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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.

These positive examples in recent years must not mask the dangerous consequences of failing to meet the Paris Agreement, the past two decades of relative inaction, the economies and sectors currently lagging behind, and the enormity of the task ahead, which leave achieving the Agreement's aims in a precarious position. Indeed, much of the data presented should serve as a wake-up call to national governments, businesses, civil society, and the health profession. However, as this report demonstrates, the world has already begun to embark on a path to a lowcarbon and healthier world. Whilst the pace of action must greatly accelerate, the direction of travel is set.

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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...

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Dietary patterns analysis is an emerging area of research. Identifying distinct patterns within a large dietary survey can give a more accurate representation of what people are eating. Furthermore, it allows researchers to analyse relationships between non-communicable diseases (NCD) and complete diets rather than individual food items or nutrients. However, few such studies have been conducted in developing countries including India, where the population has a high burden of diabetes and CVD. We undertook a systematic review of published and grey literature exploring dietary patterns and relationships with diet-related NCD in India. We identified eight studies, including eleven separate models of dietary patterns. Most dietary patterns were vegetarian with a predominance of fruit, vegetables and pulses, as well as cereals; dietary patterns based on high-fat, high-sugar foods and more meat were also identified. There was large variability between regions in dietary patterns, and there was some evidence of change in diets over time, although no evidence of different diets by sex or age was found. Consumers of high-fat dietary patterns were more likely to have greater BMI, and a dietary pattern high in sweets and snacks was associated with greater risk of diabetes compared with a traditional diet high in rice and pulses, but other relationships with NCD risk factors were less clear. This review shows that dietary pattern analyses can be highly valuable in assessing variability in national diets and diet–disease relationships. However, to date, most studies in India are limited by data and methodological shortcomings.