The 2023 Latin America report of the Lancet Countdown on health and climate change: the imperative for health-centred climate-resilient development.

In 2023, a series of climatological and political events unfolded, partly driving forward the global climate and health agenda while simultaneously exposing important disparities and vulnerabilities to climate-related events. On the policy front, a significant step forward was marked by the inaugural Health Day at COP28, acknowledging the profound impacts of climate change on health. However, the first-ever Global Stocktake showed an important gap between the current progress and the targets outlined in the Paris Agreement, underscoring the urgent need for further and decisive action. From a Latin American perspective, some questions arise: How do we achieve the change that is needed? How to address the vulnerabilities to climate change in a region with long-standing social inequities? How do we promote intersectoral collaboration to face a complex problem such as climate change? The debate is still ongoing, and in many instances, it is just starting. The renamed regional centre Lancet Countdown Latin America (previously named Lancet Countdown South America) expanded its geographical scope adding Mexico and five Central American countries: Costa Rica, El Salvador, Guatemala, Honduras, and Panama, as a response to the need for stronger collaboration in a region with significant social disparities, including research capacities and funding. The centre is an independent and multidisciplinary collaboration that tracks the links between health and climate change in Latin America, following the global Lancet Countdown's methodologies and five domains. The Lancet Countdown Latin America work hinges on the commitment of 23 regional academic institutions, United Nations agencies, and 34 researchers who generously contribute their time and expertise. Building from the first report, the 2023 report of the Lancet Countdown Latin America, presents 34 indicators that track the relationship between health and climate change up to 2022, aiming at providing evidence to public decision-making with the purpose of improving the health and wellbeing of Latin American populations and reducing social inequities through climate actions focusing on health. This report shows that Latin American populations continue to observe a growing exposure to changing climatic conditions. A warming trend has been observed across all countries in Latin America, with severe direct impacts. In 2022, people were exposed to ambient temperatures, on average, 0.38 °C higher than in 1986-2005, with Paraguay experiencing the highest anomaly (+1.9 °C), followed by Argentina (+1.2 °C) and Uruguay (+0.9 °C) (indicator 1.1.1). In 2013-2022, infants were exposed to 248% more heatwave days and people over 65 years old were exposed to 271% more heatwave days than in 1986-2005 (indicator 1.1.2). Also, compared to 1991-2000, in 2013-2022, there were 256 and 189 additional annual hours per person, during which ambient heat posed at least moderate and high risk of heat stress during light outdoor physical activity in Latin America, respectively (indicator 1.1.3). Finally, the region had a 140% increase in heat-related mortality from 2000-2009 to 2013-2022 (indicator 1.1.4). Changes in ecosystems have led to an increased risk of wildfires, exposing individuals to very or extremely high fire danger for more extended periods (indicator 1.2.1). Additionally, the transmission potential for dengue by Aedes aegypti mosquitoes has risen by 54% from 1951-1960 to 2013-2022 (indicator 1.3), which aligns with the recent outbreaks and increasing dengue cases observed across Latin America in recent months. Based on the 2023 report of the Lancet Countdown Latin America, there are three key messages that Latin America needs to further explore and advance for a health-centred climate-resilient development. Latin American countries require intersectoral public policies that simultaneously increase climate resilience, reduce social inequities, improve population health, and reduce greenhouse gas (GHG) emissions. The findings show that adaptation policies in Latin America remain weak, with a pressing need for robust vulnerability and adaptation (V&A) assessments to address climate risks effectively. Unfortunately, such assessments are scarce. Up to 2021, Brazil is the only country that has completed and officially reported a V&A to the 2021 Global Survey conducted by the World Health Organization (WHO). Argentina, Guatemala, and Panama have also conducted them, but they have not been reported (indicator 2.1.1). Similarly, efforts in developing and implementing Health National Adaptation Plans (HNAPs) are varied and limited in scope. Brazil, Chile, and Uruguay are the only countries that have an HNAP (indicator 2.1.2). Moreover, self-reported city-level climate change risk assessments are very limited in the region (indicator 2.1.3). The collaboration between meteorological and health sectors remains insufficient, with only Argentina, Brazil, Colombia, and Guatemala self-reporting some level of integration (indicator 2.2.1), hindering comprehensive responses to climate-related health risks in the region. Additionally, despite the urgent need for action, there has been minimal progress in increasing urban greenspaces across the region since 2015, with only Colombia, Nicaragua, and Venezuela showing slight improvements (indicator 2.2.2). Compounding these challenges is the decrease in funding for climate change adaptation projects in Latin America, as evidenced by the 16% drop in funds allocated by the Green Climate Fund (GCF) in 2022 compared to 2021. Alarmingly, none of the funds approved in 2022 were directed toward climate change and health projects, highlighting a critical gap in addressing health-related climate risks (indicator 2.2.3). From a vulnerability perspective, the Mosquito Risk Index (MoRI) indicates an overall decrease in severe mosquito-borne disease risk in the region due to improvements in water, sanitation, and hygiene (WASH) (indicator 2.3.1). Brazil and Paraguay were the only countries that showed an increase in this indicator. It is worth noting that significant temporal variation within and between countries still persists, suggesting inadequate preparedness for climate-related changes. Overall, population health is not solely determined by the health sector, nor are climate policies a sole responsibility of the environmental sector. More and stronger intersectoral collaboration is needed to pave development pathways that consider solid adaptation to climate change, greater reductions of GHG emissions, and that increase social equity and population health. These policies involve sectors such as finance, transport, energy, housing, health, and agriculture, requiring institutional structures and policy instruments that allow long-term intersectoral collaboration. Latin American countries need to accelerate an energy transition that prioritises people's health and wellbeing, reduces energy poverty and air pollution, and maximises health and economic gains. In Latin America, there is a notable disparity in energy transition, with electricity generation from coal increasing by an average of 2.6% from 1991-2000 to 2011-2020, posing a challenge to efforts aimed at phasing out coal (indicator 3.1.1). However, this percentage increase is conservative as it may not include all the fossil fuels for thermoelectric electricity generation, especially during climate-related events and when hydropower is affected (Panel 4). Yet, renewable energy sources have been growing, increasing by an average of 5.7% during the same period. Access to clean fuels for cooking remains a concern, with 46.3% of the rural population in Central America and 23.3% in South America lacking access to clean fuels in 2022 (indicator 3.1.2). It is crucial to highlight the concerning overreliance on fossil fuels, particularly liquefied petroleum gas (LPG), as a primary cooking fuel. A significant majority of Latin American populations, approximately 74.6%, rely on LPG for cooking. Transitioning to cleaner heating and cooking alternatives could also have a health benefit by reducing household air pollution-related mortality. Fossil fuels continue to dominate road transport energy in Latin America, accounting for 96%, although some South American countries are increasing the use of biofuels (indicator 3.1.3). Premature mortality attributable to fossil-fuel-derived PM2.5 has shown varied trends across countries, increasing by 3.9% from 2005 to 2020 across Latin America, which corresponds to 123.5 premature deaths per million people (indicator 3.2.1). The Latin American countries with the highest premature mortality rate attributable to PM2.5 in 2020 were Chile, Peru, Brazil, Colombia, Mexico, and Paraguay. Of the total premature deaths attributable to PM2.5 in 2020, 19.1% was from transport, 12.3% from households, 11.6% from industry, and 11% from agriculture. From emission and capture of GHG perspective, commodity-driven deforestation and expansion of agricultural land remain major contributors to tree cover loss in the region, accounting for around 80% of the total loss (indicator 3.3). Additionally, animal-based food production in Latin America contributes 85% to agricultural CO2 equivalent emissions, with Argentina, Brazil, Panama, Paraguay, and Uruguay ranking highest in per capita emissions (indicator 3.4.1). From a health perspective, in 2020, approximately 870,000 deaths were associated with imbalanced diets, of which 155,000 (18%) were linked to high intake of red and processed meat and dairy products (indicator 3.4.2). Energy transition in Latin America is still in its infancy, and as a result, millions of people are currently exposed to dangerous levels of air pollution and energy poverty (i.e., lack of access to essential energy sources or services). As shown in this report, the levels of air pollution, outdoors and indoors, are a significant problem in the wholeregion, with marked disparities between urban and rural areas. In 2022, Peru, Chile, Mexico, Guatemala, Colombia, El Salvador, Brazil, Uruguay, Honduras, Panama, and Nicaragua were in the top 100 most polluted countries globally. Transitioning to cleaner sources of energy, phasing out fossil fuels, and promoting better energy efficiency in the industrial and housing sectors are not only climate mitigation measures but also huge health and economic opportunities for more prosperous and healthy societies. Latin American countries need to increase climate finance through permanent fiscal commitments and multilateral development banks to pave climate-resilient development pathways. Climate change poses significant economic costs, with investments in mitigation and adaptation measures progressing slowly. In 2022, economic losses due to weather-related extreme events in Latin America were US$15.6 billion -an amount mainly driven by floods and landslides in Brazil-representing 0.28% of Latin America's Gross Domestic Product (GDP) (indicator 4.1.1). In contrast to high-income countries, most of these losses lack insurance coverage, imposing a substantial financial strain on affected families and governments. Heat-related mortality among individuals aged 65 and older in Latin America reached alarming levels, with losses exceeding the equivalent of the average income of 451,000 people annually (indicator 4.1.2). Moreover, the total potential income loss due to heat-related labour capacity reduction amounted to 1.34% of regional GDP, disproportionately affecting the agriculture and construction sectors (indicator 4.1.3). Additionally, the economic toll of premature mortality from air pollution was substantial, equivalent to a significant portion of regional GDP (0.61%) (indicator 4.1.4). On a positive note, clean energy investments in the region increased in 2022, surpassing fossil fuel investments. However, in 2020, all countries reviewed continued to offer net-negative carbon prices, revealing fossil fuel subsidies totalling US$23 billion. Venezuela had the highest net subsidies relative to current health expenditure (123%), followed by Argentina (10.5%), Bolivia (10.3%), Ecuador (8.3%), and Chile (5.6%) (indicator 4.2.1). Fossil fuel-based energy is today more expensive than renewable energy. Fossil fuel burning drives climate change and damages the environment on which people depend, and air pollution derived from the burning of fossil fuels causes seven million premature deaths each year worldwide, along with a substantial burden of disease. Transitioning to sustainable, zero-emission energy sources, fostering healthier food systems, and expediting adaptation efforts promise not only environmental benefits but also significant economic gains. However, to implement mitigation and adaptation policies that also improve social wellbeing and prosperity, stronger and solid financial systems are needed. Climate finance in Latin American countries is scarce and strongly depends on political cycles, which threatens adequate responses to the current and future challenges. Progress on the climate agenda is lagging behind the urgent pace required. While engagement with the intersection of health and climate change is increasing, government involvement remains inadequate. Newspaper coverage of health and climate change has been on the rise, peaking in 2022, yet the proportion of climate change articles discussing health has declined over time (indicator 5.1). Although there has been significant growth in the number of scientific papers focusing on Latin America, it still represents less than 4% of global publications on the subject (indicator 5.3). And, while health was mentioned by most Latin American countries at the UN General Debate in 2022, only a few addressed the intersection of health and climate change, indicating a lack of awareness at the governmental level (indicator 5.4). The 2023 Lancet Countdown Latin America report underscores the cascading and compounding health impacts of anthropogenic climate change, marked by increased exposure to heatwaves, wildfires, and vector-borne diseases. Specifically, for Latin America, the report emphasises three critical messages: the urgent action to implement intersectoral public policies that enhance climate resilience across the region; the pressing need to prioritise an energy transition that focuses on health co-benefits and wellbeing, and lastly, that need for increasing climate finance by committing to sustained fiscal efforts and engaging with multilateral development banks. By understanding the problems, addressing the gaps, and taking decisive action, Latin America can navigate the challenges of climate change, fostering a more sustainable and resilient future for its population. Spanish and Portuguese translated versions of this Summary can be found in Appendix B and C, respectively. The full translated report in Spanish is available in Appendix D.

Climate change and public health in South America: a scoping review of governance and public engagement research.

This scoping review examines peer-reviewed literature of governance and public engagement at the intersection of public health and climate change in South America. The review shows significant gaps in academic publications, particularly because health was mostly a secondary theme examined in the studies. The few studies about governmental interventions (e.g., policies and programs) suggest that these have not been effective. Regarding public engagement, no studies examined social media engagement with health and climate change, and only one examined news coverage. Finally, most articles focused primarily on individual countries, with few comparative or regional analyses of South America. Strategic action addressing climate change and its effects on public health needs to be based on empirical evidence.

The Lancet Countdown South America: increasing health opportunities by identifying the gaps in health and climate change research.

South America is experiencing the effects of climate change, including extreme weather events and changes in temperature and precipitation patterns. These effects interact with existing social vulnerabilities, exacerbating their impact on the health and wellbeing of populations. This viewpoint highlights four main messages from the series, which presented key gaps from five different perspectives of health and climate. First, there is an overall need for local analyses of priority topics to inform public policy, which include national and sub-national evidence to adequately strengthen responses and preparedness for climate change hazards and address relevant social vulnerabilities in South American countries. Second, research in health and climate is done in silos and the intersection is not clear in terms of responsibility and leadership; therefore, transdisciplinary research and action are key. Third, climate research, policies, and action need to be reflected in effective funding schemes, which until now are very limited. For adaptation and mitigation policies to be effective, they need a robust and long-term funding scheme. Finally, climate action is a big opportunity for healthier and more prosperous societies in South America, taking the advantage of strategic climate policies to face the challenges of climate change and tackle existing social inequities.

I'm Lovin' It: How Fast Food Advertising Influences Meat-Eating Preferences.

Overconsumption of red and processed meat is associated with a multitude of negative health outcomes. Previous research shows exposure to advertising messaging can influence dietary behaviors but research on the influence of meat advertising on diet, specifically, is scant. Theoretically informed by the Reasoned Action Approach, the present experiment randomly assigned participants to view a version of a print McDonald's advertisement that included meat imagery (a Big Mac), non-meat imagery (French fries), or no food (just the McDonalds' logo and slogan), which acted as a control. An online survey in the United States included 514 U.S. adults (Mage = 51 years). Participants exposed to meat imagery compared to the non-meat imagery reported a higher desire to eat meat. The meat imagery and control conditions were also significantly associated with increased cognitive accessibility of meat concepts, compared to when respondents were shown the no-meat condition. Desire to eat meat, but not the cognitive accessibility of meat concepts, was significantly associated with attitude, normative pressure, and perceived behavioral control for avoiding eating meat one day per week; these constructs predicted intention and willingness to avoid meat. Results indicate that exposure to meat imagery in advertising does have the potential to influence meat consumption behavior and also has implications for the use of meat imagery in persuasive messaging for public health campaigns.

Family and Cultural Perceptions About Meat Consumption among Hispanic/Latino and White Adults in the United States.

The study examines the extent to which Hispanic/Latino Americans and non-Hispanic White Americans report that meat is an important aspect of their cultural beliefs and practices. An online national survey was completed using quota sampling to recruit approximately equal groups of U.S. Hispanic/Latino and non-Hispanic White Americans (n = 512). A path model predicting willingness to reduce meat consumption was estimated. Hispanic/Latino Americans viewed meat as a more integral aspect of their cultural food practices, and reported that meat dishes comprise a higher percentage of their culture's traditional foods. Cultural beliefs were associated with meat consumption and willingness to reduce meat consumption.

The Mediating Role of Family and Cultural Food Beliefs on the Relationship between Family Communication Patterns and Diet and Health Issues across Racial/Ethnic Groups.

Consumption of red meat has been linked to a variety of health issues, yet Americans are resistant to reducing their meat consumption. Family communication environments shape beliefs about food and meat consumption, and therefore are locations for potential interventions to change the way people think about food. Families are embedded in cultures, and both family and cultural norms shape beliefs about what people should eat. This study (N = 773) is interested in understanding how family communication is associated with food beliefs, meat consumption, and health issues across three racial/ethnic groups: Black/African American (n = 256), Hispanic (n = 260), non-Hispanic White (n = 257). Structural equation modeling results showed that conversation orientation was consistently associated with stronger endorsement of family cultural food beliefs across race/ethnicity groups. Family food beliefs were associated with either more health issues or more meat consumption depending on race/ethnicity and mediated the association between conversation orientation and health issues/meat consumption. Conversation orientation moderated the association between conformity orientation and food beliefs for Hispanic and non-Hispanic White participants. Implications for family communication patterns theory and health scholars are discussed along with recommendations for culturally tailored family-focused health interventions.

Abstract or concrete? The effect of climate change images on people's estimation of egocentric psychological distance.

Climate change has been widely perceived as a psychologically distant risk, largely viewed as separated from one's direct experience. Using construal-level theory, we examined how the level of abstraction and concreteness of climate change imagery affects viewers' perceived psychological distance of climate change, including spatial, temporal, social, and hypothetical (level of uncertainty) distances. Participants (n = 402) were randomly assigned to one of two experimental conditions, one with abstract images and one with concrete images. Results show that the abstract and concrete images successfully activated people's abstract and concrete mind-sets, respectively, and people who viewed abstract images were more likely to perceive climate change as a spatially and temporally distant issue.

Climate Change Perceptions of NY State Farmers: The Role of Risk Perceptions and Adaptive Capacity.

Climate change is expected to severely impact agricultural practices in many important food-producing regions, including the Northeast United States. Changing climate conditions, such as increases in the amount of rainfall, will require farmers to adapt. Yet, little is known with regard to farmers' perceptions and understandings about climate change, especially in the industrialized country context. This paper aims at overcoming this research limitation, as well as determining the existing contextual, cognitive, and psychological barriers that can prevent adoption of sustainable practices of farmers in New York State. The study is framed within the adaptive capacity and risk perception literature, and is based on a qualitative analysis of in-depth interviews with farmers in 21 farms in two counties in Central New York. The results reveal diverging views about the long-term consequences of climate change. Results also reveal that past experience remains as the most important source of information that influences beliefs and perceptions about climate change, confirming previous research.

Media sources, credibility, and perceptions of science: Learning about how people learn about science.

Knowledge about science and technology has become increasingly important in this age of digital information overload. It is also becoming increasingly important to understand what contributes to scientific learning, including information sources and trust in those sources. In this study, we develop and test a multivariate model to explain scientific knowledge based on past theories on learning from the news from the fields of political communication, sociology, and media psychology. We focus on the impact of sources-by platform, such as television and online, and by expertise, such as scientists and the media-in understanding what predicts scientific knowledge. The results show that interest in science not only directly predicts knowledge but also has indirect effects on knowledge through its effects on Internet use, confidence in the press, and perception of scientists. In addition, distrust on the news sources is an important pathway to learning about science.

Climate change in Peruvian newspapers: The role of foreign voices in a context of vulnerability.

Media coverage of climate change has been an area of continued research during the last years, mostly with a focus on developed countries. This study attempts to contribute to this body of work by analyzing the coverage in a developing country. The study presents a content analysis of newspaper coverage of climate change in Peru through the study of frames, geographical focus, and climate change strategies (mitigation/adaptation). Additionally, the role of foreign voices is assessed by comparing the coverage by Peruvian reporters with the coverage by wire services, and by determining the types of sources present in the articles. Results show a prevalence of an effects frame, followed by a politics frame. Also, the study found a significant amount of stories originating from wire services. In general, coverage prioritizes mitigation strategies and policies while providing limited attention to adaptation, which can be insufficient for a highly vulnerable country.

Framing and sources: a study of mass media coverage of climate change in Peru during the V ALCUE.

Studies about mass media framing have found divergent levels of influence on public opinion; moreover, the evidence suggests that issue attributes can contribute to this difference. In the case of climate change, studies have focused exclusively on developed countries, suggesting that media influence perceptions about the issue. This study presents one of the first studies of media coverage in a developing country. It examines newspapers' reporting in Peru during the Fifth Latin America, Caribbean and European Union Summit in May 2008. The study focuses on the frames and the sources to provide an initial exploratory assessment of the coverage. The results show that the media relied mostly on government sources, giving limited access to dissenting voices such as environmentalists. Additionally, a prominence of "solutions" and "effects" frames was found, while "policy" and "science" frames were limited. The results could serve as a reference point for more comprehensive studies.