Potential planetary health impacts of the airborne plastisphere

Sustainable food systems are those that are healthy, sustainable, and equitable, while also addressing environmental challenges. The 2019 EAT-Lancet Commission on Healthy Diets for Sustainable Food Systems provides comprehensive recommendations for transforming the global food system to address malnutrition, reduce the use of antibiotics in animal agriculture, environmental degradation and climate change. However, the implementation of the EAT-Lancet recommendations has been slow and uneven across different regions and sectors. Holistic approaches to achieve food system sustainability are needed, emphasising the interconnectedness of different systems and the need for multidisciplinary approaches. One Health, Health Impact Assessment (HIA), and mandatory food fortification are all approaches that can contribute to the implementation of EAT-Lancet recommendations. The One Health approach recognizes that human health, animal health, and environmental sustainability are interconnected and that collaboration across sectors is necessary to address complex health challenges. By considering the health of animals and the environment in addition to human health, the One Health approach can inform the development of sustainable food systems that promote health for all. Health Impact Assessment (HIA) is a structured process that evaluates the potential health impacts of policies, programs, and projects. HIAs can be used to identify and address potential health risks associated with food systems and help to promote policies and interventions that support healthy and sustainable food systems. Mandatory food fortification is a strategy that involves adding essential vitamins and minerals to food products to address nutrient deficiencies. Mandatory fortification can be used to ensure that essential nutrients are present in the food supply, which can have significant impacts on public health, when consumed passively. The objective of this round table session is to show how multisectoral approaches can be used to achieve better human and planetary health and promote more sustainable and healthy food systems. This session will bring together experts from different disciplines to explore how holistic approaches can promote healthy and sustainable food systems. There will be three short presentations followed by a round table discussion in which the audience is invited to interact with the discussants. First, the One Health approach of AMR will be discussed outlining the need for a binding international legal framework. Second, a presentation on Health Impact Assessment, planning and public health in relation to the food environment in the UK will be conducted. Finally, the case for a mandatory approach of folic acid supplementation in Ireland with strict regulation, monitoring and oversight with penalties for non-compliance by the food industry is presented. Panellists will share lessons learnt from the Netherlands, the UK, Ireland and Bulgaria and the case for EU-wide approaches will be made. Key messages • Holistic approaches to achieve food system sustainability are needed, emphasising the interconnectedness of different systems and the need for multidisciplinary approaches from local to transnational. • There is a clear role for binding international legal frameworks to tackle challenges related to the food system, such as AMR, fast food outlet density and folic acid fortification. Speakers/Panelists Thom Geertsema Groningen Center Health Law, Faculty of Law, University of Groningen, Groningen, Netherlands Ben Cave Ben Cave Associates Ltd, Leeds, UK Mary Rose Sweeney Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland Desislava Vankova Medical University of Varna, Varna, Bulgaria Nikhil Gokani University of Essex, Colchester, UK

Operationalising planetary health as a game-changing paradigm: health impact assessments are key

Climate change poses a significant global health challenge, with medical procedures contributing substantially to CO2 emissions. Urology, as part of the broader healthcare sector, has begun integrating Planetary Health concepts to address this issue. While earlier studies have focused on Life Cycle Assessments (LCA) of urological procedures, these evaluations remain data-dependent, and insights into intra-hospital emissions are limited. This study introduces a methodical approach for analyzing intra-institutional processes of LCA for single-use and reusable flexible ureterorenoscopes (fURS). The LCA method was applied to assess the greenhouse gas emissions (CO2 equivalents, CO2-eq) generated across the life cycle of fURS, including production, use-phase, reprocessing, maintenance, and disposal. The study approximated the Global Warming Potential (GWP) per one-hour use and evaluated associated health impacts using the ReCiPe2016(H) method, which measures Disability-Adjusted Life Years (DALYs). Results showed that for reusable fURS, assuming 133 usages per device and maintenance after every 11th use, each application generated 1.24 kg CO2-eq, equivalent to 1.15E-06 DALYs. In contrast, single-use fURS generated 4.93 kg CO2-eq and 4.57E-06 DALYs per application. The production and reprocessing stages were identified as having the greatest environmental and health impacts. For reusable fURS, electricity required during refurbishment and use phases was a key contributor, whereas the production phase accounted for most of the impact in single-use devices. Overall, singleuse fURS had a substantially higher potential environmental and health impact than their reusable counterparts. This study underscores the environmental and health impacts of ureterorenoscopy and highlights the importance of incorporating Planetary Health principles into healthcare practices. It provides a foundation for further analyses and research, aiming to drive transformative action in the healthcare sector toward sustainability.

### Learning objectives A healthy diet is the cornerstone of cardiovascular disease (CVD) prevention.1 Dietary habits influence cardiovascular risk, through an effect on, for example, blood pressure (BP), blood lipids,...

Mini-review of the EAT-Lancet planetary health diet and its role in cardiometabolic disease prevention.

Human health: is it who you are or where you live?

What is next for occupational cancer epidemiology?

Disinfection products can have substantial environmental impacts which include associated manufacturing emissions, toxicity to marine life and potential adverse health outcomes. Despite this, disinfection is under-represented in sustainability approaches. Disinfection is a key part of healthcare provision and as such should be reflected in healthcare sustainability strategies. The adverse environmental effects of several common disinfectants are highlighted here. Sustainable alternatives should be considered. Hypochlorous acid (HOCl) is a potential alternative disinfectant that could be used in sustainability strategies, carrying a minimal toxicity profile compared to hypochlorite (bleach) and the unique ability to be made on site. Better clarity is needed regarding the environmental impact of disinfectants used in the healthcare setting and healthcare providers should move to seek sustainable alternatives such as hypochlorous acid.

The European Commission (EC) is responsible for planning, preparing and proposing better and simpler new policies, avoiding unnecessary burdens, and involving citizens and any interested stakeholders in the decision-making process. The EC is also responsible for evaluating existing European laws and proposing improvements where necessary. In achieving these goals, the EC has defined its “Better regulation” (BR) policy, governed by a set of common principles and established procedures, including the assessment of the most significant impacts on the economic, environmental, and social domains, among others. These assessments should be based on the best available evidence, which refers to multiple sources of data, information and knowledge, including quantitative (e.g. statistics and measurements) and qualitative data (e.g. opinions, stakeholder input, scientific and expert advice). BR’s principles and procedures also ensure the implementation of more effective, coherent, relevant and efficient initiatives, improving the transparency, participation, learning and accountability. With this approach, the EC also seeks to guarantee that all legislative proposals contribute to the 2030 sustainable development agenda, and to better planetary health. As stated in the EU Treaty (Article 168 TFEU), “a high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities”. Therefore, assessment of any potential health impacts should be addressed during the policy cycle. Health gains and health losses can be direct or indirect, and particular attention should be given to specific population groups that may be disproportionally affected by the intervention (e.g., children, persons with disabilities, pregnant women, the elderly, low-income groups). The design and improvement of healthy public policies was precisely the ultimate goal for which the WHO proposed in 1999 the Health impact assessment (HIA) approach. HIA practice is grounded in the WHO’s health definition, which encompasses physical, mental and social health and well-being, and it is closely linked to the social determinants of health framework and to Health in All Policy strategy. Several quantitative methods are available to estimate health impacts within HIA applied to policies. The environmental burden of disease (EBD) is one of them aiming at quantifying the impact of a health problem as measured by avoidable mortality/morbidity, financial cost, or other indicators attributed to environmental factors (e.g. exposure to chemicals). EBD approach allows policy actions to be based on estimated health gains, rather than on “safe environmental levels” of the risk factor alone. The main aim of this session will be to analyses different quantitative approaches and provide some recommendations and good practice on how epidemiological evidence can support the policy cycle, improving data collection, evaluation and reporting suitable to such context. Key messages • Refining epidemiologic data recording and reporting, especially uncertainty characterisation, is necessary to improve weight-of-evidence evaluations for a better regulation process. • Environmental burden of disease, as a tool for quantifying health impacts, provides crucial information to policy makers on how to regulate for better protecting population health.

Increasing population and disposable income has caused a change in the sub-Saharan African diet to more animal sources of protein, especially in the urban areas. Planetary health concerns are bound to be more prominent with this increased consumption. Meat alternatives has emerged as a potential alternative. However, its research in the continent is lacking despite the projected increase in meat consumption in the coming years This review aims to address this gap by examining the available literature regarding plant-based meat alternatives production and consumption. This review found that meat alternatives are similar in nutrient composition to meat, although differences in essential nutrients warrants caution. Furthermore, even though meat alternatives are less environmentally demanding, the potential health concerns demand further study. The review also found that meat is eaten for more than just physiological needs and it has socio-cultural connotations, especially in sub-Saharan Africa (SSA). Consequently, to encourage consumers to substitute their traditional meat, these barriers need to be adequately researched. Regardless, there are various opportunities for plant-based meat adoption; circumstantially evidenced by the increasing demand of vegan and vegetarian products in some parts of SSA. Yet, large-scale adoption of meat alternatives is stymied by limited consumer research in SSA.

The quality and nutritional value of dietary proteins are determined by the quantity, digestibility and bioavailability of essential amino acids (EAA), which play a critical role in human growth, longevity and metabolic health. Plant-source protein is often deficient in one or more EAAs (e.g., branched-chain amino acids, lysine, methionine and/or tryptophan) and, in its natural form, is less digestible than animal-source protein. Nevertheless, dietary intake of plant-source protein has been promoted because of its potential health benefits, lower cost of production and lower environmental impact compared to animal-source protein. Implementation of dietary strategies that improve both human and planetary health are of critical importance and subject to growing interest from researchers and consumers. Therefore, in this review we analyse current plant protein intake patterns and discuss possible countermeasures that can enhance plant protein nutrition, examples include: (1) combining different plant proteins with complementary EAA profiles; (2) identification and commercial cultivation of new and novel high-quality plant proteins; (3) industrial and domestic processing methods; and (4) genome-editing techniques.

BackgroundAn urgent transition to more sustainable diets is necessary for the improvement of human and planetary health. One way to achieve this is for sustainable practices to become mainstream. We estimated the potential health impact of wider adoption of dietary practices deemed by consumers, researchers and stakeholders in Sweden to be niche, sustainable and with the potential to be scaled up.MethodsA life table method was used to estimate the impact - changes in years of life lost (YLL) - over periods of 20 and 30 years in the Swedish population had the practices been adopted in 2010–11, when the last national adult dietary survey was conducted. The practices modelled were reducing red and processed meat (by 25, 50 and 100%), and assuming, for each stage, replacement by an equal weight of poultry/fish and vegetables +/− legumes; reducing milk intake (by 25, 50 and 100%); and reducing sugar-sweetened beverage intake (by 25, 50 and 100%). Using population data together with data on cause-specific mortality and relative risks for diet-disease outcomes, impacts were estimated for each scenario separately and in combination, for the outcomes ischaemic heart disease (IHD), ischaemic stroke, diabetes type 2 and colorectal cancer.ResultsFor a “moderate” combination of scenarios (changes at the 50% level), reductions of 513,200 YLL (lower-upper uncertainty estimate 59,400-797,900) could have been achieved over 20 years and 1,148,500 YLL (135,900-1,786,600) over 30 years. The majority (over 90%) of YLLs prevented were related to IHD, and the majority were in men. The singular practice that had the most impact was reducing the intake of red and processed meat and replacing it with a mixture of vegetables and legumes. Reducing milk intake resulted in an increase in YLL, but this was compensated for by other scenarios.ConclusionIf these practices were more widely adopted, they would be expected to lead to improvements in public health in Sweden. Over the long term, this would translate to many premature deaths postponed or prevented from a number of chronic diseases, to the benefit of individuals, society, the climate and the economy.

Global environmental degradation and climate change threaten the foundation of human health and well-being. In a confluence of crises, the accelerating pace of climate change and other environmental disruptions pose an additional, preventable danger to a global population that is both aging and carrying a growing burden of noncommunicable diseases (NCDs). Climate change and environmental disruption function as "threat multipliers," especially for those with NCDs, worsening the potential health impacts on those with suboptimal health. At the same time, these environmental factors threaten the basic pillars of health and prevention, increasing the risk of developing chronic disease. In the face of these threats, the core competencies of lifestyle medicine (LM) present crucial opportunities to mitigate climate change and human health impacts while also allowing individuals and communities to build resilience. LM health professionals are uniquely positioned to coach patients toward climate-healthy behavior changes that heal both people and the planet.

Purpose of ReviewDairy milk products are dominant in the market; however, plant-based milks are gaining prominence among USA consumers. Many questions remain about how plant-based milk products compare to dairy milk from a nutrition, public health, and planetary health perspective. Here, we compare the retail sales, nutrient profiles, and known health and environmental impacts of the production and consumption of dairy and plant-based milks and identify knowledge gaps for future studies. For our plant-based milk comparisons, we reviewed almond, soy, oat, coconut, rice, pea, cashew, and other plant-based milks as data were available.Recent FindingsThe retail unit price of plant-based milks was generally higher than that of cow’s milk, making it less accessible to lower-income groups. Many plant-based milks are fortified to match the micronutrient profile of dairy milk more closely. Notable differences remained, especially in protein, zinc, and potassium, depending on the base ingredient and individual product. Some plant-based milks contain added sugar to improve flavor. Plant-based milks were generally associated with lower environmental impacts (e.g., greenhouse gas emissions, water use) than cow’s milk, with the notable exception of the higher water footprint of almond milk.SummaryThis review of recent studies and consumer purchases confirmed that retail sales of plant-based milks are increasing and shifting among products. Further research is needed to better characterize the environmental impacts of newer plant-based milks, such as cashew, hemp, and pea milks; consumer attitudes and behavior towards plant-based milks; and the safety and potential health effects related to their long-term and more frequent consumption.

Potential Health Benefit of NO2 Abatement in China's Urban Areas: Inspirations for Source-specific Pollution Control Strategy