Lancet Planetary Health最新文献

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.

Background

Ambient air pollution, including particulate matter (such as PM₁₀ and PM_2·5) 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 PM_2·5 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, PM_2·5, 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 PM_2·5. 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.

Funding

None.

Work to reduce environmental pollution from the health system is hampered by an absence of consensus on the definition of environmentally sustainable health care and the relevant measurement needed. This scoping review aims to encourage standardisation across sustainability efforts by examining how environmentally sustainable health care is defined and measured in current literature. We conducted a scoping review to identify candidate publications that included either a definition or description of environmentally sustainable health care or a measurement of the impact of health care on the environment. 328 publications were included in the final analysis. 52 publications included definitions or descriptions of environmentally sustainable health care. Results of the study highlight the heterogeneity in the current definition, measurement, and measurement calculation methods of environmentally sustainable health care in published literature. Work is needed to create more harmonised definitions and measurement to support progress and reduce environmental pollution from health care.

Metrics for health-care sustainability are crucial for tracking progress and understanding the advantages of different operations or systems as the health-care sector addresses the climate crisis and other environmental challenges. Measurement of the key metrics of absolute energy use and greenhouse gas emissions now has substantial momentum, but our overall measurement framework generally has serious deficiencies. Because existing metrics are often borrowed from other sectors, many are unconnected to the specifics of health-care provision or existing health system performance indicators, the potential negative effects of health care on public health are largely absent, a consistent and standardised set of health-care sustainability measurement concepts does not yet exist, and current dynamics in health systems such as privatisation are largely ignored. The next generation of health-care sustainability metrics must address these deficiencies by expanding the scope of observation and the entry points for interventions. Specifically, metrics should be standardised, reliable, meaningful, integrated with data management systems, fair, and aligned with the core mission of health care. Incentives with the potential to contradict sustainability goals must be addressed in future planning and implementation if the next generation of metrics is to be effective and incentivise positive systemic change.