Migration: A Problem & Solution in the Face of Environmental Change

"Migration, in the face of environmental change, may not be just part of the problem but also part of the solution" (UK Government Office for Science, 2011:10). This essay examines the evidence behind this claim through an exploration of the problems commonly associated with migration and a demonstration of the notion that migration may constitute a solution to the challenges faced by affected communities by increasing their resilience in the face of environmental change

Governance through Economic Paradigms: Addressing Climate Change by Accounting for Health

"Climate change is a major challenge for sustainable development, impacting human health, wellbeing, security, and livelihoods. While the post-2015 development agenda sets out action on climate change as one of the Sustainable Development Goals, there is little provision on how this can be achieved in tandem with the desired economic progress and the required improvements in health and wellbeing. This paper examines synergies and tensions between the goals addressing climate change and economic progress. We identify reductionist approaches in economics, such as 'externalities', reliance on the metric of the Gross Domestic Product, positive discount rates, and short-term profit targets as some of the key sources of tensions between these goals. Such reductionist approaches could be addressed by intersectoral governance mechanisms. Health in All Policies, health-sensitive macro-economic progress indicators, and accounting for long-term and non-monetary values are some of the approaches that could be adapted and used in governance for the SDGs. Policy framing of climate change and similar issues should facilitate development of intersectoral governance approaches." (author's abstract

Household cereal crop harvest and children’s nutritional status in rural Burkina Faso

Background: Reduction of child undernutrition is one of the Sustainable Development Goals for 2030. Achievement of this goal may be made more difficult in some settings by climate change through adverse impact on agricultural productivity. However, there is only limited quantitative evidence on the link between household crop harvests and child nutrition. We examined this link in a largely subsistence farming population in rural Burkina Faso. Methods: Data on the middle-upper arm circumference (MUAC) of 975 children ≤5 years of age, household crop yields, and other parameters were obtained from the Nouna Health and Demographic Surveillance System. Multilevel modelling was used to assess the relationship between MUAC and the household crop harvest in the year 2009 estimated in terms of kilocalories per adult equivalent per day (kcal/ae/d). Results: Fourteen percent of children had a MUAC <125 mm (a value indicative of acute undernutrition). The relationship between MUAC and annual household food energy production adjusted for age, sex, month of MUAC measurement, household wealth, whether a household member had a non-agricultural occupation, garden produce, village infrastructure and market presence, suggested a decline in MUAC below around 3000 kcal/ae/d. The mean MUAC was 2.49 (95% CI 0.45, 4.52) mm less at 1000 than at 3000 kcal/ae/d. Conclusions: Low per capita household crop production is associated with poorer nutritional status of children in a rural farming population in Burkina Faso. This and similar populations may thus be vulnerable to the adverse effects of weather on agricultural harvest, especially in the context of climate change

Achieving good health with a low environmental footprint - A comparison of national indicators.

Background: Integrated metrics that account for resource use and human health are essential to help identify and support human development pathways that safeguard planetary health. We identify countries that achieved the highest levels of health and development at the lowest cost to Earth’s natural capital and report ecological within-country analyses of associations between indicators of environmental sustainability, human health, and development. Methods: We used mixed-effects multiple linear regression models of Healthy Life Expectancy (HALE) and Human Capital (HC) related to Ecological Footprint (EF) and CO2 production emissions, controlling for Gini coefficient and population density applied to data of 216 countries from 1991-2016. We performed stratified analyses by country income level and used likelihood-ratio tests to test for interaction. Results: Only Jamaica (1991) and Sri Lanka (2016) achieved high HALE at sustainable EF levels. Each 10% increase in EF was associated with 0·20 (95%CI 0·16,0·24) and 0·21 (95%CI 0·19,0·23) increases in HALE and HC respectively; increases in CO2 production emissions were also associated with increased HALE and HC. There was strong evidence for interaction by income level for each model (p<0·016). Stratified analyses showed that in high income nations HALE and HC decreased with increased levels of EF and CO2. Conclusions: Countries with high health metrics at sustainable EF levels may offer valuable lessons for sustainable national development policies. Increased environmental footprint and CO2 emissions appear associated with higher levels of human health and development only up to a certain level of income

Search strategy for "Quantifying the effectiveness and health co-benefits of climate change mitigation actions across sectors: a protocol for an umbrella review"

The search strategy was constructed for an umbrella review of systematic reviews, synthesising modelled and empirical evidence on such actions on climate change mitigation and health across all sectors and disciplines. The umbrella review is undertaken as a part of the Pathfinder Initiative (https://www.lshtm.ac.uk/research/centres-projects-groups/pathfinder-initiative

From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance

Background:Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities.Methods:Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed.Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance.Conclusion:The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed

Drought exposure as a risk factor for child undernutrition in low- and middle-income countries: A systematic review and assessment of empirical evidence.

BACKGROUND: Droughts affect around 52 million people globally each year, a figure that is likely to increase under climate change. OBJECTIVES: To assess the strength of empirical evidence on drought exposure as a risk factor for undernutrition in children <5?years of age in low- and middle-income countries (LMICs). METHODS: Systematic review of observational studies published between 1990 and 2018 in English and reporting undernutrition outcomes in children <5?years of age in relation to droughts in LMICs. The search was performed in the Global Health, Medline, Embase, and Scopus databases. We assessed the strength of evidence following the Navigation Guide. RESULTS: 27 studies met our inclusion criteria. 12 reported prevalence estimates in drought-affected conditions without comparison to unaffected conditions. These showed high prevalence of chronic and mixed undernutrition and poor to critical levels of acute undernutrition. Only two studies were judged to have low risk of bias. Overall, the strength of evidence of drought as a risk factor was found to be limited, but the two studies with low risk of bias suggested positive associations of drought exposure with children being underweight and having anaemia. CONCLUSION: Published evidence suggests high levels of all types of child undernutrition in drought-affected populations in low-income settings, but the extent to which these levels are attributable to drought has not been clearly quantified and may be context specific. This review offers suggestions for enhancing the quality of future studies to strengthen evidence on the potential magnitude, timing, and modifying factors of drought impacts

Designing a Planetary Health Watch: A System for Integrated Monitoring of the Health Effects of, and Responses to, Environmental Change

In the new geological epoch of the Anthropocene impacts of human activity on the Earth’s systems may pose major risks to human health. We propose the development of a Planetary Health Watch (PHW) system for integrated monitoring of health effects of, and responses to, global environmental changes. The PHW system will harness new capabilities emerging from the digital revolution to motivate and enable effective responses to threats posed by the transgression of planetary boundaries. It will build on the existing monitoring initiatives as a system aimed at integrated monitoring of environmental change, health effects, and intermediating factors along with the drivers of change and policy responses to protect health. In July 2019, we held a two-day engagement workshop at the Wellcome Trust in London, UK. We convened 59 experts, representatives of existing monitoring initiatives, and potential users of the system to discuss and make recommendations on key aspects of the design of such a system, particularly its scope, opportunities for building on existing initiatives, target users and use cases, strategies for generating impact and key communities for engagement. The scope of monitoring was defined by a framework integrating eight planetary boundaries (climate change, ocean acidification, atmospheric aerosol loading, novel entities, freshwater use, biogeochemical flows, land system change and biosphere integrity) with human health outcomes. (Discussion of the ninth boundary – ozone layer depletion – was omitted because the ozone hole is now healing as a result of the implementation of the Montreal protocol.) As the initial crosscutting areas for the prototype development of PHW, we selected cities, food systems, and links between land use change and human health (emerging diseases and air pollution) to act as foci for the discussion. To build on the existing monitoring efforts, PHW will purse three levels of integration: (1) across health and environmental monitoring, (2) across top down and bottom up monitoring approaches, (3) between advancing knowledge and action that can be taken to protect planetary health. Existing data platforms, large-scale initiatives and networks such as the Multi-Country Multi-City Collaborative Research Network, INDEPTH network of health and demographic surveillance sites in low- and middle-income countries, Resource Watch, Global Burden of Disease project, C40, Global Covenant of Mayors, Sustainable Development Solutions Network and many others will be essential to this process. PHW will aim to add to - the evidence on the emerging risks for human health and the most effective solutions by engaging researchers as a key user community; - awareness of the evidence on impacts and solutions by investing in an outreach strategy that includes clear messages, narratives, and strategically selected messengers; - action to protect planetary health by motivating and enabling decision-makers who influence relevant policies and their implementation across sectors to incorporate planetary health as a priority. The strategies for generating impact will include generation of clear messages comprised of both data and narratives compelling to the individual users, proposing solutions and engaging with those in power to implement them. Scientific oversight and inclusive governance processes will ensure the system’s credibility and legitimacy. The next steps involve engagement with key stakeholders, facilitation of new partnerships, and development of a long-term funding strategy