Johns T, Sthapit BR. Biocultural Diversity in the Sustainability of Developing-country Food Systems. Food and Nutrition Bulletin [Internet]. 2004;25 :143-155. Publisher's VersionAbstract

    The policy implications of a model of contemporary food systems for developing countries that integrates nutri- tion, reduction of disease risk, culture, income genera- tion, and biodiversity are reviewed within a theoretical and empirical examination of the relevance of nutrition to the priorities put forward at the World Summit on Sustainable Development in Johannesburg, South Africa, 2002. Agricultural, health, economic, and social policies with local reach are necessary responses to the increase in noncommunicable disease associated with the globali- zation of food systems. Nutrition offers a nexus for the changes in individual behavior and motivation essential for fundamental shifts in production and consumption patterns. Mutual consideration of biocultural diversity and nutrition can guide policy, research, promotion, and applied action in developing countries. Benefits from enhanced use of biodiversity must legitimately flow to the undernourished poor, while potential negative conse- quences must be minimized and mitigated. Quality and quantity of food need not be mutually exclusive. Func- tions related to energy density, glycemic control, oxidative stress, and immunostimulation define important research priorities. Tests of the hypothesis that biodiversity equates with dietary diversity and health might combine quanti- tative indicators of dietary and biological diversity with nutrition and health outcomes. Biodiversity, where it is part of traditional agricultural and food systems, can be best conserved and enhanced through rational use within a broad-based developmental focus on small-scale and low-input production. The fact that traditional systems, once lost, are hard to recreate underlines the imperative for timely documentation, compilation, and dissemina- tion of eroding knowledge of biodiversity and the use of food culture for promoting positive behaviors. 

    Wan M, Colfer CJP, Powell B. Forests, Women, and Health: Opportunities and Challenges for Conservation. International Forestry Review [Internet]. 2011;13 (3) :369-387. Publisher's VersionAbstract

    Health issues of forest women in developing countries merit more serious attention. This paper reviews existing literature on the interface of women, health and forests to highlight conservation opportunities and challenges. Most women in forests are collectors and users of forest species. However, existing conservation efforts, deforestation, poor health services and household responsibilities can intensify health and safety concerns for forest dependent women. Women are likely to bear the strenuous burden of carrying fuelwood (and other forest products) long distances and inhaling smoke while cooking. The burden of unintended childbearing, diseases and cultural issues can compound their health problems. To improve local livelihoods and environments, some organisations have initiated activities that integrate conservation and human health objectives, including family planning. This article provides project examples, where the involvement of women has been identified as a key component in effectively meeting both conservation and development goals. 

    Dounias E, Froment A. From Foraging to Farming Among Present-day Forest Hunter-Gatherers: Consequences on Diet and Health. International Forestry Review [Internet]. 2011;13 (3) :294-304. Publisher's VersionAbstract

    Throughout history, forests dwellers have adapted to permanent changes of forest ecosystems that, in essence, are dynamic. Accordingly, they have long served as models of how humans lived when their lifestyles and genetic endowment were complementary. What is now commonly described as the “paleodiet” tends to be put forward as a benchmark for present-day efforts to promote health and prevent nutritional diseases, even in industrialized countries. Although forest ecosystems provide food and medicines to forest dwellers, over the last half-century these ecosystems have undergone unprecedented pressure to make way for economic growth and industrialization, often at the cost of ecological functions that may affect human health, both in short term (i.e. increase in infectious diseases) and long term (incidence of global change). As radical alterations occur such as deforestation, modification of resource availability, and the penetration of cash economies, forest dwellers encounter increasing difficulties in accommodating their socioeconomic, cultural, and political systems, thus impeding their ecological success. Diets and diseases are sensitive indicators of the ecological and cultural costs that former hunter-gatherers currently pay to achieve their share of modernity. This paper exposes the nutritional and epidemiological consequences of the maladaptation of former hunter-gatherers in relation to their recent sedentarization. It is primarily based on case studies carried out among the Baka and Kola Pygmies of Cameroon, and the Tubu Punan of Borneo. 

    Cohen N, Jalil MA, Rahman H, Matin MA, Sprague J, Islam J, Davison J, Regt LDE, Mitra M. Landholding, Wealth, and Risk of Blinding Malnutrition in Rural Bangladesh Households. Soc Sci Med [Internet]. 1985;21 (11) :1269-1272. Publisher's VersionAbstract

    The 1982-1983 Bangladesh nutritional blindness study visited 11,618 rural households and examined 18,660 preschool-age children in an effort to determine the prevalence and determinants of eye lesions and loss of sight due to vitamin A deficiency (xerophthalmia). Risk of xerophthalmia was significantly higher for children from households without any of the indicators of relative wealth used. Almost 80% of blind children came from landless households, and even a very small garden reduced considerably the chances of a household having a xerophthalmic child. Poorer households with access to less than 0.3 acres land or no garden or without a tin roof, wristwatch, radio or cycle were at least twice as likely as their more fortunate neighbours to have a young child with any type of xerophthalmia. Taking account of such socio-environmental risk factor weightings would direct the scarce resources of intervention programmes to households and children who most need them. 

    Hanski I, Hertzen L, Fyhrquist N, Koskinen K, Torppa K, Laatikainen T, Karisola P, Auvinen P, Paulin L, Makela MJ, et al. Environmental Biodiversity, Human Microbiota, and Allergy are Interrelated. PNAS, Early Edition [Internet]. 2012. Publisher's VersionAbstract

    Rapidly declining biodiversity may be a contributing factor to another global megatrendthe rapidly increasing prevalence of allergies and other chronic inflammatory diseases among urban populations worldwide. According to the biodiversity hypothesis,reduced contact of people with natural environmental features and biodiversity may adversely affect the human commensal microbiota and its immunomodulatory capacity. Analyzing atopic sensitization (i.e., allergic disposition) in a random sample of adolescents living in a heterogeneous region of 100 × 150 km, we show that environ- mental biodiversity in the surroundings of the study subjectshomes influenced the composition of the bacterial classes on their skin. Compared with healthy individuals, atopic individuals had lower environmental biodiversity in the surroundings of their homes and significantly lower generic diversity of gammaproteobacteria on their skin. The functional role of the Gram-negative gammaproteobacteria is supported by in vitro measurements of expression of IL-10, a key anti-inflammatory cytokine in immunologic tolerance, in peripheral blood mononuclear cells. In healthy, but not in atopic, individuals, IL-10 expression was positively correlated with the abundance of the gammaproteobacterial genus Acinetobacter on the skin. These results raise fundamental questions about the consequences of biodiversity loss for both allergic conditions and public health in general. 

    Chaplin-Kramer R, Dombeck E, Gerber J, Knuth KA, Mueller ND, Mueller M, Ziv G, Klein AM. Global Malnutrition Overlaps with Pollinator-dependent Micronutrient Production. Proc R Soc B [Internet]. 2014;281. Publisher's VersionAbstract

    Pollinators contribute around 10% of the economic value of crop production globally, but the contribution of these pollinators to human nutrition is potentially much higher. Crops vary in the degree to which they benefit from pollinators, and many of the most pollinator-dependent crops are also among the richest in micronutrients essential to human health. This study examines regional differences in the pollinator dependence of crop micronutrient content and reveals overlaps between this dependency and the severity of micronutrient deficiency in people around the world. As much as 50% of the production of plant-derived sources of vitamin A requires pollination throughout much of Southeast Asia, whereas other essential micronutrients such as iron and folate have lower dependencies, scattered throughout Africa, Asia and Central America. Micronutrient deficiencies are three times as likely to occur in areas of highest pollination dependence for vitamin A and iron, suggesting that disruptions in pollination could have serious implications for the accessibility of micronutrients for public health. These regions of high nutritional vulnerability are understudied in the pollination literature, and should be priority areas for research related to ecosystem services and human well-being.

    Sandifer PA, Sutton-Grier AE, Ward BP. Exploring Connections among Nature, Biodiversity, Ecosystem Services, and Human Health and Well-being: Opportunities to Enhance Health and Biodiversity Conservation. Ecosystem Services [Internet]. 2015;12 :1-15. Publisher's VersionAbstract

    We are at a key juncture in history where biodiversity loss is occurring daily and accelerating in the face of population growth, climate change, and rampant development. Simultaneously, we are just beginning to appreciate the wealth of human health benefits that stem from experiencing nature and biodiversity. Here we assessed the state of knowledge on relationships between human health and nature and biodiversity, and prepared a comprehensive listing of reported health effects. We found strong evidence linking biodiversity with production of ecosystem services and between nature exposure and human health, but many of these studies were limited in rigor and often only correlative. Much less information is available to link biodiversity and health. However, some robust studies indicate that exposure to microbial biodiversity can improve health, specifically in reducing certain allergic and respiratory diseases. Overall, much more research is needed on mechanisms of causation. Also needed are a re- envisioning of land-use planning that places human well-being at the center and a new coalition of ecologists, health and social scientists and planners to conduct research and develop policies that promote human interaction with nature and biodiversity. Improvements in these areas should enhance human health and ecosystem, community, as well as human resilience. 

    Horowitz P, Finlayson CM. Wetlands as Settings for Human Health: Incorporating Ecosystem Services and Health Impact Assessment into Water Resource Management. BioScience [Internet]. 2011;61 (9) :678-688. Publisher's VersionAbstract

    Reconsidering the relationship between human well-being and environmental quality is central for the management of wetlands and water resources and for public health itself. We propose an integrated strategy involving three approaches. The first is to make assessments of the ecosystem services provided by wetlands more routine. The second is to adopt the “settings” approach, most developed in health promotion, wherein wetlands are one of the settings for human health and provide a context for health policies. Finally, a layered suite of health issues in wetland settings is developed, including core requirements for human health (food and water); health risks from wetland exposures; and broader social determinants of health in wetland settings, including livelihoods and lifestyles. Together, these strategies will allow wetland managers to incorporate health impact assessment processes into their decisionmaking and to examine the health consequences of trade-offs that occur in planning, investment, development, and decisionmaking outside their direct influence. 

    Zhang Y, Bi P, Hiller JE. Climate change and disability-adjusted life years. J Environ Health [Internet]. 2007;70 (3) :32-6. Publisher's VersionAbstract

    The authors conducted a systematic review of the studies of disability-adjusted life years (DALYs) lost because of climate change. The review considered both methodological issues and research results. It found that little is known about DALYs lost because of climate change, except for results based on limited information presented in the World Health Organization (WHO) global-burden-of-disease study in 2002. The measurement of DALYs attributable to climate change presents additional difficulties over measurement of DALYs attributable to other causes. Further studies linking DALYs and climate change should be conducted in various populations and in different ecological regions, including developing countries.

    Augustin J, Franzke N, Augustin M, Kappas M. Does climate change affect the incidence of skin and allergic diseases in Germany?. J Dtsch Dermatol Ges [Internet]. 2008;6 (8) :632-8. Publisher's VersionAbstract

    BACKGROUND: Skin diseases have great socio-economic importance in Germany due to their high and in some cases still-increasing prevalence. Little attention has yet been paid to the influence of the change in climate on these diseases. OBJECTIVE: Clarify the evidence of the effects of climate change on the prevalence of skin diseases and allergies in Germany. METHODS: First, a theoretical model of the possible mechanisms and influence factors of climate and weather was created for different disease groups (skin malignancies, allergies, skin infections). Then, a systematic online and manual literature search was made for model-derived key words.The relevant publications were selected and evaluated according to a priori criteria. RESULTS: From a total of n = 31,221 hits, n = 320 publications remained for evaluation.Changes in the following parameters can be regarded as essential climatologic factors influencing the prevalence of skin and allergic diseases: temperature, UV radiation, precipitation/humidity, cloudiness, and general weather conditions.There were only a few original articles addressed to this topic. Most of them address recurring phenomena (especially levels of airborne pollen), UV radiation or ozone (and the ozone hole). Quantitative statements, prognosis models and climate scenarios have not yet been published for Germany with respect to skin diseases. CONCLUSION: Only few scientific articles on the relationship between climate changes and the prevalence of skin diseases have been published. They do not allow a reliable statement on future developments. The outlook for changes in prevalence requires further clarification using published climate models.

    Lowe D, Ebi KL, Forsberg B. Factors increasing vulnerability to health effects before, during and after floods. International Journal of Environmental Research and Public Health [Internet]. 2013;10 (12) :7015-7067. Publisher's VersionAbstract

    Identifying the risk factors for morbidity and mortality effects pre-, during and post-flood may aid the appropriate targeting of flood-related adverse health prevention strategies. We conducted a systematic PubMed search to identify studies examining risk factors for health effects of precipitation-related floods, among Organisation for Economic Co-Operation and Development (OECD) member countries. Research identifying flood-related morbidity and mortality risk factors is limited and primarily examines demographic characteristics such as age and gender. During floods, females, elderly and children appear to be at greater risk of psychological and physical health effects, while males between 10 to 29 years may be at greater risk of mortality. Post-flood, those over 65 years and males are at increased risk of physical health effects, while females appear at greater risk of psychological health effects. Other risk factors include previous flood experiences, greater flood depth or flood trauma, existing illnesses, medication interruption, and low education or socio-economic status. Tailoring messages to high-risk groups may increase their effectiveness. Target populations differ for morbidity and mortality effects, and differ pre-, during, and post-flood. Additional research is required to identify the risk factors associated with pre- and post-flood mortality and post-flood morbidity, preferably using prospective cohort studies. 2013 by the authors; licensee MDPI, Basel, Switzerland.

    Bocker L, Dijst M, Prillwitz J. Impact of Everyday Weather on Individual Daily Travel Behaviours in Perspective: A Literature Review. Transport Reviews. 2013;33 (1) :71-91.Abstract

    In the light of growing societal interest for climate change adaptation and mitigation, insights into the meaning of weather conditions for travel behaviours, particularly walking and cycling, have become very important. Recently, various studies from transport, health and biometeorological disciplines have touched upon the relevance of weather for daily activities and travel, yet a review and critical assessment of the existing knowledge are lacking. Hence, the aim of this review is first to bring together these contributions and provide a systematic and comprehensive overview concerning the impact of weather conditions on daily travel activities. Second, the methodological, contextual and behavioural backgrounds of the studies will be discussed. The major conclusion is that the existing studies present an incomplete and fragmented picture of the impact of weather on travel behaviour, which makes effective planning for climate change a harsh job. In the conclusions, some lines for future research will be recommended.

    Sheffield PE, Landrigan PJ. Global climate change and children's health: threats and strategies for prevention. Environ Health Perspect [Internet]. 2011;119 (3) :291-8. Publisher's VersionAbstract

    BACKGROUND: Global climate change will have multiple effects on human health. Vulnerable populations-children, the elderly, and the poor-will be disproportionately affected. OBJECTIVE: We reviewed projected impacts of climate change on children's health, the pathways involved in these effects, and prevention strategies. DATA SOURCES: We assessed primary studies, review articles, and organizational reports. DATA SYNTHESIS: Climate change is increasing the global burden of disease and in the year 2000 was responsible for > 150,000 deaths worldwide. Of this disease burden, 88% fell upon children. Documented health effects include changing ranges of vector-borne diseases such as malaria and dengue; increased diarrheal and respiratory disease; increased morbidity and mortality from extreme weather; changed exposures to toxic chemicals; worsened poverty; food and physical insecurity; and threats to human habitation. Heat-related health effects for which research is emerging include diminished school performance, increased rates of pregnancy complications, and renal effects. Stark variation in these outcomes is evident by geographic region and socioeconomic status, and these impacts will exacerbate health disparities. Prevention strategies to reduce health impacts of climate change include reduction of greenhouse gas emissions and adaptation through multiple public health interventions. CONCLUSIONS: Further quantification of the effects of climate change on children's health is needed globally and also at regional and local levels through enhanced monitoring of children's environmental health and by tracking selected indicators. Climate change preparedness strategies need to be incorporated into public health programs.

    Goldman A, Eggen B, Golding B, Murray V. The health impacts of windstorms: a systematic literature review. Public Health [Internet]. 2014;128 (1) :3-28. Publisher's VersionAbstract

    INTRODUCTION: This systematic literature review aims to identify documented impacts that windstorms have on human health. Windstorms occur frequently and some researchers have predicted an increase in severe gales in the future, resulting in an urgent need to understand the related patterns of morbidity and mortality. STUDY DESIGN: Systematic literature review. METHODS: A systematic literature review of international evidence on the impacts of windstorms on human health was conducted in May 2012. RESULTS: This review of published evidence demonstrates that human health can be severely affected by windstorms. Direct effects occur during the impact phase of a storm, causing death and injury due to the force of the wind. Becoming airborne, being struck by flying debris or falling trees and road traffic accidents are the main dangers. Indirect effects, occurring during the pre- and post-impact phases of the storm, include falls, lacerations and puncture wounds, and occur when preparing for, or cleaning up after a storm. Power outages are a key issue and can lead to electrocution, fires and burns and carbon monoxide poisoning from gasoline powered electrical generators. Additionally, worsening of chronic illnesses due to lack of access to medical care or medication can occur. Other health impacts include infections and insect bites. CONCLUSION: Public health advice can reduce morbidity and mortality from windstorms. Findings from this review will provide material for increased awareness and education amongst the public and healthcare professionals to prevent and prepare for these health impacts. Nevertheless, more research is needed to identify more specific patterns of health impacts and how these could be reduced in the future.

    Walker R, Hassall J, Chaplin S, Congues J, Bajayo R, Mason W. Health promotion interventions to address climate change using a primary health care approach: a literature review. Health Promot J Austr [Internet]. 2011;22 Spec No :S6-12. Publisher's VersionAbstract

    ISSUE ADDRESSED: This project explored the literature in which key concepts in primary health care and health promotion are overtly applied to the problem of climate change. This paper contains a discussion of the literature relevant to health promotion principles and intervention strategies for addressing climate change mitigation and adaptation in the primary health care sector. The concept of primary health care is that used by the World Health Organization, based on the Declaration of Alma Ata and often referred to as comprehensive primary health care to differentiate it from primary medical care. METHODS: This was a review of literature identified in electronic databases using two sets of search terms. Set A consisted of 'climate change or global warming or greenhouse effect' and set B consisted of 11 key concepts in primary health care and health promotion, for example community resilience, health promotion, social change, food security and economic development. Relevant literature was identified at the intersection of search term A with a term from set B. A search was completed for each set B term. RESULTS: This paper reports a discussion of major categories of health promotion interventions, namely health communication, community building and settings approaches and uses examples drawn from literature on community resilience and summer heat. These interventions are all applicable to the primary health care sector. CONCLUSION: There is a small literature on health promotion interventions for climate change mitigation and adaptation but it is incomplete and scattered across many sources. An important area for further research is to link the logic of service provision in primary health care to the logic of mitigation and adaptation in a changing environment. Interventions that link the logic must also link diverse services to provide coherent action on local and domestic scales, the scales at which primary health care acts. Another research gap is in regard to institutional change in the primary health care sector. How do the patterns of knowledge, practice and values need to change in the array of organisations that make up comprehensive primary health care?

    Hosking J, Campbell-Lendrum D. How well does climate change and human health research match the demands of policymakers? A scoping review. Environ Health Perspect [Internet]. 2012;120 (8) :1076-82. Publisher's VersionAbstract

    BACKGROUND: In 2008, the World Health Organization (WHO) Member States passed a World Health Assembly resolution that identified the following five priority areas for research and pilot projects on climate change and human health: health vulnerability, health protection, health impacts of mitigation and adaptation policies, decision-support and other tools, and costs of health protection from climate change. OBJECTIVES: To assess the extent to which recently published research corresponds to these priorities, we undertook a scoping review of original research on climate change and human health. Scoping reviews address topics that are too broad for a systematic review and commonly aim to identify research gaps in existing literature. We also assessed recent publication trends for climate change and health research. METHODS: We searched for original quantitative research published from 2008 onward. We included disease burden studies that were specific to climate change and health and included intervention studies that focused on climate change and measured health outcomes. We used MEDLINE, Embase, and Web of Science databases and extracted data on research priority areas, geographic regions, health fields, and equity (systematic differences between advantaged and disadvantaged social groups). DISCUSSION: We identified 40 eligible studies. Compared with other health topics, the number of climate change publications has grown rapidly, with a larger proportion of reviews or editorials. Recent original research addressed four of the five priority areas identified by the WHO Member States, but we found no eligible studies of health adaptation interventions, and most of the studies focused on high-income countries. CONCLUSIONS: Climate change and health is a rapidly growing area of research, but quantitative studies remain rare. Among recently published studies, we found gaps in adaptation research and a deficit of studies in most developing regions. Funders and researchers should monitor and respond to research gaps to help ensure that the needs of policymakers are met.

    Cheng J, Xu Z, Zhu R, Wang X, Jin L, Song J, Su H. Impact of diurnal temperature range on human health: a systematic review. Int J Biometeorol [Internet]. 2014;58 (9) :2011-24. Publisher's VersionAbstract

    Increasing epidemiological studies have shown that a rapid temperature change within 1 day is an independent risk factor for human health. This paper aimed to systematically review the epidemiological evidence on the relationship between diurnal temperature range (DTR) and human health and to propose future research directions. A literature search was conducted in October 2013 using the databases including PubMed, ScienceDirect, and EBSCO. Empirical studies regarding the relationship between DTR and mortality and morbidity were included. Twenty-five relevant studies were identified, among which, 11 investigated the relationship between DTR and mortality and 14 examined the impact of DTR on morbidity. The majority of existing studies reported that DTR was significantly associated with mortality and morbidity, particularly for cardiovascular and respiratory diseases. Notably, compared with adults, the elderly and children were more vulnerable to DTR effects. However, there were some inconsistencies regarding the susceptible groups, lag time, and threshold of DTR. The impact of DTR on human health may be confounded or modified by season, socioeconomic, and educational status. Further research is needed to further confirm the adverse effects of DTR in different geographical locations; examine the effects of DTR on the health of children aged one or under; explore extreme DTR effects on human health; analyze the difference of DTR effects on human health in different locations and the modified effects of potential confounding factors; and develop detailed preventive measures against large DTR, particularly for susceptible groups.

    Xu Z, Sheffield PE, Su H, Wang X, Bi Y, Tong S. The impact of heat waves on children's health: a systematic review. Int J Biometeorol. 2014;58 (2) :239-47.Abstract

    Young children are thought to be particularly sensitive to heat waves, but relatively less research attention has been paid to this field to date. A systematic review was conducted to elucidate the relationship between heat waves and children's health. Literature published up to August 2012 were identified using the following MeSH terms and keywords: "heatwave", "heat wave", "child health", "morbidity", "hospital admission", "emergency department visit", "family practice", "primary health care", "death" and "mortality". Of the 628 publications identified, 12 met the selection criteria. The existing literature does not consistently suggest that mortality among children increases significantly during heat waves, even though infants were associated with more heat-related deaths. Exposure to heat waves in the perinatal period may pose a threat to children's health. Pediatric diseases or conditions associated with heat waves include renal disease, respiratory disease, electrolyte imbalance and fever. Future research should focus on how to develop a consistent definition of a heat wave from a children's health perspective, identifying the best measure of children's exposure to heat waves, exploring sensitive outcome measures to quantify the impact of heat waves on children, evaluating the possible impacts of heat waves on children's birth outcomes, and understanding the differences in vulnerability to heat waves among children of different ages and from different income countries. Projection of the children's disease burden caused by heat waves under climate change scenarios, and development of effective heat wave mitigation and adaptation strategies that incorporate other child protective health measures, are also strongly recommended.

    Diaz JH. The impact of hurricanes and flooding disasters on hymenopterid-inflicted injuries. Am J Disaster Med. 2007;2 (5) :257-69.Abstract

    Insect bites and stings, often complicated by allergic reactions or skin infections with community-acquired pathogens, are common sources of morbidity following hurricanes and flooding disasters. The hymenopterids are the most commonly stinging arthropods to cause allergic reactions, and include bees, wasps, and ants. To assess the evolving epidemiology of hymenopterid-inflicted injuries, and the impact of hurricanes and flooding disasters on hymenopterid-inflicted injuries in the United States, an epidemiological analysis of the scientific literature on hymenopterid stings and allergic sting reactions was conducted by MEDLINE search, 1966-2006. The increasing incidence of hymenopterid-inflicted injuries following hurricanes and flooding disasters was described. Common immunological reactions to hymenopterid-inflicted injuries were stratified by clinical severity and outcome. Current recommendations for management, prevention, and prophylaxis of hymenopterid-inflicted injuries were presented. Hymenopterid stings and allergic reactions remain common indications for emergency department visits, especially following hurricanes and flooding disasters. Unrecognized anaphylactic reactions to hymenopterid stings remain significant causes of unanticipated deaths outdoors in young people. Disaster planners and managers are obliged to alert regional healthcare providers of the increased risks of hymenopterid-inflicted injuries following flooding disasters and to assure that emergency drug formularies are properly stocked to treat hymenopterid-inflicted injuries.

    Saikat S, Kreis I, Davies B, Bridgman S, Kamanyire R. The impact of PFOS on health in the general population: a review. Environ Sci Process Impacts. 2013;15 (2) :329-35.Abstract

    Perfluorooctane sulphonate (PFOS) is a persistent organic pollutant that is toxic, bioaccumulative and undergoes wide transportation across all environmental media. It has been widely detected in environmental samples but there is limited information about the health effects on humans from environmental exposure. This paper presents the findings of a review of the literature on the impact of PFOS on the health of the general population. Fifteen relevant epidemiological studies were identified that looked at the association between human PFOS exposure and a range of health related outcomes. Small but statistically significant associations have been reported with PFOS and total cholesterol, glucose metabolism, body mass index (BMI), thyroid function, infertility, breast feeding, uric acid and attention deficit/hyperactivity disorder (ADHD). The true significance of these findings is uncertain due to the inconsistencies in some of the study results and the limitations of the literature. The majority of studies were cross-sectional and considered surrogate markers of health (e.g. cholesterol levels). The available literature is also limited in ascertaining the link between PFOS concentrations in the environment, exposure pathways and health effects. We conclude that the current evidence is inconclusive and further large-scale prospective cohort studies would be useful to assess the association between environmental exposure to PFOS, appropriate biomarkers (e.g. serum levels of PFOS) and health outcomes.