Pub Date : 2025-11-01DOI: 10.1016/j.lanplh.2025.101331
Francesco Visioli , Daniele Del Rio , Vincenzo Fogliano , Franca Marangoni , Andrea Poli
{"title":"Interpreting substitution models in nutritional epidemiology: the case for the protective role of NOVA 1 foods over the risk of NOVA 4","authors":"Francesco Visioli , Daniele Del Rio , Vincenzo Fogliano , Franca Marangoni , Andrea Poli","doi":"10.1016/j.lanplh.2025.101331","DOIUrl":"10.1016/j.lanplh.2025.101331","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 11","pages":"Article 101331"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226081","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 : 2025-11-01DOI: 10.1016/j.lanplh.2025.101335
Prof Melinda R Weathers PhD , Deepti Ganapathy PhD , Marceleen M Mosher MA , Teresa Myers PhD , Neha Gour MA , Mulin Jiang MA , Qianying Ye MA , Prof Fei Shen PhD , John Kotcher PhD , Prof Edward W Maibach PhD
<div><h3>Background</h3><div>Climate change harms human health and wellbeing, and climate solutions often have public health benefits. Previous research has shown how news media engages and shapes public understanding of climate change, yet few studies have examined how news media reports on climate change as a public health issue. Understanding how and how much news media reports on the public health implications of climate change can shed light on public engagement in climate change, which has been deemed a public health crisis.</div></div><div><h3>Methods</h3><div>Using online databases, articles were collected from five mainstream newspapers and one news agency for each of the three countries—China, India, and the USA—between Jan 1, 2012, and Dec 31, 2023. The headline or lead paragraph of all articles were searched by newspaper and within years using both climate change and public health keywords. Articles having at least one keyword from both sets (ie, climate change and public health) were included in the study, resulting in a total of 5173 articles: 1473 from China, 1487 from India, and 2213 from the USA. A detailed content analysis was then done on a randomly selected 20% of the 5173 public health-related climate change articles, which provided a dataset of 1027 articles for analysis: 294 from China, 295 from India, and 438 from the USA. Articles were then thoroughly reviewed and discarded if they were not substantively focused on climate change and public health or were non-articles (eg, obituaries, sports sections, content summaries, or letters to the editors), providing a final dataset of 3234 public health-focused climate change articles for in-depth analysis: 50 from China, 137 from India, and 137 from the USA. Each article was then coded for four sets of variables: public health impacts; vulnerable populations; solutions; and health experts as sources.</div></div><div><h3>Findings</h3><div>Across all countries and all years, 64 073 (0·3%) of 22 562 365 articles had a climate change keyword in their lead paragraph or title, although this varied significantly by country (p<0·0001) and time (p<0·0001). 5173 (8·1%) of 64 073 articles also included public health keywords, which also varied by country (p<0·0001). Among the randomly sampled 20% of articles (1025 of 5173), 3234 (31·5%) were determined to be public health-focused climate change articles. Thus, 1626 (<0·1%) of 22 562 365 articles in the total newshole (all articles published in these countries over the past decade) focused on the public health relevance of climate change, a proportion that varied by country (p<0·0001) and time (p<0·0001). 321 (99·1%) of 324 public health-focused articles reported at least one health impact, most commonly general public health (252 [77·8%] articles); extreme heat (166 [51·2%] articles); extreme weather (142 [43·8%] articles); poor air quality (115 [35·5%] articles); and food insecurity (80 [24·7%] articles). Rates of reporti
{"title":"The evolution of news coverage about climate change as a health issue: a decadal analysis in China, India, and the USA","authors":"Prof Melinda R Weathers PhD , Deepti Ganapathy PhD , Marceleen M Mosher MA , Teresa Myers PhD , Neha Gour MA , Mulin Jiang MA , Qianying Ye MA , Prof Fei Shen PhD , John Kotcher PhD , Prof Edward W Maibach PhD","doi":"10.1016/j.lanplh.2025.101335","DOIUrl":"10.1016/j.lanplh.2025.101335","url":null,"abstract":"<div><h3>Background</h3><div>Climate change harms human health and wellbeing, and climate solutions often have public health benefits. Previous research has shown how news media engages and shapes public understanding of climate change, yet few studies have examined how news media reports on climate change as a public health issue. Understanding how and how much news media reports on the public health implications of climate change can shed light on public engagement in climate change, which has been deemed a public health crisis.</div></div><div><h3>Methods</h3><div>Using online databases, articles were collected from five mainstream newspapers and one news agency for each of the three countries—China, India, and the USA—between Jan 1, 2012, and Dec 31, 2023. The headline or lead paragraph of all articles were searched by newspaper and within years using both climate change and public health keywords. Articles having at least one keyword from both sets (ie, climate change and public health) were included in the study, resulting in a total of 5173 articles: 1473 from China, 1487 from India, and 2213 from the USA. A detailed content analysis was then done on a randomly selected 20% of the 5173 public health-related climate change articles, which provided a dataset of 1027 articles for analysis: 294 from China, 295 from India, and 438 from the USA. Articles were then thoroughly reviewed and discarded if they were not substantively focused on climate change and public health or were non-articles (eg, obituaries, sports sections, content summaries, or letters to the editors), providing a final dataset of 3234 public health-focused climate change articles for in-depth analysis: 50 from China, 137 from India, and 137 from the USA. Each article was then coded for four sets of variables: public health impacts; vulnerable populations; solutions; and health experts as sources.</div></div><div><h3>Findings</h3><div>Across all countries and all years, 64 073 (0·3%) of 22 562 365 articles had a climate change keyword in their lead paragraph or title, although this varied significantly by country (p<0·0001) and time (p<0·0001). 5173 (8·1%) of 64 073 articles also included public health keywords, which also varied by country (p<0·0001). Among the randomly sampled 20% of articles (1025 of 5173), 3234 (31·5%) were determined to be public health-focused climate change articles. Thus, 1626 (<0·1%) of 22 562 365 articles in the total newshole (all articles published in these countries over the past decade) focused on the public health relevance of climate change, a proportion that varied by country (p<0·0001) and time (p<0·0001). 321 (99·1%) of 324 public health-focused articles reported at least one health impact, most commonly general public health (252 [77·8%] articles); extreme heat (166 [51·2%] articles); extreme weather (142 [43·8%] articles); poor air quality (115 [35·5%] articles); and food insecurity (80 [24·7%] articles). Rates of reporti","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 11","pages":"Article 101335"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688469","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 : 2025-11-01DOI: 10.1016/j.lanplh.2025.101348
Eva Sayone Cohen , Lisanne HJA Kouwenberg , Hannah V Dürager , Lynn E Snijder , Jesse Lammerts , Martijn van Bodegraven , Dionne S Kringos , Nicolaas H Sperna Weiland , Wouter JK Hehenkamp
Background
If the health-care sector were a country, it would rank as the fifth-largest environmental polluter globally. Minimally invasive procedures are particularly resource-intensive and energy-intensive, highlighting the importance of assessing their environmental impact in addition to their clinical benefits. In this study, we quantified the environmental impacts of two minimally invasive, clinically equivalent treatments for uterine fibroids: uterine artery embolisation (non-surgical) and total laparoscopic hysterectomy (surgical).
Methods
This study was conducted at a tertiary hospital in the Netherlands. Using comparative lifecycle assessment, we evaluated care pathways from outpatient appointments to follow-up visits, based on 40 waste inventories, considering material production, energy use, pharmaceutical production, sterilisation, transport, waste disposal, and recycling.
Findings
The embolisation procedure generated a median of 3·9 kg waste and 39 kg CO2-equivalents (CO2-eq), compared to 7·9 kg of waste and 120 kg of CO2-eq generated by the hysterectomy procedure. When accounting for both hospitalisation and outpatient visits, 9 kg of waste and 215 kg of CO2-eq were generated by the embolisation procedure and 6 kg of waste and 186 kg of CO2-eq were generated by the hysterectomy pathway. Key contributors to environmental impact included patient and staff travel; electricity consumption for heating, ventilation and air-conditioning; and single-use items.
Interpretation
This study reveals the overall environmental footprint of two minimally invasive treatments in gynaecology and identifies key areas for mitigation strategies within each care pathway. Comprehensive environmental impact assessments can offer valuable insights for health-care systems that aim to balance clinical effectiveness with environmental sustainability.
Funding
Amsterdam University Medical Centre Doctoral School.
{"title":"Environmental impact of minimally invasive procedures: lifecycle assessment of two hospital care pathways","authors":"Eva Sayone Cohen , Lisanne HJA Kouwenberg , Hannah V Dürager , Lynn E Snijder , Jesse Lammerts , Martijn van Bodegraven , Dionne S Kringos , Nicolaas H Sperna Weiland , Wouter JK Hehenkamp","doi":"10.1016/j.lanplh.2025.101348","DOIUrl":"10.1016/j.lanplh.2025.101348","url":null,"abstract":"<div><h3>Background</h3><div>If the health-care sector were a country, it would rank as the fifth-largest environmental polluter globally. Minimally invasive procedures are particularly resource-intensive and energy-intensive, highlighting the importance of assessing their environmental impact in addition to their clinical benefits. In this study, we quantified the environmental impacts of two minimally invasive, clinically equivalent treatments for uterine fibroids: uterine artery embolisation (non-surgical) and total laparoscopic hysterectomy (surgical).</div></div><div><h3>Methods</h3><div>This study was conducted at a tertiary hospital in the Netherlands. Using comparative lifecycle assessment, we evaluated care pathways from outpatient appointments to follow-up visits, based on 40 waste inventories, considering material production, energy use, pharmaceutical production, sterilisation, transport, waste disposal, and recycling.</div></div><div><h3>Findings</h3><div>The embolisation procedure generated a median of 3·9 kg waste and 39 kg CO<sub>2</sub>-equivalents (CO<sub>2</sub>-eq), compared to 7·9 kg of waste and 120 kg of CO<sub>2</sub>-eq generated by the hysterectomy procedure. When accounting for both hospitalisation and outpatient visits, 9 kg of waste and 215 kg of CO<sub>2</sub>-eq were generated by the embolisation procedure and 6 kg of waste and 186 kg of CO<sub>2</sub>-eq were generated by the hysterectomy pathway. Key contributors to environmental impact included patient and staff travel; electricity consumption for heating, ventilation and air-conditioning; and single-use items.</div></div><div><h3>Interpretation</h3><div>This study reveals the overall environmental footprint of two minimally invasive treatments in gynaecology and identifies key areas for mitigation strategies within each care pathway. Comprehensive environmental impact assessments can offer valuable insights for health-care systems that aim to balance clinical effectiveness with environmental sustainability.</div></div><div><h3>Funding</h3><div>Amsterdam University Medical Centre Doctoral School.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 ","pages":"Article 101348"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617229","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 : 2025-11-01DOI: 10.1016/j.lanplh.2025.101369
Alina Herrmann , Claudia Quitmann , Silvan Griesel , Nicola Krippl , Helen Fischer , Jessica Nieder , Patricia Nayna Schwerdtle , Till Bärnighausen , Jan Schildmann , Rafael Mikolajczyk , Ina Danquah , Eva J Kantelhardt , Nikolaus C S Mezger
Background
Climate-sensitive health counselling (CSHC) equips health professionals to incorporate climate change and health topics into patient communication. A key barrier to its implementation is uncertainty about how to deliver CSHC in a manner that is acceptable to patients. This study explored patient and physician perspectives on suitable topics and communication strategies for CSHC.
Methods
We applied a sequential mixed-methods design. We conducted qualitative in-depth interviews with physicians and patients with experience in CSHC in Germany and analysed them using thematic analysis. Findings informed a cross-sectional online survey administered to an online panel in five German federal states, quantifying topic preference and testing acceptability of topics and communication strategies in a survey experiment with mixed factorial design. We analysed the survey using descriptive statistics and mixed ANOVA.
Findings
Qualitative interviews with physicians (n=18) and patients (n=27) identified key topics for CSHC: health impacts of climate change and adaptation strategies, climate-friendly lifestyle changes, climate anxiety, and climate action. Physicians reported uncertainty about referencing climate change explicitly in lifestyle counselling. Survey data (n=1491) revealed that 47% of participants wanted to receive CSHC in general, with over 70% being interested in adaptation strategies. Health-only framings in lifestyle counselling were more acceptable than climate-and-health framings (partial η2=0·18, p<0·001) in survey experiment. Yet, patients found climate-and-health framings acceptable in qualitative interviews, if delivered in a patient-centred manner.
Interpretation
CSHC can be acceptable to patients when topics and framings are carefully matched to individual health concerns and biopsychosocial background. Patient-centred communication might support integration of CSHC into routine care.
{"title":"Making climate-sensitive health counselling acceptable for patients: insights form a mixed-methods study in Germany","authors":"Alina Herrmann , Claudia Quitmann , Silvan Griesel , Nicola Krippl , Helen Fischer , Jessica Nieder , Patricia Nayna Schwerdtle , Till Bärnighausen , Jan Schildmann , Rafael Mikolajczyk , Ina Danquah , Eva J Kantelhardt , Nikolaus C S Mezger","doi":"10.1016/j.lanplh.2025.101369","DOIUrl":"10.1016/j.lanplh.2025.101369","url":null,"abstract":"<div><h3>Background</h3><div>Climate-sensitive health counselling (CSHC) equips health professionals to incorporate climate change and health topics into patient communication. A key barrier to its implementation is uncertainty about how to deliver CSHC in a manner that is acceptable to patients. This study explored patient and physician perspectives on suitable topics and communication strategies for CSHC.</div></div><div><h3>Methods</h3><div>We applied a sequential mixed-methods design. We conducted qualitative in-depth interviews with physicians and patients with experience in CSHC in Germany and analysed them using thematic analysis. Findings informed a cross-sectional online survey administered to an online panel in five German federal states, quantifying topic preference and testing acceptability of topics and communication strategies in a survey experiment with mixed factorial design. We analysed the survey using descriptive statistics and mixed ANOVA.</div></div><div><h3>Findings</h3><div>Qualitative interviews with physicians (n=18) and patients (n=27) identified key topics for CSHC: health impacts of climate change and adaptation strategies, climate-friendly lifestyle changes, climate anxiety, and climate action. Physicians reported uncertainty about referencing climate change explicitly in lifestyle counselling. Survey data (n=1491) revealed that 47% of participants wanted to receive CSHC in general, with over 70% being interested in adaptation strategies. Health-only framings in lifestyle counselling were more acceptable than climate-and-health framings (partial η<sup>2</sup>=0·18, p<0·001) in survey experiment. Yet, patients found climate-and-health framings acceptable in qualitative interviews, if delivered in a patient-centred manner.</div></div><div><h3>Interpretation</h3><div>CSHC can be acceptable to patients when topics and framings are carefully matched to individual health concerns and biopsychosocial background. Patient-centred communication might support integration of CSHC into routine care.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 ","pages":"Article 101369"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617384","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 : 2025-11-01DOI: 10.1016/j.lanplh.2025.101385
Daniel Mason-D’Croz MA , Prof Mario Herrero PhD
Food systems underpin human health, livelihoods, and environmental sustainability; yet, they remain major contributors to climate change, biodiversity loss, and inequity. Building on the 2025 EAT–Lancet Commission on healthy, sustainable, and just food systems, a special collection of papers in The Lancet Planetary Health highlights emerging frontiers for research and modelling. Across models, dietary change remains the most effective lever for reducing greenhouse gas emissions and land-use pressure from food production, although affordability and nutritional adequacy challenges persist, particularly in low-income and middle-income countries. Productivity improvements, reductions in food loss and waste, and the adoption of circular food systems can amplify environmental gains while mitigating cost increases, but their implementation requires safeguards to prevent adverse trade-offs. Labour and equity analyses highlight how transitions might redistribute employment and income, underscoring the need for just transition strategies. Collectively, the studies reveal that bundled interventions combining dietary shifts, productivity growth, food loss and waste reduction, and mitigation policies produce the largest synergistic benefits across environmental and health outcomes. Future modelling must deepen integration of justice, political economy, and behavioural change dynamics and enhance regional specificity to inform feasible and equitable transformation pathways at policy-relevant scales. Together with more robust stakeholder processes, these priorities define a forward-looking agenda for food systems research capable of guiding sustainable, inclusive, and resilient transformations within planetary boundaries.
{"title":"Advances and future needs for modelling sustainable and just food systems transformations","authors":"Daniel Mason-D’Croz MA , Prof Mario Herrero PhD","doi":"10.1016/j.lanplh.2025.101385","DOIUrl":"10.1016/j.lanplh.2025.101385","url":null,"abstract":"<div><div>Food systems underpin human health, livelihoods, and environmental sustainability; yet, they remain major contributors to climate change, biodiversity loss, and inequity. Building on the 2025 EAT–<em>Lancet</em> Commission on healthy, sustainable, and just food systems, a special collection of papers in <em>The Lancet Planetary Health</em> highlights emerging frontiers for research and modelling. Across models, dietary change remains the most effective lever for reducing greenhouse gas emissions and land-use pressure from food production, although affordability and nutritional adequacy challenges persist, particularly in low-income and middle-income countries. Productivity improvements, reductions in food loss and waste, and the adoption of circular food systems can amplify environmental gains while mitigating cost increases, but their implementation requires safeguards to prevent adverse trade-offs. Labour and equity analyses highlight how transitions might redistribute employment and income, underscoring the need for just transition strategies. Collectively, the studies reveal that bundled interventions combining dietary shifts, productivity growth, food loss and waste reduction, and mitigation policies produce the largest synergistic benefits across environmental and health outcomes. Future modelling must deepen integration of justice, political economy, and behavioural change dynamics and enhance regional specificity to inform feasible and equitable transformation pathways at policy-relevant scales. Together with more robust stakeholder processes, these priorities define a forward-looking agenda for food systems research capable of guiding sustainable, inclusive, and resilient transformations within planetary boundaries.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 11","pages":"Article 101385"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472195","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 : 2025-11-01DOI: 10.1016/j.lanplh.2025.101332
Nathalie Kliemann , Marc J Gunter , Christopher J Millett , Inge Huybrechts
{"title":"Interpreting substitution models in nutritional epidemiology: the case for the protective role of NOVA 1 foods over the risk of NOVA 4","authors":"Nathalie Kliemann , Marc J Gunter , Christopher J Millett , Inge Huybrechts","doi":"10.1016/j.lanplh.2025.101332","DOIUrl":"10.1016/j.lanplh.2025.101332","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 11","pages":"Article 101332"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226159","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 : 2025-11-01DOI: 10.1016/j.lanplh.2025.101329
Energy security, defined as the availability of reliable, clean, and sustainable energy necessary to ensure the continuous operation of health-care facilities, is essential for delivering safe and effective health care. Yet, it is rarely measured, financed, or governed as a component of core health infrastructure. Evidence from nearly a thousand hospitals shows that power outages were common, especially in lower-income settings, disrupting surgery, diagnostics, cold chains, and digital records, with reports of direct patient harm and environmental costs. This Viewpoint highlights four potential solutions. First, measure energy security with a simple, service-oriented indicator set that tracks outage frequency and duration, clinical disruption, and harm. Second, ensure a minimum energy service for essential care, including operating theatres, maternity services, intensive care units, oxygen, and vaccine cold chains, by protecting critical circuits and embedding these standards in national health plans and SDG7 strategies. Third, build clean resilience by shifting from diesel-only back-up to context-appropriate onsite renewables with storage, integrated with stable grids and smart switching. Fourth, ensure financing by ring-fencing both capital and maintenance budgets, using asset registers, uptime targets, performance-based service contracts, and local technical capacity for operation and repair. These strategic actions would enable clinical teams globally, especially in the Global South, to consistently deliver safe and effective care while simultaneously decarbonising health systems and communities.
{"title":"Energy security as a crucial component of health infrastructure: global evidence and actions","authors":"","doi":"10.1016/j.lanplh.2025.101329","DOIUrl":"10.1016/j.lanplh.2025.101329","url":null,"abstract":"<div><div>Energy security, defined as the availability of reliable, clean, and sustainable energy necessary to ensure the continuous operation of health-care facilities, is essential for delivering safe and effective health care. Yet, it is rarely measured, financed, or governed as a component of core health infrastructure. Evidence from nearly a thousand hospitals shows that power outages were common, especially in lower-income settings, disrupting surgery, diagnostics, cold chains, and digital records, with reports of direct patient harm and environmental costs. This Viewpoint highlights four potential solutions. First, measure energy security with a simple, service-oriented indicator set that tracks outage frequency and duration, clinical disruption, and harm. Second, ensure a minimum energy service for essential care, including operating theatres, maternity services, intensive care units, oxygen, and vaccine cold chains, by protecting critical circuits and embedding these standards in national health plans and SDG7 strategies. Third, build clean resilience by shifting from diesel-only back-up to context-appropriate onsite renewables with storage, integrated with stable grids and smart switching. Fourth, ensure financing by ring-fencing both capital and maintenance budgets, using asset registers, uptime targets, performance-based service contracts, and local technical capacity for operation and repair. These strategic actions would enable clinical teams globally, especially in the Global South, to consistently deliver safe and effective care while simultaneously decarbonising health systems and communities.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 11","pages":"Article 101329"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524575","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 : 2025-11-01DOI: 10.1016/j.lanplh.2025.101328
Egid M van Bree MD , Laurens C van Gestel PhD , Eva H Visser MD , Jiska J Aardoom PhD , Evelyn A Brakema PhD , Prof Marieke A Adriaanse PhD
Background
Integrating environmental sustainability in health-care decision making might be a key strategy to achieve greener clinical practice. We aim to explore whether advising environmentally sustainable treatment options with or without explicitly mentioning sustainability as an argument in clinical counselling affects patients’ trust in care, compared with less sustainable standard treatment options, while accounting for differences in severity and types of medical problems.
Methods
This randomised, double-blind, experimental vignette study was conducted at the Leiden University Medical Center (Leiden, Netherlands). We recruited a representative sample (based on sex, age, education level, and geographical distribution) of the general Dutch adult population. Participants were masked, randomised, and allocated to one of the eight study groups (four types of advice × two levels of severity) using automatic online software. We used an online survey tool to provide participants with five short descriptions (vignettes) of hypothetical patient–physician interactions based on their allocation to high severity or low severity scenarios and their physician’s type of advice; varying in the level of environmental sustainability and whether sustainability is mentioned explicitly. Low severity scenarios described a general practice setting and high severity scenarios described a hospital setting where the patient had been referred. The primary outcome was a practice-based composite score labelled as trust in care (seven-point Likert scale from 1 [strongly disagree] to 7 [strongly agree]).
Findings
Between May 16 and 31, 2024, 2694 participants were invited to participate, of whom 1536 were included in the final sample size of the study. The mean age of participants was 51·7 years (SD 17·1). 762 (50%) participants were female and 774 (50%) were male. Participants receiving the Less Sustainable advice (mean 5·6 [SD 1·2]) generally had higher trust scores than participants receiving one of the other three types of advice (p<0·0001). Participants receiving the Sustainable made Explicit advice (mean 4·8 [1·6]) generally had lower trust scores than those receiving one of the other three types of advice (p<0·0001). Post-hoc analysis indicated that differences in trust scores were primarily driven by high severity conditions and varied across medical problems.
Interpretation
Advising more sustainable treatment options for low severity scenarios generally does not affect patients’ trust in care, including when sustainability is mentioned explicitly. For high severity scenarios, advising more sustainable treatment options might negatively affect patients’ trust; however, the size and presence of the observed effect varied across medical problems.
{"title":"Integrating environmental sustainability in clinical counselling: a randomised, double-blind, experimental vignette study in the Netherlands","authors":"Egid M van Bree MD , Laurens C van Gestel PhD , Eva H Visser MD , Jiska J Aardoom PhD , Evelyn A Brakema PhD , Prof Marieke A Adriaanse PhD","doi":"10.1016/j.lanplh.2025.101328","DOIUrl":"10.1016/j.lanplh.2025.101328","url":null,"abstract":"<div><h3>Background</h3><div>Integrating environmental sustainability in health-care decision making might be a key strategy to achieve greener clinical practice. We aim to explore whether advising environmentally sustainable treatment options with or without explicitly mentioning sustainability as an argument in clinical counselling affects patients’ trust in care, compared with less sustainable standard treatment options, while accounting for differences in severity and types of medical problems.</div></div><div><h3>Methods</h3><div>This randomised, double-blind, experimental vignette study was conducted at the Leiden University Medical Center (Leiden, Netherlands). We recruited a representative sample (based on sex, age, education level, and geographical distribution) of the general Dutch adult population. Participants were masked, randomised, and allocated to one of the eight study groups (four types of advice × two levels of severity) using automatic online software. We used an online survey tool to provide participants with five short descriptions (vignettes) of hypothetical patient–physician interactions based on their allocation to high severity or low severity scenarios and their physician’s type of advice; varying in the level of environmental sustainability and whether sustainability is mentioned explicitly. Low severity scenarios described a general practice setting and high severity scenarios described a hospital setting where the patient had been referred. The primary outcome was a practice-based composite score labelled as trust in care (seven-point Likert scale from 1 [strongly disagree] to 7 [strongly agree]).</div></div><div><h3>Findings</h3><div>Between May 16 and 31, 2024, 2694 participants were invited to participate, of whom 1536 were included in the final sample size of the study. The mean age of participants was 51·7 years (SD 17·1). 762 (50%) participants were female and 774 (50%) were male. Participants receiving the Less Sustainable advice (mean 5·6 [SD 1·2]) generally had higher trust scores than participants receiving one of the other three types of advice (p<0·0001). Participants receiving the Sustainable made Explicit advice (mean 4·8 [1·6]) generally had lower trust scores than those receiving one of the other three types of advice (p<0·0001). Post-hoc analysis indicated that differences in trust scores were primarily driven by high severity conditions and varied across medical problems.</div></div><div><h3>Interpretation</h3><div>Advising more sustainable treatment options for low severity scenarios generally does not affect patients’ trust in care, including when sustainability is mentioned explicitly. For high severity scenarios, advising more sustainable treatment options might negatively affect patients’ trust; however, the size and presence of the observed effect varied across medical problems.</div></div><div><h3>Funding</h3><div>Leiden University.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 11","pages":"Article 101328"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641386","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：