Cai, W

Gordon-Strachan, G

Lowe, R

Peña, SMH

Romanello, M

Tonne, C

van Daalen, KR

English

UCL Discovery

Correspondencewww.thelancet.com/public-health   Vol 8   April 2023 e255Challenges in tracking climate, health, and justice over time and large geographical areasIn their Comment in the Lancet Public Health, Panagiota Kotsila and Isabelle Anguelovski1 highlighted the importance of historical injustice and inequity relating to the health impacts of climate change, stressing the need to go beyond analysing susceptible populations as so-called monoliths and treating climate change as an equalising threat.1 We fully agree.Existing climate–health indicators aim to track historical and projected trends in climate-related health risks consistently and at different spatial scales to allow communication of complex climate–health trends in a more accessible format to inform research, advocacy, and decision making. However, the specific framework for tracking change in a measurable way across political boundaries is often restricted in its ability to encompass many aspects of justice. Although indicators are useful, other research and monitoring approaches (eg, qualitative data collection and case studies) can be better suited for analysing injustice in depth.The Lancet Countdown indicators often depend on publicly available data, collected for purposes other than addressing problems at the climate–health nexus.2–4 Where possible, the Lancet Countdown indicators are disaggregated by the UN Development Programme Human Development Index at the global level.3 Some indicators lend themselves to sex or gender disaggregation. However, the absence of (standardised) disaggregated health burden or population data (eg, by sex, gender, ethnicity, race, occupation, income, disability, and other social identifiers) is a major barrier to uncovering inequalities, inequities and injustices, between and within countries.2–4The Lancet Countdown regional centres in Asia,4 South America,5 Small Island Developing States, and Europe2 focus on the health implications of climate change, considering specific regional contexts. Health implications are considered in terms of exposure to, susceptibility to, and ability to cope with and recover from climate hazards and their health impacts, and responsibility for greenhouse gas emissions. The regional centres aim to continuously identify data gaps, including those needed to place justice adequately at the centre of their research.Europe is one of the major contributors to the climate crisis. Yet, other regions suffer the worst consequences and have less adaptive capacity. Therefore, the Lancet Countdown in Europe emphasises Europe’s global responsibility to climate action and the transition to low-carbon economies.2 Subsequent reports will include a crosscutting focus on inequalities, inequities and injustices by firstly providing indicators disaggregated across susceptible population groups underpinned by high-resolution European datasets, secondly discussing the equity context around each indicator, and lastly highlighting data gaps that hamper efforts to explore inequalities. In addition to innovating Lancet Countdown in Europe indicators, the related Horizon Europe projects CATALYSE and IDAlert are working to further understand underlying vulnerabilities and inequalities related to climate-health impacts, adaptation, and mitigation in Europe. For example, considering low-income households, populations on the move, gender minorities, and those with occupational climate hazard exposure, which, as Kotsila and Anguelovski1 point out, are often migrants with barriers to accessing health care.The Lancet Countdown2–5 aims to continuously improve data, methods, and communication approaches and welcomes proposals for new indicators and methodological innovations to capture the multiple dimensions of equity and justice at the intersection of climate change and health. The authors declare no competing interests.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. *Kim R van Daalen, Marina Romanello, Georgiana Gordon-Strachan, Stella M Hartinger Peña, Wenjia Cai, Cathryn Tonne, Rachel Lowekim.vandaalen@bsc.esBarcelona Supercomputing Center, Barcelona, Spain (KRvD, RL); British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care and Heart and Lung Research Institute, University of Cambridge, Cambridge, UK (KRvD); Institute for Global Health, University College London, London, UK (MR); Caribbean Institute of Health Research, University of the West Indies, Kingston, Jamaica (GG-S); Centro Latinoamericano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Perú (SMHP); Department of Earth System Science, Ministry of Education Key Laboratory for Earth System Modeling, Institute for Global Change Studies, Tsinghua University, Beijing, China (WC); Barcelona Institute for Global Health, and Universitat Pompeu Fabra, and CIBER Epidemiología y Salud Pública, Barcelona, Spain (CT); Centre on Climate Change and Planetary Health and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK (RL); Catalan Institution for Research and Advanced Studies, Barcelona, Spain (RL)1  Kotsila P, Anguelovski I. Justice should be at the centre of assessments of climate change impacts on health. Lancet Public Health 2023; 8: e11–12.2  van Daalen KR, Romanello M, Rocklöv J, et al. The 2022 Europe report of the Lancet Countdown on health and climate change: towards a climate resilient future. Lancet Public Health 2022; 7: e942–65.3  Romanello M, Di Napoli C, Drummond P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet 2022; 400: 1619–54.4  Cai W, Zhang C, Zhang S, et al. The 2022 China report of the Lancet Countdown on health and climate change: leveraging climate actions for healthy ageing. Lancet Public Health 2022; 7: e1073–90.5  Yglesias-González M, Palmeiro-Silva Y, Sergeeva M, et al. Code Red for Health response in Latin America and the Caribbean: enhancing peoples’ health through climate action. Lancet Reg Health Am 2022; 11: 100248.

Challenges in tracking climate, health, and justice over time and large geographical areas

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Challenges in tracking climate, health, and justice over time and large geographical areas

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