The consumption of fruit and vegetables (F&V) is important for human health to protect against non-communicable disease and micronutrient deficiency. Increasing consumption of F&V may also benefit planetary health if these foods are substituted for foods with higher environmental footprints such as red meat or dairy. The retail food environment (RFE) is an influential junction between the food system and individual diets as it drives access to F&V through external (physical access) and personal (availability, affordability, acceptability) domains. We performed a systematic search of six literature databases (January 2021) for studies assessing access to F&V in the RFE and its association with F&V consumption in adults in high- and upper-middle income countries. 36 studies were identified and categorised by dimensions of food access – accessibility, affordability, acceptability, availability and accommodation. More than half of the studies (n = 20) were based in the USA. F&V accessibility was the most commonly reported dimension (n = 29); no study reported on accommodation. 6 studies were rated to be high quality. A positive association of increased availability of F&V options in the RFE with intake was identified in 9 of 15 studies. Associations in both acceptability and accessibility dimensions were inconsistent. No association was observed between F&V affordability and consumption although available data were limited. Many challenges exist to building a robust evidence base within food environment research including conceptual, definitional and methodological heterogeneity and measurement standardisation. Future food policies should consider multi-dimensional interventions to promote access to F&V in the RFE across all domains.

Context: Shifting from current dietary patterns to diets rich in plant-based (PB) foods and lower in animal-based foods (ABFs) is generally regarded as a suitable strategy to improve nutritional health and reduce environmental impacts. Despite the recent growth in supply of and demand for novel plant-based foods (NPBFs), a comprehensive overview is lacking. Objectives: This review provides a synthesis of available evidence, highlights challenges, and informs public health and environmental strategies for purposeful political decision-making by systematically searching, analyzing, and summarizing the available literature. Data Sources: Five peer-reviewed databases and grey literature sources were rigorously searched for publications. Data Extraction: Study characteristics meeting the inclusion criteria regarding NPBF nutrient composition and health and environmental outcomes in high-income countries were extracted. Data analysis: Fifty-seven peer-reviewed and 36 grey literature sources were identified; these were published in 2016–2022. NPBFs typically have substantially lower environmental impacts than ABFs, but the nutritional contents are complex and vary considerably across brands, product type, and main primary ingredient. In the limited evidence on the health impacts, shifts from ABFs to PB meats were associated with positive health outcomes. However, results were mixed for PB drinks, with links to micronutrient deficiencies. Conclusion: If carefully selected, certain NPBFs have the potential to be healthier and nutrient-rich alternatives to ABFs and typically have smaller environmental footprints. More disaggregated categorization of various types of NPBFs would be a helpful step in guiding consumers and key stakeholders to make informed decisions. To enable informed policymaking on the inclusion of NPBFs in dietary transitions as part of a wider net-zero and health strategy, future priorities should include nutritional food standards, labelling, and subdivisions or categorizations of NPBFs, as well as short- and long-term health studies evaluating dietary shifts from ABFs to NPBFs and standardized environmental impact assessments, ideally from independent funders.

Background: Adaptation, to reduce the health impacts of climate change, is driven by political action, public support and events (extreme weather). National adaptation policies or strategies are limited in addressing human health risks and implementation of adaptation in the public health community is not well understood. Aim: To identify key issues in climate change adaptation implementation for public health in Europe. Methods: Key informant interviews with decision-makers in international, national and local city governments in 19 European countries. Participants were recruited if a senior decision-maker working in public health, environmental health or climate adaptation. Interviews addressed: Barriers and levers for adaptation, policy alignment, networks and evidence needs. Results: Thirty-two interviews were completed between June and October 2021 with 4 international, 5 national and 23 city/local government stakeholders. Respondents reported inadequate resources (funding, training and personnel) for health-adaptation implementation and the marginal role of health in adaptation policy. A clear mandate to act was key for implementation and resource allocation. Limited cross-departmental collaboration and poor understanding of the role of public health in climate policy were barriers to implementation. Conclusions: Across Europe, progress is varied in implementation of climate adaptation in public health planning. Providing appropriate resources, training, knowledge mobilization and supporting cross-departmental collaboration and multi-level governance will facilitate adaptation to protect human health.

Risks to older adults (OA) (aged 65+ years) associated with hot and cold weather in the UK are well-documented. The study aim is to explore OA perception of health risks from high and low temperatures, health-protective measures undertaken, and implications for public health messaging. In 2019/20, Ipsos MORI conducted face-to-face surveys with OA in England (n = 461 cold weather survey, n = 452 hot weather survey). Participants reported temperature-related symptoms, risk perceptions for different groups, and behaviours during hot and cold weather. Analysis involved binomial logistic regression models to assess potential factors (demographics, vulnerability, behaviours) associated with older adults’ health risk perception in hot and cold weather. Less than half of OA in both surveys agreed that hot or cold weather posed a risk to their health. OA with higher education, annual income >£25 000 or home ownership were less likely to perceive their health at risk during cold weather and regional differences in hot weather were identified. OA who recognized those the same age or living alone as at an increased risk were more likely to perceive their own health as at risk. OA were more likely to self-identify health risks when reporting those aged 65 yrs+ to be at an increased risk in cold weather. Various temperature-related protective behaviours were associated with older adults’ risk perception in hot and cold weather. These findings provide evidence for public health agencies to target high risk individuals, and modify temperature-related public health messaging to protect OA.

Background: Climate adaptation policies (to reduce health impacts from climate change) are being implemented across Europe driven by political action, public support, and more extreme weather. All EU countries have national climate adaptation policies but the the role of addressing public health in implementation varies by country and is often undervalued. Aim: Identify key issues in climate adaptation implementation by public health professionals in Europe. Methods: Key informant interviews were undertaken with decision makers in international, national, and local government across 20 European countries. Participants were recruited if working in public or environmental health, and in climate adaptation policy. Interviews addressed these key themes: barriers, health agenda, levers, networks, evidence needs. Interviews were conducted online, recorded, transcribed, and analysed thematically. Results: 32 interviews were completed between June-October 2021; 4 international, 5 national level and 23 city-level stakeholders. Most reported inadequate resources for health adaptation implementation (funding, training, and personnel) and the marginal role of health in climate adaptation policy development. A clear mandate to act was key for adaptation implementation and resource allocation. A reported challenge was departmental cross-collaboration, and city-level stakeholders’ awareness of the public health role in climate policy. European-level stakeholders reported strength in ability to coordinate expertise to national and regional-level governance partners highlighting the importance of interagency collaboration. Conclusions: Across Europe, there is varied progress in implementation of climate-health adaptation. Providing appropriate resources, inter-departmental collaboration, training, knowledge mobilisation, and multi-level governance support will facilitate climate and health policy implementation.