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The 2023 report of the Lancet Countdown on health and climate change: The imperative for a health-centred response in a world facing irreversible harms

Via The Lancet, a major report: The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. An excerpt from the executive summary:

The Lancet Countdown is an international research collaboration that independently monitors the evolving impacts of climate change on health, and the emerging health opportunities of climate action. In its eighth iteration, this 2023 report draws on the expertise of 114 scientists and health practitioners from 52 research institutions and UN agencies worldwide to provide its most comprehensive assessment yet.  

In 2022, the Lancet Countdown warned that people's health is at the mercy of fossil fuels and stressed the transformative opportunity of jointly tackling the concurrent climate change, energy, cost-of-living, and health crises for human health and wellbeing. This year's report finds few signs of such progress. At the current 10-year mean heating of 1·14°C above pre-industrial levels, climate change is increasingly impacting the health and survival of people worldwide, and projections show these risks could worsen steeply with further inaction. However, with health matters gaining prominence in climate change negotiations, this report highlights new opportunities to deliver health-promoting climate change action and a safe and thriving future for all.

The rising health toll of a changing climate

In 2023, the world saw the highest global temperatures in over 100 000 years, and heat records were broken in all continents through 2022. Adults older than 65 years and infants younger than 1 year, for whom extreme heat can be particularly life-threatening, are now exposed to twice as many heatwave days as they would have experienced in 1986–2005 (indicator 1.1.2). Harnessing the rapidly advancing science of detection and attribution, new analysis shows that over 60% of the days that reached health-threatening high temperatures in 2020 were made more than twice as likely to occur due to anthropogenic climate change (indicator 1.1.5); and heat-related deaths of people older than 65 years increased by 85% compared with 1990–2000, substantially higher than the 38% increase that would have been expected had temperatures not changed (indicator 1.1.5).

 

Simultaneously, climate change is damaging the natural and human systems on which people rely for good health. The global land area affected by extreme drought increased from 18% in 1951–60 to 47% in 2013–22 (indicator 1.2.2), jeopardising water security, sanitation, and food production. A higher frequency of heatwaves and droughts in 2021 was associated with 127 million more people experiencing moderate or severe food insecurity compared with 1981–2010 (indicator 1.4), putting millions of people at risk of malnutrition and potentially irreversible health effects. The changing climatic conditions are also putting more populations at risk of life-threatening infectious diseases, such as dengue, malaria, vibriosis, and West Nile virus (indicator 1.3).

 

Compounding these direct health impacts, the economic losses associated with global heating increasingly harm livelihoods, limit resilience, and restrict the funds available to tackle climate change. Economic losses from extreme weather events increased by 23% between 2010–14 and 2018–22, amounting to US$264 billion in 2022 alone (indicator 4.1.1), whereas heat exposure led to global potential income losses worth $863 billion (indicators 1.1.4 and 4.1.3). Labour capacity loss resulting from heat exposure affected low and medium Human Development Index (HDI) countries the most, exacerbating global inequities, with potential income losses equivalent to 6·1% and 3·8% of their gross domestic product (GDP), respectively (indicator 4.1.3).

 

The multiple and simultaneously rising risks of climate change are amplifying global health inequities and threatening the very foundations of human health. Health systems are increasingly strained, and 27% of surveyed cities declared concerns over their health systems being overwhelmed by the impacts of climate change (indicator 2.1.3). Often due to scarce financial resources and low technical and human capacity, the countries most vulnerable to climate impacts also face the most challenges in achieving adaptation progress, reflecting the human risks of an unjust transition. Only 44% of low HDI countries and 54% of medium HDI countries reported high implementation of health emergency management capacities in 2022, compared with 85% of very high HDI countries (indicator 2.2.5). Additionally, low and medium HDI countries had the highest proportion of cities not intending to undertake a climate change risk assessment in 2021 (12%; indicator 2.1.3).

 

These inequalities are aggravated by the persistent failure of the wealthiest countries to deliver the promised modest annual sum of $100 billion to support climate action in those countries defined as developing within the UN Framework Convention on Climate Change. Consequently, those countries that have historically contributed the least to climate change are bearing the brunt of its health impacts—both a reflection and a direct consequence of the structural inequities that lie within the root causes of climate change.

Delhi air pollution spikes to 100 times WHO health limit

India Today

Via The Guardian: Delhi air pollution spikes to 100 times WHO health limit. Excerpt:

Air quality in Delhi hit severe levels on Friday and a thick toxic smog cloaked the city, marking the beginning of a pollution season that has become an annual catastrophe for India’s capital.  

Schools were shut and non-essential construction was banned around Delhi as the air quality index in the city almost hit 500 – the highest the measurement will go and 100 times the limit deemed to be healthy by the World Health Organization. 

Air quality in the city had deteriorated over the past week, attributed to a sharp rise in farmers in the neighbouring states of Haryana and Punjab burning their fields during the crop planting season, compounded by winds that carried the pollutants into Delhi and a drop in temperatures trapping the particles.  

On Sunday, the state of Punjab saw a 740% increase in farm fires, with more than a thousand recorded in a single day. Other causes of pollution in the city are car emissions, construction and the burning of rubbish at waste plants.  

Delhi, home to about 33 million people, is regularly ranked the most polluted city in the world. According to this year’s air quality life index, compiled by the University of Chicago’s energy policy institute, the people of Delhi could have their lives shortened by 11.9 years due to the poor air they breathe.  

Doctors in Delhi said they had begun to see the damaging impacts of pollution on the city’s residents. “The number of patients with breathing problems has increased, with more people having coughs, colds, watery and irritated eyes, and breathing problems. People of all ages are affected by this. It is time for us to wear masks and go out only when needed,” said Nikhil Modi, a doctor at Apollo hospital in Delhi.

AQLI: Annual Update, August 2023

Via the Air Quality Life Index: August 2023 Annual Update. Click or tap through to download the full report and nation fact sheets. The summary:

Air pollution is the greatest external threat to human life expectancy on the planet. The AQLI’s latest 2021 data reveals that permanently reducing global PM2.5 air pollution to meet the World Health Organization (WHO) guideline would add 2.3 years onto average human life expectancy—or a combined 17.8 billion life years saved. 

The impact of PM2.5 on global life expectancy is comparable to that of smoking, more than 3 times that of alcohol use and unsafe water, more than 5 times that of transport injuries like car crashes, and more than 7 times that of HIV/AIDS.

Even low levels of air pollution can damage health, study finds

Via The Guardian: Even low levels of air pollution can damage health, study finds. Excerpt:

A study in one of the cleanest countries in the world could help governments think about future ways to manage air pollution.  

Abundant data from London’s infamous 1952 smog onwards tells us that breathing high concentrations of air pollution harms our health. This feeds into the 20th-century idea of targets for the quality of our air. However, the new study looked at the health harm from air pollution from another angle.  

Census records for more than 7 million Canadians from between 1981 and 2016 were combined with air pollution data to find out if small amounts of particle pollution were still harmful.  

Despite the relatively clean air, the study found that nearly 8,000 Canadians were dying early each year from outdoor air pollution. Notably, even people in the cleanest areas were experiencing an impact on their health.  

Air pollution harm was seen at concentrations that were at about one half of the latest World Health Organization guideline and at just quarter of the 2040 target proposed for England.  

The Canadian study was one of three funded by the US Health Effects Institute. The other two looked at more than 60 million people in the US and 27 million people in Europe. They reached similar conclusions: there is no lower limit that can be used to define safe air quality. This means governments should not constrain their ambition around setting targets for the worst air that people should breathe.  

Prof Michael Brauer from the University of British Columbia, who led the Canadian study, said: “These findings suggest important health benefits could be gained from continued reductions in air pollution and more stringent regulatory standards, including in countries such as Canada and the UK.  

“Considering that we don’t identify a ‘safe’ level of air pollution, we should rethink our approach and focus on continued reductions year by year, rather than just setting fixed concentration standards that are only reviewed every five to 10 years. The health impacts are far too large.”

AQLI Update: Most of the world breathes unsafe air, taking more than 2 years off global life expectancy

Via AQLI: AQLI Update: Most of the World Breathes Unsafe Air, Taking More Than 2 Years Off Global Life Expectancy. Click or tap through to download the full report. Excerpt:

Particulate pollution remained high even while Covid-19 slowed the global economy. At the same time, mounting evidence on the health impacts of pollution at low levels led to new guidelines that brought most of the world into the unsafe zone. 

During the first year of the Covid-19 pandemic, the world’s economy slowed. Yet, the global annual average particulate pollution (PM2.5) was largely unchanged from 2019 levels. At the same time, growing evidence shows air pollution—even when experienced at very low levels—hurts human health. This recently led the World Health Organization (WHO) to revise its guideline (from 10 µg/m³ to 5 µg/m³) for what it considers a safe level of exposure of particulate pollution, bringing most of the world—97.3 percent of the global population—into the unsafe zone.  

The Air Quality Life Index (AQLI) finds that particulate air pollution takes 2.2 years off global average life expectancy, or a combined 17 billion life-years, relative to a world that met the WHO guideline (5 µg/m3). This impact on life expectancy is comparable to that of smoking, more than three times that of alcohol use and unsafe water, six times that of HIV/AIDS, and 89 times that of conflict and terrorism.

Tonga: Volcanic eruption and tsunami

Via ReliefWeb, a UNICEF news release: Tonga: Volcanic Eruption and Tsunami - Jan 2022. Several others are available on the website. Excerpt:

After weeks of volcanic activity emitting ash, the Hunga Tonga Hunga Ha’apai underwater volcano in Tonga erupted violently on 15 January. The eruption is said to be one of the biggest in Tonga in the last 30 years, with satellite imagery indicating a 5 km wide plume of ash, steam, and gas, rising approximately 20 km above the volcano. 

The volcanic eruption generated a 1.2-metre tsunami that crashed ashore in coastal areas of Tonga’s capital, Nuku’alofa. The estimated population within 100 km of the volcano is 76,000 people. [...]  

Tonga has been blanketed by 1-2 cm of volcanic ash, affecting the majority of the country and impacting on water and food supplies. Air quality is also of concern. Power has been disrupted, and communications with Tonga are a challenge as regular phone lines are down, the internet cable from Fiji to Tonga seems to have been damaged, and satellite phones are only working intermittently.  

Alert level 4 remains active for the volcano, meaning that eruption hazards are confined to areas near or around the volcano. 

Long-term exposure to air pollution and COVID-19 incidence: A prospective study of residents in the city of Varese, Northern Italy

Via Occupational and Environmental Medicine: Long-term exposure to air pollution and COVID-19 incidence: a prospective study of residents in the city of Varese, Northern Italy. The abstract:

Objectives 

To investigate the association between long-term exposure to airborne pollutants and the incidence of SARS-CoV-2 up to March 2021 in a prospective study of residents in Varese city.  

Methods  

Citizens of Varese aged ≥18 years as of 31 December 2019 were linked by residential address to 2018 average annual exposure to outdoor concentrations of PM2.5, PM10, NO2, NO and ozone modelled using the Flexible Air quality Regional Model (FARM) chemical transport model. Citizens were further linked to regional datasets for COVID-19 case ascertainment (positive nasopharyngeal swab specimens) and to define age, sex, living in a residential care home, population density and comorbidities. We estimated rate ratios and additional numbers of cases per 1 µg/m3 increase in air pollutants from single- and bi-pollutant Poisson regression models.  

Results  

The 62 848 residents generated 4408 cases. Yearly average PM2.5 exposure was 12.5 µg/m3. Age, living in a residential care home, history of stroke and medications for diabetes, hypertension and obstructive airway diseases were independently associated with COVID-19. In single-pollutant multivariate models, PM2.5 was associated with a 5.1% increase in the rate of COVID-19 (95% CI 2.7% to 7.5%), corresponding to 294 additional cases per 100 000 person-years. The association was confirmed in bi-pollutant models; excluding subjects in residential care homes; and further adjusting for area-based indicators of socioeconomic level and use of public transportation. Similar findings were observed for PM10, NO2 and NO. Ozone was associated with a 2% decrease in disease rate, the association being reversed in bi-pollutant models.  

Conclusions  

Long-term exposure to low levels of air pollutants, especially PM2.5, increased the incidence of COVID-19. The causality warrants confirmation in future studies; meanwhile, government efforts to further reduce air pollution should continue.

Consumption in the G20 nations causes particulate air pollution resulting in two million premature deaths annually

Via Nature Communications: Consumption in the G20 nations causes particulate air pollution resulting in two million premature deaths annually. The abstract:

Worldwide exposure to ambient PM2.5 causes over 4 million premature deaths annually. As most of these deaths are in developing countries, without internationally coordinated efforts this polarized situation will continue. As yet, however, no studies have quantified nation-to-nation consumer responsibility for global mortality due to both primary and secondary PM2.5 particles. 

Here we quantify the global footprint of PM2.5-driven premature deaths for the 19 G20 nations in a position to lead such efforts. G20 consumption in 2010 was responsible for 1.983 [95% Confidence Interval: 1.685–2.285] million premature deaths, at an average age of 67, including 78.6 [71.5–84.8] thousand infant deaths, implying that the G20 lifetime consumption of about 28 [24–33] people claims one life. 

Our results indicate that G20 nations should take responsibility for their footprint rather than focusing solely on transboundary air pollution, as this would expand opportunities for reducing PM2.5-driven premature mortality. Given the infant mortality footprint identified, it would moreover contribute to ensuring infant lives are not unfairly left behind in countries like South Africa, which have a weak relationship with G20 nations.

Air pollution—time to address the silent killer

An editorial in The Lancet Air Pollution: Air pollution—time to address the silent killer.

On Sept 21, 2021, WHO published their new Air Quality Guidelines—a welcome update on the previous report from 2005—where they recommend new air quality levels for the six main pollutants (CO, lead, NO2, O3, PM, and SO2). Meeting these new levels is likely to be a challenge without substantive buy-in from governments globally, especially as pollutant projections worldwide are set to increase.  

As one of the biggest environmental contributors to poor health, air pollution has led to 7 million premature deaths globally each year. In 2017, it was reported that more than 90% of the global population lived in areas where the concentration of particulate matter (PM)2.5 was higher than the WHO recommended (2005) annual mean of 10 μg/m3—accounting for 12% of all deaths that same year. If the 2021 guidelines had been implemented in 2016, it is estimated that 3·3 million deaths in the WHO European region alone could have been prevented. If the levels proposed in the latest update of the guidelines are met, the burden of disease related to air pollution could be reduced by 80%.  

Emerging evidence of the health effects of air pollution is not only increasing in quality, but is also becoming more inclusive, with a wider array of countries represented and more low-income and middle-income countries (LMICs) contributing to the body of research. When it comes to the harms of air pollution, the lungs are first line of defence. Studies have shown associations of high levels of air pollutants with poor lung growth in early life, development of asthma, inflammation of airways, increased respiratory infections, and impaired lung function.  

Pollutants cause production of reactive oxygen species (oxidative stress) and reactive nitrogen species in the body, which in turn promote pathogenic pathways leading to inflammation, cell death, and mitochondrial dysfunction, among others. Sustained exposure to air pollutants bombards the lung's natural defences and culminates in lung injury and disease. Damage from pollutants does not stop at the lungs; direct or indirect damage to other organs can also occur. For example, acute myocardial infarction is associated with increased pollutant concentrations in the previous few days or hours.  

In Europe, steps are being taken to tackle the issue of pollution. The European Commission has agreed to a deal—the European Green Deal—which states that Europe will aim to be the first climate neutral continent in the world. The deal, made in December, 2019, revised the European Commission's air quality standards to align more closely with the 2005 WHO guidelines; however, the new WHO guidelines show that current European standards will not be enough to improve air quality to levels that have a meaningful impact on health. Only when the new, evidence-based guidelines are followed—and are legally binding—will Europe be able to meet its goal. 

Although ambient air pollution affects both developed and developing countries, LMICs have the highest burden in terms of adverse effects on health. WHO Western Pacific and South-East Asia regions bear the brunt of this burden. If there is to be a truly global commitment to reduce the burden of air pollution, the differing threats between regions need to be taken into account, and approaches must be adaptable and sustainable to best suit these regions and the people living there. Health inequalities must also be considered in any policies put in place.  

Governments and policy makers should be encouraged to agree to legally binding standards to facilitate responsibility and accountability. Without such measures, air quality and health could be deprioritised, as happened with the 2005 standards set by WHO. Campaigns that educate on the connection between air pollution and health and that mobilise people to make change will encourage individuals to consider steps that they can take to improve their health via improving air quality—whether that be decisions on a personal level or putting pressure on their governments to meet standards set.  

The health sector can also help to raise awareness. Respiratory clinicians could be at the forefront of educating their patients on the risks of air pollution. Although personal steps are welcome, government- and corporate-level change is needed to make significant inroads into climate change and air pollution. 

The WHO Air Quality Guidelines have been published at an appropriate time, just before COP26. With an opportunity to implement real change as world leaders meet, we hope that the new guidelines will be carefully considered, and air pollution and its associated respiratory health burden pushed to the forefront of health policy agendas. The silent killer can no longer be ignored.

Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders

Via The British Journal of Psychiatry: Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders: retrospective cohort study. The abstract:

Background 

Growing evidence suggests that air pollution exposure may adversely affect the brain and increase risk for psychiatric disorders such as schizophrenia and depression. However, little is known about the potential role of air pollution in severity and relapse following illness onset. 

Aims 

To examine the longitudinal association between residential air pollution exposure and mental health service use (an indicator of illness severity and relapse) among individuals with first presentations of psychotic and mood disorders. 

Method 

We identified individuals aged ≥15 years who had first contact with the South London and Maudsley NHS Foundation Trust for psychotic and mood disorders in 2008–2012 (n = 13 887). High-resolution (20 × 20 m) estimates of nitrogen dioxide (NO2), nitrogen oxides (NOx) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. In-patient days and community mental health service (CMHS) events were recorded over 1-year and 7-year follow-up periods. 

Results 

Following covariate adjustment, interquartile range increases in NO2, NOx and PM2.5 were associated with 18% (95% CI 5–34%), 18% (95% CI 5–34%) and 11% (95% CI 3–19%) increased risk for in-patient days after 1 year. Similarly, interquartile range increases in NO2, NOx, PM2.5 and PM10 were associated with 32% (95% CI 25–38%), 31% (95% CI 24–37%), 7% (95% CI 4–11%) and 9% (95% CI 5–14%) increased risk for CMHS events after 1 year. Associations persisted after 7 years. 

Conclusions 

Residential air pollution exposure is associated with increased mental health service use among people recently diagnosed with psychotic and mood disorders. Assuming causality, interventions to reduce air pollution exposure could improve mental health prognoses and reduce healthcare costs.

See also this Guardian report on the study.