ALBERT

Description: This paper investigates households’ preferences to reduce their carbon footprint (CF) measured in carbon dioxide equivalents (CO2e). It assumes that a substantial CF reduction of households is essential to reach the 1.5 °C goal under the Paris Agreement. Data was collected in four mid-size cities in France, Germany, Norway, and Sweden. Quantitative data was obtained from 308 households using a CF calculator based on a questionnaire, and a simulation game. The latter investigated households’ preferences when being confronted with the objective to reduce their CF by 50 percent by 2030 in a voluntary and forced scenario. Our results show that the greater the CO2e-reduction potential of a mitigation action, the less willing a household was to implement that action. Households preferred actions with moderate lifestyle changes foremost in the food sector. Voluntarily, households reached a 25% footprint reduction by 2030. To reach a substantial reduction of 50 percent, households needed to choose actions that meant considerable lifestyle changes, mainly related to mobility. Given our results, the 1.5 °C goal is unlikely to be realizable currently, unless households receive major policy support. Lastly, the strikingly similar preferences of households in the four European cities investigated seem to justify strong EU and international policies.

Description: IJERPH, Vol. 15, Pages 875: How Well Do COP22 Attendees Understand Graphs on Climate Change Health Impacts from the Fifth IPCC Assessment Report? International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15050875 Authors: Helen Fischer Stefanie Schütte Anneliese Depoux Dorothee Amelung Rainer Sauerborn Graphs are prevalent in the reports of the Intergovernmental Panel on Climate Change (IPCC), often depicting key points and major results. However, the popularity of graphs in the IPCC reports contrasts with a neglect of empirical tests of their understandability. Here we put the understandability of three graphs taken from the Health chapter of the Fifth Assessment Report to an empirical test. We present a pilot study where we evaluate objective understanding (mean accuracy in multiple-choice questions) and subjective understanding (self-assessed confidence in accuracy) in a sample of attendees of the United Nations Climate Change Conference in Marrakesh, 2016 (COP22), and a student sample. Results show a mean objective understanding of M = 0.33 for the COP sample, and M = 0.38 for the student sample. Subjective and objective understanding were unrelated for the COP22 sample, but associated for the student sample. These results suggest that (i) understandability of the IPCC health chapter graphs is insufficient, and that (ii) particularly COP22 attendees lacked insight into which graphs they did, and which they did not understand. Implications for the construction of graphs to communicate health impacts of climate change to decision-makers are discussed.

Description: IJERPH, Vol. 15, Pages 843: General Practitioners’ Perceptions of Heat Health Impacts on the Elderly in the Face of Climate Change—A Qualitative Study in Baden-Württemberg, Germany International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15050843 Authors: Alina Herrmann Rainer Sauerborn Heat health impacts (HHI) on the elderly are a growing concern in the face of climate change and aging populations. General practitioners (GPs) have an important role in health care for the elderly. To inform the development of effective prevention measures, it is important to investigate GPs’ perceptions of HHI. Twenty four qualitative expert interviews were conducted with GPs and analyzed using the framework approach. GPs were generally aware of heat health impacts, focusing on cardiovascular morbidity and volume imbalances. Perceptions of mortality and for instance impacts on respiratory diseases or potentially risky drugs in heat waves partly diverged from findings in literature. GPs judged the current relevance of HHI differently depending on their attitudes towards: (i) sensitivity of the elderly, (ii) status of nursing care and (iii) heat exposure in Baden-Württemberg. Future relevance of HHI was perceived to be increasing by most GPs. The main cause identified for this was population aging, while impacts of climate change were judged as uncertain by many. GPs’ perceptions, partly diverging from literature, show that GPs’ knowledge and awareness on HHI and climate change needs to be strengthened. However, they also emphasize the need for more research on HHI in the ambulant health care setting. Furthermore, GPs perceptions suggest that strong nursing care and social networks for elderly are major elements of a climate resilient health system.

Description: Background: Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries (Burkina Faso, Ghana, and Tanzania). One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods: A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". Results: The QUALMAT CDSS provides computerized guidance and clinical decision support for maternal care, during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion: The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.Trial registration: www.clinicaltrials.gov/NCT01409824.

Description: We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies.