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Depopulation, super aging, and extreme heat events in South Korea

South Korea’s population is declining and its composition changing, associated with lowest-low fertility rates and rapid aging (super aging). When estimating changes in future exposure to extreme heat events (EHE), events that are predicted to be intensified due to climate change, it is important to incorporate demographic dynamics. We analyze business-as-usual (BAU) population and climate scenarios—where BAU refers to no significant change in current processes and trends in either domain—from 2010 to 2060 for South Korea. Data for both BAU scenarios are spatially linked and used to measure and identify national and sub-national and age-group specific EHE exposure. The results reveal an increasing exposure to EHE over time at the national level, but this varies widely within the country, measured at the municipal level. The most intensive exposure levels will be in the decade ending in 2040 driven by high estimated severe EHE. Sub-nationally, Seoul will be the most vulnerable municipality associated with super aging, while severe EHE not demographic factors will be relevant in Daegu, the second-most vulnerable metropolitan area. By 2060, national estimates suggest the older population will be up to four times more exposed to EHE than today. While the population of South Korea will decline, the rapid aging of the population ensures that specific regions of the country will become exceedingly vulnerable to EHE.

The impact of humidity on Australia’s operational heatwave services

More frequent and intense heatwaves in the last decade have challenged humanitarian, health and meteorological authorities to mitigate impact. Meteorological heatwave monitoring and prediction services vary between heatwave definitions which either include humidity or are based only on temperature. Incorporation of humidity into human health heatwave studies and warning services has been variable. Whilst higher humidity is a known stressor during heatwaves, humidity is known to confound interpretation of heatwave data and can be difficult to monitor and forecast.

This study examines the effect of humidity on diagnosed heatwave severity across Australia’s diverse climate zones. Dry bulb temperature is used as the only input into the Bureau of Meteorology’s current operational Excess Heat Factor (EHF) index. Alternative humidity-affected temperature indices (Apparent Temperature, Wet Bulb Globe Temperature and Heat Index) are examined for suitability as input to EHF to compare the incidence of dry and humidity-affected heatwave severity within Australia. This paper uses maximum and minimum dry and humidity affected temperature indices extracted from Australia’s Bureau of Meteorology Atmospheric high-resolution Regional Reanalysis for Australia (BARRA).

Our investigation demonstrates Australia’s operational temperature-only percentile-based heatwave severity service provides effective heatwave warning guidance for five of Australia’s six diverse climate zones. However, rare very dry or very humid heatwaves in the tropics require both dry bulb temperature-only and Heat Index versions of Excess Heat Factor (EHF) severity index to provide competent operational heatwave early warning guidance.

Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework

Anatomical, physiologic, and socio-cultural changes during pregnancy and childbirth increase vulnerability of women and newborns to high ambient temperatures. Extreme heat can overwhelm thermoregulatory mechanisms in pregnant women, especially during labor, cause dehydration and endocrine dysfunction, and compromise placental function. Clinical sequelae include hypertensive disorders, gestational diabetes, preterm birth, and stillbirth. High ambient temperatures increase rates of infections, and affect health worker performance and healthcare seeking. Rising temperatures with climate change and limited resources heighten concerns. We propose an adaptation framework containing four prongs. First, behavioral changes such as reducing workloads during pregnancy and using low-cost water sprays. Second, health system interventions encompassing Early Warning Systems centered around existing community-based outreach; heat-health indicator tracking; water supplementation and monitoring for heat-related conditions during labor. Building modifications, passive and active cooling systems, and nature-based solutions can reduce temperatures in facilities. Lastly, structural interventions and climate financing are critical. The overall package of interventions, ideally selected following cost-effectiveness and thermal modeling trade-offs, needs to be co-designed and co-delivered with affected communities, and take advantage of existing maternal and child health platforms. Robust-applied research will set the stage for programs across Africa that target pregnant women. Adequate research and climate financing are now urgent.

Heatwave sears China: Need for actionable climate change adaptation to protect public health

Adaptation refers to adapting life to a changing climate to reduce our risk from the harmful impact. Throughout history, societies and populations adapted to changing climate with varying degrees of success. While climate change is a global issue, the extreme weather events are felt on a local scale. This past month, a series of intense heat waves engulfed dozens of cities across China with as many as 900 million people experiencing high temperatures. A total of 71 weather stations reported the hottest weather ever on record. Eighteen provincial-level regions experienced temperatures exceeding 35 degrees Celsius, and several places recorded temperatures above 44 degrees Celsius. This smelting heatwave prompted the country’s national meteorological observatory to issue the “orange alert” temperature warning on July 14th, 2022.

Public health scientists, policymakers, and the public are keenly aware of the health hazard of extreme temperatures. To measure the impact of non-optimal temperatures, researchers developed lageffect models used for time series analyses, since health outcomes onset may not occur on the same day. Pooled relative risks estimates from epidemiology studies, satellite-derived and ground monitors of temperatures, and exposure-response curves are then used as input parameters to calculate the disease burden for the general population. If estimates are correct, exposure to non-optimal temperatures is currently one of China’s highest causes of death. In the July 2022 issue of The Lancet Regional Health – Western Pacific, research on mortality burdens due to temperature estimated 593·9 thousand excess deaths that were attributable to non-optimal temperatures in a single year in China in 2019 (death rate 41.8 per 100,000). High temperature contributes to 13.9 thousand deaths (1.0 per 100,000) and low temperature contributes to a staggering 580.8 thousand deaths (40.8 per 100,000). Like all insults to the body, those with existing non-communicable diseases tend to be the most vulnerable. Geographically, Tibet has the highest cold-spell deaths, and Hainan has the highest heat-wave deaths.

Many more extreme temperature events are bound to occur in the future, with even more aberrant timing of onset and duration due to changing climate patterns. In addition to the effects on health (heat stroke and mortality), the immediate impacts will be peak electricity overload on the grid system due to greater energy demand, evapotranspiration, crop droughts, and altering of biodiversity and ecological balance.

China has one of the fastest urbanization rates, and further metropolis integration of megacities is underway, such as Beijing-Tianjin-Hebei, Yangtze River Delta (Anhui, Jiangsu, Shanghai, Zhejiang), and Pearl River Delta (Guangdong, Hong Kong, Macau). Nearly half a billion people live and work in these clusters. The sprawl of concrete in cities to make room for more human settlement erected a man-made built environment with impervious surfaces through the peri-urbanization process. This has inadvertently generated the urban heat island effect, marked by heightened air, and ground temperatures. Urban density is not entirely undesirable, however, as it could have efficiency gains through higher productivity and reduction in energy use as economic co-benefits. Thus, could cities have an advantage in climate change adaptation, and what more can be done? The 2021 report of the Lancet Countdown on health and climate change keeps track of several indicators for adaptation delivery and implementation: emergency preparedness, air conditioning, and urban greenspace.

With carbon neutrality targets set, policymakers in China submitted renewed its nationally determined contribution (NDC) to the United Nations Paris Agreement and laid out plans for proactive adaptation through climate-resilient city pilot in 28 locations.

Progress and successes are still up in the air; however, changes are underway with international cooperation on early warning and preparedness for climate disasters, conservation and rerouting of water resources, increased forestry for carbon sink with health co-benefits for cooling, and infrastructure projects to protect coastlines. While we await global cooperation on climate change targets, individuals and local communities should also make our own adaptation plans, and be ready for the next heat- and cold-wave shocks.

Improving Health Preparedness for Extreme Heat Events in South Asia

In response to the recognized high risks and potential impacts of extreme heat in South Asia, the 1st South Asia Climate Services Forum for Health focused on heat health and brought together over 25 experts in public health, climate and meteorology to discuss the needs and opportunities for multi-sectoral collaboration to better understand and address these health risks in the region.

This meeting contributes a regional perspective to a global discussion on the state of the science and practice in heat health action. Under the leadership of the US-NOAA and German Deutscher Wetterdienst (DWD), a global coalition of meteorological experts and health practitioners came together in Chicago in July 2015 to consider three issues. First, to identify knowledge gaps in our understanding of heat exposure and health outcomes across different timescales and geographies; along with the observations, monitoring, data, and forecast product needs. Secondly, to synthesize existing heat health forecasting systems being used around the world and to consider if their prediction parameters correspond to health sector requirements for preparedness. Thirdly, to identify specific partnerships, dialogues or processes needed to improve existing heat health early warning systems and develop heat related climate services for the public health sector to improve community resilience. The need for support and action in South Asia was highlighted at this meeting, and the CSFHealth dialogue and recommendations will feed back into the global effort to increase capacity and action in this region.

Myanmar National Adaptation Programme of Action (NAPA) to Climate Change

Myanmar’s climate is changing and climate variability already affects communities and socioeconomic sectors in the country. Some climate change impacts are already observable and there is broad scientific consensus that further change will occur. Even with significant global climate mitigation (activities and technologies that reduce greenhouse gas emissions), economic sectors, local communities and natural ecosystems in Myanmar will be strongly affected by climate change as a result of the emissions already in the atmosphere. Adaptation is therefore necessary for reducing Myanmar‟s vulnerability to climate variability and change.

National Adaptation Programmes of Action (NAPAs) serve as simplified, rapid and direct channels for Least Developed Countries to identify and communicate priority activities to address their urgent and immediate adaptation needs. NAPAs emerged from the multilateral discussions on adaptation measures within the UN Framework Convention on Climate Change (UNFCCC)1,2.

Myanmar;s NAPA therefore specifies 32 priority activities (referred to as Priority Adaptation Projects) for effective climate change adaptation for eight main sectors/themes (i.e. four Project Options per sector/theme), namely: i) Agriculture; ii) Early Warning Systems; iii) Forest; iv) Public Health; v) Water Resources; vi) Coastal Zone; vii) Energy, and Industry; and viii) Biodiversity(Table 1).


Singapore Climate Action Plan: Take Action Today, for a Climate-Efficient Singapore

The Climate Action Plan lays down strategies and targets to meet the pledge to reduce GHG emissions intensity by 36% by 2030 (compared to 2005), peak emissions around 2030, and ensure future resilience of Singapore.

The Climate Action Plan consists of two key documents. The first, ‘Take Action Today: For A Carbon-efficient Singapore’ lays down the key strategies that Singapore will need to take to reduce GHG emissions to fulfil the emissions reduction pledge it made in support of the Paris Agreement.

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Mumbai city, home to over 12 million people and thriving on a diverse economy, is increasingly at risk of the impacts of climate change. Increasing temperatures, depleting natural green cover, routine bouts of extreme rainfall events resulting in severe flood conditions incur severe losses to the city’s economy and its people. Recent increase in tropical cyclones along the coast and future risks from sea level rise projected over the next 3 decades pose critical challenges to Mumbai’s future. In this context, the Brihanmumbai Municipal Corporation have led the process to drafting the first ever, Mumbai Climate Action Plan ( MCAP).

The MCAP envisions a city where its communities and citizens are safer, healthier, and thrive even in the context of a changing and uncertain climate. The MCAP is committed to a net zero and climate-resilient Mumbai by 2050. This means ensuring just transitions – towards net zero pathways; big investments – towards inclusive and transformative climate solutions; and coordinated and robust governance – to ensure a targets-based approach. BMC acknowledges that the climate crisis is already affecting us all, although in varying ways, and the time for action is now to secure a better future for all by 2050.

University of Waterloo Indoor Temperature Study

Heatwaves in Canada are becoming more intense and lasting for longer periods. Heat waves can pose a serious risk to the wellbeing of many Canadians. Developing robust localized heat health warning systems are important to prevent heat-related illnesses, provide heat-relief programs, guide policy and municipal planning, and may help to prevent deaths from extreme heat.

This study will use thermostats to collect indoor temperature to see if indoor temperatures are higher than outdoor temperatures. The study will take place from May 1, 2022 to September 30, 2022.

Health checks during extreme heat events

Extreme heat events affect different people in different ways, and some people are at higher risk of experiencing heat-related illness if they do not have air conditioning. One way to reduce the public health impacts of extreme heat events is to check in regularly with susceptible people to see how they are coping. However, not everyone knows who is at most risk, how to recognize heat-related illness, or what to do in risky situations. This tool from the NCCEH was designed to help support people doing heat checks by providing all they key information and guidance in a 5-page package. This tool has been co-developed with Dr. Glen Kenny and his heat stress research group at the University of Ottawa.

Ambient temperature and term birthweight in Latin American cities


Extreme temperatures may lead to adverse pregnancy and birth outcomes, including low birthweight. Studies on the impact of temperature on birthweight have been inconclusive due to methodological challenges related to operationalizing temperature exposure, the definitions of exposure windows, accounting for gestational age, and a limited geographic scope.


We combined data on individual-level term live births (N≈15 million births) from urban areas in Brazil, Chile, and Mexico from 2010 to 2015 from the SALURBAL study (Urban Health in Latin America) with high-resolution daily air temperature data and computed average ambient temperature for every month of gestation for each newborn. Associations between full-term birthweight and average temperature during gestation were analyzed using multi-level distributed lag non-linear models that adjusted for newborn’s sex, season of conception, and calendar year of child’s birth; controlled for maternal age, education, partnership status, presence of previous births, and climate zone; and included a random term for the sub-city of mother’s residence.


Higher temperatures during the entire gestation are associated with lower birthweight, particularly in Mexico and Brazil. The cumulative effect of temperature on birthweight is mostly driven by exposure to higher temperatures during months 7–9 of gestation. Higher maternal education can attenuate the temperature-birthweight associations.


Our work shows that climate-health impacts are likely to be context- and place-specific and warrants research on temperature and birthweight in diverse climates to adequately anticipate global climate change. Given the high societal cost of suboptimal birthweight, public health efforts should be aimed at diminishing the detrimental effect of higher temperatures on birthweight.

How Climate Change May Threaten Progress in Neonatal Health in the African Region

Climate change is likely to have wide-ranging impacts on maternal and neonatal health in Africa. Populations in low-resource settings already experience adverse impacts from weather extremes, a high burden of disease from environmental exposures, and limited access to high-quality clinical care. Climate change is already increasing local temperatures. Neonates are at high risk of heat stress and dehydration due to their unique metabolism, physiology, growth, and developmental characteristics. Infants in low-income settings may have little protection against extreme heat due to housing design and limited access to affordable space cooling. Climate change may increase risks to neonatal health from weather disasters, decreasing food security, and facilitating infectious disease transmission. Effective interventions to reduce risks from the heat include health education on heat risks for mothers, caregivers, and clinicians; nature-based solutions to reduce urban heat islands; space cooling in health facilities; and equitable improvements in housing quality and food systems. Reductions in greenhouse gas emissions are essential to reduce the long-term impacts of climate change that will further undermine global health strategies to reduce neonatal mortality.

Heat stress in the Caribbean: Climatology, drivers, and trends of human biometeorology indices

Forty years (1980–2019) of reanalysis data were used to investigate climatology and trends of heat stress in the Caribbean region. Represented via the Universal Thermal Climate Index (UTCI), a multivariate thermophysiological-relevant parameter, the highest heat stress is found to be most frequent and geographically widespread during the rainy season (August, September, and October). UTCI trends indicate an increase of more than 0.2°C·decade−1, with southern Florida and the Lesser Antilles witnessing the greatest upward rates (0.45°C·decade−1). Correlations with climate variables known to induce heat stress reveal that the increase in heat stress is driven by increases in air temperature and radiation, and decreases in wind speed. Conditions of heat danger, as depicted by the heat index (HI), have intensified since 1980 (+1.2°C) and are found to occur simultaneously to conditions of heat stress suggesting a synergy between heat illnesses and physiological responses to heat. This work also includes the analysis of the record-breaking 2020 heat season during which the UTCI and HI achieved above average values, indicating that local populations most likely experienced heat stress and danger higher than the ones they are used to. These findings confirm the gradual intensification of heat stress in the Caribbean and aim to provide a guidance for heat-related policies in the region.

Stakeholder perspectives on extreme hot and cold weather alerts in England and the proposed move towards an impact-based approach

Extreme weather alerting systems are one of the central tools utilised in adapting to changing weather patterns resulting from climate change. This paper evaluates the effectiveness of the current alerting systems for hot and cold weather used in England to notify the health and social care sector of upcoming extreme weather events. We consider the views of stakeholders on the current system and explore their perspectives on the proposal to move towards an impact-based system. The paper concludes that while the current system is an effective tool, stakeholders feel they need to draw on additional material to assist with the development of an appropriate response. We also highlight that many stakeholders are concerned about the potential for creating alert fatigue due to a lack of clarity of the geographical area impact of some of the alerts. Consequently, there was a high level of support from stakeholders for the move towards an impact-focused system.

España: Plan nacional de actuaciones preventivas de los efectos del exceso de temperaturas sobre la salud

Durante los meses de verano del año 2003 se produjeron temperaturas muy elevadas en toda
Europa que provocaron un importante aumento de la morbilidad y, como posteriormente se ha
comprobado, de la mortalidad por causas en las que el factor de exceso de temperatura fue un
desencadenante. A fin de evitar episodios como los ocurridos durante ese verano, en el año 2004
el Ministerio de Sanidad puso en marcha el Plan Nacional de Actuaciones Preventivas de los
Efectos de los Excesos de Temperaturas Sobre la Salud. Desde entonces, el Plan se activa cada
verano durante los meses de junio a septiembre.
La aplicación del Plan está cumpliendo su principal objetivo: la prevención de daños a la salud
provocados por el exceso de temperatura. Desde un enfoque sanitario, la exposición a
temperaturas excesivas afecta especialmente a los menores, a las personas mayores y a las
personas con patologías crónicas de base. Desde un punto de vista social, la marginación, el
aislamiento, la dependencia, la discapacidad, las condiciones de habitabilidad de las personas
con menos recursos, añaden factores de riesgo que hacen aún más vulnerables a colectivos que,
precisamente por sus condiciones socio-económicas, deberían estar más apoyados.
El Plan establece las medidas para reducir los efectos asociados a las temperaturas excesivas y
para coordinar las instituciones de la Administración del Estado implicadas. Así mismo propone
acciones que puedan ser realizadas por las Comunidades Autónomas y la Administración Local.
El Plan establece las acciones previstas para la prevención y control, estructuradas en varios
niveles de actuación según el nivel de riesgo alcanzado como consecuencia del incremento de las

Estratégia de Adaptação às Mudanças Climáticas da Cidade do Rio de Janeiro

Este documento fornece subsídios para a elaboração do Plano de Adaptação da CRJ, peloqual de vem ser estabelecidos caminhos para a adaptação que tenham, por objetivo, assegurar a proteção do patrimônio natural e construído e preservar as relações econômicas e socioculturais face às mudanças do clima, em prol da atual e futuras gerações.

Estratégia de Adaptação está fundamentada em seis Eixos Estratégicos:
A. Fortalecer a capacidade institucional e humana;
B. Garantir a conservação e integridade dos ecossistemas e o uso racional e sustentável dos recursos naturais;
C. Fomentar a promoção da saúde da população
frente às mudanças climáticas;
D. Conduzir a ocupação e uso do território de forma a promover a qualidade urbano-ambiental;
E. Garantir a mobilidade urbana eficiente e
sustentável; e
F. Garantir o funcionamento das Infraestruturas
Estratégicas sob condições climáticas adversas.

Protecting Californians From Extreme Heat: A State Action Plan to Build Community Resilience

Actions in the plan are organized into four tracks –

(A) Build Public Awareness and Notification;

(B) Strengthen Community Services and Response;

(C) Increase Resilience of Our Built Environment; and

(D) Utilize Nature-Based Solutions.

These tracks include established and recommended state actions to address extreme heat. The Administration is committed to continued scoping and exploration of these actions. Areas of near-term focus include:

  • Implement a statewide public health monitoring system to identify heat illness events early, monitor trends, and track illnesses to intervene and prevent further harm.
  • Accelerate readiness and protection of communities most impacted by extreme heat, including through cooling schools and homes, supporting
    community resilience centers, and expanding nature-based solutions.
  • Protect vulnerable populations through codes, standards, and regulations.
  • Expand economic opportunity and build a climate smart workforce that can operate under and address extreme heat.
  • Increase public awareness to reduce risks posed by extreme heat.
  • Protect natural and working lands, ecosystems, and biodiversity from the impacts of extreme heat.

Identification of Heat Threshold and Heat Hotspots in Rajshahi, Bangladesh

This report aims to support the Rajshahi Metropolitan City and other emergency service providers in Rajshahi, such as the Disaster Management Department, the Rajshahi branch of Bangladesh Red Crescent Society (BDRCS), the unit responsible for determining the heat thresholds and hotspots indicating when and where to act before or during heatwave days. Moreover, the report intends to encourage city stakeholders to take fruitful actions in upcoming heat seasons to reduce the city’s heat risks and build stakeholder’s capacity on city heat actions.

South Africa National Heat Health Action Guidelines

Guide to extreme heat planning in South Africa for the human health sector: A package of practical, feasible, and low-cost interventions at the individual and community level can assist people to adapt to high temperatures. The health sector is the lead agency on the Heat Health Action Plan, responsible for coordinating across other departments and stakeholders, including those outside of government. The Heat Health Information Plan needs to deliver useful, timely, accessible, consistent and trustworthy information to their target audience, with a focus on vulnerable populations.

Multi-scale modeling overheating risk during heatwaves in Sri Lanka (COSMA)

COSMA is a multidisciplinary study that will bring together a group of experts in urban meteorology, building environmental engineering, architecture, urban planning and social science, to work with local stakeholders to understand the overheating risk in the urban area of Colombo. This project is funded by NERC (Natural Environment Research Council) in the UK.

At the heart of the project are the studies of:

  • how the heatwave overheating risk prediction and assessment could be improved at finer urban and building scales
  • the useful indigenous design knowledge in Sri Lanka for heatwaves mitigtion, and
  • how the designs could be regenerated and re-incorporated into the heatwave action plan and future design practice

COSMA aims to develop an integrated modelling approach by taking into account the urban heat island, building characteristics and vulnerable population to build effective early-warning systems and a city-scale heat action plan. The final outputs of the project will be a series of hierarchical overheating risk and mitigation potential maps across different scales for Colombo, Sri Lanka.

COSMA is a multidisciplinary study that will bring together a group of experts in urban meteorology, building environmental engineering, architecture, urban planning and social science, to work with local stakeholders to deliver SHEAR programme objectives. By working closely with the local community, government and professionals, one important goal of COSMA project is to harvest and regenerate traditional design knowledge (both building and urban scales) from indigenous craftsmen embedded within local culture and traditions, and feed into the heat-exposure risk mitigation plan.

COSMA, led by the University of Reading (UoR), involves collaborations with Glasgow Caledonian University (GCU), and carried out in partnership with a group of well-established Sri Lankan partners: the Department of Meteorology (DoM) and the Institute of Town Planners Sri Lanka(ITPSL) as well as researchers at University of Moratuwa (UoM).

Identification of Heat Threshold and Heat Hotspots IN Nepalgunj, Nepal

This report aims to support the Nepalgunj Upamahannagar Palika (Sub-Metropolitan City) and other emergency service providers in Nepalgunj, such as the disaster management department and the Banke branch of Nepal Red Cross Society (NRCS), the unit responsible for determining the heat thresholds and heat hotspots, indicating when and where to act before or during heatwave days. Moreover, the report intends to encourage city stakeholders to take fruitful actions in the upcoming heat seasons
to reduce the city’s heat risks and build stakeholder’s capacity on city heat actions.

Reducing Heat Impacts in Nepalgunj City, Nepal

This policy brief was produced to share insights on how the Nepalgunj City in Nepal could improve its preparedness for extreme heat through existing and new policies and plans. It provides a summary of existing policy frameworks that may be used to address heat; highlights potential gaps and makes recommendations for how heat can be better integrated into policies and plans on both short-term (days to months) and long-term (5+ years) timescales. It is based on desk-based research and key stakeholder interviews with city, disaster management, and health officials in Nepalgunj City.

Review of Heat Action Plans in India and South Asia

This review report details the available Heat Action Plans (HAPs) in South Asia, especially India. It is a qualitative review that identifies the key strategies introduced in the Heat Action Plans from the different states and cities within India. It also highlights the need for a Climate Adaptive HAP which can increase the impact and efficiency of the adaptation and mitigation efforts.

Heatwaves and Public Health in Turkey

This report’s objective is to define and divulgate the knowledge about heat stress and health consequences in general for the Turkish population. The Environment, Climate and Health Cooperation Project (ÇİSİP in Turkish) was launched by the Health and Environment Alliance (HEAL), HASUDER (Association of Public Health Professionals-Turkey) and Kocaeli University Department of Public Health in April 2020. Funded by the European Union, CISIP’s aim is to bring together all environmental health actors in Turkey and to support health professionals in the fields of environmental and climate policies.

PDMA Khyber Pakhtunkhwa Heat Wave Action Plan 2022

This document lays out an action plan for managing heatwaves in Khyber Pakhtunkhwa, Pakistan, which has been facing the brunt of climate change hazards because of its unique topography. Being home to extreme cold and hot weather, significant losses have been incurred which can be linked to climate-change-related disasters i.e. floods, glacial melting, drought, and heat waves.

The plan includes:

  • situation analysis
  • heat index
  • background to heat waves in Khyber Pakhtunkhwa
  • heatwave early warning & coordination
  • heat wave declaration
  • heat wave surveillance & coordination
  • roles and responsibilities

Wet-Bulb Globe Temperature, Universal Thermal Climate Index, and Other Heat Metrics for US Counties, 2000–2020

Epidemiologic research on extreme heat consistently finds significant impacts on human morbidity and mortality. However, most of these analyses do not use spatially explicit measures of heat (typically assessing exposures at major cities using the nearest weather station), and they frequently consider only ambient temperature or heat index. The field is moving toward more expansive analyses that use spatially resolved gridded meteorological datasets and alternative assessments of heat, such as wet-bulb globe temperature (WBGT) and universal thermal climate index (UTCI), both of which require technical geoscientific skills that may be inaccessible to many public health researchers. To facilitate research in this domain, we created a database of population-weighted, spatially explicit daily heat metrics – including WBGT, UTCI, heat index, dewpoint temperature, net effective temperature, and humidex – for counties in the conterminous United States derived from the ERA5-Land gridded data set and using previously validated equations and algorithms. We also provide an R package to calculate these metrics, including gold-standard algorithms for estimating WBGT and UTCI, to facilitate replication.

Indoor heat measurement data from low-income households in rural and urban South Asia

Rising temperatures are causing distress across the world, and for those most vulnerable, it is a silent killer. Information about indoor air temperature in residential dwellings is of interest for a range of reasons, such as health, thermal comfort and coping practices. However, there have been only few studies that measure indoor heat exposure, and contrast these to outdoor temperatures in rural-urban areas, of which none are in South Asia. We aim to close this knowledge gap with our indoor and outdoor heat measurement dataset, covering five low-income sites in South Asia. Two sites are in rural areas (Maharashtra, India), while three sites focus on urban areas (Dhaka, Delhi and Faisalabad). Data are based on 206 indoor temperature data loggers and complemented by data from five outdoor automated weather stations. The data-set can be used to examine temperature and humidity variation in low-socioeconomic status households in rural and urban areas and to better understand factors aggravating heat stress. This is important to plan and implement actions for combating heat stress.

Improving the passive survivability of residential buildings during extreme heat events in the Pacific Northwest

Extreme heat events are becoming more frequent and more severe in the Pacific Northwest and in comparable dry-summer climates worldwide, increasing the occurrence of heat-related illness and death. Much of this risk is attributed to overheating in multifamily dwellings, particularly in neighborhoods with abundant asphalt, few trees, and limited financial resources. Air-conditioning expansion is problematic, however, because it creates vulnerability to operational costs and power outages, while expelled hot air intensifies urban heat island effects. In contrast, passive cooling strategies that deflect solar radiation and recruit the cool night air typical of Mediterranean, semi-arid, and arid climates are quite promising, but their abilities to improve residential survivability during extreme heat have not yet been explored. To understand this potential, here we investigate the extent to which well-controlled shading and natural ventilation, in some cases with fan assistance, could have diminished the hours in which indoor heat index levels exceeded ‘caution’, ‘extreme caution’, ‘danger’, and ‘extreme danger’ thresholds during the June 2021 heat wave in the Pacific Northwest; building thermal performance was simulated in EnergyPlus under conditions experienced by Vancouver BC, Seattle WA, Spokane WA, Portland OR, and Eugene OR. Strikingly, we find that in Portland, where the highest temperatures occurred, integrated shading and natural ventilation eliminated all hours above the danger threshold during the 3-day event, lowering peak indoor air temperatures by approximately 14 °C (25 °F); without cooling, all 72h exceeded this threshold. During the encompassing 10-day period, these passive measures provided 130–150h of thermal relief; baseline conditions without cooling provided none. Additionally, passive cooling reduced active cooling loads by up to 80%. Together, these results show the immediate, substantial value of requiring effective operable shading and secure operable windows in apartments in mild dry-summer climates with rising heatwave intensity, as well as public health messaging to support the productive operation of these elements.

Using laboratory experiment to inform local adaptation policies for extreme heat events

Issuing early heat warnings and enhancing public climate change awareness and engagement are important local policy options for heat wave adaptation. Here, we used a laboratory experiment to inform major gaps in making these two policies, including setting proper thresholds for heat alerting systems and figuring out how heat experience shifts individuals’ climate change perceptions. Taking Nanjing as a case city, we simulated a heat event by increasing temperature from 25 °C to 40 °C (70% relative humidity) in a climate chamber and recruited 58 young adults as participants. Physical thermal responses, including skin temperature and heart rate variability, were recorded using portable devices. Subjective thermal perceptions, climate change belief and psychological distance were measured by self-rated scales before, during, and after the exposure. We found physiological responses were correlated with subjective thermal perceptions and showed sharp rises from 30° to 35°C, presenting aggravated thermal discomfort. Moreover, heat exposure increased climate change belief and reduced psychological distance significantly. After the experiment, follow-up surveys showed participants had a short memory of the heat exposure, but daily temperature variations still predicted climate change belief. The findings suggest in our case city, the current threshold (35 °C) for heat warnings may not be safe enough. Local authorities should consider prolonged periods of hot weather with temperature between 30 and 35 °C. Due to strong links between heat experience and climate change perceptions, we encourage to take this “window of opportunity” when heat events occur to communicate climate risks and enact post-event policy changes.

How are cities planning for heat? Analysis of United States municipal plans

Heat has become a central concern for cities everywhere, but heat governance has historically lagged behind other climate change hazards. This study examines 175 municipal plans from the 50 most populous cities in the United States to understand which aspects of urban heat are included or not in city plans and what factors explain inclusion. We find that a majority of plans mention heat, but few include strategies to address it and even fewer cite sources of information. The term ‘extreme heat event’ (EHE) is significantly more likely to be paired with institutional actions as a part of hazard planning, while ‘urban heat island’ (UHI) is more likely to be paired with green and grey infrastructure interventions as a part of general planning. Disparity and thermal comfort framings are not significantly related to any solutions and are used least. Plan type, followed by environmental networks (e.g. C40, Urban Sustainability Directors Network, Rockefeller 100 Resilient Cities), explain variation in plan content; social and environmental context do not. Findings point to the emergence of two independent heat governance systems, EHE and UHI, and several gaps in heat planning: integration, specificity, solutions, disparity, economy, and thermal comfort.

Community-engaged heat resilience planning: Lessons from a youth smart city STEM program

While recognition of the dangers of extreme heat in cities continues to grow, heat resilience remains a relatively new area of urban planning. One barrier to the creation and successful implementation of neighborhood-scale heat resilience plans has been a lack of reliable strategies for resident engagement. In this research, the authors designed a two-week summer STEM module for youth ages 12 to 14 in Roanoke, Virginia in the Southeastern United States. Participants collected and analyzed temperature and thermal comfort data of varying types, including from infrared thermal cameras and point sensors, handheld weather sensors, drones, and satellites, vehicle traverses, and student peer interviews. Based on primary data gathered during the program, we offer insights that may assist planners seeking to engage residents in neighborhood-scale heat resilience planning efforts. These lessons include recognizing: (1) the problem of heat in neighborhoods and the social justice aspects of heat distribution may not be immediately apparent to residents; (2) a need to shift perceived responsibility of heat exposure from the personal and home-based to include the social and landscape-based; (3) the inextricability of solutions for thermal comfort from general issues of safety and comfort in neighborhoods; and (4) that smart city technologies and high resolution data are helpful “hooks” to engagement, but may be insufficient for shifting perception of heat as something that can be mitigated through decisions about the built environment.

Extreme Heat Exposure: Access and Barriers to Cooling Centres - Maricopa and Yuma Countries, Arizona, 2010-2020

What is already known about this topic?

Exposure to excessive heat is an increasing threat in a warming climate. Some groups, including older adults, are disproportionately affected by heat exposure.

What is added by this report?

Heat exposure and heat-related illness (HRI) increased in Maricopa and Yuma counties, Arizona, during 2010–2020. Heat-related hospitalizations were higher among adults aged ≥65 years than those aged <65 years. Barriers to cooling center access among older adults include awareness of location and transportation.

What are the implications for public health practice?

States and communities can implement adaptation and evaluation strategies to mitigate and assess heat risk, such as the use of cooling centers to protect communities disproportionately affected by HRI during periods of high temperatures.

Heat exposure and child nutrition: Evidence from West Africa

Extreme heat shocks are increasingly linked to poor economic and health outcomes. This paper constructs hour-degree bins of temperature exposure to assess the effects of extreme heat on early child nutrition, a health outcome correlated with educational attainment and income in adulthood. Linking 15 rounds of repeated cross-section data from five West African countries to geo-coded weather data, we find that extreme heat exposure increases the prevalence of both chronic and acute malnutrition. We find that a 2 °C rise in temperature will increase the prevalence of stunting by 7.4 percentage points, reversing the progress made on improving nutrition during our study period.

Temporal changes of heat-attributable mortality in Prague, Czech Republic, over 1982–2019

While previous research on historical changes in heat-related mortality observed decreasing trends over the recent decades, future projections suggest increasing impact of heat on mortality in most regions of the world. This study aimed to analyse temporal changes in temperature-mortality relationships in Prague, Czech Republic in the warm season (May–September), using a daily mortality time series from 1982 to 2019. To investigate possible effect of adaptation to increasing temperature, we divided the study period into four decades (1980s–2010s). We used conditional Poisson regression models to identify decade-specific relative risk of heat-related mortality and to calculate the annual number of heat-attributable deaths and the heat-attributable fraction of total warm season deaths. We estimated their trends over the whole study period by a generalized additive model with non-parametric smoothing spline. Our results showed that the unprecedentedly hot 2010s was associated with approximately twice as large relative risk of heat-related mortality than in previous decades. This resulted in the reversal of the trend in heat-attributable mortality in the 1990s and its increase during the last two decades. Our findings highlight the importance of further improvement of adaptation measures such as heat-and-health warning systems to protect the heat-susceptible population.

Heat Action Platform

The Heat Action Platform is a living, engagement-oriented tool for city officials, practitioners, and financial institutions to find guidance, both existing resources and tailor-made solutions, on reducing the human and economic impacts of extreme heat at the regional or municipal level. The platform offers opportunities to engage with world-leading experts across a diversity of disciplines to plan, fund, implement, and measure heat resilience actions.

The platform was developed by the Adrienne Arsht-Rockefeller Foundation Resilience Center and the Extreme Heat Resilience Alliance in collaboration with the UN Environment Programme, the Cool Coalition, RMI, the Global Covenant of Mayors for Climate and Energy, Mission Innovation and the World Economic Forum’s Global Commission on BiodiverCities by 2030.

The platform can support you to:

  1. Develop a heat action plan or similar planning/goal-setting initiative;
  2. Create an individual project or policy intervention with heat-risk reduction and preparedness goals;
  3. Embed heat-risk reduction and preparedness strategies into another plan; or
  4. Make the case for investments in community heat resilience.

Effect of Temperature on Gender-Specific All-Cause Mortality: A Study of the City in Northern India

Background: The populations of developing nations are more vulnerable to high heat due to poor public health infrastructure and their sensitiveness towards changing climate. Excess mortalities caused by high temperatures have been reported from many parts of the world, including India. In the recent future, more warming and frequent hot days during summer are expected.

Methods: An analysis was carried out to study the effect of maximum temperature (Tmax) on gender-specific all-cause mortality during the summer months (May and June) of 2011 to 2015 in Chandigarh city of India. The mortality is calculated at different thresholds of temperatures of ≤35°C, ≤38°C, <40°C, ≥40°C and ≥42°C. The average number of deaths at temperatures <40°C and ≥40°C were calculated at 99% significance. The Welch t-test is applied to test the significance.

Results: Tmax shows a high degree of association with all-cause mortality in both males and females. Male to female all-cause death ratio was found to be 1.67 for the study period. Daily Tmax of 40°C was found to be the point of inflexion as the number of mortalities at Tmax ≥40°C was significantly higher than those at Tmax below 40°C. The analysis also reveals an increase in the number of death among females at the threshold Tmax ≥40°C indicating higher vulnerability of females at higher temperatures of certain threshold.

Conclusion: A temperature of 40°C should be considered a threshold temperature for issuing heatwave alerts for Chandigarh, India. The increase in vulnerability at temperatures ≥40°C was more among the females

Seasonal forecast of the percentage of days with extreme temperatures in central-northern Argentina: An operational statistical approach

Several socio-economic sectors are sensitive to the occurrence of extreme climate events. The ability to predict these extremes will allow precautionary measures to reduce their impacts. This work aims to disseminate a seasonal statistical forecast of daily temperature extremes in Argentina to the international scientific community. At the local level, this forecast is shared at monthly meetings organized by the Argentine National Meteorological Service and attended by different users. For the temperature extremes modeling, several predictors and statistical techniques were applied. We estimated the probability of each tercile category (above-normal, near-normal, and below-normal) by quantifying the percentage of models that predict each of them. The forecasts were verified by calculating different metrics. In general, we observed that the forecast system has less skill to discriminate the near-normal category in all seasons, and the other categories present a skill highly variable according to the season, region, and extreme index. The verification process revealed that predictability increases for all extreme indices with a previous La Niña phase. This product represents an advance towards an operational seasonal forecast of extreme temperatures in Argentina because it offers predictions based on a detailed study of predictors in the region, the incorporation of multiple statistical methodologies, and the predicted variables are not the most typical ones offered by forecasting centers. Finally, it is highlighted that the accuracy rate obtained with this product exceeds a forecast based on climatology, i.e., despite the uncertainties, our forecasts provide additional information to users for decision making.

Planning for Urban Heat Resilience

Heat is the number one weather-related killer in the United States. As average global temperatures continue to rise, the threats of both extreme heat events and chronic heat are projected to increase.

Heat disproportionately affects marginalized residents and those who face systematic inequities such as workplace safety, housing quality, energy affordability, transportation reliability, and healthcare access. But planning can shape heat risk. Planners will be key practitioners in helping their communities achieve greater heat resiliency by proactively managing and mitigating heat across the many systems and sectors it affects.

PAS Report 600 provides holistic guidance to help practitioners increase urban heat resilience equitably in the communities they serve. It provides an in-depth overview of the contributors to urban heat and equity implications, and it lays out an urban heat resilience framework and collection of strategies to help planners mitigate and manage heat across a variety of plans, policies, and actions.

Now is the time for the planning profession to step up and take a leading role in coordinating communities’ efforts to proactively build urban heat resilience. This PAS Report equips planners with the background knowledge, planning framework, and catalog of comprehensive approaches they need to advance urban heat resilience and create a more equitable and sustainable future in an increasingly urban and warming world.

This report is available free to all. This project was supported by financial assistance provided by the National Oceanic and Atmospheric Administration’s Extreme Heat Risk Initiative.

Designed to Fail? Heat Governance in Urban South Asia: The case of Karachi, a scoping study

This scoping study draws on a review of key policy documents, plans, grey, academic, and scientific literature to outline the role of state and non-state actors in Karachi’s heat governance. It emphasizes the need to understand heat, microclimates, urban planning, infrastructural inequities, and vulnerability in a relational context. It also presents original climate data analysis for the last 60 years in Karachi, to quantify the rapid temperature change in the city: findings that underscore why it is important now, more than ever, to talk about heat in the context of an unequal city.

Influence of temperature on mortality in the French overseas regions: a pledge for adaptation to heat in tropical marine climates

Context: Tropical areas and small islands are identified as highly vulnerable to climate change, and already experiencing shifts in their temperature distribution. However, the knowledge on the health impacts of temperatures under tropical marine climate is limited. We explored the influence of temperature on mortality in four French overseas regions located in French Guiana, French West Indies, and in the Indian Ocean, between 2000 and 2015.

Method: Distributed lag non-linear generalized models linking temperature and mortality were developed in each area, and relative risks were combined through a meta-analysis. Models were used to estimate the fraction of mortality attributable to non-optimal temperatures. The role of humidity was also investigated.

Results: An increased risk of mortality was observed when the temperature deviated from median. Results were not modified when introducing humidity. Between 2000 and 2015, 979 deaths [confidence interval (CI) 95% 531:1359] were attributable to temperatures higher than the 90th percentile of the temperature distribution, and 442 [CI 95% 178:667] to temperature lower than the 10th percentile.

Discussion: Heat already has a large impact on mortality in the French overseas regions. Results suggest that adaptation to heat is relevant under tropical marine climate.

Linking science and practice in participatory future-oriented assessment and planning of human heat stress vulnerability in Bonn, Germany

The juxtaposition of climate change and development changes is vital for understanding the future impacts of heat stress in urban areas. However, an approach that considers the relationship between climatic factors and socio-economic vulnerability in a forward-looking and stakeholder-involved manner is challenging. This article demonstrates the application of a future-oriented vulnerability scenarios approach to address human heat stress in Bonn, Germany, in 2035. The study highlights the interplays between climate trajectories and heat exposure associated with urban development scenario corridors. Moreover, this method allows for changing combinations of intersections and conditionalities of projected individual socio-economic vulnerability indicators in response to social and climate governance. However, this study found that a conventional structure within city departments might limit this integrative approach in practice. Thus, the theoretical background and the concept of alternative futures and uncertainties should be the focus of communication with practitioners to maximize the utilization of the results.

Heart rate increase from rest as an early sign of heat-related illness risk in construction workers

Heat-related illness (HRI) is a common occupational injury, especially among workers in the construction industry. Methods need to be developed to predict and minimize HRI risk. The objective of this study was to investigate whether differences in heart rate (HR) can be used to predict HRI risk. We surveyed construction workers during the period from May 1 to October 30, 2020. The physiological data of 79 workers were recorded during their working hours for a period of 3163 person-time. The resting HR was defined as the lowest reading taken within the first hour of wearing the sensor, and HRI risk was determined using the following formula: 180 – (0.65 × age). The rate of increase in HR from rest was calculated using the following formula: (maximum HR – resting HR)/resting HR. On these 3163 person-time, HRI risk was observed at 368 person-time (11.6%). After analyzing the receiver operating characteristics curve, the cut-off value was 132.9%, with a sensitivity of 75.5% and specificity of 85.0%. Our results showed that the difference in HR from rest is a good indicator for predicting HRI risk. Furthermore, continuous physiological monitoring using a wearable sensor can aid in detecting early signs of HRI risk.


Non-linear response of temperature-related mortality risk to global warming in England and Wales

Climate change is expected to lead to changes in seasonal temperature-related mortality. However, this impact on health risk does not necessarily scale linearly with increasing temperature. By examining changes in risk relative to degrees of global warming, we show that there is a delayed emergence of the increase in summer mean mortality risk in England and Wales. Due to the relatively mild summer mean temperatures under the current climate and the non-linearity of the exposure–response relationships, minimal changes in summer mean risk are expected at lower levels of warming and an escalation in risk is projected beyond 2.5 °C of global warming relative to pre-industrial levels. In contrast, a 42% increase in mortality risk during summer heat extremes is already expected by 2 °C global warming. Winter attributable mortalities, on the other hand, are projected to decrease largely linearly with global warming in England and Wales.

Increasing trees and high-albedo surfaces decreases heat impacts and mortality in Los Angeles, CA

There is a pressing need for strategies to prevent the heat-health impacts of climate change. Cooling urban areas through adding trees and vegetation and increasing solar reflectance of roofs and pavements with higher albedo surface materials are recommended strategies for mitigating the urban heat island. We quantified how various tree cover and albedo scenarios would impact heat-related mortality, temperature, humidity, and oppressive air masses in Los Angeles, California, and quantified the number of years that climate change–induced warming could be delayed in Los Angeles if interventions were implemented. Using synoptic climatology, we used meteorological data for historical summer heat waves, classifying days into discrete air mass types. We analyzed those data against historical mortality data to determine excess heat-related mortality. We then used the Weather Research and Forecasting model to explore the effects that tree cover and albedo scenarios would have, correlating the resultant meteorological data with standardized mortality data algorithms to quantify potential reductions in mortality. We found that roughly one in four lives currently lost during heat waves could be saved. We also found that climate change–induced warming could be delayed approximately 40–70 years under business-as-usual and moderate mitigation scenarios, respectively.

Improving Outdoor Thermal Comfort in a Steppe Climate: Effect of Water and Trees in an Urban Park

Excess heat in urban environments is an increasing threat to human health and well-being. Furthermore, the increasingly important phenomenon of the Urban Heat Island (UHI) is exacerbating problems of livability in urban centers. Hence, there should be an increasing effort to assess the impact of heat mitigation strategies (HMSs) on outdoor thermal comfort in cities. This research has investigated how urban areas in steppe climate zones can be more thermally comfortable due to the effects of water bodies and trees, and how this might help to mitigate heat waves. Numerical simulations using the ENVI-met microclimate model have been performed for an urban park in Tabriz, Iran. In-situ measurements of air temperature (Ta) and mean radiant temperature (MRT) have been carried out in the study site and the collected data was used to validate the model (RMSE value 0.98 °C for Ta and 5.85 °C for MRT). Results show that water body evaporation without trees may decrease the air temperature, but on the other hand also increases the humidity, which reduces the positive impact on thermal comfort. However, the combination of water body with trees represents a better performance in the regulation of urban microclimate and thermal comfort.

Heatwaves: Addressing a sweltering risk in Asia-Pacific

The last decade was the warmest on record, and leading organisations on climate change indicate that warmer temperatures are not a potential threat but a surety. This report considers ways in which disaster risk reduction (DRR), climate change adaptation (CCA), and related scientific communities can rise to data challenges in order to provide policymakers with the evidence needed to set priorities and make decisions. Given the sizeable threat posed by extreme heat events, the report details the human impacts of heat waves, ranging from individual and community health to the built environment.

The HEat and HEalth African Transdisciplinary Center (HE2AT Center)

The HE2AT Center aims to develop innovative solutions to mitigate the health impacts of climate change in Africa, including Early Warning Systems and monitoring systems. The Center also aims to build capacity on data science and climate change, and to be a resource for climate change initiatives across the continent.


Heat waves and rising temperatures have major, though underappreciated, health implications, particularly among vulnerable populations in low-income settings in Africa. Big data and data science methods can identify promising adaptation interventions and optimise programmes to reduce the impacts of climate change. The current Early Warning Systems in Africa function poorly and are not based on actual health outcome data. Moreover, there is limited knowledge on how to monitor the burden of climate change on health and the effectiveness of relevant health services.


The HE2AT Center is a U54 grant within the NIH Harnessing Data Science for Health Discovery and Innovation in Africa (DS-I Africa) programme. DS-I Africa is the NIH flagship programme of research in Africa, with USD 62,000,000 funding. The consortium consists of a trans-disciplinary group of academic and non-academic partners from three regions of Africa, and the United States. The study includes partners in South Africa, Côte d’Ivoire and Kenya, with a focus on activities in these countries. The Center includes two sub-projects. Firstly, a project to document the impacts of extreme heat on maternal and newborn health across Africa using existing data from research projects and routine health information systems. We will draw on data from all countries on the continent where data are available. These analyses will also test different indicators of the impacts of extreme heat on health. The second project will investigate the urban heat island effect in Johannesburg, South Africa and Abidjan, Côte d’Ivoire, using multiple data sources from satellites on the natural (e.g., vegetation) and the built environment, combined with weather, air pollution, and health outcome data. We will use health outcome data from large clinical trials and cohorts which has the geolocation of participants houses allowing for very precise measurements of the exposure of these individuals to heat and other environmental risk factors. Based on these analyses we will design an Early Warning System that can warn people when an extreme heat event is forecast. Risk strata will be generates in the Early Warning System, based on the risk profiles of specific risk groups, determined by a machine learning algorithm which takes into account forecasted weather conditions, characteristics such as age, geolocation and other factors that drive risk. The current approach to Early Warning Systems involves a single cut-off temperature threshold that is meant to represent risk for all members of the population. Tis approach lacks sensitivity as the health risks of extreme heat vary between population groups several fold. We will pilot a range of communication channels to deliver risk warnings tailored to different risk groups. This includes using an existing smartphone App (ClimApp). Most importantly, the HE2AT Center serves as a platform for other research projects or programmes related to climate change and health in Africa.

Relevance to the Green Climate Fund and Adaptation Fund The HE2AT Center provides a platform which has the potential to monitor projects funded by the Green Climate Fund, and to identify which interventions should be prioritised in funding proposals. Data science analytics could make a major contribution to optimising climate change and health projects. The prototype Early Warning Systems and monitoring systems that we develop could be adapted to different settings and population groups included in Green Climate Fund applications.

Timelines and anticipated impact Over a five to ten year period, the HE2AT Center will have established a data science and analytical platform capable of documenting the impacts of extreme heat, informing sensitive Early Warning Systems and monitoring systems across sub-Saharan Africa.

Other project partners University of Cape Town, South Africa; Aga Khan University, Kenya; University Peleforo Gon Coulibaly of Korhogo, Côte d’Ivoire; IBM Research Africa; University of Michigan; and University of Washington


US National Institutes of Health (NIH)

Latest Update: 02 February 2022

For more about HE2AT Center please email

Lack of vegetation exacerbates exposure to dangerous heat in dense settlements in a tropical African city

Both climate change and rapid urbanization accelerate exposure to heat in the city of Kampala, Uganda. From a network of low-cost temperature and humidity sensors, operational in 2018–2019, we derive the daily mean, minimum and maximum Humidex in order to quantify and explain intra-urban heat stress variation. This temperature-humidity index is shown to be heterogeneously distributed over the city, with a daily mean intra-urban Humidex Index deviation of 1.2 C on average. The largest difference between the coolest and the warmest station occurs between 16:00 and 17:00 local time. Averaged over the whole observation period, this daily maximum difference is 6.4 C between the warmest and coolest stations, and reaches 14.5 C on the most extreme day. This heat stress heterogeneity also translates to the occurrence of extreme heat, shown in other parts of the world to put local populations at risk of great discomfort or health danger. One station in a dense settlement reports a daily maximum Humidex Index of $\gt$40 C in 68% of the observation days, a level which was never reached at the nearby campus of the Makerere University, and only a few times at the city outskirts. Large intra-urban heat stress differences are explained by satellite earth observation products. Normalized Difference Vegetation Index has the highest (75%) power to predict the intra-urban variations in daily mean heat stress, but strong collinearity is found with other variables like impervious surface fraction and population density. Our results have implications for urban planning on the one hand, highlighting the importance of urban greening, and risk management on the other hand, recommending the use of a temperature-humidity index and accounting for large intra-urban heat stress variations and heat-prone districts in urban heat action plans for tropical humid cities.

Postnatal exposure to ambient temperature and rapid weight gain among infants delivered at term gestations: a population-based cohort study

The global prevalence of childhood obesity has risen dramatically recently. Previous studies found an association between rapid infant weight gain and childhood overweight. Evidence suggests that exposure to high ambient air temperatures during prenatal life and during adulthood is associated with birthweight and obesity respectively.

Conclusions: Exposure to higher ambient temperatures, of emerging importance in the climate change era, is associated with rapid infant weight gain in Israel. Future studies should use additional exposure, covariate, and outcome data to analyse the nature and the source of this association in more detail.

Quantifying the impact of future extreme heat on the outdoor work sector in the United States

Outdoor workers perform critical societal functions, often despite higher-than-average on-the-job risks and below-average pay. Climate change is expected to increase the frequency of days when it is too hot to safely work outdoors, compounding risks to workers and placing new stressors on the personal, local, state, and federal economies that depend on them. After quantifying the number of outdoor workers in the contiguous United States and their median earnings, we couple heat-based work reduction recommendations from the U.S. Centers for Disease Control and Prevention with an analysis of hourly weather station data to develop novel algorithms for calculating the annual number of unsafe workdays due to extreme heat. We apply these algorithms to projections of the frequency of extreme heat days to quantify the exposure of the outdoor workforce to extreme heat and the associated earnings at risk under different emissions scenarios and, for the first time, different adaptation measures. With a trajectory of modest greenhouse gas emissions reductions, outdoor worker exposure to extreme heat would triple that of the late 20th-century baseline by mid-century, and earnings at risk would reach an estimated $39.3 billion annually. By the late century with that same trajectory, exposure would increase four-fold compared to the baseline with an estimated $49.2 billion in annual earnings at risk. Losses are considerably higher with a limited-mitigation trajectory. While universal adoption of 2 specific adaptation measures in conjunction could reduce mid-century and late-century economic risks by roughly 90% and 93%, respectively, practical limitations to their adoption suggest that emissions mitigation policies will be critical for ensuring the well-being and livelihoods of outdoor workers in a warming climate.

Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study

Among both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.

Assessing Cool Corridor Heat Resilience Strategies for Human-Scale Transportation

Road pavement is a known contributor to the urban heat island effect. Several vendors are providing engineered pavements coatings – known as “cool pavement” – to reflect light and therefore heat to reduce the thermal load of roads. The City of Tucson is planning a pilot application of a cool pavement in Fall 2021 as a part of its Parks and Connections Bond work; our team has been working with the city and vendor(s) to set up an evaluation framework of the cool pavement.

Few of these cool pavements have been evaluated outside lab conditions, particularly in the desert southwest. Lab testing tends to rely heavily on surface temperature measurements with the assumption that lower surface temperatures result in the pavement being less of a heat sink and thus lowers ambient temperatures in real-world practice. Further, while heat is detrimental to the pedestrian and cyclist experience and health, almost no research exists documenting the experience of the cool pavement on active travelers including their perception of heat.

We propose a pre/post, case/control quasi-experimental design to evaluate the impacts of the cool pavement on the following heat metrics:

• Surface temperatures of the pavement
• Ambient temperatures of the area
• Thermal comfort as measured by wet bulb globe temperature (WBGT) – Governmental occupational guidance for exertion for heat is based on studies in industrial settings using wet-bulb globe temperature (WBGT), a heat index that incorporates ambient air temperature, humidity, airflow, and radiant solar heat. Known as “thermal comfort”, this index better mirrors the human – and thus pedestrian and cyclist – experience.

We anticipate four 12-hour days in the field. Each day will include seven Kestrel 5400 stations for ambient and WBGT temperatures at least every minute and surface temperatures every hour. Data will be managed and analyzed in R; outputs will include basic summary statistics, graphics, and regression analysis.

Our team has steadily increased capacity for such research over the past 2 years. In summer of 2019, Iroz-Elardo and Keith piloted a methodology to investigate how shade structures and surface materials in school gardens and play structures influenced thermal comfort as measured with a WBGT instrument and thermal heat guns. In late-spring 2020, Keith and Iroz-Elardo applied this knowledge to evaluate heat risk at COVID-19 vaccine point of distribution (POD) drive-in centers in Tucson. One of the more interesting preliminary findings from the vaccine POD evaluation was the extent to which idling vehicles appear to raise the WBGT in outdoor settings due to both mechanical and radiant heat.

Energy insecurity during temperature extremes in remote Australia

Indigenous communities in remote Australia face dangerous temperature extremes. These extremes are associated with increased risk of mortality and ill health. For many households, temperature extremes increase both their reliance on those services that energy provides, and the risk of those services being disconnected. Poor quality housing, low incomes, poor health and energy insecurity associated with prepayment all exacerbate the risk of temperature-related harm. Here we use daily smart meter data for 3,300 households and regression analysis to assess the relationship between temperature, electricity use and disconnection in 28 remote communities. We find that nearly all households (91%) experienced a disconnection from electricity during the 2018–2019 financial year. Almost three quarters of households (74%) were disconnected more than ten times. Households with high electricity use located in the central climate zones had a one in three chance of a same-day disconnection on very hot or very cold days. A broad suite of interrelated policy responses is required to reduce the frequency, duration and negative effects of disconnection from electricity for remote-living Indigenous residents.

Projected Impact of Heat on Mortality and Labour Productivity under Climate Change in Switzerland

Extreme temperatures have reached unprecedented levels in many regions of the globe due to climate change anda further increase is expected. Besides other consequences, high temperatures increase the mortality risk and severely affectthe labour productivity of workers. We perform a high-resolution spatial analysis to assess the impacts of heat on mortality and labour productivity in Switzerland and project their development under different Representative Concentration Pathway (RCP) scenarios, considering that no socio-economic changes takes place. The model is based on the risk framework of the Intergovernmental Panel on Climate Change (IPCC), which combines the three risk components: Hazard, Exposure, and Vulnerability. We model the two impact categories in the same spatially explicit framework and we integrate uncertainties into the analysis through a Monte Carlo simulation. We model, that first, about 670 people die today per year because of heat in Switzerland. Second, the economic costs caused by losses in labour productivity amount to around CHF 413 million (approx. $ 465 million) per year. Should we remain on an RCP8.5 emissions pathway, these values may double (for mortality) or even triple (for labour productivity) by the end of the century. Under an RCP2.6 scenario impacts are expected to slightly increaseand peak around mid-century, when climate is assumed to stop warming. Even though uncertainties in the model are large, theunderlying trend in impacts is unequivocal. The results of the study are valuable information for political discussions and allowfor a better understanding of the cost of inaction.

Heatwaves and Health Risks in the Northern Part of Senegal: Analysing the Distribution of Temperature Related Diseases and Associated Risk Factors

The Sahelian zone of Senegal is marked by heatwave events due to temperatures increase especially in 2013 exceeding 45 ° C with an impact on morbidity and mortality rise. In order to document health impacts of recurrent extreme temperatures in this part of the country, a study was carried out combining heatwaves detection, occurrence of climate-sensitive diseases and risk factors for exposure. Methods To do this, a set of climatic (temperatures) and health (morbidity, mortality) data were collected for April, May and June season from 2009 to 2019. These data were complemented by surveys on exposure risk factors of 1246 households. Statistical methods were used to carry out univariate and bivariate analyzes while cartographic techniques allowed visualization of the main climatic and health indicators. Results The results show an increase in temperatures compared to seasonal normal for the 1971-2000 reference period with threshold exceedances of the 90th percentiles (42°C) for the maxima and (27°C) the minima and higher temperatures during the months of May and June. From health perspective, it was noted an increase in cases of consultation on health facilities as well as a rise in declared morbidity by households especially in the departments of Kanel (17.7%), Ranérou (16.1%), Matam (13.7%) and Bakel (13.7%). The heatwaves of May 2013 were also associated with cases of death with a reported mortality (observed by medical staff) of 12.4% unevenly distributed according to the departments with a higher number of deaths in Matam (25, 2%) and in Bakel (23.5%) than in Podor (8.4%) and Kanel (0.8%). The morbidity and mortality distribution according to gender shows that women (57%) were more affected than men (43%). These health risks have been associated with a number of factors including age, access to drinkable water, type of fuel, type of housing and construction materials, existence of fan, an air conditioner, health antecedents, etc. Conclusion The heatwaves recurrence has led to an upsurge in certain diseases sensitive to rising temperatures, which is increasingly a public health issue in the Sahelian zone of Senegal.

COVID-19 pandemic modifies temperature and heat-related illness ambulance transport association in Japan: a nationwide observational study

This study provides evidence of the impact of COVID-19, particularly on the possible roles of physical interventions and behavioral changes, in modifying the temperature-health association. These findings would have implications on subsequent policies or heat-related warning strategies in light of ongoing or future pandemics.


Risk of Heat-Related Mortality, Disease, Accident, and Injury Among Korean Workers: A National Representative Study From 2002 to 2015

Many studies have shown that heat waves can cause both death and disease. Considering the adverse health effects of heat waves on vulnerable groups, this study highlights their impact on workers. The present study thus investigated the association between heat exposure and the likelihood of hospitalization and death, and further identified the risk of heat-related diseases or death according to types of heat and doseresponse modeling with heat threshold. Workers were selected from the Korean National Health Insurance Service-National Sample Cohort 2002–2015, and regional data measured by the Korea Meteorological Administration were used for weather information. The relationship between hospitalization attributable to disease and weather variables was analyzed by applying a generalized additional model. Using the Akaike information criterion, we selected a model that presented the optimal threshold. Maximum daily temperature (MaxT) was associated with an increased risk of death and outdoor mortality. The association between death outdoors and MaxT had a threshold of 31.2°C with a day zero lag effect. History of medical facility visits due to the health effects of heat waves was evident in certain infectious and parasitic diseases (A and B), cardio and cerebrovascular diseases (I20–25 and I60–69), injury, poisoning, and other consequences of external causes (S, T). The study demonstrated that heat exposure is a risk factor for death and infectious, cardio-cerebrovascular, and genitourinary diseases, as well as injuries or accidents among workers. The finding that heat exposure affects workers’ health has future implications for decision makers and researchers.

Estimating summertime heat stress in a tropical Indian city using Local Climate Zone (LCZ) framework

The Intergovernmental Panel on Climate Change (IPCC) report highlights the projected increase in heat wave (HW) frequency, intensity, and duration. Globally, HW events have caused massive deaths in the past. India has also experienced severe HWs and thousands have reportedly died during the past decade. The study uses the Local Climate Zone (LCZ) classification developed by Stewart and Oke (2012) for evaluating heat stress at the city level during the summer period. Stationery surveys were conducted to collect micro-meteorological data in different LCZs. The study analyses the unique behaviour of mapped LCZs in Nagpur, a tropical landlocked Indian city using widely adopted heat indices (heat index and humidex). It investigates two kinds of probabilities, the distribution of heat stress levels in a particular LCZ and how vulnerable are various LCZs to a given heat stress level. It adopts a statistical approach fitting a predictive logit model to estimate the probability of heat stress in various LCZs. The results show that temperature regimes differ significantly across the LCZs. Secondly, heat stress varies greatly depending upon the LCZs. The mapping scheme and the corresponding heat stress provides indispensable information for targeted heat response planning and heat stress mitigation strategies in heat-prone areas.

Perceptions of workplace heat exposure and adaption behaviors among Chinese construction workers in the context of climate change

Chinese construction workers lack heat risk awareness and are not well prepared for the likely increasing heat exposure in the workplace due to global warming. Therefore, there is a need to improve their awareness of heat-related injuries, strengthen high temperature related education and training, and update the current heat prevention policies to ensure compliance and implementation.

The effect of deforestation and climate change on all-cause mortality and unsafe work conditions due to heat exposure in Berau, Indonesia: a modelling study

Heat exposure from deforestation and climate change has already started affecting populations in low latitude, industrialising countries, and future global warming indicates substantial health impacts in these regions. Further research should examine how deforestation is currently affecting the health and wellbeing of local communities.

Indoor temperature variability in the Sahel: a pilot study in Ouagadougou, Burkina Faso

Very little research has documented the exposure of populations in Africa to extreme heat. We measured indoor air temperature and humidity hourly for 13 months in seven houses of contrasted architecture and construction materials all in the northern neighbourhoods of Ouagadougou, Burkina Faso. These measurements are compared to air temperatures recorded at the synoptic weather station of Ouagadougou airport and to land surface temperature estimates from Landsat satellite images at seven dates with clear-sky conditions. The results reveal huge temperature differences (exceeding 10 °C) between houses, especially in the afternoon hours of the warmest season. Indoor temperature is also much more variable than land surface (outdoor) temperature in the same locations, as estimated by satellite imagery. Houses with greater thermal inertia smooth the afternoon temperature peak, reducing heat exposure. Heat stress bioindicators reveal that danger thresholds, while rarely reached in some houses, are frequently exceeded in others year round except for the core of the cold winter season (December and January). In spring, the hottest season, the danger threshold is almost permanently exceeded in these dwellings, exposing their inhabitants to significant heat stress. This pilot study shows the primary role of housing in modulating indoor temperature, raising questions of public health and habitability of Sahelian regions in a warming world. This issue will be of increasing importance with ongoing climate change, hence the need for further, more detailed instrumented campaigns in African settlements.

Planning for extreme heat: A national survey of US planners

Problem, Research Strategy, and Findings: Extreme heat is the deadliest climate hazard in the United States. Climate change and the urban heat island effect are increasing the number of dangerously hot days in cities worldwide and the need for communities to plan for extreme heat. Existing literature on heat planning focuses on heat island mapping and modeling, while few studies delve into heat planning and governance processes. We surveyed planning professionals from diverse cities across the U.S. to establish critical baseline information for a growing area of planning practice and scholarship, which future research can build on. Survey results show that planners are concerned with extreme heat risks, particularly environmental and public health impacts from climate change. Planners already report impacts from extreme heat, particularly to energy and water use, vegetation and wildlife, public health, and quality of life. Especially in impacted communities, planners claim they address heat in plans and implement heat mitigation and management strategies such as urban forestry, emergency response, and weatherization, but perceive many barriers related to human and financial resources and political will. Takeaway for practice: Planners are concerned about extreme heat, especially in the face of climate change. They are beginning to address heat through different strategies and plan types, but we see opportunities to better connect planners to existing heat information sources and leverage existing planning tools, including vegetation, land use regulations, and building codes to mitigate risks. While barriers to heat planning persist, including human and capital resources, planners are uniquely qualified to coordinate communities’ efforts to address the rising threat of extreme heat.

National Action Plan on Heat Related Illnesses - India

The National Action Plan on Heat Related lllnesses, developed with inputs from various governmental and non-governmental experts, is intended to be used by government and private health care facilities, health departments, and policymakers tasked with strengthening health facilities and emergency response. This document provides guidance to manage severe heat-related illnesses and to report them under National Heat Related
Illness surveillance.

Knowledge, Attitudes & Practice around Heatwave in Karachi following a Forecast-based Heatwave Messaging Project

The humanitarian impact of extreme heat is an increasing concern, especially in low-income countries with limited access to quality healthcare and informal dwellings which can trap heat. This report analyses the knowledge, attitude and practice of Karachi residents in relation to managing extreme heat. It was conducted in 2020 following a messaging campaign led by HANDS related to extreme heat. The project was triggered through a disaster risk financing approach, using a heatwave model to trigger funding automatically when extreme heat was forecast.


Impact of environmental thermal stress on workers’ health and productivity: intervention strategies and development of an integrated weather-climatic and epidemiological heat health warning system for various occupational sectors (WORKLIMATE)


The aim of the project is to deepen, especially through the INAIL injury database, the knowledge on the effect of environmental thermal stress conditions on workers (in particular heat), with specific attention to the estimation of the social costs of injuries at work. Organizational solutions and useful operational procedures in different occupational fields (or tasks), currently not yet available, will also be proposed through the organization of ad hoc case studies in selected companies in the areas of central Italy, a survey on the perception of risk linked to exposure to extreme temperatures will carried out too. An integrated weather-climatic and epidemiological heat health warning system, specific for the occupational sector, will be developed. The heat health warning system will consist of a web forecasting platform and a web app that will provide personalized forecasts based on the individual characteristics of workers and those of the work environment (work in the sun or in shade areas). The project products will be enhanced and made available by the Italian Physical Agents Platform (PAF) in order to provide concrete and operational support helpful not only for workers but also for all actors involved in the occupational prevention and protection process.

Combating the heat island effect and poor air quality with green ventilation corridors

Stuttgart’s location in a valley basin, its mild climate, low wind speeds, industrial activity and high volume of traffic has made it susceptible to poor air quality. Development on the valley slopes has prevented air from moving through the city, which worsens the air quality and contributes to the urban heat island effect. A Climate Atlas was developed for the Stuttgart region, presenting the distribution of temperature and cold air flows according to the city’s topography and land use. Based on this information, a number of planning and zoning regulations are recommended that also aim to preserve and increase open space in densely built-up areas.

Berlin Biotope Area Factor – Implementation of guidelines helping to control temperature and runoff

In inner city Berlin, plans for the development of new buildings are subjected to the Berlin Landscape Programme, which includes a regulation requiring a proportion of the area to be left as green space: the Biotope Area Factor (BAF) or BFF (Biotop Flächenfaktor). All potential green areas, such as courtyards, roofs and walls are included in the BAF. The regulation is a part of a larger set of documents relating to landscape planning and design as well as species protection. It responds to the need to encourage more green space in densely built-up urban areas.

Climate change is expected to increase and intensify heatwaves and water-related extremes; two impacts that are particularly relevant for the urban context. By encouraging the introduction of more green space, the BAF is an important mechanism to reduce local climate change vulnerability as its measures help to lower the temperatures and improve the runoff management. The implementation of the BAF started in 1994 and is still on-going. A considerable number of new built areas in the inner city centre have implemented this regulation, translating it into green areas.

Operation of the Portuguese Contingency Heatwaves Plan

Evidence that elevated temperatures can lead to increased mortality and morbidity is well documented, with population vulnerability being location specific. The elderly are particular vulnerable to extreme heat stress. Being part of the Iberian Peninsula, Portugal has a mild Mediterranean climate. Climate change projections indicate that the number of days with extreme heat in Portugal will increase with urban areas being more sensitive. If future populations become more urbanized and the number of elderly continues to increase, the issue of heat-related mortality will likely become more severe.

During the 2003 heatwave in Europe, Portugal was one of the few countries that already had an early warning system in place: but only for Lisbon, the capital city. Following the 2003 heatwave, the Portuguese Heatwave Contingency Plan was established and has been in operation every year from May to September. This is a national plan covering the whole continental Portugal. The aim of the current Portuguese Heatwave Contingency Plan is to prevent the adverse health effects of heat stress on the population during periods of elevated temperatures. Daily alerts are key factors to the successful implementation of this plan; they indicate what protection measures must be carried out to protect the population during periods of elevated temperatures.

Operation of the Austrian Heat Protection Plan

Evidence that increasing temperatures leads to increased mortality and morbidity is well documented, with population vulnerability being location specific. Especially the 2003 heat wave in Europe raised the awareness of negative impacts of heat stress on human health in Austria. Increased incidence of heat waves leads to an increase in heat stress, especially in urban areas; the intensification of the heat-island effect is to be expected. Following the 2003 heat wave, different Austrian provinces like Styria (2011) and Carinthia (2013) developed heat protection plans, based on recommendations from the World Health Organisation, which recommended to develop strategies, plans and packages of measures in order to protect citizens from heat stress.

These plans provide an information basis for public health services. Based on the experience from the two provinces, an Austrian heat protection plan, led by the Ministry of Health and Woman´s Affairs with involvement of several relevant actors on the national and provincial level was prepared and put in action in 2017. The plan sets out the connection between climate change and health as well as the meteorological baseline information for heat warnings, which is provided by the National Met Service (ZAMG). The information and warnings are directed to the citizen via a sound network of institutions and actors in the health field.

Heat Hotline Parasol – Kassel region

Demographic change and climate change together place great challenges on the society. The life expectancy of the population in Germany rises and so does the share of older people. Besides chronic patients and children, the elderly are especially affected by the effects of the climate change. At the same time more and more people live in single person households (increase from 14.56 million in 2004 to 16.83 million in 2016 in Germany), which can influence their social isolation. How can we reach these people in order to prevent negative impacts during heatwaves? This is where the heat hotline parasol from the city of Kassel (around 200.000 inhabitants) in Germany comes into play. The heat hotline parasol is a free of charge hotline that calls registered citizens and provides information on heat-warnings from the German Weather Service and suggest measures how to best deal with and adapt to higher temperatures and heat. With this hotline special support is provided to citizens, especially elderly and their families, to deal with heat in the urban area of the city of Kassel. The Elderly Committee of the City of Kassel and the Health Department of the Kassel region cooperates in the heat hotline parasol.

Social vulnerability to heatwaves – from assessment to implementation of adaptation measures in Košice and Trnava, Slovakia

High temperatures and heatwaves in the summer pose increasing risks to people living in Slovakian cities. In particular older people and children, those living on top floors in poorly insulated buildings, and those relying on facilities such as nurseries, schools or care homes are prone to heat stress. The Carpathian Development Institute, in collaboration with local authorities in Trnava and Košice, carried out an assessment of vulnerability to high temperatures and heatwaves in residential environment, taking into account the social aspects. Factors such as presence of older people, children and location of facilities serving these vulnerable groups were considered.

Based on the results of the assessment, adaptation strategies are being implemented in both Trnava and Košice, including measures such as thickening of tree stands in parks, building and restoration of water elements (blue infrastructure) and fountains in most vulnerable places, actions aiming at changing citizen behavior during heatwaves, etc., Moreover, a neglected public open space in a vulnerable area in Trnava was redesigned to provide shading through planting of trees and other vegetation.

Adapting to the impacts of heatwaves in a changing climate in Botkyrka, Sweden

In the last century, heatwaves in Sweden occurred once every 20 years (the last being in 1975). Since the start of the new millennium, four heatwaves (2003, 2007, 2010 and 2018) have been already experienced. The frequency of these events is expected to further increase due to climate change; they will occur once every three to five years towards the end of the century. Heatwaves are already leading to increased mortality. Botkyrka is a municipality in Stockholm County in east central Sweden, not far from the capital with a population of 91.925 inhabitants. In 2010, the municipality experienced prolonged high temperatures, which led among other things to problems in elderly, retirement and nursing homes. The residents were severely hit by the heat and the staff had problems to look after them well enough.

Extensive efforts, partly in the frame of a project held within the Climatools program, have been made in the municipality of Botkyrka to reduce the health risk of heatwaves. Staff of elderly, retirement and nursing homes has acquired knowledge on heatwaves risk and on checklists that must be followed in case of heatwave warnings. If necessary, additional staff can be called and activated to ensure further support to safe care. Therefore, during the 2018 heatwave, the municipality was far better prepared and equipped than in previous situations. Botkyrka is also supporting actions aiming to improve indoor thermal comfort and to create “cool-spots” in various areas of the city.

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.

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.


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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.


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.

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.


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.


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.


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.


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’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

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.


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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

Upcoming Events

Webinar: US – NIHHIS Community Climate Studies – Observing, Modeling, and Mitigating Urban Heat for Equitable Resilience

Sep 13, 2022

This webinar will focus on 4 projects taking place across the country aiming to work with communities to understand the impacts of extreme heat, to observe and model the drivers of those impacts, and to ultimately help local decision makers make informed decisions about how to mitigate heat risk now and for the future.

Planetary Health Annual Meeting

Oct 31, 2022 - Nov 2, 2022

The theme of the 5th Planetary Health Annual Meeting is Building the Field and Growing the Movement. ​ All are invited to this virtual convening of scientists, youth, policymakers, educators, private sector, artists, and more to learn about the complexities of planetary health science, find community, seek solutions, and build skills for action and change!

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