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West Nile virus (WNV) is a growing risk to public and veterinary health in Europe, with intensifying outbreaks over recent decades coinciding with a rapidly warming climate. Thermal biology models parameterized through laboratory experiments on the mosquito vectors and the pathogen play a central role in our causal understanding of the effects of temperature on WNV transmission. We evaluated the ability of a thermal biology model of WNV's relative basic reproduction number (R0) to explain patterns of real-world transmission risk using monthly records of human West Nile virus neuroinvasive disease (WNND) in Europe between 2010 and 2023. We assessed spatial and temporal alignments of R0 estimates and WNND observations and calculated R0 estimates from temperature data of varying resolution, assessing the value of these estimates for WNND risk ranking compared to temperature alone. Moreover, we used generalized additive models to investigate if the effect of temperature on the WNND incidence across Europe mirrors the R0 temperature response, including the optimal temperature for transmission. We found that R0 accurately captured the seasonality of WNND, the temperatures associated with peak risk, and marginally improved WNND risk ranking compared to temperature alone. However, R0 poorly explained the irregular interannual incidence pattern and more limited geographical range of reported WNND cases. Additionally, nonlinear averaging of R0 calculations from high temporal resolution temperature data slightly improved risk ranking at elevated temperatures, whereas estimates based on average temperatures were better when lower temperatures were also included. Sensitivity analyses suggested that the validation of the optimal transmission temperature was largely informed by observations from Greece, as other countries contributed little information at such high temperatures. These findings demonstrate that thermal biology models capture important aspects of WNND risk in Europe. However, incorporation of additional ecological and epidemiological drivers is needed to develop more accurate risk predictions.

High resolution air quality dispersion modelling was applied to assess the health risks of long-term exposure to ultrafine particles (UFP) emitted from the transport sector and to evaluate the health benefits of different local interventions in Stockholm. Health impacts, based on associations between exposure, premature mortality and various diseases, were quantified as quality adjusted life years (QALYs) and monetized as health-related costsIrrespective of local mitigation measures in the city, fleet renewal driven byvehicle emission regulations is projected to reduce UFP exposure by 86 % between 2021 and 2030, saving almost 1700 QALYs corresponding to approximately €500 M in health-related costs. The renewal of the fleet affects mainly diesel passenger cars and heavy goods diesel vehicles equipped with particle filters, whichefficiently remove most exhaust particles, including UFPs. Among the local mitigation policies, the introduction of a low emission zone (LEZ) in 2030 covering 16 km2 of the inner city is estimated to save around 40 QALYs. In contrast, a much smaller LEZ (0.2 km2) approved by the city council would yield minimal health benefits, saving only 0.1 QALYs. Electrification of road vehicles under the business as usual (BAU) scenario is projected to save around 70 QALYs in 2030, exceeding the gains of any local policy scenario. Comparisons using PM2.5 and NO2 as predictors of health-related emissions, shows that gains in adverse health impacts of local mitigation actions may be severely underestimated if only health impacts of UFP exposure is considered.

Trafikverket har beviljat Institutionen för folkhälsa och klinisk medicin, Umeå universitet ett FOI-bidrag för projektet Reviderat underlag om hälsokonsekvenser av luftföroreningar, vilket ska komplettera underlagen om luftföroreningars hälsoeffekter till grund för rekommendationer i rapporten Analysmetod och samhällsekonomiska kalkylvärden för transportsektorn (ASEK-rapporten).

Projektets fyra delmoment syftar till

• att analysera hur morbiditetseffekter av kvävedioxid i sig kan uppskattas med direkta beräkningar
• att studera hur de i ASEK beräknade ohälsokostnaderna för slitageemissioner som PM10 påverkas av senare års resultat om sambanden mellan PM10, slitagepartiklar och mortalitet
• att bedöma vilka effekter av vägtrafikens föroreningar, specifikt kväveoxider och partiklar, på barns hälsa som det finns olika grad av evidens för och hur konsekvenserna kan uppskattas och värderas
• att föreslå en metod att uppskatta kostnader för emissioner genererande exponering för sekundärt bildade partiklar

Background and aims: Climate change affects our societies and lives through our economies, our livelihoods, and our health. Economic losses of climate change are estimated at $23 trillion, largely through externalities due to premature mortality, healthcare expenditure, and health-related work losses. Even if there are established methods to quantify the health economic burden, there is limited information on how people perceive this information. The current study aimed to examine different health cost evaluation methods and observe perceptions of stakeholders in the climate change context.

Method: The participatory research approach of the World Café with 41 participants was applied to explore four topics associated with valuing the costs of climate change. The data were analyzed following an inductive approach.

Results: Despite the willingness-to-pay approach being widely applied, many experts see actual healthcare costs as a more explicit indicator of costs; however, this approach might underestimate actual costs. Participants experienced difficulties accepting and understanding cost estimates that indicated very high externalities as a percentage of gross domestic product. The cost-effectiveness of mitigation and adaptation measures was also challenged by a concern that while the costs of such measures are incurred now, the benefits do not come to fruition until later, for example, when building bike lanes or dams.

Conclusions: Policies should favor environmentally friendly activities such as making cycling more convenient in cities with the health benefits presented in monetary terms, while limiting car driving. Moreover, the public might better understand the costs of climate change via tools that map how solutions influence different sectors and outlining the costs in evaluating the benefits for health and the environment.

Air pollution's short-term effects on a wide range of health outcomes have been studied extensively, primarily focused on vulnerable groups (e.g., children and the elderly). However, the air pollution effects on the adult working population through sick leave have received little attention. This study aims to 1) estimate the associations between particulate matter ≤2.5 μm³ (PM_2.5) and sick leave episodes and 2) calculate the attributable number of sick leave days and the consequential productivity loss in the City of Stockholm, Sweden. Individual level daily sick leave data was obtained from Statistics Sweden for the years 2011–2019. Daily average concentrations of PM_2.5 were obtained from the main urban background monitoring station in Stockholm. A case-crossover study design was applied to estimate the association between short-term PM_2.5 and onset of sick leave episodes. Conditional logistic regression was used to estimate the relative increase in odds of onset per 10 μg/m³ of PM_2.5, adjusting for temperature, season, and pollen. A human capital method was applied to estimate the PM2.5 attributable productivity loss. In total, 1.5 million (M) individual sick leave occurrences were studied. The measured daily mean PM_2.5 concentration was 4.2 μg/m³ (IQR 3.7 μg/m³). The odds of a sick leave episode was estimated to increase by 8.5% (95% CI: 7.8–9.3) per 10 μg/m³ average exposure 2–4 days before. Sub-group analysis showed that private sector and individuals 15–24 years old had a lower increase in odds of sick leave episodes in relation to PM_2.5 exposure. In Stockholm, 4% of the sick leave episodes were attributable to PM_2.5 exposure, corresponding to €17 M per year in productivity loss. Our study suggests a positive association between PM_2.5 and sick leave episodes in a low exposure area.

Few studies have explored the influence of socioeconomic status (SES) on the heat vulnerability of mental health (MH) patients. As individual socioeconomic data was unavailable, we aimed to fill this gap by using the healthcare system type as a proxy for SES. Brazilian national statistics indicate that public patients have lower SES than private. Therefore, we compared the risk of emergency department visits (EDVs) for MH between patients from both healthcare types. EDVs for MH disorders from all nine public (101,452 visits) and one large private facility (154,954) in Curitiba were assessed (2017–2021). Daily mean temperature was gathered and weighed from 3 stations. Distributed-lag non-linear model with quasi-Poisson (maximum 10-lags) was used to assess the risk. We stratified by private and public, age, and gender under moderate and extreme heat. Additionally, we calculated the attributable fraction (AF), which translates individual risks into population-representative burdens – especially useful for public policies. Random-effects meta-regression pooled the risk estimates between healthcare systems. Public patients showed significant risks immediately as temperatures started to increase. Their cumulative relative risk (RR) of MH-EDV was 7.5 % higher than the private patients (Q-Test 26.2 %) under moderate heat, suggesting their particular heat vulnerability. Differently, private patients showed significant risks only under extreme heat, when their RR became 4.3 % higher than public (Q-Test 6.2 %). These findings suggest that private patients have a relatively greater adaptation capacity to heat. However, when faced with extreme heat, their current adaptation means were potentially insufficient, so they needed and could access healthcare freely, unlike their public counterparts. MH patients would benefit from measures to reduce heat vulnerability and access barriers, increasing equity between the healthcare systems in Brazil. AF of EDVs due to extreme heat was 0.33 % (95%CI 0.16;0.50) for the total sample (859 EDVs). This corroborates that such broad population-level policies are urgently needed as climate change progresses.

BACKGROUND: Incident cases of stroke, myocardial infarction, and preterm birth have established exposure-response functions associated with air pollution. However, there are no studies reporting detailed costs per case for these health outcomes that are adapted to the cost-benefit tools that guide the regulation of air pollution.

OBJECTIVES: The primary objective was to establish non-fatal per-case monetary estimates for stroke, myocardial infarction, and preterm birth attributable to air pollution in Sweden, and the secondary objective was to ease the economic evaluation process of air pollution morbidity effects and their inclusion in cost-benefit assessments.

METHODS: Based on recommendations from the literature, the case-cost analysis considered direct and indirect medical costs, as well as production losses and informal costs relevant for the calculation of the net present value. A literature search was conducted to estimate the costs of each category for each incident case in Sweden. Informal costs were estimated using the quality-adjusted life-years approach and the corresponding willingness-to-pay in the Swedish population. The total average per-case cost was estimated based on specific health outcome durations and severity and was discounted by 3.5% per year. Sensitivity analysis included varying discount rates, severity of health outcome, and the range of societal willingness to pay for quality-adjusted life years.

RESULTS: The average net present value cost estimate was €2016 460k (185k-1M) for non-fatal stroke, €2016 24k (16k-38k) for myocardial infarction, and €2016 34k (19k-57k) for late preterm birth. The main drivers of the per-case total cost estimates were health outcome severity and societal willingness to pay for risk reduction. Varying the discount rate had the largest effect on preterm birth, with costs changing by ±30% for the discount rates analysed.

RECOMMENDATION: Because stroke, myocardial infarction, and preterm birth have established exposure-response functions linking these to air pollution, cost-benefit analyses should include the costs for these health outcomes in order to adequately guide future air pollution and climate change policies.

Record-breaking temperatures were recorded across the globe in 2023. Without climate action, adverse climate-related health impacts are expected to worsen worldwide, affecting billions of people. Temperatures in Europe are warming at twice the rate of the global average, threatening the health of populations across the continent and leading to unnecessary loss of life. The Lancet Countdown in Europe was established in 2021, to assess the health profile of climate change aiming to stimulate European social and political will to implement rapid health-responsive climate mitigation and adaptation actions. In 2022, the collaboration published its indicator report, tracking progress on health and climate change via 33 indicators and across five domains.

This new report tracks 42 indicators highlighting the negative impacts of climate change on human health, the delayed climate action of European countries, and the missed opportunities to protect or improve health with health-responsive climate action. The methods behind indicators presented in the 2022 report have been improved, and nine new indicators have been added, covering leishmaniasis, ticks, food security, health-care emissions, production and consumption-based emissions, clean energy investment, and scientific, political, and media engagement with climate and health. Considering that negative climate-related health impacts and the responsibility for climate change are not equal at the regional and global levels, this report also endeavours to reflect on aspects of inequality and justice by highlighting at-risk groups within Europe and Europe's responsibility for the climate crisis.