Health Risks and Impacts

#AntimicrobialResistance (AMR) threatens to send the world back into the era before antibiotics and other antimicrobials, when a routine infection could be deadly.     Already, an estimated 5 million people die every year from infections associated with AMR.    Over the next decade, AMR could reduce global life expectancy by 1.8 years and cost the global economy more than $800 billion annually, due to additional health costs and lost productivity.     It’s fueled by many factors:  1. Poorly functioning health systems 2. Weak regulation 3. Sub-standard practices in industrial farming and agriculture 4. Poor management of waste and wastewater      AMR disproportionately affects people in low and middle-income countries, and is closely linked to poverty and a lack of access to adequate water, sanitation and hygiene.     Later this month, the World Health Assembly will consider how to accelerate action in the human health sector, as part of a multi-sectoral #OneHealth approach.     The World Health Organization has outlined six recommendations for consideration: 1. Leadership and governance, based on effective and well-resourced coordination that includes all relevant stakeholders, and high-level oversight.   2. Allocation of domestic and international funding for accelerated national, regional and global action.   3. Evidence for action through strengthening AMR and antimicrobial use surveillance, strengthening bacteriology laboratory systems, research and sharing and use of data.    4. Accelerated implementation of a people-centred public health approach to address AMR, with a core package of interventions at all levels of health systems.    5. Scaling up learning, experience sharing and technical support for countries;    6. Promotion of science, research, and innovation, targeted to public health needs and to ensuring equitable access.   From communities to health workers. From youth organizations to parliamentarians.     From the private sector to people directly affected by drug-resistant infections and their consequences.    By working together, we can chart a clear path towards a safer world for all. 

In Delhi, the temperature hit 42.1°C this year. But some people didn't have the luxury of going indoors because the street was their workplace. India’s 3 crore+ street vendors from fruit sellers to chaat walas spend over 12 hours a day under the open sky. They’re not just battling heat; they’re battling the vanishing shade. A recent study by Azim Premji University in Hyderabad reveals a disturbing trend: "As Indian cities grow vertically, their green cover shrinks." And the hardest hit? Women, migrants, and informal workers who depend on those trees for a livelihood. “When the tree was there, I sold 20 plates of Bhel. Now, I sit in the sun and barely manage 6.” -  a street vendor in Delhi. This isn't an isolated story. According to Greenpeace India & National Hawkers Federation (2024) survey: - 50% of street vendors in Delhi lost income during the summer months - 80% saw a dip in footfall due to extreme heat - ₹500–₹600 worth of goods go bad daily due to heat damage - 71% couldn’t afford medical care - Women vendors reported rising BP, menstrual irregularities, and sleep deprivation. And yet, despite Delhi hitting a record-breaking 50°C last year, heatwaves are still not recognized as a national disaster. Worse, street vendors are often left out of urban planning and climate resilience strategies. Green spaces are not aesthetic choices- they are economic lifelines. For many vendors, a tree is more than shade. It’s a signboard, a cooling system, and a guarantee of survival. And yet, the people who pollute the least are paying the highest price for climate change. If you’re in a position to influence policy, design public spaces, or fund local initiatives - pause and ask: Are we building cities that everyone can survive in?

Terrible bicondylar tibial plateau fracture with joint comminution. These are bad injuries, with risk of compartment syndrome, wound complications, infection, and post traumatic arthritis. Studies show about 30% risk of complications. This patient had a fasciotomy and external fixation placed. Then definitive surgery 2 days later. Fracture was fixed and wounds were closed. You can see the joint was pretty smashed. It was fixed as best as possible, but it’s hard to make these perfect when there’s so much joint comminution. The lateral meniscus was torn which was fixed as well. And dual plate fixation for medial and lateral sides. ❗️The goal of surgery is to achieve a stable straight knee, and avoid complications (wound healing and infection). While many develope radiographic arthritis, most don’t need a knee replacement. ❗️Studies show the risk of total knee arthroplasty at 10 years post injury is about 7% (5 times higher than a matched cohort). So not as high as some people think, but not insignificant. This one has some radiographic evidence of post traumatic arthritis, which is expected given the initial injury. But one year later patient has minimal symptoms and great range of motion. Used with patient permission #orthotrauma #orthopaedics #orthopedics #ortho #fracture #bone #tibialplateau #knee #tibia

Contrary to popular belief, healthcare has a relatively small impact on health. In one widely cited study, healthcare explained only 20% of the variance in health. Healthy behaviors (30%), physical environment (10%), and socioeconomic factors (40%) explained far more about individuals’ length and quality of life. (The analysis excluded genetics). The point is not that healthcare is unimportant. Of course, it is. Yet, we must broaden our view and appreciate that factors traditionally existing outside of healthcare play a more powerful role. In doing so, we can recalibrate our expectations of healthcare and reimagine the roles healthcare should play in people's lives. [study: Doi:10.1016/j.amepre.2015.08.024; Image: UCLA Health]

Planet vs. Plastics - the theme for today’s #EarthDay calls for a 60% reduction in the production of plastics by 2040. An ambitious goal, but imperative, considering the tremendous damage done by plastic to human, animal, and all biodiversity’s health. Single use plastics, e.g., make for 60-95% of global marine plastic pollution. Time to ponder: What are the implications of healthcare versus plastics? The healthcare sector generates huge amounts of plastic waste daily: 25-35% of hospital waste, e.g., is plastics. Undoubtedly, the advent of plastics revolutionized the medical industry, improving access to healthcare: It is low in cost, durable, easy to process and sterilize. But how can we balance the critical role of plastics in healthcare with the need to protect health from the impacts of pollution? Our Fresenius Kabi colleagues working on enteral nutrition solutions demonstrate how to use less plastics with unchanged product quality. They produce bottles and bags with liquid nutrition for patients with malnutrition. In 10 years, the team has improved the container material to a degree that saves up to 1200 tons of plastic per year. The EasyBag, which is the lightest container, now saves 60% plastic in weight and produces 85% less waste in volume compared to tube feed bottles on the market. Reducing plastic brings savings in many parameters that are vital for climate change, like greenhouse gas emissions or primary energy consumption. The EasyBag uses up to 50% fewer non-renewable primary energy sources (compared to other containers for similar products) when it is disposed on a landfill. In general, the healthcare industry is a significant driver of global greenhouse gas and accounts for 5% of global CO2 emissions. So, our contributions to conservation and sustainability have a great impact! At Fresenius Group, we’re committed to reducing our carbon footprint by 50% until 2030. By 2040, we want to become climate neutral in our operations. Our global electricity consumption is one of the most important levers on our path to reducing emissions. Hence, we will gradually increase the purchase of electricity from renewable energies and introduce more energy-efficient solutions. I am sure that digitalization and AI will also help tackle climate change on many different levels. One of our Helios Kliniken GmbH clinics in Hamburg, e.g., tests the use of AI for building automation to save energy: A digital twin simulates the building's behavior and derives appropriate specifications for real operation, like heating, in a timely manner. Experts estimate the energy savings potential to be around 20%. AI-driven solutions will also be transformative regarding the broader demand for a healthy planet in the tradition of the #EarthDay movement. At the intersection of climate and health, AI's advanced data analysis and prediction capabilities will reveal the interlinkages – a prerequisite to address climate-related health challenges! #FutureFresenius

Job loss has fatal consequences: 🔹"For every 100,000 displaced men, there are 240 additional deaths in the first five years and 1,100 additional deaths twenty years after displacement." 🔹"Around 60% of the excess deaths occur among displaced workers, but a stunning 40% occur among partners of displaced men." 🔹"no such dire consequences are found after female job displacement" These results come from a study using Finish data from the last three decades. To identify the causal effects of job loss, only workers who lose their job because of plant closure or mass layoff are considered. Why is job loss fatal? The paper shows that "cardiovascular diseases, alcohol, and suicides are the main culprits for excess male mortality", while cause-specific mortality of the partners of displaced workers is less clear. The hospitalization data also show that job loss "carries a substantial psychological burden for men: Within five years after displacement, treatment for mental health issues increases by 17 percent, while alcohol-related visits or suicide attempts increase by 19 percent." Read the full paper here: Christina Gathmann, Kristiina Huttunen, Laura Jernström, Lauri Sääksvuori, Robin Stitzing (2025), In Sickness and in Health: Job Displacement and Health Spillovers in Couples, Review of Economics and Statistics, forthcoming. https://lnkd.in/emc5_7VX

I’m excited to share our new @Nature paper 📝, which provides strong evidence that the walkability of our built environment matters a great deal to our physical activity and health. Details below.🧵 Paper link: https://lnkd.in/gsaySAs8 8 years ago, we published a study using smartphone data to understand people's activity globally 🗺️. We found huge differences in daily steps across cities. https://lnkd.in/gv9KNPZA The big question we couldn’t yet answer at the time: is it the city that makes people walk more, or do active people just choose to live there? 🤔 To solve this, we ran a massive "natural experiment." We studied smartphone data from 2 million people 🤳, including ~5,000 who moved between 1,609 U.S. cities. This gave us a unique before-and-after picture 📸 of how their physical activity changed with their environment. The key finding: your city can make you healthier. 🏙️➡️🚶♀️ People who moved from a less walkable city to a more walkable one increased their walking by ~1,100 steps a day, on average. That's about 11 minutes of extra walking without even thinking about it! 👟 This effect is symmetric. People moving to NYC from less walkable places gained ~1,400 steps 🗽. People who moved away from NYC lost ~1,400 steps. This "before and after" picture is powerful evidence that the environment is the key driver of physical activity. 🔄 This isn't just about more steps—it’s about the right kind of steps. Our study shows this additional activity is mostly brisk walking, which is the moderate-to-vigorous exercise (MVPA) recommended by doctors to prevent disease. A move to a highly walkable city can add an hour of this health-boosting activity to a person's week. 💪📈 In fact, moving to a much more walkable city nearly doubled the chances that a person would meet the national guidelines for physical activity (150 mins of MVPA/week), jumping from 21.5% to 42.5%. This is great news! 🎉 So, is it just that active people choose walkable cities? Our data says no. People who moved between similarly walkable cities saw no change in their activity. This suggests that the built environment, not just personal choice, is a central driver. ✅ The big takeaway: city planning is a powerful public health tool 🛠️. Investing in sidewalks, parks, and mixed-use zoning is a direct investment in the health of citizens. Our work shows that creating activity-friendly environments is a powerful way to make entire populations healthier. 💚 Huge thanks to my amazing co-authors Boris Ivanovic, Abby King, Jennifer Hicks, Scott Delp, and Jure Leskovec. (representing University of Washington, Stanford University, Stanford University School of Medicine and NVIDIA) 🙏

Nature cools ❄️. Concrete and tarmac burn 🔥. This is what that looks like. This infrared footage captures the Urban Heat Island Effect in action: Tarmac, concrete and rooftops radiating intense heat. Green spaces staying dramatically cooler, even under the same sun. The difference can be as much as 12°C. And it matters more than most people realise. ⤷ Hotter cities mean higher risks: more heat-related illness, pressure on healthcare, and even avoidable deaths ⤷ Energy demand surges as air conditioning ramps up, adding to emissions ⤷ And those worst affected are often communities with the least access to nature and the fewest resources to adapt But the good news is: nature works. ⤷ A 10% increase in tree cover can lower local temperatures by up to 2°C ⤷ Green roofs can cool buildings by up to 5°C, reducing the need for artificial cooling ⤷ And greener cities support better mental and physical health, reducing stress, improving air quality, and creating spaces to connect, move and breathe This is more than a design challenge. It’s an opportunity to rethink urban resilience. By 2050, 68% of the world’s population will live in urban areas. Cities don’t have to fight against nature. They can thrive with it. 🎥 Sky News

Working with an interdisciplinary team, we have developed a website to communicate how the White House's proposed cuts to health research would cause losses of $16B and 68,500 jobs. Find out how your community may be impacted at SCIMaP: https://scienceimpacts.org As context, on Feb. 7th, 2025, the White House ordered across-the-board cuts to NIH funded research. The order drastically reduces the amount that universities/hospitals/institutes receive for essential facilities, services, and staff required for health research. Nearly two dozen states and allied institutions sued leading to a temporary injunction to across-the-board cuts nationwide. The NIH distributes approximately $37B in external grants/awards in FY 2024. These grants/awards have a force-magnifying effect, generating $2.56 of economic activity for each $1 supported, i.e., more than $94B in activity and more than 400K jobs (source: United for Medical Research). But this impact is hard to see and interpret. You might wonder: perhaps the impacts are focused only on a few, potentially 'elite' institutions? The answer is far different. Soon after the executive order was released, it became apparent that these across the board cuts would have damaging & consequential effects in communities across the United States, in places like State College, PA, Birmingham, AL, and across the medical research infrastructure of Texas. Led by the efforts of Allie Sinclair joint with Emily Falk, Clio Andris and more, we have developed an interactive visualization of the impact of federal cuts to health research in communities nationally. In practice, we take anticipated reductions in NIH supported grants and then leverage US census data on commuting to project the impact of these cuts across and within communities. Through interactive, data-driven visualizations, we aim to help Americans explore how research fuels the economy, supports jobs, and improves health outcomes. This website and interactive visualization is a step in that direction, with more to come joint with Alyssa (Allie) Sinclair (now at UPenn), Emily Falk (UPenn), Clio Andris (GT) + others in The Science and Community Impacts Mapping Project: https://scienceimpacts.org

Paris eliminated 50,000 parking spaces over 20 years. Air pollution dropped by half. New data from Ariparif shows nitrogen dioxide levels fell 50% and fine particulate matter (PM2.5) dropped 55% since 2005. Maps that once showed the entire city smothered in red pollution zones now show clean air across most neighborhoods, with contamination limited to major highways. Paris converted automotive arteries into bike lanes, banned the most polluting vehicles, pedestrianized major boulevards including parts of Rue de Rivoli and the Seine riverbank, and tripled parking fees for SUVs. Last month, Parisians voted to pedestrianize an additional 500 streets. The health implications are significant. Both PM2.5 and nitrogen dioxide are linked to heart attacks, lung cancer, bronchitis, and asthma. This isn’t theoretical risk reduction - it’s measurable improvement in what millions of people breathe every day. Mayor Anne Hidalgo has led these efforts since 2014, describing her vision as “a Paris that breathes, a Paris that is more agreeable to live in.” The policies faced pushback from car owners’ associations and suburban commuters who argued it made their lives harder. But the data is clear: ambitious urban policy can directly improve public health in large cities. Carlos Moreno, professor at Sorbonne Université, describes it as “an urban policy based on well-being.” Cities aren’t stuck with bad air. They make choices. Source: Washington Post analysis of Airparif data