Background Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world. Methods A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type. Findings In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS. Interpretation This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions. Funding Wellcome Trust.

No abstract

Small island developing states (SIDS) are often at the forefront of climate change impacts, including those related to health, but information on mental health and wellbeing is typically underreported. To help address this research lacuna, this paper reviews research about mental health and wellbeing under climate change in SIDS. Due to major differences in the literature’s methodologies, results, and analyses, the method is an overview and qualitative evidence synthesis of peer-reviewed publications. The findings show that mental health and wellbeing in the context of climate change have yet to feature prominently and systematically in research covering SIDS. It seems likely that major adverse mental health and wellbeing impacts linked to climate change impacts will affect SIDS peoples. Similar outcomes might also emerge when discussing climate change related situations, scenarios, and responses, irrespective of what has actually happened thus far due to climate change. In the context of inadequate health systems and stigmatisation of mental health diagnoses and treatments, as tends to occur globally, climate change narratives might present an opening for conversations about addressing mental health and wellbeing issues for SIDS.

BackgroundTwo themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO’s capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.MethodsThis qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?ResultsAnalysis of the interviews and documents revealed three main themes: 1) WHO’s role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO’s cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO’s cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.ConclusionThere are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO’s constitution, requires cultural and institutional changes for it to be fully implemented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0128-6) contains supplementary material, which is available to authorized users.

This paper advances the proposition that environmental policy may be particularly suited as a vehicle for the articulation of post‐material values in advanced industrial societies, and that recognition of this is likely to prove enormously helpful in future comparative and cross‐national research into the origins of environmentalism and the causes of environmental policy change. The paper notes the salient characteristics of postmaterialism and the overlap of these with the leading indicators of environmentalism. Possible structural causes for this overlap are noted and opposed to the prevailing socialization explanation for the adoption of postmaterial and environmental values. To help understand the impact of environmentalism on policy an idealized development of the movement is sketched. This leads to the description of a set of general factors likely to be related to the way environmentalism finds political expression in various countries. In the final section, the focus is on what we might want to know about the policy process in order to be able to gauge environmentalist influence on policy outputs.