Lancet Planetary Health最新文献

{"title":"Environmental impact of minimally invasive procedures: lifecycle assessment of two hospital care pathways","authors":"Eva Sayone Cohen ,&nbsp;Lisanne HJA Kouwenberg ,&nbsp;Hannah V Dürager ,&nbsp;Lynn E Snijder ,&nbsp;Jesse Lammerts ,&nbsp;Martijn van Bodegraven ,&nbsp;Dionne S Kringos ,&nbsp;Nicolaas H Sperna Weiland ,&nbsp;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 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.</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}

{"title":"Making climate-sensitive health counselling acceptable for patients: insights form a mixed-methods study in Germany","authors":"Alina Herrmann ,&nbsp;Claudia Quitmann ,&nbsp;Silvan Griesel ,&nbsp;Nicola Krippl ,&nbsp;Helen Fischer ,&nbsp;Jessica Nieder ,&nbsp;Patricia Nayna Schwerdtle ,&nbsp;Till Bärnighausen ,&nbsp;Jan Schildmann ,&nbsp;Rafael Mikolajczyk ,&nbsp;Ina Danquah ,&nbsp;Eva J Kantelhardt ,&nbsp;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 η²=0·18, p&lt;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}

{"title":"Commercial determinants of active travel: a crucial but overlooked barrier to health and sustainability","authors":"Carmen Jochem ,&nbsp;Karim Abu-Omar ,&nbsp;Dorothea Baltruks ,&nbsp;Adrian Bauman ,&nbsp;Ding Ding ,&nbsp;Sonja Kahlmeier ,&nbsp;Lisa Paulsen ,&nbsp;Lydia Reismann ,&nbsp;Birgit Wallmann-Sperlich ,&nbsp;Jens Bucksch","doi":"10.1016/j.lanplh.2025.101340","DOIUrl":"10.1016/j.lanplh.2025.101340","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 11","pages":"Article 101340"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293782","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}

{"title":"Advances and future needs for modelling sustainable and just food systems transformations","authors":"Daniel Mason-D’Croz MA ,&nbsp;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}

{"title":"Dietary schooling","authors":"The Lancet Planetary Health","doi":"10.1016/j.lanplh.2025.101410","DOIUrl":"10.1016/j.lanplh.2025.101410","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 11","pages":"Article 101410"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702321","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}

{"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 ,&nbsp;Marc J Gunter ,&nbsp;Christopher J Millett ,&nbsp;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}

{"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}

{"title":"Integrating environmental sustainability in clinical counselling: a randomised, double-blind, experimental vignette study in the Netherlands","authors":"Egid M van Bree MD ,&nbsp;Laurens C van Gestel PhD ,&nbsp;Eva H Visser MD ,&nbsp;Jiska J Aardoom PhD ,&nbsp;Evelyn A Brakema PhD ,&nbsp;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&lt;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&lt;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}

{"title":"Building climate resilience in health systems: a climate vulnerability and capacity assessment in a rural hospital in Chad","authors":"Patricia Nayna Schwerdtle ,&nbsp;Didier Tokoumnogo Zidouemba ,&nbsp;Alexi Reouhiri Dermbaye ,&nbsp;Kiran Jobanputra ,&nbsp;Melissa Mcrae ,&nbsp;Melanie Tarabbo ,&nbsp;Mohamed Njouonkou ,&nbsp;Marius Madjissem ,&nbsp;Alexandre Robert ,&nbsp;Zia Haider","doi":"10.1016/j.lanplh.2025.101354","DOIUrl":"10.1016/j.lanplh.2025.101354","url":null,"abstract":"<div><h3>Background</h3><div>Chad is highly vulnerable to climate change, with rising temperatures, irregular rainfall, droughts, and resource scarcity driving food insecurity, malnutrition, and vector-borne diseases. In Ngouri, in the Lac Region, these climate stressors have led to worsening health outcomes and strained health-care services. Without adaptation measures, facilities will struggle to sustain essential services. In this case study, we present a facility-adapted climate vulnerability and capacity assessment (VCA) for a rural hospital, identifying key risks and prioritising solutions for climate resilience.</div></div><div><h3>Methods</h3><div>This study used a participatory mixed-methods design including a literature review on climate hazards and vulnerabilities; facility audit of infrastructure and service delivery gaps; focus groups to refine risk identification; solution-matrix development with costs and feasibility analysis; and participatory prioritisation to produce a multiyear improvement plan.</div></div><div><h3>Findings</h3><div>The VCA identified elevated malarial mortality and power outages disrupting oxygen supply as key risks. 35 solutions were generated, with 22 priority actions selected for implementation, including anticipatory planning, community sensitisation, supplementary feeding programmes, and improved waste management. The process highlighted the importance of community engagement, multidisciplinary collaboration, and staff motivation for climate-resilient and sustainable health care.</div></div><div><h3>Interpretation</h3><div>The adapted VCA offers a replicable approach to assess climate-related vulnerabilities and capacities in health-care facilities. The approach used in Ngouri hospital informed feasible adaptation measures and showed relevance for similar contexts, supporting health system resilience and alignment with global sustainability goals.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 ","pages":"Article 101354"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617224","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}

{"title":"Local bodies, global goals: The frontline health workforce as agents of planetary health in India’s tribal regions","authors":"Sonal Mobar Roy","doi":"10.1016/j.lanplh.2025.101357","DOIUrl":"10.1016/j.lanplh.2025.101357","url":null,"abstract":"<div><h3>Background</h3><div>Planetary health, which emphasises the interconnection between human health and environmental systems, requires localised, culturally sensitive, and gender-responsive strategies for effective implementation. In the tribal regions of Telangana, the frontline health workforce—comprising Accredited Social Health Activists (ASHAs), (Auxiliary Nurse Midwives (ANMs), and Anganwadi Workers (AWWs)—serves as the crucial interface between state-led nutrition programmes, such as Poshan Abhiyan, and indigenous communities. This study examined how these women negotiate their roles within the sociocultural landscape of tribal areas to implement nutrition and health interventions that are ecologically and socially grounded.</div></div><div><h3>Methods</h3><div>Qualitative methods, including semistructured interviews, field observations, and participatory rural appraisal tools across six tribal-dominated blocks, were used to understand the lived experiences of these frontline workers and the communities they serve.</div></div><div><h3>Findings</h3><div>These workers act as cultural mediators who adapt state mandates to local contexts—promoting indigenous food knowledge, initiating community-based nutrigardens, and creating awareness around maternal and child health through participatory tools. Their work strengthens community engagement, promotes food diversity, and fosters ecologically aligned dietary practices. However, they face systemic barriers such as irregular incentives, poor training in environmental health, and gendered undervaluation of their labour.</div></div><div><h3>Interpretation</h3><div>Recognising and investing in the agency of female frontline workers is essential not only for the success of the Poshan Abhiyan but also for advancing planetary health in culturally diverse and ecologically sensitive regions. The efforts of these frontline workers exemplify how gendered grassroots labour is central to sustainable health futures.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 ","pages":"Article 101357"},"PeriodicalIF":21.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617305","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}