Valuation and perception of the costs of climate change on health.

BACKGROUND AND AIMS: Climate change affects our societies and lives through our economies, our livelihoods, and our health. Economic losses of climate change are estimated at $23 trillion, largely through externalities due to premature mortality, healthcare expenditure, and health-related work losses. Even if there are established methods to quantify the health economic burden, there is limited information on how people perceive this information. The current study aimed to examine different health cost evaluation methods and observe perceptions of stakeholders in the climate change context. METHOD: The participatory research approach of the World Café with 41 participants was applied to explore four topics associated with valuing the costs of climate change. The data were analyzed following an inductive approach. RESULTS: Despite the willingness-to-pay approach being widely applied, many experts see actual healthcare costs as a more explicit indicator of costs; however, this approach might underestimate actual costs. Participants experienced difficulties accepting and understanding cost estimates that indicated very high externalities as a percentage of gross domestic product. The cost-effectiveness of mitigation and adaptation measures was also challenged by a concern that while the costs of such measures are incurred now, the benefits do not come to fruition until later, for example, when building bike lanes or dams. CONCLUSIONS: Policies should favor environmentally friendly activities such as making cycling more convenient in cities with the health benefits presented in monetary terms, while limiting car driving. Moreover, the public might better understand the costs of climate change via tools that map how solutions influence different sectors and outlining the costs in evaluating the benefits for health and the environment.

The Superblock model: A review of an innovative urban model for sustainability, liveability, health and well-being.

INTRODUCTION: Current urban and transport planning practices have significant negative health, environmental, social and economic impacts in most cities. New urban development models and policies are needed to reduce these negative impacts. The Superblock model is one such innovative urban model that can significantly reduce these negative impacts through reshaping public spaces into more diverse uses such as increase in green space, infrastructure supporting social contacts and physical activity, and through prioritization of active mobility and public transport, thereby reducing air pollution, noise and urban heat island effects. This paper reviews key aspects of the Superblock model, its implementation and initial evaluations in Barcelona and the potential international uptake of the model in Europe and globally, focusing on environmental, climate, lifestyle, liveability and health aspects. METHODS: We used a narrative meta-review approach and PubMed and Google scholar databases were searched using specific terms. RESULTS: The implementation of the Super block model in Barcelona is slow, but with initial improvement in, for example, environmental, lifestyle, liveability and health indicators, although not so consistently. When applied on a large scale, the implementation of the Superblock model is not only likely to result in better environmental conditions, health and wellbeing, but can also contribute to the fight against the climate crisis. There is a need for further expansion of the program and further evaluation of its impacts and answers to related concerns, such as environmental equity and gentrification, traffic and related environmental exposure displacement. The implementation of the Superblock model gained a growing international reputation and variations of it are being planned or implemented in cities worldwide. Initial modelling exercises showed that it could be implemented in large parts of many cities. CONCLUSION: The Superblock model is an innovative urban model that addresses environmental, climate, liveability and health concerns in cities. Adapted versions of the Barcelona Superblock model are being implemented in cities around Europe and further implementation, monitoring and evaluation are encouraged. The Superblock model can be considered an important public health intervention that will reduce mortality and morbidity and generate cost savings for health and other sectors.

Assessment of health impacts and costs attributable to air pollution in urban areas using two different approaches. A case study in the Western Balkans.

In this study, two different air quality impact assessment methodologies were adopted and combined with a sensitivity analysis to estimate the unit costs. Air pollution health impact (mortality) assessment was carried out using one methodology based on log-linear concentration response functions (CRF) and another relying on the integrated exposure response curve (IER) from the Global Burden of Disease. Morbidity impacts were estimated with the CRF approach only. To assess the inequalities between low and high income countries, an area of low-medium income countries with a critical air pollution situation, was selected. The health impact and related external costs attributable to air pollution in 2019 were assessed in 30 urban areas of the Western Balkans region, one of Europe's air pollution hot spots. The evaluation was based on PM2.5, O3 and NO2 concentrations in background sites from official monitoring networks. In 2019, the cost of mortality attributable to PM2.5 in 26 urban areas was 7.8 and 9.0 billion Euro according to IER and CRF methodologies, respectively. The cost of O3 associated with all-cause mortality estimated with the CRF methodology in 17 urban areas was 1.0 billion Euro while the one attributable to NO2 pollution in 28 urban areas was 1.5 billion Euro. The study results suggest that the economic burden of air pollution in the Western Balkans is higher in terms of GDP than the one observed in EU27 in the same time window. The study concludes that CRF and IER methodologies are coherent, because the discrepancy in the results are explained by the differences in the assessed health outcomes. The two approaches are complementary because the combination of them makes it possible to obtain a wider range of outcomes. In addition, despite the different causes of death considered, the comparison between them is useful for cross-validation.

Environment-lockdown, air pollution and related diseases: could we learn something and make it last?

Although the pandemic has caused substantial losses in economic prosperity and human lives, it has also some positive impacts on the environment. Restricted mobility, complete closure, less traffic and industry have led to improved air quality especially in urban settings. Not only is air pollution an important determinant of chronic diseases, such as heart and lung disorders, but it has also been shown that poor air quality increases the risk of COVID-19. In this article, we review some of the findings on changes in air quality during the pandemic, and its potential effects on health. We need to continue to monitor the effects of change in air quality, due to COVID-19 lockdown or other factors, but also keep all our efforts to improve air quality even faster and more persistent, bringing the pollution levels below what WHO recommends are safe to live with.

Attitudes of school environment towards integration of HIV-positive pupils into regular classes and knowledge about HIV/AIDS: cross-sectional study.

AIM: To estimate the attitudes of teachers, parents, and pupils in primary schools towards the integration of HIV-positive pupils into regular schools, and their knowledge about HIV/AIDS. METHODS: Teachers (n=64), seventh and eight grade pupils (n=108), and their parents (n=124) from a big city and a small town in Croatia were examined by two specially designed instruments which measured their attitudes towards the integration of pupils with HIV/AIDS and knowledge about HIV/AIDS. RESULTS: All three populations showed positive attitudes towards the integration of children with HIV/AIDS into regular schools. A group of parents had lower attitude score (mean-/+standard deviation, 3.1-/+0.6) compared with teachers or pupils (3.5-/+0.4 and 3.4-/+0.4 respectively, P<0.001, ANOVA, and post hoc Tukey test). Knowledge about HIV/AIDS was high in all three groups. Pupils scored lower (8.2-/+4.1 out of maximum 15) than their teachers or parents (11.2-/+3.8 and 10.3-/+3.5 respectively, P<0.001). In all three subsamples, groups with higher level of education had more positive attitudes towards the integration of children with HIV/AIDS into regular schools as well as higher knowledge scores. No significant correlation was found between participants' attitudes and knowledge. CONCLUSION: School environment - teachers, pupils, parents - had generally positive attitudes towards the integration of HIV positive pupils and high level of knowledge about HIV/AIDS. Generally, parents showed less favorable attitudes than teachers and pupils and this may be a possible obstacle to the integration of HIV positive students into regular schools. There is obviously a need for a coordinated public intervention aimed at informing the public about HIV/AIDS.