气候变化对人群健康影响评估方法的研究进展

气候变化可以通过多种途径直接或间接地影响人体健康,已成为21世纪人类健康最大的威胁.准确评估气候变化健康风险并提出针对性的适应策略和减缓措施已成为当务之急.本文系统收集和整理国内外气候变化健康风险研究,对气候变化健康风险评估方法进行综述,将其归纳为生态学分析法、面板数据分析法、灾害风险分析法、生态位分析法、机制分析法、...     

城乡基层医疗人员对气候变化及其健康风险认知的差异

目的探究基层医疗人员对气候变化及其健康风险认知的城乡差异。方法采用分层随机整群抽样,抽取广东省21家城区和10家乡镇基层医疗卫生机构的医疗人员进行问卷调查,收集其基本信息和对气候变化及其健康风险的认知情况,通过卡方检验、秩和检验和logistic逐步回归分析探究气候变化认知的城乡差异。结果63.8%(468/733)的基层医疗卫生人员认同气候变化正在发生,55.4%(406/733)的人认为气候变化主要归因于人类活动。城区卫生人员对气候变化正在发生的认同程度高于乡镇,而城区与乡镇对气候变化发生原因的认知差异不明显。城区人员在高温热浪的健康风险认知上略高于乡镇,而对于气候变化与传染病关联的认知略低于乡镇,但差异不具有统计学意义。乡镇人员识别气候变化脆弱人群的能力略高于城区,差异具有统计学意义。此外,职称级别越高越能感知气候变化健康风险;临床医生相比于护士和公共卫生人员更认同气候变化正在发生且更能识别其发生原因。结论城区基层医疗卫生人员在气候变化正在发生的认同程度上略高于乡镇,但是乡镇医疗卫生人员比城区的更能识别脆弱人群。城区与乡镇基层医疗卫生人员对气候变化及其健康风险认知均不容乐观,应积极采取措施提升风险认知以增强其应对气候变化健康风险的能力。     

城乡基层医疗人员对气候变化及其健康风险认知的差异

目的探究基层医疗人员对气候变化及其健康风险认知的城乡差异。方法采用分层随机整群抽样,抽取广东省21家城区和10家乡镇基层医疗卫生机构的医疗人员进行问卷调查,收集其基本信息和对气候变化及其健康风险的认知情况,通过卡方检验、秩和检验和logistic逐步回归分析探究气候变化认知的城乡差异。结果 63. 8%(468/733)的基层医疗卫生人员认同气候变化正在发生,55. 4%(406/733)的人认为气候变化主要归因于人类活动。城区卫生人员对气候变化正在发生的认同程度高于乡镇,而城区与乡镇对气候变化发生原因的认知差异不明显。城区人员在高温热浪的健康风险认知上略高于乡镇,而对于气候变化与传染病关联的认知略低于乡镇,但差异不具有统计学意义。乡镇人员识别气候变化脆弱人群的能力略高于城区,差异具有统计学意义。此外,职称级别越高越能感知气候变化健康风险;临床医生相比于护士和公共卫生人员更认同气候变化正在发生且更能识别其发生原因。结论城区基层医疗卫生人员在气候变化正在发生的认同程度上略高于乡镇,但是乡镇医疗卫生人员比城区的更能识别脆弱人群。城区与乡镇基层医疗卫生人员对气候变化及其健康风险认知均不容乐观,应积极采取措施提升风险认知以增强其应对气候变化健康风险的能力。     

应重视环境因素对儿童健康影响的研究

在过去的几十年中,我国儿童的健康水平有了很大提高,然而随着工业化、城市化和全球化的进程加快,由此带来新的健康问题逐渐成为儿科学的主要内容之一,突出表现在环境因素对儿童健康的影响.环境因素包括自然环境和社会环境两个方面.前者主要包括生态环境的恶化、环境污染、温室效应导致的全球气候变化等宏观环境因素,以及室内污染、儿童活动空间减少等微观环境因素.     

气候变化对人类环境与健康影响

气候变化对环境与健康的影响日益受到关注。该文分析了气候变化对大气环境、水环境和土壤环境的胁迫效应,并概述了气候变化对人体健康直接与间接影响的研究进展,气候变化对人类环境与健康的影响将是今后研究的重点,值得关注。     

气候变化下饮水安全及其健康影响因素进展

我国饮水问题比较突出,近年来因气候变化导致的极端天气事件发生的频率和强度有所增加,其可通过水源、水处理过程、供水系统、居民饮用水行为等环节影响水质和水量,加剧居民饮水安全和健康问题。在全球气候变化背景下,简述了其对各国不同地区饮水安全、水相关疾病及其适应性管理3方面的研究进展,分析了气候变化对饮水安全与居民健康的相互关系。指出影响饮水安全及其健康问题的主要气象因素有气温、降水量和蒸发量;同时,在干旱期或暴雨期,降水量比温度更易对水质、水量和健康产生负面影响,但不同微生物种类、季节和水源类型、居民饮水行为及社会因素会因气候变化的相互作用而使影响更为复杂。建议:需建立气候变化与饮水安全和居民健康影响的相互关系模型,在此基础上制定有效的水质风险评估和管理对策,对缓解气候变化导致的缺水地区居民饮水安全和健康问题起至关重要作用。     

气候变化对老年人群健康的影响分析

为了提高人们对气候变化与老年人群健康关系的认识,采用文献综述的方法,系统地回顾国内外气候变化对老年人产生的健康效应。分析气候变化下极端温度、极端气候、空气污染和气候敏感性传染病对老年人群产生的直接和间接健康影响,并根据老年人死因排序,重点围绕极端温度对心脑血管系统疾病和空气污染对呼吸系统疾病的影响、致病机理及对不同地区老年人发病率和死亡率的影响程度进行探讨。为推动健康老龄化,促进老年人群应对气候变化提出以下建议:一是积极支持气候变化纳入老年健康服务体系建设;二是提高老年人对气候变化影响健康的认知;三是加大研究支持力度,尤其是交叉学科研究。     

卫生系统应对气候变化脆弱性减缓评估基线调查

目的了解卫生管理人员对气候变化的观点、态度和建议,评价卫生系统脆弱性和适应性,探索气候变化与健康相关研究方法。方法召开座谈会,采用参与式进行评价的方式,应用H表格,对回答结果进行分值量化和分析评估。结果被调查卫生管理人员认为气候变化背景下人群健康的脆弱性严重,卫生系统适应气候变化的障碍也比较严重,对卫生系统持续、有效应对气候变化所带来的健康风险尚未达到比较有信心的程度,认为目前适应气候变化,保护公众健康的措施可持续性一般。结论有些明显受气候影响的健康威胁所提出的挑战已超越了公共卫生的应对范畴,应建立多级防护系统,进行多学科、多领域综合研究,积极应对气候变化对人群健康的威胁。     

未来气候变化对人类健康的潜在影响

未来气候变化对人类健康的潜在影响正在受到人们的普遍关注。对未来可能的气候变化对人类健康的各种直接和间接的潜在影响进行了综述,并简要介绍了气候变化对健康影响的评价方法。     

健康儿童护理的有效措施分析

健康儿童护理是通过发现可能对儿童健康产生不良影响的不利因素,因而采取的一些防范措施,从而确保儿童能够健康茁壮的成长,能够沿着理想的成长轨迹发育。传统的健康儿童护理措施有预防接种,健康儿童保健,儿童健康发育护理的专科护理。健康儿童护理可以预防和解决为大多数家长们所担忧的儿童正常发育和健康茁壮成长的问题提供保障和护理的依据。     

Climate change,women's workload in smallholder agriculture,and embodied political ecologies of undernutrition in northern Ghana

The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.     

Developing and implementing a targeted health-focused climate communications campaign in Ontario—#MakeItBetter

SettingPublic health practitioners are called to effectively communicate with the public on climate change. The climate crisis requires swift action that starts with public awareness of climate-related health impacts and leads to public support for individual, community and systemic actions to mitigate and adapt to climate change.InterventionThis paper discusses learnings about public opinion research and communication strategies and how a health-focused climate communication campaign—#MakeItBetter—could help to increase awareness and engage new audiences, including public health partners, in conversations about climate change in order to reduce climate-related health impacts for current and future generations. The #MakeItBetter campaign was grounded in evidence-informed messaging, being sensitive to health inequities. Emerging research and pre-campaign testing suggest that framing climate change as a health issue is a promising practice.OutcomesThe #MakeItBetter campaign appeals to parents/caregivers to learn more about climate-related health impacts, take protective action for children and support multi-level climate action. The campaign launch secured 89 news stories, including multicultural media coverage. Longer-term evaluation is required to determine the campaign’s effectiveness in building public support for climate action.ImplicationsAn innovative approach to climate communication that draws on the intersections between behavioural and climate sciences and engages in multi-sectoral collaboration can spur both climate action and health protection, aiding public health practitioners and partners in effectively communicating the urgency for climate action. More work is needed to support communication on climate change as an inequity multiplier and promote climate action and community resilience for health equity co-benefits.     

The debate on climate change and health in the context of ecological public health: a necessary corrective to Costello et al.'s ‘biggest global health threat’, or co-opted apologists for the neoliberal hegemony?

The threat posed to global health by climate change has been widely discussed internationally. The United Kingdom public health community seem to have accepted this as fact and have called for urgent action on climate change, often through state interventionist mitigation strategies and the adoption of a risk discourse. Putting aside the climate change deniers' arguments, there are critics of this position who seem to accept climate change as a fact but argue that the market and/or economic development should address the issue. Their view is that carbon reduction (mitigation) is a distraction, may be costly and is ineffective. They argue that what is required is more economic development and progress even if that means a warmer world. Both positions however accept the fact of growth based capitalism and thus fail to critique neoliberal market driven capitalism or posit an alternative political economy that eschews growth. Ecological public health, however, appears to be a way forward in addressing not only social determinants of health but also the political and ecological determinants. This might allow us to consider not just public health but also planetary health and health threats that arise from growth based capitalism.     

Integrating planetary health into healthcare: A document analysis

BackgroundAnthropogenic climate change poses a major health risk to humankind. The healthcare sector both contributes to climate change and is vulnerable to its impacts. Healthcare's greenhouse gas emissions are primarily derived from its supply chain: the production, transport, and disposal of goods.MethodsDocument analysis was used to investigate the workplace policies of one large, Western Canadian healthcare organization. Policies that indicated how employees should engage with resources were reviewed through the lens of environmentally responsible practice and planetary health. Content and thematic analysis were applied.ResultsFour themes were identified: procurement of resources, resource utilization, resource conservation, and waste management.ConclusionThere was little evidence of environmental or climate impact consideration within the organization's policies.ImplicationsHealthcare organizations could benefit from integrating a planetary health perspective into their policies to deliver healthcare that considers the health and safety of both humans and the climate.     

Community of practice: an effective mechanism to strengthen capacity in climate change and health

SettingClimate change is one of the greatest threats to global health in the twenty-first century and has recently been declared a health emergency. The lack of effective dissemination of emerging evidence on climate change health risks, effects, and innovative interventions to health professionals presents one of the greatest challenges to climate action today.InterventionTo identify and address the knowledge gaps at the intersection of health and climate change, the Canadian Coalition for Global Health Research (CCGHR) established a Working Group on Climate Change and Health (WGCCH). WGCCH is evolving organically into a community of practice (CoP) that aims to elevate knowledge brokering on climate change and health and expand to global multi-, inter-, and transdisciplinary realms.OutcomesTo date, the WGCCH established a regular webinar series to share expert knowledge from around the world on intersections between climate change and health, developed short summaries on climate change impacts on broad health challenges, supported young professional training, and enhanced climate health research capacity and skills through collegial network development and other collaborative projects that emerged from CoP activities.ImplicationsThis paper proposes that WGCCH may serve as an example of an effective strategy to address the lack of opportunities for collaborative engagement and mutual learning between health researchers and practitioners, other disciplines, and the general public. Our experiences and lessons learned provide opportunities to learn from the growing pains and successes of an emerging climate change and health-focused CoP.     

Global climate change and children's health: threats and strategies for prevention

Background

Global climate change will have multiple effects on human health. Vulnerable populations—children, the elderly, and the poor—will be disproportionately affected.

Objective

We reviewed projected impacts of climate change on children’s health, the pathways involved in these effects, and prevention strategies.

Data sources

We assessed primary studies, review articles, and organizational reports.

Data synthesis

Climate change is increasing the global burden of disease and in the year 2000 was responsible for > 150,000 deaths worldwide. Of this disease burden, 88% fell upon children. Documented health effects include changing ranges of vector-borne diseases such as malaria and dengue; increased diarrheal and respiratory disease; increased morbidity and mortality from extreme weather; changed exposures to toxic chemicals; worsened poverty; food and physical insecurity; and threats to human habitation. Heat-related health effects for which research is emerging include diminished school performance, increased rates of pregnancy complications, and renal effects. Stark variation in these outcomes is evident by geographic region and socioeconomic status, and these impacts will exacerbate health disparities. Prevention strategies to reduce health impacts of climate change include reduction of greenhouse gas emissions and adaptation through multiple public health interventions.

Conclusions

Further quantification of the effects of climate change on children’s health is needed globally and also at regional and local levels through enhanced monitoring of children’s environmental health and by tracking selected indicators. Climate change preparedness strategies need to be incorporated into public health programs.     

Turning the tide: The shift to climate change mitigation

In the United States, a growing number of companies are taking progressive steps to reduce greenhouse gas (GHG) emissions. Already, more than half of all Fortune 100 companies have announced clean energy targets, signaling climate change risk reduction is becoming a top priority. Climate change is not without controversy, yet it is a real business concern among corporate executives and health care leaders alike. From fears stoked by devastating wildfires in California to a rising tide of financial hardships due to hurricane flooding in the Southeast, it seems no region is immune to Mother Nature's growing cost to business. This report addresses how health care leaders are approaching climate change initiatives across the country by examining research articles, key opinion leaders, and health care organizations on the bleeding edge of climate change reduction. In an already complex industry, health care leaders have a special responsibility to do no harm to the patients they serve and a financial responsibility to drive monetary returns for invested stakeholders. Significant cost savings, long‐term risk reduction, and improved population health are a few of the benefits health care organizations around the country can gain from building a sound climate change mitigation strategy.     

Climate Change,Human Health,and Biomedical Research: Analysis of the National Institutes of Health Research Portfolio

Background: According to a wide variety of analyses and projections, the potential effects of global climate change on human health are large and diverse. The U.S. National Institutes of Health (NIH), through its basic, clinical, and population research portfolio of grants, has been increasing efforts to understand how the complex interrelationships among humans, ecosystems, climate, climate variability, and climate change affect domestic and global health.Objectives: In this commentary we present a systematic review and categorization of the fiscal year (FY) 2008 NIH climate and health research portfolio.Methods: A list of candidate climate and health projects funded from FY 2008 budget appropriations were identified and characterized based on their relevance to climate change and health and based on climate pathway, health impact, study type, and objective.Results: This analysis identified seven FY 2008 projects focused on climate change, 85 climate-related projects, and 706 projects that focused on disease areas associated with climate change but did not study those associations. Of the nearly 53,000 awards that NIH made in 2008, approximately 0.17% focused on or were related to climate.Conclusions: Given the nature and scale of the potential effects of climate change on human health and the degree of uncertainty that we have about these effects, we think that it is helpful for the NIH to engage in open discussions with science and policy communities about government-wide needs and opportunities in climate and health, and about how NIH’s strengths in human health research can contribute to understanding the health implications of global climate change. This internal review has been used to inform more recent initiatives by the NIH in climate and health.     

三城市公共卫生人员对气候变化健康影响的知识、态度、行为调查

目的了解我国公共卫生专业人员气候变化相关知识、态度和行为的现状。方法采用分层整群抽样的方法,抽取3个不同地理纬度城市28家公共卫生机构的795名业务科室工作人员作为调查对象,开展自我管理式问卷调查。结果气候变化知晓率84．4％,但对气候变化这一公共卫生问题的关注率仅为43．5％。69．1％可回答3项以上热浪期间慢病患者的注意事项;58．6％可回答5项及以上中暑发生的影响因素;71．1％可回答2项及以上中暑的急救措施。75％以上的调查对象对气候变化相关工作均持肯定态度,其中84．4％认为对公众开展适应气候变化的相关健康教育很重要,但仅38．5％调查对象曾经参加过适应气候变化保护人群健康的相关活动,55％曾在热浪期间宣传慢病防治知识。大众媒体是获取气候变化及健康影响相关知识的主要途径,专业培训及会议仅占35．8％。结论我国公共卫生人员在适应气候变化保护公众健康的能力方面亟待提高,适应气候变化保护人群健康方面的工作有待进一步加强。     

Stop ringing the alarm; it is time to get out of the building!

The volume of calls for governments and public health officials to take concerted action on climate change has become almost deafening. Public health researchers and practitioners need to look beyond what we know about the health impacts of climate change, to what we are doing as our part in contributing to holding global temperature rise to under 1.5°C. This commentary reflects on the common threads across the articles of a special section in this issue of the Canadian Journal of Public Health, “Moving on IPCC 1.5°C”, which sought examples of bold research and action advancing climate change mitigation and adaptation. Among the articles, there are signs that the public health community is gaining momentum in confronting the climate crisis. Three critical lessons emerged: the need for institutional change from the top of public health, the essential power of community in intersectoral action on climate change preparedness, and the importance of centring Indigenous wisdom to decolonize colonial legacy systems. We encourage readers to move public health research and practice from an instrumental relationship with nature to one of reverence and sacred reciprocity.