Health professionals have a crucial role to play in educating the public and advocating with policymakers about the human health relevance of climate change. Here, we review 93 studies published between the years 2000–2023 on the roles health professionals can play in addressing climate change as a health issue, their knowledge of and concern about the issue, their willingness to engage with the issue, barriers they perceive to that engagement, and strategies to overcome these challenges. Overall, we found health professionals have a growing understanding of and concern about climate change's impacts on human health and are interested in communicating about the issue and advocating for climate and health solutions. Continued efforts are needed to develop effective programming and resources to help activate, train, and support health professionals as trusted voices on the issue.
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Environmental Research: Health is a multidisciplinary, open access journal devoted to addressing important global challenges at the interface of the environment and public health in a way that bridges scientific progress and assessment with efforts relating to impact/future risks, resilience, mitigation, adaptation, security and solutions in the broadest sense. All research methodologies are encouraged comprehensively covering qualitative, quantitative, experimental, theoretical and applied approaches; exposure assessments; implementation studies; and policy analysis. For detailed information about subject coverage see the About the journal section.
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Eryn Campbell et al 2025 Environ. Res.: Health 3 012002
Jonathan J Buonocore et al 2023 Environ. Res.: Health 1 021006
Oil and gas production is one of the largest emitters of methane, a potent greenhouse gas and a significant contributor of air pollution emissions. While research on methane emissions from oil and gas production has grown rapidly, there is comparatively limited information on the distribution of impacts of this sector on air quality and associated health impacts. Understanding the contribution of air quality and health impacts of oil and gas can be useful for designing mitigation strategies. Here we assess air quality and human health impacts associated with ozone, fine particulate matter, and nitrogen dioxide from the oil and gas sector in the US in 2016, and compare this impact with that of the associated methane emissions. We find that air pollution in 2016 from the oil and gas sector in the US resulted in 410 000 asthma exacerbations, 2200 new cases of childhood asthma and 7500 excess deaths, with $77 billion in total health impacts. NO2 was the highest contributor to health impacts (37%) followed by ozone (35%), and then PM2.5 (28%). When monetized, these air quality health impacts of oil and gas production exceeded estimated climate impact costs from methane leakage by a factor of 3. These impacts add to the total life cycle impacts of oil and gas, and represent potential additional health benefits of strategies that reduce consumption of oil and gas. Policies to reduce oil and gas production emissions will lead to additional and significant health benefits from co-pollutant reductions that are not currently quantified or monetized.
Liv Yoon et al 2025 Environ. Res.: Health 3 015011
Extreme heat events present significant health risks, particularly for populations facing systemic marginalization. Through interviews and FGs with 63 (n = 60 residents; n = 3 service providers (SP)) participants, this paper explores the barriers and opportunities related to access and use of cooling centres from both user and provider perspectives, as well as broader implications for addressing vulnerability to extreme heat in the metro Vancouver region of British Columbia, Canada. Initially focused on cooling centres, our research expanded to include the complexities of individual and systemic responses to heat, highlighting the complex interplay between personal preferences and structural barriers. Key barriers to cooling centre usage reported by participants included concerns over safety, hygiene, stigma, lack of information, and infrastructural challenges such as transportation. SPs faced constraints with staffing, limited hours, and underutilization of additional services. Tensions emerged between individual, do-it-yourself (DIY) approaches and collective solutions, with participants seeking agency in their choices while acknowledging the need for improved, community-based interventions. The study also uncovered the unintended effects of inclusivity, as the presence of individuals who use substances or are unhoused in cooling spaces deterred some potential users, underscoring the challenges of designing universally accessible services. Broader systemic issues, such as housing security and the quality of indoor environments, further intersected with vulnerability to extreme heat, exacerbating risks for those opting to stay at home. The paper recommends leveraging existing public spaces, enhancing social networks, improving tenant protections, and fostering 'right to cool' initiatives to balance immediate relief with long-term systemic reform, particularly around the rental housing crisis and tenant insecurity. By addressing both individual and collective needs, this approach can mitigate the health impacts of extreme heat while promoting greater equity and resilience.
Jennifer D Stowell et al 2025 Environ. Res.: Health 3 015002
The threats to human health from wildfires and wildfire smoke (WFS) in the United States (US) are increasing due to continued climate change. A growing body of literature has documented important adverse health effects of WFS exposure, but there is insufficient evidence regarding how risk related to WFS exposure varies across individual or community level characteristics. To address this evidence gap, we utilized a large nationwide database of healthcare utilization claims for emergency department (ED) visits in California across multiple wildfire seasons (May through November, 2012–2019) and quantified the health impacts of fine particulate matter <2.5 μm (PM2.5) air pollution attributable to WFS, overall and among subgroups of the population. We aggregated daily counts of ED visits to the level of the Zip Code Tabulation Area (ZCTA) and used a time-stratified case-crossover design and distributed lag non-linear models to estimate the association between WFS and relative risk of ED visits. We further assessed how the association with WFS varied across subgroups defined by age, race, social vulnerability, and residential air conditioning (AC) prevalence. Over a 7 day period, PM2.5 from WFS was associated with elevated risk of ED visits for all causes (1.04% (0.32%, 1.71%)), non-accidental causes (2.93% (2.16%, 3.70%)), and respiratory disease (15.17% (12.86%, 17.52%)), but not with ED visits for cardiovascular diseases (1.06% (−1.88%, 4.08%)). Analysis across subgroups revealed potential differences in susceptibility by age, race, and AC prevalence, but not across subgroups defined by ZCTA-level Social Vulnerability Index scores. These results suggest that PM2.5 from WFS is associated with higher rates of all cause, non-accidental, and respiratory ED visits with important heterogeneity across certain subgroups. Notably, lower availability of residential AC was associated with higher health risks related to wildfire activity.
Brian Naess et al 2025 Environ. Res.: Health 3 011001
Increased electrification of the transportation sector promises to both decrease emissions from the largest sector source of greenhouse gases as well as improve health through better air quality. The objective of this study is to evaluate the distribution of air quality health benefits of Medium- and Heavy-Duty Electric Vehicle (MHDEV) policies in New York City (NYC), quantifying differences across neighborhoods (census tracts) and population subgroups (race, ethnicity). We ran an integrated model for a 2040 baseline/business-as-usual scenario and for two policy scenarios simulating different rates of MHDEV adoption, also for 2040. Changes in air quality (fine particulate matter (PM2.5) and nitrogen dioxide (NO2)) and health and economic benefits were calculated for the two policy scenarios. We used a modified version of our previously developed ZIP Code-Level Air Pollution Policy Assessment tool which integrates two reduced form models: the Community Air Quality Tools and the Co-Benefits Risk Assessment Health Impacts Screening and Mapping Tool. Our air quality modeling employed a novel receptor network to capture sharp gradients due to medium- and heavy-duty vehicle (MHDV) emissions in the densely populated NYC region. We find that electrification of MHDVs would have substantial air pollution and health benefits for NYC, with full on-road electrification of MHDVs saving $2.4 billion in health costs in 2040, including the prevention of 248 deaths and 173 childhood asthma emergency departments visits. We find that NO2 benefits contributed between 85% and 97% of the total health benefits, emphasizing its importance for on-road health studies. We find that most health benefits would occur in neighborhoods with the highest percentage of historically marginalized populations, including substantial benefits to Hispanic populations.
Mitchell Snyder et al 2025 Environ. Res.: Health 3 015008
Wildfires are impacting communities globally, with California wildfires often breaking records of size and destructiveness. Knowing how communities are affected by these wildfires is vital to understanding recovery. We sought to identify impacted communities' post-wildfire needs and characterize how those needs change over time. The WHAT-Now study deployed a survey that was made publicly available for communities affected by the October 2017 Northern California wildfires or the accompanying smoke at beginning approximately four months post-fire with the vast majority completed by nine months post-fire. Among other questions, the survey asked an adult household member to report on their households' greatest need both one-week post-fire and at the time of survey. A total of 1461 households responded to these questions. Households reported many types of needs, with 154 responses that did not directly name needs but rather described how their households had been affected, which we classified as impacts. Four major themes were identified: physical, health, air, and information, each representing an array of varied specific needs or impacts. Physical needs (e.g. housing, food) were the most common (cited by more than 50% during the fires and about a third at the time of survey). The need for clean air was strong during the fires, but not months later, at the time of survey. In contrast, health needs were reported by a quarter of households during the fires. Needs that were reported at both times were categorized as 'persistent', and there were more persistent mental health needs over time compared to other health themes. Understanding the needs and impacts that arise during wildfires, their diversity and duration, and how they change over time is crucial to identifying types of assistance that are most needed during recovery efforts and when they are needed. Results presented here along with other wildfire needs assessments can be utilized to improve disaster preparedness, including for wildfire recovery.
Natalie Herbert et al 2025 Environ. Res.: Health 3 011002
Compounding hazards are becoming more common due to global environmental change. To build societal resilience, there is a need to focus on how people are made vulnerable by our social, political, and economic systems that turn hazards into disasters. Incremental adaptation, often piecemeal and hazard-specific actions, will be insufficient for keeping pace with the rapid global environmental changes already underway. Instead, transformative adaptation is necessary for meeting this need, although the pathways for how to create transformative as opposed to incremental change through individual action and social systems are challenging. These challenges for climate adaptation are on display in rural American Indian Tribal Nations, including the Tule River Indian Reservation, the site of this co-produced research. The Reservation is rural and isolated, and many of the 2000 members manage chronic health conditions like diabetes alongside increasing wildfire and wildfire smoke, extreme heat, drought, and flooding hazards. We ask: how do emergency managers and health practitioners on the Reservation characterize hazards and the vulnerabilities of the people they serve, and how do these understandings determine viable pathways for adaptation to support community health? We interviewed 16 practitioners with expertise in emergency management and health care services on the Tule River Indian Reservation. Using a grounded theory approach to analyze practitioner interviews, our article makes two major contributions. First, we identify a conceptual framework by which practitioners connect people to each other and to place, from place to compounding hazards, and from vulnerabilities to hazard management strategies. Second, our conceptual framework illustrates the incremental-transformative adaptation tension. Most adaptation strategies under consideration or implemented are incremental in nature and hazard-specific. Yet, we demonstrate how action at earlier points in the framework could promise transformative adaptation, addressing the disconnection between people, place, and infrastructure in ways that incremental adaptation actions cannot.
Yaning Miao et al 2025 Environ. Res.: Health 3 015006
Windblown dust is an ongoing air quality and public health concern among residents living around California's Salton Sea, a region characterized by critical socioeconomic and health outcome disparities. Dropping water levels and unique biogeochemistry at the Salton Sea have raised concerns regarding the human health impacts of drying sediments exposed on shrinking shorelines, as well as potential lake spray emissions from the water surface itself. As particles emitted from different surface types can differ greatly in terms of composition, size distribution, and other properties, variability in the resulting health impacts of windblown particulates reaching communities in the region may likewise be source dependent. However, these potential effects remain understudied. Here we use observed coarse particulate matter (PMc) concentrations and modeled atmospheric back trajectories along with land surface data to estimate individual source region contributions to particulates observed at long term surface air quality monitoring sites in the Salton Sea region. We then apply these data products to an analysis of source-specific acute cardio-respiratory impacts using a time-stratified case crossover design with conditional logistic regression based on 171 465 hospitalizations cases recorded from 2008 to 2019. To assess source-specific health impacts, we quantify and compare the acute health effects of dust arriving from different directions and from over different source surfaces on daily respiratory and cardiovascular hospitalizations. Using a remote sensing chlorophyll-a data product, we further investigate the possible influence of periodic bloom events—a result of ongoing nutrient loading into the Salton Sea—on those hospitalizations. Results suggest that a 10 μg m−3 increase in coarse PM coming from over the Salton Sea is associated with an 8.6% (Risk Ratio, RR = 1.086, 95% CI: 1.028–1.147) increased risk of respiratory hospital admissions; increases that are greater than those for dust likely originating from other surface types. Furthermore, we find even higher RR values for dust associated with Salton Sea back trajectories during bloom events: a 24.9% (RR = 1.249 95% CI: 1.031–1.514) increased risk in respiratory hospitalization. Our findings suggest that exposure to dust and aerosols potentially originating from the Salton Sea or surrounding surfaces is associated with increased respiratory hospitalizations, especially during observed bloom events. Further research is needed to determine the underlying mechanisms responsible for these health impacts, as well as possible primary or secondary preventive strategies.
Suellen Hopfer et al 2024 Environ. Res.: Health 2 035013
Families in unincorporated communities in Southern California's Eastern Coachella Valley (ECV) increasingly experience the burden of repeat wildfires and smoke. This study describes their lived wildfire and smoke experiences, health impacts, unique community-level inequities that compound wildfire risk and air quality effects, communication preferences, and resource needs for future wildfire preparedness. A wildfire community vulnerability framework informed the focus group discussion guide, exploring individual, community, and local government level factors that potentially influence community response and mitigation behaviors to repeat wildfire and smoke. Ten focus groups with 118 participants occurred in spring 2023 with four communities in ECV, California. Findings center on narratives of acute wildfire-related experiences, including evacuation and burned trailer homes, acute and chronic self report physical and mental health impacts of wildfires and smoke, daily life disruptions, staying indoors for protection, and local interactions described as a community strength in responding to fires. Participants from unincorporated, low-income, and monolingual Spanish-speaking communities predominantly consisting of farm workers requested greater emergency preparedness and response information, training and education in Spanish, postfire resources, lower trash service fees, increased enforcement of illegal dumping and burning, and use of multimodal and bilingual communication channels for wildfire, smoke, and wind alerts.
Rukun K S Khalaf et al 2025 Environ. Res.: Health 3 012001
The benefits of green and blue space (GBS) exposure on improving public health are accepted by a range of stakeholders, including policy makers. Extensive GBS research into health supports the theory that GBS promotes physical activity and has mental restorative and environmental mitigative properties. Studies exploring the impact of GBS exposure on maternal, prenatal, and/or neonatal health have mainly utilised cross-sectional methods. This does not allow for causal inference. Thus, our systematic review aimed to analyse the evidence of the impact of GBS on maternal, prenatal, and/or neonatal health. Our study adhered to PRISMA guidelines. We searched seven online databases (Medline, Scopus, Web of Science, PsycInfo, Embase, Environment Complete, and Maternity & Infant Care Database) and excluded cross-sectional studies without mediation analysis. Our risk of bias assessment framework was adapted from the ROBINS-E tool. We conducted narrative syntheses of studies examining maternal, prenatal, and/or neonatal outcomes. We carried out meta-analyses using random effects models for five birth outcomes (i.e. birthweight, low birthweight (LBW), gestational age, pre-term birth (PTB), and small-for-gestational-age (SGA)). Studies found to be high risk of bias, or very high risk of bias were excluded from our analyses. Initial searches yielded 1099 articles. Following full text screening, our review included 62 studies. Most studies were conducted in either Europe or North America (n = 41, 66%). All studies reported green space exposure as an independent variable while seven studies also included blue space exposure as an independent variable. The most reported green space variable was the Normalized Difference Vegetation Index (NDVI) (n = 46, 74%). Our meta-analyses results indicated that greater greenness is protective against LBW (OR = 0.95, 95% CI: 0.92–0.98, p = 0.002), SGA (OR = 0.95, 95% CI: 0.92–0.99, p = 0.01), PTB (OR = 0.92, 95% CI: 0.88–0.97, p = 0.001), and affects birthweight (β = 13.02 g, 95% CI: 9.99–16.05, p < 0.0001).
Marie-Claire Meadows et al 2025 Environ. Res.: Health 3 025005
As climate change intensifies, hurricanes and weather-related disasters have been increasingly frequent and severe, impacting regions like the U.S. Gulf Coast with repeated hurricanes. While acute and short-term health impacts are well-described, impacts on longer-term and chronic conditions such as hypertension remain underexplored. This study examines the association between repeated hurricane exposure and hypertension risk in survivors. We used data from the Resilience in Survivors of Katrina project, a longitudinal (2003–2018) cohort of predominantly Black, low-income mothers affected by Hurricane Katrina. A sample of 505 women who were not hypertensive pre-Katrina was analyzed. Cumulative exposure was defined as the number of hurricanes experienced post-Katrina, assessed at several survey waves over 12 years. Logistic regression estimated associations between hurricane exposure and hypertension in 2016–18, with mediation analyses exploring the indirect effect via psychological distress (PD). In adjusted models, exposure to two hurricanes was associated with a 61% increase in hypertension odds (OR = 1.61, 95% CI: 1.00, 2.63) and exposure to three or more with 87% increased odds (OR = 1.87, 95% CI: 1.01, 3.47), relative to exposure to only one hurricane. The indirect effect from hurricane exposure to hypertension via PD was statically significant (95% CI: 1.01, 1.09). Findings highlight a novel link between cumulative disaster exposure and hypertension, with PD as a potential mediator. This suggests that repeated exposure to hurricanes not only impacts mental health but may also contribute to adverse physical health outcomes. Addressing both mental and physical health in disaster response, especially for vulnerable populations, is crucial.
Jiana Wu et al 2025 Environ. Res.: Health 3 025004
Earlier definitions of noise sensitivity implicitly presupposed that some sounds can objectively be defined as noise and that some people are intrinsically more sensitive to it. Moreover, noise sensitivity has typically been thought to moderate the relationship between noise exposure and the feeling of annoyance. This cannot be true though, because the experience of sound as noise is subjective. We therefore suggest that noise sensitivity is actually the process whereby a sound is identified as noise. Using semi-structured interviews, this paper presents the results of a qualitative study focusing on the factors related to noise sensitivity, forming the basis of a revised model of noise sensitivity. Study participants were asked to share their thoughts and experiences of being sensitive to noise. Based on their responses, a thematic analysis was used to generate themes related to noise sensitivity. New factors such as masking and perceived control over the sound emerged and were incorporated into the model. The model was also modified by explicitly adopting the terminology 'low road' and 'high road' to describe inputs from the limbic system and the cortex, respectively. The revised model elucidates the potential mechanisms underlying the experience of noise, thereby providing avenues for reducing the level of harm to those who experience it.
Gabriella Y Meltzer et al 2025 Environ. Res.: Health 3 025003
Quantifying how hurricanes disrupt educational attainment is essential to evaluating the burden of climate-related disasters. Here, we examine the association between hurricane-force tropical cyclones and educational attainment among elementary and middle school students in all affected areas in the United States during the 2008/2009–2017/2018 school years. Educational performance was based on county-level average standardized test scores in math and reading/language arts (RLAs). Hurricane-force tropical cyclone-exposed counties were those that experienced a sustained maximal wind speed ⩾64 knots. We estimated the association between hurricane-force tropical cyclone exposure and long-term test scores using a Bayesian hierarchical linear model, accounting for time-varying covariates at the county and grade cohort level. For hurricane-exposed counties, compared with the rest of the state, there were better test scores in Florida in math (β = 0.14; 95% CrI: 0.02, 0.26; PP[β > 0] = 99.0%) and RLA (β = 0.11; 95% CrI: 0.02, 0.22; PP[β > 0] = 99.2%), and worse math scores in North Carolina (β = −0.16; 95% CrI: −0.29, −0.03; PP[β < 0] = 99.4%). Grade cohorts with more racialized and minoritized (e.g. Black, Hispanic, Indigenous) and socioeconomically disadvantaged students tended to have lower test scores, while grade cohorts with greater shares of students racialized as Asian and counties with more college-educated adults tended to have higher scores regardless of hurricane exposure. Disaster preparedness must maximize resilience to climate-related stressors' impacts on academic achievement, especially for vulnerable populations.
Yeongjin Gwon et al 2025 Environ. Res.: Health 3 025002
Drought is a complex climate phenomenon that varies regionally and temporally across the globe. Its frequency and intensity are expected to increase due to climate change, posing significant threats to human health. Despite these risks, there remains a notable gap in research on the health impacts of drought, particularly at the regional level within the United States. This study aims at assessing the risk of severe drought exposure to respiratory mortality in the Upper Midwest of the United States among the general population and at-risk subgroups from 2000 to 2018. Respiratory mortality was obtained for each county and month during study period based on the 10th International Classification of Disease codes. We used the Evaporative Demand Drought Index categorized into three levels and analyzed it at two timescales: 6 months and 12 months. A Bayesian two-stage time-series modeling approach was applied to estimate the county-level and overall risk along with the 95% Credible Intervals (Cr). Stratification analyses were conducted by age group, gender, race, urbanicity, and state within the region. Statistically significant associations were identified between respiratory mortality and the severe droughts. The estimated risks were 1.151 (95% Cr: 1.126–1.178) and 1.092 (95% Cr: 1.063–1.120) for the 6 and 12 month severe droughts. Our study suggests that the risks differs by subgroups: elevated risks in elderly (higher 14.4% and 9.8% for 6 and 12 month), White (15.1% and 9.0% higher for 6 and 12 month), males (12.7% and 5.1% higher for 6 and 12 month), females (15.8% and 11.1% higher for 6 and 12 month), urban 15.8% and 8.8% higher for 6 and 12 month), and rural (13.6% and 9.9% higher for 6 and 12 month) communities. Iowa showed the greatest increase (23.1%) in the 6 month severe drought, while Minnesota had the highest 20.3% in the 12 month severe drought. Our findings suggested that the elderly, both males and females, both rural and urban areas were the most affected subgroups. These findings demonstrate the need for policymakers and communities to adopt more effective drought mitigation strategies in this region.
Isabella Lenihan-Ikin et al 2025 Environ. Res.: Health 3 021002
This paper interrogates the utility of a just transition framework for climate change and human wellbeing in the context of Aotearoa New Zealand. Drawing on historical conceptualisations and applications of just transitions, their limitations and potential, we argue that an expansive and anti-reductionist conceptualisation of the just transition is best suited to address complex and inter-sectoral issues across time and space. Expansive just transitions are characterised by four features; relationality, systems-thinking, place-based and inter-generational approaches, where emancipation is held as the overarching objective. While we argue in favour of an expansive and anti-reductionist just transition framework being employed in the face of complex issues, such as the human wellbeing impacts of climate change, we introduce the concept of a just transformation: achieving true equity and justice in the face of climate change requires a transformative approach, situated outside of the confines of the hegemonic economic system and linear transitions. Transformations and not transitions are required for the health and wellbeing outcomes desired amidst threats of climate change.
Jean-François Guégan et al 2025 Environ. Res.: Health 3 012003
Despite recent interest in land-use and land-cover (LULC) change effects on emerging infectious diseases (EIDs), the debate on global potential health threats remains polarizing. These depend on diverse LULC changes, different types of infectious disease systems, and spatio-temporal scales of studies. Here, using both a bibliometric and scoping review method, we summarize the reliability and availability of published relevant studies on LULC effects on mycobacteria, an important group of infectious bacteria that affect humans and both wild and domestic animals. We make connections of LULC with environmental changes (e.g. soils) that likely lead to an increased risk of mycobacteria spillover to human and other animal populations. An important feature of our review is a focus on research from the richest countries of the world, though some studies have been done in Africa, Asia and South America. Geographically, regions experiencing important LULC transformations, such as many tropical regions of Meso- and South America and Southeast Asia, have been given little or no attention in this important topic. Research on Mycobacterium bovis, and to a larger extent on M. ulcerans, constitutes convincing illustrations of the importance of acknowledging shifts in spatio-temporal scales, from local to global and inter-annual to decadal ones, when evaluating responses of mycobacteria to LULC changes. However, studies on other pathogenic mycobacteria remain very much confined to local and dispersed scales. To date, the role of LULC change effects has not been adequately studied for many human and animal pathogens, and more research and attention to this issue is clearly needed. This review provides a comprehensive set of data on the updates of LULC change and their impact on animal and human mycobacterial infections. It also proposes several research recommendations, in particular to better understand the emergence of mycobacteria in context, by multiplying study sites in different regions of the world and in adopting an ecosystem-based perspective, in order to encourage interdisciplinary research better linking environmental microbiology, veterinary science and medical research.
Eryn Campbell et al 2025 Environ. Res.: Health 3 012002
Health professionals have a crucial role to play in educating the public and advocating with policymakers about the human health relevance of climate change. Here, we review 93 studies published between the years 2000–2023 on the roles health professionals can play in addressing climate change as a health issue, their knowledge of and concern about the issue, their willingness to engage with the issue, barriers they perceive to that engagement, and strategies to overcome these challenges. Overall, we found health professionals have a growing understanding of and concern about climate change's impacts on human health and are interested in communicating about the issue and advocating for climate and health solutions. Continued efforts are needed to develop effective programming and resources to help activate, train, and support health professionals as trusted voices on the issue.
Rukun K S Khalaf et al 2025 Environ. Res.: Health 3 012001
The benefits of green and blue space (GBS) exposure on improving public health are accepted by a range of stakeholders, including policy makers. Extensive GBS research into health supports the theory that GBS promotes physical activity and has mental restorative and environmental mitigative properties. Studies exploring the impact of GBS exposure on maternal, prenatal, and/or neonatal health have mainly utilised cross-sectional methods. This does not allow for causal inference. Thus, our systematic review aimed to analyse the evidence of the impact of GBS on maternal, prenatal, and/or neonatal health. Our study adhered to PRISMA guidelines. We searched seven online databases (Medline, Scopus, Web of Science, PsycInfo, Embase, Environment Complete, and Maternity & Infant Care Database) and excluded cross-sectional studies without mediation analysis. Our risk of bias assessment framework was adapted from the ROBINS-E tool. We conducted narrative syntheses of studies examining maternal, prenatal, and/or neonatal outcomes. We carried out meta-analyses using random effects models for five birth outcomes (i.e. birthweight, low birthweight (LBW), gestational age, pre-term birth (PTB), and small-for-gestational-age (SGA)). Studies found to be high risk of bias, or very high risk of bias were excluded from our analyses. Initial searches yielded 1099 articles. Following full text screening, our review included 62 studies. Most studies were conducted in either Europe or North America (n = 41, 66%). All studies reported green space exposure as an independent variable while seven studies also included blue space exposure as an independent variable. The most reported green space variable was the Normalized Difference Vegetation Index (NDVI) (n = 46, 74%). Our meta-analyses results indicated that greater greenness is protective against LBW (OR = 0.95, 95% CI: 0.92–0.98, p = 0.002), SGA (OR = 0.95, 95% CI: 0.92–0.99, p = 0.01), PTB (OR = 0.92, 95% CI: 0.88–0.97, p = 0.001), and affects birthweight (β = 13.02 g, 95% CI: 9.99–16.05, p < 0.0001).
Raksha Pandya-Wood et al 2024 Environ. Res.: Health 2 032002
In Malaysia, climate change typically manifests as frequent and extreme weather events. The effects on human health of such meteorological and ecological imbalances are multiple and diverse. Urgent attention is needed to address the health-related threats facing Malaysia as a result of climate change. This systematic review (SR) of available evidence adopted Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and identified and assessed a broad range of English language empirical, published research and excluded grey literature. Bias and quality of articles was assessed using Mixed Methods Assessment Tool. Using the search engines Scopus, PubMed, Ovid EMBASE, Web of Science, and EBSCO Host Medline, n = 374 results were yielded. Of these, after checking, n = 23 studies were examined. The studies can be grouped into three climatic themes Exposure, Outcomes and Planning. Our review confirms that urgent funding and investment is needed for larger-scale intervention studies on each of these themes. We observed a scarcity of high-quality empirical research, a preponderance of modelling studies to project and simulate scenarios, and a limited number of qualitative studies. Particular gaps in knowledge exist on climate change impacts on health in population groups in terms of demographic intersections to support these epidemiological data and simulation pathways. Furthermore, there was an absence of data on various topics concerning the effects of climate change on, for example, mental health, women, older people and/or the effects of displacement. The limitations of this work include accepting only English language publications and presenting only empirical studies. The study was not funded but was managed by the Monash Climate Change Communication Research node. This SR was registered on PROSPERO ID: CRD42023431868.
Sophie Glover et al 2024 Environ. Res.: Health 2 032001
Urban green and blue spaces (UGBSs) have been found to have health-enhancing properties (e.g. promotion of physical activity, improved social connectedness, and stress reduction). We examined the associations between UGBSs and cognitive function and aimed to identify any mechanistic pathways involving UGBSs and cognitive function. The initial search of four databases (MEDLINE, Embase, PSYCHInfo, and Web of Science) yielded 4838 studies when duplicates were removed to undergo abstract screening. Following abstract and full text screening, the included studies were classified as 'observational' (proximity to UGBSs, n = 28/35) or 'interventional' (n = 7/35). Of the included studies, 71.4% (n = 24/28) of 'observational' studies and 57.1% (n = 4/7) of 'interventional' studies found positive associations indicating that UGBSs are beneficial for cognitive function (i.e. enhance cognitive function, lower risk of cognitive impairment, or protect cognitive function). Overall, 71.4% (n = 20/35) of studies included within this review were considered to have a medium risk of bias. Current studies have identified relationships between UGBSs and cognitive function; however, further work is required globally to broaden our understanding and provide a reliable evidence base. Current literature has elucidated numerous mechanistic pathways by which UGBSs have the capacity to operate, including attention restoration theory and stress reduction theory. Advancing the evidence for the mechanistic pathways between UGBSs and cognitive function is required. This may advise future UGBS policies to improve the health and well-being of both the environment and the globally ageing population.
Olonilua et al
In this literature review, the critical role of coping strategies in enhancing mental health and resilience among disaster survivors is examined. Natural disasters, such as hurricanes, earthquakes, wildfires, tsunamis and floods, have been known to inflict significant psychological distress on affected populations. Similarly, man-made disasters, such as terrorist attacks, civil wars and industrial accidents, can lead to lasting mental health challenges for survivors. The focus of this paper is primarily on coping strategies and their impact on mental health and resilience among those affected by disasters. A comprehensive search was conducted using academic databases, including PubMed, PsycINFO, Web of Science, Scopus and Google Scholar, to gather peer-reviewed articles published in recent times. Search terms such as "coping strategies," "mental health," "resilience," "disaster survivors," "natural disasters" and "man-made disasters" were utilized to refine the search results. A total of 210 articles were initially identified, and 30 articles were retained for further review based on their methodological rigor, relevance to the topic and diversity of coping strategies examined. This study found that problem-focused, emotion-focused, social support and avoidance coping are crucial for understanding how to mitigate psychological distress and promote recovery after disasters. Additionally, it identified several other coping strategies, including mindfulness-based practices, cognitive-behavioral therapy (CBT), cultural coping and proactive coping. The novel contribution of this review lies in its emphasis on the intersection of coping strategies with diverse disaster experiences, offering implications for tailored public health interventions. This study is not only timely but also relevant given the increasing frequency of both natural and man-made disasters, and the growing recognition of the need for effective mental health strategies in disaster response and recovery.
Cummins
As a response to the well-documented projects for how anthropogenic climate change (ACC) will negatively impact human health, health and bioethics scholars have argued for the urgency of mitigating ecological damage healthcare systems cause. Mitigation is not the only focus because ACC is already affecting health. Under current plans to reduce emissions, the sixth Intergovernmental Panel on Climate Change (IPCC) predicts warming to exceed safe levels. Climate health scholars have begun to advocate for climate change adaptation (CCA) as it is essential to anticipate and prepare for how extreme ACC will affect health. CCA strategies that emphasize continuity of operation in the face of extreme weather events dominate. These plan project the future climate to be much like the present one, just worse, and assume an unwarranted future of climate stability. Recent scientific evidence indicate ACC is accelerating faster than climate models predicted. We may be moving from an era of climate stability to an era of instability. The dominance of CCA in preparing for ACC will, at best, preserve the status quo for population health at the expense of envisioning initiatives to help all people live healthier lives in a radically changed world. To prepare for an unstable climate future, healthcare should adopt a stance of climate change resilience (CCR) that prioritizes public health initiatives to secure healthier lives among a broader population segment.
Keil
Purpose
This systematized literature review aims to assess reporting units used by hospital LCAs to communicate their environmental impact through life-cycle assessment. As the healthcare sector increasingly prioritizes sustainability, understanding the choice of reporting unit is crucial. This analysis aims to provide recommendations for effective communication of environmental performance.
Method
A systematized literature search was conducted for life-cycle assessments and carbon footprint studies of healthcare organizations or systems in the databases PubMed and Web of Science. The identified units were analyzed using seven criteria, including the differentiation between input and output flows, treatment complexities, quantity of provided services, quality of provided services, longevity of services, matching with system boundaries, and data availability.
Results
Seven reporting flows were identified: (i) floor area, (ii) number of beds, (iii) workforce, (iv) expenditure, (v) patient load, (vi) revenue, and (vii) the diagnosis-related groups case mix. Each flow has its own advantages and disadvantages; the best reporting flow for an assessment depends on the specific goals and objectives and should be meaningful to stakeholders. However, none of the reporting flows measure the actual function of healthcare organizations, i.e., the impact on the health of the patients. However, data on this flow, such as quality-adjusted life years, are not available in a meaningful quantity.
Conclusions
In conclusion, this literature review highlights the importance of reporting unit selection in communicating the environmental impact of healthcare organizations through life-cycle assessment. The present analysis identified seven reporting flows, each with its own advantages and disadvantages. These findings are of importance for decision makers to contextualize given data and to choose the most suitable reporting flow for their own assessment. Future research might evaluate the quantitative impact of the reporting flow decision.
Locke et al
Background: The United States (U.S.) healthcare sector—a significant contributor to climate change through emissions, pollution, and waste—is beginning to integrate sustainability into operations. Sustainability science and accounting have been widely adopted across other industries to measure and communicate progress. Transparency, defined as ensuring accurate reporting and open disclosure of sustainability data, is critical. Without it, organizations risk "greenwashing," where misleading claims can erode public trust and undermine sustainability efforts.

Objectives: This scoping review evaluates the extent to which U.S. healthcare literature addresses transparency as a critical component of sustainability initiatives.

Methods: This review identified peer-reviewed and non-peer-reviewed literature on environmental sustainability within U.S. healthcare from 1994 to 2024, with a focus on transparency and related concepts. Articles were excluded if they were not in English, corporate reports, advertisements, or irrelevant to U.S. healthcare sustainability. The following databases were searched: Ovid MEDLINE, Nexis Uni, Business Source Complete, Scopus, and Health Care Administration. Two independent reviewers screened and extracted the data, with a third resolving disagreements. Qualitative and thematic analyses were employed to assess if and how transparency was defined and operationalized in the context of healthcare sustainability.

Results: Of the 835 articles screened, 33 met inclusion criteria. Only 10 of the 33 articles both defined and operationalized transparency. Key focus areas included environmental sustainability practices in healthcare (n=18, 55%); ESG or CSR and public health impact (n=18, 55%); the business of healthcare (n=8, 24%); and policy-driven sustainability initiatives (n=7, 21%). Barriers included absence of mandates, standardization, and leadership.

Conclusions: Despite a growing body of research on healthcare sustainability, studies addressing transparency are sparse. Limitations include a narrow keyword focus and limited databases searched. Transparent reporting could be considered the sixth "R" in the 5 Rs of sustainability–refuse, reduce, reuse, recycle, repurpose, and report.