Kristie L Ebi

Few communities are well prepared to effectively prepare for, cope with, and recover from current climate variability. Modifying policies and programs to reduce this adaptation deficit is expected to increase resilience to projected changes in the frequency, intensity, and extent of extreme weather events with climate change.

Modifications of public health strategies, policies, and measures to enhance health protection to climate-sensitive health outcomes may not increase resilience to future (and different) weather patterns. Communities resilient to the health risks of climate change (1) anticipate risks; (2) reduce vulnerability not just to the hazards associated with climate change, but also with the full range of factors that increase the probability of harm; (3) reduce exposure to weather and climate events through, for example, early warning systems; (4) prepare for and respond quickly and effectively to the consequences of a changing climate, including alterations in the frequency, magnitude, duration, and spatial extent of extreme weather and climate events; and (5) recover faster, with increased capacity to coping with changing weather patterns. Increasing resilience includes top-down (e.g. strengthening and maintaining disaster risk management programs) and bottom-up (e.g. increasing social cap...

Adapting to heatwaves is becoming more critical as the climate changes and extreme heat events are occurring more frequently than in decades past. Despite this trend, previous research suggests that very few U.S. communities have programs in place to prevent health problems during hot weather. The summer of 2011 in the continental U.S. presented an opportunity to study public health preparedness when 41 of the lower 48 states experienced record-breaking hot weather. This report examines local heat adaptation programs and their cost for local county government entities after the 2011 heat wave. Using a multi-modal survey approach, local health and emergency response departments were invited to participate in a survey about their climate change adaptation plans. Overall, 62% of the total respondents did not have a heatwaves plan in place. Surprisingly, those states that did not experience a heatwave in 2011 were more prepared than the states that did experience a heatwave. Other insig...

ABSTRACT Climate change is expected to increase health risks in all countries. Although public health agencies and organizations have impressive records of controlling the burden of climate-sensitive health outcomes, current and planned programs and activities may need to be modified to address the additional risks of climate change. Programs and activities need to take an iterative risk management approach if they are to maintain current levels of health burdens as diseases change their geographic range and incidence in response to changing temperature and precipitation patterns and as the risks of adverse health outcomes from extreme weather events increase. Public health can learn from the experiences in ecosystem management with adaptive management, a structured and iterative process of decision-making in the face of imperfect information, with an aim of reducing uncertainty through monitoring and evaluation. Although many of the steps in adaptive management are familiar to public health, key differences include: a stronger emphasis on stakeholder engagement; taking a systems-based approach; developing interventions based on models of future impacts; and a strong and explicit focus on iterative management that can facilitate the capacity for further adaptation. Incorporating these elements into public health programs and activities will increase their effectiveness to address the health risks of climate change. KeywordsClimate change-Public health-Adaptation-Adaptive management-Systems approach-Stakeholder engagement-Risk management-Ecohealth-Learning by doing-Health risks

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ABSTRACT A changing climate is increasing the frequency, intensity, duration and spatial extent of heat waves. These changes are associated with increased human mortality during heat extremes. At the other end of the temperature scale, it has been widely speculated that cold-related mortality could decrease in a warmer world. We aim to answer a key question; the extent to which mortality due to temperature extremes in Stockholm, Sweden during 1980–2009 can be attributed to climate change that has occurred since our reference period (1900–1929). Mortality from heat extremes in 1980–2009 was double what would have occurred without climate change. Although temperature shifted towards warmer temperatures in the winter season, cold extremes occurred more frequently, contributing to a small increase of mortality during the winter months. No evidence was found for adaptation over 1980–2009.

Climate change is widely acknowledged as a key global challenge for the 21st century, and is projected to significantly affect population health and human well-being. All of the climate change-related changes in weather patterns will affect human health, from boosting mental well-being to mortality from large-scale disasters. Human health can be affected both directly and indirectly. For various reasons, the health sector has been slow in responding to the projected health impacts of climate change. To effectively prepare for and cope with climate change impacts, public health must move from a focus on surveillance and response to a greater emphasis on prediction and prevention. The targeted agenda program dialogue identified three priorities for climate change related health actions: heat waves, vector-borne diseases; and malnutrition.

We examined the association between magnetic field (MF) exposure and survival among children with acute lymphoblastic leukaemia (ALL) treated at 51 Pediatric Oncology Group centres between 1996 and 2001. Of 1672 potentially eligible children under treatment, 482 (29%) participated and personal 24-h MF measurements were obtained from 412 participants. A total of 386 children with ALL and 361 with B-precursor ALL were included in the analysis of event-free survival (time from diagnosis to first treatment failure, relapse, secondary malignancy, or death) and overall survival. After adjustment for risk group and socioeconomic status, the event-free survival hazard ratio (HR) for children with measurements >/=0.3 muT was 1.9 (95% confidence interval (CI) 0.8, 4.9), compared to <0.1 muT. For survival, elevated HRs were found for children exposed to >/=0.3 muT (multivariate HR=4.5, 95% CI 1.5-13.8) but based on only four deaths among 19 children. While risk was increased among chi...

Over the last two decades a number of heatwaves have brought the need for heatwave early warning systems (HEWS) to the attention of many European governments. The HEWS in Europe are operating under the assumption that there is a high correlation between observed and forecasted temperatures. We investigated the sensitivity of different temperature mortality relationships when using forecast temperatures. We modelled mortality in Stockholm using observed temperatures and made predictions using forecast temperatures from the European Centre for Medium-range Weather Forecasts to assess the sensitivity. We found that the forecast will alter the expected future risk differently for different temperature mortality relationships. The more complex models seemed more sensitive to inaccurate forecasts. Despite the difference between models, there was a high agreement between models when identifying risk-days. We find that considerations of the accuracy in temperature forecasts should be part o...

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator's guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were...

Mathematical and statistical models are needed to understand the extent to which weather, climate variability, and climate change are affecting current and may affect future health burdens in the context of other risk factors and a range of possible development pathways, and the temporal and spatial patterns of any changes. Such understanding is needed to guide the design and the implementation of adaptation and mitigation measures. Because each model projection captures only a narrow range of possible futures, and because models serve different purposes, multiple models are needed for each health outcome ('horses for courses'). Multiple modeling results can be used to bracket the ranges of when, where, and with what intensity negative health consequences could arise. This commentary explores some climate change and health modeling issues, particularly modeling exposure-response relationships, developing early warning systems, projecting health risks over coming decades, and...

Addressing climate change and its associated effects is a multi-dimensional and ongoing challenge. This includes recognizing that climate change will affect the health and wellbeing of all populations over short and longer terms, albeit in varied ways and intensities. That recognition has drawn attention to the need to take adaptive actions to lessen adverse impacts over the next few decades from unavoidable climate change, particularly in developing country settings. A range of sectors is responsible for appropriate adaptive policies and measures to address the health risks of climate change, including health services, water and sanitation, trade, agriculture, disaster management, and development. To broaden the framing of governance and decision-making processes by using innovative methods and assessments to illustrate the multi-sectoral nature of health-related adaptation to climate change. This is a shift from sector-specific to multi-level systems encompassing sectors and actor...

ABSTRACT Biometeorology has a long tradition in the biophysical sciences, and has for sometime focused on what are essentially reductionist questions in its various subfields, with less thought given by its practioners to the relevance of its science to society at large. Biometeorologists have begun to reflect upon the utility of their science, as society has demanded greater accountability on the societal value of their outputs. In particular, questions such as how can an understanding of the relationships between the atmosphere and biophysical systems provide insights into how environmental and social well-being can be sustained or improved have become important in the face of significant environmental changes. This is because it is more than apparent that the environment is subject to increasing pressures from society, and many human activities are sensitive to variation and change in environmental conditions. Accordingly, there has been critical reflection in the field of biometeorology, an outcome of which has been an unashamed push to be more applied in its orientation while not neglecting a strong engagement with its theoretical base. Over the last few decades the subfields of biometeorology have accumulated a vast body of knowledge about the interactions between the atmosphere and biophysical systems; much of which has been published in the International Society of Biometeorology's International Journal of Biometeorology. That knowledge has formed a firm foundation for gaining insights into how human-induced climate change might impact biophysical systems and thus human activi-ties dependent on the ecosystem services provided by those systems. Although not explicit in its knowledge base, a theme that runs through biometeorology is that of adaptation, the process by which living organisms adjust to variable and changing environmental conditions. Climate change, including shifts in the mean climate as well as variability and extremes, will pose series challenges for human and biophysical systems. In many ways, the degree to which humans can sustain their relationship with climate, as one aspect of the environment, will depend on the ability of societies to adapt to the changing conditions associated with climate change.

Includes a description of societal and economic impacts resulting from the 2005 Illinois drought, primarily to the agricultural sector but also to energy, water resources, and retail businesses. ... Citation: Adaptation and Resilience: The Economics of Climate, Water, and Energy Challenges in the American Southwest, RFF Press, Washington, DC and London, 264 pp. ... Book including chapters examining impacts of climate change on irrigated agriculture and outdoor recreation including national park visitation and skiing, described in greater detail ...

ABSTRACT To better understand how to prevent illness and deaths during hot weather, particularly among at-risk populations, we conducted a study in Detroit, Michigan; Phoenix, Arizona; New York, New York, and Philadelphia, Pennsylvania. Our aims were to characterize and better understand how heatwave and health early warning systems (HHWS) and related prevention and sustainability programs can be more widely and effectively implemented. Specifically, we here report on the scientific evidence, expert judgments and the process used in deciding to trigger a HHWS and activate public health and social services interventions. We conducted interviews with public officials who decide if and when heat advisories/warnings are issued. After transcribing the interviews, we used a qualitative analysis software, QSR NVivo 9.0, to assign codes to portions of text from each transcript and allow analysis of information with common themes across the data. For example, several sentences in a transcript discussing a heat index might be coded as 'definition of heat wave'. A common theme across cities was that deciding what type of weather is dangerous to health is not straightforward. The time in season that heat occurs; the duration of the heat; the level of humidity and other meteorological factors; the extent to which temperatures drop at night, allowing people to cool off; and prevailing weather conditions all play a role. A single 'safe' threshold is unrealistic because people's individual sensitivity, housing, surrounding environments, behaviors, and access to air conditioning can differ greatly. However, choices must be made as to the trigger for the HHWS. Although quantitative analysis with health data (mortality, hospital admissions) can inform the design of the triggers, historical analysis has limitations, and decisions to issue heat warnings are sometimes related to planned activities, such as parades or fairs, that may expose large numbers of people to heat. The HHWS approach designed by Lawrence Kalkstein and colleagues using synoptic air mass forecasts and mortality data has been used by some cities. Other cities use National Weather Service products that are built on a variety of data inputs and approaches, including calculation of season-specific thresholds. More than one respondent mentioned distaste for 'black box' approaches that were not easily communicated to end-users. The decision to issue a heat warning can save lives, through such activities as opening cooling centers, distributing water to the homeless, and assisting elderly residents. A relatively simple triggering system that is easily understood by the media and public may facilitate more widespread adoption of HHWS. Funding: U.S. Centers for Disease Control and Prevention Grant R18-EH000348

26 20.1.2 A Wide Range of Interested Parties ... 27 28 20.2 A synthesis of new knowledge relating to impacts and adaptation ... 29 30 20.3 Impacts and adaptation in the context of multiple stresses ... 32 20.3.2 The role of the determinants of adaptive capacity

ABSTRACT Disasters the International Strategy for Disaster Reduction (ISDR) defines disasters as “a serious disruption of the functioning of a community or a society involving widespread human, material, economic, or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources.”

ABSTRACT Effectively addressing the health risks of climate change necessitates an active crosssectoral approach because health risks arise predominantly via sectors such as water, agriculture and energy. Much has been written on climate change and its impact on health, but little attention has focused on the realpolitik of how to progress the development and implementation of health-relevant strategies and policies to reduce this impact. The objective of this paper is to propose three solutions to address current deficiencies: i) strengthening the capacity and understanding of health officials in relation to climate change and health; ii) improving cross-sectoral partnerships with sectors relevant to climate change and health, and iii) identifying organisations influential in the development of climate change mitigation and adaptation strategies and policies, with a view to better target advocacy efforts. Practical examples of each solution are provided. In conclusion, as a steward of public health, the health sector must take the initiative to encourage a cross-sectoral approach that includes capacity development, coupled with an understanding of influential organisations. If this is done effectively, health, social and economic development goals can be reached more efficiently.

We evaluated temperature-related morbidity and mortality for the 2007 U.S. national assessment on impacts of climate change and variability on human health. We assessed literature published since the 2000 national assessment, evaluating epidemiologic studies, surveys, and studies projecting future impacts. Under current climate change projections, heat waves and hot weather are likely to increase in frequency, with the overall temperature distribution shifting away from the colder extremes. Vulnerable subgroups include communities in the northeastern and Midwestern U.S.; urban populations, the poor, the elderly, children, and those with impaired health or limited mobility. Temperature extremes and variability will remain important determinants of health in the United States under climate change. Research needs include estimating exposure to temperature extremes; studying nonfatal temperature-related illness; uniform criteria for reporting heat-related health outcomes; and improving effectiveness of urban heat island reduction and extreme weather response plans.

The Childhood Leukemia Survival Study is examining the possible association between magnetic field exposure and survival of children with newly diagnosed acute lymphocytic leukemia (ALL). We report the results of serial 24-h personal magnetic field monitoring for 412 US and Canadian children and present the correlations between annual values. The mean time-weighted average (TWA) and geometric mean (GM) were similar for first, second, and third year measurements [TWA: 0.11 microT (n = 412), 0.13 microT (n = 304), and 0.12 microT (n = 134), respectively]. There were no consistent differences in mean TWA or GM based on age or gender. Significantly lower mean TWA and GM were found for children living in rural areas. Higher exposures were noted among children living in urban areas, among apartments dwellers, and those living in rental homes. Measurements taken during summer months and among children residing in the northeast and Canada also tended to be higher. Correlations for most metrics were increased among children who had annual measurements performed during the same season. The metric with the highest year-to-year correlation was the GM. The lowest correlations were found for metrics estimating field intermittency and temporal stability. First to second year GMs were well correlated when taken in the same home (Spearman rank correlation = 0.70), but a lower correlation (0.44) was noted among residentially mobile children. Our findings suggest that summarizing exposure using a single measurement of GM can estimate exposures for residentially stable children, but is not a good predictor of personal exposures among children who change residence during the study interval.

ABSTRACT The Summary for Policy Makers of the IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation will be approved by the world governments in November 2011. The focus of the Special Report is on climate change and its role in altering the frequency, severity, and impact of extreme events or disasters, and on the costs of both impacts and the actions taken to prepare for, respond to, and recover from extreme events and disasters. The emphasis is on understanding the factors that make people and infrastructure vulnerable to extreme events, on recent and future changes in the relationship between climate change and extremes, and on managing the risks of disasters over a wide range of spatial and temporal scales. The assessment considers a broad suite of adaptations and explores the limits to adaptation. The assessment was designed to build durable links and foundations for partnerships between the stakeholder communities focused on climate change and those focused on disaster risk reduction. The Special Report begins with material that frames the issues, followed by an assessment of the reasons that communities are vulnerable. Two chapters assess the role of past and future climate change in altering extremes and the impact of these on the physical environment and human systems. Three chapters assess available knowledge on impacts and adaptation, with separate chapters considering the literature, stakeholder relationships, and potential policy tools relevant to the local, national, and international scales. Longer-term components of adaptation to weather and climate extremes and disasters are assessed in the context of moving toward sustainability. The final chapter provides case studies that integrate themes across several chapters or are so unique that they need to be considered separately.

ABSTRACT One challenge for statisticians and epidemiologists in projecting the future health risks of climate change is how to estimate exposure-response relationships when temperatures are higher than at present. Low dose extrapolation has been an area of rich study, resulting in well-defined methods and best practices. A primary difference between high dose and low dose extrapolation of exposure-response relationships is that low dose extrapolation is bounded at no exposure and no (or a baseline) response. With climate change altering weather variables and their variability beyond historical values, the highest future exposures in a region are projected to be higher than current experience. Modelers of the health risks of high temperatures are making assumptions about human responses associated with exposures outside the range of their data; these assumptions significantly affect the magnitude of projected future risks. Further, projections are affected by adaptation assumptions; we explore no adaptation (extrapolated response); individual (physiological) adaptation; and community adaptation. We present an example suggesting that linear models can make poor predictions of observations when no adaptation is assumed. Assumptions of the effects of weather above what has been observed needs to be more transparent in future studies. Statistical simulation studies could guide public health researchers in identifying best practices and reducing bias in projecting risks associated with extreme temperatures. Epidemiological studies should evaluate the extent and time required for adaptation, as well as the benefits of public health interventions.