Remeasuring the influence of ageing on heat-related mortality in Spain, 1980 to 2018.

Climate change and population ageing are converging challenges that are expected to significantly worsen the health impacts of high temperatures. We aimed to remeasure the implications of ageing for heat-related mortality by comparing time trends based on chronological age (number of years already lived) with those derived from the application of state-of-the-art demographic methodology which better captures the dynamics of evolving longevity: prospective age (number of years still to be lived). We conducted a nationwide time-series analysis of 13 regions in Spain over 1980-2018 using all-cause mortality microdata for people aged 65+ and annual life tables from the Spanish National Institute of Statistics, and daily mean temperatures from E-OBS. Based on confounder-adjusted quasi-Poisson regression with distributed lag non-linear models and multivariate meta-analysis in moving 15-year timeslices, we assessed sex-specific changes in absolute risk and impacts for heat-related mortality at extreme and moderate temperatures, for chronological and prospective age groups. In the conventional chronological age analysis, absolute risk fell over the study period (e.g. females, extreme heat: -54%; moderate heat: -23%); after accounting for rising longevity, the prospective age analysis, however, found a smaller decline in risk for extreme heat (-15%) and a rise for moderate heat (+46%). Additionally, while the chronological age analysis suggested a shift in mortality towards higher ages, the prospective age analysis showed that over the study period, people of largely the same (prospective) age were impacted. Further, the prospective age analysis revealed excess risk in females (compared to males) rose from 20% to 27% for extreme heat, and from 40% to 70% for moderate heat. Assessing the implications of ageing using a prospective age perspective showed the urgency of re-doubling risk reduction efforts, including accelerating healthy ageing programs that incorporate climate considerations. The age patterns of impacts suggested that such actions have the potential to mitigate ageing-related heat-health threats to generate climate change-ready, healthy societies.

The Direct and Indirect Influences of Interrelated Regional-Level Sociodemographic Factors on Heat-Attributable Mortality in Europe: Insights for Adaptation Strategies.

BACKGROUND: Heat is a significant cause of mortality, but impact patterns are heterogenous. Previous studies assessing such heterogeneity focused exclusively on risk rather than heat-attributable mortality burdens and assume predictors are independent. OBJECTIVES: We assessed how four interrelated regional-level sociodemographic predictors-education, life expectancy, the ratio of older to younger people (aging index), and relative income-influence heterogeneity in heat-attributable mortality burdens in Europe and then derived insights into adaptation strategies. METHODS: We extracted four outcomes from a temperature-mortality study covering 16 European countries: the rate of increase in mortality risk at moderate and extreme temperatures (moderate and extreme slope, respectively), the minimum mortality temperature percentile (MMTP), and the underlying mortality rate. We used structural equation modeling with country-level random effects to quantify the direct and indirect influences of the predictors on the outcomes. RESULTS: Higher levels of education were directly associated with lower heat-related mortality at moderate and extreme temperatures via lower slopes and higher MMTPs. A one standard deviation increase in education was associated with a -0.46±0.14, -0.41±0.12, and 0.41±0.12 standard deviation (±standard error) change in the moderate slope, extreme slope, and MMTP, respectively. However, education had mixed indirect influences via associations with life expectancy, the aging index, and relative income. Higher life expectancy had mixed relations with heat-related mortality, being associated with higher risk at moderate temperatures (0.33±0.11 for the moderate slope; -0.19±0.097 for the MMTP) but lower underlying mortality rates (-0.72±0.097). A higher aging index was associated with higher burdens through higher risk at extreme temperatures (0.13±0.072 for the extreme slope) and higher underlying mortality rates (0.93±0.055). Relative income had relatively small, mixed influences. DISCUSSION: Our novel approach provided insights into actions for reducing the health impacts of heat. First, the results show the interrelations between possible vulnerability-generating mechanisms and suggest future research directions. Second, the findings point to the need for a dual approach to adaptation, with actions that explicitly target heat exposure reduction and actions focused explicitly on the root causes of vulnerability. For the latter, the climate crisis may be leveraged to accelerate ongoing general public health programs. https://doi.org/10.1289/EHP11766.

The relative importance of women's education on fertility desires in sub-Saharan Africa: A multilevel analysis.

Lowering desired family size is a necessary precondition for fertility declines in high-fertility settings. Although accumulated evidence links socio-economic developments to changing fertility desires, little research has disentangled the relative importance of key socio-economic determinants. Combining individual- and community-level data from Demographic and Health Surveys in 34 sub-Saharan African (SSA) countries, we compare the relative role of different socio-economic factors on fertility desires at the individual, community, and country levels. Results show that at the individual level, women's education has a stronger effect than household wealth and area of residence. The high levels of reported desired family size in rural parts of SSA are mainly a consequence of relatively lower levels of education. The relative impact of women's education is even stronger at the community level. Our findings are robust to alternative measures of fertility preferences and strengthen previous findings regarding the relationship between fertility and women's education.

Years of good life is a well-being indicator designed to serve research on sustainability.

Sustainable development (SD) as popularized by the Brundtland Commission and politically enshrined in the Sustainable Development Goals has been the explicit focus of sustainability science. While there is broad agreement that the trend of human well-being (W) over time should serve as a sustainability criterion, the literature so far has mostly addressed this in terms of its determinants rather than focusing on W itself. There is broad agreement that an indicator for W should have multiple constituents, clearly going beyond gross domestic product. Here, we propose a tailor-made indicator to serve precisely this purpose following a set of specified desiderata, including its applicability to flexibly defined subnational populations by gender, place of residence, ethnicity, and other relevant characteristics. The indicator, years of good life (YoGL), reflects the evident fact that in order to be able to enjoy any quality of life, one has to be alive and thus is primarily based on life expectancy. However, since mere survival is not considered good enough, life years are counted conditional on meeting minimum standards in two dimensions: the objective dimension of capable longevity (consisting of being out of absolute poverty and enjoying minimal levels of physical and cognitive health) and the subjective dimension of overall life satisfaction. We illustrate the calculation of this indicator for countries and subpopulations at different stages of development and with different degrees of data availability.

Education rather than age structure brings demographic dividend.

The relationship between population changes and economic growth has been debated since Malthus. Initially focusing on population growth, the notion of demographic dividend has shifted the attention to changes in age structures with an assumed window of opportunity that opens when falling birth rates lead to a relatively higher proportion of the working-age population. This has become the dominant paradigm in the field of population and development, and an advocacy tool for highlighting the benefits of family planning and fertility decline. While this view acknowledges that the dividend can only be realized if associated with investments in human capital, its causal trigger is still seen in exogenous fertility decline. In contrast, unified growth theory has established human capital as a trigger of both demographic transition and economic growth. We assess the relative importance of changing age structure and increasing human capital for economic growth for a panel of 165 countries during the time period of 1980-2015. The results show a clear dominance of improving education over age structure and give evidence that the demographic dividend is driven by human capital. Declining youth dependency ratios even show negative impacts on income growth when combined with low education. Based on a multidimensional understanding of demography that considers education in addition to age, and with a view to the additional effects of education on health and general resilience, we conclude that the true demographic dividend is a human capital dividend. Global population policies should thus focus on strengthening the human resource base for sustainable development.

Human Capital, Values, and Attitudes of Persons Seeking Refuge in Austria in 2015.

Since its inception in 2010, the Arab Spring has evolved into a situation of violent conflict in many countries, leading to high levels of migration from the affected region. Given the social impact of the large number of individuals applying for asylum across Europe in 2015, it is important to study who these persons are in terms of their skills, motivations, and intentions. DiPAS (Displaced Persons in Austria Survey) aims to uncover the socio-demographic characteristics of the persons seeking refuge who arrived in Austria in 2015, mainly originating from Syria, Iraq and Afghanistan. Particular focus is on human capital, attitudes and values. This survey, the first of its kind in Austria and possibly in Europe, was carried out among adult displaced persons, mostly residing in Vienna, yielding 514 completed interviews. Information gathered on spouses and children allows for the analysis of 972 persons living in Austria, and of further 419 partners and children abroad. Results indicate that the surveyed population comprised mainly young families with children, particularly those coming from Syria and Iraq. Their educational level is high compared with the average level in their country of origin. A vast majority of respondents are Muslims, rating their religiosity at medium levels. Judging from stated attitudes towards gender equity, interviewed men seem to have more liberal attitudes than their compatriots. The majority of respondents do not intend to return to their home countries, mostly because of the perception of permanent threat. DiPAS provides data for political decision-making and the on-going societal dialogue. Its findings can help to inform assessments about the integration potential of the displaced population into the host society. In addition, the applied methodological technique and experiences during the fieldwork provide valuable insights on sampling asylum seekers and refugees in the current European context.

Demographic aspects of climate change mitigation and adaptation.

This paper addresses the contribution of changes in population size and structures to greenhouse gas emissions and to the capacity to adapt to climate change. The paper goes beyond the conventional focus on the changing composition by age and sex. It does so by addressing explicitly the changing composition of the population by level of educational attainment, taking into account new evidence about the effect of educational attainment in reducing significantly the vulnerability of populations to climatic challenges. This evidence, which has inspired a new generation of socio-economic climate change scenarios, is summarized. While the earlier IPCC-SRES (Intergovernmental Panel on Climate Change-Special Report on Emissions Scenarios) scenarios only included alternative trajectories for total population size (treating population essentially as a scaling parameter), the Shared Socio-economic Pathways (SSPs) in the new scenarios were designed to capture the socio-economic challenges to climate change mitigation and adaptation, and include full age, sex, and education details for all countries.

Effects on well-being of investing in cleaner air in India.

Over the past decade, India has experienced rapid economic growth along with increases in levels of air pollution. Our goal is to examine how alternative policies for air pollution abatement affect well-being there. In particular, we estimate the effects of policies to reduce the levels of ambient fine particulates (PM2.5), which are especially harmful to human health, on well-being, quantified using the United Nations' human development index (HDI). Two of the three dimensions of this index are based on gross domestic product (GDP) per capita and life expectancy. Our approach allows reductions in PM2.5 to affect both of them. In particular, economic growth is affected negatively through the costs of the additional pollution control measures and positively through the increased productivity of the population. We consider three scenarios of PM2.5 abatement, corresponding to no further control, current Indian legislation, and current European legislation. The overall effect in both control scenarios is that growth in GDP is virtually unaffected relative to the case of no further controls, life expectancy is higher, and well-being, as measured by the HDI, is improved. In India, air pollution abatement investments clearly improve well-being.