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The emergence of the planetary health approach was highlighted by the report of The Rockefeller Foundation-Lancet Commission on Planetary Health in 2015 and changed how we comprehend human well-being. The report advocates integrating the health of other living beings and Earth's natural systems as intrinsic components of human health. Drawing on over three decades of experience in respiratory epidemiology and environmental health, this article outlines how my perspective on human health underwent a transformative shift upon reading the abovementioned report. The planetary health approach offers a lens through which human health issues and potential solutions can be understood within the context of the Anthropocene. It addresses the pressing existential challenges arising from humanity's transgression of planetary limits. Embracing the planetary health paradigm within the field of health sciences can catalyze transformative changes essential for cultivating a sustainable and equitable future., (© 2024 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Residents in Louisiana, Mississippi, and Alabama have experienced repeated natural and man-made environmental exposures. As frequency and intensity of exposures increase, the need for environmental specialty care rises in environmentally overburdened communities. We evaluated access to environmental health expertise in these states. We determined if providers accepted private health insurance and/or self-pay mapping their location using ArcGIS. Of sixty-four physicians meeting inclusion criteria, only eleven (17%) accepted private health insurance and thirty-four (53%) accepted self-pay. The ratio of physicians with environmental expertise who accept private health insurance and/or self-pay, to the population is < 1:1,000,000. Occupational clinics employ specialty physicians to provide care to industry employees but generally not patients with non-work-related exposure. We discuss the implications of limited access to environmental specialty care. To improve the availability of specialty expertise in this region, we recommend increased funding for training physicians in environmental exposure assessment in underserved communities, especially environmental justice communities.

The "master of environmental medicine" is a new medical subspeciality in Germany. Specialised physicians can qualify for it, if they have spent at least an additional period of 1.5 years at a recognized institution in the field. Furthermore the attendance of a 200 hours comprehensive specialist's training course is required. Preliminary experience with this comprehensive course, as offered by our institution (Academy of Occupational and Environmental Medicine, Berlin, Germany) is lined out. Additionally, details of the curriculum, which was specifically designed for this purpose by our institution, are given. The results of an evaluation-procedure (questionnaire) among those participants, who completed the first parts of the course, are discussed.

The attainment of quality in general practice entails explicit recognition of the public-health content of primary care. General practitioners should accept responsibility for auditing the state of the practice health, monitoring and controlling environmental disease, planning local services, auditing the effectiveness of preventive programmes, and evaluating the population effects of medical intervention. This requires specific training in the skills of population medicine, reallocation of scarce resources, and cooperation with existing public-health doctors. Eventual integration of community medicine and general practice is desirable.

Abstract Microplastics have the capacity to accumulate in soil due to their high resistance to degradation, consequently altering soil properties and influencing plant growth. This study focused on assessing the impact of various types and doses of microplastics on beech seedling growth. In our experiment, we used polypropylene and styrene granules with diameter of 4.0 mm in quantities of 2.5% and 7%. The hypothesis was that microplastics significantly affect seedlings' nutritional status and growth characteristics. The research analysed seedlings' nutrition, root morphological features, above-ground growth, and enzymatic activity in the substrate. Results confirmed the importance of microplastics in shaping the nutritional status of young beech trees. Microplastic type significantly impacted N/P and Ca/Mg stoichiometry, while microplastic quantity influenced Ca/Al and Ca+K+Mg/Al stoichiometry. Notably, only in the case of root diameter were significantly thicker roots noted in the control variant, whereas microplastics played a role in shaping the leaves' characteristics of the species studied. The leaf area was significantly larger in the control variant compared to the variant with polypropylene in the amount of 2.5% and styrene in the amount of 7%. Additionally, the study indicates a significant impact of microplastics on enzyme activity. In the case of CB and SP, the activity was twice as high in the control variant compared to the variants with microplastics. In the case of BG, the activity in the control variant was higher in relation to the variants used in the experiment. Research on the impact of microplastics on the growth of beech seedlings is crucial for enhancing our understanding of the effects of environmental pollution on forest ecosystems. Such studies are integral in shaping forestry management practices and fostering a broader public understanding of the ecological implications of plastic pollution.

Background Outdoor and indoor air temperature affects human health and wellbeing. Climate change projections suggest that global temperatures will continue to increase, and this poses a threat to health. Buildings (for housing and business purposes) that can protect humans from the adverse effects of temperature are essential, especially in the context of climate change. Method In this cross-sectional study, we measured the indoor temperature inside shipping containers comprising a seven-storey block of apartments and businesses in Johannesburg, South Africa for 14 days. We assessed indoor temperature and relative humidity; evaluated measured temperatures in relation to thresholds known to be associated with adverse health risks; and sought to understand heat-health perceptions and symptoms of people living and working in shipping container units. Results Median indoor apparent temperature (AT) (a combination of temperature and relative humidity) was 16°C with values ranging from 6°C (observed at 8:00) to 42°C (observed at 17:00). Insulated units had temperatures between 2°C and 9°C cooler than the uninsulated unit. Heat-health risks from AT exposure were likely in all units, although there was variation in the number of occurrences that AT measurements exceeded the four symptom bands of caution, extreme caution, danger and extreme danger. Indoor AT was found to be 7°C higher on average when compared to outdoor AT. Some participants believed that their units were hot during hot weather and most people opened windows or did nothing during hot weather. Few participants reported experiencing adverse heat-health impacts, except for experiencing headaches (58%) and feeling tired or weak (40%). Conclusion Residents, tenants, or business owners using shipping containers should consider insulation installation and adequate windows/air conditioning for ventilation, especially in hot climates. Further research and awareness regarding heat-health risks of living or working in these spaces is needed.

In recent years, advances in nanotechnology have significantly influenced electronics manufacturing, industrial processes, and medical research. Various industries have seen a surge in the use of nanomaterials. However, several researchers have raised the alarm about the toxicological nature of nanomaterials, which appear to be quite different from their crude forms. This altered nature can be attributed to their unique physicochemical profile. They can adversely affect human health and the environment. Nanomaterials that have been released into the environment tend to accumulate over time and can cause a significant impact on the ecosystem and organisms with adverse health effects. Increased use of nanoparticles has led to increased human exposure in their daily lives, making them more vulnerable to nanoparticle toxicity. Because of their small size, nanomaterials can readily cross biological membranes and enter cells, tissues, and organs. Therefore, the effect of nanomaterials on the human environment is of particular concern. The toxicological effects of nanomaterials and their mechanisms of action are being researched worldwide. Technological advances also support monitoring new nanomaterials marketed for industrial and household purposes. It is a challenging area because of the exceptional physicochemical properties of nanomaterials. This updated review focuses on the diverse toxicological perspective of nanomaterials. We have discussed the use of different types of nanoparticles and their physiochemical properties responsible for toxicity, routes of exposure, bio-distribution, and mechanism of toxicity. The review also includes various in vivo and in vitro methods of assessing the toxicity of nanomaterials. Finally, this review will provide a detailed insight into nano material-induced toxicological response, which can be beneficial in designing safe and effective nanoparticles.

Objectives In recent years numerous initiatives aimed at reducing air pollution have been undertaken in Poland. The general objective was to examine the correlation between air pollution measured by the level of particulate matter ≤10 μm in diameter (PM 10 ) and emergency hospitalizations due to chronic obstructive pulmonary disease (COPD) and asthma in 16 Polish cities (capitals of the regions). Material and Methods The authors aimed to diagnose the situation across 16 cities over a 5‑year period (2014–2019). Data on the number of hospitalizations was retrieved from the national public insurance system, the National Health Fund. A total number of 22 600 emergency hospitalizations was analyzed (12 000 and 10 600 in 2014 and 2019, respectively). The data on air pollution was accessed via the public register of the Chief Inspectorate for Environmental Protection air quality database. The authors of this article have used the data on PM 10 daily exposure in each of the 16 cities in 2014 and 2019. Statistical methods included: non-parametric tests, a 2-stage modelling approach for time-series data, and multivariate meta-analysis of the results. Results The results indicated that there was a statistically significant decrease in PM 10 concentration in 2019 in comparison to 2014 in all cities, mainly in the autumn and winter season. However, the correlation between the improvement in the air quality and a decrease in emergency hospitalizations due to asthma and COPD turned out to not be as strong as expected. The authors observed a strong correlation between PM 10 concentrations and hospitalizations due to asthma and COPD, but only when air quality norms were significantly above acceptable levels. Conclusions Air pollution measured by PM 10 concentration might be used as one of the predictors of the asthma and COPD emergency hospitalization risk, yet other factors like respiratory tract infection, health care organizational aspect, patient self-control, compliance and comorbidities should also be taken into consideration. Int J Occup Med Environ Health. 2024;37(1):110–27

Background: Inadequate water, sanitation and hygiene (WASH) may lead to an increase in water-borne diseases like diarrhoea. The objective of the study was to assess water, sanitation and hygiene in the urban slums of Patpur, Bankura and to determine the implications of WASH on the occurrence of diarrhoea among under-five (U-5) children. Materials and Methods: A cross-sectional observational study was conducted during January–March 2020 by interviewing persons involved in water collection from each of the 182 slum households of Patpur, by two-stage sampling using a pre-designed structured schedule and the core questions on drinking WASH for household surveys: 2018 update by UNICEF and WHO. For testing the association between categorical variables, a Chi-square test was done. Binary logistic regression and the Hosmer Lemeshow test were done to know the predictors of diarrhoea in U-5 children. A P value of < 0.05 was considered statistically significant. Results: The proportion of diarrhoea among U-5 children was 0.34. Limited drinking WASH services were found in 3.30, 45.05 and 24.18% of households, respectively. Mobile objects users for handwashing were 14.05 times more prone to diarrhoea in U-5 children than those who had fixed handwashing facilities at their dwellings, yards or plots. Feeding children without handwashing had 5.70 times increased chances of diarrhoea among U-5 children than those who washed their hands before feeding. Conclusion: Handwashing facilities (fixed, mobile object or no facility) and handwashing with soap and water before feeding the child significantly affected the occurrence of diarrhoea among U-5 children.

Introduction and purpose: The education system of any country is subject to fundamental change according to the wishes of society. The need for change in the health care system, medical education and other related sciences, including environmental health, has become increasingly evident in this country in recent years. In the present study, we investigated the revision of educational content in environmental health and the answers to the fundamental questions related to it. Methods: The current study was cross-sectional and comprehensively evaluated at the national level with the participation of professors in the field of environmental health. The study involved 78 distinguished professors of environmental health, and a checklist was prepared and a survey was conducted to obtain their opinions. Data analysis was conducted using SPSS-22 software. The Friedman test was used to compare different areas. Results: The survey results show that 69.3% of the professors believe that the educational content in the field of environmental health in Iran is fundamentally different from that in developed countries. 89.8% of the distinguished professors believed that the aspects and conditions of environmental health in the country are significantly different from the first year of determining the content and curriculum in the field of environmental health. 96.2% of the distinguished professors of environmental health in the country thought that the expected skills included in the curricula of different levels of the field of environmental health should be revised. At the same time, 85.9% of the professors agreed that the monitoring of environmental pollutants that affect health is one of the most important topics in environmental health. Conclusion: Based on the survey conducted among the professors of the country ‘s health faculties, it is necessary and useful to revise the definition of environmental health and its educational content to meet the needs of society, given the new conditions in the field of environmental health.

This study evaluated the level of knowledge among parents in Jazan, Saudi Arabia, regarding substances that can harm child development. The Prevention of Toxic Chemicals in the Environment for Children Tool (PRoTECT) was used for this assessment. A cross-sectional survey using a multi-stage cluster random sampling approach was undertaken among 424 parents who were enlisted from eight primary healthcare centers (PHCCs). The PRoTECT score’s median value was 72 out of 90, suggesting a generally high level of awareness. The study found that individuals with higher education, particularly those with postgraduate degrees, had greater awareness of protecting their children’s health. Interestingly, unemployed individuals and those residing in mountainous areas also demonstrated higher awareness, possibly due to having more time to focus on their children’s health and well-being. Most participants (68.2%) acknowledged the correlation between exposure to toxic chemicals during pregnancy and early childhood, and the subsequent development of neurodevelopmental disorders. The study found a solid foundation of knowledge, with 85.1% of participants interested in learning more about reducing children’s exposure, but it also stressed the need for specific actions to turn awareness into prevention. These findings would help policymakers develop effective strategies, such as targeted educational campaigns, collaboration with healthcare providers, utilization of media channels, and encouragement of community-led initiatives, to reduce children’s exposure to developmental toxicants in line with national and global environmental health initiatives. Future research should focus on longitudinal consciousness and behavior evaluations and regional environmental contaminants.

Background: Cytopathology is defined as a branch of pathology which involves studying diseases and their diagnosis. The conventional method involves fixing the cells in alcohol, but its poor availability in ill-equipped areas can pose problems. One solution to this problem is air-drying of smears followed by rehydration. In this study, we intend to assess the cytomorphologic changes in air-dried smears rehydrated using various agents and to correlate them with the smears prepared using conventional wet technique. Also, we attempt to find the alternative to alcohol which can be used in less equipped areas. Materials and Methods: Three smears each were prepared from 24 patients (12 healthy and 12 with habits). A total of 72 smears were prepared. One smear from each patient was used as control group (alcohol fixation - total number: 24 smears). The remaining two smears were air-dried and rehydrated and were taken as the test group (test group A - rehydrated with aq. glycerine; total number: 24 smears, test group B - rehydrated with coconut oil; total number: 24 smears) for 5–10 minutes. Then, all 72 slides were stained by standard Papanicolaou stain. The slides were examined for cytomorphologic changes and a score was assigned from 0 to 3. Conclusion: Our study proved aq. glycerine to be a superior rehydrant in comparison to conventional wet fixed smears or coconut oil. Also, in studies where cytoplasmic evaluation is required, coconut oil can be used due to its superior quality. [ABSTRACT FROM AUTHOR]

Background Outdoor and indoor air temperature affects human health and wellbeing. Climate change projections suggest that global temperatures will continue to increase, and this poses a threat to health. Buildings (for housing and business purposes) that can protect humans from the adverse effects of temperature is essential, especially in the context of climate change. Method In this cross-sectional study, we measured indoor temperature inside shipping containers comprising a seven-storey block of apartments and businesses in Johannesburg, South Africa for 14 days. We assessed indoor temperature and relative humidity; evaluated measured temperatures in relation to thresholds known to be associated with adverse health risks; and sought to understand heat-health perceptions and symptoms of people living and working in shipping container units. Results Median indoor apparent temperature (AT) (a combination of temperature and relative humidity) was 16 °C with values ranging from 6 °C (observed at 8:00) to 42 °C (observed at 17:00). Insulated units had temperatures between 2°C and 9°C cooler than the uninsulated unit. Heat-health risks from AT exposure were likely in all units, although there was variation in the number of occurrences that AT measurements exceeded the four symptom bands of caution, extreme caution, danger and extreme danger. Some participants believed that their units were hot during hot weather and most people opened windows or did nothing during hot weather. Few participants reported experiencing adverse heat-health impacts, except for experiencing headaches (58%) and feeling tired or weak (40%). Conclusion Residents, tenants, or business owners using shipping containers should consider insulation installation and adequate windows/air conditioning for ventilation, especially in hot climates. Further research and awareness regarding heat-health risks of living or working in these spaces is needed.

The coronavirus may persist for an extended period, underscoring the importance of maintaining preventive environmental health recommendations and sustainable environmental health management to curb viral infections and prevent the resurgence of COVID-19. This systematic review of existing literature aimed to assess the role of environmental health in COVID-19 prevention. The systematic review involved searching scientific articles across databases including PubMed, Scopus, Embase, Web of Science, and Google Scholar, using keywords such as Environmental Health, SARS-CoV-2, COVID-19, Coronavirus, and Preventive. Articles were included based on their provision of full-text research focusing on the role of environmental health in COVID-19 prevention. Quality assessment and validation using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist were conducted independently by two authors. Ultimately, 20 articles comprising descriptive observational studies, systematic reviews, and analytical articles were selected from the total number of articles identified. Public participation in health protocols, environmental factors control, preventive recommendations, promotion of protective behaviors, immunization, and implementation of management measures emerged as critical strategies for effective risk communication and notification of preventive recommendations in addressing COVID-19. Fostering mutual understanding and sustaining public engagement are vital components in the ongoing battle against COVID-19. Given the significance of preventive measures and adherence to health protocols, ensuring the continuity of essential health services, implementing a combination of strategies to contain viral spread within society, and providing systematic information to stakeholders are underscored as crucial elements.

Purpose: Healthcare practitioners in Saudi Arabia sometimes experience workplace bullying (WPB). However, more research on this issue must be carried out in the country. This study aimed to investigate the prevalence of WPB and how individual factors among nurses contribute to different experiences of WPB in clinical settings. Methods: This cross-sectional quantitative study occurred among registered nurses in Riyadh, Saudi Arabia. A self-administered questionnaire was used, and nurses filled it out via a Google survey that included sociodemographic details such as age, gender, education, and the WBS to gauge the prevalence of workplace bullying in hospital settings. Results: Of 416 nurses, 58.7% were aged between 31 and 40, and 76.9% were women. The prevalence of WPB was found to be 54.8%. WPB was higher among middle-aged nurses, men, charge/managerial nurses, nurses with higher education, those with 3 to 6 years of experience, and those working in specialty units. Conclusions: More than half of the nurses had experienced WPB at some point. Middle-aged nurses, especially men with higher education and more experience in specialty units, were the most common victims of WPB compared to other registered nurses.

Introduction: The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide. Methods: This paper quantified the effect of community assets on major health conditions for the population of England over six years, at a fine spatial scale using a data analytic approach. Community assets, which included indices of the health system, green space, pollution, poverty, urban environment, safety, and sport and leisure facilities, were quantified in relation to major health conditions. The health conditions examined included high blood pressure, obesity, dementia, diabetes, mental health, cardiovascular conditions, musculoskeletal conditions, respiratory conditions, kidney and liver disease, and cancer. Cluster analysis and dendrograms were calculated for the community assets and major health conditions. For each health condition, a statistical model with all community assets was fitted, and model selection was performed. The number of significant community assets for each health condition was recorded. The unique variance, explained by each significant community asset per health condition, was quantified using hierarchical variance partitioning within an analysis of variance model. Results: The resulting data indicate major health conditions are often clustered, as are community assets. The results suggest that diversity and richness of community assets are key to major health condition outcomes. Primary care service waiting times and distance to public parks were significant predictors of all health conditions examined. Primary care waiting times explained the vast majority of the variances across health conditions, with the exception of obesity, which was better explained by absolute poverty. Conclusions: The implications of the combined findings of the health condition clusters and explanatory power of community assets are discussed. The vast majority of determinants of health could be accounted for by healthcare system performance and distance to public green space, with important covariate socioeconomic factors. Emphases on community approaches, significant relationships, and asset strengths and deficits are needed alongside targeted interventions. Whilst the performance of the public health system remains of key importance, community assets and local infrastructure remain paramount to the broader determinants of health.

Improper disposal of solid waste, predominantly illegal dumping, can lead to severe air and water pollution, land degradation, climate change, and health hazards due to the persistence of hazardous materials. As a result, it is threatening public and animal health, environmental sustainability, and economic development. The One Health approach, which acknowledges the interconnectedness of human, animal, and environmental health, offers a comprehensive solution. This systematic review examines the impact of improper municipal solid waste on fostering One Health approaches at the national level of Ethiopia by identifying key challenges and opportunities. Publications were retrieved from peer-reviewed, indexed journal publications, government documents (policies, proclamations, regulations, and guidelines), and credible non-governmental organization publications from selected electronic databases (Google scholar, PubMed, EMBASE, Global Health, Web of Science, etc.), and governmental offices. Despite efforts to advance the One Health approach in Ethiopia through the formation of the National One Health Steering Committee and technical working groups, implementation is hindered by challenges such as poor sectoral integration, insufficient advocacy, financial constraints, and limited research. These challenges contribute to worsening zoonotic and infectious diseases and environmental issues due to inadequate solid waste management. Nonetheless, opportunities exist through One Health integration via holistic programs, interdisciplinary collaboration, community engagement, policy enhancement, institutional capacity building, and public-private partnerships. Therefore, enhancing sectoral integration and increasing advocacy efforts and securing financial support is necessary to back waste management initiatives and related research. Further research is crucial to understand the impact of solid waste management and the potential benefits of the One Health approach in Ethiopia.

Background: Control of leishmaniasis in the Mediterranean Basin relies on the active contributions from researchers in the fields of animal, human and environmental health. The application of knowledge, perceptions and practices (KPP) questionnaires to health students and professionals in Europe could be fundamental to identify and explore gaps in KPP, highlighting the diversity of conceptions related to this disease between students and professionals active in (One) Health. The objective of this study was to characterize and compare the current knowledge, perceptions and practices regarding leishmaniasis among subgroups of students and health professionals in Portugal through the application of an online questionnaire. Methods: A cross-sectional study targeted the population of health students and professionals in Portugal, including students in medicine, veterinary medicine and environmental health, physicians, veterinarians and environmental health technicians. Potential participants were approached by email via universities and professional societies and organizations and provided with the link to access the online questionnaire. Answers to the self-administered sociodemographic and KPP questionnaire were collected between July and December 2022. Individual KPP scores were calculated by summing grades defined for each question. Logistic regression models were used to search for potential associations, and the results were expressed at estimated crude and adjusted odds ratios with 95% confidence intervals. Results: In total, 486 participants were included in this study: 254 students and 232 professionals. Overall, 75% of the participants reported having heard of both human and animal leishmaniasis, and > 80% reported hearing about the disease during their course work (although this was significantly lower among those in the field of environmental health). Around 90% of participants identified the pathogenic agent as a parasite, and an arthropod bite was identified as the main route of transmission by > 95%. Animal leishmaniasis was considered to be diagnosed in Portugal by 87% of participants and human leishmaniasis by only 69%. The main barriers pointed out by professionals to the control of leishmaniasis were: lack of knowledge in the general population, failures in the early diagnosis and treatment of diseased animals, absence/inefficacy of vector control programs and lack of knowledge in human health professionals. Median knowledge and perception scores were higher among professionals in the animal health field and higher in professionals than in students. Median practice scores were not significantly different between groups and subgroups. The multivariate analysis revealed that a longer period of study (for students) and having seen cases of leishmaniasis (for physicians) were associated with above-mentioned median knowledge score. Conclusions: Most health students and professionals are knowledgeable about the cause and transmission route of leishmaniasis. However, recognition of the disease as autochthonous in humans is less common, highlighting the importance of promoting an approach to this infection through a One-Health lens. A national structured plan to control leishmaniasis could overcome some of the barriers pointed out by professionals, namely by implementing systematic phlebotomine surveillance and integrated reporting of animal and human cases of disease. [ABSTRACT FROM AUTHOR]

Key Clinical Message We report a case of febrile illness that was presented with mild symptoms. However, laboratory investigation confirmed a malaria and Rift Valley fever co‐infection. Healthcare providers in settings endemic with several infectious diseases should seek rolling out possibilities of other infections prior to starting treatment for achieving effective case management with less resources and better safety of patients. Abstract Here we report a case of febrile illness that confirmed to be a co‐infection of malaria and Rift Valley fever. The patient was initially diagnosed with malaria and started on treatment immediately. However, due to the lack of response to the treatment further laboratory investigations were pursued.

Newly emerged SARS-CoV-2 virus has been identified in China since 2019 and is still progressing as a tense threat to the human health worldwide. This virus can cause an acute respiratory infection and lead to death under acute circumstances. To describe the environmental factors affecting the prevalence of the disease as well as make an appropriate health strategy, some databases were reviewed. Coronavirus is mainly transmitted by direct contact through respiratory droplets. It can also be transmitted through secondary routes such as air, close contact and contaminated surfaces. The transmission through food has not been conclusively proven, but there are concerns about the food preparation, storage, infected staffs and improper use of personal protective equipment as the source of infection. Some possible sources of transmission are the contaminated water and sewage, especially in the areas where patients have the symptoms of diarrhea and vomiting. In this study, we described the essential strategies in order to prevent the spread of COVID-19 disease. Based on the most important criteria, this study developed a prevention model and health strategy including updated training information, improvement programs, risk assessment, environmental monitoring, operational measures as well as supportive approaches and programs, which can be used step by step to reach a healthy environment, increase the compliance with protocols and, eventually, decrease the incidence of COVID-19.

Dear COP 28 President-Designate Sultan Ahmed Al-Jaber, This year, world leaders gathering in the UAE to take stock of their climate commitments will for the first time engage in official programming focused on health. We, the signatories of this letter, support your leadership in bringing health front and center at COP28. As global health leaders, we are committed to achieving health and well-being for all; this is not possible without a safe and stable climate. The Paris Agreement enshrined the “right to health” as a core obligation for climate action. Yet, communities, health workers, and health systems around the world already face the alarming impacts of a changing climate. Climate change-induced extreme weather events are becoming more frequent and severe; many countries are grappling with the health consequences of extreme heat, unprecedented storms, floods, food and water insecurity, wildfires, and displacement. For COP28 to truly be a “health COP,” it must address the root cause of the climate crisis: the continued extraction and use of fossil fuels, including coal, oil, and gas. We call on the COP28 Presidency and the leaders of all countries to commit to an accelerated, just, and equitable phase-out of fossil fuels as the decisive path to health for all. Ending our dangerous dependency on fossil fuels will improve the health prospects of future generations and will save lives. Keeping the global temperature increase within the 1.5°C target of the Paris Agreement is essential to ensure good health and economic prosperity for all. This will only be possible if we rapidly phase out fossil fuels. Fossil fuel phase-out will limit global warming, thereby protecting health from the devastating impacts of extreme weather, and preventing further ecological degradation and biodiversity loss. Failing to do so will lead to overwhelming health consequences, as well as the loss of key natural resources and ecosystem services that are critical to both human and non-human species health, 1 there by undermining One Health and planetary health. In addition to climate-related health impacts, air pollution caused in part by burning fossil fuels causes 7 million premature deaths annually. 2 The economic costs 3 of air pollution-related health impacts amounted to over US$8.1 trillion, or 6.1% of global GDP, in 2019. By improving air quality, governments can reduce the burden of disease from multiple cancers, heart disease, neurological conditions including stroke, and chronic and acute respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD). Investments in clean energy sources will save hundreds of billions of dollars in health care costs associated with air pollution every year, while reducing economic losses from extreme weather events with damages worth US$253 billion (in 2021). 4 A full and rapid phase-out of fossil fuels is the most significant way to provide the clean air, water, and environment that are foundational to good health. We cannot rely on unreliable and inadequate solutions, like Carbon Capture and Storage (CCS), which extend the use of fossil fuels but do not generate the real and immediate health improvements which a renewable energy transition provides. False solutions like CCS risk making harmful emissions worse, straining the health of overburdened communities, and delaying our progress toward meaningful climate progress. The energy transition must be just and equitable for all. In transitioning to a clean energy future, there is an opportunity to undo the injustices of the fossil fuel-dependent system, taking a systemic approach and emphasizing health, care and community well-being, leaving no one behind. Global leaders must ensure everyone, including fragile states and the most remote and excluded communities, has access to non-polluting, affordable, reliable, accessible, and resilient clean energy, as well as to emerging technologies that make the best use of this energy. A just transition offers the opportunity to reduce health inequities faced by minority and marginalized communities, especially with respect to the health effects of ongoing fossil fuel use and dependence. Unlocking finance is essential to deliver a healthy and just transition. Achieving climate and health goals will only be feasible if we stop investing in fossil fuels and invest instead in proven climate and health solutions. Each year, countries spend hundreds of billions of dollars subsidizing the fossil fuel industry, money that could be spent investing in a healthy future. High-income countries, development finance institutions, and the private sector must dramatically increase and fulfill their commitments to drive investments in clean energy, clean air, and economic development for the communities most harmed by climate change and fossil fuel pollution. Fossil fuel interests have no place at climate negotiations. The fossil fuel industry cannot be allowed to continue its decades-long campaign of obstructing climate action at the UNFCCC negotiations and beyond. Just as the tobacco industry is not allowed to participate in the WHO Framework Convention on Tobacco Control, it is imperative to safeguard global collaboration on climate progress from the lobbying, disinformation, and delays in favor of industry interests. Without ambitious climate action, the burden on health care systems and health care workers will be insurmountable. Health gains made in recent decades will be in vain and we will see the harmful impacts of climate change ruin our chances for a safe, equitable and just future. In this extraordinary year, with health for the first time on the COP agenda, we urge you to deliver real climate progress: commit to an accelerated, just, and equitable phase-out of fossil fuels and invest in a renewable energy transition as the decisive path to health for all. Sincerely, Global Health Organization Leadership (Alphabetical by organization) • Githinji Gitahi, CEO, Amref Health Africa • Pam Cipriano, President, International Council of Nurses • Salman Khan, Liaison Officer for Public Health Issues, International Federation of Medical Students' Associations • Naveen Thacker, President, International Pediatric Association • Dr Christos Christou, International President, Médecins Sans Frontières • María del Carmen Calle Dávila, Executive Secretary, Organismo Andino du Salud (Andean Health Organization) • Luis Eugenio de Souza, President, World Federation for Public Health Associations • Lujain Alqodmani, President, World Medical Association Regional Leaders in Health (Alphabetical by surname) • Mary T. Bassett, Director, FXB Center for Health and Human Rights, Harvard University • Fiona Godlee, Former Editor-in-chief of the British Medical Journal • (Dr.) Arvind Kumar, Chairman, Institute of Chest Surgery, Chest Onco Surgery and Lung Transplantation, Medanta Hospital, India • Dame Parveen Kumar, Emeritus Professor of Medicine and Education, Barts and The London School of Medicine and Dentistry • Lwando Maki, Secretary, Public Health Association of South Africa • Jemilah Mahmood, Executive Director, Sunway Center for Planetary Health - Malaysia • Kari C. Nadeau, MD, PhD, Chair of the Department of Environmental Health at Harvard School of Public Health • (Dr.) K Srinath Reddy, Past President of Public Health Foundation of India This letter is supported and endorsed by: National Health Organization Leadership (Alphabetical by organization) • Rosana Teresa Onocko Campos, President, Associação Brasileira de Saúde Coletiva (Brazil) • Katie Huffling, DNP, Executive Director, Alliance of Nurses for Healthy Environments (US) • Dr Latifa Patel, Representative Body Chair, British Medical Association • Kamran Abassi, Editor-in-Chief, British Medical Journal (UK) • Frances Peart, President & Board Chair, Climate and Health Alliance (Australia) • Kate Wylie, Executive Director, Doctors for the Environment Australia • Agonafer Tekalenge, President, Ethiopian Public Health Association • Diederik Aarendonk, Forum Coordinator Global Health Organization Leadership, European Forum for Primary Care • Kevin Fenton, President, Faculty of Public Health (UK) • Ansgar Gerhardus, Board Chair, German Public Health Association • Vital Ribeiro, Chair, Associação Civil Projeto Hospitais Saudáveis (Healthy Hospitals Project) • Sheila Sobrany, President, Royal College of Nursing • The Board of the Public Health Association of South Africa • Diana Zeballos, Executive Secretary, Sustainable Health Equity Movement (SHEM) • Adeline Kimambo, Executive Secretary, Tanzania Public Health Association • Richard Smith, Chair, UK Health Alliance on Climate Change

Objective: Climate change is a key threat to human health worldwide. Accordingly, medical education should prepare future physicians for climate-associated hazards and corresponding professional challenges. Currently, this is not yet implemented across the board. The aim of this review is to present (I) the knowledge and (II) the attitudes of medical students and physicians towards climate change and (III) the expectations of medical education as formulated by medical students. In addition, the available literature will be used to look at (IV) global teaching activities, (V) international learning goals and learning goal catalogues, and (VI) applied teaching methods and formats. This review should simplify and, considering the urgency of the topic, accelerate the design of future teaching activities.Methodology: The paper is based on a selective literature search supplemented by a topic-guided internet search.Results: Knowledge about the causes and concrete health consequences of climate change seems to be incomplete. The majority of medical students consider human health to be at risk from climate change and the health sector to be inadequately prepared. A majority of surveyed medical students would like to see teaching about climate change. It is evident that internationally, teaching projects on climate change and climate health, as well as topic-specific learning objectives and learning goal catalogues, have been developed and integrated into medical education.Conclusion: There is a need for and acceptance of teaching climate change in the medical curriculum. This literature review can assist in the development and implementation of new teaching formats.

Global environmental change is fundamentally altering the composition and functioning of our planetary ecosystem. Effectively presenting the largest threat to the health of present and future generations, these changes and their health impacts are forcing us to think and practice healthcare in much broader terms than ever before. In this article, we provide an early outline for a radically otherwise, yet strangely familiar, environmental physiotherapy developed through a succession of carefully developed arguments. We show how an underpinning belief in human exceptionalism has engendered an exploitative relationship with our natural planetary environment that has both shaped Western science and healthcare and led to our current environmental health crisis. Building on the dependence of human health on our planetary ecosystem, approaches like planetary health hold great promise for a corresponding, paradigmatic turn in healthcare. They fall short of this however, where they perpetuate anthropocentric interests and interventionist practices that have underpinned healthcare to date. Drawing on ethical and post-human philosophies we argue against human exceptionalism and for a solidarity that includes other-than-humans as the primary characteristic of planetary existence. Building on this foundation, we provide an early outline for a radically otherwise, yet strangely familiar, environmental physiotherapy, grounded in ecological awareness, multispecies justice, and a range of consonant practices of passivity and accompaniment, conceived as an alternative to the commonplace interventionism of healthcare. [ABSTRACT FROM AUTHOR]

The potential influence of environmental factors, particularly air pollutants such as ozone (O3), on the dynamics and progression of COVID-19 remains a significant concern. This study aimed to systematically review and analyze the current body of literature to assess the impact of short-term ozone exposure on COVID-19 transmission dynamics and disease evolution. A rigorous systematic review was conducted in March 2023, covering studies from January 2020 to January 2023 found in PubMed, Web of Science, and Scopus. We followed the PRISMA guidelines and PROSPERO criteria, focusing exclusively on the effects of short-term ozone exposure on COVID-19. The literature search was restricted to English-language journal articles, with the inclusion and exclusion criteria strictly adhered to. Out of 4674 identified studies, 18 fulfilled the inclusion criteria, conducted across eight countries. The findings showed a varied association between short-term ozone exposure and COVID-19 incidence, severity, and mortality. Some studies reported a higher association between ozone exposure and incidence in institutional settings (OR: 1.06, 95% CI: 1.00–1.13) compared to the general population (OR: 1.00, 95% CI: 0.98–1.03). The present research identified a positive association between ozone exposure and both total and active COVID-19 cases as well as related deaths (coefficient for cases: 0.214; for recoveries: 0.216; for active cases: 0.467; for deaths: 0.215). Other studies also found positive associations between ozone levels and COVID-19 cases and deaths, while fewer reports identified a negative association between ozone exposure and COVID-19 incidence (coefficient: −0.187) and mortality (coefficient: −0.215). Conversely, some studies found no significant association between ozone exposure and COVID-19, suggesting a complex and potentially region-specific relationship. The relationship between short-term ozone exposure and COVID-19 dynamics is complex and multifaceted, indicating both positive and negative associations. These variations are possibly due to demographic and regional factors. Further research is necessary to bridge current knowledge gaps, especially considering the potential influence of short-term O3 exposure on COVID-19 outcomes and the broader implications on public health policy and preventive strategies during pandemics.

Legionella pneumophila is the cause of Legionnaires’ disease, a life-threatening pneumonia that occurs after inhalation of aerosolized water containing the bacteria. Legionella growth occurs in stagnant, warm-to-hot water (77°F–113°F) that is inadequately disinfected. Piped hot spring water in Hot Springs National Park, Arkansas, USA, has naturally high temperatures (>135°F) that prevent Legionella growth, and Legionnaires’ disease has not previously been associated with the park or other hot springs in the United States. During 2018–2019, Legionnaires’ disease occurred in 5 persons after they visited the park; 3 of these persons were potentially exposed in spa facilities that used untreated hot spring water. Environmental testing revealed Legionella bacteria in piped spring water, including 134°F stagnant pipe water. These findings underscore the importance of water management programs to reduce Legionella growth in plumbing through control activities such as maintaining hot water temperatures, reducing stored water age, and ensuring adequate water flow.

This letter draws attention to the worrying situation of heavy metal pollution in Brazil, especially concerning the Amazon's Indigenous peoples affected by mercury contamination from illegal gold mining activities. Heavy metal pollution is also an emerging problem in other Brazilian biomes besides the Amazon Forest (e.g., Pampa biome in southern Brazil), as well as in coastal ecosystems/regions and large cities. Despite being a neglected problem, Brazil's heavy metal pollution causes significant detrimental impacts on human health and ecosystems. Finally, some alternatives to overcome this problem are suggested.

The international journal Science in One Health (SOH), launched a year ago, is a platform to disseminate research achievements and practical lessons in the field of One Health globally and to achieve the United Nations Sustainable Development Goals by systematic thinking with multi-disciplinary approach to solve complex health problems. This paper reviews the efforts that SOH editorial board made in the first year to promote a multi-disciplinary teamwork, create a platform for exchanges of ideas, and initiate a community for One Health. SOH has received manuscripts from six continents and published 24 articles (5 in press) in the first year. SOH is devoted to providing more and more high-quality articles in One Health disciplines including One Health database, antimicrobial resistance, zoonotic diseases, food security, One Health governance and climate changes with their impacts. This editorial illustrated the power of Science in One Health.

The deterioration of planetary health—from threats such as climate change, environmental pollution, biodiversity loss, and ocean acidification—are a growing hazard to the foundation of health and the "healthspan." For those with chronic conditions—a large and growing subset of the global population—the health dangers are even greater. Climate change is a threat to the very pillars of lifestyle medicine that we rely on to prevent and manage chronic disease. Already, the planetary crisis is limiting our ability to prescribe healthy nutrition, safe outdoor physical activity, stress management strategies, social connection, restorative sleep, and toxic substance avoidance. In this article, we discuss the proceedings of our workshop at the American College of Lifestyle Medicine (ACLM) annual conference LM2021, "Lifestyle Medicine for Personal and Planetary Health." We examine how lifestyle medicine (LM) interventions are a prescription for individual, community, and planetary health. Our prescriptions work to not only restore the health of individuals and families, but also to bolster health equity while allowing us to mitigate and adapt to the health impacts of the planetary crises. [ABSTRACT FROM AUTHOR]

This paper highlights the important leadership role of the public health sector, working with other governmental sectors and nongovernmental entities, to advance environmental public health in Latin America and the Caribbean toward the achievement of 2030 Sustainable Development Goal 3: Health and Well-Being. The most pressing current and future environmental public health threats are discussed, followed by a brief review of major historical and current international and regional efforts to address these concerns. The paper concludes with a discussion of three major components of a regional environmental public health agenda that responsible parties can undertake to make significant progress toward ensuring the health and well-being of all people throughout Latin America and the Caribbean.

Abstract Knowledge of the health impacts of environmental exposures (such as pollution disasters, poor air quality, water contamination, climate change) on children’s health has dramatically increased in the past 40 years. The World Health Organization (WHO) estimated that 23% of all deaths worldwide were attributable to the environment, and 26% of deaths in children less than 5 years old could be prevented with removal of environmental risks factors. Yet, little has permeated medical education, leaving pediatric providers ill equipped to address these issues. To address this gap, members from the Pediatric Environmental Health Specialty Units, a United States nationwide network of academically affiliated experts who have created numerous environmental health educational materials and programs, have identified fifteen core environmental health (EH) competencies needed by health care providers to enable them to effectively address environmental health concerns. These competencies can serve as the foundation for the development and implementation of relevant educational programs. The core EH competencies are based upon these foundational elements: 1) Definition of “children’s environmental health” that describes how environmental exposures (positive and negative) in early life influence the health and development in childhood and across the entire human life span 2) Children are not “little adults” and so have unique vulnerabilities to environmental hazards; 3) Environmental health inequities exist, causing some children to have a disproportionate amount of unhealthy exposures and consequently a greater risk of adverse effects; 4) Climate change will translate to numerous adverse health effects that will particularly affect children worldwide. In this article, the authors describe the core environmental health competencies and provide resources, online tools, strategies, and examples targeted to all levels of training and practice to better enable leaders and educators to bring this important content to the forefront.

In recent decades, the ecological environment has been increasingly challenged by the development of global industrialization and urbanization all over the world, even as global attention for health has raised dramatically. Common global environmental issues, such as air pollution and noise pollution, are associated with lasting impacts on health and contribute significantly to the overall burden of disease. Moreover, a global disparity exists between the burden of such environmental health issues and the global resources available to address this issue. To alleviate the environmental health impacts and ensure a sustainable future for human beings, China has made an important contribution to improving access to ecological protection, environmental governance, patriotic health campaigns, smart city construction, and so on. Experiences gained in China may be useful for some other countries, particularly the low- and middle-income countries with limited sources.

Two of the greatest challenges of our times - climate change and the linked epidemics of obesity, diabetes, and cardiovascular disease - are fueled in part by the over-consumption of carbon-intensive high calorie foodstuffs. Converging evidence from hundreds of studies has confirmed that transitioning from diets high in meat and dairy to largely plant-based diets not only is necessary for climate change mitigation but will also lead to substantive reductions in morbidity and mortality. Nevertheless, there are only the faintest beginnings of a robust science of behavioral eco-wellness, defined here as the study of how individual choices, behaviors, and habits impact both personal health and environmental sustainability. This paper focusses on the sub-field of dietary eco-wellness, which looks at health and sustainability impacts of food production, procurement, preparation, and consumption. To advance this crucial agenda, investigators will need to invent, develop, and assess approaches aimed at helping people transition towards healthier and more sustainable diets. In order to accurately and reliably assess appropriate outcomes, existing assessment methods will need to be refined, new techniques will need to be advanced, and all measurement methods will need to be validated. Local conditions will influence the effectiveness of various approaches, and so it is important that scientists and communities share their stories of success and challenge for others to learn from. This paper reviews emerging evidence from relevant studies in dozens of countries, suggesting next steps, potential pathways, and a framework for interpretation.

Background: Lead paint remains a major potential source of lead poisoning globally, but there has been no documentation on lead content in solvent paints available on the markets in Zimbabwe and Botswana. Aim: To determine the lead content of solvent-based paints available on the market in Zimbabwe and Botswana and identify a need for a larger study to inform policy. Methods: This pilot study was conducted in Harare, Zimbabwe, and Gaborone, Botswana. Popular brands of solvent-based household paints were bought from hardware shops in Harare (10 samples) and Gaborone (19 samples). Samples were analysed for lead content using inductively coupled plasma-atomic emission spectrometry. Results: Seventy percent of samples from Zimbabwe were found to contain lead above 90 parts per million (ppm), the recommended regulatory limit, with ranges from less than 60 ppm to 12 000 ppm. Twenty percent of Zimbabwean samples had lead levels above 10 000 ppm. No samples from Botswana had lead concentration above the detection limit, with all levels below 100 ppm. Lesson Learnt: Data strongly suggest very high lead content in popular brands of solvent paints in Zimbabwe, indicating a need for a larger, well-designed study for policy direction.

Abstract Background Group A Streptococcus (Strep A) is an important cause of mortality and morbidity globally. This bacterium is responsible for a range of different infections and post-infectious sequelae. Summarising the current knowledge of Strep A transmission to humans will address gaps in the evidence and inform prevention and control strategies. The objective of this study is to evaluate the modes of transmission and attack rates of group A streptococcal infection in human populations. Methods This systematic review protocol was prepared according to the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols (PRISMA-P) 2015 Statement. Using a comprehensive search strategy to identify any transmission studies that have been published in English since 1980, full-text articles will be identified and considered for inclusion against predefined criteria. We will include all studies reporting on Strep A transmission, who have identified a mode of transmission, and who reported attack rates. Risk of bias will be appraised using an appropriate tool. Our results will be described narratively and where feasible and appropriate, a meta-analysis utilizing the random-effects model will be used to aggregate the incidence proportions (attack rates) for each mode of transmission. In addition, we will also evaluate the emm genotype variants of the M protein causing Strep A infection and the association with transmission routes and attack rates, if any, by setting, socioeconomic background and geographical regions. Discussion We anticipate that this review will contribute to elucidating Strep A modes of transmission which in turn, will serve to inform evidence-based strategies including environmental health activities to reduce the transmission of Strep A in populations at risk of severe disease. Trial registration Systematic review registration: PROSPERO ( CRD42019138472 ).