BACKGROUND Achieving high wellbeing while remaining within planetary boundaries is central to post-growth and degrowth research. Although no country meets minimum social thresholds without exceeding biophysical limits, localised territories might provide exceptions. We aimed to assess whether the Greek island of Ikaria offers an empirical example of real-existing degrowth, where high levels of wellbeing are maintained alongside low household carbon footprints, and to identify the household and structural factors associated with carbon footprints and potential pathways for further reductions. METHODS We conducted a cross-sectional primary household survey across Ikaria between Oct 8 and Dec 12, 2023, collecting data on household composition, dwelling characteristics, energy use, mobility, income, employment, and wellbeing. Households with members permanently residing in Ikaria, defined as residing on the island for more than 8 months per year, and those with at least one adult household member able to provide informed consent and respond to the questionnaire were eligible to participate in the survey. Surveys were in Greek and conducted in person across five villages and the main towns of Raches, Evdilos, and Agios Kirykos. We calculated household carbon footprints using household spending data. Carbon intensity factors (expressed in kg CO2 equivalent [CO2e] per euro) were applied to reported household expenditures across electricity, heating oil, transport, food, clothing, and goods, using emission factors from environmentally extended input-output models and household carbon footprint databases. To explore the determinants of carbon footprint, we examined sociodemographic and structural variables and compared low-emitting and high-emitting households using Welch's t tests and ordinary least squares regressions. Wellbeing was assessed based on decent living standards, benchmarks, objective wellbeing indicators, and self-reported life satisfaction. Finally, we developed demand-side and supply-side scenarios to examine potential carbon footprint reductions while maintaining or enhancing wellbeing. FINDINGS From the 159 initial responses, ten were excluded as incomplete and 149 household surveys were included for the analysis. The sample represented approximately 4% of Ikaria's estimated households and mirrored the island's population distribution. Ikaria's per-capita household carbon footprint was 2·35-2·94 tCO2e per year, depending on the correction factor applied from the existing literature; this carbon footprint is substantially less than the EU average and close to Paris Agreement lifestyle benchmarks. Assuming a mean annual household carbon footprint of 2·94 tCO2e per capita per year, analysis of emissions distribution showed the largest contributions were housing (1·382 tCO2e [47%]), consumption (0·929 tCO2e [32%]), and transport (0·629 tCO2e [21%]). The island performed particularly well with respect to social connections, attachment to place, physical activity, and life satisfaction. Ikaria met or exceeded nearly all decent living thresholds, with high life satisfaction (mean score of 7·1 of 10), strong social support, and widespread participation in community life. Carbon footprints varied little by income; instead, household size and dwelling characteristics were stronger predictors. Regression analysis confirmed that higher life satisfaction was not substantially associated with a higher carbon footprint. Moderate demand-side reductions combined with renewable electricity could further reduce the footprint from 2·94 to 1·60-1·70 tCO2e per capita per year. Real-life equivalents showed that households already attaining footprints below the target had wellbeing outcomes similar to those of households above the target. INTERPRETATION Our analysis using the data from Ikaria shows that high wellbeing can coexist with low carbon footprints that vary little between households, supported by provisioning systems grounded in social cohesion, sufficiency, and localised economies. Targeted sufficiency measures and distributed renewable energy could place the island within its fair share of 1·5°C compatible emissions. Thus, our study provides quantitative evidence indicating real-existing degrowth within Europe and illustrates a viable pathway for other islands and peripheral regions. FUNDING European Research Council REAL.
Summary: Background: Fine particulate matter (PM 2·5 ) pollution constitutes a leading global health burden. However, multicountry evidence about the impact of PM 2·5 on cause-specific hospitalisations, which are key markers of clinically substantial morbidity, is scarce. This study aimed to examine the association of short-term exposure to ambient PM 2·5 pollution with hospital admissions for specific causes across multiple countries. Methods: We collected 346·5 million hospitalisation records from 949 communities across six countries and territories (Australia, Brazil, Canada, Chile, New Zealand, and Taiwan) between 2000 and 2019. At each location, we fitted quasi-Poisson generalised linear time-series models to estimate PM 2·5 -associated hospitalisation risks. These location-specific estimates were then pooled in a meta-analysis. We conducted stratified analyses by country, demographic factors, income, and time period. Findings: Short-term PM 2·5 exposure was significantly associated with increases in all-cause and cause-specific hospitalisations, with effects persisting for up to 21 days. For all-cause admissions, each 10 μg/m 3 increase in PM 2·5 concentration was associated with an 8% higher risk of hospitalisation (relative risk [RR] 1·080; 95% CI 1·074–1·086), with substantial heterogeneity across countries and territories. Short-term PM 2·5 exposure was associated with increased hospitalisation risks across all disease categories, with the strongest associations observed for malignant neoplasms (RR 1·108, 95% CI 1·094–1·123), mental disorders (1·100, 1·085–1·114), other neoplasms (1·096, 1·078–1·114), and nervous system diseases (1·085, 1·069–1·102), all exceeding the RR for respiratory diseases (1·067, 1·060–1·074). Attenuated but significant risks were observed in 2010–19, compared with those in 2000–09, for all disease categories. Using a PM 2·5 concentration of 15 μg/m 3 according to the WHO daily guideline as reference, attributable measures estimated from the observed PM 2·5 –hospitalisation associations declined over time, with the attributable fraction decreasing from 8·9% in 2000–09 to 3·9% in 2010–19 and the cumulative attributable hospitalisation rate decreasing from 11·6 to 3·5 per 1000 population per year. Interpretation: Our findings revealed that short-term PM 2·5 exposure was associated with persistent increased risks of hospitalisation across diverse settings. Reducing PM 2·5 exposure remains an important preventive measure to lower hospitalisation risk. Funding: Australian Research Council and Australian National Health and Medical Research Council.
Localised environmental pollution can generate acute concern, particularly when the health effects are uncertain. Media coverage can amplify fear and stress, necessitating transparent risk communication. This mixed-methods systematic Review (PROSPERO registration number CRD42024568007) focuses on strategies for communicating health risks associated with local pollution. We searched PubMed, Embase, Cochrane, Scopus, and PsycArticles on April 19, 2024, (from inception) and May 22, 2026 (Jan 1, 2000 onwards), supplemented by Google Scholar and OAIster (July 9, 2026), Global Index Medicus (July 10, 2026), and backward and forward citation tracking (July 16 and 17, 2026) all from Jan 1, 2000 onwards. Of 29 216 studies identified, 105 were eligible (61 quantitative, 30 qualitative, and 14 mixed-methods); all papers were written in English and included exposed populations. Review articles, animal studies, and in-vitro or in-silico studies were excluded. Quantitative outcomes comprised changes in knowledge, behaviour, stress, or fear, whereas qualitative studies analysed communication preferences or experiences. Study quality was assessed using the Mixed Methods Appraisal Tool. Qualitative data were analysed through thematic synthesis with CERQual assessment. Quantitative findings were narratively synthesised because of heterogeneity. Results were integrated using a convergent mixed-methods approach. Communities valued clear, plain-language explanations of pollutants, health effects, and exposure-reduction actions, supported by simple visuals and multiple communication channels. Interpersonal and community-embedded communication, especially from trusted local figures, enhanced understanding, reduced distress, and strengthened trust. Timely, consistent updates and transparent discussion of uncertainty were well received when delivered by trusted sources and combined with practical guidance but were less effective or potentially counterproductive when institutional trust was weak. Community collaboration improved the clarity, relevance, and acceptance of messages. Effective communication regarding local pollution depended on trust-building through open, empathic, and community-centred engagement. Clear, accessible messages from multiple media channels, supported by interpersonal dialogue, helped communities to understand risks without generating disproportionate worry.
Background Consumption of plant-based dairy alternatives (PBDAs) has increased as populations adopt more sustainable diets. However, PBDAs are often not fortified with key nutrients found in dairy products, particularly iodine. Iodine is essential for thyroid function and neurodevelopment, with increased importance during pregnancy, infancy, and adolescence. Iodine is often supplemented to cattle via feed, resulting in dairy products being a rich source. We assessed the impact of partly replacing dairy products with PBDAs on micronutrient intake and whether mandatory fortification of PBDAs or bread could mitigate potential shortfalls. Methods This modelling study combined UK national dietary data with market data on PBDA fortification. Dairy-product intake was partly or fully replaced with commercially-available PBDAs on a gram-for-gram basis, aligned with Net Zero and EAT–Lancet targets (20–100% replacement). Usual nutrient intakes were estimated using the National Cancer Institute method, and the effects on nutrient intake, adequacy, and risk of excess were evaluated under current and mandatory fortification scenarios. Findings Even partial replacement of dairy products with commercially-available PBDAs reduced iodine, calcium, riboflavin, and vitamin B12 intakes, particularly among young children, adolescents, and adult females. Replacement that aligned with the EAT–Lancet targets reduced iodine intake by 13–28%. Mandatory PBDA fortification prevented declines in micronutrient intake, although iodine inadequacy remained high among adolescent females (59% inadequate). Iodine-fortified bread improved iodine intake, reducing inadequacy among adolescent females to 37%. The combination of mandatory iodine fortification of both PBDAs and bread was the most effective strategy, maintaining or improving iodine adequacy across all population groups. There was no risk of excess nutrient intake. Interpretation Partial replacement of dairy products with PBDAs can reduce micronutrient intake under current market fortification practices, especially among population groups already at risk of iodine deficiency. However, fortification of PBDAs, bread, or both represents a feasible evidence-based strategy to counteract these reductions in micronutrient intakes, minimise the impact on population health, and inform national nutrition policy and fortification strategies during transitions to more sustainable diets. Funding Biotechnology and Biological Sciences Research Council FoodBioSystems.
