There is scientific consensus that the global climate is changing, with rising surface temperatures, melting ice and snow, rising sea levels, and increasing climate variability. These changes are expected to have substantial impacts on human health. There are known, effective public health responses for many of these impacts, but the scope, timeline, and complexity of climate change are unprecedented. We propose a public health approach to climate change, based on the essential public health services, that extends to both clinical and population health services and emphasizes the coordination of government agencies (federal, state, and local), academia, the private sector, and nongovernmental organizations.

/pdf/climate-change-the-public-health-response-q8yxmt6vj5.pdf

Climate Change: The Public Health Response

Summary Background Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Funding Bill & Melinda Gates Foundation.

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

In order to avoid unnecessary costs when you seek health care services, it’s important to be familiar with your health insurance policy. Read your health insurance policy carefully so that you know what your plan covers and does not cover, and which doctors, hospitals, and pharmacies are in your insurance plan’s network. If you are enrolled in U-M’s International Student/Scholar Health Insurance Plan (Blue Care Network), visit the U-M International Center's Health Insurance [1] section for more information. Review the Benefits and Wellness section of the U-M Human Resources website if you are enrolled in GradCare [2] or in one of U-M’s faculty/staff health insurance plans [3]. If you have a different insurance plan, consult that plan’s website.

Health Care.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61257-4.pdf

Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change

The Global Burden of Disease Study (GBD) began 30 years ago with the goal of providing timely, valid and relevant assessments of critical health outcomes. Over this period, the GBD has become progressively more granular. The latest iteration provides assessments of thousands of outcomes for diseases, injuries and risk factors in more than 200 countries and territories and at the subnational level in more than 20 countries. The GBD is now produced by an active collaboration of over 8,000 scientists and analysts from more than 150 countries. With each GBD iteration, the data, data processing and methods used for data synthesis have evolved, with the goal of enhancing transparency and comparability of measurements and communicating various sources of uncertainty. The GBD has many limitations, but it remains a dynamic, iterative and rigorous attempt to provide meaningful health measurement to a wide range of stakeholders. 

/pdf/the-global-burden-of-disease-study-at-30-years-1tk8bpn2.pdf

The Global Burden of Disease Study at 30 years

Education and debate p 865 

Why should British and other western doctors be interested in the World Bank? This week's BMJ includes the first of Kamran Abbasi's articles on the World Bank (p 865),1 yet with health system reforms, performance reviews, racism in health, plummeting morale, and continued underfunding, haven't we got enough to occupy us? Yes, but what of the plight of the 1.3 billion people living in absolute poverty on less than $1 a day? Their health is as abysmal as their wealth, and until their poverty is relieved their health will not improve. The World Bank's mission statement is “to reduce poverty, and improve living standards by promoting sustainable growth and investment in people.”2 For health workers concerned with the pathology and relief of poverty, knowledge about the bank is as important as anatomy is to surgeons.

Like the Christian churches in the nineteenth century, the bank has enormous influence in former colonies. It helps set, fund, and …

https://www.bmj.com/content/bmj/318/7187/822.full.pdf

The World Bank: Friend or foe to the poor?

Health professionals must act to tackle climate change

Environmentally friendly policies may feel like a low priority among the many pressures in a busy professional life, but promoting carbon rationing could be your most important contribution to patients9 health

https://www.bmj.com/content/bmj/332/7554/1385.full.pdf

Healthy response to climate change

Doctors and climate change.

One of the two duties of a doctor laid down by the General Medical Council of the United Kingdom is “to protect and promote the health of . . . the public.”1 Should this duty extend to working to prevent climate change? We believe it should.

Climate change leads to the extinction of species. During the past 500 million years—a mere 10th of the world's history—five major and many minor events have caused extinctions. The last major event eliminated the dinosaurs 65 million years ago. An extraterrestrial object 10 km in diameter slammed into what is now the Yucatan peninsula, Mexico. It caused firestorms, a tsunami 1 km high, planet wide darkness for months, and an extended period of carbon dioxide induced global warming. Within a few months of the event, the 150 million year reign of the dinosaurs was over, and the space for mammalian evolution was created.2

The present climate related extinction event, so far a minor one, is caused by humans. Excessive amounts of carbon dioxide are being poured into the atmosphere as a result of human activity, even though we know what the consequences will be. These consequences are starkly spelt out in the latest Intergovernmental Panel on Climate Change and Stern reports.3 4

Alterations in food production, with expected decreases in areas already under stress; rises in sea levels; the spread of vector borne disease; and water shortages are already aggravating health problems, particularly in poor countries. The impact of climate change will get much worse, and predictions of a hundred million climate refugees is no longer fanciful.

Health professionals must show leadership in tackling the potentially catastrophic effects of climate change. The Climate and Health Council was set up at the instigation of concerned doctors,5 6 and it has evolved over the past year into a focus for international action. Membership of the council is open to individuals and organisations. Many people have already signed the declaration (www.climateandhealth.org), and readers are invited to add their signatures.

The council sets out five ways in which health professionals should act. Firstly, we should inform our professional colleagues and the wider community about the health consequences of climate change, and the major health benefits that will result from tackling it, including a reduction in the prevalence of obesity in rich countries.7 8 9 Secondly, we should set an example by reducing our personal carbon footprints and ensuring that the organisations we work for do likewise. Thirdly, we should advocate. The international community recognises that a post Kyoto global framework is an essential part of any solution. Our advocacy must insist that this framework promotes health. To this end, the framework must constrain carbon dioxide emissions so that atmospheric levels do not exceed 450 parts per million, the level at which the odds for avoiding dangerous climate change are better than 50:50. The framework must also be the basis for ensuring a transfer of resources to give time to those countries that are undergoing, or have yet to undergo, the social and economic transition that fossil fuel has enabled in the rich Western world. The framework based market of contraction and convergence achieves both these aims, and is the most feasible option at present.10 Health professionals should make a concerted effort to contribute to the post Kyoto framework, and to lobby at the United Nations' conferences on climate change in Bali in December and then in Copenhagen in November 2009.

Fourthly, health professionals should seek innovative approaches to using our many networks, such as specialty associations, to facilitate the necessary changes to recruit as many organisations, institutions, and individuals as possible.

Climate change challenges the health of everybody, but particularly of people with the fewest resources. It is the major challenge of the 21st century. Unless we cap carbon emissions in ways that ensure transfer of resources to the poorer nations, we may all go the way of the dinosaurs, and the going will not be comfortable. The Climate and Health Council will be as strong as its collective membership. By adding your voice to the council and taking the necessary actions, you can help to ensure that health professionals are, in the best of our traditions, part of the solution.

/pdf/doctors-and-climate-change-31wktyejl9.pdf

Doctors and climate change

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