The health impacts of globalization: a conceptual framework.

This paper describes a conceptual framework for the health implications of globalization. The framework is developed by first identifying the main determinants of population health and the main features of the globalization process. The resulting conceptual model explicitly visualises that globalization affects the institutional, economic, social-cultural and ecological determinants of population health, and that the globalization process mainly operates at the contextual level, while influencing health through its more distal and proximal determinants. The developed framework provides valuable insights in how to organise the complexity involved in studying the health effects resulting from globalization. It could, therefore, give a meaningful contribution to further empirical research by serving as a 'think-model' and provides a basis for the development of future scenarios on health.

Climate Change Effects on Heat- and Cold-Related Mortality in the Netherlands: A Scenario-Based Integrated Environmental Health Impact Assessment.

Although people will most likely adjust to warmer temperatures, it is still difficult to assess what this adaptation will look like. This scenario-based integrated health impacts assessment explores baseline (1981-2010) and future (2050) population attributable fractions (PAF) of mortality due to heat (PAFheat) and cold (PAFcold), by combining observed temperature-mortality relationships with the Dutch KNMI'14 climate scenarios and three adaptation scenarios. The 2050 model results without adaptation reveal a decrease in PAFcold (8.90% at baseline; 6.56%-7.85% in 2050) that outweighs the increase in PAFheat (1.15% at baseline; 1.66%-2.52% in 2050). When the 2050 model runs applying the different adaptation scenarios are considered as well, however, the PAFheat ranges between 0.94% and 2.52% and the PAFcold between 6.56% and 9.85%. Hence, PAFheat and PAFcold can decrease as well as increase in view of climate change (depending on the adaptation scenario). The associated annual mortality burdens in 2050-accounting for both the increasing temperatures and mortality trend-show that heat-related deaths will range between 1879 and 5061 (1511 at baseline) and cold-related deaths between 13,149 and 19,753 (11,727 at baseline). Our results clearly illustrate that model outcomes are not only highly dependent on climate scenarios, but also on adaptation assumptions. Hence, a better understanding of (the impact of various) plausible adaptation scenarios is required to advance future integrated health impact assessments.

Climate Change and Infectious Disease Risk in Western Europe: A Survey of Dutch Expert Opinion on Adaptation Responses and Actors.

There is growing evidence of climate change affecting infectious disease risk in Western Europe. The call for effective adaptation to this challenge becomes increasingly stronger. This paper presents the results of a survey exploring Dutch expert perspectives on adaptation responses to climate change impacts on infectious disease risk in Western Europe. Additionally, the survey explores the expert sample's prioritization of mitigation and adaptation, and expert views on the willingness and capacity of relevant actors to respond to climate change. An integrated view on the causation of infectious disease risk is employed, including multiple (climatic and non-climatic) factors. The results show that the experts consider some adaptation responses as relatively more cost-effective, like fostering interagency and community partnerships, or beneficial to health, such as outbreak investigation and response. Expert opinions converge and diverge for different adaptation responses. Regarding the prioritization of mitigation and adaptation responses expert perspectives converge towards a 50/50 budgetary allocation. The experts consider the national government/health authority as the most capable actor to respond to climate change-induced infectious disease risk. Divergence and consensus among expert opinions can influence adaptation policy processes. Further research is necessary to uncover prevailing expert perspectives and their roots, and compare these.

[Climate change and health in the Netherlands]. / Klimaatverandering en gezondheid in Nederland.

Climate change possibly affects public health in the Netherlands, including changes in (a) temperature-related effects, heat stress and air pollution, (b) allergies, (c) vector borne infectious disease, and (d) food- and waterborne infectious disease. Due to many prevailing uncertainties, opinions differ regarding the exact size of the expected health risks and the speed at which these might occur, as well as regarding to what degree society would need to or could adapt to these potential health effects. Thus, the gaps in our knowledge are substantial. Scientists and experts are clearly concerned about the limited amount of attention being paid to health effects of climate change in the Netherlands. In response, a proposal for a research programme 'Klimaatverandering en Gezondheid' ('Climate change and health') has been developed over the past year.