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GHHIN

2020

Managing heat risk during the COVID-19 pandemic

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GHHIN

2020

Heat in the City: Dialogue Outcome Brief

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GHHIN

2020

Heat in the Workplace: Dialogue Outcome Brief

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Heat acclimatization and vulnerabilities of people living in the Sahel. The case of Senegal

This study analysed the heat-related impact on mortality and morbidity for a rural population in Senegal. To evaluate the effect of the duration of heat exposure, we measured heat by the average apparent temperature (with effect of humidity) in a period preceding the event (medical visit, death) ranging from one, five, and ten to thirty days. We investigated the temperature-mortality or -morbidity relationship by vulnerable groups
(children and elderly people) and by temperature type (daily minimum, maximum and average). Finally, we used three types of models: GLM, GAM and ARIMAX.

We found that, between 1984 and 2014, high heat resulted in an excess of mortality and medical diagnosed morbidity, especially among children and elderly people.

Cool Infrastructures Research Collective

This research project was developed to fill specific gaps in evidence and data on access to cooling across cities in India, Pakistan, Cameroon and Indonesia. The research design is organised around three main research questions, each anchored in theoretical debates and bodies of academic scholarship:

i. Heat, Inequality and Gender

ii. Cool Infrastructures

iii. Thermal Practices, Needs and Capacities

Cool Infrastructures is a collaboration between research institutions in Scotland, Cameroon, Pakistan, India, Indonesia, France, Germany and Singapore.

Assessment of weather and climate risks (SIETO)

The (SIETO) project has produced a national weather and climate risk assessment, focusing in particular on the vulnerabilities of different sectors to hydro-meteorological and climatological hazards. The risk assessment of the project was also used to develop the governance model for future risk assessments. The results of the project support the implementation of the National Climate Change Adaptation Plan 2022 and provide material for the national, EU and global level governance frameworks of weather and climate risk management.

Heat and Health in the Changing Climate (HEATCLIM)

The overall objective of the project is to produce new knowledge on the effects of high temperatures on human health in northern areas, and to provide cost-effective and socially acceptable solutions to adapt to climate change. The consortium project is genuinely multidisciplinary, covering natural, health, and social sciences and engineering, which enables versatile approaches to research questions. The project is coordinated by the University of Eastern Finland; other participants are Aalto University, Finnish Meteorological Institute, and Finnish Institute for Health and Welfare.

 

During the project, epidemiological analyses of health register data will be performed to evaluate the effects of heat and heatwaves on morbidity and mortality, and to identify susceptible population groups. Social and economic determinants of heat vulnerability will be evaluated using a questionnaire study, complemented with interviews and scenario work. A field study, including environmental and physiological measurements, will be conducted to create thermal comfort models for vulnerable population groups, and to evaluate the efficiency of local cooling methods. Climate modelling will be conducted to improve heat wave predictions for early warning systems and climate scenarios, and to calculate of cooling capacity needs in future climate.

 

In the last, integrative step of the project, health impact of heat in different climate, societal and adaptation scenarios will be assessed. Results will be used to guide policy makers on the scaling and targeting of adaptation measures. Central questions to be answered include:

  • How will the burden of disease caused by heat change in Finland because of climate change?
  • Which adaptation options are most efficient considering health effects, costs of the measures, and greenhouse gas emissions?
  • How do the costs of adaptation and health effects affect the Finnish economy?

Extreme Heat Kills Even in Very Hot Cities: Evidence from Nagpur, India

Although many studies have provided evidence for all-cause mortality attributed to extreme temperature across India, few studies have provided a systematic analysis of the association between all-cause mortality and temperature.

 

Objective: To estimate the risk associated with heat waves during two major heat waves of Nagpur occurred in 2010 and 2014.

 

Methods: The association between temperature and mortality was measured using a distributed lag non-linear model (DLNM) and the attributable deaths associated with the heat waves with forward perspective in the DLNM framework.

 

Results: From the ecological analysis, we found 580 and 306 additional deaths in 2010 and 2014, respectively. Moving average results also gave similar findings. DLNM results showed that the relative risk was 1.5 for the temperature above 45 °C; forward perspective analysis revealed that the attributable deaths during 2010 and 2014 were 505 and 376, respectively. Results from different methods showed that heat waves in different years had variable impacts for various reasons. However, all the results were consistent during 2010 and 2014; there were 30% and 14% extra-mortalities due to heat comparing to non-heat wave years.

 

Conclusion: We strongly recommend the city Government to implement the action plans based on this research outcome to reduce the risk from the heat wave in future.

Climate Adapted People Shelters (CAPS) in Australia

The CAPS project aimed to reimagine Sydney’s bus shelters as Climate Adapted People Shelters through an open innovation design competition.

Karachi Heatwave Management Plan: A Guide to Planning and Response

This document, Karachi Heatwave Management Plan, outlines what should happen before, during and after periods of extreme heat in Karachi. It sets out strategies that government and non-government agencies will adopt to prevent heat-related illnesses and deaths in Karachi and capacitate the public, particularly the most vulnerable residents, to take protective action. The Plan describes actions of implementation partners to ensure (1) information on weather conditions and heat health is timely and specific, (2) organizations have the capacity to respond according to their roles, and (3) strategies and actions enabling increase in effectiveness over time. In June 2015 Karachi City experienced a severe heatwave that caused over 1,200 deaths and over 50,000 cases of heat illness. The heatwave caught all levels of government and first responders off-guard, highlighting the need for inter-agency coordination, clarity in roles, and a well-publicized trigger to activate a planned response. To address this need and to prevent health impacts from future heatwaves as climate change intensifies, the Commissioner Office Karachi requested support from the Climate and Development Knowledge Network (CDKN) to develop a heatwave management plan. Karachi’s first Heatwave Management Plan is the result of a technical assistance project delivered by national and international experts between October 2016 and May 2017, working closely with the Commissioner Office and other stakeholders. The Plan will be subject to an annual performance review and updated versions will be available to implementation partners accordingly.

Supporting Asian Megacities in Managing Extreme Heat Impacts

Climate change is increasing the frequency, intensity and duration of hot weather in South Asia. When it comes to health, the most detrimental impacts from extreme heat often occur in cities in developing nations, where large populations can become exposed and capacity to prepare and respond is low. In 2015 Karachi, Pakistan, experienced a severe heatwave that caused over 1,200 deaths and over 40,000 cases of heat illness. This heatwave caught government and first responders off-guard, highlighting the need for inter-agency coordination, clarity in roles, and a management plan.

 

How We Helped & Our Project’s Impacts

Between November 2016 and April 2017, and with funding from the Climate and Development Knowledge Network (CDKN), ESSA and The Urban Unit delivered Karachi’s first Heatwave Management Plan. The Plan builds on the analysis of data from the June 2015 event, as well as input gathered over several stakeholder outreach and engagement sessions. The Management Plan outlines what should happen before, during and after periods of extreme heat in Karachi. It sets out strategies that government and non-government agencies will take together to prevent heat-related illness and death in Karachi and equip the public, particularly the most vulnerable residents, to take protective action. The Management Plan was approved by the City, which has committed to resourcing it and making it operational. It includes an evaluation framework and proposed indicators, which will facilitate annual performance reviews.

As part of the work, ESSA also delivered a Regional Toolkit for Heatwave Management in Asian Cities. The Toolkit is intended for use by local authorities and stakeholders in other large Asian cities so the health risks of extreme heat could be integrated into disaster management, public health and land use planning. It includes guidance to develop and implement a heatwave management plan, examples highlighting cities’ experiences in preparing for and responding to heatwaves, templates, checklists and sample communications material. The chair of Pakistan’s National Disaster Management Authority is “hopeful that this Toolkit will serve as an important contribution in the efforts to make our cities resilient and sustainable.”

Turn Down the Heat

Western Sydney is hot and is set to get hotter as green fields make way for new housing developments; exacerbating what scientists call the urban heat island effect. Extreme heat causes major liveability and resilience problems with critical impacts for human health, infrastructure, emergency services and the natural environment.

Turn Down the Heat is a WSROC-led initiative that takes a collaborative, multi-sector approach to tackling urban heat in Western Sydney. The initiative is guided by the Turn Down the Heat Strategy (launched in December 2018). Developed with the input of 55 different organisations, the Strategy lays out a five-year plan for a cooler, more liveable and resilient future.

Urban Climate Vulnerability in Cambodia: A Case Study in Koh Kong Province

This study investigates an urban climate vulnerability in Cambodia by constructing an index to compare three different communes, Smach Meanchey, Daun Tong, and Steong Veng, located in the Khemarak Phoumin district, Koh Kong province. It is found that Daun Tong commune is the most vulnerable location among the three communes, followed by Steong Veng. Besides, vulnerability as Expected Poverty (VEP) is used to measure the vulnerability to poverty, that is, the probability of a household income to fall below the poverty line, as it captures the impact of shocks can be conducted in the cross-sectional study. It applies two poverty thresholds: the national poverty line after taking into account the inflation rate and the international poverty line defined by the World Bank, to look into its sensitivity. By using the national poverty line, the study reveals that more than one-fourth of households are vulnerable to poverty, while the international poverty threshold shows that approximately one-third of households are in peril. With low levels of income inequality, households are not highly sensitive to poverty; however, both poverty thresholds point out that the current urban poor households are more vulnerable than non-poor families.

Characterization of Heat Waves: A Case Study for Peninsular Malaysia

The present work aims to investigate the characteristics of heat waves in Peninsular Malaysia based on the Excess Heat Factor (EHF) Index. This index was calculated based on the daily maximum and minimum temperatures over nine meteorological stations in Peninsular Malaysia during the period 2001 to 2010. The selected station is representing all of the states in Peninsular Malaysia. Statistical analysis found that the highest of the EHF happened at the Kuala Lumpur station in 2002 with an index of 9.1°C² and the lowest was in Alor Setar in 2006 with an index of 0.1°C². The EHF moderate was found at Kuantan with an index of 4.2°C². Moreover, the longest heat wave with 24 days has happened in Ipoh, Perak with amplitude of 29.4°C – 33.0°C. Most of the heat wave characterized in Malaysia occurred during the El Nino events especially moderate El Nino in 2002 until 2005, and 2010. The Southeast, northeast and west part of Malaysia experience the highest average heat wave activity. These results indicated that the heat wave conditions in Peninsular Malaysia are anxious and this requires immediate investigation because it has a direct impact on agriculture, particularly health, economic, and human being.

Too hot to handle? Heat resilience in urban South Sudan

South Sudan is at risk from the impact of climate change. This paper reviews the climate change issues faced by South Sudan, and the strategy as outlined to the United Nations. The author argues that the policy overlooks a key potential cause of future morbidity and mortality: increased ambient temperatures, particularly in urban centres due to the urban heat island effect.  The capital is especially susceptible to heat-related mortality as it faces a ‘triple threat’: rapidly rising temperatures, an at-risk population profile, and inadequate planning for the pressures of urbanisation. Four low-cost, evidence-based recommendations are given to mitigate the impact of heatwaves on human health, and it is concluded that South Sudan has great potential to become a regional leader in heat resilience.

Plan Vaudois de Prévention et d'Intervention Sanitaire en cas de Canicule

Depuis 2009, l’Etat de Vaud dispose d’un plan canicule cantonal. Il vise à protéger la santé de la population des effets des vagues de chaleur, à limiter la surcharge du système sanitaire et à coordonner les différents acteurs appelés à intervenir dans ce type de situation. Ainsi, l’Etat définit des mesures de prévention collectives et individuelles et les transmet à la population ainsi qu’aux collectivités publiques et privées. Il prend en compte les situations sanitaire et météorologique ainsi que les prévisions, coordonne les acteurs (partenaires du secteur socio-sanitaire) et prend les décisions nécessaires pour prévenir ou atténuer les atteintes à la santé dues à la canicule.

Genève: Plan canicule pour les aîné-e-s (Geneva Heatwave plan for seniors)

Suite à une mise en garde de la médecin cantonale, la Ville de Genève active dès samedi 8 août 2020 son Plan canicule en faveur des aîné-e-s et des personnes sans-abri. Un suivi régulier de celles et ceux qui se sont inscrit-e-s auprès du Service social est assuré. Cette année, ce dispositif est particulièrement important compte tenu du contexte sanitaire encore marqué par le COVID-19.

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Following a warning from the cantonal doctor, the City of Geneva is activating its heatwave plan for the elderly and homeless from Saturday August 8, 2020. Regular follow-up of those who have registered with the Social Service is ensured. This year, the plan is particularly important given the health context still marked by COVID-19.

Early Action Protocols for Heat and Cold waves in Kyrgyzstan and Tajikistan

The pilot project envisages the introduction of Forecast-based Action (FbA) in Kyrgyzstan and Tajikistan to reduce the humanitarian impact of the increasing number extreme weather events on the population. The focus is on the development of Early Action Protocols (EAPs) in order to mitigate the impact from cold waves and heat waves in rural parts of Kyrgyzstan and Tajikistan. Through these EAPs, the Red Crescent Societies of both countries will be able to draw on the FbA by the DREF fund of the IFRC in Geneva whenever weather forecasts reach critical thresholds for approaching natural disasters. These funds can be used to carry out predefined short-term measures in affected communities. People are thus better protected: Families can bring their belongings to safety, protect their livestock and better cushion the harmful consequences of extreme weather conditions. In this way, extreme weather does not throw them back again and again in their economic and health development.

World Weather Attribution

World Weather Attribution (WWA) is an international effort to analyse and communicate the possible influence of climate change on extreme weather events, such as storms, extreme rainfall, heatwaves, cold spells, and droughts.

Recognising society’s interest in reducing the human, economic, and environmental costs of weather-related disasters, WWA delivers timely and scientifically reliable information on how extreme weather may be affected by climate change.

Recent studies have quantified the impact of climate change on the likelihood and intensity of bushfiresheatwaves and storms.

Through extensive media engagement – including the Guardian, the Daily Mail, the Times, Scientific American, CBS, BBC and many more – WWA has helped to change the global conversation around climate change, influencing adaptation strategies and paving the way for new sustainability litigation. In 2020, climate change attribution was named one of MIT Tech Review’s top ten breakthrough technologies.

WWA is a partnership of:

  • Environmental Change Institute, University of Oxford (ECI)
  • Royal Netherlands Meteorological Institute (KNMI)
  • Laboratoire des Sciences du Climat et de l’Environment (LSCE)
  • University of Princeton
  • National Center for Atmospheric Research (NCAR)
  • Red Cross Red Crescent Climate Centre (The Climate Centre).

Defining heatwaves: heatwave defined as a heat impact event servicing all community and business sectors in Australia

This report proposes a new objective definition for heatwaves and heatwave severity that may be applied to any location in Australia, or for that matter the world. Using this definition, it is now possible to compare severe and extreme heat events across time and space. A heatwave intensity index has been created by combining measures of excess heat, the long-term temperature anomaly characterised by each location’s unique climatology of heat, and heat stress, the short-term temperature anomaly measuring recent thermal acclimatisation. These two measures have been factored together to create the excess heat factor (EHF).

 

The Australian community understands that heatwaves are a common summertime experience and rarely anticipates significant human health risk. This is borne out by the cumulative distribution function of EHF which indicates that most heatwaves are of low intensity. It is only rarely that heatwaves become severe enough to impact vulnerable people and rarer still that they exhibit extreme intensities capable of causing widespread health problems. Generalised extreme value theory has been used to motivate a severity threshold for the EHF, a level at which the heatwave may be considered to be severe. Case studies of Australian and international severe and extreme heatwaves are examined with the aid of EHF intensity, demonstrating the utility of the index. The methodology applied in the development of this heatwave index appeals to our common understanding of heatwave impact. Additionally, the objective statistical techniques employed here are easily extended to permit the development of a robust coldwave index, the logical extension to coldwaves being also proposed in this report. EHF can be used to appropriately alert communities according to the intensity of impending heatwaves, whilst climates trends and projections of intensity, frequency, spatial extent and length can also be considered for Australian and international locations.

Cool Streets - Sydney, Australia

Cool Streets is an initiative out of Sydney, Australia, to empower communities to cool the planet, one street at a time. Cool Streets combines scientific research and public engagement, working with local communities to implement effective street tree plantings that provide shade in heat-affected urban areas and reduce CO2 emissions.

Turn Down the Heat: Strategy and action plan

This strategy has been prepared to increase awareness and facilitate a broader and more coordinated response to the challenges of urban heat in Western Sydney.

California Heat & Health Project

As part of California’s Fourth Climate Change Assessment, Four Twenty Seven is working with project partners to develop a tool that will inform long-term planning efforts to communicate the urgency of and mitigate the public health impacts of increasing extreme heat events across the state.

Islas de calor, impactos y respuestas: El caso del cantón de Curridabat

Las islas de calor o islas térmicas se refieren al patrón térmico que se encuentra en sitios altamente urbanizados en el centro o en la periferia de las ciudades. Son generadas por la pérdida de cobertura vegetal la cual es substituida por superficies impermeables como las carreteras de asfalto, edificios de concreto, ladrillo y otros materiales de construcción, dando como resultado el cambio en el balance hídrico y radiativo superficial, generando, por lo tanto, aumentos en la temperatura de las áreas urbanizadas. La identificación de estas islas térmicas permite desarrollar medidas de adaptación en sitios puntuales de la ciudad. Con el objetivo de conocer el comportamiento de las islas de calor en el Cantón de Curridabat se realizó un análisis de las temperaturas de los últimos cuatro años obtenidas de imágenes satelitales LandSat 8. Los resultados obtenidos reflejan un patrón de calentamiento diferenciado dependiendo del nivel de urbanización y la presencia de vegetación. Así mismo, se señala la relación de estas islas de calor con diferentes grupos vulnerables de la población y la necesidad de tomar medidas considerando la situación actual y futura con los cambios probables del clima. Análisis relacionados con la vegetación remanente en el cantón muestran la importancia de tomar acciones sobre parches de bosques en propiedades privadas y la atención al espacio verde público por habitante que muestra una situación de desigualdad dependiendo del distrito en que se ubique. Finalmente se propone la necesidad de desarrollar una definición para bosque urbano, y de acciones para atender principalmente todo lo relacionado a la adaptación al cambio climático basada en ecosistemas en la ciudad.

HEATCOST Health effects and associated socio-economic costs of increasing temperatures and wildfires - A global assessment

HEATCOST will quantify health risks attributable to heat and air pollution (with a particular focus on air pollution from wildfires) in main world regions under selected climate scenarios and socioeconomic pathways.

The project capitalizes on the H2020 project Exhaustion.eu.

The researtch is co-designed with stakeholder partners engaged in development and implementation of adaptation measures. HEATCOST will increase synergies between teams across partner countries and stakeholder organizations, fostering a new climate and environmental health knowledge platform based on a transdisciplinary and end-user focused approach.

HEATCOST quantifies global current and future changes in cardiopulmonary (CPD) mortality and morbidity due to extreme heat and air pollution (including from wildfires) under selected climate scenarios, while assessing a diverse set of adaptation mechanisms and strategies, and estimates the associated costs. Extreme heat increases the rates of death (mortality) and can exacerbate a range of diseases (morbidity). In particular, heat increases mortality and morbidity for cardiovascular and respiratory diseases (CVD and RD), which together constitute cardiopulmonary diseases (CPD). The risk of wildland fires increases during periods of extreme heat and decreasing precipitation, and can cause intense air pollution. Synergistic effects of extreme heat and air pollution (O3 and PM2.5) on CPD outcomes have been identified. Complex interactions act to exacerbate the effects of extreme events on CPD outcomes. The health risk varies by region, population vulnerability, the built environment and other factors. Populations at highest risk include older adults, children, socially isolated individuals, and individuals with chronic diseases. Health effects due to heat and air pollution is largely preventable to the extent that adaptation measures can be tailored to alleviate contextual and individual vulnerability factors for vulnerable populations.

To assess future health risks, HEATCOST will review the rich literature on the exposure-response relationships between health effects and non-optimum temperature, including for EU, USA, and China, and establish exposure projections for extreme heat and air pollution based on updated and advanced modelling and downscaling efforts. HEATCOST includes a diverse set of adaptation mechanisms, calculates the associated economic and social costs and identifies effective strategies for minimizing adverse impacts. The results will be disseminated to the general public and to decision- and policy-makers.

HEATCOST will address key knowledge gaps listed by the IPCC and USGCRP: published health risk projections do not adequately reflect the adaptation to a changing climate; there is a lack of knowledge and appropriate models regarding possible interactive effects of extreme heat and air pollution; and the fundamental gap between the approach of global models and observational data for quantitative projections of the costs associated with heat, air pollution and health risks.

The High-Impact Weather Project (HIWeather)

The High Impact Weather project (HIWeather) is a ten-year activity within the WMO’s World Weather Research Programme. It serves to promote cooperative international research to achieve a dramatic increase in resilience to high impact weather, worldwide, through improving forecasts for timescales of minutes to two weeks and enhancing their communication and utility in social, economic and environmental applications.”

A case study of the heat-health vulnerability of informal settlement residents in Dar es Salaam, Tanzania

Heat has the potential to become one of the most significant public health impacts of climate change in the coming decades. Increases in temperature have been linked to both increasing mortality and morbidity. Cities have been recognized as areas of particular vulnerability to heat’s impacts on health, and marginalized groups, such as the poor, appear to have higher heat-related morbidity and mortality. Little research has examined the heat vulnerability of urban informal settlements residents in Africa, even though surface temperatures across Africa are projected to increase at a rate faster than the global average.

This paper addresses this knowledge gap through a mixed-methods analysis of the heat-health vulnerability of informal settlement residents in Dar es Salaam, Tanzania. The heat exposure, sensitivity and adaptive capacity of informal settlement residents were assessed through a combination of climate analyses, semi-structured interviews with local government actors and informal settlement residents, unstructured interviews with health sector respondents, a health impacts literature review, and a stakeholder engagement workshop.

The results suggest that increasing temperatures due to climate change will likely be a significant risk to human health in Dar es Salaam, even though the city does not reach extreme temperature conditions, because informal settlement residents have high exposure, high sensitivity and low adaptive capacity to heat, and because the heat-health relationship is currently an under-prioritized policy issue. While numerous urban planning approaches can play a key role in increasing the resilience of citizens to heat, Dar es Salaam’s past and current growth and development patterns greatly complicate the implementation and enforcement of such approaches. For African cities, the findings highlight an urgent need for more research on the vulnerability and resilience of residents to heat-health impacts, because many African cities are likely to present similar characteristics to those in Dar es Salaam that increase resident’s vulnerability.

La Plata Plan de Contingencia Hidrometeorológica (Hydrometeorological Contingency Plan)

La ciudad de La Plata y el Gran La Plata presentan una notoria vulnerabilidad ante eventos hidrometeorológicos severos, que se ve reflejada en el impacto que producen los mismos en la calidad de vida de sus habitantes, daños a bienes espacios públicos y privados. Para una adecuada Gestión Integral del Riesgo de Desastres en el Partido de La Plata, es necesario y prioritario establecer lineamientos para la Gestión de Emergencias, ya sean estas de origen Natural o Tecnológico. Este Plan General de Gestión de Emergencias -establecido a principios de 2014- tiene los siguientes objetivos:

Objetivo General:

  • Reconocer las amenazas de origen natural como las provocadas por la actividad de los seres humanos (tecnológicas).

Objetivos Específicos:

  • Identificar los actores y sectores involucrados en la gestión de emergencias.
  • Establecer roles y funciones para la gestión de emergencias.
  • Profundizar las estrategias de coordinación entre los organismos municipales, provinciales y nacionales involucrados en acciones de manejo de crisis (advertencia/alarma y respuesta) y rehabilitación ante un evento adverso.
  • Promover actividades de prevención y preparación comunitaria.
  • Indicar a la población las acciones a tomar Un Plan de Contingencia es un conjunto de procedimientos específicos que presentan una estructura estratégica y operativa contribuyentes a controlar una situación de emergencia y minimizar sus consecuencias negativas.

Surviving and thriving in the heat: evidencing heat impacts and management for exposed occupations in and beyond the workplace

Working people are particularly vulnerable to environmental heat. We will study the complex threat heat exposures pose to human health, wellbeing and productivity in working populations in Singapore and other tropical countries (Vietnam and Cambodia), and to identify sustainable preventive policies and actions that can reduce these impacts.

European Heat Health System

The Climate and Health Program (CLIMA) of the Barcelona Institute for Global Health (ISGlobal) is working to build a prototype of heat health early warning system for Europe. This unified pan-European service will be adapted to all European societies by using daily meteorological and mortality data to account for the regional differences in human vulnerability and societal adaptation to climate variability and change. The development of this epidemiological surveillance tool is aimed at contributing to a better monitoring and forecasting system of temperature-related health risks. The system will provide more realistic warnings, raising awareness and support public health management and decision making.

Heatwave Early Actions Test in Hanoi

In advance of a heatwave affecting Hanoi from 18-21 July 2019, Red Cross cooling centres and other early actions were tested in an attempt reduce the occurrence of heat-related symptoms in vulnerable populations.

Two-way effect modifications of air pollution and air temperature on total natural and cardiovascular mortality in eight European urban areas

Although epidemiological studies have reported associations between mortality and both ambient air pollution and air temperature, it remains uncertain whether the mortality effects of air pollution are modified by temperature and vice versa. Moreover, little is known on the interactions between ultrafine particles (diameter75th percentile), an increase of 10,000 particles/cm(3) in PNC corresponded to a 2.51% (95% CI: 0.39%, 4.67%) increase in cardiovascular mortality, which was significantly higher than that on days with low air temperatures (<25th percentile) [-0.18% (95% CI: -0.97%, 0.62%)]. On days with high air pollution (>50th percentile), both heat- and cold-related mortality risks increased. CONCLUSION: Our findings showed that high temperature could modify the effects of air pollution on daily mortality and high air pollution might enhance the air temperature effects.

The Role of Fluid Temperature and Form on Endurance Performance in the Heat

Exercising in the heat often results in an excessive increase in body core temperature, which can be detrimental to health and endurance performance. Research in recent years has shifted toward the optimum temperature at which drinks should be ingested. The ingestion of cold drinks can reduce body core temperature before exercise but less so during exercise. Temperature of drinks does not seem to have an effect on the rate of gastric emptying and intestinal absorption. Manipulating the specific heat capacity of a solution can further induce a greater heat sink. Ingestion of ice slurry exploits the additional energy required to convert the solution from ice to water (enthalpy of fusion). Body core temperature is occasionally observed to be higher at the point of exhaustion with the ingestion of ice slurry. There is growing evidence to suggest that ingesting ice slurry is an effective and practical strategy to prevent excessive rise of body core temperature and improve endurance performance. This information is especially important when only a fixed amount of fluid is allowed to be carried, often seen in some ultra-endurance events and military operations. Future studies should evaluate the efficacy of ice slurry in various exercise and environmental conditions.

Biophysical aspects of human thermoregulation during heat stress

Humans maintain a relatively constant core temperature through the dynamic balance between endogenous heat production and heat dissipation to the surrounding environment. In response to metabolic or environmental disturbances to heat balance, the autonomic nervous system initiates cutaneous vasodilation and eccrine sweating to facilitate higher rates of dry (primarily convection and radiation) and evaporative transfer from the body surface; however, absolute heat losses are ultimately governed by the properties of the skin and the environment. Over the duration of a heat exposure, the cumulative imbalance between heat production and heat dissipation leads to body heat storage, but the consequent change in core temperature, which has implications for health and safety in occupational and athletic settings particularly among certain clinical populations, involves a complex interaction between changes in body heat content and the body’s morphological characteristics (mass, surface area, and tissue composition) that collectively determine the body’s thermal inertia. The aim of this review is to highlight the biophysical aspects of human core temperature regulation by outlining the principles of human energy exchange and examining the influence of body morphology during exercise and environmental heat stress. An understanding of the biophysical factors influencing core temperature will enable researchers and practitioners to better identify and treat individuals/populations most vulnerable to heat illness and injury during exercise and extreme heat events. Further, appropriate guidelines may be developed to optimize health, safety, and work performance during heat stress.

Responses to hyperthermia. Optimizing heat dissipation by convection and evaporation: Neural control of skin blood flow and sweating in humans

Under normothermic, resting conditions, humans dissipate heat from the body at a rate approximately equal to heat production. Small discrepancies between heat production and heat elimination would, over time, lead to significant changes in heat storage and body temperature. When heat production or environmental temperature is high the challenge of maintaining heat balance is much greater. This matching of heat elimination with heat production is a function of the skin circulation facilitating heat transport to the body surface and sweating, enabling evaporative heat loss.

These processes are manifestations of the autonomic control of cutaneous vasomotor and sudomotor functions and form the basis of this review. We focus on these systems in the responses to hyperthermia. In particular, the cutaneous vascular responses to heat stress and the current understanding of the neurovascular mechanisms involved. The available research regarding cutaneous active vasodilation and vasoconstriction is highlighted, with emphasis on active vasodilation as a major responder to heat stress. Involvement of the vasoconstrictor and active vasodilator controls of the skin circulation in the context of heat stress and nonthermoregulatory reflexes (blood pressure, exercise) are also considered. Autonomic involvement in the cutaneous vascular responses to direct heating and cooling of the skin are also discussed. We examine the autonomic control of sweating, including cholinergic and noncholinergic mechanisms, the local control of sweating, thermoregulatory and nonthermoregulatory reflex control and the possible relationship between sudomotor and cutaneous vasodilator function. Finally, we comment on the clinical relevance of these control schemes in conditions of autonomic dysfunction.

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

Objective: To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation.

Background: Certified athletic trainers recognize and treat athletes with EHIs, often in high-risk environments. Although the proper recognition and successful treatment strategies are well documented, EHIs continue to plague athletes, and exertional heat stroke remains one of the leading causes of sudden death during sport. The recommendations presented in this document provide athletic trainers and allied health providers with an integrated scientific and clinically applicable approach to the prevention, recognition, treatment of, and return-to-activity guidelines for EHIs. These recommendations are given so that proper recognition and treatment can be accomplished in order to maximize the safety and performance of athletes.

Recommendations: Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes. The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses.

Exertional heat illness: emerging concepts and advances in prehospital care

Exertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. Although evidence is available primarily from case series and healthy volunteer studies, the consensus for treating exertional heat illness, coupled with altered mental status, is whole body rapid cooling. Cold or ice water immersion remains the most effective treatment to achieve this goal. External thermometry is unreliable in the context of heat stress and direct internal temperature measurement by rectal or esophageal probes must be used when diagnosing heat illness and during cooling. With rapid recognition and implementation of effective cooling, most patients suffering from exertional heat stroke will recover quickly and can be discharged home with instructions to rest and to avoid heat stress and exercise for a minimum of 48 hours; although, further research pertaining to return to activity is warranted.

To Cool, But Not Too Cool: That Is the Question-Immersion Cooling for Hyperthermia

Patient coolingtime can impact upon the prognosis of heat illness. Although ice-cold-water immersion will rapidly extract heat, access to ice or cold water may be limited in hot climates. Indeed, some have concerns regarding the sudden cold-water immersion of hyperthermic individuals, whereas others believe that cutaneous vasoconstriction may reduce convective heat transfer from the core. It was hypothesized that warmer immersion temperatures, which induce less powerful vasoconstriction, may still facilitate rapid cooling in hyperthermic individuals.

Heat Acclimation Decay and Re-Induction: A Systematic Review and Meta-Analysis

Although the acquisition of heat acclimation (HA) is well-documented, less is known about HA decay (HAD) and heat re-acclimation (HRA). The available literature suggests 1 day of HA is lost following 2 days of HAD. Understanding this relationship has the potential to impact upon the manner in which athletes prepare for major competitions, as a HA regimen may be disruptive during final preparations (i.e., taper).

Physiological Responses to Heat Acclimation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The aim of this meta-analysis was to evaluate the effectiveness of heat acclimatization (HA) on time trial (TT) performance, maximum oxygen uptake (VO2max), exercise heart rate (HRE), time trials heart rate (HRTT), maximal heart rate (HRM), core temperature (TC), mean skin temperature (TS), thermal comfort (TComf), plasma volume (PV), blood lactate concentration and rate of perceived exertion (RPE). Cochrane-CENTRAL, EMBASE, CINAHL and PubMed databases and reference lists of included studies were searched for randomized controlled trials that investigated the efficacy of HA in athletes. Data were then extracted from the entered studies for analyses. A total of 11 randomised controlled trials (215 participants; mean age, 26.09 years; 91% men) were included after screening of 508 titles and abstracts and 19 full-text articles. The pooled standard mean difference (SMD) between the HA and non-HA groups were 0.50 (95% CI: 0.03 to 0.97, p = 0.04) for TT performance and 1 (95% CI: 1 to 2, p = 0.007) for HRTT. The pooled mean difference (MD) between the HA and non-HA groups were -7 (95% CI: -13 to -1, p = 0.03) for HRM. The changes in TComf and RPE were too small to be meaningful. There were no significant differences between the HA and non-HA groups for VO2max, HRE, TC, TS, PV and blood lactate concentration (all p > 0.05). This meta-analysis implies that HA may improve tolerance to discomfort during heat exposure, but may not necessarily improve the associated physiological markers of improved performance.

Ambient Conditions Prior to Tokyo 2020 Olympic and Paralympic Games: Considerations for Acclimation or Acclimatization Strategies

The Tokyo Olympics and Paralympic games in 2020 will be held in hot and humid conditions. Heat acclimation (in a climatic chamber) or heat acclimatization (natural environment) is essential to prepare the (endurance) athletes and reduce the performance loss associated with work in the heat. Based on the 1990–2018 hourly meteorological data of Tokyo and the derived wet bulb globe temperature (WBGT) (Liljegren method), Heat Index and Humidex, it is shown that the circumstances prior to the games are likely not sufficiently hot to fully adapt to the heat. For instance, the WBGT 2 weeks prior to the games at the hottest moment of the day (13:00 h) is 26.4 ± 2.9∘C and 28.6 ± 2.8∘C during the games. These values include correction for global warming. The daily variation in thermal strain indices during the Tokyo Olympics (WBGT varying by 4∘C between the early morning and the early afternoon) implies that the time of day of the event has a considerable impact on heat strain. The Paralympics heat strain is about 1.5∘C WBGT lower than the Olympics, but may still impose considerable heat strain since the Paralympic athletes often have a reduced ability to thermoregulate. It is therefore recommended to acclimate about 1 month prior to the Olympics under controlled conditions set to the worst-case Tokyo climate and re-acclimatize in Japan or surroundings just prior to the Olympics.

Ergogenic effects of precooling with cold water immersion and ice ingestion: A meta-analysis

This review evaluated the effects of precooling via cold water immersion (CWI) and ingestion of ice slurry/slushy or crushed ice (ICE) on endurance performance measures (e.g. time-to-exhaustion and time trials) and psychophysiological parameters (core [Tcore] and skin [Tskin] temperatures, whole body sweat [WBS] response, heart rate [HR], thermal sensation [TS], and perceived exertion [RPE]). Twenty-two studies were included in the meta-analysis based on the following criteria: (i) cooling was performed before exercise with ICE or CWI; (ii) exercise longer than 6 min was performed in ambient temperature ≥26°C; and (iii) crossover study design with a non-cooling passive control condition. CWI improved performance measures (weighted average effect size in Hedges’ g [95% confidence interval] + 0.53 [0.28; 0.77]) and resulted in greater increase (ΔEX) in Tskin (+4.15 [3.1; 5.21]) during exercise, while lower peak Tcore (-0.93 [-1.18; -0.67]), WBS (-0.74 [-1.18; -0.3]), and TS (-0.5 [-0.8; -0.19]) were observed without concomitant changes in ΔEX-Tcore (+0.19 [-0.22; 0.6]), peak Tskin (-0.67 [-1.52; 0.18]), peak HR (-0.14 [-0.38; 0.11]), and RPE (-0.14 [-0.39; 0.12]). ICE had no clear effect on performance measures (+0.2 [-0.07; 0.46]) but resulted in greater ΔEX-Tcore (+1.02 [0.59; 1.45]) and ΔEX-Tskin (+0.34 [0.02; 0.67]) without concomitant changes in peak Tcore (-0.1 [-0.48; 0.28]), peak Tskin (+0.1 [-0.22; 0.41]), peak HR (+0.08 [-0.19; 0.35]), WBS (-0.12 [-0.42; 0.18]), TS (-0.2 [-0.49; 0.1]), and RPE (-0.01 [-0.33; 0.31]). From both ergogenic and thermoregulatory perspectives, CWI may be more effective than ICE as a precooling treatment prior to exercise in the heat.

Precooling and percooling (cooling during exercise) both improve performance in the heat: a meta-analytical review

Exercise increases core body temperature (Tc), which is necessary to optimise physiological processes. However, excessive increase in Tc may impair performance and places participants at risk for the development of heat-related illnesses. Cooling is an effective strategy to attenuate the increase in Tc. This meta-analysis compares the effects of cooling before (precooling) and during exercise (percooling) on performance and physiological outcomes.

Fluid Balance and Hydration Considerations for Women: Review and Future Directions

Although it is well understood that dehydration can have a major impact on exercise performance and thermoregulatory physiology, the potential for interactions between female sex hormone influences and the impact of dehydration on these variables is poorly understood. Female reproductive hormonal profiles over the course of the menstrual cycle have significant influences on thermoregulatory and volume regulatory physiology. Increased insight into the interactions among dehydration and menstrual cycle hormonal influences may have important implications for safety, nutritional recommendations, as well as optimal mental and physical performance. The purpose of this review is to summarize what is known in this area and highlight the areas that will be important for future work.

Consensus Recommendations on Training and Competing in the Heat

Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimise performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimise performance is to heat acclimatise. Heat acclimatisation should comprise repeated exercise-heat exposures over 1–2 weeks. In addition, athletes should initiate competition and training in a euhydrated state and minimise dehydration during exercise. Following the development of commercial cooling systems (eg, cooling-vest), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organisers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimising the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events, for hydration and body cooling opportunities, when competitions are held in the heat.

Exertional Heat Illness during Training and Competition

Exertional heat illness can affect athletes during high-intensity or long-duration exercise and result in withdrawal from activity or collapse during or soon after activity. These maladies include exercise associated muscle cramping, heat exhaustion, or exertional heatstroke. While certain individuals are more prone to collapse from exhaustion in the heat (i.e., not acclimatized, using certain medications, dehydrated, or recently ill), exertional heatstroke (EHS) can affect seemingly healthy athletes even when the environment is relatively cool. EHS is defined as a rectal temperature greater than 40°C accompanied by symptoms or signs of organ system failure, most frequently central nervous system dysfunction. Early recognition and rapid cooling can reduce both the morbidity and mortality associated with EHS. The clinical changes associated with EHS can be subtle and easy to miss if coaches, medical personnel, and athletes do not maintain a high level of awareness and monitor at-risk athletes closely. Fatigue and exhaustion during exercise occur more rapidly as heat stress increases and are the most common causes of withdrawal from activity in hot conditions. When athletes collapse from exhaustion in hot conditions, the term heat exhaustion is often applied. In some cases, rectal temperature is the only discernable difference between severe heat exhaustion and EHS in on-site evaluations. Heat exhaustion will generally resolve with symptomatic care and oral fluid support. Exercise associated muscle cramping can occur with exhaustive work in any temperature range, but appears to be more prevalent in hot and humid conditions. Muscle cramping usually responds to rest and replacement of fluid and salt (sodium). Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping.

The Inter-Association Task Force Document on Emergency Health and Safety: Best-Practice Recommendations for Youth Sports Leagues

In an effort to improve the emergency health and safety best practices and policies in youth sport, this document was developed to serve as a road map for policy and procedure recommendations. It addresses the most common conditions resulting in sudden death and outlines recommended policies and procedures designed to improve youth sport safety.

A review of outdoor thermal comfort indices and neutral ranges for hot-humid regions

This paper reviews frequently used outdoor thermal comfort indices in hot-humid regions and neutral thermal ranges to offer guidelines for selecting an appropriate index for hot-humid regions. An overview of the development of outdoor thermal comfort (OTC) indices based on type of approach, from linear equation approach – to adaptive thermal comfort model – is provided and the advantages and limitations of each index are presented. Subjective neutral ranges from 31 studies conducted in hot-humid regions were assessed on the basis of geographical location, Köppen-Geiger’s climate classification, parameters, a survey method, instrumentation set-up, respondent profile, method of analysis, neutral range, and coefficient of determinations in order to gain an understanding of their deviations. The review of 31 calibration studies of (m)PET’s, (OUT_)SET*’s and UTCI’s neutral ranges indicated that the lower threshold of (m)PET’s neutral range needs to be lowered, while the lower threshold of (OUT_)SET*’s and UTCI’s ranges should be raised. The appropriateness of (OUT_)SET*’s thermal range for hot climates was proven by its full-coverage neutral range in the evaluation. However, the accurate response to ambient thermal conditions was determined by the advancement of a human thermoregulatory model.

Advancing our Understanding of Heat Wave Criteria and Associated Health Impacts to Improve Heat Wave Alerts in Developing Country Settings

Health effects of heat waves with high baseline temperatures in areas such as India remain a critical research gap. In these regions, extreme temperatures may affect the underlying population’s adaptive capacity; heat wave alerts should be optimized to avoid continuous high alert status and enhance constrained resources, especially under a changing climate. Data from registrars and meteorological departments were collected for four communities in Northwestern India. Propensity Score Matching (PSM) was used to obtain the relative risk of mortality and number of attributable deaths (i.e., absolute risk which incorporates the number of heat wave days) under a variety of heat wave definitions (n = 13) incorporating duration and intensity. Heat waves’ timing in season was also assessed for potential effect modification. Relative risk of heat waves (risk of mortality comparing heat wave days to matched non-heat wave days) varied by heat wave definition and ranged from 1.28 [95% Confidence Interval: 1.11–1.46] in Churu (utilizing the 95th percentile of temperature for at least two consecutive days) to 1.03 [95% CI: 0.87–1.23] in Idar and Himmatnagar (utilizing the 95th percentile of temperature for at least four consecutive days). The data trended towards a higher risk for heat waves later in the season. Some heat wave definitions displayed similar attributable mortalities despite differences in the number of identified heat wave days. These findings provide opportunities to assess the “efficiency” (or number of days versus potential attributable health impacts) associated with alternative heat wave definitions. Findings on both effect modification and trade-offs between number of days identified as “heat wave” versus health effects provide tools for policy makers to determine the most important criteria for defining thresholds to trigger heat wave alerts.

Air Temperatures and Occupational Injuries in the Construction Industries: A Report From Northern Italy (2000-2013)

The aim of this study was to assess the relationship between environmental temperatures and occupational injuries (OIs) in construction workers (CWs) from a subalpine region of North-Eastern Italy. Data about OIs from 2000 to 2013, and daily weather for the specific site of the events were retrieved. Risk for daily OIs was calculate through a Poisson regression model. Estimated daily incidence for OIs was 5.7 (95%CI 5.5-5.8), or 2.8 OIs/10,000 workers/d (95%CI 2.7-2.9), with higher rates for time periods characterized by high temperatures (daily maximum ≥35°C), both in first 2 d (3.57, 95%CI 3.05-4.11) and from the third day onwards (i.e. during Heat Waves: 3.43, 95%CI 3.08-3.77). Higher risk for OIs was reported in days characterized temperatures ≥95th percentile (OR 1.145, 95%CI 1.062-1.235), summer days (daily maximum ≥25°C , OR 1.093, 95%CI 1.042-1.146). On the contrary, no significant increased risk was found for OIs having a more severe prognosis (≥40 d or more; death). In conclusion, presented findings recommend policymakers to develop appropriate procedures and guidelines, in particular aimed to improve the compliance of younger CWs towards severe-hot daily temperatures.

Analyzing the heat island magnitude and characteristics in one hundred Asian and Australian cities and regions

Urban heat island is the more documented phenomenon of climate change. Information on the magnitude and the characteristics of the canopy layer urban heat island measured in 101 cities and regions of Asia and Australia and collected through 88 scientific articles, are compiled, evaluated and presented. Data are classified in several clusters according to the experimental protocol used and the type of statistical information reported regarding the magnitude of the urban heat island. Results and detailed analysis are given for each defined cluster. Very significant differences on the UHI intensity are found between the clusters and analyzed in detail. The detailed impact of the main weather parameters and conditions on the magnitude of the UHI is also investigated. The specific influence of anthropogenic thermal fluxes as well as of the urban morphological and construction characteristics to UHI is thoroughly examined. The relation between the UHI intensity and the city size is assessed and global relationships of UHI as a function of the urban population are proposed. The seasonal and diurnal variability of the UHI is analyzed and discussed while specific features and conditions like the urban heat island characteristics in coastal cities and the existence of daytime cool islands are explored. Finally, the impact of the selected reference station and its characteristics is considered.

Asian megacity heat stress under future climate scenarios: impact of air-conditioning feedback

Future heat stress under six future global warming (ΔT GW ) scenarios (IPCC RCP8.5) in an Asian megacity (Osaka) is estimated using a regional climate model with an urban canopy and air-conditioning (AC). An urban heat ‘stress’ island is projected in all six scenarios (ΔT GW = +0.5 to +3.0 °C in 0.5 °C steps). Under ΔT GW = +3.0 °C conditions, people outdoors experience ‘extreme’ heat stress, which could result in dangerously high increases in human body core temperature. AC-induced feedback increases heat stress roughly linearly as ΔT GW increases, reaching 0.6 °C (or 12% of the heat stress increase). As this increase is similar to current possible heat island mitigation techniques, this feedback needs to be considered in urban climate projections, especially where AC use is large.

Attribution of mortality to the urban heat island during heatwaves in the West Midlands, UK

The Urban Heat Island (UHI) effect describes the phenomenon whereby cities are generally warmer than surrounding rural areas. Traditionally, temperature monitoring sites are placed outside of city centres, which means that point measurements do not always reflect the true air temperature of urban centres, and estimates of health impacts based on such data may under-estimate the impact of heat on public health. Climate change is likely to exacerbate heatwaves in future, but because climate projections do not usually include the UHI, health impacts may be further underestimated. These factors motivate a two-dimensional analysis of population weighted temperature across an urban area, for heat related health impact assessments, since populations are typically densest in urban centres, where ambient temperatures are highest and the UHI is most pronounced. We investigate the sensitivity of health impact estimates to the use of population weighting and the inclusion of urban temperatures in exposure data.

Efficacy of Heat Mitigation Strategies on Core Temperature and Endurance Exercise: A Meta-Analysis

A majority of high profile international sporting events, including the coming 2020 Tokyo Olympics, are held in warm and humid conditions. When exercising in the heat, the rapid rise of body core temperature (T c ) often results in an impairment of exercise capacity and performance. As such, heat mitigation strategies such as aerobic fitness (AF), heat acclimation/acclimatization (HA), pre-exercise cooling (PC) and fluid ingestion (FI) can be introduced to counteract the debilitating effects of heat strain. We performed a meta-analysis to evaluate the effectiveness of these mitigation strategies using magnitude-based inferences.

Heat wave and the risk of intimate partner violence

A high number of women report experiencing intimate partner violence (IPV). It is of utmost importance to identify possible factors that precipitate IPV and incorporate them into police protocols for evaluating IPV risk. Scientific evidence shows that environmental temperature is associated with a risk of violent behavior. OBJECTIVES: To analyze the effect and impact of heat waves on the risk of IPV. METHODS: Ecological, longitudinal time series study. The dependent variables are: intimate partner femicides (IPF), reports of IPV and 016 IPV telephone help line calls in the Community of Madrid from 05/01 to 09/30 in the years 2008-2016. The principal independent variable is the daily maximum temperature in Celsius (Tmax) above the heat wave threshold of 34 degrees C. A binomial negative regression was used for calls and reports and a Poisson regression was used for IPF. The attributable risk among those exposed (AR%) and the number of attributable cases was calculated for each variable. RESULTS: The risk of IPF increased three days after the heat wave, [RR(IC95%):1.40(1.00-1.97)], police reports of IPV increased one day after [RR (IC95%):1.02(1.00-1.03) and help line calls increased five days after [RR(IC95%):1.01(1.00-1.03)]. The AR% was 28.8% (IC95%: 0.3%-49.2%) for IPF, 1.7% (IC95%:0.3%-3.1%) for police reports and 1.43% (IC95:0.1%;2.8%) for help line calls. CONCLUSIONS: Our results suggest that heat waves are associated with an increase in IPV. The effect of an increase in IPV is delayed in time, with differences according to the violence indicators analyzed.

Heat-related Training and Educational Material Needs among Oil Spill Cleanup Responders

Heat-related illness (HRI), injury, and death among oil spill cleanup responders can be prevented through training and educational materials. This study assessed heat-related training and educational materials currently used and desired by oil spill cleanup responders. A needs assessment was completed by 65 oil spill cleanup responders regarding their occupational heat-related experiences and training needs. Oil spill cleanup responders reported participating on average in 37 oil spill cleanup activities per year. Most reported experiencing additional HRI risk factors, such as high temperatures and humidity and wearing personal protective equipment and clothing ensembles, respirators, and personal flotation devices. Many reported experiencing symptoms of HRI (profuse sweating, headache, weakness, decreased urine output, high body temperatures) and experiencing heat exhaustion. Although multiple prevention controls were reported, only 1 in 4 reported using an acclimatization plan. The most common training delivery method and education received included just-in-time training and printed materials. The most desirable future training delivery methods and education products were smartphone or tablet applications, printed materials, and online training. Findings from this study may be beneficial to safety and health professionals and health educators, particularly those interested in developing heat stress training and educational materials for oil spill cleanup responders.

Heatstroke (Review Article)

This review summarizes current knowledge about heatstroke, which is often misinterpreted or overlooked, focusing on its relevance for medical practitioners.

Humid heat waves at different warming levels

The co-occurrence of consecutive hot and humid days during a heat wave can strongly affect human health. Here, we quantify humid heat wave hazard in the recent past and at different levels of global warming. We find that the magnitude and apparent temperature peak of heat waves, such as the ones observed in Chicago in 1995 and China in 2003, have been strongly amplified by humidity. Climate model projections suggest that the percentage of area where heat wave magnitude and peak are amplified by humidity increases with increasing warming levels. Considering the effect of humidity at 1.5° and 2° global warming, highly populated regions, such as the Eastern US and China, could experience heat waves with magnitude greater than the one in Russia in 2010 (the most severe of the present era). The apparent temperature peak during such humid-heat waves can be greater than 55 °C. According to the US Weather Service, at this temperature humans are very likely to suffer from heat strokes. Humid-heat waves with these conditions were never exceeded in the present climate, but are expected to occur every other year at 4° global warming. This calls for respective adaptation measures in some key regions of the world along with international climate change mitigation efforts.

Implications for workability and survivability in populations exposed to extreme heat under climate change: a modelling study

Changes in temperature and humidity due to climate change affect living and working conditions. An understanding of the effects of different global temperature changes on population health is needed to inform the continued implementation of the Paris Climate Agreement and to increase global ambitions for greater cuts in emissions. By use of historical and projected climate conditions, we aimed to investigate the effects of climate change on workability (ie, the ability to work) and survivability (the ability to survive).

Public health vulnerability to heat-related impacts of climate change in Cyprus

This study investigates the heat-related impacts of climate change on public health in Cyprus. Most of the health problems in Cyprus and in the Mediterranean generally, are related mainly to the warming already occurred as well as to extreme weather events such as heatwaves. In addition projections indicate that warming and extreme events will increase in future posing serious threats on human health. For the investigation of the relationship bretween hot weather condition and mortality in Cyprus, a statistical model was constructed showing linear increase of mortality with increasing temperature. Humidex is also calculated, using outputs from several regional climate models. The analysis revealed a significant increase in the Humidex in future period mainly during summer months.

Quantifying excess deaths related to heatwaves under climate change scenarios: A multicountry time series modelling study

This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change.

Regional Characteristics of Heat-related Deaths and the Application of a Heat-health Warning System in Korea

We studied regional characteristics of mortality and meteorological conditions in Seoul and Busan during the extreme heat wave of 1994. We estimated the relationship between EHWS’s fixed criteria and observed deaths during 1991–2005. During the same period, HHWS’s warning criteria and observed excess deaths were calculated and compared to the EHWS’s to test the reliability of the system. Because of increasing urban vulnerability, the application and development of a heat warning system is imperative. Application of HHWS will reduce the urban health risks and provide efficient decision-making for public health officials.

Should Electric Fans Be Used During a Heat Wave?

Heat waves continue to claim lives, with the elderly and poor at greatest risk. A simple and cost-effective intervention is an electric fan, but public health agencies warn against their use despite no evidence refuting their efficacy in heat waves. A conceptual human heat balance model can be used to estimate the evaporative requirement for heat balance, the potential for evaporative heat loss from the skin, and the predicted sweat rate, with and without an electrical fan during heat wave conditions. Using criteria defined by the literature, it is clear that fans increase the predicted critical environmental limits for both the physiological compensation of endogenous/exogenous heat, and the onset of cardiovascular strain by an air temperature of ∼3-4 °C, irrespective of relative humidity (RH) for the young and elderly. Even above these critical limits, fans would apparently still provide marginal benefits at air temperatures as high as 51.1 °C at 10%RH for young adults and 48.1 °C at 10%RH for the elderly. Previous concerns that dehydration would be exacerbated with fan use do not seem likely, except under very hot (>40 °C) and dry (<10%RH) conditions, when predicted sweat losses are only greater with fans by a minor amount (∼20-30 mL/h). Relative to the peak outdoor environmental conditions reported during ten of the most severe heat waves in recent history, fan use would be advisable in all of these situations, even when reducing the predicted maximum sweat output for the elderly. The protective benefit of fans appears to be underestimated by current guidelines.

Spatiotemporal influence of temperature, air quality, and urban environment on cause-specific mortality during hazy days

Haze is an extreme weather event that can severely increase air pollution exposure, resulting in higher burdens on human health. Few studies have explored the health effects of haze, and none have investigated the spatiotemporal interaction between temperature, air quality and urban environment that may exacerbate the adverse health effects of haze. We investigated the spatiotemporal pattern of haze effects and explored the additional effects of temperature, air pollution and urban environment on the short-term mortality risk during hazy days. We applied a Poisson regression model to daily mortality data from 2007 through 2014, to analyze the short-term mortality risk during haze events in Hong Kong. We evaluated the adverse effect on five types of cause-specific mortality after four types of haze event. We also analyzed the additional effect contributed by the spatial variability of urban environment on each type of cause-specific mortality during a specific haze event. A regular hazy day (lag 0) has higher all-cause mortality risk than a day without haze (odds ratio: 1.029 [1.009, 1.049]). We have also observed high mortality risks associated with mental disorders and diseases of the nervous system during hazy days. In addition, extreme weather and air quality contributed to haze-related mortality, while cold weather and higher ground-level ozone had stronger influences on mortality risk. Areas with a high-density environment, lower vegetation, higher anthropogenic heat, and higher PM2.5 featured stronger effects of haze on mortality than the others. A combined influence of haze, extreme weather/air quality, and urban environment can result in extremely high mortality due to mental/behavioral disorders or diseases of the nervous system. In conclusion, we developed a data-driven technique to analyze the effects of haze on mortality. Our results target the specific dates and areas with higher mortality during haze events, which can be used for development of health warning protocols/systems.

Temporal changes in mortality attributed to heat extremes for 57 cities in Northeast Asia

Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimise performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimise performance is to heat acclimatise. Heat acclimatisation should comprise repeated exercise-heat exposures over 1–2 weeks. In addition, athletes should initiate competition and training in a euhydrated state and minimise dehydration during exercise. Following the development of commercial cooling systems (eg, cooling-vest), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organisers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimising the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events, for hydration and body cooling opportunities, when competitions are held in the heat.

PREP: Protection Resilience Efficiency and Prevention for workers in industrial agriculture in a changing climate

For over three decades, an epidemic of chronic kidney disease (CKD), not related to well-known risk factors like diabetes and hypertension, and thus named CKD of unknown origin (CKDu) has been detected in agricultural and other heavy labourers in Central America, especially sugarcane workers. CKDu is also increasingly observed in manual rural workers in other hot regions, such as Sri Lanka, India, and Egypt.

There are probably multiple risk factors for CKDu, as for most non-communicable diseases, but there is a growing body of evidence that labour practices, specifically strenuous work in heat without sufficient rest or hydration, is an important driver of the disease. Thus, this disease can be seen as having a direct link to climate change and is likely to become even more prevalent in the near future unless workplace heat stress is mitigated. As a response to this disease, members of the current project consortia have collectively implemented the Adelante Initiative at a large sugarcane mill in Nicaragua. Adelante is a scientific evaluation of workplace interventions that focus on adequate water and rest in shade together with improved ergonomics, aiming to prevent CKDu in workers while preserving productivity. The PREP program will build on the Adelante Initiative and will have three different themes:

I. To evaluate the immediate and long-term impact of a Water, Rest, and Shade intervention on workforce health (kidney health and heat related symptoms) and productivity in the sugar industry;

II. To examine the economic and social impacts on individuals, families, communities, the company and health systems affected by CKDu and whether workplace interventions to reduce heat stress and the risk for CKDu aids resilience, including mitigating migration pressures;

III. To examine the policies, or absence of policies (at multiple administrative scales) that have contributed to the CKDu disease and what policies are required to effectively address it in a future changing climate.

This program is an interdisciplinary effort that brings together researchers with expertise in occupational hygiene, medicine, health economics, plus social and political sciences. The research methods range from advanced physiological measurements, focus groups and interviews, document analysis, to semi-structured interviews and participatory workshops. Using this coordinated, interdisciplinary approach we will evaluate how occupational health and safety interventions affects worker’s health at an individual level as well as the social and economic effects in the local community, and company return-of-investment.

Together with workers, management, certifying institutions, national authorities, and consumers we will build toolkits and educational materials for those affected and those wishing to improve protection for workers in industrial agricultural and other manual outdoor work. Our findings will be broadly shared via scientific communications, workshops with worker/management, production of web-based material, films for the general public, and collaboration with media. PREP will enhance our knowledge on risk factors for CKDu in industrial agricultural workers in a hot climate, and produce evidence-based toolkits and other educational material for prevention of heat stress and its consequences, directed to the industry, governments and other stakeholders. By furthering our understanding of where and who are affected, while providing viable solutions, we can help governments and industry take a proactive and cost-effective approach to address CKDu and its associated challenges. There is a need to demonstrate that such an investment will be more economical than suffering the social and economic impact of doing nothing or inadequately attempting to treat an issue that is likely to get worse in a warming world.

Protecting Urban Livelihoods from Climate Change - Building Heat Stress Resilience amongst Da Nang City's most Vulnerable Workers

The overarching goal of this project was to protect the livelihoods of low-income workers as climate change leads to increased temperatures in Da Nang city. Specifically, the project aspired to increase the resilience of vulnerable urban workers to heat stress and thereby contribute to the resilience of the city as a whole.

The effect of cool roofs on health, environmental and economic outcomes in rural Africa

The long-term research goal is to identify viable passive housing adaptation technologies with proven health and environmental benefits to reduce the burden of heat stress in communities affected by heat in Africa. As a next step towards this goal, the project proposes to conduct a household-randomized controlled trial (RCT) in Nouna, Burkina Faso to: (i) establish the effect of the cool roof on the primary endpoint heart rate (as an indicator of physiological stress) and (ii) quantify the effects of the cool roof on a range of secondary endpoints, including indoor temperature, indoor humidity, cardiovascular morbidity and mortality, household energy consumption, and socioeconomic outcomes.

Urban health and climate resilience in India

This project aims to design an air pollution and heatwave management toolkit, school environmental monitoring program and engage with targeted national and city level governmental and non-governmental actors to support its uptake in development planning. The project is coordinated by Taru Leading Edge and ICLEI South Asia, in partnership with CDKN, and was launched in India in July 2019.

Urban Heat Island Community Science Campaigns

NOAA, in a public-private partnership with CAPA Strartegies, LLC, runs annual community science Urban Heat Island mapping campaigns in cities across the United States. Each year, lea organizations in cities apply for core support funding for this activity. Residents of participating cities use low-cost in-situ sensors attached to their cars to drive transects and sample urban temperatures at a height of 2m. The in-situ data are combined with satellite data in a machine learning model to develop an estimate of the urban heat island intensity across the city. The outputs of the project are open source, and the outcomes of the project include community science engagement, education, and usable datasets showing the distribution of urban heat island intensity across the city.

VUCRA- France

Le projet VURCA étudie la vulnérabilité des villes à des épisodes futurs de canicules, afin de proposer des stratégies d’adaptation.

Weather and Climate Information Services for Africa

The UK Met Office’s Weather and Climate Information Services for Africa (WISER) programme’s mission is to make a step change in the quality, accessibility and use of weather and climate information services at all levels of decision making for sustainable development in Africa.

The Met Office has been commissioned by the UK government’s Foreign, Commonwealth and Development Office (FCDO) to act as fund manager for the East Africa component of the programme, focussing on the Lake Victoria Basin and surrounding region (Burundi, Ethiopia, Kenya, Rwanda, Tanzania and Uganda). This component aims to improve the quality and relevance of weather and climate information and support its uptake and use.

Under the East Africa component five quick-start projects using WISER funding were commissioned in late 2015 and commenced work early in 2016. A further series of projects began in 2017. In the commissioning of new projects, applications will be invited to access WISER funding in line with the WISER strategy. Details of any open application rounds can be found on our WISER programme opportunities page.

For information on projects under the Policy & Enabling Environment Component (PEEC) please visit the ClimDev-Africa website.

World Weather Research Programme

The World Weather Research Programme (WWRP) is the WMO’s international programme for advancing and promoting research activities on weather, its prediction and its impact on society. The improvements in science and operational predictions are driven by international cooperation, and in turn international cooperation in weather science is a unique opportunity to drive sustainable development.

Yale Programme on Climate Change Communication

The Yale Programme on Climate Change Communication conducts scientific research on public climate change knowledge, attitudes, policy preferences, and behavior, and the underlying psychological, cultural, and political factors that influence them. They also engage the public in climate change science and solutions, in partnership with governments, media organizations, companies, and civil society, and with a daily, national radio program, Yale Climate Connections.

World Urban Database: Census of Global Cities

The World Urban Database and Access Portal Tools project is a community-based project to gather a census of cities around the world.

The overall aims of WUDAPT are to:

  • use the Local Climate Zone (LCZ) classification framework as the starting point for characterizing cities in a consistent manner
  • use Geo-Wiki to sample land cover and land use types across LCZs (e.g. impervious surfaces (buildings, roads, other), pervious surfaces, grassland, etc.)
  • develop tools (online and mobile-based) to obtain other parameters such as building materials, building dimensions, canopy widths, etc.
  • provide open access to this dataset so that researchers around the world can use the data for many different types of applications, from climate and weather modeling to energy balance studies
  • provide basic tools in the portal to allows researchers to aggregate the data to a user-specified reference grid (resolution and starting location) and compare cities around the world.

For WUDAPT to work, we need to build a community of interested urban experts and interested researchers who will take active part by:

  • using the training materials to classify your city into LCZs
  • contributing your LCZ map to WUDAPT
  • helping us to collect other parameters using the online and mobile-based tools that will be developed.

Electric vehicles’ health and climate benefits in China and India

Electric vehicles (EVs) are a promising solution for sustainable transport. However, making EVs a sustainable solution depends on a variety of factors such as the carbon footprint of the electricity mix.

We will focus on two major emerging markets – China and India – to investigate the conditions under which EVs can provide co-benefits for air quality, health and climate change. The growth of EVs relies on curbing the use of coal power plants, building new infrastructure and shifting consumer preferences. We will help develop solutions for these challenges by evaluating the relative importance of country-specific factors such as subsidies, regulations around EVs and the price of electricity. We will design a series of scenarios to represent these key factors and use an integrated assessment modelling method combining emissions analysis, air quality modelling and health impact assessment.

Our findings could inform policy to unlock the air quality, health and climate co-benefits of EVs in China and India.

ACASIS : Alerte aux Canicules Au Sahel et à leurs Impacts sur la Santé

The main objective of ACASIS is to set-up a pre-operational heat wave warning system over West Africa tailored to health risks of the population living in this region. This is a demonstration project focused on Senegal and Burkina Faso where national weather services have already started developing products dedicated to weather/climate and health relationships, and where several health and demographic observatories have been operating for up to several decades.

Air pollution, heat and health in Brazil under climate change

This project will estimate air pollution (fine particulate matter (PM2.5) and ozone), heat waves, and days of high or low temperatures under present day conditions and in the future under climate change for two major Brazilian cities. The project will also develop estimates of how weather and air pollution impact mortality in Brazil.

ASSAR project (Adaptation at Scale in Semi-Arid Regions)

The five-year ASSAR project (Adaptation at Scale in Semi-Arid Regions, 2014-2018) uses insights from multi-scale, interdisciplinary work to inform and transform climate adaptation policy and practice in ways that promote the long-term wellbeing of the most vulnerable and those with the least agency.

Working in 7 countries in the semi-arid regions of India, and East, Southern and West Africa, we focused our case studies on regionally-relevant, socio-ecological risks and dynamics relating to livelihoods, and resource access, use, and management.

CHAMNHA Climate, heat and maternal and neonatal health in Africa

CHAMNHA is led by a transdisciplinary team from 3 continents, spanning the natural, health and social sciences, and will address key knowledge gaps around heat and Maternal and Neonatal Health (MNH) in sub-Saharan Africa.

Abstract

The frequency and intensity of heat waves have increased in sub-Saharan Africa (SSA) and are set to escalate in the coming decades. Heatwaves present major health threats, especially for vulnerable population groups, such as those with limited socio-economic resources or compromised physiological ability to respond to heat stress. Pregnant women and neonates (<28 days after birth) have a unique set of health vulnerabilities, particularly in low- and lower-middle income countries (LLMICs), where pregnancy and childbirth are often highly precarious. Heat exposure complicates Maternal and Neonatal Health (MNH), increasing risks for maternal haemorrhage and sepsis, prematurity, low birth weight and neonatal dehydration. Few studies have assessed these impacts in sub-Saharan Africa, where maternal and neonatal deaths are frequent, facilities experience high indoor temperatures, health systems have low adaptive capacity and access to services is increasingly disrupted by climate events.

The proposed study (CHAMNHA) is led by a transdisciplinary team from 3 continents, spanning the natural, health and social sciences, and will address key knowledge gaps around heat and MNH in SSA in collaboration with stakeholders, employing qualitative and quantitative methods, implementation and evaluation science, and climate impact methods. The project is divided into three work packages (WP). WP1 will quantify impacts of heat exposure on MNH outcomes, using trial data, birth cohorts and other data sources from SSA, Norway and Sweden. We will characterize these impacts and identify sub-groups at high-risk. In WP2, qualitative research will document perceptions and local practices relating to heat exposure in pregnant women and neonates in Burkina Faso and Kenya. Then, in conjunction with pregnant women, male partners and health workers, we will co-design community- and facility-based interventions, such as improving preparedness for heat, e.g. through warning systems; changing behaviours and health worker practices to reduce heat impacts on MNH; training birth companions and traditional birth attendants on heat reduction during childbirth; and promoting breastfeeding and optimised hydration for women and neonates. WP3 will test the acceptability, feasibility and effectiveness of selected interventions using a randomized design (Kenya) and pre-post study design (Burkina Faso). In WP4, building on established collaborations with stakeholders, ministries of health and WHO, we will translate research findings into recommendations for improved MNH practice in the health sector, and national adaptation planning to reduce the current and future impacts of climate change on MNH

Co-benefits of climate actions for air and health in India

Using an interdisciplinary modelling approach, this project will quantify the air quality and health co-benefits of mitigation and adaptation policies in Ahmedabad, India in collaboration with the Indian Institute of Tropical Meteorology, Gujarat Energy Research and Management Institute, Public Health Foundation of India and the Natural Resources Defense Council. It will estimate the total electricity demand in 2030, considering climate change and demand for air conditioning. It will model and compare air quality associated with two climate change response strategies: shifting fossil fuel use to solar energy; and expanding cool roof/green landcover interventions. It will also use air quality estimates to calculate health co-benefits in 2030, relative to a 2018 baseline and a 2030 business-as-usual scenario.

Deepening and Expanding Heat Health Action in India

In 2013, the city of Ahmedabad, in Gujarat State, India, adopted and started implementing the first Heat Action Plan in South Asia. Based on learning from the project’s first phase, and interest from other state and municipal governments in India, the next phase was building on this momentum to deepen and expand action on extreme heat.

Evaluation of Heat Wave Related Mortality and Adaptation Measures in Switzerland

The heat wave in 2003 caused approximately 7% more deaths. As a result, the Swiss Federal Office of Public Health developed an information campaign for the behaviour during heat waves which has been adopted by various cantonal health authorities.

Objectives

1) Assessment of preventive measures which have been recommended or implemented by various stakeholders (communities, cantons, confederacy, MeteoSuisse, international authorities) to reduce heat-related mortality.

2) Analysis of the effect of heat waves on mortality in Switzerland on the basis of empirical data on a national level and stratified by region. The hypothesis will be tested the effect of comparable heat episodes on mortality is reduced since 2003.

3) Evaluation of regional adopted measures on the heat-related excess mortality in single cantons/regions where preventive measures have already been implemented.

4) Identification of the meteorological indicator which best describes the heat effect on mortality and identification of the highest groups at risk.

5) Preparation and dissemination of epidemiological studies on the topic for interested stakeholders with newsletters and workshops.

Methods

In a first step an assessment of the adopted and recommended measures aiming to reduce heat-related mortality will be executed. In a second step, Swiss mortality data (1990-2012) from the Federal Office of Statistics will be linked with the corresponding regional meteorological data provided by MeteoSwiss. The heat-related excess mortality will be investigated using Poisson regression analysis. Furthermore, various meteorological indicators will be investigated for the health effect of heat episodes. An important part of the project addresses the knowledge transfer. During the project, new relevant epidemiological studies will be identified, summarized and evaluated regarding to the practice. Information is made available to the relevant agencies and stakeholders by means of a newsletter.

Expectations

The project will provide an overview of adaptation measures for the prevention of heat-related mortality. It will show which meteorological parameters have the greatest effect on mortality and which age groups are particularly affected. The projects will generate evidence whether an increased sensitivity to the issue and adopted measures in the recent years had an impact on the extent of heat-related mortality.

EXHAUSTION project

The EXHAUSTION project aims to quantify the changes in cardiopulmonary mortality and morbidity due to extreme heat and air pollution (including from wildfires) under selected climate scenarios.

EXHAUSTION will address key knowledge gaps as listed by IPCC, including the following:

  • Published health risk projections do not properly account for adaptation.
  • There is a lack of knowledge and appropriate models regarding possible interactive effects of extreme heat and air pollution.
  • Quantitative projections of the costs associated with the health risks are suffering from a simplified modelling of the complex relationship between climatic and non-climatic factors, human health, and the socio-economic consequences.

EXHAUSTION will advance on these issues–adaptation, interactive effects, and socio-economic costs – and quantify the changes in cardiopulmonary disease under selected climate scenarios while including a diverse set of adaptation mechanisms and measures, calculate the associated costs, and identify effective interventions for minimizing adverse impacts. The EXHAUSTION consortium is multidisciplinary, encompassing specialists in climate and air quality modelling, cardiopulmonary medicine, epidemiology, health impact assessment, economics, and science communication. Moreover, the Consortium is pan-European, with participation of 14 partners from 10 countries in Europe and representing the territories subject of study in the project.

EXHAUSTION is a EU-funded research project led by CICERO Center for International Climate Research (Norway), and includes 13 other research institutions and partners: University of Oslo (Norway), Norwegian Institute of Public Health (Norway), Aarhus University (Denmark), Helmholtz Zentrum München (Germany), University of Porto (Portugal), National Meteorological Administration (Romania), National and Kapodistrian University of Athens (Greece), London School of Hygiene and Tropical Medicine (UK), Luxembourg Institute of Socio-Economic Research (Luxembourg), Department of Epidemiology of the Lazio Region Health Service in Roma (Italy), Finnish Meteorological Institute (Finland), InfoDesignLab AS (Norway), DRAXIS Environmental S.A. (Greece).

EXTREMA

EXTREMA’s main objectives were to raise awareness, facilitate prevention and protect health from the adverse effects of climate change. EXTREMA was a DG ECHO funded project, 2018-2019, GA 783180.

The EXTREMA project led to EXTREMA Global – see more https://www.extrema-global.com/

Forecast-based Financing to Reduce Heatwave Vulnerability in Hanoi, Vietnam

The project focuses on heat waves in Hanoi and is the first FbF project to focus on extreme events in urban areas. In Hanoi the average daily temperatures have risen in recent years; past heatwaves have led to a 20.0% increase in hospital admissions for all causes and 45.9% for respiratory diseases. One main element of the project is the identification of early actions that can reduce these health impacts of heatwaves, with a special focus on groups that are particularly affected like the elderly. Research, consultation with experts and field assessments are currently under way.

Green spaces, air pollution and climate-related heat mortality in Latin American cities

An interdisciplinary research team will use a mortality database for urban residents in nine Latin American countries to examine the impact of climate change, particularly extreme heat events, on urban population mortality. They will also examine the modifying effect of green space and fine particulate matter on the association between heat events and mortality.

Health and economic impacts of reducing overheating in cities (HEROIC)

This project will take an interdisciplinary approach to quantify the health impact of changes to urban green infrastructure, and develop an environment and health economics tool, focusing on international cities, including London, Beijing and Nairobi.

HEAT (Heat Emergency Awareness and Treatment Bundle) Trial

The purpose of this study is to develop and test a set of interventions to reduce the impact of extreme heat on urban low-income populations.

HEAT-SHIELD

The Horizon 2020 research project is dedicated to address the negative impact of increased workplace heat stress on the health and productivity of five strategic European industries: manufacturing, construction, transportation, tourism and agriculture.

LUCID - Local Urban Climate Model and its Application to the Intelligent Design of Cities

LUCID is developing, testing and applying state-of-the-art methods for calculating local climate in the urban environment. The impact on the internal built environment, energy use and the consequences for health will then be explored. The implications for urban planning will be considered in detail.

Managing heat stress among Bangladesh ready-made clothing industry workers

This study is exploring how low- to moderate-cost interventions can alleviate the impact of high temperatures and humidity in ready-made garment factories in preparation for further climate change. It compares the use of green or white roofs and actively-managed fan-assisted cross-ventilation, compared to no interventions and air-conditioning. Climate-controlled chambers, computer-based modelling temperature monitoring, and worker interviews will be used to explore perceptions of discomfort caused by heat. Findings will help estimate when it will be necessary to invest in interventions and how effective they can be.

MCC Collaborative Research Network

The Multi-City Multi-Country (MCC) network is an international collaboration of research teams working on a program aiming to produce epidemiological evidence on associations between weather and health. Interest on this topic has grown in the last few years among both researchers and the general public, due to recent events of extreme weather and alarming climate change scenarios, both linked with increased health risks.The research program benefits from the use of the largest dataset ever assembled for this purpose, including information from hundreds of locations within several countries. This allows standardized analyses on local data to address specific research questions on global weather-health associations, following a formalized yet flexible method of collaboration. The MCC network has developed during the years, through correspondence between the participants and additional meetings held at other scientific conferences.

Methods and tools to integrate air quality and health into urban climate action planning

Many greenhouse gas mitigation actions also benefit air quality and health but assessment of these co-benefits has been limited. Over the next several years, C40 Cities will be working with city governments to develop climate action plans. They will integrate a screening-level air quality model focusing on particulate matter into C40’s climate action planning tool, Pathways, for at least three pilot cities. They will test the tool to explore air quality and health co-benefits of climate action pathways. We will also assess the potential for quantifying additional health co-benefits, such as changes in ozone, nitrogen dioxide levels, physical activity, noise and green space. Data and tools will be publicly available to support additional research into links between climate and health. Their work will build a bridge between scientific evidence on co-benefits to the largest urban climate action planning effort worldwide. Pathways will create a platform to study more cities and enable long-term integration of health co-benefits into climate action planning in cities.

Mitigation of climate change-induced occupational health and productivity problems

This project will study the complex threat heat exposures pose to human health, wellbeing and productivity in working populations in Singapore and other tropical countries, and to identify sustainable preventive policies and actions that can reduce these impacts. Working people are particularly vulnerable to environmental heat because of their added internal heat production from muscle work. Singapore’s equatorial location means working populations are already chronically exposed to hot conditions (WBGT > 25°C) which are considered detrimental to health and wellbeing. These conditions require people working or engaged in exercise outdoors to take frequent rest and cooling breaks to protect health, If workers cannot or do not take rest in relation to heat stress, serious health effects can occur, including heat stroke death. Such conditions also affect productivity, which is reduced by 15% of potential annual work hours in the sun and by 4% if working in the shade.

Singapore has begun to tackle these issues by supporting mitigation and adaptation to extreme heat associated with climate change and with the urban heat island effect through research focused on public health and urban design. However, heat-health is a complex socioenvironmental problem that transgresses institutional, sectoral and disciplinary boundaries of public and occupational health and the domains of workplace, public space and the home. As such, there is a need to complement these efforts through the provision of a programme focussed on occupational exposures and their knock-on effects to support the overall effectiveness of Singaporean investments in heat-health risk management. Exposed work occurs in outdoor settings, but semi-enclosed workspaces, such as sheds or roofed workshops, can also present very hot thermal environments where cooling systems are inefficient, air conditioning cannot be used for financial or other reasons, and/or additional heat sources are present. These conditions are typical of many industries, including construction, shipping and utilities, including oil and gas transport and storage.

There is also limited evidence available concerning occupational heat exposures, and the impact of age, body mass index, physical fitness, and sex (e.g. pregnancy) on these effects, or their broader effects, such as prolonged discomfort, and mental stress, familial relationships and special health concerns, such as fertility. Improved knowledge is essential for the development of effective prevention programs. The researchers will pursue a multi-disciplinary approach uniquely positioned to address direct occupational heat exposures and impacts on health and productivity, but also the broader health and wellbeing implications that have yet to be comprehensively addressed in chronically heat-exposed countries such as Singapore. For example, physical fitness is one of the best ways of increasing heat tolerance as well as overall health. Ironically, the high heat levels in Singapore do not only discourage engagement in physical exercise, but can also be a direct health threat for people involved in sports and exercise. We will also review and test methods for analysing the most extreme effects of heat, including heat related mortality.

By following impacts on workers as well as workplaces, the study will trace how heat-health impacts emerge through exposure and exertion as a result of behaviours shaped by the climatic, urban, occupational and social environments they traverse every day. Such integrated analysis is required in order to develop policy responses that take into account the spatial and social situation of why heat-health impacts occur and how they can be managed as part of the everyday lives of chronically exposed populations. This also allows for the identification, analysis and management of ‘knock-on’ effects of occupational heat exposures on recreational and domestic life (and vice versa), including psychosocial and physiological impacts on exercise behaviours and fitness, family relationships, mental health and wellbeing and fertility rates. As our focus is on heat effects on working people, one secondary outcome of excessive heat exposure will be economic losses at individual, enterprise, community and national level due to a reduction of labour productivity due to heat. Our analysis will compare such economic impacts of heat to the costs of potential methods for climate change mitigation in selected countries. This will provide new estimates of the value of different alternatives in future climate change policy development.

Arizona’s Climate and Health Adaptation Plan

The Arizona Extreme Weather and Public Health Program’s primary climate-sensitive hazard topics include extreme heat, wildfires, air quality, drought, flooding, extreme cold, and vector-borne diseases. Extreme heat is a major concern to Arizona and a large focus of their work due to the frequency and severity of extreme heat events. A large portion of the state’s population is frequently exposed to outside temperatures above 100 degrees from May through September. Arizona experienced about 1,200 heat caused deaths during 2007–2017. In addition to extreme heat, the arid climate leads to other hazards such as flooding during monsoon season and more wildfires due to increased drought and high temperatures.


The Arizona Extreme Weather and Public Health Program facilitates the development and sharing of local knowledge of climate and health effects and the implementation of public health interventions for climate-related hazards affecting the state’s residents and visitors. Partnerships have led to several projects on extreme heat, such as heat alerts sent to schools and public and healthcare facilities that provide steps for heat safety. Additionally, local projects have assessed and improved cooling center networks, which help provide a cool space to get out of the heat during the summer. The program has created and distributed heat safety toolkits for various specific at-risk populations, including outdoor workers, older adults, and school children. The program and local partners have also increased their capacity to perform heat illness surveillance activities and coordinated a state heat preparedness workgroup.


In addition to adapting to the challenges of heat, other work has focused on understanding climate impacts on vector-borne diseases and the fungal disease called Valley fever. The program has also assisted in developing public health emergency response plans for wildfires and flooding. This work benefits various populations such as the homeless, elderly, children, local officials, and residents of low income and minority neighborhoods.

Italy National Heat Health Plan (Piano operativo nazionale di prevenzione degli effetti del caldo sulla salute)

(National Plan for the prevention of the effects of heatwaves on health)

Hermosillo, Mexico, Captures Heat-Related Illnesses at Medical Facilities Using New Database

Working with Cofepris, the Ministry of Health, and the CEC, Sonora’s regional health authority (Comisión Estatal de Protección contra Riesgos Sanitarios del Estado de Sonora—Coesprisson) established several objectives with the goal of creating a real-time SyS system for the city of Hermosillo in a 2016 pilot SyS project that would enable timely identification of health impacts due to extreme temperature and evidence-based policy development to reduce mortality and morbidity rates.

How hot will it be? Translating climate model outputs for public health practice in the United States

What meteorological factors are going to change? How much will they change? Will there be spatial variation? These are foundational issues for public health agencies in preparing for the impacts of climate change. In the wake of the Building Resilience Against Climate Effects (BRACE) framework developed by the US Centers for Disease Control and Prevention (CDC), health agencies in the United States are using forecasted meteorological data to monitor health vulnerabilities across populations and places resulting from climate change.

Implementation of the Heat-Health Action Plan of North Macedonia (2014)

Case study of the development of North Macedonia’s National Heat-Health Action Plan, which has been developed within the National Strategy for Adaptation for the health sector to implement adaptation measures and prevent health consequences associated with extreme heat due to climate change.

Innovative Heat Wave Early Warning System And Action Plan In Ahmedabad, India

Following a deadly heat wave in May 2010, the Ahmedabad Municipal Corporation (AMC) realized that coordinated action was needed to protect its residents from extreme heat and to become more climate-resilient

Iterative Development And Testing Of A 
Heat Warning And Information System In Alberta, Canada

In 2012, consistent with Alberta’s climate change adaption framework, Alberta Health, the Provincial Government Department of Health, initiated a high-level vulnerability assessment that led to the development of a Heat Warning and Information System (HWIS) involving collaboration between several agencies with expertise outside of public health.

Knowing When Cold Winters And Warm Summers Can Reduce Ambulatory Care Performance In London

As part of a climate change risk assessment, Public Health England took the initiative to analyse the impact of cold winters and warm summers on the number of ambulance call-outs and ambulance response times in London. This study is the first of its kind in the United Kingdom. Initial findings show that there is a clear relationship between air temperature and emergency ambulance calls.

Managing health impacts of heat in South East Queensland, Australia

Heatwaves kill more people than any other natural hazard in Australia. Current literature on managing health risks of heatwaves highlights the importance of implementing urban planning measures, and engaging with vulnerable groups on a local level to better understand perceptions of risk and tailor health protection measures. This paper reviews arrangements to reduce heatwave health risks in South East Queensland in response to these themes. A literature search and document analysis, stakeholder interviews, and multi-stakeholder cross-sectoral workshops revealed that although heatwave management is not always considered by local government and disaster management stakeholders, many urban planning measures to minimize urban heat have been pursued. However, greater information from vulnerable groups is still needed to better inform heatwave management measures.

Protecting People from Sweltering City Summers

Federal, state, and local agencies are working to provide more advanced warnings and services to help people better prepare for—and respond to—extreme heat events

Protecting The Elderly From Heat And Cold Stress In Hong Kong: Using Climate Information And Client-Friendly Communication Technology

Close collaboration between SCHSA and HKO highlights the importance of partnership and stakeholder engagement in improving the delivery and communication of useful weather and climate information to the health sector and promoting public awareness on the care of elderly people

Supreme: An Integrated Heat Health Warning System For Quebec

The SUPREME system, developed by the INSPQ in 2010 together with a users committee, provides access to indicators that relate exposure to hazards (temperatures, urban heat islands, etc.), socioeconomic characteristics of neighbourhoods (population density, deprivation index, etc.), health problems (deaths, emergency room admissions, etc.), and follow-up during and after an intervention by field teams. Post-event reports are produced regionally and aggregated annually.

The Heat Health Warning System of DWD - Concept and Lessons Learned

The HHWS was developed to reduce the heat related mortality. The HHWS is in operation since 2005 and preliminary studies indicate a reduction in the heat related mortality ever since.

Vulnerability to heat stress: A case study of Yavatmal, Maharashtra, India

This study provided a pilot assessment of vulnerability to heat exposure in a rural context during the peak summer months of 2016, with a focus on indoor and outdoor temperatures.

Where Do We Need Shade? Mapping Urban Heat Islands in Richmond, Virginia

Citizen-scientists took to the streets on specially equipped bikes and cars to find out where it’s hottest—and where residents might be most vulnerable to extreme urban heat.

Tatabánya, Hungary, addressing the impacts of urban heat waves and forest fires with alert measures

The City of Tatabánya has an approved comprehensive adaptation strategy, the Local Climate Change Action Plan, that is in its implementation stage. This Plan is based upon a comprehensive approach taking into consideration both mitigation and adaptation, incorporating climate considerations into decision-making, and including adaptation concerns in municipal processes. At this time, three measures have been implemented: (1) a local heat alert system; (2) the Smart Sun Educational Programme; and (3) building capacity of the fire brigade.

Addressing heat-related health risks in urban India: Ahmedabad’s Heat Action Plan

This report looks at how the local community of Ahmedabad in Western India is preparing for the increasingly extreme heat of the city.

Bracing for Heat in Minnesota

Heat waves bring some level of discomfort to nearly everyone. When excessive heat catches vulnerable populations off guard, though, discomfort can advance to illness and even death. Learn about strategies taken in Minnesota that help protect people in both rural and urban settings.

Building Evidence That Effective Heat Alert Systems Save Lives In Southeast Australia

In the January 2009 heatwave, a prototype heatwave alert system had just been introduced, based on research identifying a threshold temperature above which excess mortality occurred in Melbourne, Australia. By the time of the January 2014 heat wave, the heat alert system had been considerably refined, based on further scientific work (2–4) and intense interactions between climate scientists and public health authorities. The excess mortality associated with the 2014 heat wave was substantially lower than in 2009, even though the 2014 heat wave lasted longer.

Catalyzing Investment and Building Capacity in Las Cruces, New Mexico

Planning with extreme weather thresholds catalyzes a $400,000 green infrastructure investment in a historically underserved neighborhood in Las Cruces, New Mexico.

Cctalk! Communicating Effectively With High-Risk Populations In Austria:
 A Five-Step Methodology

In order to reduce the vulnerability of elderly people to heat waves in Austria, a new communication approach was developed and tested as part of the CcTalK! Project.

Charting Colorado’s Vulnerability to Climate Change

Responding to growing awareness of climate change impacts, the State of Colorado commissioned two of its universities to complete an initial study of the state’s vulnerabilities.

Cincinnati's Urban Canopy Policy

Cincinnati created a dedicated funding stream for its urban forestry program in 1981 that has enabled the city to maintain
a high percentage of its tree canopy. Heat mitigation is a key reason tree canopy is a priority. Although Cincinnati has a temperate climate and harsh, cold winters, the urban heat island effect can make the city up to 17°F hotter than nearby
rural areas during the summer.

Cool Neighborhoods NYC

Cool Neighborhoods NYC is a strategy developed by the Mayor’s Office of Resiliency to provide and target additional funding and to coordinate multiple extreme heat mitigation and adaptation projects. The objective of Cool Neighborhoods NYC is to “help keep New Yorkers safe during hot weather, mitigate urban heat island effect drivers and protect against the worst impacts of rising temperatures from climate change.”

Cool surfaces: roofs and roads

Los Angeles is the first U.S. city to set a citywide temperature reduction goal, and switching to cool surfaces is a key strategy for achieving that goal. Los Angeles’s goal is to reduce the urban heat island effect by 1.7°F by 2025 and average temperature 3°F by 2035, but the city is 40 percent covered by pavement. Los Angeles’s reflective paving program, which targets both rooftops and public streets, complements other UHI reduction programs including a Million Trees initiative and integrated planning with the Department of Health.

Creating a Model Climate Resilient City

The City of Long Beach, California, sees signs of climate change on land and in the ocean. After compiling the City’s official climate assessment report, local stakeholders also produced a more accessible and user-friendly summary version and shared it broadly to stimulate informed discussion and decision making across the city.

Deadly Chicago Heat Wave of 1995

This AdaptNY case study of the Chicago heat wave of 1995 looks at how the urban heat island effect is exacerbated by socio-economic factors and poor city planning.

Developing an Early Warning System to Prevent Heat Illness in the Carolinas

Residents of the Carolinas are familiar with hot summers, but in some areas excessive heat events bring a higher risk for heat-related illness—and even death. A new tool can help local communities get ahead of heat events so they can reduce risk for their residents.

Enhancing Syndromic Surveillance for Heat-Related Illness in Michigan with Improved Heat Syndrome Definition

With the goal to support the development of population heat resiliency and the capacity to withstand the effects of climate change, Michigan’s MDHHS and the CEC partnered to improve the MSSS to include a HRI-specific syndrome.

Expanding Heat Resilience Across India

This issue brief highlights the progress at the city, state and national level in India in 2019 to improve climate resilience to extreme heat, and captures key elements of heat action plans.

Expanding heat resilience across India: Heat Action Plan highlights

Drawing lessons from the ground-breaking 2013 Ahmedabad Heat Action Plan,3 city, state, and national level authorities are ramping up to implement extreme heat warning systems and preparedness plans. In 2020, the national government is working with 23 states and over 100 cities and districts to develop and implement heat action plans across India.

Finding The Right Thresholds To Trigger Action In Heat Wave Early Warning Systems In Spain

In Spain, the State Meteorological Agency (AEMET) has been successful in using weather prediction models to forecast short- and medium-range extreme temperatures, and an early warning system (Meteolerta) has been implemented in cooperation with European EUMETNET member countries (MeteoAlarm).

Green Roof Bylaw and Eco-roof incentive in Toronto

Toronto was the first city in North America to require and govern the construction of green roofs on new development. The Green Roof Bylaw (which includes a Green Roof Construction Standard) and the parallel Eco-Roof Incentive Program are responsible for more than 1.2 million square feet of new green space, an estimated reduction in citywide temperature, and widespread promotion of cool roofs.

Heat Health in Hong Kong: Overview of collaborations and projects to protect health from urban heat

This case study provides an overview of the active heat health collaborations, projects and research ongoing in Hong Kong and presented during the First Global Forum on Heat and Health.

Hong Kong faces unique challenges from environmental hazards, such as climate change and variability, due to its densely populated and almost entirely urbanized living environment. An increased vulnerability to the urban heat island effect means that its inhabitants are more susceptible to the harmful, and sometimes deadly, health effects of extreme heat. This case study exemplifies how a multidisciplinary partners and agencies are collaborating to protect the most vulnerable communities.

Heat Wave And Health Risk Early Warning Systems In China

This project, which is part of a broader WHO/UNDP Global Environment Facility (GEF)-funded project, developed and implemented a heatwave early warning system to reduce the health risks and to increase the capacity of health systems and community residents to prepare for and cope with periods of extreme temperatures. The project was piloted in four cities: Harbin, Nanjing, Shenzhen and Chongqing, located in different climate zones within China.

Results found: 48

of 4

Research

Guidance

WHO
2020

The aim of this guidance is to enhance the capacity of health care facilities to protect and improve the health of their target communities in an unstable and changing climate; and to empower health care facilities to be environmentally sustainable, by optimizing the use of resources and minimizing the release of waste into the environment. Climate resilient and environmentally sustainable health care facilities contribute to high quality of care and accessibility of services, and by helping reduce facility costs also ensure better affordability. They are, therefore, an important component of universal health coverage (UHC).

This document aims to:

  • Guide professionals working in health care settings to understand and effectively prepare for the additional health risks posed by climate change.
  • Monitor, anticipate, manage and adapt to the health risks associated with climate change.
  • Guide health care facility officials to work with health determining sectors (including water and sanitation, energy, transportation, food, urban planning, environment) to prepare for additional health risks posed by climate change through a resilience approach, and to promote environmentally sustainable practices in providing these services.
  • Provide tools to assist health care facility officials assess their resilience to climate change threats, and their environmental sustainability based upon the appropriate use of resources (in particular water and energy and sustainable procurement), and release of hazards (biological, chemical, radiological), to their surrounding environment.
  • Promote actions to ensure that health care facilities are constantly and increasingly strengthened and continue to be efficient and responsive to improve health and contribute to reducing inequities and vulnerability within their local settings.

This guidance document provides a set of suggested interventions, along the lines of four fundamental requirements for providing safe and quality care in the context of climate change: (1) the health workforce; (2) water, sanitation, hygiene and health care waste management; (3) sustainable energy services; and (4) Infrastructure, technologies and products.

Chapter 1 discusses the public health rationale, and the investment case for climate resilient and environmentally sustainable health care facilities. Chapter 2 provides the policy context and background information on the baseline or essential requirements for health care facilities to be able to provide safe and quality health care, upon which resilience and environmental sustainability should be built. Chapter 3 introduces key concepts, the goals, objectives and proposed framework for the implementation of interventions aiming to strengthen climate resilience and environmental sustainability. Chapter 4 provides proposed interventions, organized into 24 tables around the four broad areas of the framework.

Action Plan

Arizona Department of Health Services, Arizona State University, University of Arizona
2017

The Arizona Extreme Weather and Public Health Program’s primary climate-sensitive hazard topics include extreme heat, wildfires, air quality, drought, flooding, extreme cold, and vector-borne diseases. Extreme heat is a major concern to Arizona and a large focus of their work due to the frequency and severity of extreme heat events. A large portion of the state’s population is frequently exposed to outside temperatures above 100 degrees from May through September. Arizona experienced about 1,200 heat caused deaths during 2007–2017. In addition to extreme heat, the arid climate leads to other hazards such as flooding during monsoon season and more wildfires due to increased drought and high temperatures.


The Arizona Extreme Weather and Public Health Program facilitates the development and sharing of local knowledge of climate and health effects and the implementation of public health interventions for climate-related hazards affecting the state’s residents and visitors. Partnerships have led to several projects on extreme heat, such as heat alerts sent to schools and public and healthcare facilities that provide steps for heat safety. Additionally, local projects have assessed and improved cooling center networks, which help provide a cool space to get out of the heat during the summer. The program has created and distributed heat safety toolkits for various specific at-risk populations, including outdoor workers, older adults, and school children. The program and local partners have also increased their capacity to perform heat illness surveillance activities and coordinated a state heat preparedness workgroup.


In addition to adapting to the challenges of heat, other work has focused on understanding climate impacts on vector-borne diseases and the fungal disease called Valley fever. The program has also assisted in developing public health emergency response plans for wildfires and flooding. This work benefits various populations such as the homeless, elderly, children, local officials, and residents of low income and minority neighborhoods.

infographic

National Athletic Trainers' Association (NATA)

Summer’s high temperatures put student athletes at increased risk of heat illness. There are several types of heat illness. They range in severity, from heat cramps and heat exhaustion, which are common but not severe, to heat stroke, which can be deadly. Although heat illnesses can be fatal, death is preventable if they’re quickly recognized and properly treated.

Research

Floriberta Binartia, M. Donny Koerniawana, Sugeng Triyadia, Sentagi Sesotya Utamic, Andreas Matzarakis
2020

Booklet (Multiple Languages)

NSW Health
2012

This booklet provides important information about health and hot weather. The booklet is for anyone who cares for, supports or assists people at risk of serious health effects from hot weather. It includes tips and ideas on how to keep someone healthy during hot weather.

Research

Chen K, Wolf K, Breitner S, Gasparrini A, Stafoggia M, Samoli E, Andersen ZJ, Bero-Bedada G, Bellander T, Hennig F, Jacquemin B, Pekkanen J, Hampel R, Cyrys J, Peters A, Schneider A
2018

Research

Armstrong, Lawrence E. Ph.D., FACSM (Chair); Casa, Douglas J. Ph.D., ATC, FACSM; Millard-Stafford, Mindy Ph.D., FACSM; Moran, Daniel S. Ph.D., FACSM; Pyne, Scott W. M.D., FASCM; Roberts, William O. M.D.
2007

Guidance

Research

Report (EN / FR / ES / AR)

International Federation of Red Cross and Red Crescent Societies (IFRC)
2020

The impacts of climate change are already devastating lives and livelihoods every year, and they will only get worse without immediate and determined action. The World Disasters Report 2020 analyses climate disaster trends and shows how we can tackle the humanitarian impacts of the climate crisis together.

Research

Simone Russo; Jana Sillmann; Andreas Sterl
2017

Research

Jay O, Cramer MN, Ravanelli NM, Hodder SG.
2015

Research

Camilo Mora, Chelsie W.W. Counsell, Coral R. Bielecki, and Leo V Louis
2017

Toolkit (EN / FR)

Health Canada
2011

The Toolkit is based on best communication practices for addressing health risks from extreme heat events. The practices are drawn from experiences in Canadian communities and internationally. They were developed with input from public health officials and health communication experts, as well as a review of the existing literature.

Booklet (EN / FR)

Health Canada
2020

Extreme heat, and heat related illnesses, are especially dangerous for infants and young children.

Heat illnesses include heat stroke, heat exhaustion, heat fainting, heat edema (swelling of the hands, feet and ankles), heat rash (prickly heat) and heat cramps (muscle cramps). They are mainly caused by over-exposure to heat or over-exertion in the heat, and if not prevented, can lead to long-term health problems and even death.

Children most at risk include those with breathing difficulties (asthma), heart conditions, kidney problems, mental and physical disabilities, developmental disorders, diarrhea, and those who take certain medications. Consult with your family doctor or pharmacist to find out if your child’s medication increases their risk of heat related illnesses.

Report

Health Canada
2020

The purpose of this Health Canada report is to fill this gap in knowledge and provide tips, strategies, and case studies that can help public health professionals as they support local governments and organizations with reducing UHIs. The report includes nine practical case studies highlighting how public health professionals across Canada have helped to advance actions to reduce UHIs in their communities. This report focuses on advice for reducing outdoor temperatures; while actions to reduce indoor temperatures are important, they are beyond the scope of this report.

Research

Yuya Takane, Yukitaka Ohashi, C Sue B Grimmond, Masayuki Hara and Yukihiro Kikegawa
2020

Research

Sanz-Barbero B, Linares C, Vives-Cases C, Gonzalez JL, Lopez-Ossorio JJ, Diaz J
2018

Research

Research

Lee, Dae-Geun; Choi, Young-Jean; Kim, Kyu Rang; Kalkstein, Laurence; Sheridan, Scott
2011

Case Study

GHHIN Specific Resource
GHHIN

This case study provides an overview of the active heat health collaborations, projects and research ongoing in Hong Kong and presented during the First Global Forum on Heat and Health.

Hong Kong faces unique challenges from environmental hazards, such as climate change and variability, due to its densely populated and almost entirely urbanized living environment. An increased vulnerability to the urban heat island effect means that its inhabitants are more susceptible to the harmful, and sometimes deadly, health effects of extreme heat. This case study exemplifies how a multidisciplinary partners and agencies are collaborating to protect the most vulnerable communities.

Action Plan (FR)

Ville de Genève
2020

Suite à une mise en garde de la médecin cantonale, la Ville de Genève active dès samedi 8 août 2020 son Plan canicule en faveur des aîné-e-s et des personnes sans-abri. Un suivi régulier de celles et ceux qui se sont inscrit-e-s auprès du Service social est assuré. Cette année, ce dispositif est particulièrement important compte tenu du contexte sanitaire encore marqué par le COVID-19.

—–

Following a warning from the cantonal doctor, the City of Geneva is activating its heatwave plan for the elderly and homeless from Saturday August 8, 2020. Regular follow-up of those who have registered with the Social Service is ensured. This year, the plan is particularly important given the health context still marked by COVID-19.

Guidance

Nature’s Cooling Systems Project

In Greater Phoenix, urban heat is impacting health, safety, and the economy and these impacts are expected to worsen over time. The number of days above 110˚F are projected to more than double by 2060. In May 2017, The Nature Conservancy, Maricopa County Department of Public Health, Central Arizona Conservation Alliance, Urban Resilience to Extremes Sustainability Research Network, Arizona State University’s Urban Climate Research Center, and Center for Whole Communities launched a participatory Heat Action Planning process to identify both mitigation and adaptation strategies to reduce heat directly and improve the ability of residents to deal with heat. Community-based organizations with existing relationships in three neighborhoods selected for Heat Action Planning later joined the project team: Phoenix Revitalization Corporation, RAILMesa, and Puente Movement. Beyond building a community Heat Action Plan and completing demonstration projects, this participatory process was designed to develop awareness, agency, and social cohesion in underrepresented communities. Furthermore, the Heat Action Planning process was designed to serve as a model for future heat resilience efforts and create a local, contextual, and culturally appropriate vision of a safer, healthier future. The iterative planning and engagement method used by the project team strengthened relationships within and between neighborhoods, community-based organizations, decision-makers, and the core team, and it combined storytelling wisdom and scientific evidence to better understand current and future challenges residents face during extreme heat events.


As a result of three workshops within each community, the residents brought forth ideas that they want to see implemented to increase their thermal comfort and safety during extreme heat days. As depicted below, residents’ ideas intersected around similar concepts, but specific solutions varied across neighborhoods. For example, all neighborhoods would like to add shade to their pedestrian corridors but preferences for the location of shade improvements differed. Some neighborhoods prioritized routes to public transportation, others prioritized routes used by children on their way to school, and others wanted to see shaded rest stops in key places. Four overarching strategic themes emerged across all three neighborhoods: advocate and educate; improve comfort/ability to cope; improve safety; build capacity. These themes signal that there are serious heat safety challenges in residents’ day-to-day lives and that community, business, and decision-making sectors need to address those challenges.


Heat Action Plan elements are designed to be incorporated into other efforts to alleviate heat, to create climate-resilient cities, and to provide public health and safety. Heat Action Plan implementation partners are identified drawing from the Greater Phoenix region, and recommendations are given for supporting the transformation to a cooler city.


To scale this approach, project team members recommend a) continued engagement with and investments into these neighborhoods to implement change signaled by residents as vital, b) repeating the heat action planning process with community leaders in other neighborhoods, and c) working with cities, urban planners, and other stakeholders to institutionalize this process, supporting policies, and the use of proposed metrics for creating cooler communities.

Case Study

City of Toronto
Urban Land Institute. (2019) Scorched: Extreme Heat and Real Estate

Toronto was the first city in North America to require and govern the construction of green roofs on new development. The Green Roof Bylaw (which includes a Green Roof Construction Standard) and the parallel Eco-Roof Incentive Program are responsible for more than 1.2 million square feet of new green space, an estimated reduction in citywide temperature, and widespread promotion of cool roofs.

Research Summary

Johns Hopkins University
2020

This document provides a two-page summary of the research undertaken as part of the R2HC-funded study Heat (Heat Emergency Awareness and Treatment Bundle) Trial. This study evaluated the effectiveness of community awareness and emergency healthcare training programs in reducing heat-related sickness and deaths and improving community knowledge and behaviour. The findings suggest that education and awareness for communities, and training for emergency care staff could help prepare for heat waves, but more systemic changes will likely be needed in future as climate change impacts are felt.

Global Heat Health Information Network (GHHIN)

There is a need to evaluation and quantify the cost and benefits of different heat interventions in order to inform decision making. This masterclass will review the current methods for assessing health-related costs from morbidity and mortality linked to extreme heat exposures and the health and economic benefits associated with common heat adaptation interventions, such as: housing interventions, air conditioning, heat early warning systems, community cooling centers, and municipal heat action plans. The advantages and limitations of these methods will be addressed.

Guidance

Red Cross Red Crescent Climate Centre
2020

This guide is based on the comprehensive Heatwave Guide for Cities but it is tailored towards practical actions that can be led by Red Cross Red Crescent branches in preparing for, and responding to, heatwaves in towns and cities. While aspects of these actions may be new, most recommended actions can be easily integrated into existing branch activities.

Report

National Climate Change Adaptation Research Facility, Gold Coast
2013

Heat-waves are increasing in frequency, intensity and duration due to global climate change, and account for more deaths in Australia than any other natural hazard. Research has identified the aged, and those living in residential aged care facilities (ACFs), at increased risk of heat-related morbidity and mortality.

 

Aims

The study aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).

 

Methods

Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.

 

Results

Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents. Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.

 

Conclusions

This study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.

Guidance

WMO
2015

Improving the understanding of the potential impacts of severe hydrometeorological events poses a challenge to NMHSs and their partner agencies, particularly disaster reduction and civil protection agencies (DRCPAs). These Guidelines establish a road map that identifies the various milestones from weather forecasts and warnings to multi-hazard impact-based forecast and warning services.

Research

M.A.Folkerts, N. Gerrett, B.R.M. King, M.Zuurbier, H.A.M. Daanen

Guidance

WHO
2018

Improved housing conditions can save lives, prevent disease, increase quality of life, reduce poverty, and help mitigate climate change. Housing is becoming increasingly important to health in light of urban growth, ageing populations and climate change.


The WHO Housing and health guidelines bring together the most recent evidence to provide practical recommendations to reduce the health burden due to unsafe and substandard housing. Based on newly commissioned systematic reviews, the guidelines provide recommendations relevant to inadequate living space (crowding), low and high indoor temperatures, injury hazards in the home, and accessibility of housing for people with functional impairments. In addition, the guidelines identify and summarize existing WHO guidelines and recommendations related to housing, with respect to water quality, air quality, neighbourhood noise, asbestos, lead, tobacco smoke and radon. The guidelines take a comprehensive, intersectoral perspective on the issue of housing and health and highlight co-benefits of interventions addressing several risk factors at the same time.


The WHO Housing and health guidelines aim at informing housing policies and regulations at the national, regional and local level and are further relevant in the daily activities of implementing actors who are directly involved in the construction, maintenance and demolition of housing in ways that influence human health and safety. The guidelines therefore emphasize the importance of collaboration between the health and other sectors and joint efforts across all government levels to promote healthy housing. The guidelines’ implementation at country-level will in particular contribute to the achievement of the Sustainable Development Goals on health (SDG 3) and sustainable cities (SDG 11). WHO will support Member States in adapting the guidelines to national contexts and priorities to ensure safe and healthy housing for all.

Factsheet (Multiple Languages)

NSW Health
2013

This factsheet provides information on heat-related illness as well as heat stroke. Heat-related illness can range from mild conditions such as dehydration or cramps to very serious conditions such as heat stroke. Heat can also worsen many existing medical conditions.

Available Languages:

English

Italian

Filipino

Hindi

Greek

Spanish

Korean

Chinese Simplified

Chinese Traditional

Vietnamese

Arabic

Research

Chersich, M.F., Pham, M.D., Areal, A., Haghighi, M.M., Manyuchi, A., Swift, C.P., Wernecke, B., Robinson, M., Hetem, R., Boeckmann, M. and Hajat, S.
2020

Report

International Bank for Reconstruction and Development / The World Bank
2020

This compendium presents examples and analyses of space cooling interventions from across the world (from both developed and developing countries), with an aim to highlight the key insights learned. Interventions discussed in the compendium are meant to be options to inform strategies, implementation mechanisms, and road maps for countries that are seeking to address and increase sustainable space cooling. Interventions involve a combination of actions reducing cooling loads, serving cooling needs efficiently, and optimizing and controlling cooling loads. While each country will chart its own pathway toward sustainable space cooling, the need for a multipronged approach consistently applies. The best outcomes will emerge from a multipronged approach that incorporates information, policy and regulatory measures, clear leadership, financing and implementation models, training, and research and development. The objectives of the primer are to introduce a broad audience, including practitioners in different fields, to space cooling and to help initiate and advance sustainable space cooling into policy discussions and investment considerations in developing countries. The primer explains the foundational aspects of space cooling, makes the case that sustainable space cooling achieved through low-energy and low-climate-impact pathways is a critical priority, and emphasizes an integrative approach as essential to addressing space cooling sustainably.

Action Plan

Municipalidad de La Plata
2014

La ciudad de La Plata y el Gran La Plata presentan una notoria vulnerabilidad ante eventos hidrometeorológicos severos, que se ve reflejada en el impacto que producen los mismos en la calidad de vida de sus habitantes, daños a bienes espacios públicos y privados. Para una adecuada Gestión Integral del Riesgo de Desastres en el Partido de La Plata, es necesario y prioritario establecer lineamientos para la Gestión de Emergencias, ya sean estas de origen Natural o Tecnológico. Este Plan General de Gestión de Emergencias -establecido a principios de 2014- tiene los siguientes objetivos:

Objetivo General:

  • Reconocer las amenazas de origen natural como las provocadas por la actividad de los seres humanos (tecnológicas).

Objetivos Específicos:

  • Identificar los actores y sectores involucrados en la gestión de emergencias.
  • Establecer roles y funciones para la gestión de emergencias.
  • Profundizar las estrategias de coordinación entre los organismos municipales, provinciales y nacionales involucrados en acciones de manejo de crisis (advertencia/alarma y respuesta) y rehabilitación ante un evento adverso.
  • Promover actividades de prevención y preparación comunitaria.
  • Indicar a la población las acciones a tomar Un Plan de Contingencia es un conjunto de procedimientos específicos que presentan una estructura estratégica y operativa contribuyentes a controlar una situación de emergencia y minimizar sus consecuencias negativas.

Research

Sara McElroy, Lara Schwarz, Hunter Green, Isabel Corcos, Kristen Guirguis, Alexander Gershunov, Tarik Benmarhnia
2020

Investigative Series

University of Maryland’s Philip Merrill College of Journalism, NPR
2019

Journalists at the University of Maryland’s Philip Merrill College of Journalism and NPR spent a year gathering and analyzing data and talking with climate and health experts. They built temperature and humidity sensors to help understand what it was like to live in rowhouses in Baltimore’s hottest neighborhoods. Their data analysis identified McElderry Park as the city’s hottest neighborhood, and they spent a summer reporting on the community and the people who live there.

Presentation

Benjawan Tawatsup
2018

Documentary

Kartemquin Films
2019

COOKED: Survival by Zip Code is Peabody Award-winning filmmaker Judith Helfand’s searing investigation into the politics of “disaster” – by way of the deadly 1995 Chicago heat wave, in which 739 residents perished (mostly Black and living in the city’s poorest neighborhoods).

Infographic

Case Study

GHHIN Specific Resource
GHHIN

This case study provides an overview of the active heat health collaborations, projects and research ongoing in Hong Kong and presented during the First Global Forum on Heat and Health.

Hong Kong faces unique challenges from environmental hazards, such as climate change and variability, due to its densely populated and almost
entirely urbanized living environment. An increased vulnerability to the urban heat island effect means that its inhabitants are more susceptible to the harmful,
and sometimes deadly, health effects of extreme heat. This case study exemplifies how a multidisciplinary partners and agencies are collaborating to protect the most vulnerable communities.

Report

WMO
2019

This publication marks the twenty-fifth anniversary of the WMO Statement on the State of the Global Climate, which was first issued in 1994. The 2019 edition treating data for 2018 marks sustained international efforts dedicated to reporting on, analysing and understanding the year-to-year variations and long-term trends of a changing climate.

Report

International Labour Organization (ILO)
2019

The findings presented in this report make it clear that heat stress in the world of work must be tackled, above all, by promoting occupational safety and health, social dialogue and structural transformation in agriculture, and by encouraging the development of responsible and sustainable, or “green”, businesses.

Guidance

WMO, WHO
2015

This guidance considers who is at risk from heat, outlines approaches to assessing heat stress, presents the science and methodologies associated with the development of HHWSs, overviews heat-intervention strategies which are a necessary part of any truly integrated HHWS, considers the problem of communicating heat risk and how to evaluate HHWSs and draws attention to the essential elements of summer heat plans within which HHWSs are nested.

Guidance

WHO Europe
2008

This guidance results from the EuroHEAT project on improving public health responses to extreme weather/heat-waves, co-funded by the European Commission. It explains the importance of the development of heat–health action plans, their characteristics and core elements, with examples from several European countries that have begun their implementation and evaluation.

Technical Report

USAID
2019

This technical report provides a starting point to inform risk management in a warming world with a specific emphasis on experiences in the developing world.

Guidance

Red Cross Red Crescent Climate Centre
2019

This practical guide is designed with, and for, people working in city government to understand, reduce the risk of, and respond to, heatwaves in their cities.

Technical Brief

Global Heat Health Information Network (GHHIN)
2020

This technical brief describes key considerations for decision-makers and practitioners on adapting existing plans, protocols and procedures for managing the risks of extreme heat during the COVID-19 pandemic. The accompanying Q&A series and checklists present further options, supporting evidence and resources to help all stakeholders and communities take informed action.

Research

Gabrielle E. W. Giersch, Nisha Charkoudian, Rebecca L. Stearns, Douglas J. Casa
2020

Research

Yoram Epstein; Ran Yanovich
2019

Presentation

Presentation

Presentation

Presentation

Research

Presentation

Cedric Van Meerbeech, Teddy Allen, Simon Mason, Hannah Nissan
2018