Kristine Belesova

Public Food Procurement Programs (PFPPs) are increasingly recognised for their potential to improve food security and dietary diversity, particularly among children vulnerable to malnutrition. In India, school feeding interventions, including the Poshan Shakti Nirman Programme, serve as important policy mechanisms to enhance both educational participation and child nutrition. This study applies life cycle assessment (LCA) within a farm-to-fork system boundary to evaluate the environmental impacts of student feeding programme supply chains in Sarguja, Chhattisgarh. The analysis focuses on meals delivered through Anganwadi Centres and Primary Schools and compares environmental performance before and after the introduction of locally produced vegetables from home-grown nutri-gardens designed to improve dietary diversity. Primary data were collected through 166 stakeholder interviews and supplemented, where necessary, with secondary data from regional and national databases and peer-reviewed literature. The results identify key environmental hotspots within the government-managed rice and legume supply chain. Lorry transport, particularly for rice distribution, was the principal contributor to Global Warming Potential and Fossil Fuel Potential, accounting for approximately 40% of total impacts. Rice cultivation also contributed substantially to Marine Eutrophication Potential, Freshwater Eutrophication Potential, and Water Consumption Potential, representing 40–50% of meal-related burdens. The inclusion of vegetables sourced either from markets or local nutri-gardens increased overall environmental impacts only marginally, by around 10%, reflecting relatively low-impact cultivation practices. These findings provide an empirical basis for targeted mitigation strategies and policy interventions aimed at improving the environmental sustainability of school feeding programmes while maintaining progress towards enhanced child nutrition and dietary diversity.

Anthropogenic climate change affects health through pathways beyond direct weather exposure, yet attribution studies largely focus on direct impacts in high-income settings and rarely capture agriculturally mediated effects. We present an attribution framework quantifying health and migration impacts of climate change-driven crop yield losses in rural Burkina Faso. Integrating factual and counterfactual climate simulations, machine-learning crop-yield models, and life tables from the Nouna Health and Demographic Surveillance System, we estimate farmer out-migration and child mortality attributable to climate-induced yield reductions. Over 1984–2016, climate change contributed to an ~8.0% yield reduction, a 1.9% increase in farmer out-migration, 2.3% more deaths among children <5 across all households, and 12.6% more child deaths in households experiencing out-migration. These results demonstrate that climate change has already produced measurable agriculturally mediated impacts on vulnerable rural populations in the Sahel, highlighting the need for effective and ambitious adaptation policies.

Objectives: To investigate the association between drinking-water sodium concentration and blood pressure among non-pregnant women living in a high-salinity, climate-vulnerable coastal region of Bangladesh. Design: Follow-up study of women originally enrolled in a population-based study conducted during pregnancy between 2009 and 2011. Setting: Rural coastal subdistrict in southwest Bangladesh affected by saltwater intrusion and seasonal drinking-water insecurity. Participants: Of 1208 women enrolled in the original study, 900 were located in 2018 and 740 non-pregnant women were re-enrolled and included in the present analysis. Eligible participants were women from the original study who were alive and still residing in the study area; women who had migrated could not be located, declined participation or were pregnant at follow-up were excluded. Primary and secondary outcome measures: The primary outcome was blood pressure, measured using a standardised protocol. Main exposure was sodium concentration in household drinking water and reported drinking-water source. Secondary analyses assessed temporal changes in drinking-water sodium between 2009 and 2018 and associations with water source, perceived taste and changes in exposure over time. Results: Mean sodium concentration in household drinking water was highest in groundwater/tubewell users (933 mg/L, SD 372). Approximately 22% of women consumed drinking water contributing up to 94% of the WHO-recommended maximum daily sodium intake, assuming 2 L/day consumption. Sodium concentrations increased in seven of nine administrative unions between 2009 and 2018 (p=0.013). Compared with women consuming water containing 1000 mg/L was associated with higher odds of raised diastolic blood pressure (adjusted OR 2.30, 95% CI 1.40 to 3.77; p=0.001). Restricted cubic spline and piecewise regression models suggested a non-linear association, with a threshold near 1000 mg/L. No statistically significant association was observed for systolic blood pressure. Conclusions: High sodium concentrations in drinking water were associated with elevated diastolic blood pressure among women in coastal Bangladesh. Drinking-water salinity may represent an under-recognised cardiovascular risk in climate-vulnerable coastal populations. These findings support the need for salinity surveillance, climate-resilient low-sodium drinking-water supplies and further research to inform health-based standards for sodium in drinking water. Trial registration number: Not applicable.

Background: Addressing the adverse impacts of climate change on human health requires a global effort across multiple sectors. People living in low- and middle-income countries are particularly vulnerable to the health crises induced by climate change. Therefore, context specific solutions to tackle such challenges are essential to ensure preventive measures are in place for mitigating such risks. Objective: This protocol aims to outline an integrated, participatory approach to cocreate multisectoral interventions tailored to specific environmental and health challenges in Bangladesh, India, and Indonesia. This work is done as part of the Global Health Research Centre for Non-Communicable Diseases and Environmental Change, funded by the National Institute for Health and Care Research. The overall aim is to collaboratively design and assess interventions that deliver dual benefits for planetary and human health. Methods: To address the multisectoral nature of the challenges, this study will adopt a cocreation methodology that blends co-design and coproduction approaches. While the problem areas are specific to each context—tackling air pollution due to plastic burning in Indonesia, improving dietary diversity of public food procurement systems and managing extreme heat in India, and mitigating drinking water salinity in Bangladesh—the underlying cocreation framework is consistent and can be adapted to the needs of each study setting. The workflow consists of 4 key stages guided by an existing cocreation framework: planning, developing, evaluation, and reporting, with the 6 core elements of the Medical Research Council’s complex intervention development framework embedded throughout the process. Drawing on the Double Diamond design process, the cocreation stage involves the following phases: codevelopment of a theory of change to explore potential context-specific interventions, short-listing of intervention components through gap analysis and prioritization, co-designing and coproducing selected intervention components, and assessing appropriateness and feasibility of intervention implementation. The cocreation process will be evaluated using the Research Quality Plus for Co‑Production framework to ensure methodological rigor and quality. Results: Cocreation will take place over 6 months. Sampling and recruitment of cocreators (key stakeholders across sectors) have been completed in all 3 countries, with each cocreator group consisting of 20-30 members. We have developed the tools for the cocreation phase, informed by the findings from formative research, and received the necessary ethics approval to conduct these activities. We will generate a series of academic and nonacademic outputs on the cocreation process to disseminate the findings, as well as training materials for implementers to facilitate future adoption in similar settings. Conclusions: The cocreation of multisectoral interventions to tackle both environmental change and health is a comparatively new domain of implementation research. This protocol addresses the complex, multidimensional, and unique nature of such interventions by developing a structured and scientifically sound approach to be implemented in real-life settings. International Registered Report Identifier (IRRID): DERR1-10.2196/80368

In climate change-affected coastal areas, sea level rise, storm surges, droughts and altered rainfalls are significantly increasing salinity levels in drinking water sources. This is a major public health problem that affects many millions of people. We systematically reviewed and assessed the strength and quality of the evidence on the relationship between drinking water with high sodium levels (> 200 mgNa/l) and adverse cardiovascular, renal, and pregnancy-related health outcomes, following the PRISMA guidelines, the ROBINS-E Cochrane tool and the Navigation Guide. From five bibliographic databases, we identified 22 relevant studies, some of which assessed more than one health domain. The evidence was of moderate quality and strength. 14 analyses from eight studies at low risk of bias and four studies at moderate risk of bias, linked drinking high-salinity water to adverse health outcomes including hypertension and cardiovascular disease, impaired renal function, gestational hypertension and preeclampsia, and higher infant mortality. Eight studies were inconclusive. Three analyses, of which two at low risk of bias, associated drinking high-salinity water to improved health outcomes. Overall, our findings suggest that salinisation of drinking water sources is likely to increase adverse cardiovascular, renal, and pregnancy-related health outcomes. This conclusion highlights the importance of effective and timely adaptation at scale, and calls for a revision of the WHO guidelines for the intake of salt from water. The latest WHO guidelines (2022) do not set any health-based standard for sodium levels in drinking water, a problem that affects millions of people and will worsen with climate change.

Heat-related deaths occur throughout the summer months, peak during heatwaves, and are affected by temperature and exposed populations’ sensitivities to meteorological conditions. Previous studies found that climate change is increasing heat-related mortality worldwide. We build on existing epidemiological methods to shed light on the adverse effects of climate change on human health. We address limitations in existing methods and apply refined approaches to assess heat mortality attributable to human-induced climate change in Zürich, Switzerland, over 50 years (1969–2018) including a case study of summer 2018. Our methodological refinements affect how counterfactual climate scenarios are derived, and facilitate accounting for changing vulnerability, and assessing impacts during and outside heatwaves. We find nearly 1,700 heat-related deaths attributable to human-induced climate change between 1969 and 2018. Declining vulnerability to heat avoided at least 700 heat-related deaths. The approach described here could be applied elsewhere to quantify the effect of climate change on other health outcomes.

Rising temperatures in Africa present an increasing threat to agricultural productivity and public health, particularly among subsistence farming communities reliant on rain-fed agriculture. Heat exposure can impair farmers' work capacity, disrupt harvests, and heighten health risks, especially for young children vulnerable to undernutrition. The Heat to Harvest (H2H) study investigates how environmental heat exposure influences farmers' physiological and behavioral responses, and how these in turn affect harvest yields and child nutrition. It also examines differences in labor performance and recovery between households with and without cool roof coatings, although this intervention is not the central focus. H2H is designed as a prospective cohort study nested within two Health and Demographic Surveillance Systems (HDSS) in Nouna, Burkina Faso, and Siaya, Kenya. The study integrates environmental monitoring (temperature and humidity sensors used to compute Wet Bulb Globe Temperature), biometric data (via wearables tracking heart rate, temperature, physical activity, energy expenditure, and sleep), and GPS tracking (capturing spatial mobility and labor duration). The study is embedded within a larger cluster-randomized controlled trial, facilitating comparative analysis under varying thermal conditions. Findings will provide evidence-based insights into how climate-related heat stress affects health and agricultural outcomes, supporting the development of targeted adaptation strategies to enhance resilience, health, and food security in vulnerable farming communities.

Policies to implement climate-forcing pollution emission reductions have often been stymied by economic and political divisiveness. However, certain uncontested nonregret public health policies that also carry climate-forcing cobenefits with them could provide more achievable policy pathways to accelerate the implementation of climate mitigation. An International Society for Environmental Epidemiology Policy Committee endorsed pre-28th Conference of the Parties climate meeting workshop brought together experts on environment, diet, civic planning, and health to review current understanding of public health policy approaches that provide climate change mitigation cobenefits by also reducing greenhouse gas emissions. Promising public health policy areas identified as also providing climate mitigation cobenefits included: improving air quality through stronger regulation of harmful combustion-related air pollutants, advancing healthier plant-based public food procurement programs, promoting more sustainable transport options, developing healthier infrastructure (e.g., combustion-free buildings), and reducing the use of climate forcing substances in healthcare. It is concluded that cities, states, and nations, when aided by involved health professionals, can advance many practical public health, diet, and civic planning policies to improve health and well-being that will also serve to translate climate mitigation ambitions into action.

Carbon pricing is considered an important instrument in the fight against climate change (World Bank, 2022). In particular, many experts and stakeholders have called for the implementation of carbon pricing as a part of ambitious climate policy agendas (Hepburn et al., 2020). This requires consideration of the interactions of carbon pricing with other policies, as well as of the societal outcomes of carbon pricing. In particular, carbon pricing has been found to have potentially large health impacts, leading to important co-benefits as well as potentially some trade-offs (Parry et al., 2014), (Hasegawa et al., 2018). Information on health impacts of carbon pricing, their distribution and how they are affected by policy design is necessary in order to progress towards more socially sustainable and politically feasible policy design. Recent reviews have focussed on various aspects of carbon pricing design and outcomes, synthesizing evidence on its effectiveness, equity impacts or societal perception (Boyce, 2018), (Green, 2021), (Maestre-Andrés et al., 2019). Others have reviewed the evidence on health co-benefits of mitigation, but do not analyse specific policies or issues of policy design Gao et al.(2018). This review will narratively synthesize the evidence on the health impacts of carbon pricing between 2010 and 2021 and identify gaps in the literature. We will use a framework synthesis approach to analyse different categories of policy-relevant information in contexts where carbon pricing is implemented as part of wider, coordinated policy agendas or complex policy mixes. This includes for example impacts on health inequalities and how health co-benefits are affected by issues of policy design and policy interactions.

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 CO 2 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 CO 2 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 CO 2 . Conclusions Countries with high health metrics at sustainable EF levels may offer valuable lessons for sustainable national development policies. Increased environmental footprint and CO 2 emissions appear associated with higher levels of human health and development only up to a certain level of income.