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The article examines the crucial role of nurses in addressing the health impacts of climate change and advocating for systemic change. Topics include contrasting future scenarios of climate inaction versus proactive measures, emphasizing the need for nurses to engage in advocacy to support community resilience and the importance of integrating planetary health into nursing education.

Purpose: Agriculture and food production contribute to climate change. There is mounting pressure to transition to diets with less environmental impact while maintaining nutritional adequacy. MyPlanetDiet aimed to reduce diet-related greenhouse gas emissions (GHGE) in a safe, nutritionally adequate, and acceptable manner. This paper describes the trial protocol, development, and testing of personalised nutrition feedback in the MyPlanetDiet randomised controlled trial (RCT). Methods: MyPlanetDiet was a 12-week RCT that provided standardised personalised nutrition feedback to participants based on new sustainable healthy eating guidelines (intervention) or existing healthy eating guidelines (control) using decision trees and corresponding feedback messages. To test the personalised nutrition feedback, we modelled a sample of 20 of the MyPlanetDiet participants baseline diets. Diets were modelled to adhere to control and intervention decision trees and feedback messages. Modelled nutrient intakes and environmental metrics were compared using repeated measure one-way analysis of covariance. Results: Intervention diets had significantly lower (p < 0.001) diet-related GHGE per 2500 kilocalories (kcal) (4.7 kg CO2-eq) relative to control (6.6 kg CO2-eq) and baseline (7.1 kg CO2-eq). Modelled control and intervention diets had higher mean daily intakes of macronutrients (carbohydrates, fibre, and protein) and micronutrients (calcium, iron, zinc, and iodine). Modelled control and intervention diets had lower percent energy from fat and saturated fat relative to baseline. Conclusions: Adherence to the MyPlanetDiet personalised nutrition feedback would be expected to lead to better nutrient intakes and reduced diet-related GHGE. The MyPlanetDiet RCT will test the effectiveness and safety of personalised feedback for a more sustainable diet. Trial registration number and date of registration: Clinical trials registration number: NCT05253547, 23 February 2022 [ABSTRACT FROM AUTHOR]

Policy PointsThe US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate‐ready US health care system.Health care workers have numerous profession‐specific and role‐specific opportunities to address the causes and impacts of climate change.Policies must address institutional barriers to change and create incentives aligned with climate readiness goals.Institutions and individuals can support climate readiness by integrating content on the health care implications of climate change into educational curricula. [ABSTRACT FROM AUTHOR]

The US healthcare system's contribution to greenhouse gas emissions and climate change is disproportionately high and harms the public. Several medical specialties are now reassessing how they can mitigate healthcare's harmful environmental impact. Healthcare sustainability is broadly defined as measures to decrease greenhouse gas emissions, waste, and other pollutants generated during the healthcare delivery process. Prior efforts and programs by infectious diseases (ID) professionals, such as antimicrobial stewardship and infection prevention and control can form a framework for ID professionals to help apply this expertise to healthcare environmental sustainability more broadly. This call to action proposes strategies for ID societies and professionals to incorporate climate change education for trainees, increase research and funding opportunities in healthcare sustainability, and calls for action by ID societies to champion system changes to decrease greenhouse gas emissions. [ABSTRACT FROM AUTHOR]

Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world's infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet ever-increasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come. [ABSTRACT FROM AUTHOR]

Objectives Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined. Methods We accessed routine productivity data from seed (SC, N = 749) and burned (BCC, N = 535) sugarcane cutters observed over five harvest seasons with increasing RSH intervention at a large Nicaraguan sugarcane mill. Hourly field-site wet-bulb globe temperature (WBGT) was recorded by mill staff and summarized as a daily mean. Mixed linear regression was used to model daily productivity, adjusting for age (18–29, 30–44, and >45 years), sex, WBGT (<28, 28–29, 29–30, 30–31, and >31 °C) on the same and preceding day, harvest season (2017–18 to 2021–22), month, and acclimatization status (<1, 1–2, and >2 weeks). Results There was an inverse dose–response relationship between SC productivity and WBGT on the same and preceding days, decreasing by approximately 3%/°C WBGT. Productivity increased during the study period, i.e. coinciding with RSH scale-up, by approximately 19% in SC and 9% in BCC. Conclusion Agricultural worker productivity was expected lower on hotter days, strengthening the interest in all stakeholders to mitigate increasing global temperatures and their impact. Despite decreasing the total time allocated for work each day, an RSH intervention appears to result in increased productivity and no apparent loss in productivity. [ABSTRACT FROM AUTHOR]

Background: Anesthesiology has a relevant carbon footprint, mainly due to volatile anesthetics (scope 1 emissions). Additionally, energy used in the operating theater (scope 2 emissions) contributes to anesthesia-related greenhouse gas (GHG) emissions. Objectives: Optimizing the electricity use of medical devices might reduce both GHG emissions and costs might hold potential to reduce anaesthesia-related GHG-emissions and costs. We analyzed the electricity consumption of six different anesthesia workstations, calculated their GHG emissions and electricity costs and investigated the potential to reduce emissions and cost by using the devices in a more efficient way. Methods: Power consumption (active power in watt , W) was measured with the devices off, in standby mode, or fully on with the measuring instrument SecuLife ST. Devices studied were: Dräger Primus, Löwenstein Medical LeonPlus, Getinge Flow C, Getinge Flow E, GE Carestation 750 and GE Aisys. Calculations of GHG emissions were made with different emission factors, ranging from very low (0.09 kg CO2-equivalent/kWh) to very high (0.660 kg CO2-equivalent/kWh). Calculations of electricity cost were made assuming a price of 0.25 € per kWh. Results: Power consumption during operation varied from 58 W (GE CareStation 750) to 136 W (Dräger Primus). In standby, the devices consumed between 88% and 93% of the electricity needed during use. The annual electricity consumption to run 96 devices in a large clinical department ranges between 45 and 105 Megawatt-hours (MWh) when the devices are left in standby during off hours. If 80% of the devices are switched off during off hours, between 20 and 46 MWh can be saved per year in a single institution. At the average emission factor of our hospital, this electricity saving corresponds to a reduction of GHG emissions between 8.5 and 19.8 tons CO2-equivalent. At the assumed prices, a cost reduction between 5000 € and 11,600 € could be achieved by this intervention. Conclusion: The power consumption varies considerably between the different types of anesthesia workstations. All devices exhibit a high electricity consumption in standby mode. Avoiding standby mode during off hours can save energy and thus GHG emissions and cost. The reductions in GHG emissions and electricity cost that can be achieved with this intervention in a large anesthesiology department are modest. Compared with GHG emissions generated by volatile anesthetics, particularly desflurane, optimization of electricity consumption of anesthesia workstations holds a much smaller potential to reduce the carbon footprint of anesthesia; however, as switching off anesthesia workstations overnight is relatively effortless, this behavioral change should be encouraged from both an ecological and economical point of view. [ABSTRACT FROM AUTHOR]

Raising public awareness about the relevance of supporting sustainable practices is required owing to the phenomena of global warming caused by the rising production of greenhouse gases. The healthcare sector generates a relevant proportion of the total carbon emissions in developed countries, and radiology is estimated to be a major contributor to this carbon footprint. Neuroradiology markedly contributes to this negative environmental effect, as this radiological subspecialty generates a high proportion of diagnostic and interventional imaging procedures, the majority of them requiring high energy-intensive equipment. Therefore, neuroradiologists and neuroradiological departments are especially responsible for implementing decisions and initiatives able to reduce the unfavourable environmental effects of their activities, by focusing on four strategic pillars—reducing energy, water, and helium use; properly recycling and/or disposing of waste and residues (including contrast media); encouraging environmentally friendly behaviour; and reducing the effects of ionizing radiation on the environment. The purpose of this article is to alert neuroradiologists about their environmental responsibilities and to analyse the most productive strategic axes, goals, and lines of action that contribute to reducing the environmental impact associated with their professional activities. [ABSTRACT FROM AUTHOR]

Objective To identify evidence-based interventions that reduce greenhouse gas emissions in health-care systems in low- and middleincome countries and explore potential synergies from these interventions that aid climate change adaptation while mitigating emissions. Methods We systematically searched 11 electronic databases for articles published between 1990 and March 2023. We assessed risk of bias in each article and graded the quality of evidence across interventions in health-care operations, energy and supply chains. Findings After screening 25 570 unique records, we included 22 studies published between 2000 and 2022 from 11 countries across six World Health Organization regions. Identified articles reported on interventions spanning six different sources of emissions, namely energy, waste, heating and cooling, operations and logistics, building design and anaesthetic gases; all of which demonstrated potential for significant greenhouse gas emission reductions, cost savings and positive health impacts. The overall quality of evidence is low because of wide variation in greenhouse gas emissions measuring and reporting. Conclusion There are opportunities to reduce the greenhouse gas emissions from health-care systems in low- and middle-income countries, but gaps in evidence were identified across sources of emissions, such as the supply chain, as well as a lack of consideration of interactions with adaptation goals. As efforts to mitigate greenhouse gas intensify, rigorous monitoring, evaluation and reporting of these efforts are needed. Such actions will contribute to a strong evidence base that can inform policy-makers across contexts. [ABSTRACT FROM AUTHOR]

Objectives: As the threat of climate change continues to grow, bolstering individual‐level support for climate change initiatives is crucial. More research is needed to better understand how individual difference factors, such as climate change anxiety and intolerance of uncertainty (IU), may shape how people perceive climate change and respond to climate change messaging. To date, the majority of published studies have not taken these individual difference factors into consideration, and IU has been particularly neglected in the climate change literature. This study examined the independent effects of climate change anxiety and IU on three climate change‐related outcomes: climate‐related distress, support for climate change policies, and behavioural engagement. Methods: Participants were Florida residents (N = 441) who completed an online survey, including measures of climate change anxiety and IU. Participants then watched a video describing climate change consequences and completed three outcome measures: post‐video distress, climate change policy support, and behavioural engagement. Results: Controlling for demographic covariates, both climate change anxiety (β =.43, p <.001) and IU (β =.27, p <.001) were associated with greater post‐video distress, but only IU independently predicted greater policy support (β =.10, p =.034) and behavioural engagement (β =.12, p =.017). Conclusions: Our findings suggest that IU may be an important factor in promoting pro‐environmental behaviour and policy support, but climate change anxiety may increase emotional distress without boosting meaningful behaviours or support. Our findings highlight the potential influence of cognitive factors on climate change engagement and suggest that invoking uncertainty rather than anxiety may be more effective in catalysing effective environmental engagement. [ABSTRACT FROM AUTHOR]

The article focuses on the urgent need to address climate change and biodiversity loss as an indivisible global health emergency. Topics include the interconnected impact on human health, the severe threats posed by disruptions to social and economic systems, and the call for coordinated efforts and the declaration of a global health emergency by the World Health Organization.

The author argues on the insufficiency of responses to the intricate interplay between climate change and health. She discusses some initiatives being undertaken by intergovernmental organizations, states, civil society and research communities to respond to health injustices, a transformative response to the health injustices exacerbated by climate change and the most at risk of health impacts from climate change.

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PURPOSE Cancer care-related greenhouse gas (GHG) emissions harm human health. Many cancer drugs are administered at greater-than-necessary doses, frequencies, and durations. Alternative dosing strategies may enable reductions in cancer care GHG emissions without compromising patient outcomes. MATERIALS AND METHODS We used streamlined life-cycle analysis in a case-control simulation to estimate the relative reductions in GHG emissions that would be expected to result from using each of three alternative dosing strategies of trastuzumab (6-month adjuvant treatment duration, once every 4-week dosing, and both) in human epidermal growth factor receptor 2 (HER2)1 breast cancer. Using primary data and conversion factors from the environmental science literature, we estimated per-patient relative reduction in GHG emissions and, using SEER data, health impacts (in terms of disability-adjusted life-years [DALYs] and excess mortality per kg CO2) on bystanders for each alternative dosing strategy. RESULTS Compared with the trastuzumab dosing strategy commonly used at baseline (12-month duration of adjuvant therapy and once every 3-week dosing in all settings), adoption of both 6-month adjuvant trastuzumab and once every 4-week trastuzumab dosing would reduce GHG emissions by 4.5%, 18.7%, and 14.6% in the neoadjuvant, adjuvant, and metastatic settings, respectively. We estimate that US-based adoption of alternative trastuzumab dosing would reduce annual DALYs and excess lives lost due to environmental impact of US-based trastuzumab therapy for HER21 breast cancer by 1.5 and 0.9, respectively. CONCLUSION Alternative dosing strategies may materially reduce the population health impacts of cancer care by reducing environmental impact. Regulatory decision making and health technology assessments should consider a treatment's environmental and population health impacts. Clinical trials of alternative dosing strategies are justified on the basis of environmental and population health impacts. [ABSTRACT FROM AUTHOR]

Rebecca Waters outlines the leading principles of waste management. [ABSTRACT FROM AUTHOR]

Researchers using deliberative techniques tend to favour in-person processes. However, the COVID-19 pandemic has added urgency to the question of whether meaningful deliberative research is possible in an online setting. This paper considers the reasons for taking deliberation online, including bringing people together more easily; convening international events; and reducing the environmental impact of research. It reports on four case studies: a set of stakeholder workshops considering greenhouse gas removal technologies, convened online in 2019, and online research workshops investigating local climate strategies; as well as two in-person processes which moved online due to COVID-19: Climate Assembly UK, a Citizens' Assembly on climate change, and the Lancaster Citizens' Jury on Climate Change. It sets out learnings from these processes, concluding that deliberation online is substantively different from in-person meetings, but can meet the requirements of deliberative research, and can be a rewarding and useful process for participants and researchers alike. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a common heterogenous disease with significant personal implications, responsible for substantial healthcare costs. The goal of treatment and management in COPD is manageme symptoms, and reduce risk and frequency of exacerbations and hospitilisation using a patient-centred approach. This article summarises the main current pharmaceutical and non-pharmaceutical management strategies in COPD, drawing on contemporaneous clinical guidelines and evidence, and highlights how emerging COPD endotypes and phenotypes are enhancing our understanding. An overview of inhaled medications, the mainstay of COPD treatment is discussed, as well as the significance of device selection related to personal and physical considerations. Acute and long-term treatment and the criteria for specialist referral and medical management in complex patients is also presented. [ABSTRACT FROM AUTHOR]

Background: As healthcare is responsible for 7% of Australia's carbon emissions, it was recognised that a policy implemented at St George Hospital, Sydney, to reduce non‐urgent pathology testing to 2 days per week and, on other days only if essential, would also result in a reduction in carbon emissions. The aim of the study was to measure the impact of this intervention on pathology collections and associated carbon emissions and pathology costs. Aims: To measure the impact of an intervention to reduce unnecessary testing on pathology collections and associated carbon emissions and pathology costs. Methods: The difference in the number of pathology collections, carbon dioxide equivalents (CO2e) for five common blood tests and pathology cost per admission were compared between a 6‐month reference period and 6‐month intervention period. CO2e were estimated from published pathology CO2e impacts. Cost was derived from pathology billing records. Outcomes were modelled using multivariable negative binomial, generalised linear and logistic regression. Results: In total, 24 585 pathology collections in 5695 patients were identified. In adjusted analysis, the rate of collections was lower during the intervention period (rate ratio 0.90; 95% confidence interval (CI), 0.86–0.95; P < 0.001). This resulted in a reduction of 53 g CO2e (95% CI, 24–83 g; P < 0.001) and $22 (95% CI, $9–$34; P = 0.001) in pathology fees per admission. The intervention was estimated to have saved 132 kg CO2e (95% CI, 59–205 kg) and $53 573 (95% CI, 22 076–85 096). Conclusions: Reduction in unnecessary hospital pathology collections was associated with both carbon emission and cost savings. Pathology stewardship warrants further study as a potentially scalable, cost‐effective and incentivising pathway to lowering healthcare associated greenhouse gas emissions. [ABSTRACT FROM AUTHOR]

Redistributing surplus food that would otherwise be discarded represents a viable strategy both for increasing food access and for addressing climate change. This study describes a public-private partnership that scaled such an effort in Los Angeles County. Public health worked with a technology-based company to introduce a mobile app that connected various traditional (e.g. food pantries) and non-traditional (e.g. businesses with surplus food, food rescue organizations, community-based organizations that work in low-income communities) organizations with a countywide surplus food redistribution process. In 11 months, 50 food businesses participated, a total of 43,900 pounds of food were recovered, and surplus food was delivered to 34 community sites, serving 28,400 meals. Lessons from the experience suggest that mobile app use was a key component of the redistribution effort, and that diverting food waste while increasing food access, with a priority towards obtaining food of high nutritional value, was both feasible and practical. It has previously been shown that reducing food loss and waste by at least 50% in the food service sector could help reduce energy use and greenhouse gas emissions. [ABSTRACT FROM AUTHOR]

The authors call for urgent action to ensure that COP27, the 5th Conference of the Parties (COP) finally delivers climate justice for Africa and vulnerable countries. Topics covered include the needs for wealthy nations to step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change, the impact of the climate crisis on the environmental and social determinants of health across Africa, and how global inaction has caused the climate crisis.

We aim to identify the dietary changes to improve nutrition and reduce diet-related greenhouse gas emission (GHGE) simultaneously in Brazil, taking into account the heterogeneity in food habits and prices across the country. Food consumption and prices were obtained from two nationwide surveys (n = 55,970 households and 34,003 individuals). Linear programming models were performed to design optimised diets most resembling the observed diets, and meeting different sets of constraints: (i) nutritional, for preventing chronic diseases and meeting nutrient adequacy; (ii) socio-cultural: by respecting food preferences; and (iii) environmental: by reducing GHGE by steps of 10%. Moving toward a diet that meets nutritional recommendations led to a 14% to 24% cost increase and 10% to 27% GHGE reduction, depending on the stringency of the acceptability constraints. Stronger GHGE reductions were achievable (up to about 70%), with greater departure from the current diet, but not achieving calcium and potassium goals. Diet cost increment tended to be mitigated with GHGE reduction in most models, along with reductions in red meat, chicken, eggs, rice, and high-fat sugar sodium foods. [ABSTRACT FROM AUTHOR]

This article examines attempts at one life-plan community to involve older residents in mitigating the effects of global warming and environmental degradation, and, drawing upon lessons learned during the author's long career in the disability advocacy arena, offers guidance on involving older people in confronting the threats posed by climate change. [ABSTRACT FROM AUTHOR]

The article presents the discussion on limiting global temperature increase and restoring biodiversity and protecting health . Topics include health already being harmed by global temperature increase and the destruction of the natural world, a state of affairs health professionals; and disproportionately on the most vulnerable breeding more conflict, food insecurity, forced displacement, and zoonotic disease.

The article offers a perspective on the success, failure and the imperative of justice in climate negotiations. It discusses the progressive ambition principle, transparency of reporting contributions and stocktake process as mechanism intended to boost goals to reduce greenhouse gas emissions, build resilience to the effects of climate change and increase support to low-income countries. Examples of coordinated interventions by health-care professionals to achieve climate goals are cited.

An editorial is presented on the 2022 report of the Intergovernmental Panel on Climate Change (IPCC) which is linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality with pre-industrial levels. Topics include global action framework that incorporates providing climate finance to developing countries; and climate crisis has had an impact on the environmental and social determinants of health across Africa.

The article focuses on a call for urgent action to limit global temperature increases, restore biodiversity and protect health for world leaders to keep global temperatures below 1.5C and to halt the destruction of nature to prevent catastrophic harm to health and the environment.

An editorial is presented on the call for emergency action to limit global temperature increases, restore biodiversity, and protect health. Topics discussed include the UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis; and they will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, Grate Britain.

Failure to take climate change seriously enough has resulted in the world now facing a climate emergency, with rising global temperatures, melting polar ice caps, increasingly frequent and severe storms, floods and droughts, and rising sea levels. Despite being the first country in the world to set statutory carbon emissions reduction targets (in the Climate Change Act 2008), the UK government since 2012 has fallen increasingly behind, even by its own standards. This paper details what this has meant in terms of specific policies and identifies some of the reasons for this policy failure: in particular, a negative attitude towards regulation and a return to a reliance on market forces, plus an overriding concern to continue with 'business as usual', in terms of support for fossil-fuel industries and ever-increasing energy demand and supply. Ironically, this has resulted in a situation where radical solutions seem even more necessary and more urgent. [ABSTRACT FROM AUTHOR]

Objectives: This study measured nurses' awareness, motivation, concern, self‐reported behaviors at work, and self‐reported behaviors at home regarding climate change and health. Design: Descriptive study using an anonymous and voluntary web‐based survey. Sample: A nonrepresentative sample recruited from nurses. Measurements: The CHANT (Climate, Health and Nursing Tool) with five psychometrically evaluated scales used to measure awareness, motivation, concern, behaviors at work, and behaviors at home. Results: The 489 respondents reported moderate levels of awareness (2.97 mean score of 0–4) and high levels of concern (3.43) about health impacts of climate change. They were motivated to reduce greenhouse gas emissions (3.27), yet few did at home (2.28), and even fewer at work (1.81). They were motivated by clean air and water and concern about the future. Barriers to action included not knowing what to do and feeling overwhelmed. Respondents reported discussing climate and health with friends or family more frequently than they did with their colleagues. A majority (63%) never contacted elected officials. Conclusion: The respondents were aware of climate and health impacts and motivated to act. However, they reported lower frequencies of changing behaviors at work, and communicating about climate and health professionally and with elected officials. [ABSTRACT FROM AUTHOR]

An editorial is presented on call for emergency action for limiting global temperature increase and restoring biodiversity and protecting health. Topics include pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health being impossible to reverse; and breeding more conflict, food insecurity, forced displacement, and zoonotic disease.