Johan Pieter Mackenbach

One of the ways in which healthcare’s climate impact can be reduced is by taking greenhouse gas emissions into account when deciding which treatments are reimbursed and/or included in clinical guidelines. In a report for the Minister of Health, Welfare, and Sports in the Netherlands, we explored how this idea could be put into practice. We developed a set of two criteria: greenhouse gas emissions per patient (which can be compared to, for example, QALYs gained), and total amount of greenhouse gas emissions for all patients undergoing the intervention (which can be compared to, e.g., healthcare’s remaining carbon budget). In the coming three years, the National Health Care Institute will use these criteria in an experimental setting, to gain practical experience and to assess whether there is sufficient support among policy makers, practitioners, and patients for taking into account climate impact regularly.

The health care sector exists to support and promote human wellbeing; however, its operations contribute to environmental degradation undermining nature’s capacity to support the same wellbeing. Biodiversity loss, in particular, creates threats to wellbeing through a reduction in ecosystem service provisioning and increases in disease. This study aims to estimate the extinction-risk footprint associated with the health care sector, focusing on Europe. We created an environmentally-extended multi-region input–output model using data on the extinction risk of species available from the International Union for Conservation of Nature’s (IUCN) Red List of Threatened Species. Using input–output analysis, we then quantified the extinction-risk footprint of the Dutch health care sector and, for comparison, that of the 30 European nations which use similar sector classifications in their National Accounts reporting. We found that the Netherlands has the highest health care extinction-risk footprint on a per-capita basis and that health care contributes 4.4% of the Dutch consumption extinction-risk footprint compared with an average of 2.6% across the comparator set. Food and beverage supply chains make a disproportionate contribution to health care’s extinction-risk footprint, while supply chains implicated in the sector’s carbon footprint make a limited contribution. These results suggest that reducing the environmental impact of the health care sector may require a differentiated approach when multiple environmental indicators are considered.

In the Middle Ages and early modern times, hospitals were omnipresent in Western Europe, including the area within the current borders of the Netherlands. It is not generally known that these institutions not only left an architectural heritage, but also an interesting art patrimony. This article describes this patrimony, which consists of 71 works of art. Christian-religious themes predominate, related to the fact that in these institutions spiritual care was more important than bodily care. This is illustrated on the basis of a few concrete examples, in which the relationship with the hospital often remains implicit, but sometimes is visualized explicitly. Although the world of thought from which these works of art emerged is far removed from that of the 21st century, they form an interesting mirror for modern visions of the function of art in hospitals.

'Planetary health' is a new field of research, education and practice focusing on the relationship between global environmental change and human health. This includes climate change, but also biodiversity loss, environmental pollution, and other large-scale changes in the natural environment that may affect human health. This article provides an overview of the extent to which scientific knowledge is available about these health risks. Both the scientific literature and expert opinion indicate that global environmental changes may have potentially disastrous consequences for human health worldwide. Countermeasures are therefore indicated, both in the form of mitigation (combating global environmental change) and in the form of adaptation (e.g., to limit the health consequences). The health care sector has an important responsibility, also because of its own contribution to global environmental change, and both health care practices and medical education will have to change in response to the health risks of global environmental change.

Background: Japan is one of the world’s largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times.Method: We analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every three years (n ≈ 700,000 per year) in Japan, during 2001-2016. Age-standardized smoking prevalence was computed based on occupational class and educational level. We calculated smoking prevalence difference (PD) and ratio (PR) of (a) manual workers versus upper non-manual workers and (b) low versus high educational level. The slope index of inequality (SII) and relative index inequality (RII) by educational level were used as inequality measures.Results: Overall smoking prevalence (25-64 years) decreased from 56.0% to 38.4% among men and from 17.0% to 13.0% among women during 2001–2016. The PD between manual and upper non-manual workers (25-64 years) increased from 11.9% (95% confidence interval: 11.0-12.9) to 14.6% (13.5-15.6) during 2001–2016. In 2016, smoking prevalence (25-64 years) for low, middle, and highly educated individuals were 57.8%, 43.9%, and 27.8% for men, and 34.7%, 15.9%, and 5.6% for women, respectively. SII and RII by educational level increased among both sexes. Larger socioeconomic differences in smoking prevalence were observed in younger generations, which suggests that socioeconomic inequalities in smoking evolve in a cohort pattern.Conclusions: Socioeconomic inequalities in smoking widened between 2001 and 2016 in Japan, which indicates that health inequalities will continue to exist in near future.

When one approaches diseases from a historical perspective, it is striking that most diseases display a spectacular pattern of rise and fall. This article discusses an 'ecological-evolutionary theory' of the origins of disease, which explains the emergence of ever-new diseases from the fact that humans, in their tireless pursuit of better living conditions, have engaged in activities that exposed them to new health risks, at a pace that evolution cannot keep up with. This is illustrated by examples in the field of infectious diseases, ischemic heart disease and cancer. The rise of COVID-19 can be understood along the same lines. The fundamental role of behaviour and environment in the development of disease implies that public health measures are generally the best approach to tackle disease. Conflict of interest and financial support: none declared.