Stefanie Schütte

The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health

The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement, 1 and th ...

Psychosocial working conditions and psychological well-being among employees in 34 European countries

AbstractPurpose The aim of this study was to explore the associations between psychosocial working conditions and psychological well-being among employees in 34 European countries. Another objective was to examine whether these associations varied according to occupation and country.Methods The study was based on data from the European Working Conditions Survey 2010 including 33,443 employees, 16,512 men and 16,931 women, from 34 European countries. Well-being was measured by the WHO-5 well-being index. Twenty-five psychosocial work factors were constructed including job demands, role stressors, work hours, job influence and freedom, job promotion, job insecurity, social support, quality of leadership, discrimination and violence at work, and work-life imbalance. The associations between these factors and well-being were examined using multilevel logistic regression analyses. Different models were performed including interaction tests.ResultsWhen all 25 psychosocial work factors were studied simultaneously in the same model with adjustment variables, 13 showed a significant association with poor well-being among both genders: quantitative demands, demands for hiding emotions, low possibilities for development, low meaning of work, low role conflict, low quality of leadership, low social support, low sense of community, job insecurity, low job promotion, work-life imbalance, discrimination, and bullying. The association with low sense of community on poor well-being was particularly strong.ConclusionsA large number of psychosocial work factors were associated with poor well-being. Almost no country and occupational differences were found in these associations. This study gave a first European overview and could be useful to inform cross-national policy debate.

Health in climate change research from 1990 to 2014: positive trend, but still underperforming

Background Climate change has been recognized as both one of the biggest threats and the biggest opportunities for global health in the 21st century. This trend review seeks to assess and characterize the amount and type of scientific literature on the link between climate change and human health. Design We tracked the use of climate-related terms and their co-occurrence with health terms during the 25 years since the first Intergovernmental Panel on Climate Change (IPCC) report, from 1990 to 2014, in two scientific databases and in the IPCC reports. We investigated the trends in the number of publications about health and climate change through time, by nature of the health impact under study, and by geographic area. We compared the scientific production in the health field with that of other sectors on which climate change has an impact. Results The number of publications was extremely low in both databases from 1990 (325 and 1,004, respectively) until around 2006 (1,332 and 4,319, respectively), which has since then increased exponentially in recent years (6,079 and 17,395, respectively, in 2014). However, the number of climate change papers regarding health is still about half that of other sectors. Certain health impacts, particularly malnutrition and non-communicable diseases (NCDs), remain substantially understudied. Approximately two-thirds of all published studies were carried out in OECD countries (Organization for Economic Cooperation and Development), predominantly in Europe and North America. Conclusions There is a clear need for further research on the links between climate change and health. This pertains particularly to research in and by those countries in which health will be mostly affected and capacity to adapt is least. Specific undertreated topics such as NCDs, malnutrition, and mental health should gain the priority they deserve. Funding agencies are invited to take note of and establish calls for proposals accordingly. Raising the interest in this research area in young scientists remains a challenge and should lead to innovative courses for large audiences, such as Massive Open Online Courses.

Changes in psychosocial work exposures among employees between 2005 and 2010 in 30 countries in Europe.

Objective: The aim was to assess the changes in psychosocial work factors among European employees between 2005 and 2010. Methods: The study samples came from the European Working Conditions Survey, involving 23,580 and 32,516 employees in 2005 and 2010, respectively, from 30 European countries. The psychosocial work factors studied were based on job strain and effort–reward imbalance models, and more recent factors. Multilevel linear and logistic regression models were used. Differences according to occupations and countries were tested. Results: Results were mixed with improvement for some factors and decline for other factors. Some countries and occupations were more likely to be affected by negative changes, especially low-skilled employees. Conclusion: Prevention policies at the workplace should take into account that the degradation of some psychosocial work factors may be sharper for some countries and occupations.

Material, psychosocial and behavioural factors associated with self-reported health in the Republic of Ireland: cross-sectional results from the SLÁN survey

Objectives To explore the associations between various material, psychosocial and behavioural factors and self-reported health (SRH), and to determine whether these associations varied according to educational level. Design Representative national cross-sectional survey. Setting Republic of Ireland. Participants 4369 men and 5995 women aged 18 or more (Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007). Methods SRH was measured using one single item. Three groups of factors were studied: material, psychosocial and behavioural factors. Statistical analyses were performed using logistic regression analysis and interaction testing, the sample design being taken into account. All results were adjusted for age and educational level and stratified on gender. Results When each group of factors was studied separately, non-working status, no private health insurance, inability to afford enough food, no car, being non-married, low social participation, serious neighbourhood problems, low social support, smoking, no alcohol consumption, illicit drug use, low physical activity and obesity were associated with poor SRH. When studied together, some material and psychosocial factors were no longer significant. Four significant interaction terms were found, suggesting that some factors might have a stronger association with SRH among low-educated people. Conclusions Various types of factors were found to be associated with SRH, and most of these associations were similar according to educational level. Behavioural factors might be intermediate factors in the causal pathways from material and psychosocial factors to SRH. Prevention policies should integrate a large number of factors comprehensively to improve SRH.

Climate change and human health: what are the research trends? A scoping review protocol

Introduction For 28 years, the Intergovernmental Panel on Climate Change (IPCC) has been assessing the potential risks associated with anthropogenic climate change. Although interest in climate change and health is growing, the implications arising from their interaction remain understudied. Generating a greater understanding of the health impacts of climate change could be key step in inciting some of the changes necessary to decelerate global warming. A long-term and broad overview of the existing scientific literature in the field of climate change and health is currently missing in order to ensure that all priority areas are being adequately addressed. In this paper we outline our methods to conduct a scoping review of the published peer-reviewed literature on climate change and health between 1990 and 2015. Methods and analysis A detailed search strategy will be used to search the PubMed and Web of Science databases. Specific inclusion and exclusion criteria will be applied in order to capture the most relevant literature in the time frame chosen. Data will be extracted, categorised and coded to allow for statistical analysis of the results. Ethics and dissemination No ethical approval was required for this study. A searchable database of climate change and health publications will be developed and a manuscript will be complied for publication and dissemination of the findings. We anticipate that this study will allow us to map the trends observed in publications over the 25-year time period in climate change and health research. It will also identify the research areas with the highest volume of publications as well as highlight the research trends in climate change and health.

The influence of health concerns in scientific and policy debates on climate change

In 2009, scientists argued that climate change was the ‘biggest global health threat of the 21st century’,1 and 6 years later ‘the greatest global health opportunity of the 21st century’.2 While a minority of populations may experience health benefits (mostly due to a reduction in diseases related to cold weather), the global burden of disease and premature death is expected to increase progressively.3 For instance, one study showed that heat-related deaths would be expected to rise by around 257% by the 2050s from a current annual baseline of approximately 2000 deaths.4 Much of the policy development on climate change comes from the negotiations between the 195 parties to the United Nations Framework Convention on Climate Change (UNFCCC), working towards a common long-term vision of limiting global warming. The 21th Conference of the Parties (COP21) in Paris in December 2015 was one milestone in the fight against climate change, as all countries agreed to take action by curbing greenhouse gas emissions (GHGE) and keep global warming well below 2°C. The agreement also included a regular review of national commitments every 5 years to check progress. Moreover, it represented an important step to protect and promote health in the face of climate change: for the first time ‘the right to health’ was mentioned in the global agreement on climate change. The WHO referred to the COP21 as ‘a historic win for human health’, and this climate treaty might actually become a public health treaty as countries take action to develop adaptation plans that will protect human health from the worst impacts of climate change.5 This opinion article seeks to present the role of health concerns in the scientific debates on climate change, but also in actual climate policies and international negotiations. ### Climate change-related health concerns in scientific debates Awareness of the health risks caused by …

Health can help saving negotiation on climate change

www.thelancet.com Vol 385 June 13, 2015 e49 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ public health. If benefi ts of mitigation policies are often seen as long-term investments with many uncertainties, immediate cobenefi ts on health can be far more convincing arguments. In this regard, the upcoming conference “Climate, Health, Inequalities: solutions?” in Paris June 18–19, organised by the French Ministry of Health ahead of COP21, represents a huge opportunity. Importantly, COP21 is only one battlefi eld in the fi ght against climate change. Before and after December 2015, health professionals and researchers should commit to get informed on climate change, and mobilise their creativity to develop studies that will support decision making, both in the fi elds of adaptation and mitigation.

Connecting planetary health, climate change, and migration

www.thelancet.com/planetary-health Vol 2 February 2018 e58 Climate change is increasingly understood to be an important driver of migration and displacement worldwide, although the magnitude of such population movements remains disputed. Improving the health of migrants and reducing adverse health outcomes related to migration are also growing concerns globally. Current crises related to migration and displacement, whether in the Horn of Africa or the Mediterranean, highlight the different challenges related to migrants’ health, especially in humanitarian emergencies. Planetary health, as a new discipline, was created to safeguard human health in the Anthropocene epoch. It revolves around a new interdisciplinary and transdisciplinary approach that seeks to explore the effects of environmental change on human health. Planetary health focuses in particular on two dimensions: the first situates human health within human systems, looking at the threats faced by our species such as pandemics or climate change; the second concentrates on the natural systems within which our species evolve and looks at the health and diversity of the biosphere. Although migrants’ health and climate-induced migration are known to be major challenges at present, few attempts have been made to consider the complex associations that unite climate change, migration, and health in an integrated three-pronged nexus. Therefore, we propose a basic explanatory framework that highlights the linkages between these three dimensions and seeks to encourage debate, and new research, about how planetary health is concerned with, and within, this three-pronged nexus (figure). Climate change is known to affect populations’ health (pathway A; figure). Most of this influence is through direct exposures such as heatwaves or extreme weather events, although less direct impacts arise from disruptions to environmental, ecological, and social systems. Issues such as proliferation of new or resistant strains of pathogens are also an unwelcome scenario. The indirect impacts arising from environmental, ecological and social systems will affect human health through changes in food yields, freshwater flows and quality, stability of infectious disease patterns, air quality, social cohesion, and family income and livelihoods. Indeed, climate change could threaten food security through reductions in agricultural and fishery yields. This effect is particularly alarming in regions that are already facing food insecurity such as in sub-Saharan Africa and south Asia. Moreover, the occurrence of flooding or drought cycles as well as hotter summers in some regions are likely to increase risks to agricultural productivity. Climate change will also impact the geographical range, seasonality, and incidence of various infectious diseases, such as malaria, diarrhoeal diseases, and cholera. These impacts, especially extreme weather events, sea-level rise, soil degradation, and food and water scarcity are strongly associated with migration (pathway B; figure). In some cases migration will be a strategy of last resort, with people left with no other choice as a result of loss of habitable land, extreme health risks, or deteriorating livelihoods. In this case, displacement might increase the risks of adverse health outcomes, in particular for vulnerable groups such as children and the elderly, as well as those who are already suffering from (chronic) illnesses (pathway C; figure). Migration can also be a voluntary choice, although forced migration and voluntary migration are not two discrete categories, but rather the two ends of a continuum. Migration is not automatically an indicator of vulnerability; it can also be an adaptive Connecting planetary health, climate change, and migration

Participation in lung cancer screening programs: are there gender and social differences? A systematic review

Lung cancer remains the leading cause of cancer mortality worldwide. A number of screening trials for early detection of lung cancer exist, using chest X-ray, low-dose computed tomography, or both. However, little is known about the socio-demographic characteristics of participants in lung cancer screening programs. As gender and socio-economic determinants are important variables to consider for successful program implementation, this review aims to characterize the participants in such programs and to investigate whether differences in representation exist across screening programs.Systematic methods were used to identify relevant studies. A search was undertaken to locate all studies published up to August 2017 assessing the socio-demographic profile of participants in lung cancer screening programs. A search strategy was developed, refined, and implemented to search in two different online databases (MEDLINE and Web of Sciences).A total of 1588 references were retrieved of which 14 were eligible for review. The results highlight differences in gender and social characteristics of participants across programs, while noting that differences may be partly explained by the various epidemiological contexts, program inclusion criteria, and socio-economic status (SES) measures collected. Most importantly, despite a well-recognized predominance of low SES among heavy smokers, people with high SES are seemingly over-represented among participants. Male participants also seem to be over-represented. These findings are important to help inform the development and implementation processes of future lung cancer screening programs, which should likely include strategies for engaging women as well as individuals with low SES and, of course, those most at risk for developing lung cancer.