The Lancet
May 07, 2016 Volume 387 Number 10031 p1879-1968
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Australia’s offshore refugee policy in disarray
The Lancet
Summary
Australia’s contentious way of dealing with refugees and asylum seekers arriving by boat, long condemned by human rights organisations, has come under renewed attack and public scrutiny. On April 26, the Supreme Court of Papua New Guinea (PNG) ruled that the offshore detention centre on Manus Island, PNG, which had been used by Australia under the so-called Pacific Solution, was unconstitutional and ordered its closure. In its ruling, the court said that the centre violated the detainees’ rights to personal liberty under the PNG constitution.

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Comment
Mind the gap: jumping from vaccine licensure to routine use
Katherine L O’Brien, Fred Binka, Kevin Marsh, Jon S Abramson
Summary
The contribution of immunisation to improving childhood survival is one of the great achievements of global health. Driving down further infectious disease burden will require new vaccines, many of which have taken decades to develop. We are entering an era where the path from licensure to widespread routine vaccine implementation requires more than efficacy and safety data; policy recommendations for new vaccines may only be realised through implementation research to determine how to most effectively ensure widespread use.

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Articles
Global and regional health effects of future food production under climate change: a modelling study
Marco Springmann, Daniel Mason-D’Croz, Sherman Robinson, Tara Garnett, H Charles J Godfray, Douglas Gollin, Mike Rayner, Paola Ballon, Peter Scarborough
Summary
Background
One of the most important consequences of climate change could be its effects on agriculture. Although much research has focused on questions of food security, less has been devoted to assessing the wider health impacts of future changes in agricultural production. In this modelling study, we estimate excess mortality attributable to agriculturally mediated changes in dietary and weight-related risk factors by cause of death for 155 world regions in the year 2050.
Methods
For this modelling study, we linked a detailed agricultural modelling framework, the International Model for Policy Analysis of Agricultural Commodities and Trade (IMPACT), to a comparative risk assessment of changes in fruit and vegetable consumption, red meat consumption, and bodyweight for deaths from coronary heart disease, stroke, cancer, and an aggregate of other causes. We calculated the change in the number of deaths attributable to climate-related changes in weight and diets for the combination of four emissions pathways (a high emissions pathway, two medium emissions pathways, and a low emissions pathway) and three socioeconomic pathways (sustainable development, middle of the road, and more fragmented development), which each included six scenarios with variable climatic inputs.
Findings
The model projects that by 2050, climate change will lead to per-person reductions of 3·2% (SD 0·4%) in global food availability, 4·0% (0·7%) in fruit and vegetable consumption, and 0·7% (0·1%) in red meat consumption. These changes will be associated with 529,000 climate-related deaths worldwide (95% CI 314,000–736,000), representing a 28% (95% CI 26–33) reduction in the number of deaths that would be avoided because of changes in dietary and weight-related risk factors between 2010 and 2050. Twice as many climate-related deaths were associated with reductions in fruit and vegetable consumption than with climate-related increases in the prevalence of underweight, and most climate-related deaths were projected to occur in south and east Asia. Adoption of climate-stabilisation pathways would reduce the number of climate-related deaths by 29–71%, depending on their stringency.
Interpretation
The health effects of climate change from changes in dietary and weight-related risk factors could be substantial, and exceed other climate-related health impacts that have been estimated. Climate change mitigation could prevent many climate-related deaths. Strengthening of public health programmes aimed at preventing and treating diet and weight-related risk factors could be a suitable climate change adaptation strategy.