The carbon footprint of health care delivery in Western Australia's public health system.

Background: Health systems have a dual imperative to take action on climate change. First, they must develop climate resilient health services in response to the direct and indirect impacts of climate change on health. Second, they must reduce their own carbon footprint since health systems are a significant contributor to global greenhouse gas emissions. Methods: An environmentally-extended multi-region input-output analysis was carried out, incorporating National Accounts data for Australia and annual expenditure data from WA Health for financial year 2019-20. Expenditure data were categorised to one of 344 economic sectors and by location of the provider of goods or services purchased. Findings: WA Health contributes 8% of WA's total carbon footprint, driven by expenditure on chemicals (23.8% of total), transport (20.2% of total), and electricity supply (19.7% of total). These 3 sectors represent 63.7% of WA Health's carbon footprint, but only 10.8% of its total expenditure. Interpretation: Reducing emissions related to health service provision in WA will require a holistic approach that leverages carbon footprinting insights and integrates them into organisational decision-making across all health programs. The high carbon-intensity of the transport and chemicals sectors supports previous research calling for a reduction in unnecessary pathology testing and the transition to delivery of non-urgent health care via sustainable models of telehealth. The impact of WA's size and location presents challenges, with a predominantly non-renewable energy supply and reliance on transport and supply chains from other states adding significantly to emissions. Funding: The study received funding from the Australian Research Council, The University of Sydney, and the WA Department of Health. The full list of funding information can be found in Acknowledgements.

Quantifying and categorising national extinction-risk footprints.

Biodiversity, essential to delivering the ecosystem services that support humanity, is under threat. Projections show that loss of biodiversity, specifically increases in species extinction, is likely to continue without significant intervention. Human activity is the principal driver of this loss, generating direct threats such as habitat loss and indirect threats such as climate change. Often, these threats are induced by consumption of products and services in locations far-removed from the affected species, creating a geographical displacement between cause and effect. Here we quantify and categorise extinction-risk footprints for 188 countries. Seventy-six countries are net importers of extinction-risk footprint, 16 countries are net exporters of extinction-risk footprint, and in 96 countries domestic consumption is the largest contributor to the extinction-risk footprint. These profiles provide insight into the underlying sources of consumption which contribute to species extinction risk, a valuable input to the formulation of interventions aimed at transforming humanity's interactions with biodiversity.

Associations of birth size and duration of breast feeding with cardiorespiratory fitness in childhood: findings from the Avon Longitudinal Study of Parents and Children (ALSPAC).

OBJECTIVES: To explore the developmental origins of cardiorespiratory fitness. METHODS: We examined the associations of birth size and duration of breast feeding with cardiorespiratory fitness assessed at the 9 year follow-up examination in 3612 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC). We used physical work capacity at a heart rate of 170 beats per minute (PWC(170)) as our assessment of cardiorespiratory fitness. This was estimated using standard regression methods from parameters measured using an electronically braked cycle ergometer. RESULTS: Birth weight, length and ponderal index were all positively associated with cardiorespiratory fitness in both sexes, with no strong evidence of a difference in effect between girls and boys. Work capacity increased by 1.12 W (95% CI: 0.83, 1.40) on average per 1 standard deviation (SD) greater birth weight. This association was not affected by adjustment for socioeconomic position and maternal smoking during pregnancy; there was some attenuation with adjustment for both maternal and paternal height and body mass index and more marked attenuation with adjustment for the child's height and body mass index. In the fully adjusted model work capacity increased by 0.51 W (95% CI: 0.21, 0.81) per SD birth weight. Whether an individual had been breastfed and duration of breastfeeding were not associated with cardiorespiratory fitness in any models. CONCLUSION: Our results provide some support for a role of intrauterine factors in determining cardiorespiratory fitness in childhood.