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Climate change and environmental pollution from health care present urgent, complex challenges. The US health care sector produces 10% of total US greenhouse gas emissions, which have negative influences on human and environmental health. The emergency department (ED) is an important place in the hospital to become more environmentally responsible and "climate smart," a term referring to the combination of low-carbon and resilient health care strategies. Our intent is to educate and motivate emergency providers to action by providing a guide to sustainable health care and an approach to creating a climate-smart ED.
Assuntos
Pegada de Carbono , Mudança Climática , Serviço Hospitalar de Emergência , Poluição Ambiental , Setor de Assistência à Saúde , Resíduos , Ambulâncias , Reutilização de Equipamento , Alimentos , Indústria Alimentícia , Gases de Efeito Estufa , Resíduos Perigosos , Humanos , Resíduos de Serviços de Saúde , Plásticos , Embalagem de Produtos , Reciclagem , Estados Unidos , Emissões de VeículosRESUMO
In a Policy Forum, Cecilia Sorensen and colleagues discuss the implications of climate change for women's health.
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Mudança Climática , Saúde Global/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Disparidades nos Níveis de Saúde , Formulação de Políticas , Saúde da Mulher/legislação & jurisprudência , Feminino , Humanos , Medição de Risco , Fatores de Risco , Fatores SexuaisRESUMO
BACKGROUND: Quantifying the effect of natural disasters on society is critical for recovery of public health services and infrastructure. The death toll can be difficult to assess in the aftermath of a major disaster. In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64. METHODS: Using a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016. RESULTS: From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial. CONCLUSIONS: This household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate. (Funded by the Harvard T.H. Chan School of Public Health and others.).
Assuntos
Tempestades Ciclônicas , Desastres/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade Prematura , Porto Rico/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
Climate change impacts on health, including increased exposures to heat, poor air quality, extreme weather events, and altered vector-borne disease transmission, reduced water quality, and decreased food security, affect men and women differently due to biologic, socioeconomic, and cultural factors. In India, where rapid environmental changes are taking place, climate change threatens to widen existing gender-based health disparities. Integration of a gendered perspective into existing climate, development, and disaster-risk reduction policy frameworks can decrease negative health outcomes. Modifying climate risks requires multisector coordination, improvement in data acquisition, monitoring of gender specific targets, and equitable stakeholder engagement. Empowering women as agents of social change can improve mitigation and adaptation policy interventions.
RESUMO
Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship.