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İklim Değişikliği Ve Küresel Hastalık Yüküne Etkisi

CLIMATE CHANGE AND ITS IMPACT ON THE GLOBAL BURDEN OF DISEASE

Esra Nurmuhammed Pekdoğan(KIRIKKALE ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, HALK SAĞLIĞI ANABİLİM DALI)0009-0009-0572-8408
Didem Daymaz Yılmaz(KIRIKKALE ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, HALK SAĞLIĞI ANABİLİM DALI)0000-0001-5712-2082
Sayfa
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Yayın Tarihi
2026-10-08
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Yapay Zeka Hızlı Bakış & Çıkarımlar

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⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Antarktika'daki deniz buzu seviyeleri ve buz tabakalarında da rekor düzeyde erime gözlemlenmiştir.

📌 3 Maddede Bu Makale

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Amaç & Hipotez:Dünyanın 4,5 milyar yıllık geçmişinde iklim sistemi birçok kez değişime uğramış, bu da hem yeryüzü şekillerinde hem de ekosistemlerde kalıcı etkiler bırakmıştır.
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Temel Bulgular & Veri:İklim değişikliğinin etkilerinin en net gözlendiği yıllardan biri 2023 yılı olmuştur.
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Sonuç & Katkı:Antarktika'daki deniz buzu seviyeleri ve buz tabakalarında da rekor düzeyde erime gözlemlenmiştir.
🔬Tür:Literatür & Derleme Çalışması
📍Kapsam:2023 Verileri
⚙️Değişkenler:İklim · İklim değişikliği · Global hastalık yükü

Özet

Dünyanın 4,5 milyar yıllık geçmişinde iklim sistemi birçok kez değişime uğramış, bu da hem yeryüzü şekillerinde hem de ekosistemlerde kalıcı etkiler bırakmıştır. İklim değişikliğinin etkilerinin en net gözlendiği yıllardan biri 2023 yılı olmuştur. Sera gazı seviyeleri, okyanus ısı içeriği ve küresel ortalama deniz seviyesi şimdiye kadarki en yüksek düzeylere ulaşmış; Temmuz 2023, kayıtların tutulduğu en sıcak ay olarak kayda geçmiştir. Antarktika'daki deniz buzu seviyeleri ve buz tabakalarında da rekor düzeyde erime gözlemlenmiştir. İklim değişikliğiyle birlikte aşırı hava olaylarının sıklığı artmış, bu durum gıda ve su güvenliği, sanitasyon, enerji üretimi ve tedarik zincirleri üzerinde ciddi tehditler oluşturmuştur. Artan afetler nedeniyle milyonlarca insan evlerini terk etmek zorunda kalmıştır. Bu gelişmelerin insan sağlığı üzerindeki etkileri giderek artmaktadır. İklim değişikliği, temiz hava ve suya erişimden gıda güvenliğine kadar pek çok sağlık belirleyicisini olumsuz etkilemektedir. Dünya Sağlık Örgütü (DSÖ)’ne göre, 2030-2050 yılları arasında iklim değişikliğinin yalnızca yetersiz beslenme, sıtma, ishal ve sıcak stresinden kaynaklı olarak yılda yaklaşık 250.000 ek ölüme yol açması beklenmektedir. Bu nedenle, iklim değişikliğiyle mücadelede halk sağlığı temelli, kapsayıcı stratejilerin gelişti- rilmesi kritik öneme sahiptir. Bu derlemenin amacı, iklim değişikliğinin sağlık ve küresel hastalık yükü üzerindeki etkilerini güncel bilimsel kanıtlar doğrultusunda incelemek ve sağlık politikalarında ortaya çıkan yeni gereksinimleri tartışmaktır. Ayrıca, iklim değişikliğine bağlı sağlık risklerinin küresel hastalık yükünün dağılımına etkilerinin değerlendirilmesi amaçlanmaktadır.

Abstract

Over Earth’s 4.5 billion-year history, the climate system has undergone numerous changes, leaving lasting impacts on both landforms and ecosystems. One of the years in which the effects of climate change were most clearly observed was 2023. Greenhouse gas levels, ocean heat content, and average global sea level reached their highest levels ever, with July 2023 being the hottest month on record. Record-breaking sea ice levels and ice sheets in Antarctica were also observed. Climate change has increased the frequency of extreme weather events, posing serious threats to food and water security, sanitation, energy production, and supply chains. Increasing disasters have forced millions of people to flee their homes. The impacts of these developments on human health are continuously increasing. Climate change negatively impacts many determinants of health, from access to clean air and water to food security. According to the World Health Organization (WHO), climate change is expected to cause approximately 250,000 additional deaths annually between 2030 and 2050, stemming from malnutrition, malaria, diarrhea, and heat stress alone. Therefore, developing comprehensive, public health-based strategies to combat climate change is critical. This review aims to address the impacts of climate change on health and the global disease burden in light of current scientific evidence and to discuss the emerging requirements for health policies. It also aims to assess the impacts of climate change-related health risks on the glo- bal distribution of disease burden.

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Bu Makaleye Atıf Yap

Pekdoğan, E. N., Yılmaz, D. D. (2026). İklim Değişikliği Ve Küresel Hastalık Yüküne Etkisi. Akdeniz Tıp Dergisi, Cilt: 12 Sayı: 1. https://doi.org/10.53394/akd.1754271

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Kaynakça (71)

  1. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, Boykoff M, Byass P, Cai W, Campbell-Lendrum D, Capstick S, Chambers J, Coleman S, Dalin C, Daly M, Dasandi N, Dasgupta S, Davies M, Di Napoli C, Dominguez-Salas P, Drummond P, Dubrow R, Ebi KL, Eckelman M, Ekins P, Escobar LE, Georgeson L, Golder S, Grace D, Graham H, Haggar P, Hamilton I, Hartinger S, Hess J, Hsu SC, Hughes N, Jankin Mikhaylov S, Jimenez MP, Kelman I, Kennard H, Kiesewetter G, Kinney PL, Kjellstrom T, Kniveton D, Lampard P, Lemke B, Liu Y, Liu Z, Lott M, Lowe R, Martinez-Urtaza J, Maslin M, McAllister L, McGushin A, McMichael C, Milner J, Moradi-Lakeh M, Morrissey K, Munzert S,. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. Lancet. 2021;397(10269):129-70.
  2. Haines A, Ebi K. The Imperative for Climate Action to Protect Health. N Engl J Med. 2019;380(3):263-73.
  3. World Health Organization. Climate change and health, 2024 (https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health).
  4. T.C. Meteoroloji Genel Müdürlüğü. İklim, 2024 (https://www.mgm.gov.tr/iklim/iklim.aspx?key=B).
  5. World Meteorological Organization. Global climate indicators, 2024 (https://gcos.wmo.int/en/global-climate-indicators).
  6. Akçakaya A, Sümer UM, Demircan M, Demir Ö, Atay H, Eskioğlu O, Gürkan H, Yazıcı B, Kocatürk A, Şensoy S, Bölük E, Arabacı H, Açar Y, Ekici M, Yağan S, Çukurçayır F. MGM, Yeni Senaryolar İle Türkiye İklim Projeksiyonları Ve İklim Değişikliği. Ankara. Meteoroloji Genel Müdürlüğü Matbaası, 2015.
  7. United Nations Framework Convention On Climate Change, 1992. https://unfccc.int/files/essential_background/background_publications_htmlpdf/application/pdf/conveng.pdf.
  8. Masson-Delmotte V, Zhai P (eds): IPCC, 2021: Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA. https://www.ipcc.ch/report/ar6/wg1/downloads/report/IPCC_AR6_WGI_FullReport_small.pdf.
  9. World Meteorological Organization. State of the Global Climate 2023. WMO-2024.
  10. Sayman RÜ, Baş D, Tuğaç Ç, Kavak K, Bitlis M, Ergün K. A’dan Z’ye İklim Değişikliği Başucu Rehberi. 3.Baskı. Ankara. Kaynak, İklim ve Çevre Merkezi-REC Türkiye, 2023.
  11. NASA. Aura’s instruments are closely monitoring ozone, 2024 (https://science.nasa.gov/mission/aura/ozone/).
  12. Lee H, Romero J (eds). IPCC, 2023: Sections. In: Climate Change 2023: Synthesis Report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change IPCC, Geneva, Switzerland.
  13. NASA. Extreme weather and climate change, 2024 (https://science.nasa.gov/climate-change/extreme-weather/).
  14. United Nations Office for Disaster Risk Reduction (UNDRR). UN report: Dramatic rise in climate disaster over last twenty years, 2024 (https://www.undrr.org/news/un-report-dramatic-rise-climate-disaster-over-last-twenty-years).
  15. Romanello M, Di Napoli C, Green C, Kennard H, Lampard P, Scamman D, Arnell N, Belesova K, Berry H, Bouzid M, Boykoff M, Cai W, Campbell-Lendrum D, Cheong AT, Christoffersen P, Cox P, Curmi E, de la Vega-Leinert A, Dominguez-Salas P, Drummond P, Ebi KL, Ezzati M, Fraser EDG, Geidne S, Grace D, Graham H, Hamilton I, Heaton S, Hondula D, James P, Jones B, Kirbyshire A, Kovats S, Liu Q, Lucas RM, Majeed A, McGushin A, McMichael AJ, Ouyang W, Romanello L, Ruane AC, Saddler J, Saez M, Sera F, Shumake-Guillemot J, Vicedo-Cabrera AM, Watts N, Costello A, Woodward A, Haines A. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. Lancet. 2023;402(10416):2346–94.
  16. United Nations. The United Nations World Water Development Report 2024: Water for Prosperity and Peace. Paris: UNESCO; 2024.
  17. World Food Programme (WFP). Global Operational Response Plan, 2023 (https://docs.wfp.org/api/documents/WFP-0000153758/download/).
  18. Food and Agriculture Organization (FAO), International Fund for Agricultural Development (IFAD), United Nations Children’s Fund (UNICEF), World Food Programme (WFP), World Health Organization (WHO). The State of Food Security and Nutrition in the World 2024 – Financing to end hunger, food insecurity and malnutrition in all its forms. Rome; 2024.
  19. Food and Agriculture Organization (FAO). The Impact of Disasters on Agriculture and Food Security 2023 – Avoiding and reducing losses through investment in resilience. Rome; 2023.
  20. UNHCR. UN Refugee Agency warns of extreme hardship for forcibly displaced families this winter, 2025 (https://www.unhcr.org/news/briefing-notes/un-refugee-agency-warns-extreme-hardship-forcibly-displaced-families-winter).
  21. Kiraz DE. İklim Değişikliğinin Sağlık Etkilerinin Yükü. In: Bulut M, Korkut C (eds.) Döngüsel Ekonomi ve Sürdürülebilir Hayat. Türkiye Bilimler Akademisi Yayınları; 2022. p. 339–58.
  22. Özmen A. İklim değişikliğinin insan sağlığına etkileri ve sağlık sisteminin iklim değişikliğine uyumu: uluslararası hastalıkların sınıflandırılması (ICD) [Yüksek Lisans Tezi] Aydın: Adnan Menderes Üniversitesi, Sağlık Bilimleri Enstitüsü; 2021.
  23. Kavuncuoğlu D, Evci Kiraz ED, Hastalık Yüküne Yeni Yük: İklim Değişikliğinin Sağlık Etkileri. Climatehealth. 2022;2(2):22-30.
  24. Ballester J, Quijal-Zamorano M, Méndez Turrubiates RF, Pegenaute F, Herrmann FR, Robine JM, Basagaña X, Tonne C, Antó JM, Achebak H. Heat-related mortality in Europe during the summer of 2022. Nat Med. 2023;29(7):1857–66.
  25. Gronlund CJ, Sullivan KP, Kefelegn Y, Cameron L, O’Neill MS. Climate change and temperature extremes: a review of heat- and cold-related morbidity and mortality concerns of municipalities. Maturitas. 2018;114:54–9.
  26. Helldén D, Andersson C, Nilsson M, Ebi KL, Friberg P, Alfvén T. Climate change and child health: a scoping review and an expanded conceptual framework. Lancet Planet Health. 2021;5(3):e164–e175.
  27. Gümüşel D (ed): Kara Rapor 2024: Hava Kirliliği ve Sağlık Etkileri. Temiz Hava Hakkı Platformu; Eylül 2024.
  28. Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E. Environmental and Health Impacts of Air Pollution: A Review. Front Public Health. 2020;8:14.
  29. Rajagopalan S, Brook RD, Salerno PRVO, Bourges-Sevenier B, Landrigan P, Nieuwenhuijsen MJ, Munzel T, Deo SV, Al-Kindi S. Air pollution exposure and cardiometabolic risk. Lancet Diabetes Endocrinol. 2024;12(3):196–208.
  30. Louis S, Carlson AK, Suresh A, Nakagawa K, Wang Z, Melamed ML, Xu Z, Bernstein AS, Yucha CB, Levin SN, Wellenius GA, Goodfellow LT. Impacts of climate change and air pollution on neurologic health, disease, and practice: a scoping review. Neurology. 2023;100(10):474-83.
  31. Eguiluz-Gracia I, Mathioudakis AG, Bartel S, Vijverberg SJH, Fuertes E, Comberiati P, Cai YS, Tomazic PV, Diamant Z, McDonnell T, Hammad H, Bigler J, Tan KS, Akdis M, Akdis CA, Shamji MH, O’Byrne PM, Barreto-Lemos C, Traidl-Hoffmann C, Melen E, Caruso M, Heffler E, Renz H, Torres MJ, Morandini P, Schwarze J, van de Veen W, Larco JI, Nadeau KC, de Silva HJ, Leonardi-Bee J, Shamssain M, Andiappan AK, Delgado L, Westermann P, Pfaar O, Papadopoulos NG, Bonini M, Bonini S, Del Giacco SR, Sánchez-García S, Cecchi L, Anto JM, Roca J, Bousquet J, Caraballo L, Annesi-Maesano I, Canonica GW, Roberts G, Huang M, Calderon MA, van Hage M, Jutel M, Ebisawa M, Calder PC, Bachert C, Schmidt-Weber CB, Akdis M, Wang DY, Sly PD, Akdis CA, Lødrup Carlsen KC, Custovic A, Zuberbier T, Muraro A, Pawankar R, Papadopoulos NG. The need for clean air: the way air pollution and climate change affect allergic rhinitis and asthma. Allergy. 2020;75(9):2170-84.
  32. Ghosh AK, Demetres MR, Geisler BP, Schuster CJ, Goldberg RJ, Touchette DR, Karmouta R, Veazie PJ, Grossestreuer AV, McCord KA, Alper BS. Impact of hurricanes and associated extreme weather events on cardiovascular health: a scoping review. Environ Health Perspect. 2022;130(11):116003.
  33. Becquart NA, Naumova EN, Singh G, Chui KKH. Cardiovascular disease hospitalizations in Louisiana parishes’ elderly before, during and after Hurricane Katrina. Int J Environ Res Public Health. 2019;16(1):74.
  34. T.C. Sağlık Bakanlığı. İklim değişikliğinin sağlık üzerine olumsuz etkilerinin azaltılması ulusal programı ve eylem planı, 2015 (https://hsgm.saglik.gov.tr/depo/birimler/cevre-sagligi-db/Dokumanlar/Sunumlar/Iklim_Degisikligi_Eylem_Plani.pdf).
  35. Ahmed T, Zounemat-Kermani M, Scholz M. Climate Change, Water Quality and Water-Related Challenges: A Review with Focus on Pakistan. International Journal of Environmental Research and Public Health. 2020; 17(22):8518.
  36. Mora C, McKenzie T, Gaw IM, Dean JM, von Hammerstein H, Knudson TA, Setter RO, Smith CZ, Webster KM, Patz JA, Franklin EC. Over half of known human pathogenic diseases can be aggravated by climate change. Nat Clim Chang. 2022;12:869-75.
  37. Masigol H, Retter A, Pourmoghaddam MJ, Giese H, Scherlach K, Stadler M. Opening Pandora’s box: neglected biochemical potential of permafrost-associated fungal communities in a warming climate. J Fungi (Basel). 2023;10(1):20.
  38. Yarzábal LA, Salazar LMB, Batista-García RA. Climate change, melting cryosphere and frozen pathogens: Should we worry…?. Environ Sustain (Singap). 2021;4(3):489-501.
  39. Chala B, Hamde F. Emerging and Re-emerging Vector-Borne Infectious Diseases and the Challenges for Control: A Review. Front Public Health. 2021;9:715759.
  40. World Health Organization. Addressing climate change: Supplement to the WHO Water, Sanitation and Hygiene Strategy 2018–2025. Geneva: World Health Organization; 2023.
  41. World Health Organization. World Malaria Report 2023. Geneva: World Health Organization; 2023.
  42. Ahrabi SZ, Pınarlık F, Akyıldız G. Human tick biting and tick-borne disease risk in Türkiye: Systematic review. PLoS Neglected Tropical Diseases. 2025;19(2):e0013092.
  43. Yılmaz S, Yilmaz SI, Alay H, Koşan Z, Eren Z. Temporal tendency, seasonality and relationship with climatic factors of Crimean-Congo Hemorrhagic Fever cases (East of Turkey: 2012–2021). Heliyon. 2023;9(11):e22216.
  44. Umar SA, Tasduq SA. Ozone Layer Depletion and Emerging Public Health Concerns - An Update on Epidemiological Perspective of the Ambivalent Effects of Ultraviolet Radiation Exposure. Front Oncol. 2022;12:866733.
  45. World Health Organization. Ultraviolet radiation, 2024 (https://www.who.int/news-room/fact-sheets/detail/ultraviolet-radiation).
  46. Gawrych M. Climate change and mental health: a review of current literature. Psychiatria Polska. 2022;56(4):903-15.
  47. Obradovich N, Migliorini R, Paulus MP, Rahwan I. Empirical evidence of mental health risks posed by climate change. Proc Natl Acad Sci USA. 2018;115(43):10953-8.
  48. National Institutes of Health, National Library of Medicine. Glossary. Bethesda (MD), 2024 (https://www.ncbi.nlm.nih.gov/books/NBK11818/).
  49. Murray CJ, Lopez AD, Jamison DT. The global burden of disease in 1990: summary results, sensitivity analysis and future directions. Bull World Health Organ. 1994;72(3):495-509.
  50. The Lancet. Global health data to drive change and improve lives, 2024 (https://www.thelancet.com/gbd/about).
  51. Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease 2021: Findings from the GBD 2021 Study. Seattle, WA: IHME; 2024.
  52. World Health Organization. Quantification of the disease burden attributable to environmental risk factors. Geneva: World Health Organization, 2024 (https://www.who.int/docs/default-source/documents/publications/quantification-of-the-disease-burden-attributable-to-environmental-risk-factors.pdf).
  53. World Health Organization. The Global Health Observatory. Geneva: World Health Organization, 2024 (https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2391).
  54. Clark SN, Anenberg SC, Brauer M. Global Burden of Disease from Environmental Factors. Annu Rev Public Health. 2025;46(1):233-51.
  55. Prüss-Ustün A, Wolf J, Corvalán C, Bos R, Neira M. Preventing disease through healthy environments: A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016.
  56. GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2162-2203.
  57. Carlson CJ, Alam MS, North MA, Onyango E, Stewart-Ibarra AM. The health burden of climate change: A call for global scientific action. PLOS Clim. 2023;2(1):e0000126.
  58. World Health Organization. Ambient (outdoor) air pollution, 2025 (https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health).
  59. Asikainen A, Carrer P, Kephalopoulos S, de Oliveira Fernandes E, Wargocki P, Hänninen O. Reducing burden of disease from residential indoor air exposures in Europe (HEALTHVENT project). Environ Health. 2016;15(Suppl 1):S35.
  60. Liu N, Liu W, Deng F, Liu Y, Gao X, Fang L, Chen Z, Tang H, Hong S, Pan M, Liu W, Huo X, Guo K, Ruan F, Zhang W, Zhao B, Mo J, Huang C, Su C, Sun C, Zou Z, Li H, Sun Y, Qian H, Zheng X, Zeng X, Guo J, Bu Z, Mandin C, Hänninen O, Ji JS, Weschler LB, Kan H, Zhao Z, Zhang Y. The burden of disease attributable to indoor air pollutants in China from 2000 to 2017. Lancet Planet Health. 2023;7(11):e900-e911.
  61. World Health Organization. Vector-borne diseases, 2025 (https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases).
  62. T.C. Dışişleri Bakanlığı. Viyana Sözleşmesi ve Montreal Protokolü, 2024 (https://www.mfa.gov.tr/viyana-sozlesmesi-ve-montreal-protokolu.tr.mfa).
  63. T.C. Dışişleri Bakanlığı. Kyoto Protokolü, 2024 (https://www.mfa.gov.tr/kyoto-protokolu.tr.mfa).
  64. T.C. Çevre, Şehircilik ve İklim Değişikliği Bakanlığı, İklim Değişikliği Başkanlığı. Paris Anlaşması, 2024 (https://iklim.gov.tr/paris-anlasmasi-i-34).
  65. T.C. Dışişleri Bakanlığı. Paris Anlaşması, 2024 (https://www.mfa.gov.tr/paris-anlasmasi.tr.mfa).
  66. United Nations Development Programme. What are the Sustainable Development Goals?, 2024 (https://www.undp.org/sustainable-development-goals).
  67. United Nations, Department of Economic and Social Affairs. The 17 Goals, 2024 (https://sdgs.un.org/goals).
  68. Doğa Derneği. Sendai Risk Azaltma Çerçevesi Bilgi Notu. (https://dogadernegi.org/wp-content/uploads/2024/02/Bilgi-Notu-3.pdf).
  69. Linares C, Martinez GS, Kendrovski V, Diaz J. A new integrative perspective on early warning systems for health in the context of climate change. Environ Res. 2020;187:109623.
  70. Frumkin H, Hess J, Luber G, Malilay J, McGeehin M. Climate change: the public health response. Am J Public Health. 2008;98(3):435-45.
  71. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, Boykoff M, Byass P, Cai W, Campbell-Lendrum D, Capstick S, Chambers J, Coleman S, Dalin C, Daly M, Dasandi N, Dasgupta S, Davies M, Di Napoli C, Dominguez-Salas P, Drummond P, Dubrow R, Ebi KL, Eckelman M, Ekins P, Escobar LE, Georgeson L, Golder S, Grace D, Graham H, Haggar P, Hamilton I, Hartinger S, Hess J, Hsu SC, Hughes N, Jankin Mikhaylov S, Jimenez MP, Kelman I, Kennard H, Kiesewetter G, Kinney PL, Kjellstrom T, Kniveton D, Lampard P, Lemke B, Liu Y, Liu Z, Lott M, Lowe R, Martinez-Urtaza J, Maslin M, McAllister L, McGushin A, McMichael C, Milner J, Moradi-Lakeh M, Morrissey K, Munzert S,. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. Lancet. 2021;397(10269):129-70.