Assessing ozone-related health impacts under a changing climate

Improving consistency in estimating future health burdens from environmental risk factors: Case study for ambient air pollution

Future changes in exposure to risk factors should impact mortality rates and population. However, studies commonly use mortality rates and population projections developed exogenously to the health impact assessment model used to quantify future health burdens attributable to environmental risks that are therefore invariant to projected exposure levels. This impacts the robustness of many future health burden estimates for environmental risk factors. This work describes an alternative methodology that more consistently represents the interaction between risk factor exposure, population and mortality rates, using ambient particulate air pollution (PM2.5) as a case study. A demographic model is described that estimates future population based on projected births, mortality and migration. Mortality rates are disaggregated between the fraction due to PM2.5 exposure and other factors for a historic year, and projected independently. Accounting for feedbacks between future risk factor exposure and population and mortality rates can greatly affect estimated future attributable health burdens. The demographic model estimates much larger PM2.5-attributable health burdens with constant 2019 PM2.5 (∼10.8 million deaths in 2050) compared to a model using exogenous population and mortality rate projections (∼7.3 million), largely due to differences in mortality rate projection methods. Demographic model-projected PM2.5-attributable mortality can accumulate substantially over time. For example, ∼71 million more people are estimated to be alive in 2050 when WHO guidelines (5 µg m-3) are achieved compared to constant 2019 PM2.5 concentrations. Accounting for feedbacks is more important in applications with relatively high future PM2.5 concentrations, and relatively large changes in non-PM2.5 mortality rates.

Short-term health impacts related to ozone in China before and after implementation of policy measures: A systematic review and meta-analysis

This paper presents a meta-analysis of the impacts of short-term exposure to ozone (O₃) on three health endpoints: all-cause, cardiovascular, and respiratory mortality in China. All relevant studies from January 1990 to December 2021 were searched from four databases. After screening, 30 studies were included for the meta-analysis. The results showed that a significant rise of 0.41 % (95 % confidence interval (CI): 0.35 %-0.48 %) in all-cause, 0.60 % (95 % CI: 0.51 %-0.68 %) in cardiovascular and 0.45 % (95 % CI: 0.28 %-0.62 %) in respiratory mortality for each 10 μg m^-3 increase in the maximum daily 8 h average O₃ concentration (MDA8 O₃). Moreover, results stratified by heterogeneous time periods before and after implementing a policy measure in 2013, showed that the pooled effects for all-cause and respiratory mortality before were greater than those after, while the pooled effects for cardiovascular mortality before 2013 were slightly smaller than those after. The finding that short-term exposure to O₃ was positively related to the three health endpoints was validated by means of a sensitivity analysis. Furthermore, we did not observe any publication bias. Our results present an updated and better understanding of the relationship between short-term exposure to O₃ and the three health endpoints, while providing a reference for further assessment of the impact of short-term O₃ exposure on human health.

Digital health for climate change mitigation and response: a scoping review

OBJECTIVE

Climate change poses a major threat to the operation of global health systems, triggering large scale health events, and disrupting normal system operation. Digital health may have a role in the management of such challenges and in greenhouse gas emission reduction. This scoping review explores recent work on digital health responses and mitigation approaches to climate change.

MATERIALS AND METHODS

We searched Medline up to February 11, 2022, using terms for digital health and climate change. Included articles were categorized into 3 application domains (mitigation, infectious disease, or environmental health risk management), and 6 technical tasks (data sensing, monitoring, electronic data capture, modeling, decision support, and communication). The review was PRISMA-ScR compliant.

RESULTS

The 142 included publications reported a wide variety of research designs. Publication numbers have grown substantially in recent years, but few come from low- and middle-income countries. Digital health has the potential to reduce health system greenhouse gas emissions, for example by shifting to virtual services. It can assist in managing changing patterns of infectious diseases as well as environmental health events by timely detection, reducing exposure to risk factors, and facilitating the delivery of care to under-resourced areas.

DISCUSSION

While digital health has real potential to help in managing climate change, research remains preliminary with little real-world evaluation.

CONCLUSION

Significant acceleration in the quality and quantity of digital health climate change research is urgently needed, given the enormity of the global challenge.

Ozone modelling and mapping for risk assessment: An overview of different approaches for human and ecosystems health

Tropospheric ozone (O₃) is one of the most concernedair pollutants dueto its widespread impacts on land vegetated ecosystems and human health. Ozone is also the third greenhouse gas for radiative forcing. Consequently, it should be carefully and continuously monitored to estimate its potential adverse impacts especially inthose regions where concentrations are high. Continuous large-scale O₃ concentrations measurement is crucial but may be unfeasible because of economic and practical limitations; therefore, quantifying the real impact of O₃over large areas is currently an open challenge. Thus, one of the final objectives of O₃ modelling is to reproduce maps of continuous concentrations (both spatially and temporally) and risk assessment for human and ecosystem health. We here reviewedthe most relevant approaches used for O₃ modelling and mapping starting from the simplest geo-statistical approaches andincreasing in complexity up to simulations embedded into the global/regional circulation models and pro and cons of each mode are highlighted. The analysis showed that a simpler approach (mostly statistical models) is suitable for mappingO₃concentrationsat the local scale, where enough O₃concentration data are available. The associated error in mapping can be reduced by using more complex methodologies, based on co-variables. The models available at the regional or global level are used depending on the needed resolution and the domain where they are applied to. Increasing the resolution corresponds to an increase in the prediction but only up to a certain limit. However, with any approach, the ensemble models should be preferred.

Machine learning-based estimation of ground-level NO2 concentrations over China

Most current scientific research on NO₂ remote sensing focuses on tropospheric NO₂ column concentrations rather than ground-level NO₂ concentrations; however, ground-level NO₂ concentrations are more related to anthropogenic emissions and human health. This study proposes a machine learning estimation method for retrieving the ground-level NO₂ concentrations throughout China based on the tropospheric NO₂ column concentrations from the TROPOspheric Monitoring Instrument (TROPOMI) and multisource geographic data from 2018 to 2020. This method adopts the XGBoost machine learning model characterized by a strong fitting ability and complex model structure, which can explain the complex nonlinear and high-order relationships between ground-measured NO₂ and its influencing factors. The R² values between the retrievals and the validation and test datasets are 0.67 and 0.73, respectively, which suggests that the proposed method can reliably retrieve the ground-level NO₂ concentrations across China. The distribution characteristics, seasonal variations and interannual differences in ground-level NO₂ concentrations are further analyzed based on the retrieval results, demonstrating that the ground-level NO₂ concentrations exhibit significant geographical and seasonal variations, with high concentrations in winter and low concentrations in summer, and the highly polluted regions are concentrated mainly in Beijing-Tianjin-Hebei (BTH), the Yangtze River Delta (YRD), the Pearl River Delta (PRD), Cheng-Yu District (CY) and other urban agglomerations. Finally, the interannual variation in the ground-level NO₂ concentrations indicates that pollution decreased continuously from 2018 to 2020.

A Multiscale Land Use Regression Approach for Estimating Intraurban Spatial Variability of PM2.5 Concentration by Integrating Multisource Datasets

Poor air quality has been a major urban environmental issue in large high-density cities all over the world, and particularly in Asia, where the multiscale complex of pollution dispersal creates a high-level spatial variability of exposure level. Investigating such multiscale complexity and fine-scale spatial variability is challenging. In this study, we aim to tackle the challenge by focusing on PM_2.5 (particulate matter with an aerodynamic diameter less than 2.5 µm,) which is one of the most concerning air pollutants. We use the widely adopted land use regression (LUR) modeling technique as the fundamental method to integrate air quality data, satellite data, meteorological data, and spatial data from multiple sources. Unlike most LUR and Aerosol Optical Depth (AOD)-PM_2.5 studies, the modeling process was conducted independently at city and neighborhood scales. Correspondingly, predictor variables at the two scales were treated separately. At the city scale, the model developed in the present study obtains better prediction performance in the AOD-PM_2.5 relationship when compared with previous studies (R2¯ from 0.72 to 0.80). At the neighborhood scale, point-based building morphological indices and road network centrality metrics were found to be fit-for-purpose indicators of PM_2.5 spatial estimation. The resultant PM_2.5 map was produced by combining the models from the two scales, which offers a geospatial estimation of small-scale intraurban variability.

The Modeling Study about Impacts of Emission Control Policies for Chinese 14th Five-Year Plan on PM2.5 and O3 in Yangtze River Delta, China

The Chinese government has made great efforts to combat air pollution through the reductions in SO2, NOx and VOCs emissions, as part of its socioeconomic Five-Year Plans (FYPs). China aims to further reduce the emissions of VOCs and NOx by 10% in its upcoming 14th FYP (2021–2025). Here, we used a regional chemical transport model (e.g., WRF/CMAQ) to examine the responses of PM2.5 and O3 to emission control policies of the 14th FYP in the Yangtze River Delta (YRD) region. The simulation results under the 4 emission control scenarios in the 2 winter months in 2025 indicate that the average concentrations of city mean PM2.5 in 41 cities in the YRD were predicted to only decrease by 10% under both S1 and S1_E scenarios, whereas the enhanced emission control scenarios (i.e., S2_E and S3_E) could reduce PM2.5 in each city by more than 20%. The model simulation results for O3 in the 3 summer months in 2025 show that the O3 responses to the emission controls under the S1 and S1_E scenarios show different control effects on O3 concentrations in the YRD with the increase and decrease effects, respectively. The study found that both enhanced emission control scenarios (S2_E and S3_E) could decrease O3 in each city by more than 20% with more reductions in O3 under the S3_E emission control scenario because of its higher control strengths for both NOx and VOCs emissions. It was found that emission reduction policies for controlling high emission sectors of NOx and VOCs such as S2_E and S3_E were more effective for decreasing both PM2.5 and O3 in the YRD. This study shows that O3 controls will benefit from well-designed air pollution control strategies for reasonable control ratios of NOx and VOCs emissions.

Hot weather and heat extremes: health risks

Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects. However, excess deaths and many heat-related health risks are preventable, with appropriate heat action plans involving behavioural strategies and biophysical solutions. Extreme heat events are becoming permanent features of summer seasons worldwide, causing many excess deaths. Heat-related morbidity and mortality are projected to increase further as climate change progresses, with greater risk associated with higher degrees of global warming. Particularly in tropical regions, increased warming might mean that physiological limits related to heat tolerance (survival) will be reached regularly and more often in coming decades. Climate change is interacting with other trends, such as population growth and ageing, urbanisation, and socioeconomic development, that can either exacerbate or ameliorate heat-related hazards. Urban temperatures are further enhanced by anthropogenic heat from vehicular transport and heat waste from buildings. Although there is some evidence of adaptation to increasing temperatures in high-income countries, projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase.

The mortality cost of carbon

Many studies project that climate change can cause a significant number of excess deaths. Yet, in integrated assessment models (IAMs) that determine the social cost of carbon (SCC) and prescribe optimal climate policy, human mortality impacts are limited and not updated to the latest scientific understanding. This study extends the DICE-2016 IAM to explicitly include temperature-related mortality impacts by estimating a climate-mortality damage function. We introduce a metric, the mortality cost of carbon (MCC), that estimates the number of deaths caused by the emissions of one additional metric ton of CO2. In the baseline emissions scenario, the 2020 MCC is 2.26 × 10‒4 [low to high estimate -1.71× 10‒4 to 6.78 × 10‒4] excess deaths per metric ton of 2020 emissions. This implies that adding 4,434 metric tons of carbon dioxide in 2020-equivalent to the lifetime emissions of 3.5 average Americans-causes one excess death globally in expectation between 2020-2100. Incorporating mortality costs increases the 2020 SCC from $37 to $258 [-$69 to $545] per metric ton in the baseline emissions scenario. Optimal climate policy changes from gradual emissions reductions starting in 2050 to full decarbonization by 2050 when mortality is considered.

Spatiotemporal assessment of health burden and economic losses attributable to short-term exposure to ground-level ozone during 2015-2018 in China

BACKGROUND

Ground-level ozone (O3) pollution is currently the one of the severe environmental problems in China. Although existing studies have quantified the O3-related health impact and economic loss, few have focused on the acute health effects of short-term exposure to O3 and have been limited to a single temporal and spatial dimension.

METHODS

Based on the O3 concentration obtained from ground monitoring networks in 334 Chinese cities in 2015-2018, this study used a two-stage exposure parameter weighted Log-linear exposure-response function to estimate the cause-specific mortality for short-term exposure to O3.

RESULTS

The value of statistical life (VSL) method that were used to calculate the economic loss at the city-level. Our results show that in China, the national all-cause mortality attributed to O3 was 0.27(95% CI: 0.14-0.55) to 0.39 (95% CI: 0.20-0.67) million across 2015-2018. The estimated economic loss caused by O3 was 387.76 (95% CI: 195.99-904.50) to 594.08 (95% CI: 303.34-1140.65) billion CNY, accounting for 0.52 to 0.69% of total reported GDP. Overall, the O3 attributed health and economic burden has begun to decline in China since 2017. However, highly polluted areas still face severe burden, and undeveloped areas suffer from high GDP losses.

CONCLUSIONS

There are substantial health impacts and economic losses related to short-term O3 exposure in China. The government should pay attention to the emerging ozone pollution, and continue to strengthen the intervention in traditional priority areas while solving the pollution problem in non-priority areas.

Update on Climate Change: Its Impact on Respiratory Health at Work, Home, and at Play

Climate change is a crisis of vast proportions that has serious implications for pulmonary health. Increasing global temperatures influence respiratory health through extreme weather events, wildfires, prolonged allergy seasons, and worsening air pollution. Children, elderly patients, and patients with underlying lung disease are at elevated risk of complications from these effects of climate change. This paper summarizes the myriad ways in which climate change affects the respiratory health of patients at home and in outdoor environments and outlines measures for patients to protect themselves.

On the linkage between urban heat island and urban pollution island: Three-decade literature review towards a conceptual framework

With the doubling of urban population within the next two decades and the disproportionate growth of megacities, it is critical to explore the synergism between urban heat and pollution. In this paper, a systematic review is conducted on the existing knowledge, collected since 1990, on the link between urban heat island (UHI) and urban pollution island (UPI). Results from 16 countries and 11 Köppen-Geiger climatic zones are perused and compared to delineate methodological and experimental trends, geographical dependencies and research gaps. Detailed content analysis is conducted according to five prominent topics: i) the role of UHI on temperature-dependent chemistry, ii) the daytime/nighttime variability in the UHI-UPI interaction, iii) the role of urban geomorphic types, forms and growth schemes, iv) future trends and v) primary and secondary effects of UHI mitigation on urban air quality. Different approaches and observations are eventually harmonized to outline opportunities and challenges towards the disentanglement and/or the two-way mitigation of both phenomena. This will help governments and urban planners to deliver coping strategies and precautions towards a more salutogenic urban design.

Controlling and preventing climate-sensitive noncommunicable diseases in urban sub-Saharan Africa

Research continues to highlight the link between climate change and health outcomes. There is, however, limited evidence in research, policies and in the Sustainable Development Goals (SDGs) about the impact of environmental factors on noncommunicable diseases (NCDs) for people living in urban areas of sub-Saharan Africa (SSA). Important is that 80% of NCDs are taking place in low- and middle-income countries (LMICs) and linked to a third of the deaths in SSA. The question is, what would these statistics look like if environmental risk factors (e.g., pollution, chemicals) for NCDs, linked to climate change, were prevented and controlled. This article presents a framework for understanding climatic pathways' impacts on climate-sensitive NCDs and achieving the SDGs. It further explains how current global mitigation interventions in high income urban settings, with implied health co-benefits for NCD reduction (i.e., promoting use of less polluting vehicles, bicycles, walking, public transport, green spaces), experience major implementation challenges in SSA cities (i.e., too costly, lack of availability, poor road conditions, gender and cultural norms, security problems). Recommendations are made for applying this framework to control climate change impacts on NCDs and achieving the SDGs in SSA cities. These include, support for more research on the climate - NCD nexus, ensuring health professional training includes sustainable health education, and including a focus on climate change and health in primary and secondary school curricula. Further recommendations for addressing climate-sensitive NCDs and urban environmental health towards achieving and sustaining the SDGs, are linked to promoting climate-sensitive and health policies and governance, as well as controlling the influence of advertising. Lastly, improving communication of research findings for policy makers and the public in a manner for informed policy making, and how to comprehend this information to promote the reduction and prevention of NCDs in urban SSA, is key.

Environmental degradation and population health outcomes: a global panel data analysis

This study investigates the relationship between environmental degradation and population health using a global panel data of 180 countries from 1990 to 2016. The empirical analysis is conducted using fixed-effects approach based on Hausman test. Moreover, two-stage least squares (2SLS) and system-generalized method of moments (SGMM) are used to deal with the endogenous nature of environmental degradation. The indicators of life expectancy and infant mortality are used to measure population health, whereas environmental degradation is measured by CO₂ emissions. The empirical findings show that environmental degradation negatively influences population health outcomes. It implies that countries having a high level of environmental degradation experience low life expectancy and high infant mortality rates. Findings of the study suggest that health-related reforms need to be aligned with policies which ensure lower environmental degradation.

Estimating health burden and economic loss attributable to short-term exposure to multiple air pollutants in China

Existing studies focused on the evaluation of health burden of long-term exposure to air pollutants, whereas limited information is available on short-term exposure, particularly in China. Air pollutant concentrations in 338 Chinese cities in 2017 were used to estimate the air pollutants related health burden which was defined as premature mortalities from all-cause, cardiovascular and respiratory disease as well as hospital admissions for cardiovascular and respiratory disease. Log-linear model was used as the exposure-response function to estimate the health burden attributable to each air pollutant. The value of statistical life and cost of illness methods were used to estimate economic loss of the premature mortalities and hospital admissions, respectively. The national all-cause premature mortalities attributable to all air pollutants was 1.35 million, accounting for 17.2% of reported deaths in China in 2017. Among all-cause premature mortality, contributions of PM_2.5, PM_2.5-10, NO₂, SO₂, O₃ and CO were11.1%, 5.2%, 28.9%, 9.6%, 23.0%, and 22.2%, respectively. The national cardiovascular and respiratory premature mortalities were 0.77 and 0.21 million, respectively. About 7.8 million cardiovascular and respiratory disease hospital admissions were attributed to short-term exposure to all air pollutants. The economic loss of the overall health burden (premature mortality and hospital admissions) was 2065.54 billion Yuan, which was equivalent to 2.5% of the national GDP in 2017. The health burden and economic loss attributable to short-term exposure to ambient air pollutant are substantial in China. It suggested that the adverse health effects attributable to short-term exposure to air pollutant should not be neglected in China. In order to reduce the health impact of air pollution, each city should develop air pollution prevention and control measures based on existing scientific evidence.

Application of geostatistical approaches to predict the spatio-temporal distribution of summer ozone in Houston, Texas

Mitigation of adverse effects of air pollution requires understanding underlying exposures, such as ambient ozone concentrations. Geostatistical approaches were employed to analyze temporal trends and estimate spatial patterns of summertime ozone concentrations for Houston, Texas, based on hourly ozone observations obtained from the Texas Commission on Environmental Quality. We systematically assess the accuracy of several spatial interpolation methods, comparing inverse distance weighting, simple kriging, ordinary kriging, and universal kriging methods utilizing the hourly ozone observations and meteorological measurements from monitoring sites. Model uncertainty was assessed by leave-one-out cross-validation. Kriging methods performed better, showing greater consistency in the generated surfaces, fewer interpolation errors, and lower biases. Universal kriging did not significantly improve the interpolation results compared to ordinary kriging, and thus ordinary kriging was determined to be the optimal method, striking a balance between accuracy and simplicity. The resulting spatial patterns indicate that the more industrialized areas east and northeast of Houston exhibit the highest summertime ozone concentrations. Estimated daily maximum 8 h ozone concentration fields generated will be used to inform research on population health risks from exposure to surface ozone in Houston.

Estimating the Health-Related Costs of 10 Climate-Sensitive U.S. Events During 2012

Climate change threatens human health, but there remains a lack of evidence on the economic toll of climate-sensitive public health impacts. We characterize human mortality and morbidity costs associated with 10 climate-sensitive case study events spanning 11 US states in 2012: wildfires in Colorado and Washington, ozone air pollution in Nevada, extreme heat in Wisconsin, infectious disease outbreaks of tick-borne Lyme disease in Michigan and mosquito-borne West Nile virus in Texas, extreme weather in Ohio, impacts of Hurricane Sandy in New Jersey and New York, allergenic oak pollen in North Carolina, and harmful algal blooms on the Florida coast. Applying a consistent economic valuation approach to published studies and state estimates, we estimate total health-related costs from 917 deaths, 20,568 hospitalizations, and 17,857 emergency department visits of $10.0 billion in 2018 dollars, with a sensitivity range of $2.7-24.6 billion. Our estimates indicate that the financial burden of deaths, hospitalizations, emergency department visits, and associated medical care is a key dimension of the overall economic impact of climate-sensitive events. We found that mortality costs (i.e., the value of a statistical life) of $8.4 billion exceeded morbidity costs and lost wages ($1.6 billion combined). By better characterizing health damages in economic terms, this work helps to shed light on the burden climate-sensitive events already place on U.S. public health each year. In doing so, we provide a conceptual framework for broader estimation of climate-sensitive health-related costs. The high health-related costs associated with climate-sensitive events highlight the importance of actions to mitigate climate change and adapt to its unavoidable impacts.

How to Maintain a Sustainable Environment? A Spatial Evolution of Urban Atmospheric Pollution and Impact Factors in China

Urban pollution has significantly contributed to the spread of diseases and global warming. The analysis of spatial distribution characteristics of atmospheric pollutants is crucial for making sustainable industrial policy, and environmentally friendly urban planning. In this paper, GeoDa software is used to analyze how sulfur dioxide (SO2), nitrogen oxides (NOx), and smoke dust (DUS) are spatially distributed in various provinces of China. Then, global spatial correlation test and cluster analysis are carried out to obtain the spatial evolution characteristics of three pollutants. Afterward, the spatial panel data model is applied to explore the factors that affect the spatial evolution of SO2, NOx and smoke dust (DUS) nationwide. MATLAB is used to estimate the Spatial Lag Model (SLM) and the Spatial Error Model (SEM) of the three pollutants, respectively. According to our analysis, SEM is more applicable for SO2 and NOx, whereas SLM is optimal for smoke dust (DUS). The results show that foreign direct investment (FDI), industrial structure, and urbanization aggravate environmental pollution, while per capita gross domestic products (per capita GDP) has a negative relationship with the cluster of pollutants. The study concludes by informing public policy makers on environment friendly policies for a more sustainable development.

Exploration of the heterogeneous effect of climate change on ozone concentration in an urban environment

Ozone is a significant causative agent of mortality in cities. Urban environments are expressly vulnerable to global warming because of the extensive emission of air pollutants with urban heat island effect enhancing much rapidly the ozone concentration than in the less urbanized regions. This effect previously was not studied in local scale. It was hypothesized that climate change will cause heterogenic increase of ozone concentration in the different parts of the cities. To study this effect, the near-surface ozone concentration of 10 points of a Hungarian city was measured and modeled. At first step, the local correlations between solar radiation, air temperature, relative humidity and the near surface ozone concentrations at 3 m height were determined, specifying the local ozone-producing conditions. Then, based on the scenario of the Intergovernmental Panel on Climate Change 5th assessment report, the future seasonal near-surface ozone concentrations were modeled. Based on the model, it was determined that climate change will result in a heterogenic increase of near-surface ozone concentration.

Effect of Health-Related Uncertainty and Natural Variability on Health Impacts and Cobenefits of Climate Policy

Climate policy can mitigate health risks attributed to intensifying air pollution under climate change. However, few studies quantify risks of illness and death, examine their contribution to climate policy benefits, or assess their robustness in light of natural climate variability. We employ an integrated modeling framework of the economy, climate, air quality, and human health to quantify the effect of natural variability on U.S. air pollution impacts under future climate and two global policies (2 and 2.5 °C stabilization scenarios) using 150 year ensemble simulations for each scenario in 2050 and 2100. Climate change yields annual premature deaths related to fine particulate matter and ozone (95CI: 25 000-120 000), heart attacks (900-9400), and lost work days (3.6M-4.9M) in 2100. It raises air pollution health risks by 20%, while policies avert these outcomes by 40-50% in 2050 and 70-88% in 2100. Natural variability introduces "climate noise", yielding some annual estimates with negative cobenefits, and others that reach 100% of annual policy costs. This "noise" is three times the magnitude of uncertainty (95CI) in health and economic responses in 2050. Averaging five annual simulations reduces this factor to two, which is still substantially larger than health-related uncertainty. This study quantifies the potential for inaccuracy in climate impacts projected using too few annual simulations.

Future ozone-related acute excess mortality under climate and population change scenarios in China: A modeling study

BACKGROUND

Climate change is likely to further worsen ozone pollution in already heavily polluted areas, leading to increased ozone-related health burdens. However, little evidence exists in China, the world's largest greenhouse gas emitter and most populated country. As China is embracing an aging population with changing population size and falling age-standardized mortality rates, the potential impact of population change on ozone-related health burdens is unclear. Moreover, little is known about the seasonal variation of ozone-related health burdens under climate change. We aimed to assess near-term (mid-21st century) future annual and seasonal excess mortality from short-term exposure to ambient ozone in 104 Chinese cities under 2 climate and emission change scenarios and 6 population change scenarios.

METHODS AND FINDINGS

We collected historical ambient ozone observations, population change projections, and baseline mortality rates in 104 cities across China during April 27, 2013, to October 31, 2015 (2013-2015), which included approximately 13% of the total population of mainland China. Using historical ozone monitoring data, we performed bias correction and spatially downscaled future ozone projections at a coarse spatial resolution (2.0° × 2.5°) for the period April 27, 2053, to October 31, 2055 (2053-2055), from a global chemistry-climate model to a fine spatial resolution (0.25° × 0.25°) under 2 Intergovernmental Panel on Climate Change Representative Concentration Pathways (RCPs): RCP4.5, a moderate global warming and emission scenario where global warming is between 1.5°C and 2.0°C, and RCP8.5, a high global warming and emission scenario where global warming exceeds 2.0°C. We then estimated the future annual and seasonal ozone-related acute excess mortality attributable to both climate and population changes using cause-specific, age-group-specific, and season-specific concentration-response functions (CRFs). We used Monte Carlo simulations to obtain empirical confidence intervals (eCIs), quantifying the uncertainty in CRFs and the variability across ensemble members (i.e., 3 predictions of future climate and air quality from slightly different starting conditions) of the global model. Estimates of future changes in annual ozone-related mortality are sensitive to the choice of global warming and emission scenario, decreasing under RCP4.5 (-24.0%) due to declining ozone precursor emissions but increasing under RCP8.5 (10.7%) due to warming climate in 2053-2055 relative to 2013-2015. Higher ambient ozone occurs under the high global warming and emission scenario (RCP8.5), leading to an excess 1,476 (95% eCI: 898 to 2,977) non-accidental deaths per year in 2053-2055 relative to 2013-2015. Future ozone-related acute excess mortality from cardiovascular diseases was 5-8 times greater than that from respiratory diseases. Ozone concentrations increase by 15.1 parts per billion (10-9) in colder months (November to April), contributing to a net yearly increase of 22.3% (95% eCI: 7.7% to 35.4%) in ozone-related mortality under RCP8.5. An aging population, with the proportion of the population aged 65 years and above increased from 8% in 2010 to 24%-33% in 2050, will substantially amplify future ozone-related mortality, leading to a net increase of 23,838 to 78,560 deaths (110% to 363%). Our analysis was mainly limited by using a single global chemistry-climate model and the statistical downscaling approach to project ozone changes under climate change.

CONCLUSIONS

Our analysis shows increased future ozone-related acute excess mortality under the high global warming and emission scenario RCP8.5 for an aging population in China. Comparison with the lower global warming and emission scenario RCP4.5 suggests that climate change mitigation measures are needed to prevent a rising health burden from exposure to ambient ozone pollution in China.

Seasonal changes in surface ozone over South Korea

Recently, the surface ozone concentration in the Korean peninsula has been increasing more rapidly than in the past, and seasonal changes are appearing such as increases in the number of ozone alerts in springtime. We examined changes in the timing of annual maximum South Korean O₃ levels by fitting a sine function to data from 54 air-quality monitoring sites over a 10-year period (2005–2014). The analytical results show that the date of maximum ozone concentration at 23 points in the last 10 years has been advanced by about 2.1 days per year (E-sites), while the remaining 31 points have been delayed by about 2.5 days per year (L-sites). We attribute these differences to seasonal O₃ changes: E-sites show a larger increase in O₃ level in March–April (MA) than in June–July (JJ), while L-sites show a larger increase in JJ than in MA. Furthermore, these shifts are significantly larger in magnitude than those reported for Europe and North America. We also examined one possible reason for these seasonal differences: the relationship between O₃ and precursors such as NO₂ and CO. E-sites showed a rapid decrease in NO₂ (NO) concentration in MA over the last decade. As a result, the ozone concentration at E-sites seems to have increased due to the absence of ozone destruction by NOx titration in early spring. In L-Sites, the concentrations of ozone precursors such as NO₂ and CO in JJ showed a smaller decrease than those at other sites. Therefore, in L-sites, relatively large amounts of ozone precursors were distributed in JJ, implying that more ozone was generated. We suggest that shifts in the South Korean O₃ seasonal cycle are due to changes in early spring and summer NO₂ (NO) and CO levels; this should be tested further by modeling studies.

Climate change impacts on human health over Europe through its effect on air quality

This review examines the current literature on the effects of future emissions and climate change on particulate matter (PM) and O₃ air quality and on the consequent health impacts, with a focus on Europe. There is considerable literature on the effects of climate change on O₃ but fewer studies on the effects of climate change on PM concentrations. Under the latest Intergovernmental Panel on Climate Change (IPCC) 5th assessment report (AR5) Representative Concentration Pathways (RCPs), background O₃ entering Europe is expected to decrease under most scenarios due to higher water vapour concentrations in a warmer climate. However, under the extreme pathway RCP8.5 higher (more than double) methane (CH₄) abundances lead to increases in background O₃ that offset the O₃ decrease due to climate change especially for the 2100 period. Regionally, in polluted areas with high levels of nitrogen oxides (NO_x), elevated surface temperatures and humidities yield increases in surface O₃ - termed the O₃ climate penalty - especially in southern Europe. The O₃ response is larger for metrics that represent the higher end of the O₃ distribution, such as daily maximum O₃. Future changes in PM concentrations due to climate change are much less certain, although several recent studies also suggest a PM climate penalty due to high temperatures and humidity and reduced precipitation in northern mid-latitude land regions in 2100.A larger number of studies have examined both future climate and emissions changes under the RCP scenarios. Under these pathways the impact of emission changes on air quality out to the 2050s will be larger than that due to climate change, because of large reductions in emissions of O₃ and PM pollutant precursor emissions and the more limited climate change response itself. Climate change will also affect climate extreme events such as heatwaves. Air pollution episodes are associated with stagnation events and sometimes heat waves. Air quality during the 2003 heatwave over Europe has been examined in numerous studies and mechanisms for enhancing O₃ have been identified.There are few studies on health effects associated with climate change impacts alone on air quality, but these report higher O₃-related health burdens in polluted populated regions and greater PM_2.5 health burdens in these emission regions. Studies that examine the combined impacts of climate change and anthropogenic emissions change under the RCP scenarios report reductions in global and European premature O₃-respiratory related and PM mortalities arising from the large decreases in precursor emissions. Under RCP 8.5 the large increase in CH₄ leads to global and European excess O₃-respiratory related mortalities in 2100. For future health effects, besides uncertainty in future O₃ and particularly PM concentrations, there is also uncertainty in risk estimates such as effect modification by temperature on pollutant-response relationships and potential future adaptation that would alter exposure risk.

Human Health and Economic Impacts of Ozone Reductions by Income Group

Low-income households may be disproportionately affected by ozone pollution and ozone policy. We quantify how three factors affect the relative benefits of ozone policies with household income: (1) unequal ozone reductions; (2) policy delay; and (3) economic valuation methods. We model ozone concentrations under baseline and policy conditions across the full continental United States to estimate the distribution of ozone-related health impacts across nine income groups. We enhance an economic model to include these impacts across household income categories, and present its first application to evaluate the benefits of ozone reductions for low-income households. We find that mortality incidence rates decrease with increasing income. Modeled ozone levels yield a median of 11 deaths per 100 000 people in 2005. Proposed policy reduces these rates by 13%. Ozone reductions are highest among low-income households, which increases their relative welfare gains by up to 4% and decreases them for the rich by up to 8%. The median value of reductions in 2015 is either $30 billion (in 2006 U.S. dollars) or $1 billion if reduced mortality risks are valued with willingness-to-pay or as income from increased life expectancy. Ozone reductions were relatively twice as beneficial for the lowest- compared to the highest-income households. The valuation approach affected benefits more than a policy delay or differential ozone reductions with income.

Multiple Threats to Child Health from Fossil Fuel Combustion: Impacts of Air Pollution and Climate Change

BACKGROUND

Approaches to estimating and addressing the risk to children from fossil fuel combustion have been fragmented, tending to focus either on the toxic air emissions or on climate change. Yet developing children, and especially poor children, now bear a disproportionate burden of disease from both environmental pollution and climate change due to fossil fuel combustion.

OBJECTIVE

This commentary summarizes the robust scientific evidence regarding the multiple current and projected health impacts of fossil fuel combustion on the young to make the case for a holistic, child-centered energy and climate policy that addresses the full array of physical and psychosocial stressors resulting from fossil fuel pollution.

DISCUSSION

The data summarized here show that by sharply reducing our dependence on fossil fuels we would achieve highly significant health and economic benefits for our children and their future. These benefits would occur immediately and also play out over the life course and potentially across generations.

CONCLUSION

Going beyond the powerful scientific and economic arguments for urgent action to reduce the burning of fossil fuels is the strong moral imperative to protect our most vulnerable populations. Citation: Perera FP. 2017. Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change. Environ Health Perspect 125:141-148; http://dx.doi.org/10.1289/EHP299.

An Overview of Occupational Risks From Climate Change

Changes in atmosphere and temperature are affecting multiple environmental indicators from extreme heat events to global air quality. Workers will be uniquely affected by climate change, and the occupational impacts of major shifts in atmospheric and weather conditions need greater attention. Climate change-related exposures most likely to differentially affect workers in the USA and globally include heat, ozone, polycyclic aromatic hydrocarbons, other chemicals, pathogenic microorganisms, vector-borne diseases, violence, and wildfires. Epidemiologic evidence documents a U-, J-, or V-shaped relationship between temperature and mortality. Whereas heat-related morbidity and mortality risks are most evident in agriculture, many other outdoor occupational sectors are also at risk, including construction, transportation, landscaping, firefighting, and other emergency response operations. The toxicity of chemicals change under hyperthermic conditions, particularly for pesticides and ozone. Combined with climate-related changes in chemical transport and distribution, these interactions represent unique health risks specifically to workers. Links between heat and interpersonal conflict including violence require attention because they pose threats to the safety of emergency medicine, peacekeeping and humanitarian relief, and public safety professionals. Recommendations for anticipating how US workers will be most susceptible to climate change include formal monitoring systems for agricultural workers; modeling scenarios focusing on occupational impacts of extreme climate events including floods, wildfires, and chemical spills; and national research agenda setting focusing on control and mitigation of occupational susceptibility to climate change.

Temperature in summer and children's hospitalizations in two Mediterranean cities

BACKGROUND AND OBJECTIVE

Children are potentially vulnerable to hot ambient temperature. However, the evidence on heat-related children's morbidity is still scarce. Our aim was to examine the association between temperatures in summer (May to September) and children's hospitalizations in two Mediterranean cities, Rome and Valencia, during the period 2001-2010.

METHODS

Quasi-Poisson generalised additive models and distributed lag non-linear models were combined to study the relationship between daily mean temperature and hospital admissions for all natural, respiratory and gastrointestinal diseases in children under 15 years of age. Associations were summarised as the percentage of change (Ch%) in admissions at 50th, 75th, 90th, 95th and 98th percentiles of temperature in summer compared to 1.) the 50th percentile in the whole year (50th(y)) and 2.) the preceding percentile in the previous series. Cumulated risks were obtained for groups of lags showing a similar pattern: 0-1, 2-7, 8-14 and 15-21 days.

RESULTS

Almost whatever increase of temperature from 50th(y) was significantly associated with an increase of paediatric hospitalizations by all natural diseases at short term (lag 0-1), while small increases at high temperatures only had a delayed effect on this outcome. The same pattern was observed in Rome for respiratory admissions, while in Valencia only a delayed association (days 8-14) was observed. The increase of temperature from 50th to 75th percentiles was associated at short time to an increase of gastrointestinal admissions in both cities.

CONCLUSION

Children's hospitalizations rose with heat in Rome and Valencia. Patterns of delays and critical windows of exposure mainly varied according the outcome considered.

Projecting ozone-related mortality in East China

BACKGROUND

The concentrations of ozone (O3) in China are increasing, especially in East China, but its future trends and potential health impacts remain to be explored.

OBJECTIVES

The objective was to assess future trends in O3 concentrations and related premature death in East China between 2005 and 2030.

METHODS

First, a global chemical transport model (MIROC-ESM-CHEM) and regional chemical transport modelling system (including the Weather Research and Forecasting model and the Community Multiscale Air Quality model) were combined to estimate daily O3 concentrations in 2005 and 2030 in East China under the "current legislation" (CLE) and "maximum technically feasible reduction" (MFR) scenarios which were applied globally. O3 concentrations were then linked with population projections, mortality projections, and O3-mortality associations to estimate changes in O3-related mortality in East China.

RESULTS

The annual mean O3 concentration was projected to increase in East China between 2005 and 2030 under the CLE scenario, while decrease under the MFR scenario. Under the CLE scenario, O3-attributable health burden could increase by at least 40,000 premature deaths in East China, without considering the population growth. Under the MFR scenario, the health burden could decrease by up to 260,000 premature deaths as a result of the reduction in O3 concentration with a static population. However, when the population growth was considered, O3-attributable health burden could increase by up to 46,000 premature deaths in East China under the MFR scenario.

CONCLUSIONS

The results suggest that the health burden attributable to O3 may increase in East China in 2030.

Global Health Solidarity

For much of the 20th century, vulnerability to deprivations of health has often been defined by geographical and economic factors. Those in wealthy, usually ‘Northern’ and ‘Western’, parts of the world have benefited from infrastructures, and accidents of geography and climate, which insulate them from many serious threats to health. Conversely, poorer people are typically exposed to more threats to health, and have lesser access to the infrastructures needed to safeguard them against the worst consequences of such exposure. However, in recent years the increasingly globalized nature of the world’s economy, society and culture, combined with anthropogenic climate change and the evolution of antibiotic resistance, has begun to shift the boundaries that previously defined the categories of person threatened by many exogenous threats to health. In doing so, these factors expose both new and forgotten similarities between persons, and highlight the need for global cooperative responses to the existential threats posed by climate change and the evolution of antimicrobial resistance. In this article, we argue that these emerging health threats, in demonstrating the similarities that exist between even distant persons, provides a catalyst for global solidarity, which justifies, and provides motivation for, the establishment of solidaristic, cooperative global health infrastructures.

The effect of future ambient air pollution on human premature mortality to 2100 using output from the ACCMIP model ensemble

Ambient air pollution from ground-level ozone and fine particulate matter (PM_2.5) is associated with premature mortality. Future concentrations of these air pollutants will be driven by natural and anthropogenic emissions and by climate change. Using anthropogenic and biomass burning emissions projected in the four Representative Concentration Pathway scenarios (RCPs), the ACCMIP ensemble of chemistry-climate models simulated future concentrations of ozone and PM_2.5 at selected decades between 2000 and 2100. We use output from the ACCMIP ensemble, together with projections of future population and baseline mortality rates, to quantify the human premature mortality impacts of future ambient air pollution. Future air pollution-related premature mortality in 2030, 2050 and 2100 is estimated for each scenario and for each model using a health impact function based on changes in concentrations of ozone and PM_2.5 relative to 2000 and projected future population and baseline mortality rates. Additionally, the global mortality burden of ozone and PM_2.5 in 2000 and each future period is estimated relative to 1850 concentrations, using present-day and future population and baseline mortality rates. The change in future ozone concentrations relative to 2000 is associated with excess global premature mortality in some scenarios/periods, particularly in RCP8.5 in 2100 (316 thousand deaths/year), likely driven by the large increase in methane emissions and by the net effect of climate change projected in this scenario, but it leads to considerable avoided premature mortality for the three other RCPs. However, the global mortality burden of ozone markedly increases from 382,000 (121,000 to 728,000) deaths/year in 2000 to between 1.09 and 2.36 million deaths/year in 2100, across RCPs, mostly due to the effect of increases in population and baseline mortality rates. PM_2.5 concentrations decrease relative to 2000 in all scenarios, due to projected reductions in emissions, and are associated with avoided premature mortality, particularly in 2100: between -2.39 and -1.31 million deaths/year for the four RCPs. The global mortality burden of PM_2.5 is estimated to decrease from 1.70 (1.30 to 2.10) million deaths/year in 2000 to between 0.95 and 1.55 million deaths/year in 2100 for the four RCPs, due to the combined effect of decreases in PM_2.5 concentrations and changes in population and baseline mortality rates. Trends in future air pollution-related mortality vary regionally across scenarios, reflecting assumptions for economic growth and air pollution control specific to each RCP and region. Mortality estimates differ among chemistry-climate models due to differences in simulated pollutant concentrations, which is the greatest contributor to overall mortality uncertainty for most cases assessed here, supporting the use of model ensembles to characterize uncertainty. Increases in exposed population and baseline mortality rates of respiratory diseases magnify the impact on premature mortality of changes in future air pollutant concentrations and explain why the future global mortality burden of air pollution can exceed the current burden, even where air pollutant concentrations decrease.

Environmental Predictors of US County Mortality Patterns on a National Basis

A growing body of evidence has found that mortality rates are positively correlated with social inequalities, air pollution, elevated ambient temperature, availability of medical care and other factors. This study develops a model to predict the mortality rates for different diseases by county across the US. The model is applied to predict changes in mortality caused by changing environmental factors. A total of 3,110 counties in the US, excluding Alaska and Hawaii, were studied. A subset of 519 counties from the 3,110 counties was chosen by using systematic random sampling and these samples were used to validate the model. Step-wise and linear regression analyses were used to estimate the ability of environmental pollutants, socio-economic factors and other factors to explain variations in county-specific mortality rates for cardiovascular diseases, cancers, chronic obstructive pulmonary disease (COPD), all causes combined and lifespan across five population density groups. The estimated models fit adequately for all mortality outcomes for all population density groups and, adequately predicted risks for the 519 validation counties. This study suggests that, at local county levels, average ozone (0.07 ppm) is the most important environmental predictor of mortality. The analysis also illustrates the complex inter-relationships of multiple factors that influence mortality and lifespan, and suggests the need for a better understanding of the pathways through which these factors, mortality, and lifespan are related at the community level.

Projecting Fine Particulate Matter-Related Mortality in East China

China is suffering from severe air pollution from fine particulate matter [≤ 2.5 μm in aerodynamic diameter (PM2.5)], especially East China. But its future trends and potential health impacts remain unclear. The study objectives were to project future trends of PM2.5 and its short-term effect on mortality in East China by 2030. First, daily changes in PM2.5 concentrations between 2005 and 2030 were projected under the "current legislation" scenario (CLE) and the "maximum technically feasible reduction" scenario (MFR). Then, they were linked to six population projections, two mortality rate projections, and PM2.5-mortality associations to estimate the changes in PM2.5-related mortality in East China between 2005 and 2030. Under the CLE scenario, the annual mean PM2.5 concentration was projected to decrease by 0.62 μg/m(3) in East China, which could cause up to 124,000 additional deaths, when considering the population growth. Under the MFR scenario, the annual mean PM2.5 concentration was projected to decrease by 20.41 μg/m(3) in East China. At least 230,000 deaths could be avoided by such a large reduction in PM2.5 concentration under MFR scenario, even after accounting for the population growth. Therefore, our results suggest that reducing PM2.5 concentration substantially in East China would benefit the public health. Otherwise, it may still remain as a great health risk in the future, especially when the population keeps growing.

U.S. Air Quality and Health Benefits from Avoided Climate Change under Greenhouse Gas Mitigation

We evaluate the impact of climate change on U.S. air quality and health in 2050 and 2100 using a global modeling framework and integrated economic, climate, and air pollution projections. Three internally consistent socioeconomic scenarios are used to value health benefits of greenhouse gas mitigation policies specifically derived from slowing climate change. Our projections suggest that climate change, exclusive of changes in air pollutant emissions, can significantly impact ozone (O3) and fine particulate matter (PM2.5) pollution across the U.S. and increase associated health effects. Climate policy can substantially reduce these impacts, and climate-related air pollution health benefits alone can offset a significant fraction of mitigation costs. We find that in contrast to cobenefits from reductions to coemitted pollutants, the climate-induced air quality benefits of policy increase with time and are largest between 2050 and 2100. Our projections also suggest that increasing climate policy stringency beyond a certain degree may lead to diminishing returns relative to its cost. However, our results indicate that the air quality impacts of climate change are substantial and should be considered by cost-benefit climate policy analyses.

Projecting future air pollution-related mortality under a changing climate: progress, uncertainties and research needs

BACKGROUND

Climate change may affect mortality associated with air pollutants, especially for fine particulate matter (PM2.5) and ozone (O3). Projection studies of such kind involve complicated modelling approaches with uncertainties.

OBJECTIVES

We conducted a systematic review of researches and methods for projecting future PM2.5-/O3-related mortality to identify the uncertainties and optimal approaches for handling uncertainty.

METHODS

A literature search was conducted in October 2013, using the electronic databases: PubMed, Scopus, ScienceDirect, ProQuest, and Web of Science. The search was limited to peer-reviewed journal articles published in English from January 1980 to September 2013.

DISCUSSION

Fifteen studies fulfilled the inclusion criteria. Most studies reported that an increase of climate change-induced PM2.5 and O3 may result in an increase in mortality. However, little research has been conducted in developing countries with high emissions and dense populations. Additionally, health effects induced by PM2.5 may dominate compared to those caused by O3, but projection studies of PM2.5-related mortality are fewer than those of O3-related mortality. There is a considerable variation in approaches of scenario-based projection researches, which makes it difficult to compare results. Multiple scenarios, models and downscaling methods have been used to reduce uncertainties. However, few studies have discussed what the main source of uncertainties is and which uncertainty could be most effectively reduced.

CONCLUSIONS

Projecting air pollution-related mortality requires a systematic consideration of assumptions and uncertainties, which will significantly aid policymakers in efforts to manage potential impacts of PM2.5 and O3 on mortality in the context of climate change.

Climate change primer for respirologists

Climate change is already affecting the cardiorespiratory health of populations around the world, and these impacts are expected to increase. The present overview serves as a primer for respirologists who are concerned about how these profound environmental changes may affect their patients. The authors consider recent peer-reviewed literature with a focus on climate interactions with air pollution. They do not discuss in detail cardiorespiratory health effects for which the potential link to climate change is poorly understood. For example, pneumonia and influenza, which affect >500 million people per year, are not addressed, although clear seasonal variation suggests climate-related effects. Additionally, large global health impacts in low-resource countries, including migration precipitated by environmental change, are omitted. The major cardiorespiratory health impacts addressed are due to heat, air pollution and wildfires, shifts in allergens and infectious diseases along with respiratory impacts from flooding. Personal and societal choices about carbon use and fossil energy infrastructure should be informed by their impacts on health, and respirologists can play an important role in this discussion.

Spatially resolved estimation of ozone-related mortality in the United States under two Representative Concentration Pathways (RCPs) and their uncertainty

The spatial pattern of the uncertainty in air pollution-related health impacts due to climate change has rarely been studied due to the lack of high-resolution model simulations, especially under the Representative Concentration Pathways (RCPs), the latest greenhouse gas emission pathways. We estimated future tropospheric ozone (O3) and related excess mortality and evaluated the associated uncertainties in the continental United States under RCPs. Based on dynamically downscaled climate model simulations, we calculated changes in O3 level at 12 km resolution between the future (2057-2059) and base years (2001-2004) under a low-to-medium emission scenario (RCP4.5) and a fossil fuel intensive emission scenario (RCP8.5). We then estimated the excess mortality attributable to changes in O3. Finally, we analyzed the sensitivity of the excess mortality estimates to the input variables and the uncertainty in the excess mortality estimation using Monte Carlo simulations. O3-related premature deaths in the continental U.S. were estimated to be 1,312 deaths/year under RCP8.5 (95% confidence interval (CI): 427 to 2,198) and -2,118 deaths/year under RCP4.5 (95% CI: -3,021 to -1,216), when allowing for climate change and emissions reduction. The uncertainty of O3-related excess mortality estimates was mainly caused by RCP emissions pathways. Excess mortality estimates attributable to the combined effect of climate and emission changes on O3 as well as the associated uncertainties vary substantially in space and so do the most influential input variables. Spatially resolved data is crucial to develop effective community level mitigation and adaptation policy.

Effects of elevated temperature on the toxicity of copper and oxytetracycline in the marine model, Euplotes crassus: a climate change perspective

Trace metals and broad-spectrum antibiotic drugs are common environmental contaminants, the importance of which is increasing due to global climate change-related effects. In the present study, the biological model organism E. crassus was first acclimated to five temperatures, from 25 °C to 33 °C, followed by exposure to nominal concentrations of copper, the antibiotic model compound oxytetracycline and mixtures of both, at increasing thermal conditions. Variations of temperature-related toxicity were assessed by two high-level endpoint tests, survival and replication rates, and two sublethal parameters: endocytosis rate and lysosomal membrane stability. The selected toxicants presented opposite behaviours as the protozoa's survival rates increased following an increasing thermal gradient in the oxytetracycline-related treatments, and a decline of tolerance in metal-related treatments was observed. Results of tests combining binary mixtures of tested toxicants showed a complex pattern of responses.

Who is more affected by ozone pollution? A systematic review and meta-analysis

Ozone is associated with adverse health; however, less is known about vulnerable/sensitive populations, which we refer to as sensitive populations. We systematically reviewed epidemiologic evidence (1988-2013) regarding sensitivity to mortality or hospital admission from short-term ozone exposure. We performed meta-analysis for overall associations by age and sex; assessed publication bias; and qualitatively assessed sensitivity to socioeconomic indicators, race/ethnicity, and air conditioning. The search identified 2,091 unique papers, with 167 meeting inclusion criteria (73 on mortality and 96 on hospitalizations and emergency department visits, including 2 examining both mortality and hospitalizations). The strongest evidence for ozone sensitivity was for age. Per 10-parts per billion increase in daily 8-hour ozone concentration, mortality risk for younger persons, at 0.60% (95% confidence interval (CI): 0.40, 0.80), was statistically lower than that for older persons, at 1.27% (95% CI: 0.76, 1.78). Findings adjusted for publication bias were similar. Limited/suggestive evidence was found for higher associations among women; mortality risks were 0.39% (95% CI: -0.22, 1.00) higher than those for men. We identified strong evidence for higher associations with unemployment or lower occupational status and weak evidence of sensitivity for racial/ethnic minorities and persons with low education, in poverty, or without central air conditioning. Findings show that some populations, especially the elderly, are particularly sensitive to short-term ozone exposure.

Is enough attention given to climate change in health service planning? An Australian perspective

BACKGROUND

Within an Australian context, the medium to long-term health impacts of climate change are likely to be wide, varied and amplify many existing disorders and health inequities. How the health system responds to these challenges will be best considered in the context of existing health facilities and services. This paper provides a snapshot of the understanding that Australian health planners have of the potential health impacts of climate change.

METHODS

The first author interviewed (n=16) health service planners from five Australian states and territories using an interpretivist paradigm. All interviews were digitally recorded, key components transcribed and thematically analysed.

RESULTS

Results indicate that the majority of participants were aware of climate change but not of its potential health impacts. Despite this, most planners were of the opinion that they would need to plan for the health impacts of climate change on the community.

CONCLUSION

With the best available evidence pointing towards there being significant health impacts as a result of climate change, now is the time to undertake proactive service planning that address market failures within the health system. If considered planning is not undertaken then Australian health system can only deal with climate change in an expensive ad hoc, crisis management manner. Without meeting the challenges of climate change to the health system head on, Australia will remain unprepared for the health impacts of climate change with negative consequences for the health of the Australian population.

A Statistical Modeling Framework for Projecting Future Ambient Ozone and its Health Impact due to Climate Change

The adverse health effects of ambient ozone are well established. Given the high sensitivity of ambient ozone concentrations to meteorological conditions, the impacts of future climate change on ozone concentrations and its associated health effects are of concern. We describe a statistical modeling framework for projecting future ozone levels and its health impacts under a changing climate. This is motivated by the continual effort to evaluate projection uncertainties to inform public health risk assessment. The proposed approach was applied to the 20-county Atlanta metropolitan area using regional climate model (RCM) simulations from the North American Regional Climate Change Assessment Program. Future ozone levels and ozone-related excesses in asthma emergency department (ED) visits were examined for the period 2041-2070. The computationally efficient approach allowed us to consider 8 sets of climate model outputs based on different combinations of 4 RCMs and 4 general circulation models. Compared to the historical period of 1999-2004, we found consistent projections across climate models of an average 11.5% higher ozone levels (range: 4.8%, 16.2%), and an average 8.3% (range: -7% to 24%) higher number of ozone exceedance days. Assuming no change in the at-risk population, this corresponds to excess ozone-related ED visits ranging from 267 to 466 visits per year. Health impact projection uncertainty was driven predominantly by uncertainty in the health effect association and climate model variability. Calibrating climate simulations with historical observations reduced differences in projections across climate models.

Climate change. A global threat to cardiopulmonary health

Recent changes in the global climate system have resulted in excess mortality and morbidity, particularly among susceptible individuals with preexisting cardiopulmonary disease. These weather patterns are projected to continue and intensify as a result of rising CO2 levels, according to the most recent projections by climate scientists. In this Pulmonary Perspective, motivated by the American Thoracic Society Committees on Environmental Health Policy and International Health, we review the global human health consequences of projected changes in climate for which there is a high level of confidence and scientific evidence of health effects, with a focus on cardiopulmonary health. We discuss how many of the climate-related health effects will disproportionally affect people from economically disadvantaged parts of the world, who contribute relatively little to CO2 emissions. Last, we discuss the financial implications of climate change solutions from a public health perspective and argue for a harmonized approach to clean air and climate change policies.

Climate change and respiratory health: current evidence and knowledge gaps

Climate change is a key driver of the accelerating environmental change affecting populations around the world. Many of these changes and our response to them can affect respiratory health. This is an expert opinion review of recent peer-reviewed literature, focused on more recent medical journals and climate-health relevant modeling results from non-biomedical journals pertaining to climate interactions with air pollution. Global health impacts in low resource countries and migration precipitated by environmental change are addressed. The major findings are of respiratory health effects related to heat, air pollution, shifts in infectious diseases and allergens, flooding, water, food security and migration. The review concludes with knowledge gaps and research need that will support the evidence-base required to address the challenges ahead.

Quantifying the health impacts of air pollution under a changing climate-a review of approaches and methodology

Climate change has been predicted to affect future air quality, with inevitable consequences for health. Quantifying the health effects of air pollution under a changing climate is crucial to provide evidence for actions to safeguard future populations. In this paper, we review published methods for quantifying health impacts to identify optimal approaches and ways in which existing challenges facing this line of research can be addressed. Most studies have employed a simplified methodology, while only a few have reported sensitivity analyses to assess sources of uncertainty. The limited investigations that do exist suggest that examining the health risk estimates should particularly take into account the uncertainty associated with future air pollution emissions scenarios, concentration-response functions, and future population growth and age structures. Knowledge gaps identified for future research include future health impacts from extreme air pollution events, interactions between temperature and air pollution effects on public health under a changing climate, and how population adaptation and behavioural changes in a warmer climate may modify exposure to air pollution and health consequences.