Background. Market-cycle forecasts are vulnerable to hindsight because a low becomes identifiable only after subsequent price confirmation. Objective. This study evaluated whether an adaptive, confirmation-aware interval could attain at least 80% chronological forecast precision for daily cycle lows (DCLs) and weekly cycle lows (WCLs) in Bitcoin, S&P 500 futures, and gold. Methods. The Adaptive Quantile-Calibrated Cycle Window used only the latest 20 completed cycles. Its lower endpoint was the empirical 10th percentile of prior low-to-low durations, and its upper endpoint was the 90th percentile of prior-low-to-next-confirmation durations. Forecasts originating from 1 January 2021 through 14 July 2026 were evaluated sequentially, and the retrospective protocol was externally preregistered. Results. Fixed clocks achieved 70.9% DCL precision and 55.6% WCL precision. The adaptive interval achieved 109/127 DCL hits (85.8%; 95% CI 78.7%–90.8%) and 27/27 WCL hits (100.0%; 95% CI 87.5%–100.0%). Mean window width increased from 14.7 to 32.8 days for DCL and from 4.0 to 11.7 weeks for WCL. A wider 5th–95th percentile band produced 93.7% DCL precision with a 95% lower confidence bound of 88.1%. Conclusion. Adaptive interval calibration exceeded the 80% point target, but the gain depended on materially wider windows and a small WCL sample; prospective replication remains necessary.
BACKGROUND: Climate shocks increasingly threaten Africa’s economic and institutional stability, yet their indirect effects through social sectors such as health remain insufficiently understood. Guided by political economy and welfare theory, this study examines how climate-induced disruptions affect access to healthcare, public or institutional trust, and the broader risk of social unrest and attitude towards coups d’état support across African countries. METHODS: The analysis uses cross-sectional data from 53,176 households across Africa and applies an ordered probit model with country fixed effects to account for country size and population structure. RESULTS: Climate shocks notably drought and flood events, significantly reduce access to healthcare services and erode public trust in health governance systems. Diminished health access and declining institutional confidence further increase the likelihood of social unrest and coup events, serving as key mediating channels through which environmental stress contributes to political instability. CONCLUSION: Strengthening climate-resilient health infrastructure, decentralizing public health financing, and investing in highly exposed regions are essential policy responses. Enhancing social protection and institutional credibility can help break the destabilizing feedback loop between environmental shocks, welfare declines, and political unrest.
INTRODUCTION: Somalia, the 44th largest country in the world by land area, struggles with a heavy burden of infectious diseases. Since 1991, populations have lacked essential health services, exacerbated by recurring infectious-disease outbreaks. Recurrent outbreaks of measles, cholera, and polio have devastated public health, generating significant morbidity and mortality. Despite improvements through new graduates, these issues remain unresolved. This study examines the impact of climate change on infectious-disease outbreaks in Somalia focusing on cholera, measles, and polio-to fill a gap in the literature by linking climate variability with outbreak dynamics and identifying weaknesses in Somalia's health system. The findings will inform targeted public-health strategies. METHOD: Following PRISMA guidelines, we undertook a narrative review of English-language literature (1990 - March 2025). Searches in PubMed, Scopus, Web of Science and Google Scholar combined terms for infectious-disease outbreaks, climate change and Somalia/Horn of Africa. Of 202 records identified, 74 met inclusion criteria. Two reviewers independently screened, extracted data and applied six-step inductive coding in NVivo 12, synthesizing findings into thematic domains. RESULTS: Four interlinked themes emerged. (1) Fragile health system: < 0.4 doctors, nurses and midwives per 10 000 population, poorly equipped facilities and patchy surveillance. (2) Control measures: routine immunization completeness ≈20%; limited oral-cholera-vaccine and WASH coverage sustain transmission. (3) Political instability and conflict: insecurity, decentralized coordination and ≥ 2.6 million IDPs hamper rapid response. (4) Impact of climate change: drought-induced water scarcity and flood-related latrine breaches create year-round face-oral exposure, while climate shocks divert resources and swell susceptibility pools. CONCLUSION: Outbreak control in Somalia now hinges on integrating climate adaptation with health-system strengthening. Climate-proofed WASH infrastructure, mobile vaccination and surveillance linked to hydro-meteorological alerts, a National Outbreak Operations Centre, and ring-fenced financing are urgent priorities. Without such measures each extreme-weather event will erase hard-won gains; with them, Somalia can break the climate-outbreak feedback loop.
Planetary health is an emergent transdisciplinary field, focused on understanding and addressing the interactions of climate change and human health, which offers interventional challenges given its complexity. While various articles have assessed the use of blockchain (web3) technologies in health, little consideration has been given to the potential use of web3 for addressing planetary health. A scoping review to explore the intersection of web3 and planetary health was conducted. Seven databases (Ovid Medline, Global Health, Web of Science, Scopus, Geobase, ACM Digital Library, and IEEE Xplore) were searched for peer-reviewed literature using key terms relating to planetary health and blockchain. Findings were reported narratively. A total of 3245 articles were identified and screened, with 23 articles included in the final review. The health focus of the articles included pandemics and disease outbreaks, the health of vulnerable groups, population health, health financing, research and medicines use, environmental health, and the negative impacts of blockchain mining on human health. All articles included the use of blockchain technology, with others additionally incorporating smart contracts, the Internet of Things, artificial intelligence and machine learning. The application of web3 to planetary health can be broadly categorised across data, financing, identity, medicines and devices, and research. Shared values that emerged include equity, decentralisation, transparency and trust, and managing complexity. Web3 has the potential to facilitate approaches towards planetary health, with the use of tools and applications that are underpinned by shared values. Further research, particularly primary research into blockchain for public goods and planetary health, will allow this hypothesis to be better tested.
Climate change will widen health inequities; action on the social determinants of health is essential In a conversation recently, a former senior public servant suggested to me that the social determinants of health are too theoretical. It is true that there are a number of theoretical perspectives associated with social determinants. A key one, from Nobel Laureate Amartya Sen,1 highlights the importance of having the freedoms and capabilities to lead a flourishing life. According to theory, these are shaped by the conditions in which people are born, live, work and age, which are unequally distributed.2 There is, however, nothing theoretical about the manifestation of social inequities and their impact on peoples’ health. Every day, people living in Australia embody stark inequities in income, working conditions, lived environment, and access to quality health and social care. For example, before the coronavirus disease 2019 (COVID-19) pandemic, Australians in the top 20% income bracket received six times more money than the lowest 20%.3 Three million Australians were estimated to be living below the poverty line in 2017, including 18% of all children.3 Before the pandemic, more than a million people were in rental stress, and waiting lists for social housing were into the hundreds of thousands.4 Within the first few months of 2020, 880 000 Australians lost their jobs, with women, young people, and those in precarious employment disproportionally affected.3 Workers in casual employment accounted for 63% of job losses between February and May 2020.3 Since the COVID-19 pandemic began, Australia’s 31 billionaires have increased their wealth by $85 billion.5 People embody these inequities,6 which makes them sick and contributes to high levels of premature death. In 2017, 17% of Victorians reported high psychological distress. In 2020, that rose to 44% and to 60% among those who lost their jobs.7 Across Australia, people living in the lowest socio-economic quintile had mortality rates twice as high as those in the highest quintile, and these inequities widened between 2011 and 2016.8 Despite narrowing, the gap in life expectancy between Indigenous and non-Indigenous Australians remains high.9 What do social determinants have to do with climate change and planetary health? The fires, hail, floods and droughts that Australia has endured in recent years10 affect everyone, but not everyone experiences them equally.11 Affluent people can afford to live in insulated buildings with air conditioning and air purifiers, or add flood proofing and extra drainage. Meanwhile, people who are poor, older individuals, people with disabilities, and those who are socially marginalised are the least able to adapt to the changing climate, unable to escape the fires and heat, and live in dwellings and environments that amplify its effects.11 As has happened in other countries experiencing similar impacts from climate change, having lost homes and livelihoods, and fearful for the future, some people may leave their communities and perhaps the country.12 This will exacerbate inequities, with those who have more financial and social capital having more options — wealthy Australians are already buying land in Tasmania to escape the worst ravages of climate change.13 For people living in caravan parks in Lismore, New South Wales, having insurance is a stretch.13 Moving is not an option. This climate change-exacerbated social inequity adds to existing inequities in disease burdens and premature mortality — this is climate change interacting with the social determinants of health inequities.11 Planetary health inequity is a concept that recognises the impact of climate change on social and health inequities. It also recognises the importance for health equity of considering planetary systems — if we do not have a functioning Earth system, we have social disruption and risk to human survival. Planetary health inequity therefore embodies the common drivers of climate change and health inequity. These common drivers comprise major structural forces. Power asymmetries between actors, institutions and ideas, a neoliberal fetishism of market forces and individualism, hyperglobalisation, and the associated norms and values that permeate institutions and communities affect policy decisions that structure society and differentially affect daily living conditions and, ultimately, health.14-18 These structural social determinants of health inequity overlap substantially with the drivers of climate change and can be described collectively as the global “consumptogenic system”. The consumptogenic system is characterised by institutions, policies, business practices, and social norms that embed and entrench principles of extractive capitalism and colonialism.19 Such a system encourages and rewards excessive production and hyperconsumerism of fossil fuel-reliant goods and services that are unhealthy and inequitably valued and distributed.20 If left on the current trajectory, the consumptogenic system will amplify potentially irreversible consequences for environmental degradation, inequalities and poor health. Governments have the chance to advance planetary health equity goals by addressing the consumptogenic system and inequitable distribution of resources that create negative health outcomes and climate change. The issue is not that it is too theoretical, the issue is the often lack of political will to address inequality, adopt a social model of health, and tackle climate change. In the May 2022 federal election, the Australian electorate demanded change. Encouragingly, the new Labor government promised to do better by the people and, although not in the language of the social determinants, their proposed action plan21 will go some of the way to advance planetary health equity goals. But it must go further. Achieving the transformative goal of planetary health equity requires a “social vaccine”22 (Box), the targets of which are the conditions underpinning four basic requirements for health and equity to flourish: a life with security, opportunities that are fair, a planet that is habitable by humans and supports biodiversity, and governance that is just. Achieving these conditions requires the ambition, design and implementation of policies that ensure a fair social foundation and economic environment operating within the ecological ceiling.23 In Australia, as elsewhere, we have long needed policy that helps with adaptation to the damage already done by climate change. Good social and planning policy that ensures access to safe, stable and affordable housing, decent working conditions for all, income support levels that enable living with dignity, and inclusive infrastructure development is good climate adaptation policy. They are also good health equity policies. Adaptation is essential. So too is mitigation. The Climate Change Bill 2022 commits Australia to a greenhouse gas emissions reduction target of a 43% reduction from 2005 levels by 2030. This target should be considered only a starting point. A roadmap to net zero and an empowered secure Climate Change Authority is essential. Adequate climate change mitigation and planetary health equity will not be achieved unless there is ambitious and immediate action that disrupts the consumptogenic system. The targets should be the institutions, actors, structures and discourses that embed, facilitate and normalise the global dominance of a consumptogenic system addicted to growth regardless of the environmental, social and health costs. At the very least, any new fossil fuel project must be assessed for potential damage to species and environments through its impacts on climate change. Fundamentally, however, disruption of this system requires Australia and the rest of the world to stop extracting, burning and investing in oil, coal, gas and other fossil fuels, with government vetoing all new fossil fuel developments. The absence of an overarching framework guiding the actions of all Australian Government departments in a mission towards planetary health equity is problematic. This lack of authorising environment enables at best an ineffective siloed, scattergun approach; at worst policy silence. Implementing a national strategy that brings together climate change, inequality and health, such as the proposed Climate and Health Alliance’s Healthy, Regenerative and Just framework, is essential.24 An engaged strong civil society is key to the delivery of a social vaccine. Implementing a progressive policy framework will confront stubborn resistance and challenge the power of dominant vested interests. Public-interest coalitions can support governments to act, as well as hold them to account.25 Climate change and health alliances are essential — doctors and other health professionals have knowledge, opportunity and political leverage that can help ensure actions are taken.24 This article has laid out ways of advancing planetary health equity goals. To help achieve these, the health community must advocate for and engage in intersectoral policy discussions relating to the social determinants and the structural consumptogenic system. Acting immediately on these issues is critically important if we are to avert a planetary health inequity crisis. No relevant disclosures. Commissioned; externally peer reviewed. Open access publishing facilitated by Australian National University, as part of the Wiley - Australian National University agreement via the Council of Australian University Librarians.
I wanted to like this book, and tried hard, but ultimately failed. I have recently written several papers on inappropriate corporate influences on the funding and conduct of epidemiological research, and have discussed several examples of hazards where the epidemiologic findings were strongly, and unethically, opposed by industry and by academic epidemiologists funded by industry.1–3 This book provides ‘the other side of the coin’ and discusses in depth four examples (environmental causes of breast cancer, electromagnetic fields and cancer, residential radon exposure and lung cancer and passive smoking) where, in the author's opinion, the health risks were low or non-existent, but were hyped by researchers and policy makers thus resulting in unnecessary research, inappropriate funding decisions and unjustified public concern. Such things certainly happen, and we need books like this which attempt to discuss them objectively, and which point out that academic researchers may also be affected by a range of influences including career and funding opportunities, even if they only accept peer-reviewed government funding and do not accept corporate funding. Thus, they may have incentives to overstate the evidence, just as industry and industry-funded epidemiologists may have incentives to negate or understate the evidence of health risks from environmental exposures. The book states its case well, is clearly written and discusses complicated issues in a relatively simple and readable way. It makes the case that ‘each side tends to cite the evidence that supports its point of view in order to influence public policy’ (p. 6) and that ‘the tendency to overstate the evidence, for whatever purpose, actually strengthens the opposing party's hand. It sanctions the partisan use of science that should be rejected, no matter who is engaging in it.’ (p. 7) The book also makes the important points that: (i) we have to some extent reached the limits of ‘risk factor’ epidemiology and have identified the strong risks (e.g. active smoking and lung cancer) and are now trying to assess weak risks (e.g. passive smoking and lung cancer), which are much more difficult to assess and much more prone to be overwhelmed by bias; (ii) for many of these risks (e.g. residential radon exposure and lung cancer) it is not possible to directly estimate the risks from low exposures, and it is necessary to make theoretical assumptions to interpolate from the findings of studies of highly exposed occupational populations (e.g. miners exposed to radon); and (iii) many of these risks are very small and have received perhaps excessive funding and scientific attention in comparison with other public health risks. So far so good. I agree with all of the above statements, and started reading the book in a positive frame of mind, with the expectation that it was an important book that would be an essential antidote to the writings of myself and others who have tended to emphasize the hazards of corporate influences. However, I became more frustrated and less impressed as I worked my way through the book, particularly when coming to discussions of issues that I had been involved in (e.g. electromagnetic fields and cancer). This probably reflects my own influences and prejudices. However, it became increasingly difficult, as I worked my way through the book, to avoid the conclusion that the discussions of these issues were, for want of a better word, ‘biased’, as well as being rather ‘grumpy’ and unpleasant in parts. It seems that no one can get it right. No single study is good enough or big enough, but meta-analyses should be discouraged because they combine studies from different exposure settings and with different methodologies. Researchers are criticized for arguing that ‘one must rely upon the evaluation of the data as a whole using expert judgement and the meta-analyses as a guide’ (p. 101), because this simply reflects their vested interests to continue researching a topic when an individual study is inconclusive. The findings of individual studies are dismissed because they are ‘not statistically significant’, even if they are consistent with previous findings. Significant associations are dismissed because they involved multiple comparisons, even if the specific associations were the a priori reason for the study and had been found previously [e.g. ‘the reported association [of EMFs with childhood] leukaemia was one of a very large number of comparisons made by the researchers and hence could well have arisen by chance’ (p. 100)]. Studies that show interesting dose-response associations verging on statistical significance, such as the National Cancer Institute childhood leukaemia study,4 are not only dismissed, but also researchers are condemned for not accepting the findings as proof of lack of risk (‘it is hard to escape the impression that the reluctance of the NIEHS working group to close the door on the possibility of EMF as a cause of leukaemia had more to do with its members’ stake in this area of research than with scientific rigor’ (p. 101). While every academic researcher who wants to study these issues apparently has a vested interest, even if their university salary is already funded, critics of the research are apparently unbiased, reasonable and objective, even if their criticisms are directly or indirectly funded by industry. Researchers into radon and lung cancer are biased because they do not repeatedly emphasize that tobacco smoking is the major cause of lung cancer, and that most cases of radon-induced lung cancer involve joint effects with smoking (the corollary that some cases of lung cancer in smokers are due to joint effects with radon exposure is never mentioned, nor is it mentioned that the same arguments could be applied to many other important lung carcinogens such as asbestos). The book gives particular emphasis to issues of biological plausibility, even though there are many historical examples of associations that were not biologically plausible when they were first discovered by epidemiologists, and the aetiological mechanisms involved were only subsequently discovered in laboratory-based studies. This is why, for example, all of the 30–40 known occupational causes of cancer (as classified by the International Agency for Research on Cancer) were first discovered in epidemiological studies, not in the laboratory. If it had been plausible that these substances caused cancer, then they would not have been used in the workplace. So epidemiology will always be in front of mechanistic research with regards to discovering new environmental and occupational causes of disease. The book also fails to mention that there are many historical examples of risks (dioxin and cancer is one example) where the evidence was initially weak and inconsistent but has strengthened over time (leading to the classification of dioxin as a carcinogen by the International Agency for Research on Cancer in 1997). So what are we supposed to do about ubiquitous environmental exposures that may carry weak risks, but which may account for a substantial number of cases of disease on a population level? Kabat's solution is nihilistic, namely that we simply should not study such exposures, or at least not attempt to quantify their effects: ‘it is entirely plausible that in some cases exposure to ETS may account for a few cases of lung cancer in nonsmokers, but … it is not possible to quantify the excess risk with any certainty’ (p. 150). The argument is essentially that the risks are too small to quantify accurately, and therefore should not be studied, or at least should not be estimated quantitatively. We are never told how we should decide if a risk is too ‘small’ to be concerned about if we do not first attempt to estimate its magnitude. And how are we supposed to tell the public that the risks are small (and their concerns are unimportant) without attempting to estimate them? And who decides what is a ‘small’ risk? The book finishes, literally on the last page, by advocating a ‘broader/integrative vision of epidemiology—one that can accommodate social, economic, and ecological/environmental realities … as well as rapidly evolving knowledge of the mechanisms of disease at the molecular level’ (p. 186).5–8 Such developments are to be encouraged, but they are intended to be inclusive, not exclusive, and we will have to continue to grapple with problems of studying weak risks from ubiquitous environmental exposures, even if they receive less attention than they have in the past. It is important to consider the influences on such research, including influences on academic researchers with regards to career opportunities and funding, even though these will continue to be relatively minor compared with the massive and pervasive influences of corporate funding of research and of critics of research.1–3 This book could have made a major contribution in this regard, but its lack of balance means that it fails to make such a contribution.