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The next decade is likely to produce any number of global challenges that will affect health and health care, including pan-national infections such as the new coronavirus COVID-19 and others that will be related to global warming. Nurses will be required to react to these events, even though they will also be affected as ordinary citizens. The future resilience of healthcare services will depend on having sufficient numbers of nurses who are adequately resourced to face the coming challenges.

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Decreasing labour productivity, increased capacity for the transmission of diseases such as dengue fever, malaria, and cholera, and threats to food security provide early warning of compounding negative health and nutrition effects if temperatures continue to rise. Adaptation, planning, and resilience for health Global inertia in adapting to climate change persists, with a mixed response from national governments since the signing of the Paris Agreement in 2015. More than half of global cities surveyed expect climate change to seriously compromise public health infrastructure, either directly, with extremes of weather disrupting crucial services, or indirectly, through the overwhelming of existing services with increased burdens of disease (indicator 2.2). Globally, spending for climate change adaptation remains well below the $100 billion per year commitment made under the Paris Agreement. Within this annual spending, only 3•8% of total development spending committed through formal UN Framework Convention on Climate Change (UNFCCC) mechanisms is dedicated to human health (indicator 2.8). This low investment in Panel 1: Progress towards the recommendations of the 2015 Lancet Commission on health and climate change In 2015, the Lancet Commission made ten policy recommendations. Of these ten recommendations, the Lancet Countdown is measuring progress on the following: Recommendation 1: invest in climate change and public health research Since 2007, the number of published articles on health and climate change in scientific journals has increased by 182% (indicator 5.2). Recommendation 2: scale up financing for climate-resilient health systems Spending on direct health adaptation as a proportion of total adaptation spending increased in 2017 to 4•8% (£11•68 billion), which is an increase in absolute and relative terms from the previous year (indicator 2.7). Health-related adaptation spending (including disaster response and food and agriculture) was estimated at 15•2% of total adaptation spend. Although this national-level spending is increasing, climate financing for mitigation and adaptation remains well below the US$100 billion per year committed in the Paris Agreement (indicator 2.8). Recommendation 3: phase out coal-fired power Coal consumption remains high, but continued to decline in 2017, a trend which is largely driven by China's decreased reliance and continued investment in renewable energy (indicators 3.2 and 3.3). The Powering Past Coal Alliance (an alliance of 23 countries including the UK, Italy, Canada, and France) was launched at the 23rd Conference of the Parties to the UN Framework Convention on Climate Change (UNFCCC) in December, 2017 (COP23), committing to phase out coal use by 2030 or earlier. Recommendation 4: encourage city-level low-carbon transition to reduce urban pollution In 2017, a new milestone was reached, with more than 2 million electric vehicles on the road, and with global per-capita electricity consumption for road transport increasing by 13% from 2013 to 2015 (indicator 3.6). C...

BackgroundGlobal climate change is already increasing the average temperature and direct heat exposure in many places around the world.ObjectivesTo assess the potential impact on occupational health and work capacity for people exposed at work to increasing heat due to climate change.DesignA brief review of basic thermal physiology mechanisms, occupational heat exposure guidelines and heat exposure changes in selected cities.ResultsIn countries with very hot seasons, workers are already affected by working environments hotter than that with which human physiological mechanisms can cope. To protect workers from excessive heat, a number of heat exposure indices have been developed. One that is commonly used in occupational health is the Wet Bulb Globe Temperature (WBGT). We use WBGT to illustrate assessing the proportion of a working hour during which a worker can sustain work and the proportion of that same working hour that (s)he needs to rest to cool the body down and maintain core body temperature below 38°C. Using this proportion a ‘work capacity’ estimate was calculated for selected heat exposure levels and work intensity levels. The work capacity rapidly reduces as the WBGT exceeds 26–30°C and this can be used to estimate the impact of increasing heat exposure as a result of climate change in tropical countries.ConclusionsOne result of climate change is a reduced work capacity in heat-exposed jobs and greater difficulty in achieving economic and social development in the countries affected by this somewhat neglected impact of climate change.

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Ambient heat exposure is a well-known health hazard, which reduces human performance and work capacity at heat levels already common in tropical and subtropical areas. Various health problems have been reported. Increasing heat exposure during the hottest seasons of each year is a key feature of global climate change. Heat exhaustion and reduced human performance are often overlooked in climate change health impact analysis. Later this century, many among the four billion people who live in hot areas worldwide will experience significantly reduced work capacity owing to climate change. In some areas, 30-40% of annual daylight hours will become too hot for work to be carried out. The social and economic impacts will be considerable, with global gross domestic product (GDP) losses greater than 20% by 2100. The analysis to date is piecemeal. More analysis of climate change-related occupational health impact assessments is greatly needed.

The WBGT heat stress index has been well tested under a variety of climatic conditions and quantitative links have been established between WBGT and the work-rest cycles needed to prevent heat stress effects at the workplace. While there are more specific methods based on individual physiological measurements to determine heat strain in an individual worker, the WBGT index is used in international and national standards to specify workplace heat stress risks. In order to assess time trends of occupational heat exposure at population level, weather station records or climate modelling are the most widely available data sources. The prescribed method to measure WBGT requires special equipment which is not used at weather stations. We compared published methods to calculate outdoor and indoor WBGT from standard climate data, such as air temperature, dew point temperature, wind speed and solar radiation. Specific criteria for recommending a method were developed and original measurements were used to evaluate the different methods. We recommend the method of Liljegren et al.