4) for breast cancer. No association was observed for endometrial cancer (0·4% [−0·4 to 1·1]). Of the PM<sub>2·5</sub> constituents, vanadium contributed the largest relative weight in the observed associations (ranging from 23·7–36·1%). Increased incidence of all five cancers was associated with PM<sub>2·5</sub> sourced from fuel oil combustion (14·1% [95% CI 6·5–22·3] for lung cancer, 15·6% [7·5–24·2] for colorectal cancer, 18·4% [5·2–33·4] for prostate cancer, 9·2% [7·9–10·5] for breast cancer, and 5·6% [2·9–8·3] for endometrial cancer for each 1 μg/m<sup>3</sup> increase in concentration) and with PM<sub>2·5</sub> sourced from coal combustion (6·9% [3·3–10·7] for lung cancer, 9·2% [6·6–11·9] for colorectal cancer, 7·3% [3·6–11·1] for prostate cancer, 6·2% [3·2–9·3] for breast cancer, and 3·3% [2·2–4·3] for endometrial cancer).</div></div><div><h3>Interpretation</h3><div>PM<sub>2·5</sub> exposure was ass","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101334"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101390
Nurshad Ali PhD , Jenny Katsouli MRes , Eric Auyang MSc , Jorge Bernardino de la Serna PhD
Microplastics and nanoplastics (MNPs) are emerging pollutants widely dispersed in the environment, with humans primarily exposed through ingestion and inhalation. Although their biological effects are being increasingly studied, their potential effect on human health and disease risk remains uncertain. This Review summarises evidence on potential disease risks of human exposure to MNPs, while highlighting key limitations and research gaps. Evidence suggests that MNP exposure might elevate the risk of various diseases, including metabolic, respiratory, cardiovascular, neuroendocrine, hepatic, renal, and skin disorders, as well as infectious diseases, cancer, and ageing-related disorders. Despite extensive evidence of adverse effects in animal models and cell cultures, direct evidence linking MNP exposure to human disease risk remains scarce. A key challenge on research of MNPs lies in the scarcity of robust human exposure data and the narrow scope of existing studies on specific types of MNPs, leaving several environmentally prevalent plastic particles understudied. Addressing these gaps will require investigating the mechanisms of toxicity, relevant biomarkers, and disease pathways associated with MNP exposure. Such efforts will be essential to clarify human health risks and inform future regulatory and mitigation strategies.
{"title":"Microplastic and nanoplastic pollution and associated potential disease risks","authors":"Nurshad Ali PhD , Jenny Katsouli MRes , Eric Auyang MSc , Jorge Bernardino de la Serna PhD","doi":"10.1016/j.lanplh.2025.101390","DOIUrl":"10.1016/j.lanplh.2025.101390","url":null,"abstract":"<div><div>Microplastics and nanoplastics (MNPs) are emerging pollutants widely dispersed in the environment, with humans primarily exposed through ingestion and inhalation. Although their biological effects are being increasingly studied, their potential effect on human health and disease risk remains uncertain. This Review summarises evidence on potential disease risks of human exposure to MNPs, while highlighting key limitations and research gaps. Evidence suggests that MNP exposure might elevate the risk of various diseases, including metabolic, respiratory, cardiovascular, neuroendocrine, hepatic, renal, and skin disorders, as well as infectious diseases, cancer, and ageing-related disorders. Despite extensive evidence of adverse effects in animal models and cell cultures, direct evidence linking MNP exposure to human disease risk remains scarce. A key challenge on research of MNPs lies in the scarcity of robust human exposure data and the narrow scope of existing studies on specific types of MNPs, leaving several environmentally prevalent plastic particles understudied. Addressing these gaps will require investigating the mechanisms of toxicity, relevant biomarkers, and disease pathways associated with MNP exposure. Such efforts will be essential to clarify human health risks and inform future regulatory and mitigation strategies.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101390"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101373
Patrick Fahr DPhil , Francois Cohen PhD , Jessica Schiff SM , Anant Jani PhD , Mateo Petel MSc , Prof Malcolm McCulloch PhD , Radhika Khosla PhD , Prof Rafael Perera-Salazar DPhil
<div><h3>Background</h3><div>Climate change poses a severe and escalating threat to human health, yet its broader implications for health-care systems remain poorly understood. Although previous studies have examined mortality and hospital admissions, crucial domains such as medical prescriptions and system-wide costs have been overlooked. This study aims to provide the first comprehensive analysis of the impact of daily average temperature variability on a national health-care system.</div></div><div><h3>Methods</h3><div>In this economic analysis of resource use and costs, we analysed 4 366 981 patient records from the National Health Service (NHS) in England from the Clinical Practice Research Datalink GOLD, from April 1, 2007, to June 1, 2019. We sourced weather data from the Met Office HadUK-Gridded climate observations. We used a fixed-effects regression model, aligned with methodologies used in other climate-health studies, to estimate the temperature–health-care relationship while controlling for seasonality and practice-specific characteristics. Outcomes included daily counts of health-care events and associated costs per 1000 general-practice-registered individuals, stratified by age, sex, and care domains. We conducted additional robustness checks using alternative lag structures and model specifications.</div></div><div><h3>Findings</h3><div>Colder days (average temperature 0°C to 9°C) were associated with cumulative increases in consultations with general practitioners, inpatient admissions, and deaths, with disproportionately larger effects among older adults (age >65 years). In contrast, attendance to the Accident and Emergency (A&E) department declined on cold days. Very hot days (>23°C) produced sharp same-day surges in A&E attendances and prescriptions, but cumulative effects were attenuated once the dips in the following days were included. Overall, suboptimal temperature exposure accounted for 3·0% (95% CI 1·2–4·7) of total health-care expenditure, with cold driving 64·4% of this burden. Robustness checks confirmed that these results were stable across alternative model specifications and lag structures.</div></div><div><h3>Interpretation</h3><div>Temperature variability disrupts health-care delivery, straining service capacity during busy periods. These findings provide the first system-wide benchmark for understanding the health burden of temperature, highlighting potential discrepancies between mortality and access to care. Globally, health-care systems must anticipate these disruptions, and adaptation policies outside of health-care systems are essential to reduce health and financial pressures. Investments in climate-resilient infrastructure and strategies to protect vulnerable populations, especially older adults, are urgently needed.</div></div><div><h3>Funding</h3><div>Oxford Martin School’s Future of Cooling Programme at the University of Oxford and the Spanish Ministry of Science, Innovation, and Univers
{"title":"Quantifying the health-care burden of temperature in the National Health Service in England: an economic analysis of resource use and costs","authors":"Patrick Fahr DPhil , Francois Cohen PhD , Jessica Schiff SM , Anant Jani PhD , Mateo Petel MSc , Prof Malcolm McCulloch PhD , Radhika Khosla PhD , Prof Rafael Perera-Salazar DPhil","doi":"10.1016/j.lanplh.2025.101373","DOIUrl":"10.1016/j.lanplh.2025.101373","url":null,"abstract":"<div><h3>Background</h3><div>Climate change poses a severe and escalating threat to human health, yet its broader implications for health-care systems remain poorly understood. Although previous studies have examined mortality and hospital admissions, crucial domains such as medical prescriptions and system-wide costs have been overlooked. This study aims to provide the first comprehensive analysis of the impact of daily average temperature variability on a national health-care system.</div></div><div><h3>Methods</h3><div>In this economic analysis of resource use and costs, we analysed 4 366 981 patient records from the National Health Service (NHS) in England from the Clinical Practice Research Datalink GOLD, from April 1, 2007, to June 1, 2019. We sourced weather data from the Met Office HadUK-Gridded climate observations. We used a fixed-effects regression model, aligned with methodologies used in other climate-health studies, to estimate the temperature–health-care relationship while controlling for seasonality and practice-specific characteristics. Outcomes included daily counts of health-care events and associated costs per 1000 general-practice-registered individuals, stratified by age, sex, and care domains. We conducted additional robustness checks using alternative lag structures and model specifications.</div></div><div><h3>Findings</h3><div>Colder days (average temperature 0°C to 9°C) were associated with cumulative increases in consultations with general practitioners, inpatient admissions, and deaths, with disproportionately larger effects among older adults (age >65 years). In contrast, attendance to the Accident and Emergency (A&E) department declined on cold days. Very hot days (>23°C) produced sharp same-day surges in A&E attendances and prescriptions, but cumulative effects were attenuated once the dips in the following days were included. Overall, suboptimal temperature exposure accounted for 3·0% (95% CI 1·2–4·7) of total health-care expenditure, with cold driving 64·4% of this burden. Robustness checks confirmed that these results were stable across alternative model specifications and lag structures.</div></div><div><h3>Interpretation</h3><div>Temperature variability disrupts health-care delivery, straining service capacity during busy periods. These findings provide the first system-wide benchmark for understanding the health burden of temperature, highlighting potential discrepancies between mortality and access to care. Globally, health-care systems must anticipate these disruptions, and adaptation policies outside of health-care systems are essential to reduce health and financial pressures. Investments in climate-resilient infrastructure and strategies to protect vulnerable populations, especially older adults, are urgently needed.</div></div><div><h3>Funding</h3><div>Oxford Martin School’s Future of Cooling Programme at the University of Oxford and the Spanish Ministry of Science, Innovation, and Univers","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101373"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101318
Jing Yang PhD , Lei Gao PhD , Zhaoxia Guo PhD , Yucheng Dong PhD , Enayat A Moallemi PhD , Sibel Eker PhD , Qi Liu PhD , Zengxiao Chi MSc , Prof Fengming Liu PhD , Prof Michael Obersteiner PhD , Prof Brett A Bryan PhD
<div><h3>Background</h3><div>Progress towards the UN’s 17 Sustainable Development Goals (SDGs) is far off track. An effective and comprehensive assessment of policy impacts on the SDGs is crucial for accelerating global progress towards their achievement. We aimed to provide a comprehensive assessment of progress towards ten SDGs under future deep uncertainties and identify the most effective policy portfolios that best achieve these SDGs simultaneously.</div></div><div><h3>Methods</h3><div>In this study, we used an integrative modelling approach to capture important aspects of the complex behaviours of the global environmental and socioeconomic system. The study was conducted based on the functional enviro-economic linkages integrated nexus model, which is a system dynamics model that simulates interdependencies among global social, economic, and environmental components across 12 sectoral modules, including population, education, economy, poverty, energy, land use, water, food and diet change, fertiliser use, climate, carbon cycle, and biodiversity. The model was constructed with historical data from 1950 to 2021, sourced primarily from official international organisations such as the Food and Agriculture Organization of the UN, the International Energy Agency, the World Bank, the UN Development Programme, and the Intergovernmental Panel on Climate Change. We used 32 SDG assessment indicators to quantify the impacts of 6480 policy portfolios from seven policy clusters interactively on ten SDGs up until 2050. We then used a multiobjective sorting and ranking method to identify robust policy portfolios that most effectively accelerate progress towards the ten SDGs simultaneously across five future socioeconomic pathways.</div></div><div><h3>Findings</h3><div>Although single-sector policies can boost progress towards the SDGs, multisectoral policy portfolios consisting of complementary policies from different sectors are required to achieve societal, economic, and environmental goals, and to capitalise on synergies and minimise undesirable trade-offs amongst SDGs. The policy portfolios play a more important role than more general socioeconomic development pathways in accelerating progress towards the SDGs. Two robust policy portfolios composed of seven policies, including ambitious education, energy supply decarbonisation, crop yield increase, sustainable water use, high nitrogen use efficiency, healthy and sustainable dietary change, and climate change mitigation with careful consideration of ecosystem impacts, were the most effective for global sustainable transformations regardless of future uncertainties, effecting up to a 19·6% to 29·5% improvement in overall progress towards the ten SDGs by 2050 compared with a reference policy portfolio without additional policies taken.</div></div><div><h3>Interpretation</h3><div>Greater progress towards multiple SDGs can be made through more ambitious policies and their more integrated implementation. Our
{"title":"Integrative Sustainable Development Goal policy portfolios to accelerate global progress towards a more sustainable future: a modelling study","authors":"Jing Yang PhD , Lei Gao PhD , Zhaoxia Guo PhD , Yucheng Dong PhD , Enayat A Moallemi PhD , Sibel Eker PhD , Qi Liu PhD , Zengxiao Chi MSc , Prof Fengming Liu PhD , Prof Michael Obersteiner PhD , Prof Brett A Bryan PhD","doi":"10.1016/j.lanplh.2025.101318","DOIUrl":"10.1016/j.lanplh.2025.101318","url":null,"abstract":"<div><h3>Background</h3><div>Progress towards the UN’s 17 Sustainable Development Goals (SDGs) is far off track. An effective and comprehensive assessment of policy impacts on the SDGs is crucial for accelerating global progress towards their achievement. We aimed to provide a comprehensive assessment of progress towards ten SDGs under future deep uncertainties and identify the most effective policy portfolios that best achieve these SDGs simultaneously.</div></div><div><h3>Methods</h3><div>In this study, we used an integrative modelling approach to capture important aspects of the complex behaviours of the global environmental and socioeconomic system. The study was conducted based on the functional enviro-economic linkages integrated nexus model, which is a system dynamics model that simulates interdependencies among global social, economic, and environmental components across 12 sectoral modules, including population, education, economy, poverty, energy, land use, water, food and diet change, fertiliser use, climate, carbon cycle, and biodiversity. The model was constructed with historical data from 1950 to 2021, sourced primarily from official international organisations such as the Food and Agriculture Organization of the UN, the International Energy Agency, the World Bank, the UN Development Programme, and the Intergovernmental Panel on Climate Change. We used 32 SDG assessment indicators to quantify the impacts of 6480 policy portfolios from seven policy clusters interactively on ten SDGs up until 2050. We then used a multiobjective sorting and ranking method to identify robust policy portfolios that most effectively accelerate progress towards the ten SDGs simultaneously across five future socioeconomic pathways.</div></div><div><h3>Findings</h3><div>Although single-sector policies can boost progress towards the SDGs, multisectoral policy portfolios consisting of complementary policies from different sectors are required to achieve societal, economic, and environmental goals, and to capitalise on synergies and minimise undesirable trade-offs amongst SDGs. The policy portfolios play a more important role than more general socioeconomic development pathways in accelerating progress towards the SDGs. Two robust policy portfolios composed of seven policies, including ambitious education, energy supply decarbonisation, crop yield increase, sustainable water use, high nitrogen use efficiency, healthy and sustainable dietary change, and climate change mitigation with careful consideration of ecosystem impacts, were the most effective for global sustainable transformations regardless of future uncertainties, effecting up to a 19·6% to 29·5% improvement in overall progress towards the ten SDGs by 2050 compared with a reference policy portfolio without additional policies taken.</div></div><div><h3>Interpretation</h3><div>Greater progress towards multiple SDGs can be made through more ambitious policies and their more integrated implementation. Our","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101318"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101381
Anaseini Ratu , Sione Tu’itahi , Timoci Naivalulevu , Donald Wilson , Helen Moewaka Barnes , Rebecca Patrick , Hannah A Turley , Stacy D Jupiter , Alice Latinne , Joel Negin , Margot W Parkes , Anthony Capon , Pierre Horwitz , Aaron P Jenkins
{"title":"Healthy Islands at 30: revitalising an ecological framework for planetary health","authors":"Anaseini Ratu , Sione Tu’itahi , Timoci Naivalulevu , Donald Wilson , Helen Moewaka Barnes , Rebecca Patrick , Hannah A Turley , Stacy D Jupiter , Alice Latinne , Joel Negin , Margot W Parkes , Anthony Capon , Pierre Horwitz , Aaron P Jenkins","doi":"10.1016/j.lanplh.2025.101381","DOIUrl":"10.1016/j.lanplh.2025.101381","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101381"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanplh.2025.101344
Edgar Eggert MSc , Prof Hanns-Christian Gunga Dr , Ali Sié MD PhD , Lucienne Ouermi MD MPH , Windpanga Aristide Ouédraogo MSc , Daniel Kwaro MD , Prof Rainer Sauerborn MD PhD , Aditi Bunker PhD , Sandra Barteit PhD , Prof Till Bärnighausen PD PhD , Martina Anna Maggioni PD PhD
<div><h3>Background</h3><div>Climate change-related heat stress disproportionately affects people in sub-Saharan Africa, impairing physical performance and increasing the risk of heat-related illnesses. Despite subsistence farming's key role in food security, scarce studies have measured farmers' physical effort during labour and the impact of behavioural adaptations to heat stress in real-life settings. This long-term, empirical study in Burkina Faso, one of the world’s resource-poorest countries, aimed to measure the heat stress-labour effort relationships among subsistence farmers, accounting for gender-related differences in labour roles.</div></div><div><h3>Methods</h3><div>We conducted a 1-year observational study using the Nouna Health and Demographic Surveillance System in Burkina Faso. We included participants who were healthy, actively practising farmers aged 20–45 years who were neither overweight nor underweight, had no chronic illnesses, no planned pregnancy or breastfeeding status, and resided within a 10-km radius of the weather station. Using research-grade wearables, we collected time-series data on environmental conditions, tracking indoor and outdoor wet-bulb globe temperature (WBGT) and physiological responses such as daily activity, estimated core body temperature, heart rate, and GPS-tracked movements. To operationalise physical effort during labour, we evaluated the physiological strain index (PSI; 0–10 scale with 10 being highest strain) and activity intensity during fieldwork, measured as functions of WBGT. Behavioural adaptations were measured using working patterns including work duration, break times, and seasonal work distribution. The main outcomes are compared across genders and complemented by analyses of monthly vital sign assessments and heat impact surveys.</div></div><div><h3>Findings</h3><div>Between Aug 9, 2021, and Aug 30, 2022, we recruited 39 subsistence farmer households (39 women, 39 men). One household dropped out of follow-up, and 38 households (76 participants [38 men, 38 women]) were included in the analysis. During fieldwork, PSI decreased as WBGT increased (–0·04 [95% CI –0·07 to –0·01], p=0·0056), suggesting adaptive pacing. Men reduced their average activity intensity once WBGT exceeded 27°C. By contrast, women experienced a higher PSI and activity intensity during fieldwork than men (PSI: 0·47 [0·07–0·87], p=0·025). Each 1°C WBGT rise extended daily working time by 12·3 min (95% CI 2·75–21·89, p=0·013) and participants shifted work patterns in response to heat stress by increasing break duration and shifting work to cooler times.</div></div><div><h3>Interpretation</h3><div>Heat stress significantly reduces the physical effort during labour. Self-employed subsistence farmers appear to adapt to heat stress by lowering labour intensity, redistributing tasks throughout the day, and shifting work to cooler months. As climate change worsens, these adaptations could become inadequate. Women, who often
背景：与气候变化相关的热应激对撒哈拉以南非洲地区的人们造成了不成比例的影响，损害了身体机能，增加了患与热有关疾病的风险。尽管自给农业在粮食安全方面发挥着关键作用，但很少有研究衡量农民在劳动期间的体力劳动以及在现实生活中对热应激的行为适应的影响。这项在布基纳法索（世界上资源最贫乏的国家之一）进行的长期实证研究，旨在衡量自给农民之间的热应激-劳动努力关系，并考虑到劳动角色的性别差异。方法：我们利用布基纳法索的Nouna健康和人口监测系统进行了为期1年的观察性研究。我们纳入了健康、积极从事农业活动、年龄在20-45岁之间、既不超重也不体重不足、没有慢性疾病、没有计划怀孕或母乳喂养状况、居住在气象站10公里半径范围内的参与者。使用研究级可穿戴设备，我们收集了环境条件的时间序列数据，跟踪室内和室外湿球温度（WBGT）和生理反应，如日常活动、估计的核心体温、心率和gps跟踪的运动。为了操作劳动期间的体力劳动，我们评估了野外工作期间的生理应变指数（PSI； 0-10量表，10为最高应变）和活动强度，作为WBGT的函数来测量。行为适应是通过工作模式来衡量的，包括工作时间、休息时间和季节性工作分配。主要结果在性别之间进行比较，并辅以每月生命体征评估和热影响调查的分析。研究结果：在2021年8月9日至2022年8月30日期间，我们招募了39个自给农户（39名女性，39名男性）。1个家庭退出随访，38个家庭（76名参与者[38名男性，38名女性]）被纳入分析。在野外工作中，PSI随着WBGT的增加而下降（- 0.04 [95% CI - 0.07至- 0.01],p= 0.0056），提示适应性起搏。一旦WBGT超过27°C，男性的平均活动强度就会降低。女性在野外工作中的PSI和活动强度均高于男性（PSI: 0.47 [0.07 - 0.87], p= 0.025）。WBGT每升高1°C，每日工作时间延长12.3分钟（95% CI 2.75 - 21.89, p= 0.013），参与者通过增加休息时间和将工作转移到较冷的时间来改变工作模式，以应对热应激。解释：热应激显著降低了分娩时的体力消耗。自谋生计的农民似乎通过降低劳动强度、在一天中重新分配任务以及将工作转移到较冷的月份来适应热应激。随着气候变化的恶化，这些适应可能会变得不够。女性往往要平衡家务和野外工作，她们的节奏策略有限，这使她们更容易受到日益严重的热应激的影响。我们的研究结果强调了迫切需要有针对性的适应策略，以在分娩期间保持体力劳动，并保护弱势群体，特别是妇女，免受不断升级的热应激。资助：德国研究基金会（DFG-German Research Foundation）。
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