The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises.

TRANSLATIONS: For the Chinese, French, German, and Spanish translations of the abstract see Supplementary Materials section.

The 2020 special report of the MJA-Lancet Countdown on health and climate change: lessons learnt from Australia's "Black Summer".

The MJA-Lancet Countdown on health and climate change was established in 2017, and produced its first Australian national assessment in 2018 and its first annual update in 2019. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In the wake of the unprecedented and catastrophic 2019-20 Australian bushfire season, in this special report we present the 2020 update, with a focus on the relationship between health, climate change and bushfires, highlighting indicators that explore these linkages. In an environment of continuing increases in summer maximum temperatures and heatwave intensity, substantial increases in both fire risk and population exposure to bushfires are having an impact on Australia's health and economy. As a result of the "Black Summer" bushfires, the monthly airborne particulate matter less than 2.5 µm in diameter (PM2.5 ) concentrations in New South Wales and the Australian Capital Territory in December 2019 were the highest of any month in any state or territory over the period 2000-2019 at 26.0 µg/m3 and 71.6 µg/m3 respectively, and insured economic losses were $2.2 billion. We also found growing awareness of and engagement with the links between health and climate change, with a 50% increase in scientific publications and a doubling of newspaper articles on the topic in Australia in 2019 compared with 2018. However, despite clear and present need, Australia still lacks a nationwide adaptation plan for health. As Australia recovers from the compounded effects of the bushfires and the coronavirus disease 2019 (COVID-19) pandemic, the health profession has a pivotal role to play. It is uniquely suited to integrate the response to these short term threats with the longer term public health implications of climate change, and to argue for the economic recovery from COVID-19 to align with and strengthen Australia's commitments under the Paris Agreement.

The 2019 report of the MJA-Lancet Countdown on health and climate change: a turbulent year with mixed progress.

The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this.

The Lancet Countdown: tracking progress on health and climate change.

The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be "the greatest global health opportunity of the 21st century". The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process-from November, 2016 to early 2017-to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.

The MJA-Lancet Countdown on health and climate change: Australian policy inaction threatens lives.

Climate plays an important role in human health and it is well established that climate change can have very significant impacts in this regard. In partnership with The Lancet and the MJA, we present the inaugural Australian Countdown assessment of progress on climate change and health. This comprehensive assessment examines 41 indicators across five broad sections: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. These indicators and the methods used for each are largely consistent with those of the Lancet Countdown global assessment published in October 2017, but with an Australian focus. Significant developments include the addition of a new indicator on mental health. Overall, we find that Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In a number of respects, Australia has gone backwards and now lags behind other high income countries such as Germany and the United Kingdom. Examples include the persistence of a very high carbon-intensive energy system in Australia, and its slow transition to renewables and low carbon electricity generation. However, we also find some examples of good progress, such as heatwave response planning. Given the overall poor state of progress on climate change and health in Australia, this country now has an enormous opportunity to take action and protect human health and lives. Australia has the technical knowhow and intellect to do this, and our annual updates of this assessment will track Australia's engagement with and progress on this vitally important issue.

A multicentre cross-sectional observational study to determine the effect of living with frailty on digital exclusion from video consultations: (Access-VIGIL).

OBJECTIVES: Many older people regularly access digital services, but many others are totally excluded. Age alone may not explain these discrepancies. As health care services offer more video consultations, we aimed to determine if living with frailty is a significant risk factor for digital exclusion in accessing video consultations, and if this changes if a person has a support network to help with access. DESIGN: We undertook a muticenter cross-sectional survey across South West England. SETTING AND PARTICIPANTS: Patients in primary care, hospital at home, and secondary care services were enrolled between February 21 and April 12, 2022. METHODS: The primary outcome was complete digital exclusion defined as no individual access or network support access to video consultations. Secondary analysis looked at the person's digital exclusion when ignoring any network support. The association between frailty and outcomes was analyzed with logistic regression. In addition, older people's digital skills, motivation, and confidence were examined. RESULTS: 255 patients were included in the analysis. The median age was 63 years (interquartile range 43-77) with 148 (57%) women. Complete digital exclusion was rare (5.1%). Only 1 of 155 who were not frail (Clinical Frailty Scale 1-3) experienced complete digital exclusion compared with 12 of 99 (10.7%) who were living with frailty (Clinical Frailty Scale 4-8). There was no association between frailty and complete digital exclusion. Frailty was associated with individual digital exclusion when no network support was available to assist. CONCLUSIONS AND IMPLICATIONS: When taking into account a person's support network, complete digital exclusion from video consultation was rare. When no support network was available, frailty was associated with individual digital exclusion. Health care services should ask about a person's support network to help people living with frailty access video consultations.

Evaluating progress and accountability for achieving COP26 Health Programme international ambitions for sustainable, low-carbon, resilient health-care systems.

A global initiative to develop low-carbon, resilient health systems-the COP26 Health Programme-launched at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in 2021. As of May, 2024, 83 nations have committed to participate in this initiative. This analysis evaluates the effectiveness of existing and proposed indicators towards public monitoring and accountability to these commitments. Our findings reveal substantial gaps in data availability and indicator relevance, with many countries reporting process indicators that do not reflect actual progress towards achieving sustainable health-care systems. We found a dearth of suitable indicators and an urgent need to develop robust ones that are adaptable to different health-care system contexts. These indicators should be designed to capture tangible outcomes, support policy making, and prevent greenwashing. Integration of more robust indicators into independent scientific monitoring can support systematic inclusion of health care in global climate strategies, thereby enhancing the overall effectiveness of the COP26 Health Programme.

The public health implications of the Paris Agreement: a modelling study.

BACKGROUND: nationally determined contributions (NDCs) serve to meet the goals of the Paris Agreement of staying "well below 2°C", which could also yield substantial health co-benefits in the process. However, existing NDC commitments are inadequate to achieve this goal. Placing health as a key focus of the NDCs could present an opportunity to increase ambition and realise health co-benefits. We modelled scenarios to analyse the health co-benefits of NDCs for the year 2040 for nine representative countries (ie, Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK, and the USA) that were selected for their contribution to global greenhouse gas emissions and their global or regional influence. METHODS: Modelling the energy, food and agriculture, and transport sectors, and mortality related to risk factors of air pollution, diet, and physical activity, we analysed the health co-benefits of existing NDCs and related policies (ie, the current pathways scenario) for 2040 in nine countries around the world. We compared these health co-benefits with two alternative scenarios, one consistent with the goal of the Paris Agreement and the Sustainable Development Goals (ie, the sustainable pathways scenario), and one in line with the sustainable pathways scenario, but also placing health as a central focus of the policies (ie, the health in all climate policies scenario). FINDINGS: Compared with the current pathways scenario, the sustainable pathways scenario resulted in an annual reduction of 1·18 million air pollution-related deaths, 5·86 million diet-related deaths, and 1·15 million deaths due to physical inactivity, across the nine countries, by 2040. Adopting the more ambitious health in all climate policies scenario would result in a further reduction of 462 000 annual deaths attributable to air pollution, 572 000 annual deaths attributable to diet, and 943 000 annual deaths attributable to physical inactivity. These benefits were attributable to the mitigation of direct greenhouse gas emissions and the commensurate actions that reduce exposure to harmful pollutants, as well as improved diets and safe physical activity. INTERPRETATION: A greater consideration of health in the NDCs and climate change mitigation policies has the potential to yield considerable health benefits as well as achieve the "well below 2°C" commitment across a range of regional and economic contexts. FUNDING: This work was in part funded through an unrestricted grant from the Wellcome Trust (award number 209734/Z/17/Z) and supported by an Engineering and Physical Sciences Research Council grant (grant number EP/R035288/1).

Determinants of penetrance and variable expressivity in monogenic metabolic conditions across 77,184 exomes.

Hundreds of thousands of genetic variants have been reported to cause severe monogenic diseases, but the probability that a variant carrier develops the disease (termed penetrance) is unknown for virtually all of them. Additionally, the clinical utility of common polygenetic variation remains uncertain. Using exome sequencing from 77,184 adult individuals (38,618 multi-ancestral individuals from a type 2 diabetes case-control study and 38,566 participants from the UK Biobank, for whom genotype array data were also available), we apply clinical standard-of-care gene variant curation for eight monogenic metabolic conditions. Rare variants causing monogenic diabetes and dyslipidemias display effect sizes significantly larger than the top 1% of the corresponding polygenic scores. Nevertheless, penetrance estimates for monogenic variant carriers average 60% or lower for most conditions. We assess epidemiologic and genetic factors contributing to risk prediction in monogenic variant carriers, demonstrating that inclusion of polygenic variation significantly improves biomarker estimation for two monogenic dyslipidemias.