Andrea E. Schmidt

Anthropogenic climate change presents significant health challenges for older people with care needs across all care settings, from private homes and supported living arrangements to institutional care facilities. Those particularly at risk include individuals with limited mobility, multimorbidity, or social isolation. Care and support systems therefore need to implement measures for both climate change mitigation and adaptation. Mitigation encompasses reducing energy and water consumption, minimising waste, decreasing reliance on fossil fuels, managing chemicals, and strengthening political and regulatory cooperation. Adaptation involves capacity building, technological innovation, financial management, education and research, monitoring and evaluation, as well as institutional and social support. The effectiveness of structural, organisational, and social measures, such as thermally resilient buildings, efficient ventilation and cooling systems, emergency power supply, secure water and waste infrastructure, hygiene standards, and community-based support services, is well documented. Good practice examples, including community-based support in home settings, structural and technical modernisation in care facilities, and strategic instruments in procurement and governance, demonstrate that climate-resilient strategies enhance care security, support the prevention of care dependency, improve the quality of life of older people, and simultaneously achieve ecological and economic objectives. Climate mitigation and adaptation are integral components of future-oriented, needs-based care, positioning care facilities and community structures as key levers for sustainable transformation.

Informal caregivers play a crucial role in supporting older adults, yet they often face challenges that compromise their own health and well-being, particularly in family-based care regimes like Austria. These challenges leave little room for adopting ecologically sustainable behaviours, calling for societal strategies to address climate change without adding pressure. We examined barriers in areas linked to the “triple win” of health promotion, climate mitigation, and social inclusion, and explored the role of Information and Communication Technologies (ICTs). Data were collected in 2024 from a non-probability sample of Austrian caregivers on social contacts, mobility, nutrition, and digital device use. We present descriptive results. Unpaid caregiving responsibilities reshaped daily routines and challenged health and sustainability (N=204, 81% females; mean age 58±13 years): 15–20% of participants were at risk of social isolation, 54% reported fewer social interactions. Awareness of healthy diets increased partially, but 26% had less time to eat. Mobility patterns showed strong car reliance with higher weekly travel demands (69%). Internet and ICT were used for communication daily (72%). Mobility and nutrition offer high co-benefit potential, but structural changes, not individual responsibility, are key. ICT tools should complement in person engagement to leverage positive aspects of caregiving for climate-health co-benefits.

Climate crisis demands urgent measures that address the carbon footprints of everyday activities. Daily activities include work - both paid employment and unpaid care work - as well as free time. While technical solutions and energy transitions are important, a socio-ecological transformation is necessary to reorganize everyday activities in a climate-friendly and equitable way. This paper explores the intersection of time-use, household carbon footprints, gender, social wellbeing, and health, using Austria's recent time-use and consumption data (2021/22). By linking these data to carbon footprints derived from a multi-regional input-output (MRIO) model, we identify potentials for reducing carbon footprints.,Our analysis highlights the role of time as a limited resource, with time use shaped by paid and unpaid work, infrastructure, and care responsibilities. We investigate how age, gender, and caring responsibilities influence carbon footprints. Research questions focus on identifying carbon-intensive activities and assessing potentials for emission reductions. Additionally, we examine the wellbeing and health co-benefits of climate-friendly time-use.,We find that the gendered division of work remains persistent, that time scarcity stemming from ”double burden” of paid and unpaid work has effects on and that infrastructure plays a crucial role in enabling low-carbon lifestyles. By investigating carbon footprints, we provide insights into strategies that foster a climate-friendly distribution of paid and unpaid work. This article contributes to research on socio-ecological transformation and the care economy and emphasizes the benefits of linking low-carbon strategies to social wellbeing and health, with a focus on structural and equity issues in work and everyday life.

Zusammenfassung: Hintergrund: Der Klimawandel und seine Auswirkungen auf die Gesundheit rücken zunehmend in den gesundheitspolitischen Blickpunkt. Herausforderungen ergeben sich u. a. durch häufigere Hitzewellen, erhöhte Pollenbelastung, vermehrtes Auftreten von Vektoren. Auch sind Personen in vulnerablen Kontexten überproportional betroffen. Dem Gesundheitssystem kommt durch Gesundheitsförderung, Prävention und Krankenversorgung in diesem Zusammenhang eine wesentliche Rolle zu. In einem klimaresilienten Gesundheitssystem haben klimakompetente Angehörige der Gesundheitsberufe eine zentrale Rolle. Der Artikel beleuchtet die Arbeiten auf nationaler Ebene, die darauf abzielen, ein gemeinsames Verständnis aufzubauen und einen adäquaten inhaltlichen Rahmen der gesundheitsbezogenen Klimakompetenz auszuarbeiten. Materialien und Methoden: Zur Erarbeitung der Fragestellung wurde eine explorative Herangehensweise mit einer Kombination verschiedener Methoden ausgewählt. Basierend auf einer Literaturrecherche wurde der inhaltliche Rahmen entlang internationaler Beispiele guter Praxis für die österreichischen gesetzlich Gesundheitsberufe abgeleitet. Zur Qualitätssicherung und -verbesserung erfolgte eine Begutachtung durch Expert:innen aus den Bereichen Klima, Gesundheit und Bildung. Ergebnisse: Zur langfristigen Verankerung der Klimakompetenz in den Gesundheitsberufen braucht es drei Implementierungsprozesse, um die Zielgruppen, d. h. jene, die eine Ausbildung absolvieren, die bereits in Gesundheitsberufen Tätigen und Lehrende für Gesundheitsberufe, zu adressieren. Den inhaltlichen Rahmen dafür bildet das berufsgruppenübergreifende Handbuch zur Stärkung der Klimakompetenz in den Gesundheitsberufen. Schlussfolgerung: Ein systematischer Aufbau und die Stärkung der Klimakompetenz im Gesundheitssystems, insbesondere bei den Angehörigen der Gesundheitsberufe, ist zielführend, um die vielfältigen und erheblichen Auswirkungen des Klimawandels auf die Gesundheit und das Wohlbefinden der Menschen abzufedern.

Background: Global threats, such as the coronavirus disease 2019 (COVID-19) pandemic, have highlighted the critical importance of robust and well-functioning health information systems (HIS) in effectively addressing public health emergencies. To enhance the understanding and the functioning of such systems, it is crucial to perform HIS assessments. This article explores key gaps and identifies best practices in the COVID-19 HIS of eight European countries. Furthermore, it provides recommendations to strengthen European systems for better pandemic preparedness. Methods: Assessments were carried out in eight European countries using an adapted version of the WHO support tool to strengthen HIS and the Joint Action on Health Information assessment tool. The assessments took place between January 2022 and April 2023. Results: Four main themes emerged regarding the gaps and best practices identified in the various HIS: organizational, technical, legal and resources. The results of these assessments show different approaches implemented by countries to improve their HIS and respond to the demands of the pandemic. Conclusions: It is imperative for countries to draw valuable insights from the COVID-19 pandemic and strengthen their HIS. This involves the adaptation or development of pandemic preparedness plans, strengthening legislative framework for data sharing and privacy protection, promotion of data standards and international definitions and implementation of a unique person identifier. Additionally, countries will have to act in this post-pandemic era and integrate the newly developed systems and innovations into existing structures, maintain and develop trust by citizens through transparent communication and engage in infodemic management and address resource gaps in the workforce.

Background: Resilience of national health systems in Europe remains a major concern in times of multiple crises and as more evidence is emerging relating to the indirect effects of the COVID-19 pandemic on health care utilization (HCU), resulting from de-prioritization of regular, non-pandemic healthcare services. Most extant studies focus on regional, disease specific or early pandemic HCU creating difficulties in comparing across multiple countries. We provide a comparatively broad definition of HCU across multiple countries, with potential to expand across regions and timeframes. Methods: Using a cross-country federated research infrastructure (FRI), we examined HCU for acute cardiovascular events, elective surgeries and serious trauma. Aggregated data were used in forecast modelling to identify changes from predicted European age-standardized counts via fitted regressions (2017–19), compared against post-pandemic data. Results: We found that elective surgeries were most affected, universally falling below predicted levels in 2020. For cardiovascular HCU, we found lower-than-expected cases in every region for heart attacks and displayed large sex differences. Serious trauma was the least impacted by the COVID-19 pandemic. Conclusion: The strength of this study comes from the use of the European Population Health Information Research Infrastructure’s (PHIRI) FRI, allowing for rapid analysis of regional differences to assess indirect impacts of events such as pandemics. There are marked differences in the capacity of services to return to normal in terms of elective surgery; additionally, we found considerable differences between men and women which requires further research on potential sex or gender patterns of HCU during crises.

Background: By 2050, about 70% of the global population will be living in cities. At the same time the health burden due to climate change is increasing in urban areas e.g. as heat waves become more frequent and prolonged and the socio-economic inequalities increase. Also, health systems are faced with multiple stress tests due to multimorbidity, lack of health personnel, and the direct and indirect health impacts of the climate crisis, falling disproportionately on disadvantaged populations. Gaining a better understanding of the climate-health-equity nexus represents huge potential for health policy to contribute to climate change mitigation and for climate policy to reduce disease burden while tackling socio-economic inequalities and health inequity. Objective: Building on a systematic literature review, this paper presents a framework of the interdependencies between the climate crisis, public health, and social aspects and applies it to urban areas. It then links the domains identified with data requirements at the European level and highlights potential pitfalls for European health information systems, and all six building blocks of health systems following WHO's framework on climate resilience, from governance to health workforce to early warning systems. Results: The review showcases risks associated with acting in “policy-silos”, neglecting the interactions between climate, health and inequality, compounding negative consequences both for planetary health and human health. Our data framework shows that the interdependencies described open up various opportunities for a European research infrastructure, in the aftermath of the COVID-19 pandemic and in a transformation towards more health promotion. Conclusions: A European Green Deal with a strengthened focus on public health would have the potential to address these challenges, in cities and beyond. All health system building blocks need to contribute to such a climate-health pact at the European level.

Background: The climate crisis constitutes the largest threat to public health in the 21st century, from which severe health risks emerge that hit older age groups disproportionately. In addition, the health sector itself contributes to the climate crisis (up to 10% of national carbon emissions) and health inequity. We use the Health for all Policies paradigm and apply it to the links between equity, climate, and health in old-age. The paper develops a conceptual framework for strengthening interdisciplinary approaches toward a climate-resilient future for all age groups. Methods: We conducted a systematic literature review for the analysis of the links between health, climate, and equity, by considering a health for all Policies (HfaP) paradigm and highlight results focusing on the living situation of vulnerable subgroups of older people in this presentation. Results: The climate crisis with its pending health threats has multiple links with HfaP, and can be applied to an analysis for specific subgroups of older people, vulnerable due to intersectional and overlapping challenges related to their health status, economic situation, gender or race, specific living or family situation. An in-depth understanding of the equity-climate-health nexus helps avoid a low-carbon shift may become that is too narrow in its scope, compounding vulnerable groups's situations. At the interlinkages between health, climate and inequality multiple co-benefits (e. g. inclusive infrastructure for active mobility) can be achieved and trade-offs avoided. Conclusions: Policymakers worldwide and in the EU take up the challenge to substantially reduce greenhouse gas emissions, but the complex interconnection of climate, health and equity has found very little attention, even less so applied to older people. Vulnerable subgroups of older people have limited resources for dealing with the severe impacts of climate change on health, calling for adaptation measures to be planned with an equity lens.

Background: Systematic assessments of a country’s health information system (HIS) help identify strengths and weaknesses and may stimulate actions for improvement. They represent a capacity-building process for the country assessed as well as for the assessor. The joint action on HISs (InfAct) developed a peer-to-peer assessment methodology adapting an established WHO support tool. The aim of this study is to identify lessons learnt and the added value of the InfAct peer assessment for the assessors. Methods: A qualitative evaluation of the peer HIS assessment was performed based on 12 semi-structured interviews: nine interviews were carried out with assessors from nine participating countries, and three with an observer (present during assessments). The interviews were carried out between May 2019 and January 2020. Interviews were analysed using qualitative content analysis. Results: The interviews revealed the experiences of the assessors mainly occurred in five areas: assessors strengthened their understanding of what a population-based HIS is; they strengthened their understanding of how a HIS operates in different countries; they learnt how to carry out a HIS assessment; they strengthened their organization, communication, negotiation and reporting skills and they strengthened the networks in health information within and between countries. Conclusion: Since the assessors are key personnel in their respective national health systems, the impact of the assessment is not limited to the assessor alone but may extend to stakeholders in their country. The deployment of the InfAct HIS peer assessment, anchored in systematic HIS capacity building across European countries, is recommended.

Background: The COVID-19 pandemic has had an unprecedented impact on Europe. Health systems came under strain, with non-urgent treatments postponed and resources reserved for treatment of COVID-19 patients. Delayed care seeking has been reported, for fear of infection with SARS-CoV2. Yet, the scale of this impact remains under researched. This study aims to compare indirect effects of the pandemic in a European cross-country study aiming to highlight the potential of Population Health Information Research Infrastructures (www.phiri.eu). Methods: Focusing on (i) major vascular events (MVE) and (ii) elective surgery for joint replacements (ESJR) as well as (iii) serious trauma this study analyses individual level hospital data in a standardised harmonised data model. We compared pre-pandemic incidence rates (2018-2019) with rates for 2020 and 2021. Analyses are systematically contrasted with SARS CoV2 incidence rates, and policy measures taken based on the OxCGRT index. Results: A drop in hospital discharge rates was observed during the pandemic in all countries but differing by condition and month. Socio-economic differences also varied by condition. Our evidence suggests that periods of more severe policy measures also correlated with more dramatic drops in regular hospital activities. Conclusions: Our findings provide new insights on the dramatic level of de-prioritisation of essential services faced by non-COVID-19 patients in Europe. From a public health perspective, hospital escalation plans should be developed early on to avoid negative mid and long-term health and financial consequences of indirect effects. The study demonstrates the tremendous potential in exploiting health information systems in a systematic way across countries and the value of the PHIRI system. Further research should investigate policy trade-offs involved in severe lockdown measures during a pandemic and variations in health service resilience for future pandemic preparedness.