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Lenders are likely to face significant financial risks from the shift to a low-carbon economy, but it remains unclear whether such risks are incorporated into their lending practices. The extent of this risk depends on whether banks incorporate such risks into their lending activity and whether financial instruments' tenors are long enough to cover the period when such risks materialize. Using a case study of shipping loans, we combine quantitative data and semi-structured interviews with key shipping debt providers. Our results show that banks, in particular signatories of the Poseidon Principles, a voluntary disclosure initiative in shipping, have started to price in the climate score of shipowners they lend to after the Paris Agreement but on a corporate rather than an asset basis. However, signatories do not differentiate their margins based on a ship's carbon intensity, despite a relatively long loan maturity, reinforcing the limitations of disclosure initiatives to influence investment outlays., Competing Interests: The authors declare no competing interests., (© 2024 The Authors.)

A social-moral norm against new fossil fuel projects has strong potential to contribute to achieving global climate goals.

The winter of 2022/23 has seen large increases in energy prices and in the cost of living in many countries around the world, including Great Britain. Here, we report the results of two surveys, combining cross-sectional and longitudinal analysis, in a sample of about 5400 British households. One survey was conducted early in 2023, the other when participants had signed up to an ongoing research study in the past five years. Thermostat settings were about 1°C lower during the cost-of-living crisis than before, and householders were more likely to turn the heating off when the home was unoccupied. The effort to save energy increased compared to pre-cost-of-living-crisis levels. Using the in-home display more in the cost-of-living crisis than before correlated with greater effort to save energy, supporting the notion that displaying energy data can be a useful tool for energy reductions. Finding it difficult to keep comfortably warm in the home and struggling with meeting heating costs were linked to lower wellbeing, strengthening evidence links between cold, damp, and hard-to-heat homes and negative mental health outcomes. About 40% of respondents lowered the flow temperature of the boiler which might imply that highly tailored information campaigns can be effective in changing behaviour., (© 2023. The Author(s).)

Food trade is generally perceived to increase the availability and diversity of foods available to consumers, but there is little empirical evidence on its implications for human health. Here we show that a substantial proportion of dietary risks and diet-related mortality worldwide is attributable to international food trade and that whether the contributions of food trade are positive or negative depends on the types of food traded. Using bilateral trade data for 2019 and food-specific risk-disease relationships, we estimate that imports of fruits, vegetables, legumes and nuts improved dietary risks in the importing countries and were associated with a reduction in mortality from non-communicable diseases of ~1.4 million deaths globally. By contrast, imports of red meat aggravated dietary risks in the importing countries and were associated with an increase of ~150,000 deaths. The magnitude of our findings suggests that considering impacts on dietary risks will become an important aspect of health-sensitive trade and agriculture policies, and of policy responses to disruptions in food chains., (© 2023. The Author(s).)

The mitigation scenarios database of the Intergovernmental Panel on Climate Change's Sixth Assessment Report is an important resource for informing policymaking on energy transitions. However, there is a large variety of models, scenario designs, and resulting outputs. Here we analyse the scenarios consistent with limiting warming to 2 °C or below regarding the speed, trajectory, and feasibility of different fossil fuel reduction pathways. In scenarios limiting warming to 1.5 °C with no or limited overshoot, global coal, oil, and natural gas supply (intended for all uses) decline on average by 95%, 62%, and 42%, respectively, from 2020 to 2050, but the long-term role of gas is highly variable. Higher-gas pathways are enabled by higher carbon capture and storage (CCS) and carbon dioxide removal (CDR), but are likely associated with inadequate model representation of regional CO 2 storage capacity and technology adoption, diffusion, and path-dependencies. If CDR is constrained by limits derived from expert consensus, the respective modelled coal, oil, and gas reductions become 99%, 70%, and 84%. Our findings suggest the need to adopt unambiguous near- and long-term reduction benchmarks in coal, oil, and gas production and use alongside other climate mitigation targets., (© 2023. Springer Nature Limited.)

Tracking and measuring national carbon footprints is key to achieving the ambitious goals set by the Paris Agreement on carbon emissions. According to statistics, more than 10% of global transportation carbon emissions result from shipping. However, accurate tracking of the emissions of the small boat segment is not well established. Past research looked into the role played by small boat fleets in terms of greenhouse gases, but this has relied either on high-level technological and operational assumptions or the installation of global navigation satellite system sensors to understand how this vessel class behaves. This research is undertaken mainly in relation to fishing and recreational boats. With the advent of open-access satellite imagery and its ever-increasing resolution, it can support innovative methodologies that could eventually lead to the quantification of greenhouse gas emissions. Our work used deep learning algorithms to detect small boats in three cities in the Gulf of California in Mexico. The work produced a methodology named BoatNet that can detect, measure and classify small boats with leisure boats and fishing boats even under low-resolution and blurry satellite images, achieving an accuracy of 93.9% with a precision of 74.0%. Future work should focus on attributing a boat activity to fuel consumption and operational profile to estimate small boat greenhouse gas emissions in any given region., Competing Interests: Research ethics statementNot applicable to this article.Consent for publication statementThe authors declare that research participants’ informed consent to publication of findings – including photos, videos and any personal or identifiable information – was secured prior to publication.Conflicts of interest statementThe authors declare no conflicts of interest with this work.The authors declare no conflicts of interest with this work., (© 2023 The Authors.)

Given concerns about the ambition and effectiveness of current climate policies, a case has been made for the combination of demand side policies such as carbon pricing with supply side bans on fossil fuel extraction. However, little is known about their interplay in the context of climate stabilization strategies. Here, we present a multi-model assessment quantifying the effectiveness of supply side policies and their interactions with demand-side ones. We explore a variety of fossil fuel bans with four integrated assessment models and find that international supply side policies reduce carbon emissions but not at sufficient levels to stabilize temperature increase to well below 2°C. When combined with demand side policies, supply side policies reduce the required carbon price, dampen reliance on CO 2 removal technologies, and increase investment in renewable energy. The results indicate the opportunity to integrate fossil fuel bans alongside price-based policies when exploring pathways to reach ambitious mitigation targets., Competing Interests: The authors have no conflict of interest to declare., (© 2023 The Authors.)

The electrification of heating and transport and decarbonisation of supply creates a need for demand side flexibility to balance the grid. Heat pumps are expected to form a major part of heat delivery, and many modelling studies have investigated the technical potential of heat pump demand response. However, little empirical work has been reported on the practical implementation of such demand response in occupied homes. This paper presents a cross-case comparison of three early adopters of heat pump demand response in the UK. The aim was to reduce heat pump electricity consumption during the same peak period, but each employed a different control strategy: lowered air temperature setpoints, lowered flow temperature and blocked heat pump compressor. A 56-90% electricity reduction during the peak period was observed; the success of the demand response depended on how the control strategy affected the heat pump and the rest of the heating system. However, no one stakeholder is responsible for all these system components. The fabric, heating distribution and control system and heat pumps installed are highly heterogeneous across the stock, highlighting that flexibility mechanisms must be developed that can be tailored to or work across their range., Practical Application: Three case studies of different heat pump demand response control strategies in real homes are presented. All three households reduced their electricity consumption during a peak period but delivered unintended consequences where the heat pump's logic did not correspond to the demand response requirements. This study highlights that the implementation of heat pump demand response to support electricity system operation requires a clear definition of electricity system need as well as practical demand response mechanisms to be integrated into heating system design., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Competing Interests: Declaration of interests CD was supported by the UK Natural Environment Research Council (NE/R010811/1) and the UK Natural Environment Research Council Independent Research Fellowship (NE/N01524X/1) and contributes to the Sustainable and Healthy Food Systems project supported by the Wellcome Trust (205200/Z/16/Z). MD was supported by the Wellcome Trust's Complex Urban Systems for Sustainability and Health (CUSSH) project (209387/Z/17/Z). YL was supported by the US National Aeronautics and Space Administration Applied Sciences Program (80NSSC21K0507). RL was supported by a Royal Society Dorothy Hodgkin Fellowship. MSo was supported by Horizon 2020 project EXHAUSTION (820655) and Academy of Finland HEATCOST (334798). SHG and JKWL were supported by Singapore's National Research Foundation, Singapore's Prime Minister's Office, under its Campus for Research Excellence and Technological Enterprise programme. IH was supported by the UK Research and Innovation (UKRI) Engineering and Physical Sciences Research Council Centre for Research in Energy Demand Solutions (EP/R035288/1) and UKRI APEx (NE/T001887/1). JM was supported by the German Ministry for Education and Research (01LA1826A and 03SFK5J0). ML was supported by the Sloan Foundation. All other authors declare no competing interests.

Russia's war against Ukraine has raised concerns not about the fate of Ukrainian science and scientists but also academic freedom and international cooperation in science., (© 2022 The Authors.)

Aims: Primary prevention strategies for heart failure (HF) have had limited success, possibly due to a wide range of underlying risk factors (RFs). Systematic evaluations of the prognostic burden and preventive potential across this wide range of risk factors are lacking. We aimed at estimating evidence, prevalence and co-occurrence for primary prevention and impact on prognosis of RFs for incident HF., Methods and Results: We systematically reviewed trials and observational evidence of primary HF prevention across 92 putative aetiologic RFs for HF identified from US and European clinical practice guidelines. We identified 170 885 individuals aged ≥30 years with incident HF from 1997 to 2017, using linked primary and secondary care UK electronic health records (EHR) and rule-based phenotypes (ICD-10, Read Version 2, OPCS-4 procedure and medication codes) for each of 92 RFs. Only 10/92 factors had high quality observational evidence for association with incident HF; 7 had effective randomized controlled trial (RCT)-based interventions for HF prevention (RCT-HF), and 6 for cardiovascular disease prevention, but not HF (RCT-CVD), and the remainder had no RCT-based preventive interventions (RCT-0). We were able to map 91/92 risk factors to EHR using 5961 terms, and 88/91 factors were represented by at least one patient. In the 5 years prior to HF diagnosis, 44.3% had ≥4 RFs. By RCT evidence, the most common RCT-HF RFs were hypertension (48.5%), stable angina (34.9%), unstable angina (16.8%), myocardial infarction (15.8%), and diabetes (15.1%); RCT-CVD RFs were smoking (46.4%) and obesity (29.9%); and RCT-0 RFs were atrial arrhythmias (17.2%), cancer (16.5%), heavy alcohol intake (14.9%). Mortality at 1 year varied across all 91 factors (lowest: pregnancy-related hormonal disorder 4.2%; highest: phaeochromocytoma 73.7%). Among new HF cases, 28.5% had no RCT-HF RFs and 38.6% had no RCT-CVD RFs. 15.6% had either no RF or only RCT-0 RFs., Conclusion: One in six individuals with HF have no recorded RFs or RFs without trials. We provide a systematic map of primary preventive opportunities across a wide range of RFs for HF, demonstrating a high burden of co-occurrence and the need for trials tackling multiple RFs., (© 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: The residential sector releases around 17% of global greenhouse gas emissions and making residential buildings more energy efficient can help mitigate climate change. Engineering models are often used to predict the effects of residential energy efficiency interventions (REEI) on energy consumption, but empirical studies find that these models often over-estimate the actual impact of REEI installation. Different empirical studies often estimate different impacts for the same REEI, possibly due to variations in implementation, climate and population. Funding for this systematic review was provided by the evaluation function at the European Investment Bank Group., Objectives: The review aims to assess the effectiveness of installing REEIs on the following primary outcomes: energy consumption, energy affordability, CO 2 emissions and air quality indices and pollution levels., Search Methods: We searched CAB Abst, Econlit, Greenfile, Repec, Academic Search Complete, WB e-lib, WoS (SCI and SSCI) and other 42 databases in November 2020. In addition, we searched for grey literature on websites, checked the reference lists of included studies and relevant reviews, used Google Scholar to identify studies citing included studies, and contacted the authors of studies for any ongoing and unpublished studies. We retrieved a total of 13,629 studies that we screened at title and abstract level, followed by full-text screening and data extraction., Selection Criteria: We included randomised control trials, and quasi-experimental studies that evaluated the impact of installing REEIs anywhere in the world and with any comparison., Data Collection and Analysis: Two independent reviewers screened studies for eligibility, extracted data and assessed risk of bias. When more than one included study examined the same installation of the same type of REEI for a similar outcome, we conducted a meta-analysis. We also performed subgroup analyses., Main Results: A total of 16 studies were eligible and included in the review: two studies evaluated the installation of efficient lighting, three studies the installation of attic/loft insulation, two studies the installation of efficient heat pumps, eight studies the installation of a bundle of energy efficiency measures (EEMs), and one study evaluated other EEMs. Two studies, neither appraised as having a low risk of bias, find that lighting interventions lead to a significant reduction in electricity energy consumption (Hedges' g  = -0.29; 95% confidence interval [CI]: -0.48, -0.10). All the other interventions involved heating or cooling, and effects were synthesizised by warmer or colder climate and then across climates. Four studies examined the impact of attic/loft insulation on energy consumption, and two of these studies were appraised as having a low risk of bias. Three studies took place in colder climates with gas consumption as an outcome, and one study took place in a warmer climate, with the electricity consumption (air conditioning) as the outcome. The average impact across all climates was small (Hedges' g  = 0.04; 95% CI: -0.09, 0.01) and statistically insignificant. However, two of the studies appear to have evaluated the effect of installing small amounts (less than 75 mm) of insulation. The other two studies, one of which was appraised as low risk of bias and the other involving air conditioning, found significant reductions in consumption. Two studies examined the impact of installing electric heat pumps. The average impact across studies was not statistically significant (Hedges' g  = -0.11; 95% CI: -0.41, 0.20). However, there was substantial variation between the two studies. Replacing older pumps with more efficient versions significantly reduced electricity consumption in a colder climate (Hedges' g  = -0.36; 95% CI, -0.57, -0.14) in a high risk of bias study. However, a low risk of bias study found a significant increase in electricity consumption from installing new heat pumps (Hedges' g  = 0.09; 95% CI, 0.06, 0.12). Supplemental analyses in the latter study indicate that households also used the heat pumps for cooling and that the installed heat pumps most likely reduced overall energy consumption across all sources-that is, households used more electricity but less gas, wood and coal. Seven studies examined bundled REEIs where the households chose which EEMs to install (in five studies the installation occurred after an energy audit that recommended which EEMs to install). Overall, the studies estimated that installing an REEI bundle is associated with a significant reduction in energy consumption (Hedges' g  = -0.36; 95% CI, -0.52, -0.19). In the two low risk of bias studies, conducted with mostly low-income households, installed bundles reduced energy consumption by a statistically significant amount (Hedges' g  = -0.16; 95% CI, -0.13, -0.18)., Authors' Conclusions: The 16 included studies indicate that installing REEIs can significantly reduce energy consumption. However, the same type of REEI installed in different studies caused different effects, indicating that effects are conditional on implementation and context. Exploring causes of this variation is usually not feasible because existing research often does not clearly report the features of installed interventions. Additional high quality impact evaluations should be commissioned in more diverse contexts (only one study was conducted in either Asia or Africa-both involved lighting interventions-and no studies were conducted in South America or Southern Europe)., (© 2021 The Authors. Campbell Systematic Reviews published by John Wiley & Sons Ltd on behalf of The Campbell Collaboration.)

This review aims to identify, appraise and synthesise the evidence available on the effectiveness of energy efficiency measure installations, including those bundled with behavioural interventions. The synthesis will estimate the overall impact of these interventions as well as examine possible causes of variation in impacts. We will also attempt to assess the cost-effectiveness of residential energy efficiency interventions., (© 2021 The Authors. Campbell Systematic Reviews published by John Wiley & Sons Ltd on behalf of The Campbell Collaboration.)

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017, and produced its first national assessment in 2018, its first annual update in 2019, and its second annual update in 2020. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. Our special report in 2020 focused on the unprecedented and catastrophic 2019-20 Australian bushfire season, highlighting indicators that explore the relationships between health, climate change and bushfires. For 2021, we return to reporting on the full suite of indicators across each of the five domains and have added some new indicators. We find that Australians are increasingly exposed to and vulnerable to excess heat and that this is already limiting our way of life, increasing the risk of heat stress during outdoor sports, and decreasing work productivity across a range of sectors. Other weather extremes are also on the rise, resulting in escalating social, economic and health impacts. Climate change disproportionately threatens Indigenous Australians' wellbeing in multiple and complex ways. In response to these threats, we find positive action at the individual, local, state and territory levels, with growing uptake of rooftop solar and electric vehicles, and the beginnings of appropriate adaptation planning. However, this is severely undermined by national policies and actions that are contrary and increasingly place Australia out on a limb. Australia has responded well to the COVID-19 public health crisis (while still emerging from the bushfire crisis that preceded it) and it now needs to respond to and prepare for the health crises resulting from climate change., (© 2021 AMPCo Pty Ltd.)

Competing Interests: Declaration of interests We declare no competing interests.

In this paper, we explored the interplay between the electricity market structure, methods of electricity trading and different stakeholder dynamics within the Nigerian Electricity Supply Industry (NESI) with a view to understanding how these interplays impact on various forms of interventions in the Nigerian electricity sector. We started off by exploring the market structure and electricity trading system within the Nigerian electricity sector and reviewed the various stakeholder groups within centralized and decentralized electricity systems in Nigeria's electricity sector by highlighting their core responsibilities and the dynamics at play in satisfying their interests. This study revealed that: (1) external stakeholder groups (such as donor agencies and multi-lateral organizations) exert more influence in Nigeria's electricity sector through financial interventions; (2) lack of coordination and engagement among various stakeholder groups pose a challenge to effective electricity infrastructure interventions that address the needs of people in society. The study concludes by highlighting the implications of these challenges and the need to address the rising complexities and uncertainties for better stakeholder involvement in addressing the salient challenges in the sector., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Parties to the 2015 Paris Agreement pledged to limit global warming to well below 2 °C and to pursue efforts to limit the temperature increase to 1.5 °C relative to pre-industrial times 1 . However, fossil fuels continue to dominate the global energy system and a sharp decline in their use must be realized to keep the temperature increase below 1.5 °C (refs. 2-7 ). Here we use a global energy systems model 8 to assess the amount of fossil fuels that would need to be left in the ground, regionally and globally, to allow for a 50 per cent probability of limiting warming to 1.5 °C. By 2050, we find that nearly 60 per cent of oil and fossil methane gas, and 90 per cent of coal must remain unextracted to keep within a 1.5 °C carbon budget. This is a large increase in the unextractable estimates for a 2 °C carbon budget 9 , particularly for oil, for which an additional 25 per cent of reserves must remain unextracted. Furthermore, we estimate that oil and gas production must decline globally by 3 per cent each year until 2050. This implies that most regions must reach peak production now or during the next decade, rendering many operational and planned fossil fuel projects unviable. We probably present an underestimate of the production changes required, because a greater than 50 per cent probability of limiting warming to 1.5 °C requires more carbon to stay in the ground and because of uncertainties around the timely deployment of negative emission technologies at scale., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Finance is vital for the green energy transition, but access to low cost finance is uneven as the cost of capital differs substantially between regions. This study shows how modelled decarbonisation pathways for developing economies are disproportionately impacted by different weighted average cost of capital (WACC) assumptions. For example, representing regionally-specific WACC values indicates 35% lower green electricity production in Africa for a cost-optimal 2 °C pathway than when regional considerations are ignored. Moreover, policy interventions lowering WACC values for low-carbon and high-carbon technologies by 2050 would allow Africa to reach net-zero emissions approximately 10 years earlier than when the cost of capital reduction is not considered. A climate investment trap arises for developing economies when climate-related investments remain chronically insufficient. Current finance frameworks present barriers to these finance flows and radical changes are needed so that capital is more equitably distributed.

Objective: Excess winter deaths are a major public health concern in England and Wales, with an average of 20 000 deaths per year since 2010. Feeling cold at home during winter is associated with reporting poor general health; cold and damp homes have greater prevalence in lower socioeconomic groups. Overheating in the summer also has adverse health consequences. This study evaluates the association between indoor temperature and general health and the extent to which this is affected by socioeconomic and household factors., Design: Cross-sectional study., Setting: England., Participants: Secondary data of 74 736 individuals living in England that took part in the Health Survey for England (HSE) between 2003 and 2014. The HSE is an annual household survey which uses multilevel stratification to select a new, nationally representative sample each year. The study sample comprised adults who had a nurse visit; the analytical sample was adults who had observations for indoor temperature and self-rated health., Results: Using both logistic and linear regression models to examine indoor temperature and health status, adjusting for socioeconomic and housing factors, the study found an association between poor health and higher indoor temperatures. Each one degree increase in indoor temperature was associated with a 1.4% (95% CI 0.5% to 2.3%) increase in the odds of poor health. After adjusting for income, education, employment type, household size and home ownership, the OR of poor health for each degree temperature rise increased by 19%, to a 1.7% (95% CI 0.7% to 2.6%) increase in odds of poor health with each degree temperature rise., Conclusion: People with worse self-reported health had higher indoor temperatures after adjusting for household factors. People with worse health may have chosen to maintain warmer environments or been advised to. However, other latent factors, such as housing type and energy performance could have an effect., Competing Interests: Competing interests: JSM and AM report grants from NHS Digital during the conduct of the study; IH report grants from the Engineering and Physical Sciences Research Council (EPSRC)., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: nationally determined contributions (NDCs) serve to meet the goals of the Paris Agreement of staying "well below 2°C", which could also yield substantial health co-benefits in the process. However, existing NDC commitments are inadequate to achieve this goal. Placing health as a key focus of the NDCs could present an opportunity to increase ambition and realise health co-benefits. We modelled scenarios to analyse the health co-benefits of NDCs for the year 2040 for nine representative countries (ie, Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK, and the USA) that were selected for their contribution to global greenhouse gas emissions and their global or regional influence., Methods: Modelling the energy, food and agriculture, and transport sectors, and mortality related to risk factors of air pollution, diet, and physical activity, we analysed the health co-benefits of existing NDCs and related policies (ie, the current pathways scenario) for 2040 in nine countries around the world. We compared these health co-benefits with two alternative scenarios, one consistent with the goal of the Paris Agreement and the Sustainable Development Goals (ie, the sustainable pathways scenario), and one in line with the sustainable pathways scenario, but also placing health as a central focus of the policies (ie, the health in all climate policies scenario)., Findings: Compared with the current pathways scenario, the sustainable pathways scenario resulted in an annual reduction of 1·18 million air pollution-related deaths, 5·86 million diet-related deaths, and 1·15 million deaths due to physical inactivity, across the nine countries, by 2040. Adopting the more ambitious health in all climate policies scenario would result in a further reduction of 462 000 annual deaths attributable to air pollution, 572 000 annual deaths attributable to diet, and 943 000 annual deaths attributable to physical inactivity. These benefits were attributable to the mitigation of direct greenhouse gas emissions and the commensurate actions that reduce exposure to harmful pollutants, as well as improved diets and safe physical activity., Interpretation: A greater consideration of health in the NDCs and climate change mitigation policies has the potential to yield considerable health benefits as well as achieve the "well below 2°C" commitment across a range of regional and economic contexts., Funding: This work was in part funded through an unrestricted grant from the Wellcome Trust (award number 209734/Z/17/Z) and supported by an Engineering and Physical Sciences Research Council grant (grant number EP/R035288/1)., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world., Methods: A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type., Findings: In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS., Interpretation: This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions., Funding: Wellcome Trust., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Modeling suggests that climate change mitigation actions can have substantial human health benefits that accrue quickly and locally. Documenting the benefits can help drive more ambitious and health-protective climate change mitigation actions; however, documenting the adverse health effects can help to avoid them. Estimating the health effects of mitigation (HEM) actions can help policy makers prioritize investments based not only on mitigation potential but also on expected health benefits. To date, however, the wide range of incompatible approaches taken to developing and reporting HEM estimates has limited their comparability and usefulness to policymakers., Objective: The objective of this effort was to generate guidance for modeling studies on scoping, estimating, and reporting population health effects from climate change mitigation actions., Methods: An expert panel of HEM researchers was recruited to participate in developing guidance for conducting HEM studies. The primary literature and a synthesis of HEM studies were provided to the panel. Panel members then participated in a modified Delphi exercise to identify areas of consensus regarding HEM estimation. Finally, the panel met to review and discuss consensus findings, resolve remaining differences, and generate guidance regarding conducting HEM studies., Results: The panel generated a checklist of recommendations regarding stakeholder engagement: HEM modeling, including model structure, scope and scale, demographics, time horizons, counterfactuals, health response functions, and metrics; parameterization and reporting; approaches to uncertainty and sensitivity analysis; accounting for policy uptake; and discounting., Discussion: This checklist provides guidance for conducting and reporting HEM estimates to make them more comparable and useful for policymakers. Harmonization of HEM estimates has the potential to lead to advances in and improved synthesis of policy-relevant research that can inform evidence-based decision making and practice. https://doi.org/10.1289/EHP6745.

Measures to control the spread of coronavirus disease 2019 (COVID-19) are having unprecedented impacts on people's lives around the world. In this paper, we argue that those conducting social research in the energy domain should give special consideration to the internal and external validity of their work conducted during this pandemic period. We set out a number of principles that researchers can consider to give themselves and research users greater confidence that findings and recommendations will still be applicable in years to come. Largely grounded in existing good practice guidance, our recommendations include collecting and reporting additional supporting contextual data, reviewing aspects of research design for vulnerability to validity challenges, and building in longitudinal elements where feasible. We suggest that these approaches also bring a number of opportunities to generate new insights. However, we caution that a more systemic challenge to validity of knowledge produced during this period may result from changes in the kinds of social research that it is practicable to pursue., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 Elsevier Ltd. All rights reserved.)

Disparities in outdoor air pollution exposure between individuals of differing socio-economic status is a growing area of research, widely explored in the environmental health literature. However, in developed countries, around 80% of time is spent indoors, meaning indoor air pollution may be a better proxy for personal exposure. Building characteristics - such as build quality, volume and ventilation - and occupant behaviour, mean indoor air pollution may also vary across socio-economic groups, leading to health inequalities. Much of the existing literature has focused on inequalities in exposure to outdoor air pollution, and there is thus a lack of an evidence base reviewing data for indoor environments. In this study, a scoping review of the literature on indoor air pollution exposures across different socio-economic groups is performed, examining evidence from both monitoring and modelling studies in the developed world. The literature was reviewed, identifying different indoor pollutants, definitions for socio-economic status and pre- and post- housing interventions. Based on the review, the study proposes a modelling methodology for evaluating the effects of environmental policies on different socio-economic populations. Using a sample size calculation, obstacles in obtaining sufficiently large samples of monitored data are demonstrated. A modelling framework for the rapid quantification of daily home exposure is then outlined as a proof of concept. While significant additional research is required to examine inequalities in indoor exposures, modelling approaches may provide opportunities to quantify exposure disparities due to housing and behaviours across populations of different socio-economic status., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

The rapid phase-out of fossil fuels is critical to achieving a well-below 2 °C world. An emerging body of research explores the implications of this phase-out for fossil fuel producing countries, including the perceived tension between least-cost and most-equitable pathways. Here we present modelling, which re-distributes remaining fossil fuel production towards developing countries. We show that redistribution is challenging due to large economic disincentives required to shift production, and offers limited economic benefit for developing countries given the long timeframe required to effect change, and the wider impact of rising fuel import and energy systems costs. Furthermore, increases in production shares are offset by shrinking markets for fossil fuels, which are part dependent on carbon capture and storage (CCS). We argue that while there is a weak economic case for redistribution, there is a clear role for equity principles in guiding the development of supply side policy and in development assistance.

In today's world, urban systems play an important role in sustainable economic development. In particular, urbanisation trends and the increasing demands of urban mobility place additional pressure on existing transportation infrastructure, and this creates new challenges for urban planners in terms of developing integrated and sustainable urban mobility policies. Here, we take a novel and holistic approach to analysing transformative pathways towards sustainable urban mobility, considering the complex dynamics in metropolitan regions. To achieve this, we develop a toolset to assess the impact of potential measures to be taken by decision makers. Our innovative approach is based on the introduction of a new system framework to link the interrelated sector parameters of mobility systems by considering the effects of innovative mixed methods (both qualitative and quantitative) on scenario development and evaluation on the basis of global trends at the macro scale and their specific influences on the mobility sector at the local scale. To this end, we used a participatory modelling approach to develop scenarios and evaluate them as integrated simulation runs via a comprehensive and holistic system dynamics (SD) model. Thus, we estimated dynamic interdependencies between all of the factors relating to the mobility sector and then assigned business decision-making criteria to the urban systems. Furthermore, we introduced a sustainable net present value framework to estimate the sustainability outcomes of government investment in urban mobility infrastructure. A case study relating to the Rhine-Rhine-Ruhr metropolitan region in Germany was applied in order to simulate four scenarios co-created with stakeholders involved in our study, namely, Smart City, Sustainable/Healthy City, Deurbanisation and Business-as-Usual (BaU), which served as a solid basis from which to quantify path dependencies in terms of policy implementation. At the same time, recommendations were derived for sustainable mobility transformation within metropolitan regions., (© 2020 Elsevier Ltd. All rights reserved.)

Background: Exposure to cold is known to be associated with severe health impacts. The primary epidemiological evidence for this is the seasonal variation in mortality. However, there is a paucity of directly measured data for personal cold temperature exposure. This paper develops the concept of experienced temperature, and reports how it varies with season, demographics and housing factors., Methods: This study uses data from 77 743 UK Biobank participants. A novel method to directly measure participant's exposure to low temperatures using a thermistor in a wrist-worn activity monitor is described. These readings are combined with demographic and housing factor variables in a multiple regression model to understand underlying relationships., Results: The study reveals a significant difference in experienced temperature of ~1.8°C between the periods of coldest and hottest external temperature. A number of demographic differences were also observed-such as people of Chinese ethnic background experiencing 0.65°C lower temperatures than other groups., Conclusions: This paper presents primary evidence for a seasonal variation in experienced temperature. This variation likely contributes to cold related mortality and morbidity. It is hypothesized that this relationship would be less strong in countries which suffer fewer impacts of cold winter temperatures., (© The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Research on cascading failures in power-transmission networks requires detailed data on the capacity of individual transmission lines. However, these data are often unavailable to researchers. Consequently, line limits are often modeled by assuming that they are proportional to some average load. However, there is scarce research to support this assumption as being realistic. In this paper, we analyze the proportional loading (PL) approach and compare it to two linear models that use voltage and initial power flow as variables and are trained on the line limits of a real power network that we have access to. We compare these artificial line-limit methods using four tests: the ability to model true line limits, the damage done during an attack, the order in which edges are lost, and accuracy ranking the relative performance of different attack strategies. We find that the linear models are the top-performing method or are close to the top in all the tests we perform. In comparison, the tolerance value that produces the best PL limits changes depending on the test. The PL approach was a particularly poor fit when the line tolerance was less than two, which is the most commonly used value range in cascading failure research. We also find indications that the accuracy of modeling line limits does not indicate how well a model will represent grid collapse. The findings of this paper provide an understanding of the weaknesses of the PL approach and offer an alternative method of line-limit modeling.

Exposure to radon gas is the second leading cause of lung cancer worldwide behind smoking. Changing the energy characteristics of a dwelling can influence both its thermal and ventilative properties, which can affect indoor air quality. This study uses radon measurements made in 470 689 UK homes between 1980 and 2015, linked to dwelling information contained within the Home Energy Efficiency Database (HEED). The linked dataset, the largest of its kind, was used to analyze the association of housing and energy performance characteristics with indoor radon concentrations in the UK. The findings show that energy efficiency measures that increase the airtightness of properties are observed to have an adverse association with indoor radon levels. Homes with double glazing installed had radon measurements with a significantly higher geometric mean, 67% (95% CI: 44, 89) greater than those without a recorded fabric retrofit. Those with loft insulation (47%, 95% CI: 26, 69) and wall insulation (32%, 95% CI: 11, 53) were also found to have higher radon readings. Improving the energy performance of the UK's housing stock is vital in meeting carbon emission reduction targets. However, compromising indoor air quality must be avoided through careful assessment and implementation practices., (© 2019 The Authors. Indoor Air published by John Wiley & Sons Ltd.)

Introduction: There is a lack of evidence on the adverse effects of air pollution on cognition for people with air quality-related health conditions. We propose that educational attainment, as a proxy for cognition, may increase with improved air quality. This study will explore whether asthma and seasonal allergic rhinitis, when exacerbated by acute exposure to air pollution, is associated with educational attainment., Objective: To describe the preparation of individual and household-level linked environmental and health data for analysis within an anonymised safe haven. Also to introduce our statistical analysis plan for our study: COgnition, Respiratory Tract illness and Effects of eXposure (CORTEX)., Methods: We imported daily air pollution and aeroallergen data, and individual level education data into the SAIL databank, an anonymised safe haven for person-based records. We linked individual-level education, socioeconomic and health data to air quality data for home and school locations, creating tailored exposures for individuals across a city. We developed daily exposure data for all pupils in repeated cross sectional exam cohorts (2009-2015)., Conclusion: We have used the SAIL databank, an innovative, data safe haven to create individual-level exposures to air pollution and pollen for multiple daily home and school locations. The analysis platform will allow us to evaluate retrospectively the impact of air quality on attainment for multiple cross-sectional cohorts of pupils. Our methods will allow us to distinguish between the pollution impacts on educational attainment for pupils with and without respiratory health conditions. The results from this study will further our understanding of the effects of air quality and respiratory-related health conditions on cognition., Highlights: This city-wide study includes longitudinal routinely-recorded educational attainment data for all pupils taking exams over seven years;High spatial resolution air pollution data were linked within a privacy protected databank to obtain individual exposure at multiple daily locations;This study will use health data linked at the individual level to explore associations between air pollution, related morbidity, and educational attainment., Competing Interests: Competing interests: The authors declare that they have no competing interests.

Objectives: We examine if temperatures in winter in English homes meet the recommendation of being at least 18°C at all times. We analyse how many days meet this criterion and calculate the hours per day and night being at/above 18°C. These metrics are compared between households with occupants aged above 64 years or having a long-term disability (LTD) and those younger and without disability., Design: Cross-sectional, observational., Setting: England., Participants: 635 households., Outcomes Measures: (1) Mean temperatures, (2) proportion of days of the measurement period meeting the criterion, (3) average hours at/above 18°C, (4) average hours at night at/above 18°C., Results: Mean winter temperatures in the bedroom were M BR =18.15°C (SD=2.51), the living room M LR =18.90°C (SD=2.46) and the hallway M Hall =18.25°C (SD=2.57).The median number of days meeting the criterion was 19-31%. For the living room, more days meet the criterion in the group with a LTD (M disability =342 vs M no_disability =301, 95% CI 8 to 74), and with someone over 64 years present (M above64 =341, M below65 =301 95%, CI 8 to 74).The median number of hours/day meeting the criterion was 13-17. In the living room, households with a disability had more hours at 18°C (M disability =364, M no_disability =297, 95% CI 17 to 83) as did the older age group (M above64 =347, M below65 =296, 95% CI 18 to 84). In the hallway, more hours met the criterion in households with a disability (M disability =338, M no_disability =302, 95% CI 3 to 70).247 homes had at least nine hours of at least 18°C at night; no effect of age or disability., Conclusions: Many households are at risk of negative health outcomes because of temperatures below recommendations., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Hopes are high that removing fossil fuel subsidies could help to mitigate climate change by discouraging inefficient energy consumption and levelling the playing field for renewable energy. In September 2016, the G20 countries re-affirmed their 2009 commitment (at the G20 Leaders' Summit) to phase out fossil fuel subsidies and many national governments are using today's low oil prices as an opportunity to do so. In practical terms, this means abandoning policies that decrease the price of fossil fuels and electricity generated from fossil fuels to below normal market prices. However, whether the removal of subsidies, even if implemented worldwide, would have a large impact on climate change mitigation has not been systematically explored. Here we show that removing fossil fuel subsidies would have an unexpectedly small impact on global energy demand and carbon dioxide emissions and would not increase renewable energy use by 2030. Subsidy removal would reduce the carbon price necessary to stabilize greenhouse gas concentration at 550 parts per million by only 2-12 per cent under low oil prices. Removing subsidies in most regions would deliver smaller emission reductions than the Paris Agreement (2015) climate pledges and in some regions global subsidy removal may actually lead to an increase in emissions, owing to either coal replacing subsidized oil and natural gas or natural-gas use shifting from subsidizing, energy-exporting regions to non-subsidizing, importing regions. Our results show that subsidy removal would result in the largest CO 2 emission reductions in high-income oil- and gas-exporting regions, where the reductions would exceed the climate pledges of these regions and where subsidy removal would affect fewer people living below the poverty line than in lower-income regions.

The electricity consumption of 27 departments was measured across 8 medium to large General Acute hospitals in England (largely by the authors, some data was donated and authorised for publication by the respective hospitals). The departments fall into 6 different categories which have been selected due to their prevalence in General Acute Hospitals (wards), their high energy intensities (theatres, laboratories, imaging and radiotherapy) or their distinct operating hours (day clinics). This data article provides floor areas and the time series of departmental power loads, mostly encompassing lighting and small power (but excluding central electricity use for ventilation, pumping and medical gas services). Comparative interpretations of the data are published in doi: 10.1016/j.enbuild.2016.02.052 [1].

Background: The UK government has an ambitious goal to reduce carbon emissions from the housing stock through energy efficiency improvements. This single policy goal is a strong driver for change in the housing system, but comes with positive and negative "unintended consequences" across a broad range of outcomes for health, equity and environmental sustainability. The resulting policies are also already experiencing under-performance through a failure to consider housing as a complex system. This research aimed to move from considering disparate objectives of housing policies in isolation to mapping the links between environmental, economic, social and health outcomes as a complex system. We aimed to support a broad range of housing policy stakeholders to improve their understanding of housing as a complex system through a collaborative learning process., Methods: We used participatory system dynamics modelling to develop a qualitative causal theory linking housing, energy and wellbeing. Qualitative interviews were followed by two interactive workshops to develop the model, involving representatives from national and local government, housing industries, non-government organisations, communities and academia., Results: More than 50 stakeholders from 37 organisations participated. The process resulted in a shared understanding of wellbeing as it relates to housing; an agreed set of criteria against which to assess to future policy options; and a comprehensive set of causal loop diagrams describing the housing, energy and wellbeing system. The causal loop diagrams cover seven interconnected themes: community connection and quality of neighbourhoods; energy efficiency and climate change; fuel poverty and indoor temperature; household crowding; housing affordability; land ownership, value and development patterns; and ventilation and indoor air pollution., Conclusions: The collaborative learning process and the model have been useful for shifting the thinking of a wide range of housing stakeholders towards a more integrated approach to housing. The qualitative model has begun to improve the assessment of future policy options across a broad range of outcomes. Future work is needed to validate the model and increase its utility through computer simulation incorporating best quality data and evidence. Combining system dynamics modelling with other methods for weighing up policy options, as well as methods to support shifts in the conceptual frameworks underpinning policy, will be necessary to achieve shared housing goals across physical, mental, environmental, economic and social wellbeing.

Radical changes to current national energy systems-including energy efficiency and the decarbonization of electricity-will be required in order to meet challenging carbon emission reduction commitments. Technology explicit energy system optimization models (ESOMs) are widely used to define and assess such low-carbon pathways, but these models only account for the emissions associated with energy combustion and either do not account for or do not correctly allocate emissions arising from infrastructure, manufacturing, construction and transport associated with energy technologies and fuels. This paper addresses this shortcoming, through a hybrid approach that estimates the upstream CO2 emissions across current and future energy technologies for the UK using a multiregional environmentally extended input-output model, and explicitly models the direct and indirect CO2 emissions of energy supply and infrastructure technologies within a national ESOM (the UK TIMES model). Results indicate the large significance of nondomestic indirect emissions, particularly coming from fossil fuel imports, and finds that the marginal abatement cost of mitigating all emissions associated with UK energy supply is roughly double that of mitigating only direct emissions in 2050.

Objective: To assess potential public health impacts of changes to indoor air quality and temperature due to energy efficiency retrofits in English dwellings to meet 2030 carbon reduction targets., Design: Health impact modelling study., Setting: England., Participants: English household population., Intervention: Three retrofit scenarios were modelled: (1) fabric and ventilation retrofits installed assuming building regulations are met; (2) as with scenario (1) but with additional ventilation for homes at risk of poor ventilation; (3) as with scenario (1) but with no additional ventilation to illustrate the potential risk of weak regulations and non-compliance., Main Outcome: Primary outcomes were changes in quality adjusted life years (QALYs) over 50 years from cardiorespiratory diseases, lung cancer, asthma and common mental disorders due to changes in indoor air pollutants, including secondhand tobacco smoke, PM2.5 from indoor and outdoor sources, radon, mould, and indoor winter temperatures., Results: The modelling study estimates showed that scenario (1) resulted in positive effects on net mortality and morbidity of 2241 (95% credible intervals (CI) 2085 to 2397) QALYs per 10,000 persons over 50 years follow-up due to improved temperatures and reduced exposure to indoor pollutants, despite an increase in exposure to outdoor-generated particulate matter with a diameter of 2.5 μm or less (PM₂.₅). Scenario (2) resulted in a negative impact of -728 (95% CI -864 to -592) QALYs per 10,000 persons over 50 years due to an overall increase in indoor pollutant exposures. Scenario (3) resulted in -539 (95% CI -678 to -399) QALYs per 10,000 persons over 50 years follow-up due to an increase in indoor exposures despite the targeting of pollutants., Conclusions: If properly implemented alongside ventilation, energy efficiency retrofits in housing can improve health by reducing exposure to cold and air pollutants. Maximising the health benefits requires careful understanding of the balance of changes in pollutant exposures, highlighting the importance of ventilation to mitigate the risk of poor indoor air quality., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Low carbon energy technologies are not deployed in a social vacuum; there are a variety of complex ways in which people understand and engage with these technologies and the changing energy system overall. However, the role of the public's socio-environmental sensitivities to low carbon energy technologies and their responses to energy deployments does not receive much serious attention in planning decarbonisation pathways to 2050. Resistance to certain resources and technologies based on particular socio-environmental sensitivities would alter the portfolio of options available which could shape how the energy system achieves decarbonisation (the decarbonisation pathway) as well as affecting the cost and achievability of decarbonisation. Thus, this paper presents a series of three modelled scenarios which illustrate the way that a variety of socio-environmental sensitivities could impact the development of the energy system and the decarbonisation pathway. The scenarios represent risk aversion (DREAD) which avoids deployment of potentially unsafe large-scale technology, local protectionism (NIMBY) that constrains systems to their existing spatial footprint, and environmental awareness (ECO) where protection of natural resources is paramount. Very different solutions for all three sets of constraints are identified; some seem slightly implausible (DREAD) and all show increased cost (especially in ECO).