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Heat index (HI) is a biometeorological indicator that combines temperature and relative humidity. This study aimed to investigate the relationship between the Heat Index and daily counts of diarrhoea hospitalisation in Dhaka, Bangladesh. Data on daily diarrhoea hospitalisations and meteorological variables from 1981 to 2010 were collected. We categorised the Heat Index of >94.3 °F (>34.6 °C), >100.7 °F (>38.2 °C) and >105 °F (>40.6 °C) as high, very high and extremely high Heat Index, respectively. We applied a time series adjusted generalised linear model (GLM) with negative binomial distribution to investigate the effects of the Heat Index and extreme Heat Index on hospitalisations for diarrhoea. Effects were assessed for all ages, children under 5 years old and by gender. A unit higher HI and high, very high and extremely high HI were associated with 0.8%, 8%, 7% and 9% increase in diarrhoea hospitalisations in all ages, respectively. The effects varied slightly by gender and were most pronounced in children under 5 years old with a rise of 1°F in high, very high and extremely high HI associated with a 14.1% (95% CI: 11.3-17.0%), 18.3% (95% CI: 13.4-23.5%) and 18.1% (95% CI: 8.4-28.6%) increase of diarrhoea, respectively. This suggests that the Heat Index may serve as an alternative indicator for measuring the combined effects of temperature and humidity on diarrhoea.

Background: Exposure to heat and cold poses a serious threat to human health. In the UK, hotter summers, milder winters and an ageing population will shift how populations experience temperature-related health burdens. Estimating future burdens can provide insights on the drivers of temperature-related health effects and removing biases in temperature projections is an essential step to generating these estimates, however, the impact of various methods of correction is not well examined., Methods: We conducted a detailed health impact assessment by estimating mortality attributable to temperature at a baseline period (2007-2018) and in future decades (2030s, 2050s and 2070s). Epidemiological exposure-response relationships were derived for all England regions and UK countries, to quantify cold and heat risk, and temperature thresholds where mortality increases. UK climate projections 2018 (UKCP18)were bias-corrected using three techniques: correcting for mean bias (shift or SH), variability (bias-correction or BC) and extreme values (quantile mapping or QM). These were applied in the health impact assessment, alongside consideration of population ageing and growth to estimate future temperature-related mortality., Findings: In the absence of adaptation and assuming a high-end emissions scenario (RCP8.5), annual UK temperature-related mortality is projected to increase, with substantial differences in raw vs. calibrated projections for heat-related mortality, but smaller differences for cold-related mortality. The BC approach gave an estimated 29 deaths per 100,000 in the 2070s, compared with 50 per 100,000 using uncorrected future temperatures. We also found population ageing may exert a bigger impact on future mortality totals than the impact from future increases in temperature alone. Estimating future health burdens associated with heat and cold is an important step towards equipping decision-makers to deliver suitable care to the changing population. Correcting inherent biases in temperature projections can improve the accuracy of projected health burdens to support health protection measures and long-term resilience planning., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Dhaka is one of the world's densely populated cities and faces significant public health challenges including high burden of diarrhoeal diseases. Climate change is intensifying existing environmental problems including urban heat island effect and poor water quality. While numerous epidemiological studies have linked meteorological factors to diarrhoeal diseases in Bangladesh, assessment of the impacts of future climate change on diarrhoeal diseases is scarce. We provide the assessment of climate change impacts on diarrhoeal disease in Dhaka and project future health risks under climate change scenarios. About 3 million acute diarrhoea cases presenting to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b) during 1981-2010 were linked to daily temperature, rainfall and humidity and association investigated using time series adapted negative binomial regression models employing constrained distributed lag linear models. The findings were applied to climate projections to estimate future risks of diarrhoea under various global warming scenarios. There was a significantly raised risk of diarrhoea hospitalisation in all ages with daily mean temperature (RR: 3.4, 95% CI: 3.0-3.7) after controlling for the confounding effects of heavy rainfall, humidity, autocorrelations, day of the week effect, long-term time, and seasonal trends. Using the incidence rate ratio (IRR) of 1.034, temperature increases based on the global warming targets of 1.5-2°C could result in an increase of diarrhoea hospitalisations by 4.5-7.4% in all age groups by the 2100s. These effects were more pronounced among <5 children where the predicted temperature increases could raise diarrhoea hospitalisation by 5.7% - 9.4%. Diarrhoea hospitalisation will increase significantly in Dhaka even if the global warming targets adopted by the Paris Agreement is reached. This underscores the importance of preparing the city for management and prevention of diarrhoeal diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Haque et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The temperature rise and increases in extreme heat events related to global climate change is a growing public health threat. Populations in temperate climates, including the UK, must urgently adapt to increased hot weather as current infrastructure primarily focusses on resilience to cold. As we adapt, care should be taken to ensure existing health inequalities are reduced. Lessons can be learned from regions that experience warmer climates and applied to adaptation in the UK. We identified known indicators of heat-health risk and explored their distribution across area level income for London. Understanding these indicators and their distributions across populations can support the development of interventions that have the dual aim of improving health and reducing inequalities. An exploratory analysis was conducted for each indicator at neighbourhood level to assess existence of disparities in their distributions across London. A systems-thinking approach was employed to deduce if these amount to systemic inequalities in heat risk, whereby those most exposed to heat are more susceptible and less able to adapt. Using this information, we proposed interventions and made recommendations for their implementation. We find inequalities across indicators relating to exposure, vulnerability, and adaptive capacity. Including inequalities in urban greening and access to greenspace, physical and mental health and access to communication and support. Through a system diagram we demonstrate how these indicators interact and suggest that systemic inequalities in risk exist and will become more evident as exposure increases with rising temperatures, depending on how we adapt. We use this information to identify barriers to the effective implementation of adaptation strategies and make recommendations on the implementation of interventions. This includes effective and wide-reaching communication considering the various channels and accessibility requirements of the population and consideration of all dwelling tenures when implementing policies relating to home improvements in the context of heat., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The extent to which populations will successfully adapt to continued warming temperatures will be a crucial factor in determining future health burdens. Previous health impact assessments of future temperature-related mortality burdens mostly disregard adaptation or make simplistic assumptions. We apply a novel evidence-based approach to model adaptation that takes into account the fact that adaptation potential is likely to vary at different temperatures. Temporal changes in age-specific mortality risk associated with low and high temperatures were characterised for Scotland between 1974 and 2018 using temperature-specific RR ratios to reflect past changes in adaptive capacity. Three scenarios of future adaption were constructed consistent with the SSPs. These adaptation projections were combined with climate and population projections to estimate the mortality burdens attributable to high (above the 90th percentile of the historical temperature distribution) and low (below the 10th percentile) temperatures up to 2080 under five RCP-SSP scenarios. A decomposition analysis was conducted to attribute the change in the mortality burden into adaptation, climate and population. In 1980-2000, the heat burden (21 deaths/year) was smaller than the colder burden (312 deaths/year). In the 2060-2080 period, the heat burden was projected to be the highest under RCP8.5-SSP5 (1285 deaths/year), and the cold burden was the highest under RCP4.5-SSP4 (320 deaths/year). The net burden was lowest under RCP2.6-SSP1 and highest under RCP8.5-SSP5. Improvements in adaptation was the largest factor reducing the cold burden under RCP2.6-SSP1 whilst temperature increase was the biggest factor contributing to the high heat burdens under RCP8.5-SSP5. Ambient heat will become a more important health determinant than cold in Scotland under all climate change and socio-economic scenarios. Adaptive capacity will not fully counter projected increases in heat deaths, underscoring the need for more ambitious climate mitigation measures for Scotland and elsewhere., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Adaptation, to reduce the health impacts of climate change, is driven by political action, public support and events (extreme weather). National adaptation policies or strategies are limited in addressing human health risks and implementation of adaptation in the public health community is not well understood., Aim: To identify key issues in climate change adaptation implementation for public health in Europe., Methods: Key informant interviews with decision-makers in international, national and local city governments in 19 European countries. Participants were recruited if a senior decision-maker working in public health, environmental health or climate adaptation., Interviews Addressed: Barriers and levers for adaptation, policy alignment, networks and evidence needs., Results: Thirty-two interviews were completed between June and October 2021 with 4 international, 5 national and 23 city/local government stakeholders. Respondents reported inadequate resources (funding, training and personnel) for health-adaptation implementation and the marginal role of health in adaptation policy. A clear mandate to act was key for implementation and resource allocation. Limited cross-departmental collaboration and poor understanding of the role of public health in climate policy were barriers to implementation., Conclusions: Across Europe, progress is varied in implementation of climate adaptation in public health planning. Providing appropriate resources, training, knowledge mobilization and supporting cross-departmental collaboration and multi-level governance will facilitate adaptation to protect human health., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association.)

Exposure to high and low ambient temperatures can cause harm to human health. Due to global warming, heat-related health effects are likely to increase substantially in future unless populations adapt to living in a warmer world. Adaptation to temperature may occur through physiological acclimatisation, behavioural mechanisms, and planned adaptation. A fundamental step in informing responses to climate change is understanding how adaptation can be appropriately accounted for when estimating future health burdens. Previous studies modelling adaptation have used a variety of methods, and it is often unclear how underlying assumptions of adaptation are made and if they are based on evidence. Consequently, the most appropriate way to quantitatively model adaptation in projections of health impacts is currently unknown. With increasing interest from decisionmakers around implementation of adaptation strategies, it is important to consider the role of adaptation in anticipating future health burdens of climate change. To address this, a literature review using systematic scoping methods was conducted to document the quantitative methods employed by studies projecting future temperature-related health impacts under climate change that also consider adaptation. Approaches employed in studies were coded into methodological categories. Categories were discussed and refined between reviewers during synthesis. Fifty-nine studies were included and grouped into eight methodological categories. Methods of including adaptation in projections have changed over time with more recent studies using a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most common approaches to model adaptation are heat threshold shifts and reductions in the exposure-response slope. Just under 20% of studies were identified as using an intervention-based empirical basis for statistical assumptions. Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives. To quantify past reductions in cold-related mortality attributable to anthropogenic climate change. Methods. We performed a daily time-series regression analysis employing distributed lag nonlinear models of 1 203 981 deaths in Greater London, United Kingdom, in winter months (November-March) during 1976 to 2019. We made attribution assessment by comparing differential cold-related mortality impacts associated with observed temperatures to those using counterfactual temperatures representing no climate change. Results. Over the past decade, the average number of cold days (below 8 °C) per year was 120 in the observed series and 158 in the counterfactual series. Since 1976, we estimate 447 (95% confidence interval = 330, 559) annual cold-related all-cause deaths have been avoided because of milder temperatures associated with climate change. Annually, 241 cardiovascular and 73 respiratory disease deaths have been avoided. Conclusions. Anthropogenic climate change made some contribution to reducing previous cold-related deaths in London; however, cold remains an important public health risk factor. Public Health Implications. Better adaptation to both heat and cold should be promoted in public health measures to protect against climate change. In England, this has been addressed by the development of a new year-round Adverse Weather and Health Plan. ( Am J Public Health. 2024;114(4):398-402. https://doi.org/10.2105/AJPH.2023.307552).

Anthropogenic climate change will have a detrimental impact on global health, including the direct impact of higher ambient temperatures. Existing projections of heat-related health outcomes in a changing climate often consider increasing ambient temperatures alone. Population growth and structure has been identified as a key source of uncertainty in future projections. Age acts as a modifier of heat risk, with heat-risk generally increasing in older age-groups. In many countries the population is ageing as lower birth rates and increasing life expectancy alter the population structure. Preparing for an older population, in particular in the context of a warmer climate should therefore be a priority in public health research and policy. We assess the level of inclusion of population growth and demographic changes in research projecting exposure to heat and heat-related health outcomes. To assess the level of inclusion of population changes in the literature, keyword searches of two databases were implemented, followed by reference and citation scans to identify any missed papers. Relevant papers, those including a projection of the heat health burden under climate change, were then checked for inclusion of population scenarios. Where sensitivity to population change was studied the impact of this on projections was extracted. Our analysis suggests that projecting the heat health burden is a growing area of research, however, some areas remain understudied including Africa and the Middle East and morbidity is rarely explored with most studies focusing on mortality. Of the studies pairing projections of population and climate, specifically SSPs and RCPs, many used pairing considered to be unfeasible. We find that not including any projected changes in population or demographics leads to underestimation of health burdens of on average 64 %. Inclusion of population changes increased the heat health burden across all but two studies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The Gaza Strip is one of the world’s most fragile states and faces substantial public health and development challenges. Climate change is intensifying existing environmental problems, including increased water stress. We provide the first published assessment of climate impacts on diarrhoeal disease in Gaza and project future health burdens under climate change scenarios. Over 1 million acute diarrhoea cases presenting to health facilities during 2009−2020 were linked to weekly temperature and rainfall data and associations assessed using time-series regression analysis employing distributed lag non-linear models (DLNMs). Models were applied to climate projections to estimate future burdens of diarrhoeal disease under 2 °C and 1.5 °C global warming scenarios. There was a significantly raised risk of diarrhoeal disease associated with both mean weekly temperature above 19 °C and total weekly rainfall below 6 mm in children 0−3 years. A heat effect was also present in subjects aged > 3 years. Annual diarrhoea cases attributable to heat and low rainfall was 2209.0 and 4070.3, respectively, in 0−3-year-olds. In both age-groups, heat-related cases could rise by over 10% under a 2 °C global warming level compared to baseline, but would be limited to below 2% under a 1.5 °C scenario. Mean rises of 0.9% and 2.7% in diarrhoea cases associated with reduced rainfall are projected for the 1.5 °C and 2 °C scenarios, respectively, in 0−3-year-olds. Climate change impacts will add to the considerable development challenges already faced by the people of Gaza. Substantial health gains could be achieved if global warming is limited to 1.5 °C.

Background: Hot weather leads to increased illness and deaths. The Heatwave Plan for England (HWP) aims to protect the population by raising awareness of the dangers of hot weather, especially for those most vulnerable. Individuals at increased risk to the effects of heat include older adults, particularly 75+, and those with specific chronic conditions, such as diabetes, respiratory and heart conditions. The HWP recommends specific protective actions which relate to five heat-health alert levels (levels 0-4). This study examines the attitudes to hot weather of adults in England, and the protective measures taken during a heatwave., Methods: As part of a wider evaluation of the implementation and effects of the HWP, a survey (n = 3153) and focus groups, a form of group interview facilitated by a researcher, were carried out after the June 2017 level 3 heat-health alert. Survey respondents were categorised into three groups based on their age and health status: 'vulnerable' (aged 75+), 'potentially vulnerable' (aged 18-74 in poor health) and 'not vulnerable' (rest of the adult population) to hot weather. Multivariable logistic regression models identified factors associated with these groups taking protective measures. In-person group discussion, focused on heat-health, were carried out with 25 people, mostly aged 75 + ., Results: Most vulnerable and potentially vulnerable adults do not consider themselves at risk of hot weather and are unaware of the effectiveness of important protective behaviours. Only one-quarter of (potentially) vulnerable adults reported changing their behaviour as a result of hearing hot weather-related health advice during the level 3 alert period. Focus group findings showed many vulnerable adults were more concerned about the effects of the sun's ultra-violet radiation on the skin than on the effects of hot temperatures on health., Conclusions: Current public health messages appear to be insufficient, given the low level of (potentially) vulnerable adults changing their behaviour during hot weather. In the context of increasingly warmer summers in England due to climate change, public health messaging needs to convince (potentially) vulnerable adults of all the risks of hot weather (not just effects of sunlight on the skin) and of the importance of heat protective measures., (© 2021. The Author(s).)

Climate change represents one of the largest global health threats of the 21st century with immediate and long-term consequences for the most vulnerable populations, especially in the poorest countries with the least capacity to adapt to climate change. Pregnant women and newborns are increasingly being recognized as vulnerable populations in the context of climate change. The effects can be direct or indirect through heat stress, extreme weather events and air pollution, potentially impacting both the immediate and long-term health of pregnant women and newborns through a broad range of mechanisms. In 2008, the World Health Organization passed a resolution during the 61st World Health Assembly, recognizing the need for research to identify strategies and health-system strengthening to mitigate the effects of climate change on health. Climate adaptation plans need to consider vulnerable populations such as pregnant women and neonates and a broad multisectoral approach to improve overall resilience of societies., (© 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Both climate change and migration present key concerns for global health progress. Despite this, a transparent method for identifying and understanding the relationship between climate change, migration and other contextual factors remains a knowledge gap. Existing conceptual models are useful in understanding the complexities of climate migration, but provide varying degrees of applicability to quantitative studies, resulting in non-homogenous transferability of knowledge in this important area. This paper attempts to provide a critical review of climate migration literature, as well as presenting a new conceptual model for the identification of the drivers of migration in the context of climate change. It focuses on the interactions and the dynamics of drivers over time, space and society. Through systematic, pan-disciplinary and homogenous application of theory to different geographical contexts, we aim to improve understanding of the impacts of climate change on migration. A brief case study of Malawi is provided to demonstrate how this global conceptual model can be applied into local contextual scenarios. In doing so, we hope to provide insights that help in the more homogenous applications of conceptual frameworks for this area and more generally.

Objective: Management of the natural and built environments can help reduce the health impacts of climate change. This is particularly relevant in large cities where urban heat island makes cities warmer than the surrounding areas. We investigate how urban vegetation, housing characteristics and socio-economic factors modify the association between heat exposure and mortality in a large urban area., Methods: We linked 185,397 death records from the Greater London area during May-Sept 2007-2016 to a high resolution daily temperature dataset. We then applied conditional logistic regression within a case-crossover design to estimate the odds of death from heat exposure by individual (age, sex) and local area factors: land-use type, natural environment (vegetation index, tree cover, domestic garden), built environment (indoor temperature, housing type, lone occupancy) and socio-economic factors (deprivation, English language, level of employment and prevalence of ill-health)., Results: Temperatures were higher in neighbourhoods with lower levels of urban vegetation and with higher levels of income deprivation, social-rented housing, and non-native English speakers. Heat-related mortality increased with temperature increase (Odds Ratio (OR), 95% CI = 1.039, 1.036-1.043 per 1 °C temperature increase). Vegetation cover showed the greatest modification effect, for example the odds of heat-related mortality in quartiles with the highest and lowest tree cover were OR, 95%CI 1.033, 1.026-1.039 and 1.043, 1.037-1.050 respectively. None of the socio-economic variables were a significant modifier of heat-related mortality., Conclusions: We demonstrate that urban vegetation can modify the mortality risk associated with heat exposure. These findings make an important contribution towards informing city-level climate change adaptation and mitigation policies., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: There is a growing discussion regarding the mortality burdens of hot and cold weather and how the balance between these may alter as a result of climate change. Net effects of climate change are often presented, and in some settings these may suggest that reductions in cold-related mortality will outweigh increases in heat-related mortality. However, key to these discussions is that the magnitude of temperature-related mortality is wholly sensitive to the placement of the temperature threshold above or below which effects are modelled. For cold exposure especially, where threshold effects are often ill-defined, choices in threshold placement have varied widely between published studies, even within the same location. Despite this, there is little discussion around appropriate threshold selection and whether reported associations reflect true causal relationships - i.e. whether all deaths occurring below a given temperature threshold can be regarded as cold-related and are therefore likely to decrease as climate warms., Objectives: Our objectives are to initiate a discussion around the importance of threshold placement and examine evidence for causality across the full range of temperatures used to quantify cold-related mortality. We examine whether understanding causal mechanisms can inform threshold selection, the interpretation of current and future cold-related health burdens and their use in policy formation., Methods: Using Greater London data as an example, we first illustrate the sensitivity of cold related mortality to threshold selection. Using the Bradford Hill criteria as a framework, we then integrate knowledge and evidence from multiple disciplines and areas- including animal and human physiology, epidemiology, biomarker studies and population level studies. This allows for discussion of several possible direct and indirect causal mechanisms operating across the range of 'cold' temperatures and lag periods used in health impact studies, and whether this in turn can inform appropriate threshold placement., Results: Evidence from a range of disciplines appears to support a causal relationship for cold across a range of temperatures and lag periods, although there is more consistent evidence for a causal effect at more extreme temperatures. It is plausible that 'direct' mechanisms for cold mortality are likely to occur at lower temperatures and 'indirect' mechanisms (e.g. via increased spread of infection) may occur at milder temperatures., Conclusions: Separating the effects of 'extreme' and 'moderate' cold (e.g. temperatures between approximately 8-9 °C and 18 °C in the UK) could help the interpretation of studies quoting attributable mortality burdens. However there remains the general dilemma of whether it is better to use a lower cold threshold below which we are more certain of a causal relationship, but at the risk of under-estimating deaths attributable to cold., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Cold-related mortality and morbidity remains an important public health problem in the UK and elsewhere. Health burdens have often reported to be higher in the UK compared to other countries with colder climates, however such assessments are usually based on comparison of excess winter mortality indices, which are subject to biases. Daily time-series regression or case-crossover studies provide the best evidence of the acute effects of cold exposure. Such studies report a 6% increase in all-cause deaths in England & Wales for every 1 °C fall in daily mean temperature within the top 5% of the coldest days. In major Scottish cities, a 1 °C reduction in mean temperature below 11 °C was associated with an increase in mortality of 2.9%, 3.4%, 4.8% and 1.7% from all-causes, cardiovascular, respiratory, and non-cardio-respiratory causes respectively. In Northern Ireland, a 1 °C fall during winter months led to increases of 4.5%, 3.9% and 11.2% for all-cause, cardiovascular and respiratory deaths respectively among adults. Raised risks are also observed with morbidity outcomes. Hip fractures among the elderly are only weakly associated with snow and ice conditions in the UK, with the majority of cases occurring indoors. A person's susceptibility to cold weather is affected by both individual- and contextual-level risk factors. Variations in the distributions of health, demographic, socio-economic and built-environment characteristics are likely to explain most differences in cold risk observed between UK regions. Although cold-related health impacts reduced throughout much of the previous century in UK populations, there is little evidence on the contribution that milder winters due to climate change may have made to reductions in more recent decades. Intervention measures designed to minimise cold exposure and reduce fuel poverty will likely play a key role in determining current and future health burdens associated with cold weather.

It is widely acknowledged that the climate is warming globally and within the UK. In this paper, studies which assess the direct impact of current increased temperatures and heat-waves on health and those which project future health impacts of heat under different climate change scenarios in the UK are reviewed.This review finds that all UK studies demonstrate an increase in heat-related mortality occurring at temperatures above threshold values, with respiratory deaths being more sensitive to heat than deaths from cardiovascular disease (although the burden from cardiovascular deaths is greater in absolute terms). The relationship between heat and other health outcomes such as hospital admissions, myocardial infarctions and birth outcomes is less consistent. We highlight the main populations who are vulnerable to heat. Within the UK, these are older populations, those with certain co-morbidities and those living in Greater London, the South East and Eastern regions.In all assessments of heat-related impacts using different climate change scenarios, deaths are expected to increase due to hotter temperatures, with some studies demonstrating that an increase in the elderly population will also amplify burdens. However, key gaps in knowledge are found in relation to how urbanisation and population adaptation to heat will affect health impacts, and in relation to current and future strategies for effective, sustainable and equitable adaptation to heat. These and other key gaps in knowledge, both in terms of research needs and knowledge required to make sound public- health policy, are discussed.

Background: Improved data linkages between diverse environment and health datasets have the potential to provide new insights into the health impacts of environmental exposures, including complex climate change processes. Initiatives that link and explore big data in the environment and health arenas are now being established., Objectives: To encourage advances in this nascent field, this article documents the development of a web browser application to facilitate such future research, the challenges encountered to date, and how they were addressed., Methods: A 'storyboard approach' was used to aid the initial design and development of the application. The application followed a 3-tier architecture: a spatial database server for storing and querying data, server-side code for processing and running models, and client-side browser code for user interaction and for displaying data and results. The browser was validated by reproducing previously published results from a regression analysis of time-series datasets of daily mortality, air pollution and temperature in London., Results: Data visualisation and analysis options of the application are presented. The main factors that shaped the development of the browser were: accessibility, open-source software, flexibility, efficiency, user-friendliness, licensing restrictions and data confidentiality, visualisation limitations, cost-effectiveness, and sustainability., Conclusions: Creating dedicated data and analysis resources, such as the one described here, will become an increasingly vital step in improving understanding of the complex interconnections between the environment and human health and wellbeing, whilst still ensuring appropriate confidentiality safeguards. The issues raised in this paper can inform the future development of similar tools by other researchers working in this field., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Introduction: Climate change and rapid population ageing are significant public health challenges. Understanding which health problems are affected by temperature is important for preventing heat and cold-related deaths and illnesses, particularly in the elderly. Here we present a systematic review and meta-analysis on the effects of ambient hot and cold temperature (excluding heat/cold wave only studies) on elderly (65+ years) mortality and morbidity., Methods: Time-series or case-crossover studies comprising cause-specific cases of elderly mortality (n=3,933,398) or morbidity (n=12,157,782) were pooled to obtain a percent change (%) in risk for temperature exposure on cause-specific disease outcomes using a random-effects meta-analysis., Results: A 1°C temperature rise increased cardiovascular (3.44%, 95% CI 3.10-3.78), respiratory (3.60%, 3.18-4.02), and cerebrovascular (1.40%, 0.06-2.75) mortality. A 1°C temperature reduction increased respiratory (2.90%, 1.84-3.97) and cardiovascular (1.66%, 1.19-2.14) mortality. The greatest risk was associated with cold-induced pneumonia (6.89%, 20-12.99) and respiratory morbidity (4.93% 1.54-8.44). A 1°C temperature rise increased cardiovascular, respiratory, diabetes mellitus, genitourinary, infectious disease and heat-related morbidity., Discussion: Elevated risks for the elderly were prominent for temperature-induced cerebrovascular, cardiovascular, diabetes, genitourinary, infectious disease, heat-related, and respiratory outcomes. These risks will likely increase with climate change and global ageing., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: High and low ambient temperatures are associated with increased mortality in temperate and subtropical climates. Temperature-related mortality patterns are expected to change throughout this century because of climate change., Objectives: We compared mortality associated with heat and cold in UK regions and Australian cities for current and projected climates and populations., Methods: Time-series regression analyses were carried out on daily mortality in relation to ambient temperatures for UK regions and Australian cities to estimate relative risk functions for heat and cold and variations in risk parameters by age. Excess deaths due to heat and cold were estimated for future climates., Results: In UK regions, cold-related mortality currently accounts for more than one order of magnitude more deaths than heat-related mortality (around 61 and 3 deaths per 100,000 population per year, respectively). In Australian cities, approximately 33 and 2 deaths per 100,000 population are associated every year with cold and heat, respectively. Although cold-related mortality is projected to decrease due to climate change to approximately 42 and 19 deaths per 100,000 population per year in UK regions and Australian cities, heat-related mortality is projected to increase to around 9 and 8 deaths per 100,000 population per year, respectively, by the 2080s, assuming no changes in susceptibility and structure of the population., Conclusions: Projected changes in climate are likely to lead to an increase in heat-related mortality in the United Kingdom and Australia over this century, but also to a decrease in cold-related deaths. Future temperature-related mortality will be amplified by aging populations. Health protection from hot weather will become increasingly necessary in both countries, while protection from cold weather will be still needed.

Background: The most direct way in which climate change is expected to affect public health relates to changes in mortality rates associated with exposure to ambient temperature. Many countries worldwide experience annual heat-related and cold-related deaths associated with current weather patterns. Future changes in climate may alter such risks. Estimates of the likely future health impacts of such changes are needed to inform public health policy on climate change in the UK and elsewhere., Methods: Time-series regression analysis was used to characterise current temperature-mortality relationships by region and age group. These were then applied to the local climate and population projections to estimate temperature-related deaths for the UK by the 2020s, 2050s and 2080s. Greater variability in future temperatures as well as changes in mean levels was modelled., Results: A significantly raised risk of heat-related and cold-related mortality was observed in all regions. The elderly were most at risk. In the absence of any adaptation of the population, heat-related deaths would be expected to rise by around 257% by the 2050s from a current annual baseline of around 2000 deaths, and cold-related mortality would decline by 2% from a baseline of around 41 000 deaths. The cold burden remained higher than the heat burden in all periods. The increased number of future temperature-related deaths was partly driven by projected population growth and ageing., Conclusions: Health protection from hot weather will become increasingly necessary, and measures to reduce cold impacts will also remain important in the UK. The demographic changes expected this century mean that the health protection of the elderly will be vital., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Extreme cold and heat waves, characterized by a number of cold or hot days in succession, place a strain on people's cardiovascular and respiratory systems. The increase in deaths due to these waves may be greater than that predicted by extreme temperatures alone. We examined cold and heat waves in 99 US cities for 14 years (1987-2000) and investigated how the risk of death depended on the temperature threshold used to define a wave, and a wave's timing, duration and intensity. We defined cold and heat waves using temperatures above and below cold and heat thresholds for two or more days. We tried five cold thresholds using the first to fifth percentiles of temperature, and five heat thresholds using the 95-99 percentiles. The extra wave effects were estimated using a two-stage model to ensure that their effects were estimated after removing the general effects of temperature. The increases in deaths associated with cold waves were generally small and not statistically significant, and there was even evidence of a decreased risk during the coldest waves. Heat waves generally increased the risk of death, particularly for the hottest heat threshold. Cold waves of a colder intensity or longer duration were not more dangerous. Cold waves earlier in the cool season were more dangerous, as were heat waves earlier in the warm season. In general there was no increased risk of death during cold waves above the known increased risk associated with cold temperatures. Cold or heat waves earlier in the cool or warm season may be more dangerous because of a build up in the susceptible pool or a lack of preparedness for extreme temperatures., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To examine the short term relation between ambient temperature and risk of myocardial infarction., Design: Daily time series regression analysis., Setting: 15 conurbations in England and Wales., Participants: 84,010 hospital admissions for myocardial infarction recorded in the Myocardial Ischaemia National Audit Project during 2003-6 (median 57 events a day)., Main Outcome Measures: Change in risk of myocardial infarction associated with a 1 degrees C difference in temperature, including effects delayed by up to 28 days., Results: Smoothed graphs revealed a broadly linear relation between temperature and myocardial infarction, which was well characterised by log-linear models without a temperature threshold: each 1 degrees C reduction in daily mean temperature was associated with a 2.0% (95% confidence interval 1.1% to 2.9%) cumulative increase in risk of myocardial infarction over the current and following 28 days, the strongest effects being estimated at intermediate lags of 2-7 and 8-14 days: increase per 1 degrees C reduction 0.6% (95% confidence interval 0.2% to 1.1%) and 0.7% (0.3% to 1.1%), respectively. Heat had no detrimental effect. Adults aged 75-84 and those with previous coronary heart disease seemed more vulnerable to the effects of cold than other age groups (P for interaction 0.001 or less in each case), whereas those taking aspirin were less vulnerable (P for interaction 0.007)., Conclusions: Increases in risk of myocardial infarction at colder ambient temperatures may be one driver of cold related increases in overall mortality, but an increased risk of myocardial infarction at higher temperatures was not detected. The risk of myocardial infarction in vulnerable people might be reduced by the provision of targeted advice or other interventions, triggered by forecasts of lower temperature.

Background: Given the double jeopardy of global increases in rates of obesity and climate change, it is increasingly important to recognise the dangers posed to diabetic patients during periods of extreme weather. We aimed to characterise the associations between ambient temperature and general medical practitioner consultations made by a cohort of type-2 diabetic patients. Evidence on the effects of temperature variation in the primary care setting is currently limited.Methods: Case-crossover analysis of 4,474,943 consultations in England during 2012-2014, linked to localised temperature at place of residence for each patient. Conditional logistic regression was used to assess associations between each temperature-related consultation and control days matched on day-of-week.Results: There was an increased odds of seeking medical consultation associated with high temperatures: Odds ratio (OR) = 1.097 (95% confidence interval = 1.041, 1.156) per 1 °C increase above 22 °C. Odds during low temperatures below 0 °C were also significantly raised: OR = 1.024 (1.019, 1.030). Heat-related consultations were particularly high among diabetics with cardiovascular comorbidities: OR = 1.171 (1.031, 1.331), but there was no heightened risk with renal failure or neuropathy comorbidities. Surprisingly, lower odds of heat-related consultation were associated with the use of diuretics, anticholinergics, antipsychotics or antidepressants compared to non-use, especially among those with cardiovascular comorbidities, although differences were not statistically significant.Conclusions: Type-2 diabetic patients are at increased odds of medical consultation during days of temperature extremes, especially during hot weather. The common assumption that certain medication use heightens the risk of heat illness was not borne-out by our study on diabetics in a primary care setting and such advice may need to be reconsidered in heat protection plans. [ABSTRACT FROM AUTHOR]

In recent years, both the EU Commission and the Belmont Forum have funded projects focusing on health and climate change with the aim of expanding research and evidence and improving intersectoral cooperation. The EU-funded ENBEL project is developing tools to streamline climate and health research to support policies and strategies and improve response and resilience. Methods: Within ENBEL a stakeholder analysis is being carried out for Europe to identify key decision makers involved in climate change and health adaptation, understand interlinkages and identify areas for action to promote collaboration and uptake. Semi-structured interviews with key institutions and stakeholders at different levels (International, European, national and local) will help identify key evidence needs and research gaps and findings will be used to define knowledge tools and policy briefs to enhance adaptation. Furthermore, current policies on adaptation in Europe and how health issues are addressed, especially taking into account the Next Generation EU (NGEU) funding in support of COVID-19 recovery as well as Green Deal and Climate Action, will be reviewed to ensure ENBEL products fit the EU policy agenda. Conclusions: ENBEL offers an opportunity to produce targeted research syntheses for decision makers as well an ensuring health becomes a key aspect in climate change policy decision making. The ENBEL project will engage with key decision makers involved in climate change and health adaptation across Europe, providing knowledge, understanding interlinkages and identifying areas for action to promote climate policies that enhance health benefits. [ABSTRACT FROM AUTHOR]

Studies conducted in diverse regions of the world have shown mortality and morbidity increases at temperature extremes, and global climate change may worsen the toll in certain areas. We evaluated associations between apparent temperature (a combination of temperature and relative humidity) and daily mortality in two Mexican cities (Mexico City and Monterrey), and examined whether associations differed by age and cause-of-death. Monterrey is Mexico's third largest city and is in the north (altitude 540 M); Mexico City, the capital and Mexico's largest city (altitude 2,240) is in central Mexico. Both have semi-arid climates. We used robust Poisson regression to model time series from each city: 1994-1998 in Mexico City, and 1996-1999 in Monterrey, fitting separate models for total, and cause- and age-specific mortality. We used natural spline terms to control for possible confounding by respiratory epidemics, defined as periods where respiratory-cause mortality exceeded the 90th percentile for 10 or more consecutive days. Temperature was modeled as the natural spline of the mean apparent temperature lags 0 to 13, and covariates in the model were indicator variables for day of week and public holidays, a linear term for PM10 (average lags 0-3), and natural splines for day of study and the respiratory epidemics. Autoregressive terms were added if necessary and degrees of freedom for day of study adjusted to minimize the sum of the partial autocorrelation function. Percent changes in mortality and 95% confidence intervals (CI's) associated with ‘heat’ and ‘cold’ were calculated for 1 degree increments enclosing the most extreme temperature reached during 50 or more days, relative to the increment enclosing the mean temperature (15.5o for Mexico City, and 25.3o for Monterrey). Because the ‘extreme’ heat increment for Mexico City was 19-20 o and the cold increment for Monterrey was 17-18 o, neither of which is likely to be physiologically stressful, we report only the results for the Mexico City cold effect (10-11o) and Monterrey hot effect (35-36 o). For total mortality, the cold effect in Mexico City was 13.1% (95% CI: 10.9%, 15.3%) and the heat effect in Monterrey, 16.9% (95% CI: 8.1%, 26.5%). In Monterrey, the heat effect was stronger among those over age 65: 30.2% excess mortality (95% CI: 17.7%, 44.1%). Cardiovascular and respiratory mortality had lower effects compared to all-cause. In Mexico City, the cold association was higher for respiratory mortality (26.2%, 95% CI: 19.7%, 33.0%), and for those over 65 (15.6%, 95% CI:12.6%, 18.6%). Cardiovascular mortality was slightly higher than for total. The elderly are at greatest risk for heat-related mortality in Monterrey, and the elderly and those with respiratory conditions are most vulnerable to cold in Mexico City. [ABSTRACT FROM AUTHOR]