Comment younger than 18 years, or those who have liver disease). 2 Cornely OA, Bassetti M, Calandra T, et al. ESCMID* guideline for the diagnosis and management of candida diseases 2012: non-neutropenic Finally, the role of rezafungin for the treatment of adult patients. Clin Microbiol Infect 2012; 18 (suppl 7): 19–37. patients with infections with special considerations 3 Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases (septic arthritis and osteomyelitis, eye-involved Society of America. Clin Infect Dis 2016; 62: e1–50. infections, CNS infection, biofilm-associated infections 4 Andes DR, Safdar N, Baddley JW, et al. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive [eg, endocarditis or situations in which indwelling candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis 2012; 54: 1110–22. catheters should be kept], and patients infected by 5 Sandison T, Ong V, Lee J, Thye D. Safety and pharmacokinetics of CD101 IV, moderately echinocandin-susceptible species, such as a novel echinocandin, in healthy adults. Antimicrob Agents Chemother 2017; 61: e01627–16. Candida parapsilosis) is an enigma. However, clinicians 6 Lakota EA, Ong V, Flanagan S, Rubino CM. Population pharmacokinetic should be ready to welcome rezafungin, a new and analyses for rezafungin (CD101) efficacy using phase 1 data. Antimicrob Agents Chemother 2018; 62: e02603-17. promising antifungal drug for the management of 7 Thompson GR 3rd, Soriano A, Skoutelis A, et al. Rezafungin versus patients with invasive candida infections. caspofungin in a phase 2, randomized, double-blind study for the treatment of candidemia and invasive candidiasis: the STRIVE trial. I hold a permanent researcher position at Fundación para Investigación Sanitaria Clin Infect Dis 2021; 73: e3647–55. del Hospital Gregorio Marañón. I report research grants from Basilea, Gilead, 8 Thompson G 3rd, Soriano A, Cornely O, et al. Rezafungin versus Scynexis, Cidara, F2G, and Mundipharma and personal fees from Pfizer, caspofungin for treatment of candidaemia and invasive candidiasis Mundipharma, Gilead, and MSD, outside the submitted work. (ReSTORE): a multicentre, double-blind, double-dummy, randomised phase 3 trial. Lancet 2022; published online Nov 25. https://doi. Jesús Guinea org/10.1016/S0140-6736(22)02324-8. jguineaortega@yahoo.es 9 Zhao Y, Prideaux B, Nagasaki Y, et al. Unraveling drug penetration of echinocandin antifungals at the site of infection in an intra-abdominal Clinical Microbiology and Infectious Diseases, Hospital General Universitario abscess model. Antimicrob Agents Chemother 2017; 61: e01009–17. Gregorio Marañón, Madrid 28007, Spain; Instituto de Investigación Sanitaria 10 Grau S, Luque S, Campillo N, et al. Plasma and peritoneal fluid population Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de pharmacokinetics of micafungin in post-surgical patients with severe Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain peritonitis. J Antimicrob Chemother 2015; 70: 2854–61. 1 Kullberg BJ, Arendrup MC. Invasive candidiasis. N Engl J Med 2016; 374: 794–95. Climate change, health, and discrimination: action towards racial justice The health impacts of climate change will affect everyone. Panel on Climate Change (IPCC) recognise “historical Published Online November 4, 2022 But the consequences are unevenly distributed, falling and ongoing patterns of inequity such as colonialism” https://doi.org/10.1016/ much harder on some communities than others. as a factor in vulnerability to climate change.6 As S0140-6736(22)02182-1 Although discourse on climate change and health Farhana Sultana observed: “colonialism haunts the acknowledges principles of equity,1 little attention is past, present, and future through climate”.7 Colonialism given to underlying structural discri­mination and the need for racial justice. From vulnerable communities in Panel: Values to guide research and action on climate Puerto Rico coping with the effects of hurricane Fiona, to change, health, and structural discrimination excessive heat in racially segregated neighbourhoods in • Pursue research that acknowledges and repairs the USA, to the tens of millions of people who have been structural discrimination displaced by flooding in Pakistan during 2022, minoritised • Measures of success in research, policy, and action should lie populations2 bear the brunt of the health impacts of with accountability to the most affected people and areas climate change, despite being least responsible for it. • Justice and equity need to be the starting point, not Racism kills,3 and climate change kills.4 Together, racism afterthoughts • Centre the voices and solutions of the most affected and climate change interact and have disproportionate people and areas in research, policy making, education, effects on the lives of minoritised people within countries advocacy, and action and between the Global North and the Global South.4,5 • Support initiatives that foster healing and repair, Structural discrimination and racism can be traced back including calls for reparations to colonialism, which is seldom mentioned in climate • Take a solidarity-driven approach, bringing intersecting issues together such as migrant and racial justice discourse. Only in 2022 did the Intergovernmental www.thelancet.com Vol 401 January 7, 2023 5 Comment has caused the decimation of land and resources, the What can the health community do? It is crucial enslavement of people, and plundered the wealth of that all those who work on climate change and health colonised regions through continuing mechanisms of pay attention to these histories and inequalities. As extraction and appropriation. Histories of colonial and Araceli Carmago highlighted: “as planetary dysregulation neocolonial extraction have left low-income regions more continues so will discrimination and oppressions”.16 vulnerable to, and less able to adapt to, the impacts of Minoritised people are disproportionately exposed to the climate change. social, political, and commercial determinants of health Just as the health impacts of climate change are that are underwritten by unfair systems and maintained unequally distributed, so too is responsibility for causing by oppressive structures and hierarchies.17 For example, the climate crisis. Countries of the Global North represent white supremacy enables environmental racism—ie, 14% of the world’s population but are responsible for 92% racial discrimination in environmental policy making, of historical carbon dioxide emissions in excess of the safe the targeting of communities of colour in exposure to planetary boundary.8 These nations have colonised the polluting industries, and the under-representation of atmospheric commons for their own enrichment through minoritised people in environmental decision making and forms of industrialisation and growth that have relied movements.18,19 The health community must adopt an on colonial patterns of appropriation.9 Even within rich expansive vision of climate change and health, bringing countries, responsibility lies primarily with the affluent power analyses of colonial, white supremacist, patriarchal, and ruling classes, due to their higher levels of emissions10 and other oppressive structures into its work.20 and disproportionate control over energy systems and With this kind of vision, there will be increased national legislation. opportunities for research on climate change, health, and An example of these dynamics can be seen in the Niger structural discrimination. Although some national-level Delta. Before Nigeria’s independence in 1960, the oil studies have monitored the unequal health impacts of company Shell began oil exploration in the Niger Delta, climate change,21,22 data on health outcomes for people asserting corporate colonial control over the land.11 The who are minoritised due to caste, skin colour, ethnicity, region was at the heart of Nigeria’s agricultural economy. race, Indigeneity, migratory status, and religion are Since then, due to the degradation of the land through largely underexamined, especially in the Global South. It oil spills and contamination and subsequent militancy is crucial to work towards more data granularity to expose in the region during the 1990s and 2000s, people in inequalities within countries, rather than homogenising the Niger Delta experience high levels of poverty and entire national populations. Such an exercise could help unemployment, and therefore poor mental and physical guide policy actions that address loss and damage in health.12 Shell and other transnational oil companies accordance with treaties such as the Paris Agreement, continue to extract oil from the region for global and establish reparations owed to communities for markets. health harms related to colonial legacies and ongoing These legacies of profit and power are also present in damage.23 Alongside quantitative research, inequalities contemporary medical systems and influence unequal must be highlighted using qualitative approaches such life outcomes of minoritised generations. For example, as testimonies and case studies that centre the voices health-care workers in the UK are told to question people’s and lived expertise of the most affected people and migratory status upfront, and migrants who are ineligible areas (MAPA) and young people. Beyond research, can be charged for or denied care.13 The failure to equitably embedding anti-discrimination in climate change and distribute COVID-19 vaccines globally has revealed power health discourse can be done through education, policy, dynamics whereby patents prevent some countries advocacy, art, public engagement, and more. The panel from producing their own vaccines.14 Such events reflect highlights values to guide evolving work in this field. racial capitalism, an economic system where capital We must also recognise the rich body of work, led accumulation in the core areas of wealth, and among especially by Indigenous Peoples and front-line MAPA elites, relies on leveraging racial ideology to dehumanise communities, to address structural discrimination and and justify the exploitation of racially minoritised people climate change, while fostering relational ways of being in various peripheries.15 that respect planetary boundaries.24 For example, scholars 6 www.thelancet.com Vol 401 January 7, 2023 Comment in New Zealand and Canada are working on Indigenous 1 Healthy Climate Prescription Signatories. #HealthyClimatePrescription: an urgent call for climate action from the health community. 2021. https:// Health Promotion—a process of healing rooted in healthyclimateletter.net/ (accessed Oct 20, 2022). Indigenous peoples’ concerns including land-based 2 Selvarajah S, Deivanayagam TA, Lasco G, et al. Categorisation and minoritisation. BMJ Glob Health 2020; 5: e004508. learning, health equity, environmental sustainability, 3 Devakumar D, Selvarajah S, Shannon G, et al. Racism, the public health crisis cultural integrity, and decolonisation.25 Decolonisation we can no longer ignore. Lancet 2020; 395: e112–13. 4 Romanello M, Di Napoli C, Drummond P, et al. The 2022 report of the Lancet requires the restoration of land and space for Indigenous Countdown on health and climate change: health at the mercy of fossil knowledge and practice.26 Calls for reparations must also fuels. Lancet 2022; 400: 1619–54. 5 Smith GS, Anjum E, Francis C, Deanes L, Acey C. Climate change, be supported23 to address the economic dominance of the environmental disasters, and health inequities: the underlying role of structural inequalities. Curr Environ Health Rep 2022; 9: 80–89. Global North, repair past colonial harms, and build just 6 Intergovernmental Panel on Climate Change. Pörtner H-O, Roberts DC, futures.7 Voices that have been silenced and erased from Adams H, et al, eds. IPCC sixth assessment report. Climate change 2022: impacts, adaptation and vulnerability. 2022. https://www.ipcc.ch/report/ dominant discussions on health and climate change must ar6/wg2/ (accessed Oct 31, 2022). be restored and further oppression must not take place 7 Sultana F. The unbearable heaviness of climate coloniality. Polit Geogr 2022; published online March 28. https://doi.org/10.1016/j. while engaging in these efforts. polgeo.2022.102638. By remaining technocratic and apolitical, scientists 8 Hickel J. Quantifying national responsibility for climate breakdown: an equality-based attribution approach for carbon dioxide emissions in and the health community are complicit in perpetuating excess of the planetary boundary. Lancet Planet Health 2020; 4: e399–404. discrimination in this field. Every interaction with a 9 Hickel J, Dorninger C, Wieland H, Suwandi I. Imperialist appropriation in the world economy: drain from the Global South through unequal exchange, person from a minoritised community is an interface 1990–2015. Glob Environ Change 2022; 73: 102467. 10 Oxfam International. Confronting carbon inequality. 2020. https://www. with these legacies. Each interaction therefore becomes oxfam.org/en/research/confronting-carbon-inequality (accessed an opportunity for the health worker to acknowledge, Nov 2, 2022). 11 Henshaw K. Corporate profiteering in the Niger Delta. The Ecologist. reflect, and act at the individual, community, and systemic Oct 13, 2021. https://theecologist.org/2021/oct/13/corporate-profiteering- levels. Scientists and health workers must interrogate niger-delta (accessed Oct 15, 2022). 12 Nriagu J, Udofia EA, Ekong I, Ebuk G. Health risks associated with oil pollution the narratives and practices that perpetuate the multiple in the Niger Delta, Nigeria. Int J Environ Res Public Health 2016; 13: 346. intersecting forms of oppression that give rise to the 13 Kmietowicz Z. NHS staff march against passport checks. BMJ 2017; 359: j4559. systems and industries that fuel climate change and health 14 Yamey G, Garcia P, Hassan F, et al. It is not too late to achieve global COVID-19 vaccine equity. BMJ 2022; 376: e070650. inequalities. The health community can offer scholarship, 15 Bhattacharyya G. Rethinking racial capitalism: questions of reproduction skills, and solidarity, maximise its organising power, and and survival. London: Rowman & Littlefield International, 2018. be a strong voice for climate and racial justice. Such efforts 16 Müller M, Carmago A. Growing up in crisis. Urban Health Council. 2022. https://www.urbanhealthcouncil.com/reports-playbooks/growing-up-in- must be part of a wider movement ecology for climate crisis (accessed Oct 20, 2022). 17 Marya R, Patel R. Inflamed: deep medicine and the anatomy of injustice. justice that is accountable to front-line MAPA communities London: Penguin, 2021. as it mobilises for equitable climate and health action. 18 Bullard RD. Confronting environmental racism: voices from the grassroots. Boston, MA: South End Press, 1993. TAD, SS, PdMS, JB, SE, MH, RI, HM, HPN, CS, and DD report grants from the 19 Tessum CW, Apte JS, Goodkind AL, et al. Inequity in consumption of goods Wellcome Trust (224687/Z/21/Z) paid to University College London and for which and services adds to racial-ethnic disparities in air pollution exposure. DD is the principal investigator. The other authors declare no competing interests. Proc Natl Acad Sci USA 2019; 116: 6001–06. *Thilagawathi Abi Deivanayagam, Sujitha Selvarajah, 20 Redvers N. The determinants of planetary health. Lancet Planet Health 2021; 5: e111–12. Jason Hickel, Renzo R Guinto, Priscila de Morais Sato, 21 Levy BS, Patz JA. Climate change, human rights, and social justice. Jon Bonifacio, Sonora English, Mita Huq, Rita Issa, Ann Glob Health 2015; 81: 310–22. Hans Mulindwa, Heizal Patricia Nagginda, Chetna Sharma, 22 US Environmental Protection Agency. EPA report shows disproportionate impacts of climate change on socially vulnerable populations in the Delan Devakumar United States. Sept 2, 2021. https://www.epa.gov/newsreleases/epa- abi.deivanayagam@ucl.ac.uk report-shows-disproportionate-impacts-climate-change-socially- vulnerable (accessed Oct 25, 2022). Institute for Global Health, University College London, London WC1N 1EH, UK 23 Táíwò OO. Reconsidering reparations. Oxford: Oxford University Press, 2022. (TAD, SS, SE, MH, RI, CS, DD); Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK (TAD); Institute for Environmental 24 Jones R, Reid P, Macmillan A. Navigating fundamental tensions towards a decolonial relational vision of planetary health. Lancet Planet Health 2022; Science and Technology and Department of Anthropology, Autonomous 6: e834–41. University of Barcelona, Barcelona, Spain (JH); International Inequalities 25 Ratima M, Martin D, Castleden H, Delormier T. Indigenous voices and Institute, London School of Economics and Political Science, London, UK (JH); knowledge systems—promoting planetary health, health equity, Planetary and Global Health Program, St Luke’s Medical Center College of and sustainable development now and for future generations. Medicine-William H Quasha Memorial, Quezon City, Philippines (RRG); Sunway Glob Health Promot 2019; 26: 3–5. Centre for Planetary Health, Sunway University, Selangor, Malaysia (RRG); 26 Redvers N, Yellow Bird M, Quinn D, Yunkaporta T, Arabena K. Molecular School of Public Health, University of São Paulo, São Paulo, Brazil (PdMS); Youth decolonization: an Indigenous microcosm perspective of planetary health. Advocates for Climate Action Philippines, Quezon City, Philippines (JB); Climate Int J Environ Res Public Health 2020; 17: 4586. Operation Ltd, Kampala, Uganda (HM, HPN) www.thelancet.com Vol 401 January 7, 2023 7