Pub Date : 2024-09-01DOI: 10.1016/S2542-5196(24)00147-5
Annegeke Jansen MSc , Ranran Wang PhD , Paul Behrens PhD , Rutger Hoekstra PhD
Policy making has long focused on economic growth as measured by gross domestic product (GDP), diverting attention from sustainable wellbeing for all. Despite high-quality proposals to go beyond GDP, their integration into policy and societal discourse remains limited. A new UN initiative, Valuing What Counts, provides an opportunity for establishing and institutionalising global measurement of metrics beyond GDP, a crucial step to enable a transition into a safe and just space for humanity. Here, we inform this process by consolidating 50 years of literature on Beyond GDP metrics, addressing three core challenges. First, we resolve the lack of interdisciplinary collaboration by integrating five scientific schools of thought in one measurement approach. Second, we alleviate confusion arising from numerous Beyond GDP alternatives, offering a structured analysis of 65 metrics, delineating their measurement objectives. Finally, we bridge the divide between scientific proposals and country-specific approaches. We unite country-specific needs with a standardised and interdisciplinary measurement approach, presenting a dashboard for sustainable and inclusive wellbeing.
长期以来,政策制定一直侧重于以国内生产总值(GDP)衡量的经济增长,从而转移了对全民可持续福祉的关注。尽管提出了超越 GDP 的高质量建议,但将其纳入政策和社会讨论的程度仍然有限。联合国的一项新倡议--"重视有价值的东西"--为建立超越 GDP 的全球衡量标准并使之制度化提供了一个机会,这是使人类过渡到安全和公正空间的关键一步。在此,我们通过整合 50 年来有关超越 GDP 的衡量标准的文献,为这一进程提供信息,并解决三个核心挑战。首先,我们通过将五大科学流派整合为一种衡量方法,解决了缺乏跨学科合作的问题。其次,我们对 65 个衡量标准进行了结构化分析,明确了它们的衡量目标,从而缓解了因众多超越 GDP 的替代方法而产生的混淆。最后,我们弥合了科学建议与国别方法之间的鸿沟。我们将各国的具体需求与标准化的跨学科衡量方法结合起来,为可持续和包容性福祉提供了一个仪表板。
{"title":"Beyond GDP: a review and conceptual framework for measuring sustainable and inclusive wellbeing","authors":"Annegeke Jansen MSc , Ranran Wang PhD , Paul Behrens PhD , Rutger Hoekstra PhD","doi":"10.1016/S2542-5196(24)00147-5","DOIUrl":"10.1016/S2542-5196(24)00147-5","url":null,"abstract":"<div><p>Policy making has long focused on economic growth as measured by gross domestic product (GDP), diverting attention from sustainable wellbeing for all. Despite high-quality proposals to go beyond GDP, their integration into policy and societal discourse remains limited. A new UN initiative, Valuing What Counts, provides an opportunity for establishing and institutionalising global measurement of metrics beyond GDP, a crucial step to enable a transition into a safe and just space for humanity. Here, we inform this process by consolidating 50 years of literature on Beyond GDP metrics, addressing three core challenges. First, we resolve the lack of interdisciplinary collaboration by integrating five scientific schools of thought in one measurement approach. Second, we alleviate confusion arising from numerous Beyond GDP alternatives, offering a structured analysis of 65 metrics, delineating their measurement objectives. Finally, we bridge the divide between scientific proposals and country-specific approaches. We unite country-specific needs with a standardised and interdisciplinary measurement approach, presenting a dashboard for sustainable and inclusive wellbeing.</p></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e695-e705"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001475/pdfft?md5=7536f904a7d67bc93b75c4139dd74767&pid=1-s2.0-S2542519624001475-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136481","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 : 2024-09-01DOI: 10.1016/S2542-5196(24)00167-0
Prof Kathryn H Jacobsen PhD , Prof Caryl E Waggett PhD , Pamela Berenbaum MSc , Brett R Bayles PhD , Gail L Carlson PhD , René English MBchB PhD , Carlos A Faerron Guzmán MD , Meredith L Gartin PhD , Prof Liz Grant PhD , Thomas L Henshaw PhD , Prof Lora L Iannotti PhD , Prof Philip J Landrigan MD , Nina Lansbury PhD , Prof Hao Li PhD , Prof Maureen Y Lichtveld MD , Ketrell L McWhorter PhD , Prof Jessica E Rettig PhD , Cecilia J Sorensen MD , Prof Eric J Wetzel PhD , Dawn Michele Whitehead PhD , Keith Martin MD
Planetary health is an emerging field that emphasises that humans depend on a healthy Earth for survival and, conversely, that the sustainability of Earth systems is dependent on human behaviours. In response to member demands for resources to support teaching and learning related to planetary health, the Consortium of Universities for Global Health (CUGH) convened a working group to develop a set of planetary health learning objectives (PHLOs) that would complement the existing ten CUGH global health learning objectives. The eight PHLOs feature Earth system changes, planetary boundaries, and climate change science; ecological systems and One Health; human health outcomes; risk assessment, vulnerability, and resilience; policy, governance, and laws (including the UN Framework Convention on Climate Change and the Paris Agreement); roles and responsibilities of governments, businesses, civil society organisations, other institutions, communities, and individuals for mitigation, adaptation, conservation, restoration, and sustainability; environmental ethics, human rights, and climate justice; and environmental literacy and communication. Educators who use the PHLOs as a foundation for teaching, curriculum design, and programme development related to the health–environment nexus will equip learners with a knowledge of planetary health science, interventions, and communication that is essential for future global health professionals.
{"title":"Planetary health learning objectives: foundational knowledge for global health education in an era of climate change","authors":"Prof Kathryn H Jacobsen PhD , Prof Caryl E Waggett PhD , Pamela Berenbaum MSc , Brett R Bayles PhD , Gail L Carlson PhD , René English MBchB PhD , Carlos A Faerron Guzmán MD , Meredith L Gartin PhD , Prof Liz Grant PhD , Thomas L Henshaw PhD , Prof Lora L Iannotti PhD , Prof Philip J Landrigan MD , Nina Lansbury PhD , Prof Hao Li PhD , Prof Maureen Y Lichtveld MD , Ketrell L McWhorter PhD , Prof Jessica E Rettig PhD , Cecilia J Sorensen MD , Prof Eric J Wetzel PhD , Dawn Michele Whitehead PhD , Keith Martin MD","doi":"10.1016/S2542-5196(24)00167-0","DOIUrl":"10.1016/S2542-5196(24)00167-0","url":null,"abstract":"<div><p>Planetary health is an emerging field that emphasises that humans depend on a healthy Earth for survival and, conversely, that the sustainability of Earth systems is dependent on human behaviours. In response to member demands for resources to support teaching and learning related to planetary health, the Consortium of Universities for Global Health (CUGH) convened a working group to develop a set of planetary health learning objectives (PHLOs) that would complement the existing ten CUGH global health learning objectives. The eight PHLOs feature Earth system changes, planetary boundaries, and climate change science; ecological systems and One Health; human health outcomes; risk assessment, vulnerability, and resilience; policy, governance, and laws (including the UN Framework Convention on Climate Change and the Paris Agreement); roles and responsibilities of governments, businesses, civil society organisations, other institutions, communities, and individuals for mitigation, adaptation, conservation, restoration, and sustainability; environmental ethics, human rights, and climate justice; and environmental literacy and communication. Educators who use the PHLOs as a foundation for teaching, curriculum design, and programme development related to the health–environment nexus will equip learners with a knowledge of planetary health science, interventions, and communication that is essential for future global health professionals.</p></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e706-e713"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001670/pdfft?md5=eb76a108c45912a25d819fdd31d75726&pid=1-s2.0-S2542519624001670-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136497","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 : 2024-09-01DOI: 10.1016/S2542-5196(24)00160-8
Chloe Brimicombe PhD , Katharina Wieser BSc , Tobias Monthaler BSc , Prof Debra Jackson PhD , Jeroen De Bont PhD , Prof Matthew F Chersich PhD , Prof Ilona M Otto PhD
Background
Reducing child mortality is a Sustainable Development Goal, and climate change constitutes numerous challenges for Africa. Previous research has shown an association between leading causes of child mortality and climate change. However, few studies have examined these effects in detail. We aimed to explore the effects of ambient heat on neonate, post-neonate, and child mortality rates.
Methods
For this pooled time-series analysis, health data were obtained from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Health and Demographic Surveillance System. We included data from 29 settlements from 13 countries across Africa, collected via monthly surveys from Jan 1, 1993, to Dec 31, 2016. Climate data were obtained from ERA5, collected from Jan 1, 1991, to Dec 31, 2019. We pooled these data for monthly mean daily maximum wet bulb globe temperature (WBGT) and downscaled to geolocations. Due to data heaping, we pooled our health data on a monthly temporal scale and a spatial scale into six different climate regions (ie, Sahel [ie, Burkina Faso and northern Ghana], Guinea [ie, southern Ghana, Côte d'Ivoire, and Nigeria], Senegal and The Gambia, eastern Africa [ie, Kenya, Malawi, Tanzania, Mozambique, and Uganda], South Africa, and Ethiopia). Our outcomes were neonate (ie, younger than 28 days), post-neonate (ie, aged 28 days to 1 year), and child (ie, older than 1 year and younger than 5 years) mortality. To assess the association between WBGT and monthly all-cause mortality, we used a time-series regression with a quasi-Poisson, polynomial-distributed lag model.
Findings
Between Jan 1, 1993, and Dec 31, 2016, there were 44 909 deaths in children younger than 5 years across the 29 sites in the 13 African countries: 10 078 neonates, 14 141 post-neonates, and 20 690 children. We observed differences in the association of heat with neonate, post-neonate, and child mortality by study region. For example, for Ethiopia, the relative risk ratio of mortality at the 95th percentile compared with median heat exposure during the study period was 1·14 (95% CI 1·06–1·23) for neonates, 0·99 (0·90–1·07) for post-neonates, and 0·79 (0·73–0·87) for children. Across the whole year, there was a significant increase in the relative risk of increased mortality for children in eastern Africa (relative risk 1·27, 95% CI 1·19–1·36) and Senegal and The Gambia (1·11, 1·04–1·18).
Interpretation
Our results show that the influence of extreme heat on mortality risk in children younger than 5 years varies by age group, region, and season. Future research should explore potentially informative ways to measure subtleties of heat stress and the factors contributing to vulnerability.
Funding
EU Horizons as part of the Heat Indicators for Global Health (HIGH) Horizons project.
{"title":"Effects of ambient heat exposure on risk of all-cause mortality in children younger than 5 years in Africa: a pooled time-series analysis","authors":"Chloe Brimicombe PhD , Katharina Wieser BSc , Tobias Monthaler BSc , Prof Debra Jackson PhD , Jeroen De Bont PhD , Prof Matthew F Chersich PhD , Prof Ilona M Otto PhD","doi":"10.1016/S2542-5196(24)00160-8","DOIUrl":"10.1016/S2542-5196(24)00160-8","url":null,"abstract":"<div><h3>Background</h3><p>Reducing child mortality is a Sustainable Development Goal, and climate change constitutes numerous challenges for Africa. Previous research has shown an association between leading causes of child mortality and climate change. However, few studies have examined these effects in detail. We aimed to explore the effects of ambient heat on neonate, post-neonate, and child mortality rates.</p></div><div><h3>Methods</h3><p>For this pooled time-series analysis, health data were obtained from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Health and Demographic Surveillance System. We included data from 29 settlements from 13 countries across Africa, collected via monthly surveys from Jan 1, 1993, to Dec 31, 2016. Climate data were obtained from ERA5, collected from Jan 1, 1991, to Dec 31, 2019. We pooled these data for monthly mean daily maximum wet bulb globe temperature (WBGT) and downscaled to geolocations. Due to data heaping, we pooled our health data on a monthly temporal scale and a spatial scale into six different climate regions (ie, Sahel [ie, Burkina Faso and northern Ghana], Guinea [ie, southern Ghana, Côte d'Ivoire, and Nigeria], Senegal and The Gambia, eastern Africa [ie, Kenya, Malawi, Tanzania, Mozambique, and Uganda], South Africa, and Ethiopia). Our outcomes were neonate (ie, younger than 28 days), post-neonate (ie, aged 28 days to 1 year), and child (ie, older than 1 year and younger than 5 years) mortality. To assess the association between WBGT and monthly all-cause mortality, we used a time-series regression with a quasi-Poisson, polynomial-distributed lag model.</p></div><div><h3>Findings</h3><p>Between Jan 1, 1993, and Dec 31, 2016, there were 44 909 deaths in children younger than 5 years across the 29 sites in the 13 African countries: 10 078 neonates, 14 141 post-neonates, and 20 690 children. We observed differences in the association of heat with neonate, post-neonate, and child mortality by study region. For example, for Ethiopia, the relative risk ratio of mortality at the 95th percentile compared with median heat exposure during the study period was 1·14 (95% CI 1·06–1·23) for neonates, 0·99 (0·90–1·07) for post-neonates, and 0·79 (0·73–0·87) for children. Across the whole year, there was a significant increase in the relative risk of increased mortality for children in eastern Africa (relative risk 1·27, 95% CI 1·19–1·36) and Senegal and The Gambia (1·11, 1·04–1·18).</p></div><div><h3>Interpretation</h3><p>Our results show that the influence of extreme heat on mortality risk in children younger than 5 years varies by age group, region, and season. Future research should explore potentially informative ways to measure subtleties of heat stress and the factors contributing to vulnerability.</p></div><div><h3>Funding</h3><p>EU Horizons as part of the Heat Indicators for Global Health (HIGH) Horizons project.</p></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e640-e646"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001608/pdfft?md5=566361fd4da7e1ff3e0cab9adc092192&pid=1-s2.0-S2542519624001608-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917889","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 : 2024-09-01DOI: 10.1016/S2542-5196(24)00171-2
Caroline Shaw PhD , Anja Mizdrak DPhil , Ryan Gage MPH , Melissa McLeod PhD , Rhys Jones MPH , Prof Alistair Woodward PhD , Linda Cobiac PhD
<div><h3>Background</h3><p>Health co-benefits are a key potential advantage of transport decarbonisation policy. However, health effects will occur in the context of existing transport–health inequities and decarbonisation policies will themselves affect inequities. This research examines the effects of national decarbonisation pathways for transport on population health, health inequity, and health-system costs in Aotearoa New Zealand.</p></div><div><h3>Methods</h3><p>We modelled the health, health-system, and environmental impacts of two pathways to net zero for transport developed by the New Zealand Climate Change Commission using a proportional multistate lifetable model. The behaviour pathway emphasises a mixed approach, including reduced driving, increased cycling and use of public transport, and light vehicle electrification, and the technology pathway focuses on vehicle electrification. We used data from transport, environmental, population health, and health-care sources to populate the model. We simulated changes in health effects through the pathways of physical activity, air pollution (PM<sub>2·5</sub> and NO<sub>2</sub>), and injury for the Aotearoa New Zealand population from 2018 to 2050. We modelled impacts for Māori (the Indigenous People of Aotearoa) and non-Māori. For each pathway to net zero, we calculated changes in overall health-adjusted life-years (HALYs), age-standardised HALYs, and rate ratios for Māori and non-Māori. We also calculated changes in health-system costs and transport greenhouse gas emissions. 95% uncertainty intervals (95% UIs) were derived for all model outputs by use of a Monte Carlo simulation.</p></div><div><h3>Findings</h3><p>Both pathways show improvements in population health, reductions in health-system costs, and reduced lifecycle greenhouse gas emissions compared with baseline, although health gains were substantially larger in the behaviour pathway. For example, an extra 2100 HALYs (95% UI 1500–3100) were gained in the behaviour scenario compared with baseline. Health gains were 20–30% larger for Māori than non-Māori in both pathways, although more HALYs were gained by Māori in the behaviour pathway. For the cohort aged 0–4 years in 2018, healthy life expectancy differences between Māori and non-Māori reduced by 0·5% in the behaviour pathway over their lifetime. HALYs gained by Māori and non-Māori were altered substantially depending on assumptions about the equity of the implemented pathway.</p></div><div><h3>Interpretation</h3><p>Decarbonising transport might improve overall population health, save the health system money, and reduce health inequities between Māori and non-Māori. Pathways that increase physical activity have a larger effect on population health than those that rely on low-emission vehicles. The effects on inequity between Māori and non-Māori are larger in the behaviour pathway than in the technology pathway but dependent on how equitably policies supporting decarbonisation are
{"title":"Policy approaches to decarbonising the transport sector in Aotearoa New Zealand: modelling equity, population health, and health-system effects","authors":"Caroline Shaw PhD , Anja Mizdrak DPhil , Ryan Gage MPH , Melissa McLeod PhD , Rhys Jones MPH , Prof Alistair Woodward PhD , Linda Cobiac PhD","doi":"10.1016/S2542-5196(24)00171-2","DOIUrl":"10.1016/S2542-5196(24)00171-2","url":null,"abstract":"<div><h3>Background</h3><p>Health co-benefits are a key potential advantage of transport decarbonisation policy. However, health effects will occur in the context of existing transport–health inequities and decarbonisation policies will themselves affect inequities. This research examines the effects of national decarbonisation pathways for transport on population health, health inequity, and health-system costs in Aotearoa New Zealand.</p></div><div><h3>Methods</h3><p>We modelled the health, health-system, and environmental impacts of two pathways to net zero for transport developed by the New Zealand Climate Change Commission using a proportional multistate lifetable model. The behaviour pathway emphasises a mixed approach, including reduced driving, increased cycling and use of public transport, and light vehicle electrification, and the technology pathway focuses on vehicle electrification. We used data from transport, environmental, population health, and health-care sources to populate the model. We simulated changes in health effects through the pathways of physical activity, air pollution (PM<sub>2·5</sub> and NO<sub>2</sub>), and injury for the Aotearoa New Zealand population from 2018 to 2050. We modelled impacts for Māori (the Indigenous People of Aotearoa) and non-Māori. For each pathway to net zero, we calculated changes in overall health-adjusted life-years (HALYs), age-standardised HALYs, and rate ratios for Māori and non-Māori. We also calculated changes in health-system costs and transport greenhouse gas emissions. 95% uncertainty intervals (95% UIs) were derived for all model outputs by use of a Monte Carlo simulation.</p></div><div><h3>Findings</h3><p>Both pathways show improvements in population health, reductions in health-system costs, and reduced lifecycle greenhouse gas emissions compared with baseline, although health gains were substantially larger in the behaviour pathway. For example, an extra 2100 HALYs (95% UI 1500–3100) were gained in the behaviour scenario compared with baseline. Health gains were 20–30% larger for Māori than non-Māori in both pathways, although more HALYs were gained by Māori in the behaviour pathway. For the cohort aged 0–4 years in 2018, healthy life expectancy differences between Māori and non-Māori reduced by 0·5% in the behaviour pathway over their lifetime. HALYs gained by Māori and non-Māori were altered substantially depending on assumptions about the equity of the implemented pathway.</p></div><div><h3>Interpretation</h3><p>Decarbonising transport might improve overall population health, save the health system money, and reduce health inequities between Māori and non-Māori. Pathways that increase physical activity have a larger effect on population health than those that rely on low-emission vehicles. The effects on inequity between Māori and non-Māori are larger in the behaviour pathway than in the technology pathway but dependent on how equitably policies supporting decarbonisation are ","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e647-e656"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001712/pdfft?md5=6a94785081d6355250efbdc1ed5932ae&pid=1-s2.0-S2542519624001712-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135800","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 : 2024-09-01DOI: 10.1016/S2542-5196(24)00175-X
Prof Dann Mitchell PhD , Y T Eunice Lo PhD , Emily Ball PhD , Joanne L Godwin PhD , Oliver Andrews PhD , Prof Rosa Barciela PhD , Prof Lea Berrang Ford PhD , Claudia Di Napoli PhD , Prof Kristie L Ebi PhD , Neven S Fučkar PhD , Prof Antonio Gasparrini PhD , Prof Brian Golding PhD , Celia L Gregson MRCP PhD , Gareth J Griffith PhD , Sara Khalid PhD , Caitlin Robinson PhD , Prof Daniela N Schmidt PhD , Charles H Simpson PhD , Prof Sir Robert Stephen John Sparks PhD , Josephine G Walker PhD
Weather and climate patterns play an intrinsic role in societal health, yet a comprehensive synthesis of specific hazard–mortality causes does not currently exist. Country-level health burdens are thus highly uncertain, but harnessing collective expert knowledge can reduce this uncertainty, and help assess diverse mortality causes beyond what is explicitly quantified. Here, surveying 30 experts, we provide the first structured expert judgement of how weather and climate directly impact mortality, using the UK as an example. Current weather-related mortality is dominated by short-term exposure to hot and cold temperatures leading to cardiovascular and respiratory failure. We find additional underappreciated health outcomes, especially related to long-exposure hazards, including heat-related renal disease, cold-related musculoskeletal health, and infectious diseases from compound hazards. We show potential future worsening of cause-specific mortality, including mental health from flooding or heat, and changes in infectious diseases. Ultimately, this work could serve to develop an expert-based understanding of the climate-related health burden in other countries.
{"title":"Expert judgement reveals current and emerging UK climate-mortality burden","authors":"Prof Dann Mitchell PhD , Y T Eunice Lo PhD , Emily Ball PhD , Joanne L Godwin PhD , Oliver Andrews PhD , Prof Rosa Barciela PhD , Prof Lea Berrang Ford PhD , Claudia Di Napoli PhD , Prof Kristie L Ebi PhD , Neven S Fučkar PhD , Prof Antonio Gasparrini PhD , Prof Brian Golding PhD , Celia L Gregson MRCP PhD , Gareth J Griffith PhD , Sara Khalid PhD , Caitlin Robinson PhD , Prof Daniela N Schmidt PhD , Charles H Simpson PhD , Prof Sir Robert Stephen John Sparks PhD , Josephine G Walker PhD","doi":"10.1016/S2542-5196(24)00175-X","DOIUrl":"10.1016/S2542-5196(24)00175-X","url":null,"abstract":"<div><p>Weather and climate patterns play an intrinsic role in societal health, yet a comprehensive synthesis of specific hazard–mortality causes does not currently exist. Country-level health burdens are thus highly uncertain, but harnessing collective expert knowledge can reduce this uncertainty, and help assess diverse mortality causes beyond what is explicitly quantified. Here, surveying 30 experts, we provide the first structured expert judgement of how weather and climate directly impact mortality, using the UK as an example. Current weather-related mortality is dominated by short-term exposure to hot and cold temperatures leading to cardiovascular and respiratory failure. We find additional underappreciated health outcomes, especially related to long-exposure hazards, including heat-related renal disease, cold-related musculoskeletal health, and infectious diseases from compound hazards. We show potential future worsening of cause-specific mortality, including mental health from flooding or heat, and changes in infectious diseases. Ultimately, this work could serve to develop an expert-based understanding of the climate-related health burden in other countries.</p></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e684-e694"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S254251962400175X/pdfft?md5=9be276f4cbdb8fd11684479cd18fb136&pid=1-s2.0-S254251962400175X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136480","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 : 2024-09-01DOI: 10.1016/S2542-5196(24)00169-4
Somya Bansal MSc , Jue Tao Lim PhD , Chee-Seng Chong PhD , Borame Dickens PhD , Youming Ng BSc , Lu Deng BSc , Caleb Lee MSc , Li Yun Tan BSc , Evdoxia G Kakani PhD , Yanni Yoong BSc , David Du Yu PhD , Grace Chain BSc , Pei Ma MSc , Shuzhen Sim PhD , Lee Ching Ng PhD , Cheong Huat Tan PhD
<div><h3>Background</h3><p>Incompatible insect technique (IIT) coupled with sterile insect technique (SIT) via the release of sterile male <em>Wolbachia</em>-infected mosquitoes is a promising tool for <em>Aedes</em>-borne disease control. Yet, real-world evidence on the suppressive effectiveness of IIT-SIT on mosquito abundance remains mostly limited to small semi-rural village and suburban localities over short trial durations. However, a large proportion of <em>Aedes</em>-borne diseases occur in dense, urban, and high-rise locations, limiting the applicability of previous studies for these settings with high disease burden. The sustainability and use of this technology over multiple years is also unknown.</p></div><div><h3>Methods</h3><p>In this synthetic control study, we conducted a large-scale, field trial of IIT-SIT targeting <em>Aedes aegypti</em> among high-rise public housing estates in Singapore, an equatorial city state. Routinely collected data from a large, nationwide surveillance system of 57 990 unique mosquito traps, combined with a high-dimensional set of anthropogenic and environmental confounders were collected to ascertain mosquito abundance and its key drivers. Four townships were selected as the intervention groups (approximate population size of 607 872 residents as of 2022), wherein interventions that combined ITT with SIT over the course of the study period were conducted. Townships were subject to releases of <em>w</em>AlbB-SG male <em>A aegypti</em> mosquitoes twice a week. Data were assessed over the course of epidemiological weeks (EWs), which provide the finest temporal resolution of recorded <em>Wolbachia</em> release schedule and mosquito abundance data. A novel synthetic control framework was then developed to account for the non-randomised and staggered adoption setting of the intervention across trial sectors to identify the direct suppressive effectiveness of IIT-SIT on female <em>A aegypti</em> populations, the spillover effects in non-release areas, and the effect of the intervention on other mosquito populations such as <em>Aedes albopictus</em>. Furthermore, we recalculated effectiveness in terms of calendar time, time since intervention, and over multiple sites to examine heterogeneities in IIT-SIT effectiveness.</p></div><div><h3>Findings</h3><p>Between EW27 2018 and EW26 2022, <em>Wolbachia</em> releases were conducted across 117 sectors, of which 97 had sufficient trap data, which were collected between EW8 2019 and EW26 2022. We found that <em>Wolbachia</em>-based IIT-SIT reduced wild-type female <em>A aegypti</em> populations by a mean of 62·01% (95% CI 60·68 to 63·26) by 3 months, 78·40% (77·56 to 79·18) by 6 months, and 91·32% (90·95 to 91·66) by at least 18 months of releases. We also found a smaller but non-negligible spillover suppression effect that gradually increased over time (mean spillover intervention effectiveness 61·02% [95% CI 57·89 to 63·72] in adjacent, non-intervention sectors). Alt
{"title":"Effectiveness of Wolbachia-mediated sterility coupled with sterile insect technique to suppress adult Aedes aegypti populations in Singapore: a synthetic control study","authors":"Somya Bansal MSc , Jue Tao Lim PhD , Chee-Seng Chong PhD , Borame Dickens PhD , Youming Ng BSc , Lu Deng BSc , Caleb Lee MSc , Li Yun Tan BSc , Evdoxia G Kakani PhD , Yanni Yoong BSc , David Du Yu PhD , Grace Chain BSc , Pei Ma MSc , Shuzhen Sim PhD , Lee Ching Ng PhD , Cheong Huat Tan PhD","doi":"10.1016/S2542-5196(24)00169-4","DOIUrl":"10.1016/S2542-5196(24)00169-4","url":null,"abstract":"<div><h3>Background</h3><p>Incompatible insect technique (IIT) coupled with sterile insect technique (SIT) via the release of sterile male <em>Wolbachia</em>-infected mosquitoes is a promising tool for <em>Aedes</em>-borne disease control. Yet, real-world evidence on the suppressive effectiveness of IIT-SIT on mosquito abundance remains mostly limited to small semi-rural village and suburban localities over short trial durations. However, a large proportion of <em>Aedes</em>-borne diseases occur in dense, urban, and high-rise locations, limiting the applicability of previous studies for these settings with high disease burden. The sustainability and use of this technology over multiple years is also unknown.</p></div><div><h3>Methods</h3><p>In this synthetic control study, we conducted a large-scale, field trial of IIT-SIT targeting <em>Aedes aegypti</em> among high-rise public housing estates in Singapore, an equatorial city state. Routinely collected data from a large, nationwide surveillance system of 57 990 unique mosquito traps, combined with a high-dimensional set of anthropogenic and environmental confounders were collected to ascertain mosquito abundance and its key drivers. Four townships were selected as the intervention groups (approximate population size of 607 872 residents as of 2022), wherein interventions that combined ITT with SIT over the course of the study period were conducted. Townships were subject to releases of <em>w</em>AlbB-SG male <em>A aegypti</em> mosquitoes twice a week. Data were assessed over the course of epidemiological weeks (EWs), which provide the finest temporal resolution of recorded <em>Wolbachia</em> release schedule and mosquito abundance data. A novel synthetic control framework was then developed to account for the non-randomised and staggered adoption setting of the intervention across trial sectors to identify the direct suppressive effectiveness of IIT-SIT on female <em>A aegypti</em> populations, the spillover effects in non-release areas, and the effect of the intervention on other mosquito populations such as <em>Aedes albopictus</em>. Furthermore, we recalculated effectiveness in terms of calendar time, time since intervention, and over multiple sites to examine heterogeneities in IIT-SIT effectiveness.</p></div><div><h3>Findings</h3><p>Between EW27 2018 and EW26 2022, <em>Wolbachia</em> releases were conducted across 117 sectors, of which 97 had sufficient trap data, which were collected between EW8 2019 and EW26 2022. We found that <em>Wolbachia</em>-based IIT-SIT reduced wild-type female <em>A aegypti</em> populations by a mean of 62·01% (95% CI 60·68 to 63·26) by 3 months, 78·40% (77·56 to 79·18) by 6 months, and 91·32% (90·95 to 91·66) by at least 18 months of releases. We also found a smaller but non-negligible spillover suppression effect that gradually increased over time (mean spillover intervention effectiveness 61·02% [95% CI 57·89 to 63·72] in adjacent, non-intervention sectors). Alt","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e617-e628"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001694/pdfft?md5=fe8c04e9101cf515070255d742d01b09&pid=1-s2.0-S2542519624001694-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135798","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 : 2024-09-01DOI: 10.1016/S2542-5196(24)00170-0
Caleigh M Sawicki PhD , Gautam Ramesh MD , Linh Bui MD , Nilendra K Nair PhD , Prof Frank B Hu MD , Prof Eric B Rimm ScD , Prof Meir J Stampfer MD , Prof Walter C Willett MD , Shilpa N Bhupathiraju PhD
<div><h3>Background</h3><p>In 2019, the EAT–<em>Lancet</em> Commission on healthy diets from sustainable food systems proposed a Planetary Health Diet that seeks to optimise both chronic disease prevention as well as global environmental health. In this study, we aimed to examine the association between a dietary index based on the Planetary Health Diet and risk of cardiovascular disease.</p></div><div><h3>Methods</h3><p>We included women from the Nurses’ Health Study (NHS I; 1986–2016), women from the Nurses’ Health Study II (NHS II; 1991–2017), and men from the Health Professionals Follow-up Study (HPFS; 1986–2016) who were free of cardiovascular disease, cancer, and diabetes at baseline. Dietary data were collected every 4 years using a validated, semi-quantitative food frequency questionnaire. The Planetary Health Diet Index (PHDI) was based on 15 food groups: whole grains, vegetables, fruit, fish and shellfish, nuts and seeds, non-soy legumes, soy foods, and unsaturated oils were scored positively; starchy vegetables, dairy, red or processed meat, poultry, eggs, saturated fats and trans fat, and added sugar received negative scores. Scores for each food group were summed to get a total score of 0–140. Higher scores indicated greater adherence to the PHDI. We used Cox proportional hazards regression with time-varying covariates to evaluate the association between PHDI score, cumulatively averaged, and incident cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), adjusting for demographic, health, and lifestyle confounders in all participants with available data. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses.</p></div><div><h3>Findings</h3><p>Of the 62 919 women included from the NHS I, 88 535 women included from the NHS II, and 42 164 men included from the HPFS, a total of 9831 cases of cardiovascular disease were confirmed over 4 541 980 person-years of follow-up. Mean PHDI scores ranged from 60·7 (SD 5·1) to 90·6 (5·3) in the lowest versus highest quintile in NHS I, 55·6 (4·9) to 86·3 (6·3) in NHS II, and 59·6 (5·9) to 94 (5·9) in HPFS. In the multivariable-adjusted meta-analysis, participants in the highest quintile of PHDI score had a lower risk of incident cardiovascular disease than did those in the lowest quintile (hazard ratio [HR] 0·83 [95% CI 0·78–0·89]; p-trend <0·0001). When we examined cardiovascular disease subtypes, the highest quintile of PHDI was also associated with a lower risk of coronary heart disease (HR 0·81 [95% CI 0·74–0·88]; p-trend <0·0001) and total stroke (HR 0·86 [0·78–0·95]; p-trend=0·0004) compared with the lowest quintile.</p></div><div><h3>Interpretation</h3><p>We found that adherence to the Planetary Health Diet, designed to be a more environmentally sustainable dietary pattern, was associated with a lower risk of cardiovascular disease in three large cohorts of men and women in the USA. These observations suppor
{"title":"Planetary health diet and cardiovascular disease: results from three large prospective cohort studies in the USA","authors":"Caleigh M Sawicki PhD , Gautam Ramesh MD , Linh Bui MD , Nilendra K Nair PhD , Prof Frank B Hu MD , Prof Eric B Rimm ScD , Prof Meir J Stampfer MD , Prof Walter C Willett MD , Shilpa N Bhupathiraju PhD","doi":"10.1016/S2542-5196(24)00170-0","DOIUrl":"10.1016/S2542-5196(24)00170-0","url":null,"abstract":"<div><h3>Background</h3><p>In 2019, the EAT–<em>Lancet</em> Commission on healthy diets from sustainable food systems proposed a Planetary Health Diet that seeks to optimise both chronic disease prevention as well as global environmental health. In this study, we aimed to examine the association between a dietary index based on the Planetary Health Diet and risk of cardiovascular disease.</p></div><div><h3>Methods</h3><p>We included women from the Nurses’ Health Study (NHS I; 1986–2016), women from the Nurses’ Health Study II (NHS II; 1991–2017), and men from the Health Professionals Follow-up Study (HPFS; 1986–2016) who were free of cardiovascular disease, cancer, and diabetes at baseline. Dietary data were collected every 4 years using a validated, semi-quantitative food frequency questionnaire. The Planetary Health Diet Index (PHDI) was based on 15 food groups: whole grains, vegetables, fruit, fish and shellfish, nuts and seeds, non-soy legumes, soy foods, and unsaturated oils were scored positively; starchy vegetables, dairy, red or processed meat, poultry, eggs, saturated fats and trans fat, and added sugar received negative scores. Scores for each food group were summed to get a total score of 0–140. Higher scores indicated greater adherence to the PHDI. We used Cox proportional hazards regression with time-varying covariates to evaluate the association between PHDI score, cumulatively averaged, and incident cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), adjusting for demographic, health, and lifestyle confounders in all participants with available data. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses.</p></div><div><h3>Findings</h3><p>Of the 62 919 women included from the NHS I, 88 535 women included from the NHS II, and 42 164 men included from the HPFS, a total of 9831 cases of cardiovascular disease were confirmed over 4 541 980 person-years of follow-up. Mean PHDI scores ranged from 60·7 (SD 5·1) to 90·6 (5·3) in the lowest versus highest quintile in NHS I, 55·6 (4·9) to 86·3 (6·3) in NHS II, and 59·6 (5·9) to 94 (5·9) in HPFS. In the multivariable-adjusted meta-analysis, participants in the highest quintile of PHDI score had a lower risk of incident cardiovascular disease than did those in the lowest quintile (hazard ratio [HR] 0·83 [95% CI 0·78–0·89]; p-trend <0·0001). When we examined cardiovascular disease subtypes, the highest quintile of PHDI was also associated with a lower risk of coronary heart disease (HR 0·81 [95% CI 0·74–0·88]; p-trend <0·0001) and total stroke (HR 0·86 [0·78–0·95]; p-trend=0·0004) compared with the lowest quintile.</p></div><div><h3>Interpretation</h3><p>We found that adherence to the Planetary Health Diet, designed to be a more environmentally sustainable dietary pattern, was associated with a lower risk of cardiovascular disease in three large cohorts of men and women in the USA. These observations suppor","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e666-e674"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001700/pdfft?md5=5f97f66b42f0071539c3769382de41ad&pid=1-s2.0-S2542519624001700-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135802","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 : 2024-09-01DOI: 10.1016/S2542-5196(24)00168-2
Maximilian Schwarz MSc , Prof Annette Peters PhD , Massimo Stafoggia PhD , Francesca de'Donato PhD , Francesco Sera PhD , Prof Michelle L Bell PhD , Prof Yuming Guo PhD , Prof Yasushi Honda PhD , Veronika Huber PhD , Prof Jouni J K Jaakkola PhD , Aleš Urban PhD , Ana Maria Vicedo-Cabrera PhD , Pierre Masselot PhD , Prof Eric Lavigne PhD , Souzana Achilleos PhD , Jan Kyselý PhD , Prof Evangelia Samoli PhD , Prof Masahiro Hashizume PhD , Chris Fook Sheng Ng PhD , Susana das Neves Pereira da Silva MSc , Antonella Zanobetti
Background
Ambient air pollution, including particulate matter (such as PM10 and PM2·5) and nitrogen dioxide (NO2), has been linked to increases in mortality. Whether populations’ vulnerability to these pollutants has changed over time is unclear, and studies on this topic do not include multicountry analysis. We evaluated whether changes in exposure to air pollutants were associated with changes in mortality effect estimates over time.
Methods
We extracted cause-specific mortality and air pollution data collected between 1995 and 2016 from the Multi-Country Multi-City (MCC) Collaborative Research Network database. We applied a two-stage approach to analyse the short-term effects of NO2, PM10, and PM2·5 on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models.
Findings
Over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries over the study period were included in the analysis. All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM10, PM2·5, or NO2 and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95% CI –0·05 to 0·80) in 1998 to 0·85% (0·55 to 1·16) in 2012 with a 10 μg/m3 increase in PM2·5. Two-pollutant models generally showed similar results to single-pollutant models for PM fractions and indicated temporal differences for NO2.
Interpretation
Although air pollution levels decreased during the study period, the effect sizes per unit increase in air pollution concentration have not changed. This observation might be due to the composition, toxicity, and sources of air pollution, as well as other factors, such as socioeconomic determinants or changes in population distribution and susceptibility.
{"title":"Temporal variations in the short-term effects of ambient air pollution on cardiovascular and respiratory mortality: a pooled analysis of 380 urban areas over a 22-year period","authors":"Maximilian Schwarz MSc , Prof Annette Peters PhD , Massimo Stafoggia PhD , Francesca de'Donato PhD , Francesco Sera PhD , Prof Michelle L Bell PhD , Prof Yuming Guo PhD , Prof Yasushi Honda PhD , Veronika Huber PhD , Prof Jouni J K Jaakkola PhD , Aleš Urban PhD , Ana Maria Vicedo-Cabrera PhD , Pierre Masselot PhD , Prof Eric Lavigne PhD , Souzana Achilleos PhD , Jan Kyselý PhD , Prof Evangelia Samoli PhD , Prof Masahiro Hashizume PhD , Chris Fook Sheng Ng PhD , Susana das Neves Pereira da Silva MSc , Antonella Zanobetti","doi":"10.1016/S2542-5196(24)00168-2","DOIUrl":"10.1016/S2542-5196(24)00168-2","url":null,"abstract":"<div><h3>Background</h3><p>Ambient air pollution, including particulate matter (such as PM<sub>10</sub> and PM<sub>2·5</sub>) and nitrogen dioxide (NO<sub>2</sub>), has been linked to increases in mortality. Whether populations’ vulnerability to these pollutants has changed over time is unclear, and studies on this topic do not include multicountry analysis. We evaluated whether changes in exposure to air pollutants were associated with changes in mortality effect estimates over time.</p></div><div><h3>Methods</h3><p>We extracted cause-specific mortality and air pollution data collected between 1995 and 2016 from the Multi-Country Multi-City (MCC) Collaborative Research Network database. We applied a two-stage approach to analyse the short-term effects of NO<sub>2</sub>, PM<sub>10</sub>, and PM<sub>2·5</sub> on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models.</p></div><div><h3>Findings</h3><p>Over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries over the study period were included in the analysis. All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM<sub>10</sub>, PM<sub>2·5</sub>, or NO<sub>2</sub> and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95% CI –0·05 to 0·80) in 1998 to 0·85% (0·55 to 1·16) in 2012 with a 10 μg/m<sup>3</sup> increase in PM<sub>2·5</sub>. Two-pollutant models generally showed similar results to single-pollutant models for PM fractions and indicated temporal differences for NO<sub>2</sub>.</p></div><div><h3>Interpretation</h3><p>Although air pollution levels decreased during the study period, the effect sizes per unit increase in air pollution concentration have not changed. This observation might be due to the composition, toxicity, and sources of air pollution, as well as other factors, such as socioeconomic determinants or changes in population distribution and susceptibility.</p></div><div><h3>Funding</h3><p>None.</p></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e657-e665"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001682/pdfft?md5=28e586822af31df1557ea9d75dc0c6d4&pid=1-s2.0-S2542519624001682-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135801","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}