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Climate change with increasing temperature is making a significant impact on human health, including more heat-related diseases, and increasing the burden on the healthcare system. Although many studies have explored the association between increasing temperatures and negative health outcomes, research on the associated costs of heat-related diseases remains relatively sparse. Furthermore, estimations of future costs associated with heat-attributable hospital healthcare have not been well explored. This study used a distributed lag nonlinear model to estimate heat-attributable hospital healthcare costs in Perth, Western Australia. Using 2006–2012 as the baseline, future costings for 2026–2032 and 2046–2052 were estimated under RCP2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospital healthcare costs. The total hospital costs attributable to heat over the baseline period 2006–2012 was estimated to be 79.5 million AUD, with costs for mental health hospitalizations being the largest contributor of the heat-related conditions examined. Costs are estimated to increase substantially to 125.8–129.1 million AUD in 2026–2032, and 174.1–190.3 million AUD by midcentury under climate change scenarios. Our findings of a notable burden of heat-attributable healthcare costs now and in the future emphasize the importance of climate change adaptation measures to reduce the adverse health effects of increasing temperatures and heat exposure on the people of Perth.

Background: Bacillary dysentery (BD) remains a significant public health issue, especially in developing countries. Evidence assessing the risk of BD from temperature is limited, particularly from national studies including multiple locations with different climatic characteristics. Objectives: We estimated the effect of temperature on BD across China, assessed heterogeneity and attributable risks across cities and regions, and projected the future risk of BD under climate change. Methods: Daily BD surveillance and meteorological data over 2014–2016 were collected from the Chinese Center for Disease Control and Prevention and the China Meteorology Administration, respectively. A two-stage statistical model was used to estimate city-specific temperature–BD relationships that were pooled to derive regional and national estimates. The risk of BD attributable to temperature was estimated, and the future burden of BD attributable to temperature was projected under different climate change scenarios. Results: A positive linear relationship for the pooled effect was estimated at the national level. Subgroup analyses indicate that the estimated effect of temperature on BD was similar by age (≤5y or >5y) and gender. At baseline, estimated attributable risks for BD due to average daily mean temperatures above the 50th percentile were highest for the Inner Mongolia (16%), Northeast China (14%), and Northern China (13%). Most of the individual cities in the same regions and most of the cities in the Northwest, Southern, and Southwest regions, had high attributable risks (≥5%). The Northern, Northeast, Inner Mongolia, Northwest, and Southern China regions were identified as high risk for future BD, with estimated increases by the 2090s compared with baseline of 20% (95% confidence interval: 11%, 27%), 15% (6%, 20%), 15% (−1%, 22%), 12% (1%, 19%), and 11% (5%, 15%), respectively, under Representative Concentration Pathway 8.5. Conclusions: The positive association between temperature and BD in different climatic regions of China, and the projection for increased risk due to climate change, support efforts to mitigate future risks. https://doi.org/10.1289/EHP5779

To characterise the burden of work-related injuries in South Australia, workers&rsquo, compensation claim data were obtained from SafeWork South Australia between 2000 and 2014. Descriptive analyses were performed to investigate the burden of work-related injuries by age, gender, occupation, industry, and nature and mechanism of injury. Dunn&rsquo, s test was used to compare the injury costs and working days lost by industry and occupation. Ordinary linear regression was used to investigate the age-injury cost association. A total of 464,139 workers&rsquo, compensation claims were reported during the 15-year period in South Australia, with an overall rate of 4.6 claims per 100 employees, resulting in a total of 20,861,001 working days lost and AU$14.9 billion dollars of compensation payment. Between 2000 to 2014, the annual claim rates, compensation payments, working days lost, and number of work-related death reduced by 59.3, 73.8, 87.1, and 78.6 percent, respectively, while the median compensation payment increased by 67.3% from AU$968 to AU$1620. A 1-year increase in age was associated with a 2.1% (Rate Ratio, RR = 1.021, 95% CI: 1.020&ndash, 1.022) increase in compensation costs and a 1.3% (RR = 1.013, 95% CI: 1.012&ndash, 1.020) increase in working days lost. Work-related injury rates are declining in most sectors, however some workers, especially young male technicians and labourers in the community services industry, remain at higher risk. Challenges for workers&rsquo, health and safety include the aging labour force, vehicle incidents, and severe injuries among new and foreign-born workers.

Objectives Infectious diseases are a major cause of morbidity and mortality in China. The capacity of hospitals to deal with the challenge from emerging and re-emerging infectious diseases due to climate change is of great importance to population health. This study aimed to explore the capacity of hospitals in China to deal with such challenges. Methods A cross-sectional questionnaire survey was utilized to gauge information regarding capacity of hospitals to deal with infectious diseases in the context of climate change among 611 clinical professionals whose roles pertained to infectious disease diagnosis, treatment and management in Anhui Province of China. Descriptive analysis and logistic regression analysis were performed on the data. Results More than 90% of participants believed climate change would have an adverse influence on population health and infectious disease control in China. Most indicated that their hospitals were well prepared for emerging infectious diseases at present, and they considered that logistical support in hospitals (e.g. administrative and maintenance services) should be strengthened for future capacity building. The majority of participants suggested that effective prevention and control measures, more interdisciplinary collaborations, more funding in rural areas for health care, and improved access to facilities enabling online reporting of infectious diseases, were extremely important strategies in building capacity to curb the population health impact of emerging and re-emerging infectious diseases due to climate change in China. Conclusions Clinical professionals recognized that climate change will likely increase the transmission of infectious diseases. Although rural health care and hospitals’ logistical support need to be improved, most professionals believed their hospitals to be capable of dealing with emerging diseases. They thought that interdisciplinary and cross-regional collaborations, together with necessary resource support (e.g. improved facilities for rural health care) would be important control strategies., Highlights • Most participants indicated climate change would affect infectious diseases. • Generally, hospitals were well prepared for emerging infectious diseases. • Hospital's logistical support should be strengthened urgently. • Improving the capacity of rural health care and hospitals were extremely important.

Background Hemorrhagic fever with renal syndrome (HFRS) is a serious public health problem in China. Although the incidence of HFRS sharply reduced towards the end of the twentieth century, there has been a re-emergence of the disease after 2008 in some parts of China. The aim of this study was to gauge the perceptions of health professionals in China concerning HFRS control and climate change. Methods A cross-sectional survey about HFRS and climate change was conducted among staff in the Centers for Disease Control and Prevention (CDC) in Liaoning and Anhui Provinces, where HFRS is still a public health concern. Descriptive analyses were performed to assess survey results. Results In total, 412 questionnaires were distributed, and 381 participants completed the survey. > 80% of participants thought climate change would have an influence on population health and infectious diseases. However, fewer participants (

Increasing temperature and its impact on population health is an emerging significant public health issue in the context of climate change in Australia. While previous studies have primarily focused on risk assessment, very few studies have evaluated heat-attributable emergency department (ED) visits and associated healthcare costs, or projected future health and economic burdens. This study used a distributed lag non-linear model to estimate heat attributable ED visits and associated healthcare costs from 13 hospitals in Perth, Western Australia, and to project the future healthcare costs in 2030s and 2050s under three climate change scenarios—Representative Concentration Pathways (RCPs)2.6, RCP4.5 and RCP8.5. There were 3697 ED visits attributable to heat (temperatures above 20.5 °C) over the study period 2012–2019, accounting for 4.6% of the total ED visits. This resulted in AU$ 2.9 million in heat-attributable healthcare costs. The number of ED visits projected to occur in the 2030s and 2050s ranges from 5707 to 9421 under different climate change scenarios, which would equate to AU$ 4.6–7.6 million in heat associated healthcare costs. The heat attributable fraction for ED visits and associated healthcare costs would increase from 4.6% and 4.1% in 2010s to 5.0%–6.3% and 4.4%–5.6% in 2030s and 2050s, respectively. Future heat attributable ED visits and associated costs will increase in Perth due to climate change. Excess heat will generate a substantial population health challenge and economic burdens on the healthcare system if there is insufficient heat adaptation. It is vital to reduce greenhouse gas emissions, develop heat-related health interventions and optimize healthcare resources to mitigate the negative impact on the healthcare system and population health in the face of climate change.

Zoonotic diseases transmitted by arthropods and rodents are a major public health concern in China. However, interventions in recent decades have helped lower the incidence of several diseases despite the country's large, frequently mobile population and socio-economic challenges. Increasing globalization, rapid urbanization and a warming climate now add to the complexity of disease control and prevention and could challenge China's capacity to respond to threats of emerging and re-emerging zoonoses. To investigate this notion, face-to-face interviews were conducted with 30 infectious disease experts in four cities in China. The case study diseases under discussion were malaria, dengue fever and haemorrhagic fever with renal syndrome, all of which may be influenced by changing meteorological conditions. Data were analysed using standard qualitative techniques. The study participants viewed the current disease prevention and control system favourably and were optimistic about China's capacity to manage climate-sensitive diseases in the future. Several recommendations emerged from the data including the need to improve health literacy in the population regarding the transmission of infectious diseases and raising awareness of the health impacts of climate change amongst policymakers and health professionals. Participants thought that research capacity could be strengthened and human resources issues for front-line staff should be addressed. It was considered important that authorities are well prepared in advance for outbreaks such as dengue fever in populous subtropical areas, and a prompt and coordinated response is required when outbreaks occur. Furthermore, health professionals need to remain skilled in the identification of diseases for which incidence is declining, so that re-emerging or emerging trends can be rapidly identified. Recommendations such as these may be useful in formulating adaptation plans and capacity building for the future control and prevention of climate-sensitive zoonotic diseases in China and neighbouring countries. Refereed/Peer-reviewed

Several studies have explored the factors associated with repeat workers’ compensation claims, however, none investigated the impact of migration status on repeat claims among injured workers. Using South Australian workers’ compensation claims data from 2000 to 2014, generalized estimating equation models were used to compare the differences in repeat claims between foreign-born workers (FBW) and Australian-born workers. Time intervals between repeat claims, compensation costs, and working days lost by region of birth, as well as the change of severity between repeat claims were examined. Amongst 464,596 accepted compensation claims, repeat claims for FBW (50.5%) was lower than that of Australian-born workers (57.4%, incidence-rate ratio, IRR = 0.83, 95% CI 0.82–0.84). However, region-specific analysis showed that European-born migrant workers were 19% more likely to make repeat claims than Australian-born workers (IRR = 1.19, 95% CI 1.17–1.22), including burns, digestive diseases, fractures, infectious diseases, mental disorders, musculoskeletal diseases, and skin injuries. The time interval between repeat claims was shorter for FBW compared to Australian-born workers and compensation payments of repeat claims were higher. Regardless of birth region, time intervals between repeat claims showed a decreasing temporal trend, while it was the opposite in terms of injury severity. Foreign-born workers were generally less likely to make a repeat claim than Australian-born workers, but with birth region differences. This may be attributable to underreporting from some workers. Foreign-born workers were generally less likely to have time off work but the overall costs were higher. These differences should be considered in future injury prevention strategies.

China is one of the largest countries in the world with nearly 20% of the world’s population. There have been significant improvements in economy, education and technology over the last three decades. Due to substantial investments from all levels of government, the public health system in China has been improved since the 2003 severe acute respiratory syndrome (SARS) outbreak. However, infectious diseases still remain a major population health issue and this may be exacerbated by rapid urbanization and unprecedented impacts of climate change. This commentary aims to explore China’s current capacity to manage infectious diseases which impair population health. It discusses the existing disease surveillance system and underscores the critical importance of strengthening the system. It also explores how the growing migrant population, dramatic changes in the natural landscape following rapid urbanization, and changing climatic conditions can contribute to the emergence and re-emergence of infectious disease. Continuing research on infectious diseases, urbanization and climate change may inform the country’s capacity to deal with emerging and re-emerging infectious diseases in the future. Refereed/Peer-reviewed

Background Though there was the significant decrease in the incidence of malaria in central and southwest China during the 1980s and 1990s, there has been a re-emergence of malaria since 2000. Methods A cross-sectional survey was conducted amongst the staff of eleven Centers for Disease Control and Prevention (CDC) in China to gauge their perceptions regarding the impacts of climate change on malaria transmission and its control and prevention. Descriptive analysis was performed to study CDC staff’s knowledge, attitudes, perceptions and suggestions for malaria control in the face of climate change. Results A majority (79.8%) of CDC staff were concerned about climate change and 79.7% believed the weather was becoming warmer. Most participants (90.3%) indicated climate change had a negative effect on population health, 92.6 and 86.8% considered that increasing temperatures and precipitation would influence the transmission of vector-borne diseases including malaria. About half (50.9%) of the surveyed staff indicated malaria had re-emerged in recent years, and some outbreaks were occurring in new geographic areas. The main reasons for such re-emergence were perceived to be: mosquitoes in high-density, numerous imported cases, climate change, poor environmental conditions, internal migrant populations, and lack of health awareness. Conclusions This study found most CDC staff endorsed the statement that climate change had a negative impact on infectious disease transmission. Malaria had re-emerged in some areas of China, and most of the staff believed that this can be managed. However, high densities of mosquitoes and the continuous increase in imported cases of malaria in local areas, together with environmental changes are bringing about critical challenges to malaria control in China. This study contributes to an understanding of climate change related perceptions of malaria control and prevention amongst CDC staff. It may help to formulate in-house training guidelines, community health promotion programmes and policies to improve the capacity of malaria control and prevention in the face of climate change in China. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1790-3) contains supplementary material, which is available to authorized users.

Background: Dengue fever is an important climate-sensitive mosquito-borne viral disease that poses a risk to half the world's population. The disease is a major public health issue in China where in 2014 a major outbreak occurred in Guangdong Province. This study aims to gauge health professionals'; perceptions about the capacity of infectious disease control and prevention to meet the challenge of dengue fever in the face of climate change in Guangdong Province, China. Methods: A cross-sectional questionnaire survey was administered among staff in the Centers for Disease Control and Prevention (CDCs) in Guangdong Province. Data analysis was undertaken using descriptive methods and logistic regression. Results: In total, 260 questionnaires were completed. Most participants (80.7%) thought climate change would have a negative effect on population health, and 98.4% of participants reported dengue fever had emerged or re-emerged in China in recent years. Additionally, 74.9% of them indicated that the capability of the CDCs to detect infectious disease outbreak/epidemic at an early stage was excellent; 86.3% indicated laboratories could provide diagnostic support rapidly; and 83.1% believed levels of current staff would be adequate in the event of a major outbreak. Logistic regression analysis showed higher levels of CDCs were perceived to have better capacity for infectious disease control and prevention. Only 26.8% of participants thought they had a good understanding of climate change, and most (85.4%) thought they needed more information about the health impacts of climate change. Most surveyed staff suggested the following strategies to curb the public health impact of infectious diseases in relation to climate change: primary prevention measures, strengthening the monitoring of infectious diseases, the ability to actively forecast disease outbreaks by early warning systems, and more funding for public health education programs. Conclusion: Vigilant disease and vector surveillance, preventive practice and health promotion programs will likely be significant in addressing the threat of dengue fever in the future. Further efforts are needed to strengthen the awareness of climate change among health professionals, and to promote relevant actions to minimize the health burden of infectious diseases in a changing climate. Results will be critical for policy makers facing the current and future challenges associated with infectious disease prevention and control in China. Refereed/Peer-reviewed