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Chapter 16 on Causation explores the challenges of proving causation in an interconnected system like the climate, where multiple actors contribute to the overall impacts. The authors highlight the significance of probabilistic approaches, recognising that establishing direct causation can be challenging due to the nature of climate change and the cumulative nature of greenhouse gas emissions. In their exploration of emerging best practices, the authors underscore the growing recognition among courts of the need for nuanced interpretations of causation requirements in climate litigation. They highlight innovative judicial strategies that utilise scientific evidence and expert testimony to assess the contribution of specific actors to climate impacts, even in the absence of direct causation. They emphasise the importance of interdisciplinary collaboration between legal and scientific experts to navigate the complexities of causation in climate cases. By incorporating and further developing these emerging best practices, courts can facilitate an accurate and fair distribution of responsibilities through the cases they adjudicate.
Some trials have evaluated peer support for people with mental ill health in high-income, mainly English-speaking countries, but the quality of the evidence is weak.
Aims
To investigate the effectiveness of UPSIDES peer support in high-, middle- and low-income countries.
Method
This pragmatic multicentre parallel-group wait-list randomised controlled trial (registration: ISRCTN26008944) with three measurement points (baseline and 4 and 8 months) took place at six study sites: two in Germany, and one each in Uganda, Tanzania, Israel and India. Participants were adults with long-standing severe mental health conditions. Outcomes were improvements in social inclusion (primary) and empowerment, hope, recovery, health and social functioning (secondary). Participants allocated to the intervention group were offered UPSIDES peer support.
Results
Of the 615 participants (305 intervention group), 337 (54.8%) identified as women. The average age was 38.3 (s.d. = 11.2) years, and the mean illness duration was 14.9 (s.d. = 38.4) years. Those allocated to the intervention group received 6.9 (s.d. = 4.2) peer support sessions on average. Intention-to-treat analysis showed effects on two of the three subscales of the Social Inclusion Scale, Empowerment Scale and HOPE Scale. Per-protocol analysis with participants who had received three or more intervention sessions also showed an effect on the Social Inclusion Scale total score (β = 0.18, P = 0.031, 95% CI: 0.02–0.34).
Conclusions
Peer support has beneficial impacts on social inclusion, empowerment and hope among people with severe mental health conditions across diverse settings. As social isolation is a key driver of mental ill health, and empowerment and hope are both crucial for recovery, peer support can be recommended as an effective component of mental healthcare. Peer support has the potential to move global mental health closer towards a recovery- and rights-based orientation.
Healthcare facilities in the U.S. are well positioned to assist with measles control by timely identification and isolation of suspected or confirmed cases and, as measles is nationally notifiable, by informing local health departments about both suspected and confirmed cases. However, responding to measles cases in acute healthcare settings presents unique challenges, is disruptive, and requires an intense outlay of resources before, during, and afterward primarily due to exposure investigations. We describe our measles preparedness efforts to improve identification of measles cases, facilitate appropriate isolation, reduce exposures, and provide timely post-exposure prophylaxis.
In this article, we examine the relationship between the World Health Organization International Health Regulations (IHR) and human rights and its implications for IHR reform, considering the evolution of human rights in the 2005 IHR, the role of human rights in IHR reforms and the implications of these reforms in key domains including equity and solidarity, medical countermeasures, core capacities, travel restrictions, vaccine certificates, social measures, accountability, and financing.
Coercive measures such as involuntary psychiatric admission are considered a last resort in the treatment of people with psychiatric disorders. So far, numerous factors have been identified that influence their use. However, the link between a pandemic – in particular, restrictions such as lockdowns – and the use of involuntary psychiatric admission is unclear.
Aim
To examine the association between COVID-19 lockdowns and involuntary psychiatric admissions in Austria.
Method
This retrospective exploratory study assessed all involuntary psychiatric admissions and use of mechanical restraint in Austria, except for the federal state of Vorarlberg, between 1 January 2018 and 31 December 2020. Descriptive statistics and regression models were used.
Results
During the 3-year study period, 40 012 individuals (45.9% females, mean age 51.3 years) had 66 124 involuntary psychiatric admissions for an average of 10.9 days. Mechanical restraint was used during 33.9% of these admissions. In weeks of nationwide COVID-19 lockdowns (2020 v. 2018/2019), involuntary psychiatric admissions were significantly fewer (odds ratio = 0.93, P = 0.0001) but longer (11.6 (s.d.: 16) v. 10.9 (s.d.: 15.8) days). The likelihood of involuntary admission during lockdowns was associated with year (2020 v. 2018–2019; adjusted odds ratio = 0.92; P = 0.0002) but not with sex (P = 0.814), age (P = 0.310), use of mechanical restraint (P = 0.653) or type of ward (P = 0.843).
Conclusions
Restrictions such as lockdowns affect coercive measures and resulted in fewer but longer involuntary psychiatric admissions during weeks of lockdown in Austria. These results strengthen previous findings that showed the dependence of coercive measures on external factors, highlighting the need to further clarify causality and desired prevention effects when using coercive measures.
Many formerly incarcerated people have civil legal needs that can imperil their successful re-entry to society and, consequently, their health. We categorize these needs and assess their association with cardiovascular disease risk factors in a sample of recently released people. We find that having legal needs related to debt, public benefits, housing, or healthcare access is associated with psychosocial stress, but not uncontrolled high blood pressure or high cholesterol, in the first three months after release.
Improving equity in the context of protected areas conservation cannot be achieved in situations where people have different capabilities to participate. Participatory video has the potential to uncover hidden perspectives and worldviews and to build trustworthy, transparent and accountable relationships between marginalized communities and external agencies. We present findings from video-mediated dialogues between Indigenous peoples and decision makers involved in the management of three protected areas in Guyana. Participatory films created by Indigenous researchers in their communities were screened and discussed with protected area managers. We recorded their responses and presented them back to the communities. We show how the video-mediated process provided a rich and contextualized understanding of equity issues. It enabled recognition and respect by protected area managers for Indigenous lived experiences and the contribution of their values and knowledge. For Indigenous peoples, the participatory video process built confidence and critical reflection on their own activities and responsibilities whilst allowing them to challenge decision makers on issues of transparency, communication and accountability. We show that equity is an evolving process and that different protected areas with their differing histories and relationships with Indigenous communities produce distinct outcomes over time. Thus, promoting equity in protected areas and conservation must be a long-term process, enabling participation and producing the conditions for regular, transparent and honest communications. Standardized indicators of protected areas equity could be useful for reporting on international targets, but video-mediated dialogue can facilitate deeper understanding, greater representation and a recognition of rights.
Hi, Dan. Hi, Gabriela. I also wanted to thank the organizers for facilitating a hybrid format so I could be here with you today. I think in terms of that question, Dan, you and I have both been at negotiations where the plenary starts with all the countries there and a minute of silence for some victims of some typhoon in one of the countries that is there, or victims of a hurricane of a country that is there, and then the minute of silence ends. Then we swiftly move on to the business of negotiating. I think that it is not as much of a motivational factor in the outcomes of the negotiations. I think it does motivate some of the countries that are there, and of course, they are the more vulnerable countries, and they are the ones that have less influence in terms of crafting the outcomes of the negotiations.
Healthcare workers (HCWs) are a high-priority group for coronavirus disease 2019 (COVID-19) vaccination and serve as sources for public information. In this analysis, we assessed vaccine intentions, factors associated with intentions, and change in uptake over time in HCWs.
Methods:
A prospective cohort study of COVID-19 seroprevalence was conducted with HCWs in a large healthcare system in the Chicago area. Participants completed surveys from November 25, 2020, to January 9, 2021, and from April 24 to July 12, 2021, on COVID-19 exposures, diagnosis and symptoms, demographics, and vaccination status.
Results:
Of 4,180 HCWs who responded to a survey, 77.1% indicated that they intended to get the vaccine. In this group, 23.2% had already received at least 1 dose of the vaccine, 17.4% were unsure, and 5.5% reported that they would not get the vaccine. Factors associated with intention or vaccination were being exposed to clinical procedures (vs no procedures: adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.16–1.65) and having a negative serology test for COVID-19 (vs no test: AOR, 1.46; 95% CI, 1.24–1.73). Nurses (vs physicians: AOR, 0.24; 95% CI, 0.17–0.33), non-Hispanic Black (vs Asians: AOR, 0.35; 95% CI, 0.21–0.59), and women (vs men: AOR, 0.38; 95% CI, 0.30–0.50) had lower odds of intention to get vaccinated. By 6-months follow-up, >90% of those who had previously been unsure were vaccinated, whereas 59.7% of those who previously reported no intention of getting vaccinated, were vaccinated.
Conclusions:
COVID-19 vaccination in HCWs was high, but variability in vaccination intention exists. Targeted messaging coupled with vaccine mandates can support uptake.
To determine the changes in severe acute respiratory coronavirus virus 2 (SARS-CoV-2) serologic status and SARS-CoV-2 infection rates in healthcare workers (HCWs) over 6-months of follow-up.
Design:
Prospective cohort study.
Setting and participants:
HCWs in the Chicago area.
Methods:
Cohort participants were recruited in May and June 2020 for baseline serology testing (Abbott anti-nucleocapsid IgG) and were then invited for follow-up serology testing 6 months later. Participants completed monthly online surveys that assessed demographics, medical history, coronavirus disease 2019 (COVID-19), and exposures to SARS-CoV-2. The electronic medical record was used to identify SARS-CoV-2 polymerase chain reaction (PCR) positivity during follow-up. Serologic conversion and SARS-CoV-2 infection or possible reinfection rates (cases per 10,000 person days) by antibody status at baseline and follow-up were assessed.
Results:
In total, 6,510 HCWs were followed for a total of 1,285,395 person days (median follow-up, 216 days). For participants who had baseline and follow-up serology checked, 285 (6.1%) of the 4,681 seronegative participants at baseline seroconverted to positive at follow-up; 138 (48%) of the 263 who were seropositive at baseline were seronegative at follow-up. When analyzed by baseline serostatus alone, 519 (8.4%) of 6,194 baseline seronegative participants had a positive PCR after baseline serology testing (4.25 per 10,000 person days). Of 316 participants who were seropositive at baseline, 8 (2.5%) met criteria for possible SARS-CoV-2 reinfection (ie, PCR positive >90 days after baseline serology) during follow-up, a rate of 1.27 per 10,000 days at risk. The adjusted rate ratio for possible reinfection in baseline seropositive compared to infection in baseline seronegative participants was 0.26 (95% confidence interval, 0.13–0.53).
Conclusions:
Seropositivity in HCWs is associated with moderate protection from future SARS-CoV-2 infection.
The chapter opens with the historic decision by the Philippines Human Rights Commission that carbon-major companies can be liable for climate-induced harms. While this decision has no direct legal impact on companies, it illustrates the ever closer connection between human rights and climate impacts. The chapter assesses the transnational business and human rights landscape, primarily through an assessment of the UN Guiding Principles on Business and Human Rights and illustrated by a recent dispute mediated by the Dutch National Contact Point under the OECD Guidelines on the climate impacts of ING’s lending practices. It charts the two waves of climate-based litigation against states and companies, with a focus on cases in the United States, The Netherlands, and Pakistan and two recent UK cases. The chapter provides an assessment of the direct overlap between human rights and climate litigation with the RWE v Lliuya case and the Philippines Human Rights Commission’s investigation of carbon-majors. The chapter closes with a look at the potential crystallisation of corporate climate obligations in the future through the Principles of Climate Obligations of Enterprises and the barrier that separate legal personality poses within corporate groups to the success of climate litigation efforts.
Chapter 7 examines both fiscal barriers and incentives to corporate climate action. Barriers such as fossil fuel subsidies and relative political inaction on that issue (at the World Trade Organization and other fora) and on the issue of carbon taxes are assessed. In contrast, the picture at the institutional investor level looks more active, with investors becoming increasingly concerned about the risks of climate change to fiscal stability. Issues of stranded assets, divestment, short-termism and financial regulatory developments are covered. In addition, some limited climate litigation initiated by investors (and its mixed results) is assessed. Varying jurisdictional approaches to sustainable investing from the SEC in the United States to the Bank of England in the United Kingdom are highlighted. Recent statements by Lord Sales at the Anglo-Australasian Law Society, as well as by the institutional investor BlackRock, in 2019 are indicative of a changing approach to climate investing. Regulatory developments requiring climate risk disclosure by the Department for Works and Pension, guidance by the Financial Conduct Authority and the focus on ESG investing in the EU, all signal the slow greening of capital in the context of climate change.
Chapter 4 assesses the history of companies in the international environmental law movement.Traditional voluntary-only approaches of industry groups to international environmental law led to a burgeoning of largely voluntary corporate social responsibility (CSR) initiatives. A review of the United Nations Framework Convention on Climate Change and the Kyoto Protocol are provided, along with a detailed examination of the Paris Agreement. Unlike previous experiences with international environmental law, many non-state actors supported the Paris Agreement, and some even wanted to become a party to it. While it remains a state-based treaty, non-state actors have become a main pillar of its implementation, particularly its long-term temperature goals. This international consensus shifting on climate change has led to new CSR and private environmental governance initiatives, specifically around climate change. These are eliciting a compliance reaction from many companies, with net-zero emissions targets announced by a variety of industry actors. Examples of Canadian Supreme Court decisions around corporate citizenship, the King IV Report from South Africa and CSR provisions in the Indian Companies Act 2013, as well as new corporate climate reporting requirements in the United Kingdom based on the recommendations of the Task Force on Climate-Related Financial Disclosures, are illustrative of this shift.
This concluding chapter ties together the various elements of regulatory and market-based developments covered earlier in the book and the impacts they have on dominant corporate norms. International consensus shifting on climate change indicates that these dominant theories and norms have become outdated, and should be adapted to reflect broader public and private investor concerns around climate change. The systemic risks of climate change are proving to be a market driver for reallocation of capital away from fossil fuel assets and towards a low or no carbon economy. Companies themselves are reacting with net-zero emissions targets, although these approaches mainly cabin climate concerns to risk-based approaches. This chapter argues that public regulation is still needed to ensure corporate climate action protects not only profits but the public. It ends with two areas of likely future regulatory development – standardised disclosure obligations for companies on climate risk, as well as governance and strategy making by companies on climate change. It also advocates that companies hire climate expertise on an either an ad hoc or permanent basis to help directors reimagine the corporate purpose in the Anthropocene.
The chapter begins with the historic announcement by then UK Prime Minister Theresa May of a net-zero emissions target. It looks at the theory of regulation as applied to companies, and EU and UK energy and climate law in particular. With a focus on the Climate Change Act 2008, this chapter highlights some of the unique characteristics of the independent and expert-based nature of the Committee on Climate Change, and its relationship to climate science. It also looks at the increasing overlap between the reporting requirements on directors under the Companies Act 2006 and the Climate Change Act 2008. It focuses on the desire for a ‘Green Brexit’ as the motivation behind the UK Environmental Bill 2020, the Clean Growth Strategy and plans for a UK emissions trading system. The chapter includes a section on energy companies’ evolving approach to climate and energy regulation, with a focus on market-based mechanisms like the EU emissions trading system and Article 6 of the Paris Agreement.
This chapter provides a deep dive into UK company law, assessing the common law before the changes to the Companies Act enacted in 2006. It finds that prior to 2006, the judiciary provided directors with a significant amount of discretion to make even profit-sacrificing actions if they benefited the company as a whole, widely reflecting the entity theory of companies. Corporate governance reviews, from the Cadbury Report onwards, did not reflect this common law approach. A detailed examination of the work of the Company Law Review Steering Group illustrates that the changes codified in s172 of the Companies Act 2006 actually entrenched a shareholder primacy approach to company law that previously was not dominant in English common law. This development could have negative impacts for the climate, although the relationship between s172 and the prior common law interpretation of directors’ duties remains unclear. Post-2006 cases are also assessed, and an overview of where climate liability could arise for directors under the 2006 Act is provided.