Climate change, food, water and population health in China.

Anthropogenic climate change appears to be increasing the frequency, duration and intensity of extreme weather events. Such events have already had substantial impacts on socioeconomic development and population health. Climate change's most profound impacts are likely to be on food, health systems and water. This paper explores how climate change will affect food, human health and water in China. Projections indicate that the overall effects of climate change, land conversion and reduced water availability could reduce Chinese food production substantially - although uncertainty is inevitable in such projections. Climate change will probably have substantial impacts on water resources - e.g. changes in rainfall patterns and increases in the frequencies of droughts and floods in some areas of China. Such impacts would undoubtedly threaten population health and well-being in many communities. In the short-term, population health in China is likely to be adversely affected by increases in air temperatures and pollution. In the medium to long term, however, the indirect impacts of climate change - e.g. changes in the availability of food, shelter and water, decreased mental health and well-being and changes in the distribution and seasonality of infectious diseases - are likely to grow in importance. The potentially catastrophic consequences of climate change can only be avoided if all countries work together towards a substantial reduction in the emission of so-called greenhouse gases and a substantial increase in the global population's resilience to the risks of climate variability and change.

Le changement climatique anthropique est à l'origine d'une augmentation de la fréquence, de la durée et de l'intensité de phénomènes météorologiques extrêmes. Ces phénomènes ont déjà eu des conséquences notables sur le développement socioéconomique et la santé des populations. Les effets les plus marqués du changement climatique se manifesteront certainement au niveau de l'alimentation, des systèmes sanitaires et de l'eau. Cet article examine la manière dont le changement climatique affectera l'alimentation, la santé humaine et l'eau en Chine. Selon les prévisions, les effets globaux du changement climatique, la conversion des terres et la diminution de l'eau disponible pourraient considérablement réduire la production alimentaire chinoise, bien que de telles prévisions comportent inévitablement un certain degré d'incertitude. Le changement climatique aura probablement des conséquences importantes sur les ressources en eau, avec par exemple des modifications des régimes de précipitations ou encore des sécheresses et des inondations plus fréquentes dans certaines régions de Chine. Ces effets mettront indubitablement en péril la santé et le bien-être de nombreuses communautés. À court terme, la santé des populations en Chine devrait se trouver affectée par l'augmentation des températures de l'air et de la pollution. Sur le moyen et le long terme, cependant, ce sont les effets indirects du changement climatique (par ex., changements au niveau de la disponibilité des denrées alimentaires, de l'eau et des lieux de résidence, dégradation de la santé mentale et du bien-être des personnes, changements dans la répartition et la saisonnalité des maladies infectieuses) qui devraient prendre de l'importance. Les conséquences potentiellement catastrophiques du changement climatique ne peuvent être évitées que si tous les pays œuvrent ensemble en vue de réduire sensiblement les émissions de gaz à effet de serre et d'augmenter la résilience de la population mondiale face aux risques de variabilité et de changement climatiques.

Parece que el cambio climático antropogénico está aumentando la frecuencia, duración e intensidad de fenómenos meteorológicos extremos. Tales fenómenos ya han afectado enormemente el desarrollo socioeconómico y la salud pública. Los efectos más profundos del cambio climático tienen posibilidades de afectar a la alimentación, los sistemas sanitarios y el agua. En este artículo se explora cómo influirá el cambio climático en la alimentación, la salud pública y el agua en China. Las previsiones indican que los efectos generales del cambio climático, la conversión del suelo y la menor disponibilidad de agua podrían reducir la producción de alimentación en China de forma sustancial, a pesar de que la incertidumbre es inevitable en dichas previsiones. Es probable que el cambio climático afecte de manera importante a los recursos de agua, por ejemplo, cambios en los patrones de las precipitaciones y aumentos de la frecuencia de las sequías y las inundaciones en algunas zonas de China. Sin duda, tales impactos amenazarán la salud pública y el bienestar de muchas comunidades. A corto plazo, la salud pública china se verá perjudicada por los aumentos de la temperatura del aire y la contaminación. Sin embargo, de medio a largo plazo, es probable que aumente la importancia de los efectos indirectos del cambio climático, como los cambios de la disponibilidad de alimentos, refugio y agua, una reducción del bienestar y la salud mental y cambios en la propagación y estacionalidad de enfermedades infecciosas. Las posibles consecuencias catastróficas del cambio climático pueden evitarse únicamente si todos los países trabajan juntos para reducir en gran medida la emisión de los conocidos gases de efecto invernadero y para aumentar la resistencia de la población mundial ante los riesgos de la variabilidad y el cambio climáticos.

Transformational change in healthcare: an examination of four case studies.

Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences. Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form. Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership. Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare. What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.

Suicide and drought in New South Wales, Australia, 1970-2007.

There is concern in Australia that droughts substantially increase the incidence of suicide in rural populations, particularly among male farmers and their families. We investigated this possibility for the state of New South Wales (NSW), Australia between 1970 and 2007, analyzing data on suicides with a previously established climatic drought index. Using a generalized additive model that controlled for season, region, and long-term suicide trends, we found an increased relative risk of suicide of 15% (95% confidence interval, 8%-22%) for rural males aged 30-49 y when the drought index rose from the first quartile to the third quartile. In contrast, the risk of suicide for rural females aged >30 y declined with increased values of the drought index. We also observed an increased risk of suicide in spring and early summer. In addition there was a smaller association during unusually warm months at any time of year. The spring suicide increase is well documented in nontropical locations, although its cause is unknown. The possible increased risk of suicide during drought in rural Australia warrants public health focus and concern, as does the annual, predictable increase seen each spring and early summer. Suicide is a complex phenomenon with many interacting social, environmental, and biological causal factors. The relationship between drought and suicide is best understood using a holistic framework. Climate change projections suggest increased frequency and severity of droughts in NSW, accompanied and exacerbated by rising temperatures. Elucidating the relationships between drought and mental health will help facilitate adaptation to climate change.

The future healthcare?

BACKGROUND: Healthcare systems in Australia and around the world are failing to address the challenges ofthe modern world. Healthcare leaders are calling for radical, transformational change and entirely new systems of care. However it is unclear what a future, sustainable healthcare system would look like. METHODS: A narrative review to examine emerging trends in health and social care was conducted. RESULTS AND CONCLUSIONS: Six key trends were identified. Collectively, they suggest that future systems are likely to be characterised by increasingly sophisticated technology, but at the same time greater personal and community responsibility for health and well being, innovative use of social capital, and a new approach to ageing and end-of-life care.

Energy and human health.

Energy use is central to human society and provides many health benefits. But each source of energy entails some health risks. This article reviews the health impacts of each major source of energy, focusing on those with major implications for the burden of disease globally. The biggest health impacts accrue to the harvesting and burning of solid fuels, coal and biomass, mainly in the form of occupational health risks and household and general ambient air pollution. Lack of access to clean fuels and electricity in the world's poor households is a particularly serious risk for health. Although energy efficiency brings many benefits, it also entails some health risks, as do renewable energy systems, if not managed carefully. We do not review health impacts of climate change itself, which are due mostly to climate-altering pollutants from energy systems, but do discuss the potential for achieving near-term health cobenefits by reducing certain climate-related emissions.

A Transdisciplinary Approach to Address Climate Change Adaptation for Human Health and Well-Being in Africa.

The health sector response to dealing with the impacts of climate change on human health, whether mitigative or adaptive, is influenced by multiple factors and necessitates creative approaches drawing on resources across multiple sectors. This short communication presents the context in which adaptation to protect human health has been addressed to date and argues for a holistic, transdisciplinary, multisectoral and systems approach going forward. Such a novel health-climate approach requires broad thinking regarding geographies, ecologies and socio-economic policies, and demands that one prioritises services for vulnerable populations at higher risk. Actions to engage more sectors and systems in comprehensive health-climate governance are identified. Much like the World Health Organization's 'Health in All Policies' approach, one should think health governance and climate change together in a transnational framework as a matter not only of health promotion and disease prevention, but of population security. In an African context, there is a need for continued cross-border efforts, through partnerships, blending climate change adaptation and disaster risk reduction, and long-term international financing, to contribute towards meeting sustainable development imperatives.

Early diagnosis of kala-azar in Bangladesh: Findings from a population based mixed methods research informing the post-elimination era.

BACKGROUND: Global annual reports of visceral leishmaniasis or kala-azar ("black fever") reduced from 200,000 cases in 2012 to 23,804 in 2015. India, Bangladesh and Nepal reported 80% of the global cases in 2012, but 39% in 2015. We sought to identify major amenable barriers to early diagnosis of kala-azar in peripheral areas of Mymensingh district, an area of Bangladesh that was highly endemic for kala-azar. METHODS: We conducted sequential exploratory mixed methods research. Qualitative data were first derived from in-depth interviews and focus group discussions among 29 patients diagnosed with kala-azar, their families, and neighbours. Preliminary results from qualitative analysis were used to design a structured questionnaire, which was administered to collect data on the processes leading to the diagnosis of kala-azar from 102 patients. Qualitative and quantitative data were integrated consistent with the chronology for kala-azar patients seeking care. The study was conducted from September 2011 to May 2012 in Fulbaria and Gaffargaon sub-districts of Mymensingh. RESULTS: The median delay from fever onset to confirmatory diagnosis of kala-azar was 60 days, with 38% of the cases diagnosed within 30 days. Public health facilities and Gaffargaon sub-district achieved high proportions of early diagnosis. Individual barriers to early diagnosis were low awareness of symptoms and treatment facilities, poverty, and traditional beliefs. Other factors were the remoteness of health care centres, wet season transport difficulty, mis-diagnosis as typhoid, limited availability of rK-39 testing at the community level, and the inclusion of splenomegaly in the case definition. CONCLUSIONS: Targeted community awareness campaigns appropriate for underprivileged communities will increase care seeking and consequently diagnosis. Improved diagnostic guidelines and a strong referral chain for kala-azar will accelerate diagnosis. These steps will contribute significantly to the National Kala-azar Elimination Program of Bangladesh, especially during the post-elimination era.

Public health benefits of strategies to reduce greenhouse-gas emissions: food and agriculture.

Agricultural food production and agriculturally-related change in land use substantially contribute to greenhouse-gas emissions worldwide. Four-fifths of agricultural emissions arise from the livestock sector. Although livestock products are a source of some essential nutrients, they provide large amounts of saturated fat, which is a known risk factor for cardiovascular disease. We considered potential strategies for the agricultural sector to meet the target recommended by the UK Committee on Climate Change to reduce UK emissions from the concentrations recorded in 1990 by 80% by 2050, which would require a 50% reduction by 2030. With use of the UK as a case study, we identified that a combination of agricultural technological improvements and a 30% reduction in livestock production would be needed to meet this target; in the absence of good emissions data from Brazil, we assumed for illustrative purposes that the required reductions would be the same for our second case study in São Paulo city. We then used these data to model the potential benefits of reduced consumption of livestock products on the burden of ischaemic heart disease: disease burden would decrease by about 15% in the UK (equivalent to 2850 disability-adjusted life-years [DALYs] per million population in 1 year) and 16% in São Paulo city (equivalent to 2180 DALYs per million population in 1 year). Although likely to yield benefits to health, such a strategy will probably encounter cultural, political, and commercial resistance, and face technical challenges. Coordinated intersectoral action is needed across agricultural, nutritional, public health, and climate change communities worldwide to provide affordable, healthy, low-emission diets for all societies.

Primary, secondary and tertiary effects of eco-climatic change: the medical response.

Climatic and ecological change threaten human health globally. Manifestations include lost species, vanishing glaciers and more frequent heavy rain. In the second half of this century, accelerating sea level rise is likely to cause crop loss, and population dislocation. These problems may be magnified by dysfunctional human responses, including conflict. The population health consequences of these events can be classified as primary, secondary and tertiary. Primary signs include the acute and chronic stress of heat waves, and trauma from increased bush fires and flooding. Secondary signs are indirect, such as an altered distribution of arthropod vectors, intermediate hosts and pathogens that will produce changes in the epidemiology of many infectious diseases. More severe future health consequences of climate change are classified here as tertiary effects. If moderate or severe climate change scenarios prove accurate then these manifestations will occur over large areas, and could include famine, war and significant population displacement. Such effects would threaten governance and health. The health professions must respond to these challenges, especially the task of recognising and seeking to minimise tertiary health consequences. The gap between what we know and what we need to know concerning these issues can be narrowed by a new field of medical practice. The framework for this emerging discipline includes climate change, ecology and global health. Combined, these dimensions may be called ecomedicine. Actions to reduce individual emissions, to promote active transport (with its 'co-benefit' of preventing chronic disease), and involvement in group action to protect the environment and to prevent war, informed by understanding of the health of individual patients and populations, will be central to the practice of ecomedicine.

Climate change and family planning: least-developed countries define the agenda.

The links between rapid population growth and concerns regarding climate change have received little attention. Some commentators have argued that slowing population growth is necessary to reduce further rises in carbon emissions. Others have objected that this would give rise to dehumanizing 'population control' programmes in developing countries. Yet the perspective of the developing countries that will be worst affected by climate change has been almost completely ignored by the scientific literature. This deficit is addressed by this paper, which analyses the first 40 National Adaptation Programmes of Action reports submitted by governments of least-developed countries to the Global Environment Facility for funding. Of these documents, 93% identified at least one of three ways in which demographic trends interact with the effects of climate change: (i) faster degradation of the sources of natural resources; (ii) increased demand for scarce resources; and (iii) heightened human vulnerability to extreme weather events. These findings suggest that voluntary access to family planning services should be made more available to poor communities in least-developed countries. We stress the distinction between this approach, which prioritizes the welfare of poor communities affected by climate change, and the argument that population growth should be slowed to limit increases in global carbon emissions. The paper concludes by calling for increased support for rights-based family planning services, including those integrated with HIV/AIDS services, as an important complementary measure to climate change adaptation programmes in developing countries.

Food, livestock production, energy, climate change, and health.

Food provides energy and nutrients, but its acquisition requires energy expenditure. In post-hunter-gatherer societies, extra-somatic energy has greatly expanded and intensified the catching, gathering, and production of food. Modern relations between energy, food, and health are very complex, raising serious, high-level policy challenges. Together with persistent widespread under-nutrition, over-nutrition (and sedentarism) is causing obesity and associated serious health consequences. Worldwide, agricultural activity, especially livestock production, accounts for about a fifth of total greenhouse-gas emissions, thus contributing to climate change and its adverse health consequences, including the threat to food yields in many regions. Particular policy attention should be paid to the health risks posed by the rapid worldwide growth in meat consumption, both by exacerbating climate change and by directly contributing to certain diseases. To prevent increased greenhouse-gas emissions from this production sector, both the average worldwide consumption level of animal products and the intensity of emissions from livestock production must be reduced. An international contraction and convergence strategy offers a feasible route to such a goal. The current global average meat consumption is 100 g per person per day, with about a ten-fold variation between high-consuming and low-consuming populations. 90 g per day is proposed as a working global target, shared more evenly, with not more than 50 g per day coming from red meat from ruminants (ie, cattle, sheep, goats, and other digastric grazers).

Climate Change, Health and Existential Risks to Civilization: A Comprehensive Review (1989⁻2013).

Background: Anthropogenic global warming, interacting with social and other environmental determinants, constitutes a profound health risk. This paper reports a comprehensive literature review for 1989⁻2013 (inclusive), the first 25 years in which this topic appeared in scientific journals. It explores the extent to which articles have identified potentially catastrophic, civilization-endangering health risks associated with climate change. Methods: PubMed and Google Scholar were primarily used to identify articles which were then ranked on a three-point scale. Each score reflected the extent to which papers discussed global systemic risk. Citations were also analyzed. Results: Of 2143 analyzed papers 1546 (72%) were scored as one. Their citations (165,133) were 82% of the total. The proportion of annual papers scored as three was initially high, as were their citations but declined to almost zero by 1996, before rising slightly from 2006. Conclusions: The enormous expansion of the literature appropriately reflects increased understanding of the importance of climate change to global health. However, recognition of the most severe, existential, health risks from climate change was generally low. Most papers instead focused on infectious diseases, direct heat effects and other disciplinary-bounded phenomena and consequences, even though scientific advances have long called for more inter-disciplinary collaboration.

Planetary Epidemiology: Towards First Principles.

PURPOSE OF REVIEW: To combine evolutionary principles of competition and co-operation with limits to growth models, generating six principles for a new sub-discipline, called "planetary epidemiology." Suggestions are made for how to quantify four principles. RECENT FINDINGS: Climate change is one of a suite of threats increasingly being re-discovered by health workers as a major threat to civilization. Although "planetary health" is now in vogue, neither it nor its allied sub-disciplines have, as yet, had significant impact on epidemiology. Few if any theorists have sought to develop principles for Earth system human epidemiology, in its ecological, social, and technological milieu. The principles of planetary epidemiology described here can be used to stimulate applied, quantitative work to explore past, contemporary, and future population health, at scales from local to planetary, in order to promote enduring health. It is also proposed that global well-being will decline this century, without radical reform.