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Fil: Smith, Matthew R. Harvard T.H. Chan School of Public Health. Department of Environmental Health. Estados Unidos. Fil: Mueller, Nathaniel D. Colorado State University. Department of Ecosystem Science and Department of Soil and Crop Sciences. Estados Unidos. Fil: Springmann, Marco. London School of Hygiene and Tropical Medicine. Centre on Climate Change and Planetary Health. Reino Unido. Fil: Sulser, Timothy B. International Food Policy Research Institute. Environment and Production Technology Division. Estados Unidos. Fil: Garibaldi, Lucas Alejandro. Universidad Nacional de Río Negro. Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural. Río Negro, Argentina. Fil: Garibaldi, Lucas Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural. Río Negro, Argentina. Fil: Gerber, James. University of Minnesota. Institute on the Environment. Estados Unidos. Fil: Wiebe, Keith. International Food Policy Research Institute. Environment and Production Technology Division. Estados Unidos. Fil: Myers, Samuel S. Harvard T.H. Chan School of Public Health. Department of Environmental Health. Estados Unidos. Background: Animal pollination supports agricultural production for many healthy foods, such as fruits, vegetables, nuts, and legumes, that provide key nutrients and protect against noncommunicable disease. Today, most crops receive suboptimal pollination because of limited abundance and diversity of pollinating insects. Animal pollinators are currently suffering owing to a host of direct and indirect anthropogenic pressures: land-use change, intensive farming techniques, harmful pesticides, nutritional stress, and climate change, among others. Objectives: We aimed to model the impacts on current global human health from insufficient pollination via diet. Methods: We used a climate zonation approach to estimate current yield gaps for animal-pollinated foods and estimated the proportion of the gap attributable to insufficient pollinators based on existing research. We then simulated closing the "pollinator yield gaps" by eliminating the portion of total yield gaps attributable to insufficient pollination. Next, we used an agriculture-economic model to estimate the impacts of closing the pollinator yield gap on food production, interregional trade, and consumption. Finally, we used a comparative risk assessment to estimate the related changes in dietary risks and mortality by country and globally. In addition, we estimated the lost economic value of crop production for three diverse case-study countries: Honduras, Nepal, and Nigeria. Results: Globally, we calculated that 3%-5% of fruit, vegetable, and nut production is lost due to inadequate pollination, leading to an estimated 427,000 (95% uncertainty interval: 86,000, 691,000) excess deaths annually from lost healthy food consumption and associated diseases. Modeled impacts were unevenly distributed: Lost food production was concentrated in lower-income countries, whereas impacts on food consumption and mortality attributable to insufficient pollination were greater in middle- and high-income countries with higher rates of noncommunicable disease. Furthermore, in our three case-study countries, we calculated the economic value of crop production to be 12%-31% lower than if pollinators were abundant (due to crop production losses of 3%-19%), mainly due to lost fruit and vegetable production. Discussion: According to our analysis, insufficient populations of pollinators were responsible for large present-day burdens of disease through lost healthy food consumption. In addition, we calculated that low-income countries lost significant income and crop yields from pollinator deficits. These results underscore the urgent need to promote pollinator-friendly practices for both human health and agricultural livelihoods. https://doi.org/10.1289/EHP10947.

Summary Background Adoption of healthy and sustainable diets could be essential for safe-guarding the Earth's natural resources and reducing diet-related mortality, but their adoption could be hampered if such diets proved to be more expensive and unaffordable for some populations. Therefore, we aimed to estimate the costs of healthy and sustainable diets around the world. Methods In this modelling study, we used regionally comparable food prices from the International Comparison Program for 150 countries. We paired those prices with estimates of food demand for different dietary patterns that, in modelling studies, have been associated with reductions in premature mortality and environmental resource demand, including nutritionally balanced flexitarian, pescatarian, vegetarian, and vegan diets. We used estimates of food waste and projections of food demand and prices to specify food system and socioeconomic change scenarios up to 2050. In the full cost accounting, we estimated diet-related health-care costs by pairing a comparative risk assessment of dietary risks with cost-of-illness estimates, and we estimated climate change costs by pairing the diet scenarios with greenhouse gas emission footprints and estimates of the social cost of carbon. Findings Compared with the cost of current diets, the healthy and sustainable dietary patterns were, depending on the pattern, up to 22–34% lower in cost in upper-middle-income to high-income countries on average (when considering statistical means), but at least 18–29% more expensive in lower-middle-income to low-income countries. Reductions in food waste, a favourable socioeconomic development scenario, and a fuller cost accounting that included the diet-related costs of climate change and health care in the cost of diets increased the affordability of the dietary patterns in our future projections. When these measures were combined, the healthy and sustainable dietary patterns were up to 25–29% lower in cost in low-income to lower-middle-income countries, and up to 37% lower in cost on average, for the year 2050. Variants of vegetarian and vegan dietary patterns were generally most affordable, and pescatarian diets were least affordable. Interpretation In high-income and upper-middle-income countries, dietary change interventions that incentivise adoption of healthy and sustainable diets can help consumers in those countries reduce costs while, at the same time, contribute to fulfilling national climate change commitments and reduce public health spending. In low-income and lower-middle-income countries, healthy and sustainable diets are substantially less costly than western diets and can also be cost-competitive in the medium-to-long term, subject to beneficial socioeconomic development and reductions in food waste. A fuller accounting of the costs of diets would make healthy and sustainable diets the least costly option in most countries in the future. Funding Global Panel on Agriculture and Food Systems for Nutrition and Wellcome Trust.

In the past few decades, major public health advances have happened in Europe, with drastic decreases in premature mortality and a life expectancy increase of almost 9 years since 1980. European countries have some of the best health-care systems in the world. However, Europe is challenged with unprecedented and overlapping crises that are detrimental to human health and livelihoods and threaten adaptive capacity, including the COVID-19 pandemic, the Russian invasion of Ukraine, the fastest-growing migrant crisis since World War 2, population displacement, environmental degradation, and deepening inequalities. Compared with pre-industrial times, the mean average European surface air temperature increase has been almost 1°C higher than the average global temperature increase, and 2022 was the hottest European summer on record. As the world's third largest economy and a major contributor to global cumulative greenhouse gas emissions, Europe is a key stakeholder in the world's response to climate change and has a global responsibility and opportunity to lead the transition to becoming a low-carbon economy and a healthier, more resilient society. Peer Reviewed Article signat per 44 autors/autores: Institute for Global Health (K R van Daalen MPhil, M Romanello PhD), Institute for Sustainable Resources (P Drummond MSc, D Scamman EngD), and Energy Institute (Prof I Hamilton PhD, H Kennard PhD), University College London, London, UK; Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK (K R van Daalen); Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany (Prof J Rocklöv PhD, Prof J C Semenza PhD); Department of Public Health and Clinical Medicine (Prof J Rocklöv, Z Farooq MSc, M O Sewe PhD, H Sjödin PhD) and Department of Epidemiology and Global Health (Prof M Nilsson PhD), Umeå University, Umeå, Sweden; Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain (C Tonne ScD, H Achebak PhD, J Ballester PhD, S J Lloyd PhD, C Milà MSc, Prof J C Minx PhD, Prof M Nieuwenhuijsen PhD, M Quijal-Zamorano MSc, Prof J M Anto MD); Universitat Pompeu Fabra (UPF), Barcelona, Spain (C Tonne, C Milà, M Nieuwenhuijsen, M Quijal-Zamorano, J M Anto); CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (C Tonne, C Milà, J C Minx, M Nieuwenhuijsen, J M Anto); BC3 Basque Centre for Climate Change, Bilbao, Spain (Prof A Markandya PhD); School of Government, University of Birmingham, Birmingham, UK (N Dasandi PhD); Data Science Lab, Hertie School, Berlin, Germany (Prof S Jankin PhD, H Bechara PhD, O Gasparyan PhD); Priestley International Centre for Climate, University of Leeds, Leeds, UK (M W Callaghan MPP); Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany (M W Callaghan); Energy Efficiency Group, Institute for Environmental Sciences (ISE), University of Geneva, Switzerland (J Chambers PhD); Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Venice, Italy (S Dasgupta PhD); Grantham Research Institute on Climate Change and the Environment, London School of Economics and Political Sciences (LSE), UK (S Dasgupta, Prof E J Z Robinson PhD); Barcelona Supercomputing Center (BSC), Barcelona, Spain (N Gonzalez-Reviriego PhD, B Solaraju-Murali MSc, Prof R Lowe PhD, M Lotto Batista MSc); Finnish Meteorological Institute (FMI), Helsinki, Finland (R Hänninen DSci, J Palamarchuk PhD, M Sofiev PhD); European Environment Agency, Copenhagen, Denmark (A Kazmierczak PhD); European Centre for Environment and Health, WHO Regional Office for Europe, Bonn, Germany (V Kendrovski PhD, O Schmoll Dipl Ing); Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria (G Kiesewetter PhD); Helmholtz Centre for Infection Research, Department of Epidemiology, Brunswick, Germany (M Lotto Batista); Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain (Prof J Martinez-Urtaza PhD); Oxford Martin Programme on the Future of Food and Nuffield Department of Population Health, University of Oxford, Oxford, UK (M Springmann PhD); Department of Electronics and Computer Science, Universidade de Santiago de Compostela, Santiago, Spain (J Triñanes PhD); Centre for Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK (Prof R Lowe); Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain (Prod R Lowe)

Summary Background Nationally determined contributions (NDCs) serve to meet the goals of the Paris Agreement of staying “well below 2°C”, which could also yield substantial health co-benefits in the process. However, existing NDC commitments are inadequate to achieve this goal. Placing health as a key focus of the NDCs could present an opportunity to increase ambition and realise health co-benefits. We modelled scenarios to analyse the health co-benefits of NDCs for the year 2040 for nine representative countries (ie, Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK, and the USA) that were selected for their contribution to global greenhouse gas emissions and their global or regional influence. Methods Modelling the energy, food and agriculture, and transport sectors, and mortality related to risk factors of air pollution, diet, and physical activity, we analysed the health co-benefits of existing NDCs and related policies (ie, the current pathways scenario) for 2040 in nine countries around the world. We compared these health co-benefits with two alternative scenarios, one consistent with the goal of the Paris Agreement and the Sustainable Development Goals (ie, the sustainable pathways scenario), and one in line with the sustainable pathways scenario, but also placing health as a central focus of the policies (ie, the health in all climate policies scenario). Findings Compared with the current pathways scenario, the sustainable pathways scenario resulted in an annual reduction of 1·18 million air pollution-related deaths, 5·86 million diet-related deaths, and 1·15 million deaths due to physical inactivity, across the nine countries, by 2040. Adopting the more ambitious health in all climate policies scenario would result in a further reduction of 462 000 annual deaths attributable to air pollution, 572 000 annual deaths attributable to diet, and 943 000 annual deaths attributable to physical inactivity. These benefits were attributable to the mitigation of direct greenhouse gas emissions and the commensurate actions that reduce exposure to harmful pollutants, as well as improved diets and safe physical activity. Interpretation A greater consideration of health in the NDCs and climate change mitigation policies has the potential to yield considerable health benefits as well as achieve the “well below 2°C” commitment across a range of regional and economic contexts. Funding This work was in part funded through an unrestricted grant from the Wellcome Trust (award number 209734/Z/17/Z) and supported by an Engineering and Physical Sciences Research Council grant (grant number EP/R035288/1).

Summary: Background: Sustainable diets are intended to address the increasing health and environmental concerns related to food production and consumption. Although many candidates for sustainable diets have emerged, a consistent and joint environmental and health analysis of these diets has not been done at a regional level. Using an integrated health and environmental modelling framework for more than 150 countries, we examined three different approaches to sustainable diets motivated by environmental, food security, and public health objectives. Methods: In this global modelling analysis, we combined analyses of nutrient levels, diet-related and weight-related chronic disease mortality, and environmental impacts for more than 150 countries in three sets of diet scenarios. The first set, based on environmental objectives, replaced 25–100% of animal-source foods with plant-based foods. The second set, based on food security objectives, reduced levels of underweight, overweight, and obesity by 25–100%. The third set, based on public health objectives, consisted of four energy-balanced dietary patterns: flexitarian, pescatarian, vegetarian, and vegan. In the nutrient analysis, we calculated nutrient intake and changes in adequacy based on international recommendations and a global dataset of nutrient content and supply. In the health analysis, we estimated changes in mortality using a comparative risk assessment with nine diet and weight-related risk factors. In the environmental analysis, we combined country-specific and food group-specific footprints for greenhouse gas emissions, cropland use, freshwater use, nitrogen application, and phosphorus application to analyse the relationship between the health and environmental impacts of dietary change. Findings: Following environmental objectives by replacing animal-source foods with plant-based ones was particularly effective in high-income countries for improving nutrient levels, lowering premature mortality (reduction of up to 12% [95% CI 10–13] with complete replacement), and reducing some environmental impacts, in particular greenhouse gas emissions (reductions of up to 84%). However, it also increased freshwater use (increases of up to 16%) and had little effectiveness in countries with low or moderate consumption of animal-source foods. Following food-security objectives by reducing underweight and overweight led to similar reductions in premature mortality (reduction of up to 10% [95% CI 9–11]), and moderately improved nutrient levels. However, it led to only small reductions in environmental impacts at the global level (all impacts changed by

inVIVO Planetary Health (inVIVO) is a progressive scientific movement providing evidence, advocacy, and inspiration to align the interests and vitality of people, place, and planet. Our goal is to transform personal and planetary health through awareness, attitudes, and actions, and a deeper understanding of how all systems are interconnected and interdependent. Here, we present the abstracts and proceedings of our 8th annual conference, held in Detroit, Michigan in May 2019, themed “From Challenges, to Opportunities”. Our far-ranging discussions addressed the complex interdependent ecological challenges of advancing global urbanization, including the biopsychosocial interactions in our living environment on physical, mental, and spiritual wellbeing, together with the wider community and societal factors that govern these. We had a strong solutions focus, with diverse strategies spanning from urban-greening and renewal, nature-relatedness, nutritional ecology, planetary diets, and microbiome rewilding, through to initiatives for promoting resilience, positive emotional assets, traditional cultural narratives, creativity, art projects for personal and community health, and exploring ways of positively shifting mindsets and value systems. Our cross-sectoral agenda underscored the importance and global impact of local initiatives everywhere by contributing to new normative values as part of a global interconnected grass-roots movement for planetary health.

The COVID-19 pandemic reveals that societies place a high value on healthy lives. Leveraging this momentum to establish a more central role for human health in the policy process will provide further impetus to a sustainable transformation of energy and food systems.

Objective: To estimate the impact of integrating the price of greenhouse gas emissions into the price of food commodities on dietary and weight‐related risk factors and associated disease burden in Australia, as well as on national emissions reductions and public revenues. Methods: We used country‐specific data for Australia to build a coupled modelling framework that includes economic, environmental and health analyses. Data sources included the 2011‐12 Australian food and nutrition survey, meta‐analysis of food‐related lifecycle emissions, and price and income elasticities. Consumption‐related changes in disease burden were calculated using a comparative risk assessment framework with 11 disease states and seven diet and weight‐related risk factors. Results: Including a price of 23 dollars per tonne of carbon dioxide equivalent (tCO2‐eq) – the starting price of the former Australian carbon pricing mechanism – into the price of food commodities in our model simulations led to 49,500 avoided disability‐adjusted life years (DALYs) (95% confidence interval [CI] 43,200‐55,200). Food‐related greenhouse gas emissions were reduced by 6% (2.3 MtCO2‐eq), and greenhouse gas tax revenues amounted to $866 million. Conclusion: Incorporating the price of food‐related greenhouse gas emissions into the price of food commodities in Australia could be beneficial for population health, while generating public finance revenues and supporting Australia's emission‐reduction commitment. Implications for public health: Climate policies that integrate the price of greenhouse gas emissions into the price of food commodities in Australia are compatible with public health objectives to reduce diet‐related disease mortality.

Background One of the most important consequences of climate change could be its impact on agriculture. While much research has focused on questions of food security, less attention has been devoted to assessing the wider health impacts of future changes in agricultural production. We estimate excess mortality due to agriculturally mediated changes in dietary and weight-related risk factors by cause of death for 155 world regions in the year 2050. Methods We linked a detailed agricultural modelling framework, the International Model for Policy Analysis of Agricultural Commodities and Trade (IMPACT), to a comparative risk assessment of changes in fruit and vegetable consumption, red-meat consumption, and body weight for deaths from coronary heart disease, stroke, cancer, and an aggregate of other causes. We calculated the change in the number of deaths due to climate-related changes in weight and diets for the combination of four emissions and three socio-economic pathways, which each included six scenarios with variable climatic inputs. Results The model predicts that by 2050 climate change will lead to per-capita reductions of 3%, 4%, and 1% in global food availability, fruit and vegetable consumption, and red-meat consumption, respectively. Those changes were associated with 529,000 climate-related deaths globally (95% CI: 314,000–736,000), representing a 28% reduction in the number of deaths that would be avoided due to changes in dietary and weight-related risk factors between 2010 and 2050. Twice as many climate-related deaths were associated with reductions in fruit and vegetable consumption than with climate-related increases in the prevalence of underweight, and most climate-related deaths were projected to occur in South and East Asia. Adopting climate-stabilisation pathways reduced the number of climate-related deaths by 29–71% depending on their stringency. Conclusion The health impacts of climate change from changes in dietary and weight-related risk factors could be significant, and exceed other climate-related health impacts that have been estimated. Climate change mitigation could prevent a substantial number of climate-related deaths. Strengthening public-health programmes aimed at preventing and treating diet and weight-related risk factors could be a suitable climate change adaptation strategy.