Heat is an environmental and occupational hazard. The prevention of deaths in the community caused by extreme high temperatures (heat waves) is now an issue of public health concern. The risk of ...heat-related mortality increases with natural aging, but persons with particular social and/or physical vulnerability are also at risk. Important differences in vulnerability exist between populations, depending on climate, culture, infrastructure (housing), and other factors. Public health measures include health promotion and heat wave warning systems, but the effectiveness of acute measures in response to heat waves has not yet been formally evaluated. Climate change will increase the frequency and the intensity of heat waves, and a range of measures, including improvements to housing, management of chronic diseases, and institutional care of the elderly and the vulnerable, will need to be developed to reduce health impacts.
Background: Global climate change is anticipated to reduce future cereal yields and threaten food security, thus potentially increasing the risk of undernutrition. The causation of undernutrition is ...complex, and there is a need to develop models that better quantify the potential impacts of climate change on population health. OBJECTIVES: We developed a model for estimating future undernutrition that accounts for food and nonfood (socioeconomic) causes and can be linked to available regional scenario data. We estimated child stunting attributable to climate change in five regions in South Asia and sub-Saharan Africa (SSA) in 2050. METHODS: We used current national food availability and undernutrition data to parameterize and validate a global model, using a process-driven approach based on estimations of the physiological relationship between a lack of food and stunting. We estimated stunting in 2050 using published modeled national calorie availability under two climate scenarios and a reference scenario (no climate change). RESULTS: We estimated that climate change will lead to a relative increase in moderate stunting of 1-29% in 2050 compared with a future without climate change. Climate change will have a greater impact on rates of severe stunting, which we estimated will increase by 23% (central SSA) to 62% (South Asia). Conclusions: Climate change is likely to impair future efforts to reduce child malnutrition in South Asia and SSA, even when economic growdi is taken into account. Our model suggests that to reduce and prevent future undernutrition, it is necessary to both increase food access and improve socioeconomic conditions, as well as reduce greenhouse gas emissions.
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BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even ...hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Assessments of the potential human health impacts of climate change are needed to inform the development of adaptation strategies, policies, and measures to lessen projected adverse impacts. We ...developed methods for country-level assessments to help policy makers make evidence-based decisions to increase resilience to current and future climates, and to provide information for national communications to the United Nations Framework Convention on Climate Change. The steps in an assessment should include the following: a) determine the scope of the assessment; b) describe the current distribution and burden of climate-sensitive health determinants and outcomes; c) identify and describe current strategies, policies, and measures designed to reduce the burden of climate-sensitive health determinants and outcomes; d) review the health implications of the potential impacts of climate variability and change in other sectors; e) estimate the future potential health impacts using scenarios of future changes in climate, socioeconomic, and other factors; f) synthesize the results; and g) identify additional adaptation policies and measures to reduce potential negative health impacts. Key issues for ensuring that an assessment is informative, timely, and useful include stakeholder involvement, an adequate management structure, and a communication strategy.
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BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
High ambient temperatures are associated with an acute increase in mortality risk. Although heat exposure during the night is anecdotally cited as being important, this has not been rigorously ...demonstrated in the epidemiological literature.
We quantified the contribution of nighttime temperatures using time-series quasi-Poisson regression on cause and age-specific daily mortality in London between 1993 and 2015. Daytime and nighttime exposures were characterized by average temperatures between 9 am and 9 pm and between 4 am and 8 am, respectively, lagged by 7 days. We also examined the differential impacts of hot and cool nights preceded by very hot days. All models were adjusted for air quality, season, and day of the week. Nighttime models were additionally adjusted for daytime exposure.
Effects from nighttime exposure persisted after adjusting for daytime exposure. This was highest for stroke, RR (relative risk) = 1.65 (95% confidence interval (CI) = 1.27 to 2.14) estimated by comparing mortality risk at the 80th and 99th temperature percentiles. Compared to daytime exposure, nighttime exposure had a higher mortality risk on chronic ischemic and stroke and in the younger age groups. Respiratory mortality was most sensitive to daytime temperatures. Hot days followed by hot nights had a greater mortality risk than hot days followed by cool nights.
Nighttime exposures make an additional important contribution to heat-related mortality. This impact was highest on warm nights that were preceded by a hot day, which justifies the alert criteria in heat-health warning system that is based on hot days followed by hot nights. The highest mortality risk was from stroke; targeted interventions would benefit patients most susceptible to stroke.
ObjectivesSeveral observational studies have suggested an association between high temperatures and all-cause mortality. However, estimates on more specific mortality outcomes are sparse, and ...frequently assessed in studies using different analytical methods.MethodsA time series analysis was performed on 10 regions in England and Wales during the summers (June–September) of 1993–2006. Average percentage linear increases in risk for a 1°C increase in temperature above region-specific thresholds and attributable deaths were computed by cause-specific mortality and age groups (0–64, 65–74, 75–84, 85+).ResultsThere was evidence of increased mortality with heat for almost all cause-of-death groups examined, with an overall increase in all-cause mortality of 2.1% (95% CI 1.6% to 2.6%) for a 1°C rise above the regional heat threshold. Among main causes, the steepest increase in risk was for respiratory mortality (+4.1% (3.5% to 4.8%) per 1°C). It was much smaller for cardiovascular causes (+1.8% (1.2% to 2.5%)) and myocardial infarction (+1.1% (0.7% to 1.5%)), but comparatively high for arrhythmias (+5.0% (3.2% to 6.9%)) and pulmonary heart disease (+8.3% (2.7% to 14.3%)). Among non- cardiorespiratory causes, the strongest effects were for genitourinary (+3.8% (2.9% to 4.7%)) and nervous system (+4.6% (3.7% to 5.4%)) disorders. 33.9% of heat deaths were attributable to cardiovascular causes, 24.7% to respiratory causes and 41.3% to all other causes combined.ConclusionsThese results suggest that the risk of heat-related mortality is distributed across a wide range of different causes, and that targeting of preventative actions based on pre-existing disease is unlikely to be efficient.
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Heat related mortality is of great concern for public health, and estimates of future mortality under a warming climate are important for planning of resources and possible adaptation measures. ...Papers providing projections of future heat-related mortality were critically reviewed with a focus on the use of climate model data. Some best practice guidelines are proposed for future research.
The electronic databases Web of Science and PubMed/Medline were searched for papers containing a quantitative estimate of future heat-related mortality. The search was limited to papers published in English in peer-reviewed journals up to the end of March 2017. Reference lists of relevant papers and the citing literature were also examined. The wide range of locations studied and climate data used prevented a meta-analysis.
A total of 608 articles were identified after removal of duplicate entries, of which 63 were found to contain a quantitative estimate of future mortality from hot days or heat waves. A wide range of mortality models and climate model data have been used to estimate future mortality. Temperatures in the climate simulations used in these studies were projected to increase. Consequently, all the papers indicated that mortality from high temperatures would increase under a warming climate. The spread in projections of future climate by models adds substantial uncertainty to estimates of future heat-related mortality. However, many studies either did not consider this source of uncertainty, or only used results from a small number of climate models. Other studies showed that uncertainty from changes in populations and demographics, and the methods for adaptation to warmer temperatures were at least as important as climate model uncertainty. Some inconsistencies in the use of climate data (for example, using global mean temperature changes instead of changes for specific locations) and interpretation of the effects on mortality were apparent. Some factors which have not been considered when estimating future mortality are summarised.
Most studies have used climate data generated using scenarios with medium and high emissions of greenhouse gases. More estimates of future mortality using climate information from the mitigation scenario RCP2.6 are needed, as this scenario is the only one under which the Paris Agreement to limit global warming to 2°C or less could be realised. Many of the methods used to combine modelled data with local climate observations are simplistic. Quantile-based methods might offer an improved approach, especially for temperatures at the ends of the distributions. The modelling of adaptation to warmer temperatures in mortality models is generally arbitrary and simplistic, and more research is needed to better quantify adaptation. Only a small number of studies included possible changes in population and demographics in their estimates of future mortality, meaning many estimates of mortality could be biased low. Uncertainty originating from establishing a mortality baseline, climate projections, adaptation and population changes is important and should be considered when estimating future mortality.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Seasonal fluctuation in suicide has been observed in many populations. High temperature may contribute to this, but the effect of short-term fluctuations in temperature on suicide rates has not been ...studied.
To assess the relationship between daily temperature and daily suicide counts in England and Wales between 1 January 1993 and 31 December 2003 and to establish whether heatwaves are associated with increased mortality from suicide.
Time-series regression analysis was used to explore and quantify the relationship between daily suicide counts and daily temperature. The impact of two heatwaves on suicide was estimated.
No spring or summer peak in suicide was found. Above 18 degrees C, each 1 degrees C increase in mean temperature was associated with a 3.8 and 5.0% rise in suicide and violent suicide respectively. Suicide increased by 46.9% during the 1995 heatwave, whereas no change was seen during the 2003 heat wave.
There is increased risk of suicide during hot weather.
With rapid economic development, China has been plagued by choking air pollution in recent years, and the frequent occurrence of haze episodes has caused widespread public concern. The purpose of ...this study is to describe the sources and formation of haze, summarize the mitigation measures in force, review the relationship between haze pollution and public health, and to discuss the challenges, potential research directions and policy options. Haze pollution has both natural and man-made causes, though it is anthropogenic sources that are the major contributors. Accumulation of air pollutants, secondary formation of aerosols, stagnant meteorological conditions, and trans-boundary transportation of pollutants are the principal causes driving the formation and evolution of haze. In China, haze includes gaseous pollutants and fine particles, of which PM2.5 is the dominant component. Short and long-term exposure to haze pollution are associated with a range of negative health outcomes, including respiratory diseases, cardiovascular and cerebrovascular diseases, mental health problems, lung cancer and premature death. China has paid increasing attention to the improvement of air quality, and has introduced action plans and policies to tackle pollution, but many interventions have only temporary effects. There may be fierce resistance from industry groups and some government agencies, and often it is challenging to enforce relevant control measures and laws. We discuss the potential policy options for prevention, the need for wider public dialogue and the implications for scientific research.
The sources, formation, and health effects of haze pollution in China. Display omitted
•The relationship between haze pollution and public health in China was reviewed for the first time.•The sources and formation of haze episode were described.•The existing mitigation measures and challenges faced China were summarized.•The potential policy options and future research directions were discussed.•Individual prevention measures during haze events from the public aspects were further suggested.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
•People living in urban areas that have more trees and more vegetation experience lower temperatures.•We demonstrate for the first time in the UK the benefit of urban vegetation for heat-related ...mortality.•There was no evidence of modification of heat-related mortality by local area social-economic indicators.•Urban greenspace should be maintained and increased as part of wider strategy to adapt to climate change.
Management of the natural and built environments can help reduce the health impacts of climate change. This is particularly relevant in large cities where urban heat island makes cities warmer than the surrounding areas. We investigate how urban vegetation, housing characteristics and socio-economic factors modify the association between heat exposure and mortality in a large urban area.
We linked 185,397 death records from the Greater London area during May-Sept 2007–2016 to a high resolution daily temperature dataset. We then applied conditional logistic regression within a case-crossover design to estimate the odds of death from heat exposure by individual (age, sex) and local area factors: land-use type, natural environment (vegetation index, tree cover, domestic garden), built environment (indoor temperature, housing type, lone occupancy) and socio-economic factors (deprivation, English language, level of employment and prevalence of ill-health).
Temperatures were higher in neighbourhoods with lower levels of urban vegetation and with higher levels of income deprivation, social-rented housing, and non-native English speakers. Heat-related mortality increased with temperature increase (Odds Ratio (OR), 95% CI = 1.039, 1.036–1.043 per 1 °C temperature increase). Vegetation cover showed the greatest modification effect, for example the odds of heat-related mortality in quartiles with the highest and lowest tree cover were OR, 95%CI 1.033, 1.026–1.039 and 1.043, 1.037–1.050 respectively. None of the socio-economic variables were a significant modifier of heat-related mortality.
We demonstrate that urban vegetation can modify the mortality risk associated with heat exposure. These findings make an important contribution towards informing city-level climate change adaptation and mitigation policies.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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