Letizia Richelli , Eline L.F.M.G. Vissers , Alessandra Gorini , Marijn H.C. Meijers , Eline S. Smit , Thomas Gültzow
{"title":"Understanding environmental decision making: The association between stages of decision making and decisional conflict","authors":"Letizia Richelli , Eline L.F.M.G. Vissers , Alessandra Gorini , Marijn H.C. Meijers , Eline S. Smit , Thomas Gültzow","doi":"10.1016/j.joclim.2025.100467","DOIUrl":"10.1016/j.joclim.2025.100467","url":null,"abstract":"<div><div>Introduction: As research highlights how climate change impacts individual and planetary health, people might consider reducing their ecological footprint by acting pro-environmentally. However, their choice might depend on how far along they are in the process of deciding to act pro-environmentally (i.e., different stages of decision making) and on their experienced difficulty in deciding in favour of the environment and which behaviour to conduct (i.e., decisional conflict).</div><div>Methods: To explore in which stage participants find themselves (i.e., not yet thinking about choices, showing interest in doing so, actively considering options, approaching a decision, having already decided but remaining open to reconsideration, or being firmly committed to a decision with little chance of change) and whether their respective stages are correlated with their experienced decisional conflict, an online, cross-sectional questionnaire was distributed among a convenience sample of 418 English-, Dutch-, and Italian-speaking adults to measure participants’ demographics, stages, and extent to which they experience decisional conflict.</div><div>Results: Based on regression analyses, we observed that participants who were further along in the stages experienced less decisional conflict.</div><div>Conclusion: Therefore, we suggest that interventions (e.g., decision aids) take stages into account to better meet users’ needs and assist people in making environmental decisions.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100467"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie Y Parker , Kimalie F Parchment , Maria Walawender , Georgiana Gordon-Strachan
{"title":"Prioritizing evidence for action from the 2024 small island developing states report of the Lancet Countdown on health and climate change","authors":"Stephanie Y Parker , Kimalie F Parchment , Maria Walawender , Georgiana Gordon-Strachan","doi":"10.1016/j.joclim.2025.100482","DOIUrl":"10.1016/j.joclim.2025.100482","url":null,"abstract":"<div><h3>Introduction</h3><div>Small island developing states (SIDS) are vulnerable to the ill-health effects associated with unabated atmospheric warming driven by larger, more developed countries. Hence, the health-centered focus of the <em>Lancet</em> Countdown on Health and Climate Change has immense value for SIDS.</div></div><div><h3>Methods</h3><div>Given resource constraints and data limitations across the SIDS region, the inaugural 2024 SIDS report of the <em>Lancet</em> Countdown required a method of singling out the most regionally relevant indicators from 47 <em>Lancet</em> Countdown global indicators. A two-stage semi-qualitative method was designed for this purpose.</div></div><div><h3>Results</h3><div>The evaluation stage involved identifying two indicator sets from stakeholder consultation (<em>n</em> = 32) and a multi-criteria assessment (<em>n</em> = 11). Using both sets of indicators, only 11 met the criteria of being regionally representative and relevant, further confirming data limitations. To adjust for this challenge, 14 indicators were added to the final list based on relevance. Therefore, 25 <em>Lancet</em> Countdown indicators were selected for the 2024 SIDS report of the <em>Lancet</em> Countdown on Health and Climate Change. To further prioritize the wide range of evidence from these indicators, a qualitative multiplication matrix was used to define relationships between regional data coverage and differences from global benchmarks. Six indicators marked successes in adaptation, and 14 evidenced negative implications compared to global benchmarks.</div></div><div><h3>Conclusion</h3><div>The impact of heat on physical activity, food security, and economic development was of critical regional importance, as was the need for more research. The study identified critical areas where urgent climate action is needed, emphasizing the need for increased research and data collection in SIDS.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100482"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Teanibuaka Tabunga , Sarah Medcalf , Annabelle Workman
{"title":"Climate-sensitive maternal and child health outcomes: A scoping review and policy implications for Kiribati","authors":"Teanibuaka Tabunga , Sarah Medcalf , Annabelle Workman","doi":"10.1016/j.joclim.2025.100479","DOIUrl":"10.1016/j.joclim.2025.100479","url":null,"abstract":"<div><h3>Background</h3><div>Kiribati is situated in the central Pacific Ocean with a population of over 119,000 people. It is facing numerous health and other challenges from climate change, with adverse impacts on priority populations including women and children. Limited capacity and data gaps create challenges for responsive approaches to protect the health of priority populations. This scoping review surveys the peer-reviewed literature on several climate-sensitive maternal and child health outcomes, and considers this evidence in the context of Kiribati’s current climate and health policy landscape.</div></div><div><h3>Methods</h3><div>A search of PubMed, Web of Science and Scopus was conducted in August 2024 to identify peer-reviewed articles published in English between 2000 and 2024 examining climate-sensitive child and maternal health outcomes in the Pacific and developing countries. The search returned 463 results. Following abstract and full text screening, 34 articles were included in the review. Kiribati’s climate- and health-related policies were also identified and examined.</div></div><div><h3>Results</h3><div>Most (91 %) eligible articles have been published since 2010. Diarrheal disease and malnutrition are the commonest outcomes studied, with temperature and rainfall being key climatic factors affecting disease prevalence. Both outcomes are highly relevant for Kiribati. The limited evidence on climate-related maternal and adverse pregnancy outcomes also suggests temperature and rainfall are influential climatic factors.</div></div><div><h3>Conclusion</h3><div>There is increasing evidence across developing contexts that climate change adversely impacts maternal and child health outcomes. An opportunity exists to proactively identify and implement targeted interventions for women and children to reduce the prevalence of climate-sensitive maternal and child health outcomes.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100479"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul F Dellaripa , Candace Feldman , Lydia Gedmintas , Susan Ritter , Caleb Dresser
{"title":"Implementation of a heat alert system for clinical staff in an ambulatory setting: A pilot project","authors":"Paul F Dellaripa , Candace Feldman , Lydia Gedmintas , Susan Ritter , Caleb Dresser","doi":"10.1016/j.joclim.2025.100478","DOIUrl":"10.1016/j.joclim.2025.100478","url":null,"abstract":"<div><h3>Introduction</h3><div>Climate change leads to an increasing risk of heat exposure and pre-emptive alerting to patients may be an important intervention to limit health risks related to heat. The process of providing counseling and resources related to impending dangerous heat in an ambulatory clinic setting has not been described. In this pilot project utilizing an electronic heat alert system, we describe the implementation of a clinic-level protocol for providing alert-based heat health information and proactively educating rheumatology patients in an ambulatory setting on dangerous heat conditions.</div></div><div><h3>Methods</h3><div>Physicians, nurses and medical assistants received electronic notifications of dangerous heat forecasts via a external heat alert system (Realtime Climate Heat Risk). Participating staff completed surveys at the midpoint and end of the heat season. The primary endpoint was a self-reported estimate of the percentage of patients engaged regarding heat safety on days where heat alerts were issued.</div></div><div><h3>Results</h3><div>There were 4 heat alert days during the study period. Half of participating staff members reported they had engaged 50 % or more of their patients on this topic. Self-reported levels of engagement by medical assistants were significantly higher than those of physicians and nurses, (<em>W</em> = 4.5, p-value = 0.036).</div></div><div><h3>Conclusions</h3><div>Heat and other environmental exposures present risks to patients as the effects of climate change worsen. Heat alerts may help staff address health risks with their patients. This pilot study demonstrates that an external heat alert system can be implemented utilizing providers of different skill levels and at all points of patient interaction in an ambulatory clinic setting.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100478"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of medicines dispensation data in city-based air-health surveillance and health preparedness","authors":"Ritu Parchure , Santu Ghosh , Santosh Satam , Aparna Gokhale , Balasaheb Pawar , Vinay Kulkarni","doi":"10.1016/j.joclim.2025.100483","DOIUrl":"10.1016/j.joclim.2025.100483","url":null,"abstract":"<div><h3>Introduction</h3><div>Air pollution in India is a significant public health issue. Air-health surveillance has been recently introduced in heavily polluted Indian cities, to inform relevant mitigation and health preparedness actions. The air-health surveillance tracks emergency room visits (ERV) for acute respiratory illnesses in select sentinel hospitals. Reporting from multiple facilities is necessary to get a representative picture, but expanding coverage poses challenges. In this context, pharmaceutical data can serve as an alternative data source to aid surveillance efforts.</div></div><div><h3>Methods</h3><div>We examined the potential role of data on sales of respules (a combination of corticosteroid and bronchodilator medicines, used in nebulizers) as an indicator in air-health surveillance. The association between daily respules sold at a trust-based hospital in Pune, India, and daily concentration of local ambient particulate matter (PM<sub>2.5</sub>) was assessed using a time-stratified case-crossover design.</div></div><div><h3>Results</h3><div>A positive correlation, with a lag effect, was observed. A 10 µg/m<sup>3</sup> increase in PM<sub>2.5</sub> level led to an 8 % and 6 % increase in respules sales after a lag of 3 and 4 days, respectively. The number of respules sold correlated well with ERV.</div></div><div><h3>Discussion</h3><div>The findings indicate that respules sold could serve as a reliable proxy for tracking health impacts from air pollution.</div></div><div><h3>Conclusion</h3><div>Our study provides a proof-of-concept analysis showing that pharmaceutical data can be used as a proxy measure to assess the short-term health impacts of air pollution. Further exploration is needed to evaluate its utility for air-health surveillance efforts in India.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100483"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Planetary health education in Indian medical curricula","authors":"Prasoon Pattanaik , Anandita Pattnaik","doi":"10.1016/j.joclim.2025.100481","DOIUrl":"10.1016/j.joclim.2025.100481","url":null,"abstract":"<div><h3>Introduction</h3><div>This study assesses the state of planetary health education in Indian medical schools and proposes actionable recommendations for enhancement.</div></div><div><h3>Materials and Methods</h3><div>The Planetary Health Report Card (PHRC), an international student-driven metric-based tool, was used to evaluate planetary health content in six report cards from four prominent Indian medical schools. Five key categories were evaluated: planetary health curriculum, interdisciplinary research, community outreach and advocacy, support for student initiatives, and campus sustainability measures.</div></div><div><h3>Results</h3><div>Disparities were found in integrating planetary health into medical education among surveyed schools. While some topics like \"the effect of extreme heat and pollution on health\" were commonly integrated, critical topics such as \"the carbon footprint of healthcare systems\" were often overlooked. Limited interdisciplinary research and community engagement were noted, with insufficient support for student initiatives. However, all schools showed progress in campus sustainability. The National Medical Commission’s curriculum includes only limited content on planetary health. The absence of dedicated coursework and inconsistent implementation has resulted in uneven integration across the country, with much of it depending on individual faculty initiatives.</div></div><div><h3>Conclusion</h3><div>Recommendations include developing dedicated coursework with clear learning outcomes, promoting planetary health research, organizing outreach activities, making educational materials accessible, supporting student initiatives, and enhancing campus sustainability. These recommendations aim to equip future healthcare professionals with the knowledge and skills to address the relationship between human health and planetary well-being, fostering a sustainable healthcare system in India.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100481"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anayawa Nyambe , Edwell S Mwaanga , Allan Mayaba Mwiinde , Charles Michelo
{"title":"Heat stress risk assessment of farmers working in a hot environment: What about in Zambia?","authors":"Anayawa Nyambe , Edwell S Mwaanga , Allan Mayaba Mwiinde , Charles Michelo","doi":"10.1016/j.joclim.2025.100457","DOIUrl":"10.1016/j.joclim.2025.100457","url":null,"abstract":"<div><h3>Introduction</h3><div>Farmers are vulnerable to heat stress due to the nature of their work and the environment. This cross-sectional study aimed to assess the heat stress risk among rural farmers in the Monze and Sioma districts of Zambia.</div></div><div><h3>Method</h3><div>Wet Bulb Globe Temperature (WBGT) readings were taken by trained farmers to assess environmental heat stress risk. Additionally, structured questionnaires on heat stress risk at the workplace were used to assess the personal experience of 200 farmers from September to November 2021.</div></div><div><h3>Results</h3><div>Male (<em>n</em> = 92) and female (<em>n</em> = 108) respondents had a mean age of 45.4 years (<em>SD</em> = 13.75) with 97.5 % of respondents being crop farmers. WBGT readings of greater than 28 °C, which is considered an upper heat stress risk threshold for a heavy workload, were recorded. Results revealed 62.5 % of the farmers were at risk of developing heat stress, with multiple factors emerging as potential contributors to the risk.</div></div><div><h3>Conclusions</h3><div>There is a growing heat stress risk among farmers in Monze and Sioma, along with a need to investigate heat stress effects on productivity and specific drivers of heat stress that consider differential geographical and population demographic variations. Climate adaptive and mitigative measures, including Indigenous knowledge-based approaches used by communities in rural area's should be assessed.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100457"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrina Soares Simon , Marcos Amaku , Eduardo Massad
{"title":"The spread of infectious diseases in migration routes between caravans and resident communities: Modelling yellow fever in Central America","authors":"Sabrina Soares Simon , Marcos Amaku , Eduardo Massad","doi":"10.1016/j.joclim.2025.100473","DOIUrl":"10.1016/j.joclim.2025.100473","url":null,"abstract":"<div><h3>Introduction</h3><div>Climate-sensitive diseases are significantly affected by weather patterns and the social consequences of a changing climate. In this context, epidemics and human mobility can interact, leading to unpredictable impacts on both human and planetary health.</div></div><div><h3>Methods</h3><div>To investigate the impact of yellow fever (YF) vaccination in the context of an outbreak and its association with migration, we use a SEIRV-SEI compartmental deterministic model for humans and vectors and numerical simulations applied to three coupled populations - caravans, endemic and disease-free communities. Two scenarios are evaluated with different vaccination coverage levels at endemic communities and in caravans.</div></div><div><h3>Results</h3><div>When communities endemic to YF are the source of migration, herd immunity is critical, but vaccinating caravans is by far the most significant intervention to protect migrants and disease-free communities upwards from the risk of YF introduction.</div></div><div><h3>Conclusion</h3><div>Preventing outbreaks of climate-sensitive infectious diseases in the context of migration must be a joint effort of common interest. Maintaining vaccination coverage at recommended levels combined with the continued effort to vaccinate people on the move is the only intervention that can prevent a health crisis. Therefore, vaccination against climate-sensitive diseases should be considered climate adaptation.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100473"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elaine C. Flores , Daniela C. Fuhr , Victoria Simms , Andres G. Lescano , Nicki Thorogood
{"title":"“Beyond the flood: Exploring the psychosocial consequences and resilience challenges in the aftermath of “El Niño” in Tumbes, Peru”","authors":"Elaine C. Flores , Daniela C. Fuhr , Victoria Simms , Andres G. Lescano , Nicki Thorogood","doi":"10.1016/j.joclim.2025.100477","DOIUrl":"10.1016/j.joclim.2025.100477","url":null,"abstract":"<div><h3>Background</h3><div>El Niño's impacts on health are widespread, but evidence of its psychosocial effects on historically affected communities is limited. We aimed to describe perceived mental health impacts, local barriers to psychological well-being, and challenges in accessing support post-El Niño in Tumbes, Peru.</div></div><div><h3>Methods</h3><div>Between May-June 2017, we conducted 27 semi-structured interviews and three focus groups in Spanish with 24 adult residents, including local authorities and residents from heavily and minimally El Niño affected areas. Data were analyzed thematically.</div></div><div><h3>Results</h3><div>Initially, participants minimized El Niño's mental health impact, claiming to be \"accustomed\" to it. However, most described specific cases of suffering, including socioeconomic struggles, feelings of lack of support, unfairness, and helplessness. Local authorities acknowledged inadequate support availability. Psychosocial distress was exacerbated by poverty, scarce work opportunities, and disproportionate effects on vulnerable groups. Contextual factors like corruption, underfunding of prevention, and lack of reconstruction led to despair and distrust of authorities. Participants identified responsibility gaps at different levels but rarely acknowledged their responsibility or suggested alternatives. Psychosocial problems, therapy availability, or community support programs were seldom mentioned, though mutual collaboration was highlighted as useful but non-existent.</div></div><div><h3>Conclusions</h3><div>We found multiple interrelated issues in under-resourced post-disaster communities, highlighting the psychological burden of living \"between disasters\" and how socioeconomic distress and lack of support contribute to suffering. Beyond emergency aid, these communities require integrated care considering contextual and community-level distress, improving access to prevention and reconstruction activities, and addressing ongoing anxiety about future disasters to foster long-term resilience.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100477"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Willemijn vd Wal , Dennis G. Barten , Linsay Ketelings , Frits H.M. van Osch , Madhura Rao , Luc Mortelmans , Joost Bierens
{"title":"Preemptive hospital evacuation during the 2021 European floods: A qualitative study on factors influencing decision-making","authors":"Willemijn vd Wal , Dennis G. Barten , Linsay Ketelings , Frits H.M. van Osch , Madhura Rao , Luc Mortelmans , Joost Bierens","doi":"10.1016/j.joclim.2025.100460","DOIUrl":"10.1016/j.joclim.2025.100460","url":null,"abstract":"<div><h3>Introduction</h3><div>In July 2021, several European countries were affected by severe floods, with water levels of the river Meuse reaching a record high. It was decided to completely evacuate VieCuri Medical Center (Venlo, The Netherlands), a hospital located directly adjacent to this river. The aim of this study was to explore the decision-making process of this emergency hospital evacuation.</div></div><div><h3>Methods</h3><div>This descriptive qualitative study assessed factors influencing the decision-making process of this hospital evacuation. Data were collected through semi-structured interviews with 11 key stakeholders. Data were analyzed by reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Three themes were constructed from the interviews: risk-assessment and estimation; prior experience; and prerequisites for evacuation. The decision to evacuate was made when there was uncertainty regarding maximum water level forecasts. Therefore, the risks of a hospital evacuation were balanced against the risk of the loss of essential services in case of a dike breach. Prior experiences with crises played a major role, and the use of a national patient coordination center (NPCC), which was established during the COVID-19 pandemic, enabled rapid assessment of the capacity of destination hospitals and facilitated patient transfers. It was determined that prerequisites for evacuation include clear evacuation guidelines, concise communication and collaboration.</div></div><div><h3>Conclusion</h3><div>The decision to evacuate was made when there was uncertainty regarding maximum expected water levels, while administrators balanced the risk of hospital evacuation against the risk of essential services failure in case of a dike breach. Prior experience with crises and the availability of a NPCC were decisive factors in this evacuation procedure. The NPCC allowed for swift identification of available capacity in appropriate destination hospitals.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100460"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}