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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 June 2016)

Special Issue Editor

Guest Editor
Prof. Dr. Jan C. Semenza (Website)

European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 83 Stockholm, Sweden
Phone: 00-46-76-101-0711

Special Issue Information

Dear Colleagues,

Climate change is here to stay, at least for the foreseeable future, even with immediate reductions in greenhouse gas emissions. A multitude of climate change impacts have already been documented, particularly those on the hydrologic cycle, cryosphere, ecosystems, biodiversity, agriculture, forests, oceans, etc. Climate change impacts in the health sector have also been recognized; they often manifest themselves as an extension or amplification of existing vulnerabilities. Some of these health endpoints include heat-related mortality and morbidity, respiratory diseases, mental health, drowning, vector-, food- or waterborne diseases. Moreover, indirect socio-economic effects that can result in malnutrition, homelessness, refugees, etc. can also have serious health consequences. However, the field suffers from a number of challenges; specifically, the question of attribution presents a number of methodological hurdles. While extreme weather events can statistically be linked to climate change, quantifying the contribution of climate change on individual events is problematic, no less the relative contribution of climate change to the disease burden.

This special issue in IJERPH aims to advance the field of human health impacts of climate change with topical contributions. It aims to synthesise some of these public health issues but also to address the technical challenges. This issue welcomes both quantitative and qualitative studies and is intended to include papers that measure, monitor and describe health impacts. Of particular interest are decision-support tools for identifying and prioritizing risks through surveillance, vulnerability, impact and adaptation assessments. Interventions on climate-sensitive health risks are also of interest, particularly rigorous cost-effectiveness, program, and process evaluations. Monitoring environmental precursors of disease can be used as early warning for health threats and the application of these tools is of great interest to public health practitioners. Thus, this special issue prioritizes research papers over review papers, unless there is an obvious gap in the literature. This special issue on Climate Change and Human Health represents an effort to capture current developments in the field and provide a forum for cutting edge contributions to the literature.

Prof. Dr. Jan C. Semenza
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed Open Access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs).

Published Papers (53 papers)

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Editorial

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Open AccessEditorial Climate Change and Human Health
Int. J. Environ. Res. Public Health 2014, 11(7), 7347-7353; doi:10.3390/ijerph110707347
Received: 7 July 2014 / Accepted: 9 July 2014 / Published: 18 July 2014
Cited by 6 | PDF Full-text (173 KB) | HTML Full-text | XML Full-text
Abstract
Climate change impacts on human health span the trajectory of time—past, present, and future. The key finding from the Working Group II, Fifth Assessment Report (AR5) of the Intergovernmental Panel on Climate Change (IPCC) states that health impacts due to climate change [...] Read more.
Climate change impacts on human health span the trajectory of time—past, present, and future. The key finding from the Working Group II, Fifth Assessment Report (AR5) of the Intergovernmental Panel on Climate Change (IPCC) states that health impacts due to climate change have already occurred in the past, are currently occurring and will continue to occur, at least for the foreseeable future, even with immediate reductions in greenhouse gas emissions [1]. According to the IPCC, there has been increased heat-related mortality and decreased cold-related mortality in some regions as a result of warming (Box 1). Moreover, local changes in temperature and rainfall have altered the distribution of some water-borne illnesses and disease vectors. Impacts of climate-related extremes include alteration of ecosystems, disruption of food production and water supply, damage to infrastructure and settlements, morbidity and mortality, and consequences for mental health and human well-being [1]. [...] Full article
(This article belongs to the Special Issue Climate Change and Human Health)

Research

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Open AccessArticle Economic Burden of Hospitalizations for Heat-Related Illnesses in the United States, 2001–2010
Int. J. Environ. Res. Public Health 2016, 13(9), 894; doi:10.3390/ijerph13090894
Received: 30 July 2016 / Revised: 25 August 2016 / Accepted: 29 August 2016 / Published: 8 September 2016
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Abstract
Understanding how heat waves affect morbidity and mortality, as well as the associated economic costs, is essential for characterizing the human health impacts of extreme heat under a changing climate. Only a handful of studies have examined healthcare costs associated with exposures [...] Read more.
Understanding how heat waves affect morbidity and mortality, as well as the associated economic costs, is essential for characterizing the human health impacts of extreme heat under a changing climate. Only a handful of studies have examined healthcare costs associated with exposures to high temperatures. This research explores costs associated with hospitalizations for heat-related illness (HRI) in the United States using the 2001 to 2010 Nationwide Inpatient Sample (NIS). Descriptive statistics of patient data for HRI hospitalizations were examined and costs of hospitalizations were reported using the all-payer inpatient cost-to-charge ratio. Costs were examined using a log-gamma model with patient and hospital characteristics included as fixed effects. Adjusted mean costs were then compared across racial groups. The mean costs of HRI hospitalizations were higher among racial/ethnic minorities compared to Whites, who accounted for almost 65% of all HRI hospitalizations. Observed differences in costs based on income, insurance, and gender were also significant. These results suggest that these populations are suffering disproportionately from health inequity, thus, they could shoulder greater disease and financial burdens due to climate change. These findings may have important implications in understanding the economic impact public health planning and interventions will have on preventing hospitalizations related to extreme heat. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Public Health Adaptation to Climate Change in OECD Countries
Int. J. Environ. Res. Public Health 2016, 13(9), 889; doi:10.3390/ijerph13090889
Received: 22 May 2016 / Revised: 23 August 2016 / Accepted: 24 August 2016 / Published: 7 September 2016
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Abstract
Climate change is a major challenge facing public health. National governments play a key role in public health adaptation to climate change, but there are competing views on what responsibilities and obligations this will—or should—include in different nations. This study aims to: [...] Read more.
Climate change is a major challenge facing public health. National governments play a key role in public health adaptation to climate change, but there are competing views on what responsibilities and obligations this will—or should—include in different nations. This study aims to: (1) examine how national-level public health adaptation is occurring in Organization for Economic Cooperation and Development (OECD) countries; (2) examine the roles national governments are taking in public health adaptation; and (3) critically appraise three key governance dimensions of national-level health adaptation—cross-sectoral collaboration, vertical coordination and national health adaptation planning—and identify practical examples suited to different contexts. We systematically reviewed publicly available public health adaptation to climate change documents and webpages by national governments in ten OECD countries using systematic web searches, assessment of self-reporting, and content analysis. Our findings suggest national governments are primarily addressing infectious disease and heat-related risks posed by climate change, typically emphasizing capacity building or information-based groundwork initiatives. We find national governments are taking a variety of approaches to public health adaptation to climate change that do not follow expected convergence and divergence by governance structure. We discuss practical options for incorporating cross-sectoral collaboration, vertical coordination and national health adaptation planning into a variety of contexts and identify leaders national governments can look to to inform their public health adaptation planning. Following the adoption of the Paris Agreement and subsequent increased momentum for adaptation, research tracking adaptation is needed to define what health adaptation looks like in practice, reveal insights that can be taken up across states and sectors, and ensure policy orientated learning. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
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Open AccessArticle Temperature Variability and Occurrence of Diarrhoea in Children under Five-Years-Old in Cape Town Metropolitan Sub-Districts
Int. J. Environ. Res. Public Health 2016, 13(9), 859; doi:10.3390/ijerph13090859
Received: 8 June 2016 / Revised: 10 August 2016 / Accepted: 17 August 2016 / Published: 29 August 2016
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Abstract
This paper describes the relationship between temperature change and diarrhoea in under five-year-old children in the Cape Town Metropolitan Area (CTMA) of South Africa. The study used climatic and aggregated surveillance diarrhoea incidence data of two peak periods of seven months each [...] Read more.
This paper describes the relationship between temperature change and diarrhoea in under five-year-old children in the Cape Town Metropolitan Area (CTMA) of South Africa. The study used climatic and aggregated surveillance diarrhoea incidence data of two peak periods of seven months each over two consecutive years. A Poisson regression model and a lagged Poisson model with autocorrelation was performed to test the relationship between climatic parameters (minimum and maximum temperature) and incidence of diarrhoea. In total, 58,617 cases of diarrhoea occurred in the CTMA, which is equivalent to 8.60 cases per 100 population under five years old for the study period. The mixed effect overdispersed Poisson model showed that a cluster adjusted effect of an increase of 5 °C in minimum and maximum temperature results in a 40% (Incidence risk ratio IRR: 1.39, 95% CI 1.31–1.48) and 32% (IRR: 1.32, 95% CI: 1.22–1.41) increase in incident cases of diarrhoea, respectively, for the two periods studied. Autocorrelation of one-week lag (Autocorrelation AC 1) indicated that a 5 °C increase in minimum and maximum temperature led to 15% (IRR: 1.46, 95% CI: 1.09–1.20) and 6% (IRR: 1.06, 95% CI: 1.01–1.12) increase in diarrhoea cases, respectively. In conclusion, there was an association between an increase in minimum and maximum temperature, and the rate at which diarrhoea affected children under the age of five years old in the Cape Town Metropolitan Area. This finding may have implications for the effects of global warming and requires further investigation. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
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Open AccessArticle Working with Climate Projections to Estimate Disease Burden: Perspectives from Public Health
Int. J. Environ. Res. Public Health 2016, 13(8), 804; doi:10.3390/ijerph13080804
Received: 20 June 2016 / Revised: 2 August 2016 / Accepted: 3 August 2016 / Published: 9 August 2016
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Abstract
There is interest among agencies and public health practitioners in the United States (USA) to estimate the future burden of climate-related health outcomes. Calculating disease burden projections can be especially daunting, given the complexities of climate modeling and the multiple pathways by [...] Read more.
There is interest among agencies and public health practitioners in the United States (USA) to estimate the future burden of climate-related health outcomes. Calculating disease burden projections can be especially daunting, given the complexities of climate modeling and the multiple pathways by which climate influences public health. Interdisciplinary coordination between public health practitioners and climate scientists is necessary for scientifically derived estimates. We describe a unique partnership of state and regional climate scientists and public health practitioners assembled by the Florida Building Resilience Against Climate Effects (BRACE) program. We provide a background on climate modeling and projections that has been developed specifically for public health practitioners, describe methodologies for combining climate and health data to project disease burden, and demonstrate three examples of this process used in Florida. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
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Open AccessArticle A Comprehensive Evaluation of the Burden of Heat-Related Illness and Death within the Florida Population
Int. J. Environ. Res. Public Health 2016, 13(6), 551; doi:10.3390/ijerph13060551
Received: 23 April 2016 / Revised: 22 May 2016 / Accepted: 25 May 2016 / Published: 31 May 2016
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Abstract
The failure of the human body to thermoregulate can lead to severe outcomes (e.g., death) and lasting physiological damage. However, heat-related illness (HRI) is highly preventable via individual- and community-level modification. A thorough understanding of the burden is necessary for effective intervention. [...] Read more.
The failure of the human body to thermoregulate can lead to severe outcomes (e.g., death) and lasting physiological damage. However, heat-related illness (HRI) is highly preventable via individual- and community-level modification. A thorough understanding of the burden is necessary for effective intervention. This paper describes the burden of severe HRI morbidity and mortality among residents of a humid subtropical climate. Work-related and non-work-related HRI emergency department (ED) visits, hospitalizations, and deaths among Florida residents during May to October (2005–2012) were examined. Sub-groups susceptible to HRI were identified. The age-adjusted rates/100,000 person-years for non-work-related HRI were 33.1 ED visits, 5.9 hospitalizations, and 0.2 deaths, while for work-related HRI/100,000 worker-years there were 8.5 ED visits, 1.1 hospitalizations, and 0.1 deaths. The rates of HRI varied by county, data source, and work-related status, with the highest rates observed in the panhandle and south central Florida. The sub-groups with the highest relative rates regardless of data source or work-relatedness were males, minorities, and rural residents. Those aged 15–35 years had the highest ED visit rates, while for non-work-related hospitalizations and deaths the rates increased with age. The results of this study can be used for targeted interventions and evaluating changes in the HRI burden over time. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Health Aspects of Climate Change in Cities with Mediterranean Climate, and Local Adaptation Plans
Int. J. Environ. Res. Public Health 2016, 13(4), 438; doi:10.3390/ijerph13040438
Received: 30 December 2015 / Revised: 5 April 2016 / Accepted: 13 April 2016 / Published: 21 April 2016
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Abstract
Cities with a Mediterranean-type climate (Med-cities) are particularly susceptible to health risks from climate change since they are located in biogeographical hot-spots that experience some of the strongest effects of the changing climate. The study aims to highlight health impacts of climate [...] Read more.
Cities with a Mediterranean-type climate (Med-cities) are particularly susceptible to health risks from climate change since they are located in biogeographical hot-spots that experience some of the strongest effects of the changing climate. The study aims to highlight health impacts of climate change in Med-cities, analyze local climate adaptation plans and make adaptation policy recommendations for the Med-city level. We identified five Med-cities with a climate change adaptation plan: Adelaide, Barcelona, Cape Town, Los Angeles and Santiago. Beyond their similar Med-climate features (although Santiago’s are slightly different), the cities have different socio-economic characteristics in various aspects. We analyzed each plan according to how it addresses climate change-related drivers of health impacts among city dwellers. For each driver, we identified the types of policy adaptation tools that address it in the urban climate adaptation plans. The surveyed cities address most of the fundamental climate change-related drivers of risks to human health, including rising temperatures, flooding and drought, but the policy measures to reduce negative impacts vary across cities. We suggest recommendations for Med-cities in various aspects, depending on their local needs and vulnerability challenges: assessment of health risks, extreme events management and long-term adaptation, among others. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Do Climate Change Policies Promote or Conflict with Subjective Wellbeing: A Case Study of Suzhou, China
Int. J. Environ. Res. Public Health 2016, 13(3), 344; doi:10.3390/ijerph13030344
Received: 29 January 2016 / Revised: 9 March 2016 / Accepted: 16 March 2016 / Published: 21 March 2016
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Abstract
As public expectations for health rise, health measurements broaden from a focus on death, disease, and disability to wellbeing. However, wellbeing hasn’t been incorporated into the framework of climate change policy decision-making in Chinese cities. Based on survey data (n = [...] Read more.
As public expectations for health rise, health measurements broaden from a focus on death, disease, and disability to wellbeing. However, wellbeing hasn’t been incorporated into the framework of climate change policy decision-making in Chinese cities. Based on survey data (n = 763) from Suzhou, this study used Generalized Estimation Equation approach to model external conditions associated with wellbeing. Then, semi-quantitative analyses were conducted to provide a first indication to whether local climate change policies promote or conflict with wellbeing through altering these conditions. Our findings suggested: (i) Socio-demographic (age, job satisfaction, health), psychosocial (satisfaction with social life, ontological security/resilience) and environmental conditions (distance to busy road, noise annoyance and range hoods in the kitchen) were significantly associated with wellbeing; (ii) None of existing climate change strategies in Suzhou conflict with wellbeing. Three mitigation policies (promotion of tertiary and high–tech industry, increased renewable energy in buildings, and restrictions on car use) and one adaption policy (increasing resilience) brought positive co–benefits for wellbeing, through the availability of high-satisfied jobs, reduced dependence on range hoods, noise reduction, and valuing citizens, respectively. This study also provided implications for other similar Chinese cities that potential consequences of climate change interventions for wellbeing should be considered. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Mortality during a Large-Scale Heat Wave by Place, Demographic Group, Internal and External Causes of Death, and Building Climate Zone
Int. J. Environ. Res. Public Health 2016, 13(3), 299; doi:10.3390/ijerph13030299
Received: 15 January 2016 / Revised: 20 February 2016 / Accepted: 22 February 2016 / Published: 9 March 2016
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Abstract
Mortality increases during periods of elevated heat. Identification of vulnerable subgroups by demographics, causes of death, and geographic regions, including deaths occurring at home, is needed to inform public health prevention efforts. We calculated mortality relative risks (RRs) and excess deaths associated [...] Read more.
Mortality increases during periods of elevated heat. Identification of vulnerable subgroups by demographics, causes of death, and geographic regions, including deaths occurring at home, is needed to inform public health prevention efforts. We calculated mortality relative risks (RRs) and excess deaths associated with a large-scale California heat wave in 2006, comparing deaths during the heat wave with reference days. For total (all-place) and at-home mortality, we examined risks by demographic factors, internal and external causes of death, and building climate zones. During the heat wave, 582 excess deaths occurred, a 5% increase over expected (RR = 1.05, 95% confidence interval (CI) 1.03–1.08). Sixty-six percent of excess deaths were at home (RR = 1.12, CI 1.07–1.16). Total mortality risk was higher among those aged 35–44 years than ≥65, and among Hispanics than whites. Deaths from external causes increased more sharply (RR = 1.18, CI 1.10–1.27) than from internal causes (RR = 1.04, CI 1.02–1.07). Geographically, risk varied by building climate zone; the highest risks of at-home death occurred in the northernmost coastal zone (RR = 1.58, CI 1.01–2.48) and the southernmost zone of California’s Central Valley (RR = 1.43, CI 1.21–1.68). Heat wave mortality risk varied across subpopulations, and some patterns of vulnerability differed from those previously identified. Public health efforts should also address at-home mortality, non-elderly adults, external causes, and at-risk geographic regions. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Spatial Patterns of Heat-Related Cardiovascular Mortality in the Czech Republic
Int. J. Environ. Res. Public Health 2016, 13(3), 284; doi:10.3390/ijerph13030284
Received: 30 November 2015 / Revised: 31 January 2016 / Accepted: 23 February 2016 / Published: 4 March 2016
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Abstract
The study examines spatial patterns of effects of high temperature extremes on cardiovascular mortality in the Czech Republic at a district level during 1994–2009. Daily baseline mortality for each district was determined using a single location-stratified generalized additive model. Mean relative deviations [...] Read more.
The study examines spatial patterns of effects of high temperature extremes on cardiovascular mortality in the Czech Republic at a district level during 1994–2009. Daily baseline mortality for each district was determined using a single location-stratified generalized additive model. Mean relative deviations of mortality from the baseline were calculated on days exceeding the 90th percentile of mean daily temperature in summer, and they were correlated with selected demographic, socioeconomic, and physical-environmental variables for the districts. Groups of districts with similar characteristics were identified according to socioeconomic status and urbanization level in order to provide a more general picture than possible on the district level. We evaluated lagged patterns of excess mortality after hot spell occurrences in: (i) urban areas vs. predominantly rural areas; and (ii) regions with different overall socioeconomic level. Our findings suggest that climatic conditions, altitude, and urbanization generally affect the spatial distribution of districts with the highest excess cardiovascular mortality, while socioeconomic status did not show a significant effect in the analysis across the Czech Republic as a whole. Only within deprived populations, socioeconomic status played a relevant role as well. After taking into account lagged effects of temperature on excess mortality, we found that the effect of hot spells was significant in highly urbanized regions, while most excess deaths in rural districts may be attributed to harvesting effects. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Evaluating the Appropriateness of Downscaled Climate Information for Projecting Risks of Salmonella
Int. J. Environ. Res. Public Health 2016, 13(3), 267; doi:10.3390/ijerph13030267
Received: 19 August 2015 / Revised: 7 February 2016 / Accepted: 17 February 2016 / Published: 29 February 2016
Cited by 1 | PDF Full-text (2381 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Foodborne diseases have large economic and societal impacts worldwide. To evaluate how the risks of foodborne diseases might change in response to climate change, credible and usable climate information tailored to the specific application question is needed. Global Climate Model (GCM) data [...] Read more.
Foodborne diseases have large economic and societal impacts worldwide. To evaluate how the risks of foodborne diseases might change in response to climate change, credible and usable climate information tailored to the specific application question is needed. Global Climate Model (GCM) data generally need to, both, be downscaled to the scales of the application to be usable, and represent, well, the key characteristics that inflict health impacts. This study presents an evaluation of temperature-based heat indices for the Washington D.C. area derived from statistically downscaled GCM simulations for 1971–2000—a necessary step in establishing the credibility of these data. The indices approximate high weekly mean temperatures linked previously to occurrences of Salmonella infections. Due to bias-correction, included in the Asynchronous Regional Regression Model (ARRM) and the Bias Correction Constructed Analogs (BCCA) downscaling methods, the observed 30-year means of the heat indices were reproduced reasonably well. In April and May, however, some of the statistically downscaled data misrepresent the increase in the number of hot days towards the summer months. This study demonstrates the dependence of the outcomes to the selection of downscaled climate data and the potential for misinterpretation of future estimates of Salmonella infections. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Effect of Climate Factors on the Childhood Pneumonia in Papua New Guinea: A Time-Series Analysis
Int. J. Environ. Res. Public Health 2016, 13(2), 213; doi:10.3390/ijerph13020213
Received: 17 October 2015 / Revised: 13 January 2016 / Accepted: 3 February 2016 / Published: 15 February 2016
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Abstract
This study aimed to assess the association between climate factors and the incidence of childhood pneumonia in Papua New Guinea quantitatively and to evaluate the variability of the effect size according to their geographic properties. The pneumonia incidence in children under five-year [...] Read more.
This study aimed to assess the association between climate factors and the incidence of childhood pneumonia in Papua New Guinea quantitatively and to evaluate the variability of the effect size according to their geographic properties. The pneumonia incidence in children under five-year and meteorological factors were obtained from six areas, including monthly rainfall and the monthly average daily maximum temperatures during the period from 1997 to 2006 from national health surveillance data. A generalized linear model was applied to measure the effect size of local and regional climate factor. The pooled risk of pneumonia in children per every 10 mm increase of rainfall was 0.24% (95% confidence interval: −0.01%–0.50%), and risk per every 1 °C increase of the monthly mean of the maximum daily temperatures was 4.88% (95% CI: 1.57–8.30). Southern oscillation index and dipole mode index showed an overall negative effect on childhood pneumonia incidence, −0.57% and −4.30%, respectively, and the risk of pneumonia was higher in the dry season than in the rainy season (pooled effect: 12.08%). There was a variability in the relationship between climate factors and pneumonia which is assumed to reflect distribution of the determinants of and vulnerability to pneumonia in the community. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Evaluation of an Early-Warning System for Heat Wave-Related Mortality in Europe: Implications for Sub-seasonal to Seasonal Forecasting and Climate Services
Int. J. Environ. Res. Public Health 2016, 13(2), 206; doi:10.3390/ijerph13020206
Received: 30 November 2015 / Accepted: 1 February 2016 / Published: 6 February 2016
Cited by 1 | PDF Full-text (3375 KB) | HTML Full-text | XML Full-text
Abstract
Heat waves have been responsible for more fatalities in Europe over the past decades than any other extreme weather event. However, temperature-related illnesses and deaths are largely preventable. Reliable sub-seasonal-to-seasonal (S2S) climate forecasts of extreme temperatures could allow for better short-to-medium-term resource [...] Read more.
Heat waves have been responsible for more fatalities in Europe over the past decades than any other extreme weather event. However, temperature-related illnesses and deaths are largely preventable. Reliable sub-seasonal-to-seasonal (S2S) climate forecasts of extreme temperatures could allow for better short-to-medium-term resource management within heat-health action plans, to protect vulnerable populations and ensure access to preventive measures well in advance. The objective of this study is to assess the extent to which S2S climate forecasts could be incorporated into heat-health action plans, to support timely public health decision-making ahead of imminent heat wave events in Europe. Forecasts of apparent temperature at different lead times (e.g., 1 day, 4 days, 8 days, up to 3 months) were used in a mortality model to produce probabilistic mortality forecasts up to several months ahead of the 2003 heat wave event in Europe. Results were compared to mortality predictions, inferred using observed apparent temperature data in the mortality model. In general, we found a decreasing transition in skill between excellent predictions when using observed temperature, to predictions with no skill when using forecast temperature with lead times greater than one week. However, even at lead-times up to three months, there were some regions in Spain and the United Kingdom where excess mortality was detected with some certainty. This suggests that in some areas of Europe, there is potential for S2S climate forecasts to be incorporated in localised heat–health action plans. In general, these results show that the performance of this climate service framework is not limited by the mortality model itself, but rather by the predictability of the climate variables, at S2S time scales, over Europe. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Flood-Exposure is Associated with Higher Prevalence of Child Undernutrition in Rural Eastern India
Int. J. Environ. Res. Public Health 2016, 13(2), 210; doi:10.3390/ijerph13020210
Received: 22 December 2015 / Accepted: 2 February 2016 / Published: 6 February 2016
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Abstract
Background: Child undernutrition and flooding are highly prevalent public health issues in Asia, yet epidemiological studies investigating this association are lacking. Methods: To investigate to what extent floods exacerbate poor nutritional status in children and identify most vulnerable groups, we [...] Read more.
Background: Child undernutrition and flooding are highly prevalent public health issues in Asia, yet epidemiological studies investigating this association are lacking. Methods: To investigate to what extent floods exacerbate poor nutritional status in children and identify most vulnerable groups, we conducted a population-based survey of children aged 6–59 months inhabiting flooded and non-flooded communities of the Jagatsinghpur district, Odisha (India), one year after large floods in 2008. Anthropometric measurements on 879 children and child, parental and household level variables were collected through face-to-face interviews in September 2009. The association between flooding and the prevalence of wasting, stunting and underweight was examined using weighted multivariate logistic regression for children inhabiting communities exposed solely to floods in 2008 and those communities repeatedly flooded (2006 and 2008) controlling for parental education and other relevant variables. We examined the influence of age on this association. Propensity score matching was conducted to test the robustness of our findings. Results: The prevalence of wasting among children flooded in 2006 and 2008 was 51.6%, 41.4% in those flooded only in 2008, and 21.2% in children inhabiting non-flooded communities. Adjusting by confounders, the increased prevalence relative to non-flooded children in the exposed groups were 2.30 (adjusted prevalence ratio (aPR); 95% CI: 1.86, 2.85) and 1.94 (95% CI: 1.43, 2.63), respectively. Among repeatedly flooded communities, cases of severe wasting in children were 3.37 times more prevalent than for children inhabiting in those non-flooded (95% CI: 2.34, 4.86) and nearly twice more prevalent relative to those flooded only once. Those children younger than one year during previous floods in 2006 showed the largest difference in prevalence of wasting compared to their non-flooded counterparts (aPR: 4.01; 95% CI: 1.51, 10.63). Results were robust to alternative adjusted models and in propensity score matching analyses. For similar analyses, no significant associations were found for child stunting, and more moderate effects were observed in the case of child underweight. Conclusions: Particularly in low-resource or subsistence-farming rural settings, long-lasting nutritional response in the aftermath of floods should be seriously considered to counteract the long-term nutritional effects on children, particularly infants, and include their mothers on whom they are dependent. The systematic monitoring of nutritional status in these groups might help to tailor efficient responses in each particular context. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Impacts of Climatic Variability on Vibrio parahaemolyticus Outbreaks in Taiwan
Int. J. Environ. Res. Public Health 2016, 13(2), 188; doi:10.3390/ijerph13020188
Received: 18 November 2015 / Revised: 28 December 2015 / Accepted: 14 January 2016 / Published: 3 February 2016
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Abstract
This study aimed to investigate and quantify the relationship between climate variation and incidence of Vibrio parahaemolyticus in Taiwan. Specifically, seasonal autoregressive integrated moving average (ARIMA) models (including autoregression, seasonality, and a lag-time effect) were employed to predict the role of climatic [...] Read more.
This study aimed to investigate and quantify the relationship between climate variation and incidence of Vibrio parahaemolyticus in Taiwan. Specifically, seasonal autoregressive integrated moving average (ARIMA) models (including autoregression, seasonality, and a lag-time effect) were employed to predict the role of climatic factors (including temperature, rainfall, relative humidity, ocean temperature and ocean salinity) on the incidence of V. parahaemolyticus in Taiwan between 2000 and 2011. The results indicated that average temperature (+), ocean temperature (+), ocean salinity of 6 months ago (+), maximum daily rainfall (current (−) and one month ago (−)), and average relative humidity (current and 9 months ago (−)) had significant impacts on the incidence of V. parahaemolyticus. Our findings offer a novel view of the quantitative relationship between climate change and food poisoning by V. parahaemolyticus in Taiwan. An early warning system based on climate change information for the disease control management is required in future. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Association between Floods and Acute Cardiovascular Diseases: A Population-Based Cohort Study Using a Geographic Information System Approach
Int. J. Environ. Res. Public Health 2016, 13(2), 168; doi:10.3390/ijerph13020168
Received: 23 November 2015 / Revised: 20 January 2016 / Accepted: 22 January 2016 / Published: 28 January 2016
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Abstract
Background: Floods represent a serious threat to human health beyond the immediate risk of drowning. There is few data on the potential link between floods and direct consequences on health such as on cardiovascular health. This study aimed to explore the impact [...] Read more.
Background: Floods represent a serious threat to human health beyond the immediate risk of drowning. There is few data on the potential link between floods and direct consequences on health such as on cardiovascular health. This study aimed to explore the impact of one of the worst floods in the history of Quebec, Canada on acute cardiovascular diseases (CVD). Methods: A cohort study with a time series design with multiple control groups was built with the adult population identified in the Quebec Integrated Chronic Disease Surveillance System. A geographic information system approach was used to define the study areas. Logistic regressions were performed to compare the occurrence of CVD between groups. Results: The results showed a 25%–27% increase in the odds in the flooded population in spring 2011 when compared with the population in the same area in springs 2010 and 2012. Besides, an increase up to 69% was observed in individuals with a medical history of CVD. Conclusion: Despite interesting results, the association was not statistically significant. A possible explanation to this result can be that the population affected by the flood was probably too small to provide the statistical power to answer the question, and leaves open a substantial possibility for a real and large effect. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle The Impact of Heatwaves on Community Morbidity and Healthcare Usage: A Retrospective Observational Study Using Real-Time Syndromic Surveillance
Int. J. Environ. Res. Public Health 2016, 13(1), 132; doi:10.3390/ijerph13010132
Received: 30 November 2015 / Revised: 23 December 2015 / Accepted: 9 January 2016 / Published: 16 January 2016
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Abstract
We investigated the impact of a moderate heatwave on a range of presenting morbidities in England. Asthma, difficulty breathing, cerebrovascular accident, and cardiovascular symptoms were analysed using general practitioner in hours (GPIH), out of hours (GPOOH) and emergency department (ED) syndromic surveillance [...] Read more.
We investigated the impact of a moderate heatwave on a range of presenting morbidities in England. Asthma, difficulty breathing, cerebrovascular accident, and cardiovascular symptoms were analysed using general practitioner in hours (GPIH), out of hours (GPOOH) and emergency department (ED) syndromic surveillance systems. Data were stratified by age group and compared between a heatwave year (2013) and non-heatwave years (2012, 2014). Incidence rate ratios were calculated to estimate the differential impact of heatwave compared to non-heatwave summers: there were no apparent differences for the morbidities tested between the 2013 heatwave and non-heatwave years. A subset of GPIH data were used to study individuals at higher risk from heatwaves based on their pre-existing disease. Higher risk patients were not more likely to present at GPs or ED than other individuals. Comparing GPIH consultations and ED attendances for myocardial infarction/ischaemia (MI), there was evidence of a fall in the presentation of MI during the heatwave, which was particularly noted in the 65–74 years age group (and over 75 years in ED attendances). These results indicate the difficulty in identifying individuals at risk from non-fatal health effects of heatwaves and hot weather. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Effects of Extreme Temperatures on Cause-Specific Cardiovascular Mortality in China
Int. J. Environ. Res. Public Health 2015, 12(12), 16136-16156; doi:10.3390/ijerph121215042
Received: 29 October 2015 / Revised: 12 December 2015 / Accepted: 14 December 2015 / Published: 21 December 2015
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Abstract
Objective: Limited evidence is available for the effects of extreme temperatures on cause-specific cardiovascular mortality in China. Methods: We collected data from Beijing and Shanghai, China, during 2007–2009, including the daily mortality of cardiovascular disease, cerebrovascular disease, ischemic heart disease [...] Read more.
Objective: Limited evidence is available for the effects of extreme temperatures on cause-specific cardiovascular mortality in China. Methods: We collected data from Beijing and Shanghai, China, during 2007–2009, including the daily mortality of cardiovascular disease, cerebrovascular disease, ischemic heart disease and hypertensive disease, as well as air pollution concentrations and weather conditions. We used Poisson regression with a distributed lag non-linear model to examine the effects of extremely high and low ambient temperatures on cause-specific cardiovascular mortality. Results: For all cause-specific cardiovascular mortality, Beijing had stronger cold and hot effects than those in Shanghai. The cold effects on cause-specific cardiovascular mortality reached the strongest at lag 0–27, while the hot effects reached the strongest at lag 0–14. The effects of extremely low and high temperatures differed by mortality types in the two cities. Hypertensive disease in Beijing was particularly susceptible to both extremely high and low temperatures; while for Shanghai, people with ischemic heart disease showed the greatest relative risk (RRs = 1.16, 95% CI: 1.03, 1.34) to extremely low temperature. Conclusion: People with hypertensive disease were particularly susceptible to extremely low and high temperatures in Beijing. People with ischemic heart disease in Shanghai showed greater susceptibility to extremely cold days. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Challenges and Opportunities for Advancing Work on Climate Change and Public Health
Int. J. Environ. Res. Public Health 2015, 12(12), 15649-15672; doi:10.3390/ijerph121215010
Received: 1 October 2015 / Revised: 28 November 2015 / Accepted: 1 December 2015 / Published: 9 December 2015
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Abstract
Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This [...] Read more.
Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change’s health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Changes in the Effect of Heat on Mortality in the Last 20 Years in Nine European Cities. Results from the PHASE Project
Int. J. Environ. Res. Public Health 2015, 12(12), 15567-15583; doi:10.3390/ijerph121215006
Received: 9 October 2015 / Revised: 30 November 2015 / Accepted: 1 December 2015 / Published: 8 December 2015
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Abstract
The European project PHASE aims to evaluate patterns of change in the temperature–mortality relationship and in the number of deaths attributable to heat in nine European cities in two periods, before and after summer 2003 (1996–2002 and 2004–2010). We performed age-specific Poisson [...] Read more.
The European project PHASE aims to evaluate patterns of change in the temperature–mortality relationship and in the number of deaths attributable to heat in nine European cities in two periods, before and after summer 2003 (1996–2002 and 2004–2010). We performed age-specific Poisson regression models separately in the two periods, controlling for seasonality, air pollution and time trends. Distributed lag non-linear models were used to estimate the Relative Risks of daily mortality for increases in mean temperature from the 75th to 99th percentile of the summer distribution for each city. In the recent period, a reduction in the mortality risk associated to heat was observed only in Athens, Rome and Paris, especially among the elderly. Furthermore, in terms of heat-attributable mortality, 985, 787 and 623 fewer deaths were estimated, respectively, in the three cities. In Helsinki and Stockholm, there is a suggestion of increased heat effect. Noteworthy is that an effect of heat was still present in the recent years in all cities, ranging from +11% to +35%. In Europe, considering the warming observed in recent decades and population ageing, effective intervention measures should be promoted across countries, especially targeting vulnerable subgroups of the population with lower adaptive resources. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Vulnerable Populations Perceive Their Health as at Risk from Climate Change
Int. J. Environ. Res. Public Health 2015, 12(12), 15419-15433; doi:10.3390/ijerph121214994
Received: 14 September 2015 / Revised: 23 November 2015 / Accepted: 26 November 2015 / Published: 4 December 2015
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Abstract
Climate change is already taking a toll on human health, a toll that is likely to increase in coming decades. The relationship between risk perceptions and vulnerability to climate change’s health threats has received little attention, even though an understanding of the [...] Read more.
Climate change is already taking a toll on human health, a toll that is likely to increase in coming decades. The relationship between risk perceptions and vulnerability to climate change’s health threats has received little attention, even though an understanding of the dynamics of adaptation among particularly susceptible populations is becoming increasingly important. We demonstrate that some people whose health will suffer the greatest harms from climate change—due to social vulnerability, health susceptibility, and exposure to hazards—already feel they are at risk. In a 2013 survey we measured Maryland residents’ climate beliefs, health risk perceptions, and household social vulnerability characteristics, including medical conditions (n = 2126). We paired survey responses with secondary data sources for residence in a floodplain and/or urban heat island to predict perceptions of personal and household climate health risk. General health risk perceptions, political ideology, and climate beliefs are the strongest predictors. Yet, people in households with the following characteristics also see themselves at higher risk: members with one or more medical conditions or disabilities; low income; racial/ethnic minorities; and residence in a floodplain. In light of these results, climate health communication among vulnerable populations should emphasize protective actions instead of risk messages. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Differential Effects of Temperature Extremes on Hospital Admission Rates for Respiratory Disease between Indigenous and Non-Indigenous Australians in the Northern Territory
Int. J. Environ. Res. Public Health 2015, 12(12), 15352-15365; doi:10.3390/ijerph121214988
Received: 16 October 2015 / Revised: 16 November 2015 / Accepted: 1 December 2015 / Published: 3 December 2015
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Abstract
The health gap between Indigenous and non-Indigenous Australians may be exacerbated by climate change if temperature extremes have disproportionate adverse effects on Indigenous people. To explore this issue, we analysed the effect of temperature extremes on hospital admissions for respiratory diseases, stratified [...] Read more.
The health gap between Indigenous and non-Indigenous Australians may be exacerbated by climate change if temperature extremes have disproportionate adverse effects on Indigenous people. To explore this issue, we analysed the effect of temperature extremes on hospital admissions for respiratory diseases, stratified by age, Indigenous status and sex, for people living in two different climates zones in the Northern Territory during the period 1993–2011. We examined admissions for both acute and chronic respiratory diagnoses, controlling for day of the week and seasonality variables. Our analysis showed that: (1) overall, Indigenous hospital admission rates far exceeded non-Indigenous admission rates for acute and chronic diagnoses, and Top End climate zone admission rates exceeded Central Australia climate zone admission rates; (2) extreme cold and hot temperatures were associated with inconsistent changes in admission rates for acute respiratory disease in Indigenous and non-Indigenous children and older adults; and (3) no response to cold or hot temperature extremes was found for chronic respiratory diagnoses. These findings support our two hypotheses, that extreme hot and cold temperatures have a different effect on hospitalisations for respiratory disease between Indigenous and non-Indigenous people, and that these health risks vary between the different climate zones. We did not, however, find that there were differing responses to temperature extremes in the two populations, suggesting that any increased vulnerability to climate change in the Indigenous population of the Northern Territory arises from an increased underlying risk to respiratory disease and an already greater existing health burden. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Impact of Heat and Cold on Total and Cause-Specific Mortality in Vadu HDSS—A Rural Setting in Western India
Int. J. Environ. Res. Public Health 2015, 12(12), 15298-15308; doi:10.3390/ijerph121214980
Received: 25 August 2015 / Revised: 12 November 2015 / Accepted: 18 November 2015 / Published: 2 December 2015
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Abstract
Many diseases are affected by changes in weather. There have been limited studies, however, which have examined the relationship between heat and cold and cause-specific mortality in low and middle-income countries. In this study, we aimed to estimate the effects of heat [...] Read more.
Many diseases are affected by changes in weather. There have been limited studies, however, which have examined the relationship between heat and cold and cause-specific mortality in low and middle-income countries. In this study, we aimed to estimate the effects of heat and cold days on total and cause-specific mortality in the Vadu Health and Demographic Surveillance System (HDSS) area in western India. We used a quasi-Poisson regression model allowing for over-dispersion to examine the association of total and cause-specific mortality with extreme high (98th percentile, >39 °C) and low temperature (2nd percentile, <25 °C) over the period January 2003 to December 2012. Delays of 0 and 0–4 days were considered and relative risks (RR) with 95% confidence intervals (CI) were calculated. Heat was significantly associated with daily deaths by non-infectious diseases (RR = 1.57; CI: 1.18–2.10). There was an increase in the risk of total mortality in the age group 12–59 years on lag 0 day (RR = 1.43; CI: 1.02–1.99). A high increase in total mortality was observed among men at lag 0 day (RR = 1.38; CI: 1.05–1.83). We did not find any short-term association between total and cause-specific mortality and cold days. Deaths from neither infectious nor external causes were associated with heat or cold. Our results showed a strong and rather immediate relationship between high temperatures and non-infectious disease mortality in a rural population located in western India, during 2003–2012. This study may be used to develop targeted interventions such as Heat Early Warning Systems in the area to reduce mortality from extreme temperatures. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Vulnerabilities to Temperature Effects on Acute Myocardial Infarction Hospital Admissions in South Korea
Int. J. Environ. Res. Public Health 2015, 12(11), 14571-14588; doi:10.3390/ijerph121114571
Received: 10 October 2015 / Revised: 9 November 2015 / Accepted: 10 November 2015 / Published: 13 November 2015
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Abstract
Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of [...] Read more.
Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004–2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07–1.76) for heat and 1.11 (95% CI: 1.04–1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle On the Science-Policy Bridge: Do Spatial Heat Vulnerability Assessment Studies Influence Policy?
Int. J. Environ. Res. Public Health 2015, 12(10), 13321-13349; doi:10.3390/ijerph121013321
Received: 24 August 2015 / Revised: 15 October 2015 / Accepted: 20 October 2015 / Published: 23 October 2015
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Abstract
Human vulnerability to heat varies at a range of spatial scales, especially within cities where there can be noticeable intra-urban differences in heat risk factors. Mapping and visualizing intra-urban heat vulnerability offers opportunities for presenting information to support decision-making. For example the [...] Read more.
Human vulnerability to heat varies at a range of spatial scales, especially within cities where there can be noticeable intra-urban differences in heat risk factors. Mapping and visualizing intra-urban heat vulnerability offers opportunities for presenting information to support decision-making. For example the visualization of the spatial variation of heat vulnerability has the potential to enable local governments to identify hot spots of vulnerability and allocate resources and increase assistance to people in areas of greatest need. Recently there has been a proliferation of heat vulnerability mapping studies, all of which, to varying degrees, justify the process of vulnerability mapping in a policy context. However, to date, there has not been a systematic review of the extent to which the results of vulnerability mapping studies have been applied in decision-making. Accordingly we undertook a comprehensive review of 37 recently published papers that use geospatial techniques for assessing human vulnerability to heat. In addition, we conducted an anonymous survey of the lead authors of the 37 papers in order to establish the level of interaction between the researchers as science information producers and local authorities as information users. Both paper review and author survey results show that heat vulnerability mapping has been used in an attempt to communicate policy recommendations, raise awareness and induce institutional networking and learning, but has not as yet had a substantive influence on policymaking or preventive action. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Quantifying Vulnerability to Extreme Heat in Time Series Analyses: A Novel Approach Applied to Neighborhood Social Disparities under Climate Change
Int. J. Environ. Res. Public Health 2015, 12(9), 11869-11879; doi:10.3390/ijerph120911869
Received: 3 July 2015 / Revised: 29 August 2015 / Accepted: 15 September 2015 / Published: 22 September 2015
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Abstract
Objectives: We propose a novel approach to examine vulnerability in the relationship between heat and years of life lost and apply to neighborhood social disparities in Montreal and Paris. Methods: We used historical data from the summers of 1990 through [...] Read more.
Objectives: We propose a novel approach to examine vulnerability in the relationship between heat and years of life lost and apply to neighborhood social disparities in Montreal and Paris. Methods: We used historical data from the summers of 1990 through 2007 for Montreal and from 2004 through 2009 for Paris to estimate daily years of life lost social disparities (DYLLD), summarizing social inequalities across groups. We used Generalized Linear Models to separately estimate relative risks (RR) for DYLLD in association with daily mean temperatures in both cities. We used 30 climate scenarios of daily mean temperature to estimate future temperature distributions (2021–2050). We performed random effect meta-analyses to assess the impact of climate change by climate scenario for each city and compared the impact of climate change for the two cities using a meta-regression analysis. Results: We show that an increase in ambient temperature leads to an increase in social disparities in daily years of life lost. The impact of climate change on DYLLD attributable to temperature was of 2.06 (95% CI: 1.90, 2.25) in Montreal and 1.77 (95% CI: 1.61, 1.94) in Paris. The city explained a difference of 0.31 (95% CI: 0.14, 0.49) on the impact of climate change. Conclusion: We propose a new analytical approach for estimating vulnerability in the relationship between heat and health. Our results suggest that in Paris and Montreal, health disparities related to heat impacts exist today and will increase in the future. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle A Conceptual Framework for Planning Systemic Human Adaptation to Global Warming
Int. J. Environ. Res. Public Health 2015, 12(9), 10700-10722; doi:10.3390/ijerph120910700
Received: 13 July 2015 / Revised: 15 August 2015 / Accepted: 24 August 2015 / Published: 31 August 2015
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Abstract
Human activity is having multiple, inter-related effects on ecosystems. Greenhouse gas emissions persisting along current trajectories threaten to significantly alter human society. At 0.85 °C of anthropogenic warming, deleterious human impacts are acutely evident. Additional warming of 0.5 °C–1.0 °C from already [...] Read more.
Human activity is having multiple, inter-related effects on ecosystems. Greenhouse gas emissions persisting along current trajectories threaten to significantly alter human society. At 0.85 °C of anthropogenic warming, deleterious human impacts are acutely evident. Additional warming of 0.5 °C–1.0 °C from already emitted CO2 will further intensify extreme heat and damaging storm events. Failing to sufficiently address this trend will have a heavy human toll directly and indirectly on health. Along with mitigation efforts, societal adaptation to a warmer world is imperative. Adaptation efforts need to be significantly upscaled to prepare society to lessen the public health effects of rising temperatures. Modifying societal behaviour is inherently complex and presents a major policy challenge. We propose a social systems framework for conceptualizing adaptation that maps out three domains within the adaptation policy landscape: acclimatisation, behavioural adaptation and technological adaptation, which operate at societal and personal levels. We propose that overlaying this framework on a systems approach to societal change planning methods will enhance governments’ capacity and efficacy in strategic planning for adaptation. This conceptual framework provides a policy oriented planning assessment tool that will help planners match interventions to the behaviours being targeted for change. We provide illustrative examples to demonstrate the framework’s application as a planning tool. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Limitations to Thermoregulation and Acclimatization Challenge Human Adaptation to Global Warming
Int. J. Environ. Res. Public Health 2015, 12(7), 8034-8074; doi:10.3390/ijerph120708034
Received: 23 April 2015 / Revised: 15 June 2015 / Accepted: 30 June 2015 / Published: 15 July 2015
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Abstract
Human thermoregulation and acclimatization are core components of the human coping mechanism for withstanding variations in environmental heat exposure. Amidst growing recognition that curtailing global warming to less than two degrees is becoming increasing improbable, human survival will require increasing reliance on [...] Read more.
Human thermoregulation and acclimatization are core components of the human coping mechanism for withstanding variations in environmental heat exposure. Amidst growing recognition that curtailing global warming to less than two degrees is becoming increasing improbable, human survival will require increasing reliance on these mechanisms. The projected several fold increase in extreme heat events suggests we need to recalibrate health protection policies and ratchet up adaptation efforts. Climate researchers, epidemiologists, and policy makers engaged in climate change adaptation and health protection are not commonly drawn from heat physiology backgrounds. Injecting a scholarly consideration of physiological limitations to human heat tolerance into the adaptation and policy literature allows for a broader understanding of heat health risks to support effective human adaptation and adaptation planning. This paper details the physiological and external environmental factors that determine human thermoregulation and acclimatization. We present a model to illustrate the interrelationship between elements that modulate the physiological process of thermoregulation. Limitations inherent in these processes, and the constraints imposed by differing exposure levels, and thermal comfort seeking on achieving acclimatization, are then described. Combined, these limitations will restrict the likely contribution that acclimatization can play in future human adaptation to global warming. We postulate that behavioral and technological adaptations will need to become the dominant means for human individual and societal adaptations as global warming progresses. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Building Resilience against Climate Effects—A Novel Framework to Facilitate Climate Readiness in Public Health Agencies
Int. J. Environ. Res. Public Health 2014, 11(6), 6433-6458; doi:10.3390/ijerph110606433
Received: 8 April 2014 / Revised: 3 June 2014 / Accepted: 6 June 2014 / Published: 20 June 2014
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Abstract
Climate change is anticipated to have several adverse health impacts. Managing these risks to public health requires an iterative approach. As with many risk management strategies related to climate change, using modeling to project impacts, engaging a wide range of stakeholders, and [...] Read more.
Climate change is anticipated to have several adverse health impacts. Managing these risks to public health requires an iterative approach. As with many risk management strategies related to climate change, using modeling to project impacts, engaging a wide range of stakeholders, and regularly updating models and risk management plans with new information—hallmarks of adaptive management—are considered central tenets of effective public health adaptation. The Centers for Disease Control and Prevention has developed a framework, entitled Building Resilience Against Climate Effects, or BRACE, to facilitate this process for public health agencies. Its five steps are laid out here. Following the steps laid out in BRACE will enable an agency to use the best available science to project likely climate change health impacts in a given jurisdiction and prioritize interventions. Adopting BRACE will also reinforce public health’s established commitment to evidence-based practice and institutional learning, both of which will be central to successfully engaging the significant new challenges that climate change presents. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle European Monitoring Systems and Data for Assessing Environmental and Climate Impacts on Human Infectious Diseases
Int. J. Environ. Res. Public Health 2014, 11(4), 3894-3936; doi:10.3390/ijerph110403894
Received: 29 December 2013 / Revised: 25 March 2014 / Accepted: 28 March 2014 / Published: 9 April 2014
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Abstract
Surveillance is critical to understanding the epidemiology and control of infectious diseases. The growing concern over climate and other drivers that may increase infectious disease threats to future generations has stimulated a review of the surveillance systems and environmental data sources that [...] Read more.
Surveillance is critical to understanding the epidemiology and control of infectious diseases. The growing concern over climate and other drivers that may increase infectious disease threats to future generations has stimulated a review of the surveillance systems and environmental data sources that might be used to assess future health impacts from climate change in Europe. We present an overview of organizations, agencies and institutions that are responsible for infectious disease surveillance in Europe. We describe the surveillance systems, tracking tools, communication channels, information exchange and outputs in light of environmental and climatic drivers of infectious diseases. We discuss environmental and climatic data sets that lend themselves to epidemiological analysis. Many of the environmental data sets have a relatively uniform quality across EU Member States because they are based on satellite measurements or EU funded FP6 or FP7 projects with full EU coverage. Case-reporting systems for surveillance of infectious diseases should include clear and consistent case definitions and reporting formats that are geo-located at an appropriate resolution. This will allow linkage to environmental, social and climatic sources that will enable risk assessments, future threat evaluations, outbreak management and interventions to reduce disease burden. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Heat-Related Deaths in Hot Cities: Estimates of Human Tolerance to High Temperature Thresholds
Int. J. Environ. Res. Public Health 2014, 11(3), 3304-3326; doi:10.3390/ijerph110303304
Received: 19 October 2013 / Revised: 7 March 2014 / Accepted: 7 March 2014 / Published: 20 March 2014
Cited by 12 | PDF Full-text (1014 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled [...] Read more.
In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥65 during the months May–October for years 2000–2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90–97 °F; 32.2‒36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
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Open AccessArticle Implementing Cargo Movement into Climate Based Risk Assessment of Vector-Borne Diseases
Int. J. Environ. Res. Public Health 2014, 11(3), 3360-3374; doi:10.3390/ijerph110303360
Received: 28 November 2013 / Revised: 5 March 2014 / Accepted: 10 March 2014 / Published: 20 March 2014
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Abstract
During the last decades the disease vector Aedes albopictus (Asian tiger mosquito) has rapidly spread around the globe. Global shipment of goods contributes to its permanent introduction. Invaded regions are facing novel and serious public health concerns, especially regarding the transmission of [...] Read more.
During the last decades the disease vector Aedes albopictus (Asian tiger mosquito) has rapidly spread around the globe. Global shipment of goods contributes to its permanent introduction. Invaded regions are facing novel and serious public health concerns, especially regarding the transmission of formerly non-endemic arboviruses such as dengue and chikungunya. The further development and potential spread to other regions depends largely on their climatic suitability. Here, we have developed a tool for identifying and prioritizing European areas at risk for the establishment of Aedes albopictus by taking into account, for the first time, the freight imports from this mosquito’s endemic countries and the climate suitability at harbors and their surrounding regions. In a second step we consider the further transport of containers by train and inland waterways because these types of transport can be well controlled. We identify European regions at risk, where a huge amount of transported goods meet climatically suitable conditions for the disease vector. The current and future suitability of the climate for Aedes albopictus was modeled by a correlative niche model approach and the Regional Climate Model COSMO-CLM. This risk assessment combines impacts of globalization and global warming to improve effective and proactive interventions in disease vector surveillance and control actions. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
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Open AccessArticle Indicators for Tracking European Vulnerabilities to the Risks of Infectious Disease Transmission due to Climate Change
Int. J. Environ. Res. Public Health 2014, 11(2), 2218-2235; doi:10.3390/ijerph110202218
Received: 18 November 2013 / Revised: 26 January 2014 / Accepted: 10 February 2014 / Published: 21 February 2014
Cited by 5 | PDF Full-text (1251 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
A wide range of infectious diseases may change their geographic range, seasonality and incidence due to climate change, but there is limited research exploring health vulnerabilities to climate change. In order to address this gap, pan-European vulnerability indices were developed for 2035 [...] Read more.
A wide range of infectious diseases may change their geographic range, seasonality and incidence due to climate change, but there is limited research exploring health vulnerabilities to climate change. In order to address this gap, pan-European vulnerability indices were developed for 2035 and 2055, based upon the definition vulnerability = impact/adaptive capacity. Future impacts were projected based upon changes in temperature and precipitation patterns, whilst adaptive capacity was developed from the results of a previous pan-European study. The results were plotted via ArcGISTM to EU regional (NUTS2) levels for 2035 and 2055 and ranked according to quintiles. The models demonstrate regional variations with respect to projected climate-related infectious disease challenges that they will face, and with respect to projected vulnerabilities after accounting for regional adaptive capacities. Regions with higher adaptive capacities, such as in Scandinavia and central Europe, will likely be better able to offset any climate change impacts and are thus generally less vulnerable than areas with lower adaptive capacities. The indices developed here provide public health planners with information to guide prioritisation of activities aimed at strengthening regional preparedness for the health impacts of climate change. There are, however, many limitations and uncertainties when modeling health vulnerabilities. To further advance the field, the importance of variables such as coping capacity and governance should be better accounted for, and there is the need to systematically collect and analyse the interlinkages between the numerous and ever-expanding environmental, socioeconomic, demographic and epidemiologic datasets so as to promote the public health capacity to detect, forecast, and prepare for the health threats due to climate change. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Extreme Precipitation and Beach Closures in the Great Lakes Region: Evaluating Risk among the Elderly
Int. J. Environ. Res. Public Health 2014, 11(2), 2014-2032; doi:10.3390/ijerph110202014
Received: 18 November 2013 / Revised: 27 January 2014 / Accepted: 8 February 2014 / Published: 14 February 2014
Cited by 2 | PDF Full-text (1037 KB) | HTML Full-text | XML Full-text
Abstract
As a result of climate change, extreme precipitation events are expected to increase in frequency and intensity. Runoff from these extreme events poses threats to water quality and human health. We investigated the impact of extreme precipitation and beach closings on the [...] Read more.
As a result of climate change, extreme precipitation events are expected to increase in frequency and intensity. Runoff from these extreme events poses threats to water quality and human health. We investigated the impact of extreme precipitation and beach closings on the risk of gastrointestinal illness (GI)-related hospital admissions among individuals 65 and older in 12 Great Lakes cities from 2000 to 2006. Poisson regression models were fit in each city, controlling for temperature and long-term time trends. City-specific estimates were combined to form an overall regional risk estimate. Approximately 40,000 GI-related hospital admissions and over 100 beach closure days were recorded from May through September during the study period. Extreme precipitation (≥90th percentile) occurring the previous day (lag 1) is significantly associated with beach closures in 8 of the 12 cities (p < 0.05). However, no association was observed between beach closures and GI-related hospital admissions. These results support previous work linking extreme precipitation to compromised recreational water quality. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Effect of Ambient Temperature on Australian Northern Territory Public Hospital Admissions for Cardiovascular Disease among Indigenous and Non-Indigenous Populations
Int. J. Environ. Res. Public Health 2014, 11(2), 1942-1959; doi:10.3390/ijerph110201942
Received: 22 November 2013 / Revised: 21 January 2014 / Accepted: 22 January 2014 / Published: 13 February 2014
Cited by 7 | PDF Full-text (636 KB) | HTML Full-text | XML Full-text
Abstract
Hospitalisations are associated with ambient temperature, but little is known about responses in population sub-groups. In this study, heat responses for Indigenous and non-Indigenous people in two age groups were examined for two categories of cardiac diseases using daily hospital admissions from [...] Read more.
Hospitalisations are associated with ambient temperature, but little is known about responses in population sub-groups. In this study, heat responses for Indigenous and non-Indigenous people in two age groups were examined for two categories of cardiac diseases using daily hospital admissions from five Northern Territory hospitals (1992–2011). Admission rates during the hottest five per cent of days and the coolest five per cent of days were compared with rates at other times. Among 25–64 year olds, the Indigenous female population was more adversely affected by very hot days than the non-Indigenous female population, with admission rates for ischaemic heart disease (IHD) increasing by 32%. People older than 65 were more sensitive to cold, with non-Indigenous male admissions for heart failure increasing by 64%, and for IHD by 29%. For older Indigenous males, IHD admissions increased by 52% during cold conditions. For older non-Indigenous females, increases in admissions for heart failure were around 50% on these cold days, and 64% for older Indigenous females. We conclude that under projected climate change conditions, admissions for IHD amongst younger Indigenous people would increase in hot conditions, while admissions among elderly people during cold weather may be reduced. The responses to temperature, while showing significant relationships across the Northern Territory, may vary by region. These variations were not explored in this assessment. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Strategies to Reduce the Harmful Effects of Extreme Heat Events: A Four-City Study
Int. J. Environ. Res. Public Health 2014, 11(2), 1960-1988; doi:10.3390/ijerph110201960
Received: 18 November 2013 / Revised: 4 February 2014 / Accepted: 6 February 2014 / Published: 13 February 2014
Cited by 6 | PDF Full-text (645 KB) | HTML Full-text | XML Full-text
Abstract
Extreme heat events (EHEs) are becoming more intense, more frequent and longer lasting in the 21st century. These events can disproportionately impact the health of low-income, minority, and urban populations. To better understand heat-related intervention strategies used by four U.S. cities, we [...] Read more.
Extreme heat events (EHEs) are becoming more intense, more frequent and longer lasting in the 21st century. These events can disproportionately impact the health of low-income, minority, and urban populations. To better understand heat-related intervention strategies used by four U.S. cities, we conducted 73 semi-structured interviews with government and non-governmental organization leaders representing public health, general social services, emergency management, meteorology, and the environmental planning sectors in Detroit, MI; New York City, NY; Philadelphia, PA and Phoenix, AZ—cities selected for their diverse demographics, climates, and climate adaptation strategies. We identified activities these leaders used to reduce the harmful effects of heat for residents in their city, as well as the obstacles they faced and the approaches they used to evaluate these efforts. Local leaders provided a description of how local context (e.g., climate, governance and city structure) impacted heat preparedness. Despite the differences among study cities, political will and resource access were critical to driving heat-health related programming. Upon completion of our interviews, we convened leaders in each city to discuss these findings and their ongoing efforts through day-long workshops. Our findings and the recommendations that emerged from these workshops could inform other local or national efforts towards preventing heat-related morbidity and mortality. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Data Mashups: Potential Contribution to Decision Support on Climate Change and Health
Int. J. Environ. Res. Public Health 2014, 11(2), 1725-1746; doi:10.3390/ijerph110201725
Received: 14 October 2013 / Revised: 16 January 2014 / Accepted: 16 January 2014 / Published: 4 February 2014
Cited by 3 | PDF Full-text (456 KB) | HTML Full-text | XML Full-text
Abstract
Linking environmental, socioeconomic and health datasets provides new insights into the potential associations between climate change and human health and wellbeing, and underpins the development of decision support tools that will promote resilience to climate change, and thus enable more effective adaptation. [...] Read more.
Linking environmental, socioeconomic and health datasets provides new insights into the potential associations between climate change and human health and wellbeing, and underpins the development of decision support tools that will promote resilience to climate change, and thus enable more effective adaptation. This paper outlines the challenges and opportunities presented by advances in data collection, storage, analysis, and access, particularly focusing on “data mashups”. These data mashups are integrations of different types and sources of data, frequently using open application programming interfaces and data sources, to produce enriched results that were not necessarily the original reason for assembling the raw source data. As an illustration of this potential, this paper describes a recently funded initiative to create such a facility in the UK for use in decision support around climate change and health, and provides examples of suitable sources of data and the purposes to which they can be directed, particularly for policy makers and public health decision makers. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Using Social Network Analysis to Evaluate Health-Related Adaptation Decision-Making in Cambodia
Int. J. Environ. Res. Public Health 2014, 11(2), 1605-1625; doi:10.3390/ijerph110201605
Received: 17 December 2013 / Revised: 15 January 2014 / Accepted: 16 January 2014 / Published: 30 January 2014
Cited by 3 | PDF Full-text (444 KB) | HTML Full-text | XML Full-text
Abstract
Climate change adaptation in the health sector requires decisions across sectors, levels of government, and organisations. The networks that link these different institutions, and the relationships among people within these networks, are therefore critical influences on the nature of adaptive responses to [...] Read more.
Climate change adaptation in the health sector requires decisions across sectors, levels of government, and organisations. The networks that link these different institutions, and the relationships among people within these networks, are therefore critical influences on the nature of adaptive responses to climate change in the health sector. This study uses social network research to identify key organisational players engaged in developing health-related adaptation activities in Cambodia. It finds that strong partnerships are reported as developing across sectors and different types of organisations in relation to the health risks from climate change. Government ministries are influential organisations, whereas donors, development banks and non-government organisations do not appear to be as influential in the development of adaptation policy in the health sector. Finally, the study highlights the importance of informal partnerships (or ‘shadow networks’) in the context of climate change adaptation policy and activities. The health governance ‘map’ in relation to health and climate change adaptation that is developed in this paper is a novel way of identifying organisations that are perceived as key agents in the decision-making process, and it holds substantial benefits for both understanding and intervening in a broad range of climate change-related policy problems where collaboration is paramount for successful outcomes. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle The Impact of Climate Change on Ozone-Related Mortality in Sydney
Int. J. Environ. Res. Public Health 2014, 11(1), 1034-1048; doi:10.3390/ijerph110101034
Received: 6 October 2013 / Revised: 30 December 2013 / Accepted: 31 December 2013 / Published: 13 January 2014
Cited by 2 | PDF Full-text (649 KB) | HTML Full-text | XML Full-text
Abstract
Coupled global, regional and chemical transport models are now being used with relative-risk functions to determine the impact of climate change on human health. Studies have been carried out for global and regional scales, and in our paper we examine the impact [...] Read more.
Coupled global, regional and chemical transport models are now being used with relative-risk functions to determine the impact of climate change on human health. Studies have been carried out for global and regional scales, and in our paper we examine the impact of climate change on ozone-related mortality at the local scale across an urban metropolis (Sydney, Australia). Using three coupled models, with a grid spacing of 3 km for the chemical transport model (CTM), and a mortality relative risk function of 1.0006 per 1 ppb increase in daily maximum 1-hour ozone concentration, we evaluated the change in ozone concentrations and mortality between decades 1996–2005 and 2051–2060. The global model was run with the A2 emissions scenario. As there is currently uncertainty regarding a threshold concentration below which ozone does not impact on mortality, we calculated mortality estimates for the three daily maximum 1-hr ozone concentration thresholds of 0, 25 and 40 ppb. The mortality increase for 2051–2060 ranges from 2.3% for a 0 ppb threshold to 27.3% for a 40 ppb threshold, although the numerical increases differ little. Our modeling approach is able to identify the variation in ozone-related mortality changes at a suburban scale, estimating that climate change could lead to an additional 55 to 65 deaths across Sydney in the decade 2051–2060. Interestingly, the largest increases do not correspond spatially to the largest ozone increases or the densest population centres. The distribution pattern of changes does not seem to vary with threshold value, while the magnitude only varies slightly. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Figures

Open AccessArticle Comparison of UTCI with Other Thermal Indices in the Assessment of Heat and Cold Effects on Cardiovascular Mortality in the Czech Republic
Int. J. Environ. Res. Public Health 2014, 11(1), 952-967; doi:10.3390/ijerph110100952
Received: 20 September 2013 / Revised: 10 December 2013 / Accepted: 30 December 2013 / Published: 9 January 2014
Cited by 13 | PDF Full-text (516 KB) | HTML Full-text | XML Full-text
Abstract
We compare the recently developed Universal Thermal Climate Index (UTCI) with other thermal indices in analysing heat- and cold-related effects on cardiovascular (CVD) mortality in two different (urban and rural) regions in the Czech Republic during the 16-year period from 1994–2009. Excess [...] Read more.
We compare the recently developed Universal Thermal Climate Index (UTCI) with other thermal indices in analysing heat- and cold-related effects on cardiovascular (CVD) mortality in two different (urban and rural) regions in the Czech Republic during the 16-year period from 1994–2009. Excess mortality is represented by the number of deaths above expected daily values, the latter being adjusted for long-term changes, annual and weekly cycles, and epidemics of influenza/acute respiratory infections. Air temperature, UTCI, Apparent Temperature (AT) and Physiologically Equivalent Temperature (PET) are applied to identify days with heat and cold stress. We found similar heat effects on CVD mortality for air temperature and the examined thermal indices. Responses of CVD mortality to cold effects as characterised by different indices were much more varied. Particularly important is the finding that air temperature provides a weak cold effect in comparison with the thermal indices in both regions, so its application—still widespread in epidemiological studies—may underestimate the magnitude of cold-related mortality. These findings are important when possible climate change effects on heat- and cold-related mortality are estimated. AT and PET appear to be more universal predictors of heat- and cold- related mortality than UTCI when both urban and rural environments are of concern. UTCI tends to select windy rather than freezing days in winter, though these show little effect on mortality in the urban population. By contrast, significant cold-related mortality in the rural region if UTCI is used shows potential for UTCI to become a useful tool in cold exposure assessments. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Health in the New Scenarios for Climate Change Research
Int. J. Environ. Res. Public Health 2014, 11(1), 30-46; doi:10.3390/ijerph110100030
Received: 18 October 2013 / Revised: 4 December 2013 / Accepted: 4 December 2013 / Published: 19 December 2013
Cited by 12 | PDF Full-text (231 KB) | HTML Full-text | XML Full-text
Abstract
The climate change research community is developing a toolkit for creating new scenarios to explore and evaluate the extensive uncertainties associated with future climate change and development pathways. Components of the toolkit include pathways for greenhouse gas emissions over this century and [...] Read more.
The climate change research community is developing a toolkit for creating new scenarios to explore and evaluate the extensive uncertainties associated with future climate change and development pathways. Components of the toolkit include pathways for greenhouse gas emissions over this century and their associated magnitude and pattern of climate change; descriptions of a range of possible socioeconomic development pathways, including qualitative narratives and quantitative elements; and climate change policies to achieve specific levels of radiative forcing and levels of adaptive capacity. These components are combined within a matrix architecture to create a scenario. Five reference socioeconomic development pathways have been described along axes describing increasing socioeconomic and environmental challenges to adaptation and to mitigation. This paper extends these global pathways to describe their possible consequences for public health and health care, and considers the additional elements that could be added to increase the relevance of the new scenarios to address a wider range of policy relevant questions than previously possible. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Risk Factors, Health Effects and Behaviour in Older People during Extreme Heat: A Survey in South Australia
Int. J. Environ. Res. Public Health 2013, 10(12), 6721-6733; doi:10.3390/ijerph10126721
Received: 9 October 2013 / Revised: 21 November 2013 / Accepted: 22 November 2013 / Published: 3 December 2013
Cited by 15 | PDF Full-text (198 KB) | HTML Full-text | XML Full-text
Abstract
Older people had a high incidence of hospitalisation during the 2009 heat wave in South Australia. We sought to explore resilience, behaviours, health risk factors and health outcomes during recent heat waves for a representative sample of independently living residents. A telephone [...] Read more.
Older people had a high incidence of hospitalisation during the 2009 heat wave in South Australia. We sought to explore resilience, behaviours, health risk factors and health outcomes during recent heat waves for a representative sample of independently living residents. A telephone survey of 499 people aged 65 years and over was conducted, and included both metropolitan and rural residences. A variety of adaptive strategies were reported, with 75% maintaining regular appointments and activities during the heat. However, 74% took medication for chronic disease and 25% assessed their health status to be fair to poor. In a multivariate model, factors associated with heat health outcomes included medication for mental health, heart failure, diabetes or respiratory health, reporting a reduced health status, use of mobility aids and being female. Compared with younger participants, those over 75 had more check-up calls and visits by family, friends and neighbours. However, confidence to call on support was associated with indicators of social isolation. The study indicates that older people are generally resilient, but interventions addressing multi-morbidity and medication interactions and social isolation should be developed. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Projected Heat-Related Mortality in the U.S. Urban Northeast
Int. J. Environ. Res. Public Health 2013, 10(12), 6734-6747; doi:10.3390/ijerph10126734
Received: 16 October 2013 / Revised: 19 November 2013 / Accepted: 19 November 2013 / Published: 3 December 2013
Cited by 9 | PDF Full-text (323 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Increased heat-related mortality is projected to be among the major impacts of climate change on human health, and the United States urban Northeast region is likely to be particularly vulnerable. In support of regional adaptation planning, quantitative information is needed on potential [...] Read more.
Increased heat-related mortality is projected to be among the major impacts of climate change on human health, and the United States urban Northeast region is likely to be particularly vulnerable. In support of regional adaptation planning, quantitative information is needed on potential future health responses at the urban and regional scales. Here, we present future projections of heat-related mortality in Boston, New York and Philadelphia utilizing downscaled next-generation climate models and Representative Concentration Pathways (RCPs) developed in support of the Intergovernmental Panel on Climate Change (IPCC)’s Fifth Assessment Report (AR5). Our analyses reveal that heat-related mortality rates per 100,000 of population during the baseline period between 1985 and 2006 were highest in Philadelphia followed by New York City and Boston. However, projected heat-related mortality rates in the 2020s, 2050s and 2080s were highest in New York City followed by Philadelphia and Boston. This study may be of value in developing strategies for reducing the future impacts of heat and building climate change resilience in the urban Northeast region. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Extreme Heat and Health: Perspectives from Health Service Providers in Rural and Remote Communities in South Australia
Int. J. Environ. Res. Public Health 2013, 10(11), 5565-5583; doi:10.3390/ijerph10115565
Received: 2 September 2013 / Revised: 18 October 2013 / Accepted: 22 October 2013 / Published: 29 October 2013
Cited by 5 | PDF Full-text (266 KB) | HTML Full-text | XML Full-text
Abstract
Among the challenges for rural communities and health services in Australia, climate change and increasing extreme heat are emerging as additional stressors. Effective public health responses to extreme heat require an understanding of the impact on health and well-being, and the risk [...] Read more.
Among the challenges for rural communities and health services in Australia, climate change and increasing extreme heat are emerging as additional stressors. Effective public health responses to extreme heat require an understanding of the impact on health and well-being, and the risk or protective factors within communities. This study draws on lived experiences to explore these issues in eleven rural and remote communities across South Australia, framing these within a socio-ecological model. Semi-structured interviews with health service providers (n = 13), and a thematic analysis of these data, has identified particular challenges for rural communities and their health services during extreme heat. The findings draw attention to the social impacts of extreme heat in rural communities, the protective factors (independence, social support, education, community safety), and challenges for adaptation (vulnerabilities, infrastructure, community demographics, housing and local industries). With temperatures increasing across South Australia, there is a need for local planning and low-cost strategies to address heat-exacerbating factors in rural communities, to minimise the impact of extreme heat in the future. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle Focusing Resource Allocation-Wellbeing as a Tool for Prioritizing Interventions for Communities at Risk
Int. J. Environ. Res. Public Health 2013, 10(8), 3435-3452; doi:10.3390/ijerph10083435
Received: 3 April 2013 / Revised: 23 July 2013 / Accepted: 25 July 2013 / Published: 6 August 2013
Cited by 1 | PDF Full-text (337 KB) | HTML Full-text | XML Full-text
Abstract
Objective: This study examined whether a wellbeing approach to resilience and adaptation would provide practical insights for prioritizing support to communities experiencing environmental and socio-economic stressors. Methods: A cross-sectional survey, based on a purposive sample of 2,196 stakeholders (landholders, hobby [...] Read more.
Objective: This study examined whether a wellbeing approach to resilience and adaptation would provide practical insights for prioritizing support to communities experiencing environmental and socio-economic stressors. Methods: A cross-sectional survey, based on a purposive sample of 2,196 stakeholders (landholders, hobby farmers, town resident and change agents) from three irrigation-dependent communities in Australia’s Murray-Darling Basin. Respondents’ adaptive capacity and wellbeing (individual and collective adaptive capacity, subjective wellbeing, social support, community connectivity, community leadership, in the context of known life stressors) were examined using chi-square, comparison of mean scores, hierarchical regression and factor-cluster analysis. Results: Statistically significant correlations (p < 0.05) were observed between individual (0.331) and collective (0.318) adaptive capacity and wellbeing. Taking into account respondents’ self-assessed health and socio-economic circumstances, perceptions of individual (15%) and collective adaptive capacity (10%) as well as community connectivity (13%) were associated with wellbeing (R2 = 0.36; F (9, 2099) = 132.9; p < 0.001). Cluster analysis found that 11% of respondents were particularly vulnerable, reporting below average scores on all indicators, with 56% of these reporting below threshold scores on subjective wellbeing. Conclusions: Addressing the capacity of individuals to work with others and to adapt to change, serve as important strategies in maintaining wellbeing in communities under stress. The human impacts of exogenous stressors appear to manifest themselves in poorer health outcomes; addressing primary stressors may in turn aid wellbeing. Longitudinal studies are indicated to verify these findings. Wellbeing may serve as a useful and parsimonious proxy measure for resilience and adaptive capacity. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessArticle A Cross-Sectional, Randomized Cluster Sample Survey of Household Vulnerability to Extreme Heat among Slum Dwellers in Ahmedabad, India
Int. J. Environ. Res. Public Health 2013, 10(6), 2515-2543; doi:10.3390/ijerph10062515
Received: 12 May 2013 / Revised: 5 June 2013 / Accepted: 7 June 2013 / Published: 18 June 2013
Cited by 11 | PDF Full-text (813 KB) | HTML Full-text | XML Full-text
Abstract
Extreme heat is a significant public health concern in India; extreme heat hazards are projected to increase in frequency and severity with climate change. Few of the factors driving population heat vulnerability are documented, though poverty is a presumed risk factor. To [...] Read more.
Extreme heat is a significant public health concern in India; extreme heat hazards are projected to increase in frequency and severity with climate change. Few of the factors driving population heat vulnerability are documented, though poverty is a presumed risk factor. To facilitate public health preparedness, an assessment of factors affecting vulnerability among slum dwellers was conducted in summer 2011 in Ahmedabad, Gujarat, India. Indicators of heat exposure, susceptibility to heat illness, and adaptive capacity, all of which feed into heat vulnerability, was assessed through a cross-sectional household survey using randomized multistage cluster sampling. Associations between heat-related morbidity and vulnerability factors were identified using multivariate logistic regression with generalized estimating equations to account for clustering effects. Age, preexisting medical conditions, work location, and access to health information and resources were associated with self-reported heat illness. Several of these variables were unique to this study. As sociodemographics, occupational heat exposure, and access to resources were shown to increase vulnerability, future interventions (e.g., health education) might target specific populations among Ahmedabad urban slum dwellers to reduce vulnerability to extreme heat. Surveillance and evaluations of future interventions may also be worthwhile. Full article
(This article belongs to the Special Issue Climate Change and Human Health)

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Open AccessReview Exploring the Climate Change, Migration and Conflict Nexus
Int. J. Environ. Res. Public Health 2016, 13(4), 443; doi:10.3390/ijerph13040443
Received: 23 November 2015 / Revised: 8 April 2016 / Accepted: 19 April 2016 / Published: 22 April 2016
PDF Full-text (1233 KB) | HTML Full-text | XML Full-text
Abstract
The potential link between climate change, migration, and conflict has been widely discussed and is increasingly viewed by policy makers as a security issue. However, considerable uncertainty remains regarding the role that climate variability and change play among the many drivers of [...] Read more.
The potential link between climate change, migration, and conflict has been widely discussed and is increasingly viewed by policy makers as a security issue. However, considerable uncertainty remains regarding the role that climate variability and change play among the many drivers of migration and conflict. The overall objective of this paper is to explore the potential pathways linking climate change, migration and increased risk of conflict. We review the existing literature surrounding this issue and break the problem into two components: the links between climate change and migration, and those between migration and conflict. We found a large range of views regarding the importance of climate change as a driver for increasing rates of migration and subsequently of conflict. We argue that future research should focus not only on the climate-migration-conflict pathway but also work to understand the other pathways by which climate variability and change might exacerbate conflict. We conclude by proposing five questions to help guide future research on the link between climate change, migration, and conflict. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessReview The Mental Health Outcomes of Drought: A Systematic Review and Causal Process Diagram
Int. J. Environ. Res. Public Health 2015, 12(10), 13251-13275; doi:10.3390/ijerph121013251
Received: 2 September 2015 / Revised: 14 October 2015 / Accepted: 15 October 2015 / Published: 22 October 2015
Cited by 2 | PDF Full-text (2258 KB) | HTML Full-text | XML Full-text
Abstract
Little is understood about the long term, indirect health consequences of drought (a period of abnormally dry weather). In particular, the implications of drought for mental health via pathways such as loss of livelihood, diminished social support, and rupture of place bonds [...] Read more.
Little is understood about the long term, indirect health consequences of drought (a period of abnormally dry weather). In particular, the implications of drought for mental health via pathways such as loss of livelihood, diminished social support, and rupture of place bonds have not been extensively studied, leaving a knowledge gap for practitioners and researchers alike. A systematic review of literature was performed to examine the mental health effects of drought. The systematic review results were synthesized to create a causal process diagram that illustrates the pathways linking drought effects to mental health outcomes. Eighty-two articles using a variety of methods in different contexts were gathered from the systematic review. The pathways in the causal process diagram with greatest support in the literature are those focusing on the economic and migratory effects of drought. The diagram highlights the complexity of the relationships between drought and mental health, including the multiple ways that factors can interact and lead to various outcomes. The systematic review and resulting causal process diagram can be used in both practice and theory, including prevention planning, public health programming, vulnerability and risk assessment, and research question guidance. The use of a causal process diagram provides a much needed avenue for integrating the findings of diverse research to further the understanding of the mental health implications of drought. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessReview Climate Change, Drought and Human Health in Canada
Int. J. Environ. Res. Public Health 2015, 12(7), 8359-8412; doi:10.3390/ijerph120708359
Received: 2 June 2015 / Revised: 3 July 2015 / Accepted: 8 July 2015 / Published: 17 July 2015
Cited by 7 | PDF Full-text (603 KB) | HTML Full-text | XML Full-text
Abstract
Droughts have been recorded all across Canada and have had significant impacts on individuals and communities. With climate change, projections suggest an increasing risk of drought in Canada, particularly in the south and interior. However, there has been little research on the [...] Read more.
Droughts have been recorded all across Canada and have had significant impacts on individuals and communities. With climate change, projections suggest an increasing risk of drought in Canada, particularly in the south and interior. However, there has been little research on the impacts of drought on human health and the implications of a changing climate. A review of the Canadian, U.S. and international literature relevant to the Canadian context was conducted to better define these impacts and adaptations available to protect health. Drought can impact respiratory health, mental health, illnesses related to exposure to toxins, food/water security, rates of injury and infectious diseases (including food-, water- and vector-borne diseases). A range of direct and indirect adaptation (e.g., agricultural adaptation) options exist to cope with drought. Many have already been employed by public health officials, such as communicable disease monitoring and surveillance and public education and outreach. However, gaps exist in our understanding of the impacts of short-term vs. prolonged drought on the health of Canadians, projections of drought and its characteristics at the regional level and the effectiveness of current adaptations. Further research will be critical to inform adaptation planning to reduce future drought-related risks to health. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessReview The Construction and Validation of the Heat Vulnerability Index, a Review
Int. J. Environ. Res. Public Health 2015, 12(7), 7220-7234; doi:10.3390/ijerph120707220
Received: 22 April 2015 / Revised: 3 June 2015 / Accepted: 16 June 2015 / Published: 26 June 2015
Cited by 3 | PDF Full-text (775 KB) | HTML Full-text | XML Full-text
Abstract
The occurrence of extreme heat and its adverse effects will be exacerbated with the trend of global warming. An increasing number of researchers have been working on aggregating multiple heat-related indicators to create composite indices for heat vulnerability assessments and have visualized [...] Read more.
The occurrence of extreme heat and its adverse effects will be exacerbated with the trend of global warming. An increasing number of researchers have been working on aggregating multiple heat-related indicators to create composite indices for heat vulnerability assessments and have visualized the vulnerability through geographic information systems to provide references for reducing the adverse effects of extreme heat more effectively. This review includes 15 studies concerning heat vulnerability assessment. We have studied the indicators utilized and the methods adopted in these studies for the construction of the heat vulnerability index (HVI) and then further reviewed some of the studies that validated the HVI. We concluded that the HVI is useful for targeting the intervention of heat risk, and that heat-related health outcomes could be used to validate and optimize the HVI. In the future, more studies should be conducted to provide references for the selection of heat-related indicators and the determination of weight values of these indicators in the development of the HVI. Studies concerning the application of the HVI are also needed. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessReview A Review of National-Level Adaptation Planning with Regards to the Risks Posed by Climate Change on Infectious Diseases in 14 OECD Nations
Int. J. Environ. Res. Public Health 2013, 10(12), 7083-7109; doi:10.3390/ijerph10127083
Received: 16 October 2013 / Revised: 27 November 2013 / Accepted: 27 November 2013 / Published: 12 December 2013
Cited by 6 | PDF Full-text (385 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Climate change is likely to have significant implications for human health, particularly through alterations of the incidence, prevalence, and distribution of infectious diseases. In the context of these risks, governments in high income nations have begun developing strategies to reduce potential climate [...] Read more.
Climate change is likely to have significant implications for human health, particularly through alterations of the incidence, prevalence, and distribution of infectious diseases. In the context of these risks, governments in high income nations have begun developing strategies to reduce potential climate change impacts and increase health system resilience (i.e., adaptation). In this paper, we review and evaluate national-level adaptation planning in relation to infectious disease risks in 14 OECD countries with respect to “best practices” for adaptation identified in peer-reviewed literature. We find a number of limitations to current planning, including negligible consideration of the needs of vulnerable population groups, limited emphasis on local risks, and inadequate attention to implementation logistics, such as available funding and timelines for evaluation. The nature of planning documents varies widely between nations, four of which currently lack adaptation plans. In those countries where planning documents were available, adaptations were mainstreamed into existing public health programs, and prioritized a sectoral, rather than multidisciplinary, approach. The findings are consistent with other scholarship examining adaptation planning indicating an ad hoc and fragmented process, and support the need for enhanced attention to adaptation to infectious disease risks in public health policy at a national level. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
Open AccessReview Impediments to Comprehensive Research on Climate Change and Health
Int. J. Environ. Res. Public Health 2013, 10(11), 6096-6105; doi:10.3390/ijerph10116096
Received: 8 October 2013 / Revised: 31 October 2013 / Accepted: 6 November 2013 / Published: 12 November 2013
Cited by 7 | PDF Full-text (251 KB) | HTML Full-text | XML Full-text
Abstract
During every climatic era Life on Earth is constrained by a limited range of climatic conditions, outside which thriving and then surviving becomes difficult. This applies at both planetary and organism (species) levels. Further, many causal influences of climate change on human [...] Read more.
During every climatic era Life on Earth is constrained by a limited range of climatic conditions, outside which thriving and then surviving becomes difficult. This applies at both planetary and organism (species) levels. Further, many causal influences of climate change on human health entail changes—often disruptive, sometimes irreversible—in complex system functioning. Understanding the diverse health risks from climate change, and their influence pathways, presents a challenge to environmental health researchers whose prior work has been in a more definable, specific and quantitative milieu. Extension of the research agenda and conceptual framework to assess present and future health risks from climate change may be constrained by three factors: (i) lack of historically-informed understanding of population-health sensitivity to climatic changes; (ii) an instinctual ‘epidemiologising’ tendency to choose research topics amenable to conventional epidemiological analysis and risk estimation; and (iii) under-confidence in relation to interdisciplinary collaborative scenario-based modeling of future health risks. These constraints must be recognized and remedied. And environmental researchers must argue for heightened public attention to today’s macro-environmental threats to present and future population health—emphasising the ecological dimension of these determinants of long-term health that apply to whole populations and communities, not just to individuals and social groupings. Full article
(This article belongs to the Special Issue Climate Change and Human Health)

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Open AccessCommentary Infectious Diseases, Urbanization and Climate Change: Challenges in Future China
Int. J. Environ. Res. Public Health 2015, 12(9), 11025-11036; doi:10.3390/ijerph120911025
Received: 9 July 2015 / Revised: 24 August 2015 / Accepted: 31 August 2015 / Published: 7 September 2015
Cited by 2 | PDF Full-text (646 KB) | HTML Full-text | XML Full-text
Abstract
China is one of the largest countries in the world with nearly 20% of the world’s population. There have been significant improvements in economy, education and technology over the last three decades. Due to substantial investments from all levels of government, the [...] Read more.
China is one of the largest countries in the world with nearly 20% of the world’s population. There have been significant improvements in economy, education and technology over the last three decades. Due to substantial investments from all levels of government, the public health system in China has been improved since the 2003 severe acute respiratory syndrome (SARS) outbreak. However, infectious diseases still remain a major population health issue and this may be exacerbated by rapid urbanization and unprecedented impacts of climate change. This commentary aims to explore China’s current capacity to manage infectious diseases which impair population health. It discusses the existing disease surveillance system and underscores the critical importance of strengthening the system. It also explores how the growing migrant population, dramatic changes in the natural landscape following rapid urbanization, and changing climatic conditions can contribute to the emergence and re-emergence of infectious disease. Continuing research on infectious diseases, urbanization and climate change may inform the country’s capacity to deal with emerging and re-emerging infectious diseases in the future. Full article
(This article belongs to the Special Issue Climate Change and Human Health)

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