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      Decision-support tools to build climate resilience against emerging infectious diseases in Europe and beyond

      review-article
      a , b , , a , b , c , d , d , e , f , g , h , i , a , f , j , k , l , m , n , o , p , q , r , j , s , t , r , u , v , w , r , b , c , x , q , y , z , aa , ab , ac , ad , b , ae , af , x , r , a , r , IDAlert Consortium, g , h , m , r
      The Lancet Regional Health - Europe
      Elsevier
      Climate change, Infectious disease, One Health, Planetary health, Human health, Climate policy, Co-production, Adaptation, Mitigation

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          Summary

          Climate change is one of several drivers of recurrent outbreaks and geographical range expansion of infectious diseases in Europe. We propose a framework for the co-production of policy-relevant indicators and decision-support tools that track past, present, and future climate-induced disease risks across hazard, exposure, and vulnerability domains at the animal, human, and environmental interface. This entails the co-development of early warning and response systems and tools to assess the costs and benefits of climate change adaptation and mitigation measures across sectors, to increase health system resilience at regional and local levels and reveal novel policy entry points and opportunities. Our approach involves multi-level engagement, innovative methodologies, and novel data streams. We take advantage of intelligence generated locally and empirically to quantify effects in areas experiencing rapid urban transformation and heterogeneous climate-induced disease threats. Our goal is to reduce the knowledge-to-action gap by developing an integrated One Health—Climate Risk framework.

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          Most cited references70

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          Designing Difference in Difference Studies: Best Practices for Public Health Policy Research

          The difference in difference (DID) design is a quasi-experimental research design that researchers often use to study causal relationships in public health settings where randomized controlled trials (RCTs) are infeasible or unethical. However, causal inference poses many challenges in DID designs. In this article, we review key features of DID designs with an emphasis on public health policy research. Contemporary researchers should take an active approach to the design of DID studies, seeking to construct comparison groups, sensitivity analyses, and robustness checks that help validate the method's assumptions. We explain the key assumptions of the design and discuss analytic tactics, supplementary analysis, and approaches to statistical inference that are often important in applied research. The DID design is not a perfect substitute for randomized experiments, but it often represents a feasible way to learn about casual relationships. We conclude by noting that combining elements from multiple quasi-experimental techniques may be important in the next wave of innovations to the DID approach.
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            Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics

            We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in primary sewage sludge in the New Haven, Connecticut, USA, metropolitan area during the Coronavirus Disease 2019 (COVID-19) outbreak in Spring 2020. SARS-CoV-2 RNA was detected throughout the more than 10-week study and, when adjusted for time lags, tracked the rise and fall of cases seen in SARS-CoV-2 clinical test results and local COVID-19 hospital admissions. Relative to these indicators, SARS-CoV-2 RNA concentrations in sludge were 0-2 d ahead of SARS-CoV-2 positive test results by date of specimen collection, 0-2 d ahead of the percentage of positive tests by date of specimen collection, 1-4 d ahead of local hospital admissions and 6-8 d ahead of SARS-CoV-2 positive test results by reporting date. Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics.
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              From “one medicine” to “one health” and systemic approaches to health and well-being☆

              Faced with complex patterns of global change, the inextricable interconnection of humans, pet animals, livestock and wildlife and their social and ecological environment is evident and requires integrated approaches to human and animal health and their respective social and environmental contexts. The history of integrative thinking of human and animal health is briefly reviewed from early historical times, to the foundation of universities in Europe, up to the beginning of comparative medicine at the end of the 19th century. In the 20th century, Calvin Schwabe coined the concept of “one medicine”. It recognises that there is no difference of paradigm between human and veterinary medicine and both disciplines can contribute to the development of each other. Considering a broader approach to health and well-being of societies, the original concept of “one medicine” was extended to “one health” through practical implementations and careful validations in different settings. Given the global health thinking in recent decades, ecosystem approaches to health have emerged. Based on complex ecological thinking that goes beyond humans and animals, these approaches consider inextricable linkages between ecosystems and health, known as “ecosystem health”. Despite these integrative conceptual and methodological developments, large portions of human and animal health thinking and actions still remain in separate disciplinary silos. Evidence for added value of a coherent application of “one health” compared to separated sectorial thinking is, however, now growing. Integrative thinking is increasingly being considered in academic curricula, clinical practice, ministries of health and livestock/agriculture and international organizations. Challenges remain, focusing around key questions such as how does “one health” evolve and what are the elements of a modern theory of health? The close interdependence of humans and animals in their social and ecological context relates to the concept of “human-environmental systems”, also called “social-ecological systems”. The theory and practice of understanding and managing human activities in the context of social-ecological systems has been well-developed by members of The Resilience Alliance and was used extensively in the Millennium Ecosystem Assessment, including its work on human well-being outcomes. This in turn entails systems theory applied to human and animal health. Examples of successful systems approaches to public health show unexpected results. Analogous to “systems biology” which focuses mostly on the interplay of proteins and molecules at a sub-cellular level, a systemic approach to health in social-ecological systems (HSES) is an inter- and trans-disciplinary study of complex interactions in all health-related fields. HSES moves beyond “one health” and “eco-health”, expecting to identify emerging properties and determinants of health that may arise from a systemic view ranging across scales from molecules to the ecological and socio-cultural context, as well from the comparison with different disease endemicities and health systems structures.
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                Author and article information

                Contributors
                Journal
                Lancet Reg Health Eur
                Lancet Reg Health Eur
                The Lancet Regional Health - Europe
                Elsevier
                2666-7762
                07 August 2023
                September 2023
                07 August 2023
                : 32
                : 100701
                Affiliations
                [a ]Heidelberg Institute of Global Health (HIGH) & Interdisciplinary Centre for Scientific Computing (IWR), Heidelberg University, Heidelberg, Germany
                [b ]Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
                [c ]Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Venice, Italy
                [d ]Graham Research Institute on Climate Change and the Environment, London School of Economics and Political Science (LSE), London, United Kingdom
                [e ]Faculty of Veterinary Medicine, Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, Leipzig, Germany
                [f ]Red Cross Red Crescent Centre on Climate Change and Disaster Preparedness, The Hague, the Netherlands
                [g ]Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
                [h ]Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
                [i ]Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
                [j ]Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
                [k ]Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
                [l ]Theoretical and Computational Ecology Group, Centre d’Estudis Avançats de Blanes (CEAB-CSIC), Blanes, Spain
                [m ]Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
                [n ]Centre de Recerca Ecològica i Aplicacions Forestals (CREAF), Barcelona, Spain
                [o ]Pest Surveillance and Control, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
                [p ]Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Barcelona, Spain
                [q ]Climate Service Center Germany (GERICS), Helmholtz-Zentrum Hereon, Hamburg, Germany
                [r ]Barcelona Supercomputing Center (BSC), Barcelona, Spain
                [s ]Center for Climate, Health and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA, USA
                [t ]Three O'clock, Paris, France
                [u ]British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
                [v ]Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
                [w ]Irideon, Barcelona, Spain
                [x ]Department of Viroscience, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
                [y ]Laboratory of Insects & Parasites of Medical Importance, Benaki Phytopathological Institute (BPI), Attica, Greece
                [z ]Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
                [aa ]CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
                [ab ]Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
                [ac ]Department of Chemistry, Environment, and Feed Hygiene, National Veterinary Institute (SVA), Uppsala, Sweden
                [ad ]Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
                [ae ]Institute for Global Health, University College London (UCL), London, United Kingdom
                [af ]Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
                Author notes
                []Corresponding author. Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umea University, Umea 901 87, Sweden. joacim.rockloev@ 123456uni-heidelberg.de
                Article
                S2666-7762(23)00120-5 100701
                10.1016/j.lanepe.2023.100701
                10424206
                37583927
                972d286a-468a-42fb-b564-aa26508a32d2
                © 2023 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 3 May 2023
                : 11 July 2023
                : 12 July 2023
                Categories
                Health Policy

                climate change,infectious disease,one health,planetary health,human health,climate policy,co-production,adaptation,mitigation

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