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  • 1. Ayres, JG
    et al.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Annesi-Maesano, I
    Dey, R
    Ebi, KL
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Helms, PJ
    Medina-Ramón, M
    Windt, M
    Forastiere, F
    Climate change and respiratory disease: European Respiratory Society position statement2009In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 34, no 2, p. 295-302Article in journal (Refereed)
    Abstract [en]

    Climate change will affect individuals with pre-existing respiratory disease, but the extent of the effect remains unclear. The present position statement was developed on behalf of the European Respiratory Society in order to identify areas of concern arising from climate change for individuals with respiratory disease, healthcare workers in the respiratory sector and policy makers. The statement was developed following a 2-day workshop held in Leuven (Belgium) in March 2008. Key areas of concern for the respiratory community arising from climate change are discussed and recommendations made to address gaps in knowledge. The most important recommendation was the development of more accurate predictive models for predicting the impact of climate change on respiratory health. Respiratory healthcare workers also have an advocatory role in persuading governments and the European Union to maintain awareness and appropriate actions with respect to climate change, and these areas are also discussed in the position statement.

  • 2. Bowen, Kathryn J.
    et al.
    Ebi, Kristie L.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Governing the health risks of climate change: towards multi-sector responses2015In: Current Opinion in Environmental Sustainability, ISSN 1877-3435, E-ISSN 1877-3443, Vol. 12, p. 80-85Article in journal (Refereed)
    Abstract [en]

    Climate change will exacerbate current and create new health risks. Because many upstream drivers of these risks arise from outside the sector, multi-sectoral approaches are required for effective adaptation. This paper focuses on showcasing successful stories of collaboration from four relevant arenas - One Health, Disaster Risk Management, the Commission on Social Determinants of Health, and Health in All Policies (HiAP). Common themes from these case studies include first, the importance of systems-based approaches incorporating partnership with all relevant sectors, and second structural supports, including leadership, sufficient resources and responsive governments, are necessary to provide the supporting conditions for collaboration and partnerships.

  • 3.
    Ebi, Kristie L.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kram, Tom
    van Vuuren, Detlef P.
    O'Neill, Brian C.
    Kriegler, Elmar
    A New Toolkit for Developing Scenarios for Climate Change Research and Policy Analysis2014In: Environment, ISSN 0013-9157, E-ISSN 1939-9154, Vol. 56, no 2, p. 6-16Article in journal (Refereed)
  • 4.
    Lowe, Dianne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Centre for Health Communication and Participation, School of Public Health & Human Biosciences, La Trobe University, Victoria, Australia.
    Ebi, Kristie L.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Factors Increasing Vulnerability to Health Effects before, during and after Floods2013In: International journal of environmental research and public health, ISSN 1660-4601, Vol. 10, no 12, p. 7015-7067Article in journal (Refereed)
    Abstract [en]

    Identifying the risk factors for morbidity and mortality effects pre-, during and post-flood may aid the appropriate targeting of flood-related adverse health prevention strategies. We conducted a systematic PubMed search to identify studies examining risk factors for health effects of precipitation-related floods, among Organisation for Economic Co-Operation and Development (OECD) member countries. Research identifying flood-related morbidity and mortality risk factors is limited and primarily examines demographic characteristics such as age and gender. During floods, females, elderly and children appear to be at greater risk of psychological and physical health effects, while males between 10 to 29 years may be at greater risk of mortality. Post-flood, those over 65 years and males are at increased risk of physical health effects, while females appear at greater risk of psychological health effects. Other risk factors include previous flood experiences, greater flood depth or flood trauma, existing illnesses, medication interruption, and low education or socio-economic status. Tailoring messages to high-risk groups may increase their effectiveness. Target populations differ for morbidity and mortality effects, and differ pre-, during, and post-flood. Additional research is required to identify the risk factors associated with pre- and post-flood mortality and post-flood morbidity, preferably using prospective cohort studies.

  • 5.
    Lowe, Dianne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, Kristie L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Heatwave early warning systems and adaptation advice to reduce human health consequences of heatwaves2011In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 8, no 12, p. 4623-4648Article in journal (Refereed)
    Abstract [en]

    Introduction: With climate change, there has been an increase in the frequency, intensity and duration of heatwave events. In response to the devastating mortality and morbidity of recent heatwave events, many countries have introduced heatwave early warning systems (HEWS). HEWS are designed to reduce the avoidable human health consequences of heatwaves through timely notification of prevention measures to vulnerable populations.

    Objective: To identify the key characteristics of HEWS in European countries to help inform modification of current, and development of, new systems and plans.

    Methods: We searched the internet to identify HEWS policy or government documents for 33 European countries and requested information from relevant organizations. We translated the HEWS documents and extracted details on the trigger indicators, thresholds for action, notification strategies, message intermediaries, communication and dissemination strategies, prevention strategies recommended and specified target audiences.

    Findings and Conclusions: Twelve European countries have HEWS. Although there are many similarities among the HEWS, there also are differences in key characteristics that could inform improvements in heatwave early warning plans.

  • 6.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Andersson, Camilla
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Ebi, Kristie L
    ClimAdapt, Los Altos, California, USA.
    Langner, Joakim
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Impact of climate change on ozone-related mortality and morbidity in Europe2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 41, no 2, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level ozone are expected to increase due to climate change.Ozone-related health impacts under a changing climate are projected using emission scenarios, models and epidemiological data. European ozone concentrations are modelled with MATCH-RCA3 (50×50 km). Projections from two climate models, ECHAM4 and HadCM3, are applied, under greenhouse gas emission scenarios A2 and A1B respectively. We apply a European-wide exposure-response function to gridded population data and country-specific baseline mortality and morbidity.Comparing the current situation (1990-2009) with the baseline period (1961-1990), the largest increase in ozone-associated mortality and morbidity due to climate change (4-5%) have occurred in Belgium, Ireland, Netherlands and UK. Comparing the baseline period and the future periods (2021-2050 and 2041-2060), much larger increase in ozone-related mortality and morbidity are projected for Belgium, France, Spain and Portugal with the impact being stronger using the climate projection from ECHAM4 (A2). However, in Nordic and Baltic countries the same magnitude of decrease is projected.The current study suggests that projected effects of climate change on ozone concentrations could differentially influence mortality and morbidity across Europe.

  • 7.
    Oudin Åström, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, Kristie L.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden2013In: Nature Climate Change, ISSN 1758-678X, E-ISSN 1758-6798, Vol. 3, no 12, p. 1050-1054Article in journal (Refereed)
    Abstract [en]

    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.

  • 8.
    Oudin Åström, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, Kristie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reply to 'Adaptation to extreme heat in Stockholm County, Sweden'2014In: Nature Climate Change, ISSN 1758-678X, E-ISSN 1758-6798, Vol. 4, no 5, p. 303-303Article in journal (Refereed)
  • 9.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bao Giang, Kim
    Van Minh, Hoang
    Ebi, Kristie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Washington, Sch Publ Hlth, Seattle, WA 98195 USA.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Local research evidence for public health interventions against climate change in Vietnam2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 26552Article in journal (Refereed)
  • 10.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, K
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bellander, T
    Forsberg, B
    Mortality related to temperature and persistent temperature extremes: a study of potential susceptibility factorsManuscript (preprint) (Other academic)
  • 11.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, K
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, B
    Contrast in mortality related to temperature and persistent temperature extremes: a study of cause-specific and age stratified mortalityArticle in journal (Other academic)
  • 12.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, Kristie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mortality related to temperature and persistent extreme temperatures: a study of cause-specific and age-stratified mortality.2011In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 68, no 7, p. 531-536Article in journal (Refereed)
    Abstract [en]

    Objectives High and low ambient temperatures are associated with large numbers of deaths annually. Many studies show higher mortalities during heatwaves. However, such effects are rarely explicitly incorporated in models of temperature and mortality, although dehydration followed by cardiovascular stress is more likely to occur. The authors aim to establish time-series models in which the effects of persistent extreme temperature and temperature in general can be disentangled.

    Methods The authors established time-series Poisson regression models based on cause-specific mortality and age-stratified mortality in Stockholm County (Sweden), 1990–2002, adjusting for time trends and potential confounders, and studied the effects of temperature and persistence of extreme temperature.

    Results Persistent extremely high temperature was associated with additional deaths, and the risk of death increased significantly per day of extended heat exposure. Extreme exposure to heat was associated with higher death rates in adults and for cardiovascular causes of death, compared with a rise in temperature. Warmer temperatures increase daily mortality from natural causes, while decreasing colder temperatures increase the risk of cardiovascular deaths. Furthermore, the impact of warm and cold temperatures decreases within the season, while the impact of persistent extremely high temperatures remains similar throughout the summer.

    Conclusions The authors found the mortality impact of persistence of extreme high temperatures to increase proportionally to the length of the heat episode in addition to the effects of temperature based on the temperature–mortality relationship. Thus, the additional effect of persistent extreme heat was found to be important to incorporate for models of mortality related to ambient temperatures to avoid negatively biased attributed risks, especially for cardiovascular mortality. Moreover, the effects associated with non-extreme temperatures may decline as the pool of fragile individuals shrink as well as due to acclimatisation/adaptation. However, a similar decline was not observed for the effects associated with extreme heat episodes.

  • 13.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ebi, Kristie L.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    High Dose Extrapolation in Climate Change Projections of Heat-Related Mortality2012In: Journal of Agricultural Biological and Environmental Statistics, ISSN 1085-7117, E-ISSN 1537-2693, Vol. 17, no 3, p. 461-475Article in journal (Refereed)
    Abstract [en]

    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.

  • 14.
    Sauerborn, Rainer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ebi, Kristie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Stanford University, CA, USA.
    Climate change and natural disasters: integrating science and practice to protect health2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: Hydro-meteorological disasters are the focus of this paper. The authors examine, to which extent climate change increases their frequency and intensity. Methods: Review of IPCC-projections of climate-change related extreme weather events and related literature on health effects. Results: Projections show that climate change is likely to increase the frequency, intensity, duration, and spatial distribution of a range of extreme weather events over coming decades. Conclusions: There is a need for strengthened collaboration between climate scientists, the health researchers and policy-makers as well as the disaster community to jointly develop adaptation strategies to protect human.

  • 15.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. orru@ut.ee.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Strandberg, Gustav
    Rossby Centre, SMHI, Norrköping, Sweden.
    Ebi, Kristie L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 1, p. e001842-Article in journal (Refereed)
    Abstract [en]

    Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a large relative increase for respiratory diseases. Expected increases in mean temperature and the number of extreme heat events over the coming decades due to climate change raise questions about the possible health impacts. We assess the number of heat-related respiratory hospital admissions in a future with a different climate.                                

    Design A Europe-wide health impact assessment.                                

    Setting An assessment for each of the EU27 countries.                                

    Methods Heat-related hospital admissions under a changing climate are projected using multicity epidemiological exposure–response relationships applied to gridded population data and country-specific baseline respiratory hospital admission rates. Times-series of temperatures are simulated with a regional climate model based on four global climate models, under two greenhouse gas emission scenarios.                                

    Results Between a reference period (1981–2010) and a future period (2021–2050), the total number of respiratory hospital admissions attributed to heat is projected to be larger in southern Europe, with three times more heat attributed respiratory hospital admissions in the future period. The smallest change was estimated in Eastern Europe with about a twofold increase. For all of Europe, the number of heat-related respiratory hospital admissions is projected to be 26 000 annually in the future period compared with 11 000 in the reference period.                                

    Conclusions The results suggest that the projected effects of climate change on temperature and the number of extreme heat events could substantially influence respiratory morbidity across Europe.                                

     

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