Background:The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals.Objectives:We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease–Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden—both current and projected.Methods:We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment.Discussion:A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure–risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD’s current methods do not fully account for lead’s impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk–outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD’s estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496

Climate change is likely to induce a large range of household-and individual-level responses, including changes in human fertility behaviors and outcomes. These responses may have important implications for human and economic development and women's empowerment. Drawing on the literature linking climate conditions to rice cultivation in Indonesia, we use longitudinal household survey and high-resolution climate data to explore changes in childbearing intentions, family planning use, and births following community-level climate shocks from 1993 to 2015. We find that fertility intentions increase and family planning use declines in response to delays in monsoon onset occurring within the previous year, particularly for wealthier populations. However, women on farms are significantly more likely to use family planning and less likely to give birth following abnormally high temperatures during the previous five years. We also measure parallel shifts in household well-being as measured by rice, food, and non-food consumption expenditures. Our findings advance the environmental fertility literature by showing that longer duration environmental shocks can have impacts on fertility behaviors and outcomes. Collectively, our results illustrate human fertility responses to climate change in a country vulnerable to its effects, and demonstrate that in some cases, climate shocks can constrain human fertility.

Vulnerability and adaptation assessments can provide valuable input to foster climate-resilient health systems. However, these assessments often do not explore the potential health risks of climate change far outside the range of recent experience with extreme weather events and other climate-related hazards. Climate and health stress tests are designed to increase the capacity of health systems and related sectors to manage potentially disruptive climate-related shocks and stresses. Stress tests focus on hypothetical scenarios, during which it would be difficult for the health system to maintain its essential function of providing services to protect population health. The stress test explores approaches to effectively manage acute and chronic climate-related events and conditions that could directly impact health systems, and climate-related events in non-health sectors that can indirectly impact health outcomes and/or health system function. We provide detailed methods and guidance for conducting climate and health stress tests, centering on three primary activities: (1) preparing and scoping the stress test; (2) successfully conducting the stress test; and (3) communicating the results to key stakeholders to facilitate policy and programmatic reforms.

A growing body of literature addresses how climate change is likely to have substantial and generally adverse effects on population health and health systems around the world. These effects are likely to vary within and between countries and, importantly, will vary depending on different socioeconomic development patterns. Transitioning to a more resilient and sustainable world to prepare for and manage the effects of climate change is likely to result in better health outcomes. Sustained fossil fuel development will likely result in continued high burdens of preventable conditions, such as undernutrition, malaria, and diarrheal diseases. Using a new set of socioeconomic development trajectories, the Shared Socioeconomic Pathways (SSPs), along with the World Health Organization’s Operational Framework for Building Climate Resilient Health Systems, we extend existing storylines to illustrate how various aspects of health systems are likely to be affected under each SSP. We also discuss the implications of our findings on how the burden of mortality and the achievement of health-related Sustainable Development Goal targets are likely to vary under different SSPs.

Background:Abundant historical evidence demonstrates how environmental changes can affect social stability and, in turn, human health. A rapidly growing body of literature, largely from political science and economics, is examining the potential for and consequences associated with social instability related to current climate change. However, comparatively little of this research incorporates the effects on human health or the role of health systems in influencing the magnitude and types of instability that could occur.Objective:The objective of this commentary is to articulate a conceptual framework incorporating health outcomes and health systems into theorized and observed linkages between climate change and social instability, illustrating in particular the health effects of natural resource shortages, infectious disease outbreaks, and migration.Discussion:Although increasing evidence exists that climate change, health, and social instability are related, key questions remain about the pathways linking these factors, as well as the magnitude, causality, and directionality of relationships across spatial and temporal scales. Models seeking to explain and predict climate-related social unrest should incorporate the many linkages between climate change, human health, and social instability. Members of the environmental health research community should work closely with those in the political science and economics communities to help deepen understandings of climate-related stressors and shocks that affect instability and worsen health outcomes. https://doi.org/10.1289/EHP4534

Background. Though many studies have long considered the broad social implications of climate change, researchers have only recently started to consider the gendered unevenness of the global landscape of vulnerability, exposure, and adaptive capacity to environmental stressors and shocks. Historically, policies and interventions addressing natural resource-based livelihoods have rarely considered underlying gender dynamics despite the global pervasiveness of gendered disparities in both economic opportunities and welfare outcomes. Methods/Design. Using two electronic databases, Web of Science and Scopus, we conducted a systematic review of peer-reviewed academic literature describing livelihoods policies or interventions that included documentation of gendered impacts. We focused on natural resource-based livelihoods most likely to be affected by climate change, centering on interventions targeting agriculture, fisheries and aquaculture, and forestry. Review Results/ Synthesis. We identified 131 relevant articles, most of which focus on adoption or participation in interventions rather than outcomes. In general, women are less likely than men to engage with sustainable livelihoods interventions. When women do engage, some researchers have documented income and food security gains as well as improvements in environmental indicators in the shortterm. However, these initiatives have also been found to increase women's labor burden without corresponding gains in income. Few studies measure longer-term effects of women's engagement on welfare and environmental outcomes, a key gap in the literature. Additionally, relatively few studies explore the intersectional impacts of initiatives, such as the added burdens of ethnicity, class, education, or other differences that modify gender disparities. Discussion. Climate change has gendered impacts on natural resource-based livelihoods. In general, existing initiatives designed to increase livelihood resilience fail to reduce gender disparities and improve women's livelihoods. Greater attention should be paid to gender when designing sustainable livelihoods policies and interventions in order to increase adoption and participation, negotiate trade-offs, improve environmental conditions, and promote broadly beneficial welfare outcomes.

This paper examines changes over time for a full generation of migrant settlers in the Northern Ecuadorian Amazon (NEA). Data were collected from a 2014 household survey covering a subsample of households surveyed previously in 1990 and 1999. We observed changes in demographic behavior, land use, forest cover, and living conditions. As the frontier develops, human fertility is continuing to decline with contraceptive prevalence rising. Meanwhile, out-migration from colonist households, largely to destinations within the region, persists. More households have secure land tenure than in 1999, and are better off as measured by possession of assets. There is continued growth in pasture, largely at the expense of forest. Farms still serve as an important livelihood source for families, though growing cities in the NEA are creating more non-agricultural economic opportunities. Our findings provide a snapshot of demographic, economic, land use, and livelihood changes occurring in the NEA during the past quarter century, providing useful information for policymakers seeking to balance economic and environmental goals in order to promote sustainable development as well as protect biodiversity. KEYWORDS: family planning, deforestation, livelihoods, migration Población y desarrollo en la Amazonia: Un estudio longitudinal de colonos migrantes en la Amazonía norte del Ecuador RESUMEN Este artículo describe cambios para una generación de migrantes en la Amazonía norte del Ecuador (ANE). Nosotros realizamos una encuesta en el 2014 de un subgrupo de fincas que encuestamos en 1990 y 1999. Observamos cambios demográficos, del uso de la tierra, de la cubierta forestal, y de las condiciones de vida de este grupo. Encontramos que la fecundidad está disminuyendo y que el uso de planificación familiar está aumentando. La migración fuera de las fincas continúa, la mayoría a destinos en la ANE. Más fincas tienen los derechos de su tierra y las familias tienen más bienes. Desde 1999 ha habido conversión en las fincas de bosques a pasto. Las fincas son fuentes importantes de sustento de vida, pero las ciudades en crecimiento están creando otras oportunidades económicas. Nuestros resultados demuestran cambios significativos demográficos, económicos, del uso de la tierra, y de las condiciones de vida durante el periodo 1990-2014. Nuestro artículo provee información útil para líderes que quieran avanzar metas económicas y ambientales para promover el desarrollo sostenible y proteger la biodiversidad. PALABRAS CLAVE: planificación familiar, deforestación, sustento de vida, migración 322

Climate change will create numerous risks for human health, including impacts associated with temperature extremes, diarrheal diseases, and undernutrition. Such risks, along with other socioeconomic and development trends, will affect cause-of-death patterns experienced in the coming decades. This study explores future mortality trends using the shared socioeconomic pathways (SSP) framework, a widely utilized tool for understanding socioeconomic development trends in a world with climate change. Existing projections for GDP, urbanization, and demographic trends based on SSP narratives are incorporated into an integrated assessment model, International Futures (IFs), in order to project mortality levels by cause of death for all countries from 2020 to 2100. Under more optimistic SSPs, non-communicable diseases (NCDs) rise as a proportion of all deaths, particularly in low- and middle-income countries, while more pessimistic SSPs suggest a continued high burden of largely preventable communicable diseases. In high-income countries, significant continued burdens of NCDs are projected for the remainder of the century under all SSPs. Comparisons are also made to recent cause-of-death projections from the Institute for Health Metrics and Evaluation (IHME) to assess how the IFs and IHME models vary. Electronic supplementary material The online version of this article (10.1007/s10584-020-02824-0) contains supplementary material, which is available to authorized users.