Oxford-led study estimates NHS spends around 3% of its primary and secondary care budget on the health impacts of heat and cold in England

Analysis of 4.37 million patient records in England finds resources asymmetrically impacted by winter cold and summer heat, with about 64% linked to common cold days while very hot days drive sharp same-day demand surges

University of Oxford

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

A new University of Oxford-led study, published in The Lancet Planetary Health, is the first to link daily temperature data to health-care use and costs across primary and secondary care in England.

Using linked patient records from 4,366,981 people registered at 244 English GP practices between April 2007 and June 2019, the researchers estimate that exposure to average daily temperatures outside a mild reference range (18°C to 21°C) accounts for around 3.0% of recorded health-care costs in their dataset.

Using illustrative budget figures detailed below, this may amount to £3 billion in costs for NHS England and be of the same order of magnitude as spending on dentistry.

As NHS leaders plan for winter pressures and wider service resilience, the study provides new evidence on how temperature-related demand and costs sit across the health system in England.

The UK frequently experiences cold conditions, with days averaging 0°C to 9°C accounting for around 64.4% of the estimated burden, reflecting cumulative increases in NHS use across the winter period. The study also raises a practical concern in extreme cold: when average temperatures fell below 0°C, health-care use declined in the data. This suggests barriers to seeking care in hazardous cold conditions such as snow and black ice.

However, the study also highlights that hot weather, which is becoming more frequent under climate change, also conveys concerning health risks. Very hot days were rare in the study period, which limits precision, but the data reports sharp, same-day surges in parts of the system - including A&E attendances and prescribing - when temperatures are unusually high. 

In other words, while cold is linked to a larger cumulative burden on the NHS, heat is linked to sudden spikes that can challenge day-to-day service delivery. Older adults were consistently the most affected group across the findings. 

Dr Patrick Fahr, Senior Health Economist at the Nuffield Department of Primary Health Care Sciences, University of Oxford, and a lead author of the study, said: 
‘Temperature affects the NHS every day, but until now nobody knew how costly this was. Three percent is both a small and a large figure, because these costs are concentrated on cold and hot days only when demand is spiking. Historically, the winter season has been and remains associated with additional health risks, which occur routinely each year, however heatwaves are emerging as a new challenge. 

‘In the data, heat tends to be associated with short, same day increases in demand and pressure on services, requiring a rapid response. Overall, the practical implication is that planning for temperature-related variation in service use is a year-round issue. Vulnerable people, such as older adults, can be particularly at risk.’

Illustrative budget impact

The study estimates the share of recorded healthcare costs associated with non-optimal temperature exposure (relative to a reference temperature), rather than producing a national budget total. As an illustration, if a similar proportion applied to NHS England’s planned 2023/24 spending on acute services, specialised services and primary medical care (combined £101.4bn), this would correspond to costs on the order of £3bn per year across those categories.

For context, that illustrative figure is above the £2.899bn spent on NHS dentistry reported in DHSC annual accounts for 2022/23, as highlighted by the British Dental Association.

-ENDS-

Notes to editors

Study title: ‘Quantifying the health-care burden of temperature in the National Health Service in England: an economic analysis of resource use and costs’

Journal: The Lancet Planetary Health

URL: https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(25)00251-7/fulltext

About the University of Oxford
Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the tenth year running, and ​number 3 in the QS World Rankings 2024. At the heart of this success are the twin-pillars of our ground-breaking research and innovation and our distinctive educational offer.

Oxford is world-famous for research and teaching excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research alongside our personalised approach to teaching sparks imaginative and inventive insights and solutions.

Through its research commercialisation arm, Oxford University Innovation, Oxford is the highest university patent filer in the UK and is ranked first in the UK for university spinouts, having created more than 300 new companies since 1988. Over a third of these companies have been created in the past five years. The university is a catalyst for prosperity in Oxfordshire and the United Kingdom, contributing around £16.9 billion to the UK economy in 2021/22, and supports more than 90,400 full time jobs.

---

Journal

The Lancet Planetary Health

DOI

10.1016/j.lanplh.2025.101373 

Article Title

Quantifying the health-care burden of temperature in the National Health Service in England: an economic analysis of resource use and costs

Article Publication Date

18-Dec-2025

 

The suspension of the foreign corrupt practices act generated record gains for companies involved in overseas corruption cases

Università di Bologna

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

When, on 10 February 2025, United States President Donald Trump signed the
executive order suspending the enforcement of the Foreign Corrupt Practices Act (FCPA), companies previously involved in overseas corruption cases collectively gained around USD 39 billion. On average, on that day, each individual company that had been subject to investigations or sanctions under the FCPA increased its market capitalisation by USD 160 million. One month later, the average gain per company had risen to approximately USD 6.5 billion.

The data come from a study published in the journal International Organization and authored by Lorenzo Crippa (University of Strathclyde), Edmund J. Malesky (Duke University) and Lucio Picci (University of Bologna). Using sophisticated statistical analysis methods, the scholars examined companies’ market valuations before and after the suspension of the Foreign Corrupt Practices Act. The aim was to understand how this decision by the US administration affected investor behaviour.

“The reaction of investors suggests that the main deterrent to corruption is the risk of legal sanctions: once this threat is removed, companies already known for risky behaviour in the area of corruption are perceived as more profitable,” says Lucio Picci, professor in the Department of Economics at the University of Bologna. “Over recent decades, the United States has played a crucial role in countering corruption practices at the international level: this abrupt change of course could now have serious consequences for the future of global anti-corruption institutions.”

When the Foreign Corrupt Practices Act came into force in 1977, the United States became the first country in the world to adopt legislation designed to prevent international corruption: the law establishes that US individuals and companies may not bribe foreign officials to obtain or retain business relationships.

However, the law was suspended without prior notice on 10 February 2025 by an executive order signed by United States President Donald Trump. The scholars therefore took the opportunity to analyse how this shift in anti-corruption policy affected 261 companies listed on US stock exchanges that had previously been investigated or sanctioned for violations of the Foreign Corrupt Practices Act. The market performance of these companies was compared with that of 236 comparable firms that had never been subject to investigations for breaches of anti-corruption rules.

“President Trump justified his decision to suspend the Foreign Corrupt Practices Act by arguing that the law represents an obstacle for US multinational companies compared with their competitors elsewhere in the world,” explains Professor Picci. “If this were true, however, all US multinationals should have benefited from the administration’s decision; our data instead show that the suspension of the FCPA disproportionately benefited companies already involved in overseas corruption cases compared with those that have never been investigated.”

On the day the executive order suspending the Foreign Corrupt Practices Act was signed, 10 February, the researchers calculated an average increase of USD 160 million in the market capitalisation of companies already involved in overseas corruption cases – a figure comparable to the average fine imposed on companies previously convicted of violating the anti-corruption law.

On that day, the total gain for the companies considered amounted to approximately USD 39 billion, with individual multinationals previously involved in corruption cases recording increases in market capitalisation in the order of billions of dollars – figures that exceed the largest fines ever imposed for FCPA violations.

“Investors interpreted this decision by the US administration as a signal that investing in these companies had become less risky and more profitable in the short term,” Picci confirms. “This led to significant increases in the market capitalisation of companies that were more likely to become involved in investigations for violations of the anti-corruption law, generating substantial returns for investors.”

The scholars stress that the consequences of suspending this law do not stop at the US context, as they could prompt other countries to scale back their own efforts to combat international corruption.

Between 2000 and 2018, more than half of all anti-corruption legal cases involving companies worldwide were pursued by US authorities. A quarter of all cases were initiated by the United States against non-US companies. This strong enforcement action also encouraged other countries to strengthen and expand their own oversight activities. The risk now is that the shift in direction by the United States will lead to an overall reduction in global anti-corruption efforts.

“When there are stringent regulations and effective oversight, markets can be directed towards less risky and more socially beneficial investments,” Picci comments. “But when regulations are suspended, this positive effect risks coming to a halt, because investors may no longer be discouraged from backing companies that do not comply with the rules.”

---

Journal

International Organization

DOI

10.1017/S0020818325100970 

Article Title

Making Bribery Profitable Again? The Market Effects of Suspending Accountability for Overseas Bribery

 

Night shifts aren’t just tiring, they can be deadly

New research reveals that disrupting our internal body clock weakens immune defenses and fuels aggressive cancer — while pointing to a promising new treatment

Texas A&M University

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

Dr. Tapasree Roy Sarkar

Co-Director, Center for Statistical Bioinformatics

view more 

Credit: Texas A&M University College of Arts and Sciences

Working the night shift, frequently flying across time zones or keeping an irregular sleep schedule does more than just leave us exhausted; it can fuel the risk of aggressive breast cancer. Exactly how and why this happens has remained a mystery, until now.

A new study from the Texas A&M University College of Arts and Sciences led by Dr. Tapasree Roy Sarkar sheds light on this elusive link, finding that circadian disruptions change the structure of mammary glands and weaken the immune system’s defenses, all the while pointing toward a new way to counteract these effects.

"Cancer keeps time," Sarkar said. "If your internal clock is disrupted, cancer takes advantage — but now we’ve found a new way to fight back."

When the clock is off, danger is on

Circadian rhythms — our internal 24-hour clock — do far more than regulate sleep. They help coordinate hormone release, tissue repair and the immune system’s surveillance.

When disrupted, the body’s natural defenses begin to falter.

“The circadian rhythm orchestrates how our tissues function, and how our immune system recognizes danger,” Sarkar said. “When that rhythm is disrupted, the consequences can be seriously dangerous.”

To investigate these effects, the researchers used two groups of genetically engineered models that develop aggressive breast cancer. One group lived on a normal night-day schedule, while the other lived on a disrupted light cycle that threw off their internal clocks.

The findings, published in Nature group journal Oncogene, were striking.

Typical models develop cancer around the 22-week marker. The circadian-disrupted group, however, showed signs of cancer much earlier — at almost 18 weeks.

Tumors in circadian-disrupted models were also far more aggressive, and far more likely to spread to the lungs, a key indicator of poor outcomes in breast cancer patients.

At the same time, disruption of the models’ internal clock suppressed immune defenses, creating a more hospitable environment for cancer growth.

“It wasn’t just that tumors grew faster,” Sarkar said. “The immune system was actively restrained, creating more favorable conditions for cancer cells to survive and spread.”

But the effects weren’t just limited to the tumors themselves. The researchers also found that long-term circadian disruption changed the makeup of healthy breast tissue, making it more vulnerable to cancer.

“We observed clear changes in the morphology of the mammary glands, the milk-producing tissue of the breast,” Sarkar said.

An immune ‘off switch’ revealed

To understand how circadian disruptions affected healthy breast tissue and suppressed immune defenses, the researchers took a closer look inside the tumors.

One molecule stood out: leukocyte immunoglobulin-like receptor B4 (LILRB4), a receptor already known to suppress immune responses in several cancers.

Under normal conditions, LILRB4 helps prevent excessive inflammation and protects healthy tissue.

In cancer, however, it can go into overdrive and become dangerous. Think of LILRB4 as the immune system’s “off switch.”

“LILRB4 acts as an immune checkpoint,” Sarkar said. “When we targeted LILRB4, the tumor microenvironment became less immunosuppressive, and even under disrupted circadian conditions, we observed less cancer spread.”

Disabling this immune checkpoint helped restore the immune system’s ability to fight back, suggesting a new therapeutic angle for treating aggressive breast cancers linked to circadian disruptions.

“When we began to intervene and regulate LILRB4’s activity, we observed significantly less cancer metastasis and tumor growth,” Sarkar said.

A new context for a known target: Personalized cancer treatment

By experimentally linking circadian disruptions to breast cancer progression, the study opens new doors to targeted therapies for patients whose lifestyles or occupations place them at chronic circadian risk.

“This study shows what can happen when our internal clock is repeatedly disrupted, and how we might begin to repair the damage,” Sarkar said.

It also offers some of the strongest evidence that circadian disruption doesn’t just correlate with cancer risk, it can actively drive cancer progression.

“The study reframes sleep and timing as powerful players in cancer progression and treatment,” Sarkar said.

And in a world that actively runs around the clock, the implications extend far beyond the laboratory. An estimated 12 to 35 percent of Americans work irregular schedules, including night and rotating shifts.

“A significant portion of the population works night or rotating shifts,” Sarkar said. “This makes understanding the impact of circadian disruptions on cancer risk incredibly important.”

The research team’s next big project is to investigate how the effects of chronic circadian disruptions might be reversed in humans, with the aim of improving health outcomes for night-shift workers and others with irregular sleep schedules, like flight attendants and frequent travelers.

“Our next goal is to better understand how we can reverse the effects of circadian disruption and help advance human health with a real-world impact,” Sarkar said.

Cancer may keep time — but with monumental discoveries like these, scientists are learning how to take control of the clock.

 

More information: LILRB4 regulates circadian disruption-induced mammary tumorigenesis via non-canonical WNT signaling pathway. Oncogene 44, 4491–4504 (2025)
DOI 10.1016/j.celbio.2025.100152 
https://www.nature.com/articles/s41388-025-03597-5

Journal information: Oncogene

 

---

Journal

Oncogene

DOI

10.1038/s41388-025-03597-5 

Article Title

LILRB4 regulates circadian disruption-induced mammary tumorigenesis via non-canonical WNT signaling pathway

Article Publicatio

MONOPOLY CAPITALI$M

Investigation Shows How Decades of Corporate Consolidation Have Devastated US Cattle Ranchers

“The marketplace is fundamentally broken,” one rancher explained.

Cattle rancher Denise McConville puts a gate back up after feeding alfalfa to her black angus cattle on September 12, 2022 in McCook, NE.
(Photo by Ricky Carioti/The Washington Post via Getty Images)

Brad Reed
Dec 23, 2025
COMMON DREAMS

Even as US beef prices have continued to surge, American cattle ranchers have come under increased financial pressure—and a new report from More Perfect Union claims that this is due in part to industry consolidation in the meat-packing industry.

Bill Bullard, the CEO of the trade association R-CALF USA, explained to More Perfect Union that cattle ranchers are essentially at the bottom of the pyramid in the beef-producing process, while the top is occupied by “four meat packers controlling 80% of the market.”

“It’s there that the meat packers are able to exert their market power in order to leverage down the price that the cattle feeder receives for the animals,” Bullard said.

To illustrate the impact this has had on farmers, Bullard pointed out that cattle producers in 1980 received 63 cents for every dollar paid by consumers for beef, whereas four decades later they were receiving just 37 cents for every dollar.

“That allocation has flipped on its head because the marketplace is fundamentally broken,” Bullard told More Perfect Union.



Angela Huffman, president of Farm Action, recently highlighted the role played by the four big meatpacking companies—Tyson, Cargill, National Beef, and JBS—in hurting US ranchers.

Writing on her Substack page earlier this month, Huffman zeroed in on Tyson’s recent decision to close one of its meatpacking plants in Lexington, Nebraska to demonstrate the outsize power that big corporations have over the US food supply.

The Lexington plant employs more than 3,000 people and is capable of processing 5,000 head of cattle a day, and its closure is expected to both devastate the local economy and have a major impact on US ranchers throughout the region.

Huffman noted a report from the Associated Press estimating that the Lexington plant’s closure, combined with projected job cuts at a Tyson plant in Amarillo, Texas, could cut national beef processing capacity by up to 9%.

“Ranchers were already dealing with high costs, drought, and years of uneven prices,” Huffman wrote. “Now they face even less competition for their cattle. When there are fewer packers active in the market, ranchers have less bargaining power, and cattle prices fall even as beef prices in grocery stores stay near record highs.”

Dan Osborn, an independent US Senate candidate running in Nebraska, has made the dangers of corporate consolidation a central theme of his campaign, and on Monday he released a video explaining why he spends so much time talking about monopolies, particularly in the agricultural industry.

“If you’re a farmer, your inputs, your seed, your chemicals, you have to buy from monopolies,” he said. “Sygenta, Chinese-owned company you’ve got to buy your seed from, they control and manipulate that market. And then when your production’s over and you’re selling it, you’re selling it to monopolies as well.”



Osborn said that the trend of industry consolidation wasn’t just limited to agriculture, but is now moving forward with major railroad and media mergers.

“We need to create an economic environment in this country that favors competition,” he said. “That’s what a free market is. A free market isn’t three or four big people or big corporations controlling everything.”