Air quality and health co-benefits of climate change mitigation and adaptation actions by 2030: an interdisciplinary modeling study in Ahmedabad, India.

Climate change-driven temperature increases worsen air quality in places where coal combustion powers electricity for air conditioning. Climate solutions that substitute clean and renewable energy in place of polluting coal and promote adaptation to warming through reflective cool roofs can reduce cooling energy demand in buildings, lower power sector carbon emissions, and improve air quality and health. We investigate the air quality and health co-benefits of climate solutions in Ahmedabad, India-a city where air pollution levels exceed national health-based standards-through an interdisciplinary modeling approach. Using a 2018 baseline, we quantify changes in fine particulate matter (PM2.5) air pollution and all-cause mortality in 2030 from increasing renewable energy use (mitigation) and expanding Ahmedabad's cool roofs heat resilience program (adaptation). We apply local demographic and health data and compare a 2030 mitigation and adaptation (M&A) scenario to a 2030 business-as-usual (BAU) scenario (without climate change response actions), each relative to 2018 pollution levels. We estimate that the 2030 BAU scenario results in an increase of PM2.5 air pollution of 4.13 µg m-3 from 2018 compared to a 0.11 µg m-3 decline from 2018 under the 2030 M&A scenario. Reduced PM2.5 air pollution under 2030 M&A results in 1216-1414 fewer premature all-cause deaths annually compared to 2030 BAU. Achievement of National Clean Air Programme, National Ambient Air Quality Standards, or World Health Organization annual PM2.5 Air Quality Guideline targets in 2030 results in up to 6510, 9047, or 17 369 fewer annual deaths, respectively, relative to 2030 BAU. This comprehensive modeling method is adaptable to estimate local air quality and health co-benefits in other settings by integrating climate, energy, cooling, land cover, air pollution, and health data. Our findings demonstrate that city-level climate change response policies can achieve substantial air quality and health co-benefits. Such work can inform public discourse on the near-term health benefits of mitigation and adaptation.

Climate change and 2030 cooling demand in Ahmedabad, India: opportunities for expansion of renewable energy and cool roofs.

Most of India's current electricity demand is met by combustion of fossil fuels, particularly coal. But the country has embarked on a major expansion of renewable energy and aims for half of its electricity needs to be met by renewable sources by 2030. As climate change-driven temperature increases continue to threaten India's population and drive increased demand for air conditioning, there is a need to estimate the local benefits of policies that increase renewable energy capacity and reduce cooling demand in buildings. We investigate the impacts of climate change-driven temperature increases, along with population and economic growth, on demand for electricity to cool buildings in the Indian city of Ahmedabad between 2018 and 2030. We estimate the share of energy demand met by coal-fired power plants versus renewable energy in 2030, and the cooling energy demand effects of expanded cool roof adaptation in the city. We find renewable energy capacity could increase from meeting 9% of cooling energy demand in 2018 to 45% in 2030. Our modeling indicates a near doubling in total electricity supply and a nearly threefold growth in cooling demand by 2030. Expansion of cool roofs to 20% of total roof area (associated with a 0.21 TWh reduction in cooling demand between 2018 and 2030) could more than offset the city's climate change-driven 2030 increase in cooling demand (0.17 TWh/year). This study establishes a framework for linking climate, land cover, and energy models to help policymakers better prepare for growing cooling energy demand under a changing climate.

Climate Change Adaptation: Prehospital Data Facilitate the Detection of Acute Heat Illness in India.

INTRODUCTION: Extreme heat is a significant cause of morbidity and mortality, and the incidence of acute heat illness (AHI) will likely increase secondary to anthropogenic climate change. Prompt diagnosis and treatment of AHI are critical; however, relevant diagnostic and surveillance tools have received little attention. In this exploratory cross-sectional and diagnostic accuracy study, we evaluated three tools for use in the prehospital setting: 1) case definitions; 2) portable loggers to measure on-scene heat exposure; and 3) prevalence data for potential AHI risk factors. METHODS: We enrolled 480 patients who presented to emergency medical services with chief complaints consistent with AHI in Ahmedabad, India, from April-June 2016 in a cross-sectional study. We evaluated AHI case definition test characteristics in reference to trained prehospital provider impressions, compared on-scene heat index measured by portable loggers to weather station measurements, and identified AHI behavioral and environmental risk factors using logistic regression. RESULTS: The case definition for heat exhaustion was 23.8% (12.1-39.5%) sensitive and 93.6% (90.9-95.7%) specific. The positive and negative predictive values were 33.5% (20.8-49.0%) and 90.1% (88.5-91.5%), respectively. Mean scene heat index was 6.7°C higher than the mean station heat index (P < 0.001), and station data systematically underestimated heat exposure, particularly for AHI cases. Heat exhaustion cases were associated with on-scene heat index ≥ 49°C (odds ratio [OR] 2.66 [1.13-6.25], P = 0.025) and a history of recent exertion (OR 3.66 [1.30-10.29], P = 0.014), while on-scene air conditioning was protective (OR 0.29 [0.10-0.85], P = 0.024). CONCLUSION: Systematic collection of prehospital data including recent activity history and presence of air conditioning can facilitate early AHI detection, timely intervention, and surveillance. Scene temperature data can be reliably collected and improve heat exposure and AHI risk assessment. Such data may be important elements of surveillance, clinical practice, and climate change adaptation.

Estimating The Costs Of Inaction And The Economic Benefits Of Addressing The Health Harms Of Climate Change.

National and international assessments have drawn attention to the substantial economic risks of climate change. The costs of climate-sensitive health outcomes responsive to meteorological or seasonal patterns are among the least studied of those risks. In this article we describe how cost valuation analyses that relate climate-sensitive health outcomes to damages in economic terms can illuminate the costs of inaction on the climate crisis and the economic savings of addressing this problem. We identify major challenges to expanding the application of climate-health valuation research and suggest solutions to overcome these obstacles to better characterize the burden of climate-sensitive health outcomes and health disparities. The projected health and economic harms of climate-sensitive risks could be enormous if climate change continues to accelerate and communities are not prepared to reduce or prevent their impact. Expanded valuation of climate-sensitive health outcomes can inform policies that slow climate change and promote stronger investments in health-protective climate change adaptation efforts.

Guidelines for Modeling and Reporting Health Effects of Climate Change Mitigation Actions.

BACKGROUND: Modeling suggests that climate change mitigation actions can have substantial human health benefits that accrue quickly and locally. Documenting the benefits can help drive more ambitious and health-protective climate change mitigation actions; however, documenting the adverse health effects can help to avoid them. Estimating the health effects of mitigation (HEM) actions can help policy makers prioritize investments based not only on mitigation potential but also on expected health benefits. To date, however, the wide range of incompatible approaches taken to developing and reporting HEM estimates has limited their comparability and usefulness to policymakers. OBJECTIVE: The objective of this effort was to generate guidance for modeling studies on scoping, estimating, and reporting population health effects from climate change mitigation actions. METHODS: An expert panel of HEM researchers was recruited to participate in developing guidance for conducting HEM studies. The primary literature and a synthesis of HEM studies were provided to the panel. Panel members then participated in a modified Delphi exercise to identify areas of consensus regarding HEM estimation. Finally, the panel met to review and discuss consensus findings, resolve remaining differences, and generate guidance regarding conducting HEM studies. RESULTS: The panel generated a checklist of recommendations regarding stakeholder engagement: HEM modeling, including model structure, scope and scale, demographics, time horizons, counterfactuals, health response functions, and metrics; parameterization and reporting; approaches to uncertainty and sensitivity analysis; accounting for policy uptake; and discounting. DISCUSSION: This checklist provides guidance for conducting and reporting HEM estimates to make them more comparable and useful for policymakers. Harmonization of HEM estimates has the potential to lead to advances in and improved synthesis of policy-relevant research that can inform evidence-based decision making and practice. https://doi.org/10.1289/EHP6745.

Assessment of Climate-Health Curricula at International Health Professions Schools.

Importance: Researchers have published surveys on health professionals' perceptions of the possible association between climate change and health (climate-health) and assessed climate-health or planetary health curricula in medical schools. However, curricula on climate-health are still lacking and gaps in knowledge persist. Objective: To understand the state of climate-health curricula among health professions institutions internationally. Design, Setting, and Participants: A survey of 160 institutional members of the Global Consortium on Climate and Health Education, which includes international health professions schools and programs, was conducted from August 3, 2017, to March 1, 2018. The survey, hosted by Columbia University Mailman School of Public Health, used an online survey tool for data collection. Main Outcomes and Measures: The survey assessed climate-health curricular offerings across health professions institutions internationally, including existing climate-health educational offerings, method of teaching climate-health education, whether institutions are considering adding climate-health education, whether institutions received a positive response to adding climate-health curricula and/or encountered challenges in adding curricula, and opportunities to advance climate-health education. Results: Overall response rate to the survey was 53%, with 84 of 160 institutional responses collected; 59 of the responses (70%) were from schools/programs of public health, health sciences, or health professions; 15 (18%) were from medicine; 9 (11%) were from nursing; and 1 (1%) was from another type of health profession institution. Among respondents, 53 (63%) institutions offer climate-health education, most commonly as part of a required core course (41 [76%]). Sixty-one of 82 respondents (74%) reported that climate-health offerings are under discussion to add, 42 of 59 respondents (71%) encountered some challenges trying to institute the curriculum, and most respondents have received a positive response to adding content, mainly from students (39 of 58 [67%]), faculty (35 of 58 [60%]), and administration (23 of 58 [40%]). Conclusions and Relevance: Current climate-health educational offerings appear to vary considerably among health professions institutions. Students, faculty, and administration are important groups to engage when instituting curricula, and awareness, support, and resources may be able to assist in this effort.

Temperature-related changes in airborne allergenic pollen abundance and seasonality across the northern hemisphere: a retrospective data analysis.

BACKGROUND: Ongoing climate change might, through rising temperatures, alter allergenic pollen biology across the northern hemisphere. We aimed to analyse trends in pollen seasonality and pollen load and to establish whether there are specific climate-related links to any observed changes. METHODS: For this retrospective data analysis, we did an extensive search for global datasets with 20 years or more of airborne pollen data that consistently recorded pollen season indices (eg, duration and intensity). 17 locations across three continents with long-term (approximately 26 years on average) quantitative records of seasonal concentrations of multiple pollen (aeroallergen) taxa met the selection criteria. These datasets were analysed in the context of recent annual changes in maximum temperature (Tmax) and minimum temperature (Tmin) associated with anthropogenic climate change. Seasonal regressions (slopes) of variation in pollen load and pollen season duration over time were compared to Tmax, cumulative degree day Tmax, Tmin, cumulative degree day Tmin, and frost-free days among all 17 locations to ascertain significant correlations. FINDINGS: 12 (71%) of the 17 locations showed significant increases in seasonal cumulative pollen or annual pollen load. Similarly, 11 (65%) of the 17 locations showed a significant increase in pollen season duration over time, increasing, on average, 0·9 days per year. Across the northern hemisphere locations analysed, annual cumulative increases in Tmax over time were significantly associated with percentage increases in seasonal pollen load (r=0·52, p=0·034) as were annual cumulative increases in Tmin (r=0·61, p=0·010). Similar results were observed for pollen season duration, but only for cumulative degree days (higher than the freezing point [0°C or 32°F]) for Tmax (r=0·53, p=0·030) and Tmin (r=0·48, p=0·05). Additionally, temporal increases in frost-free days per year were significantly correlated with increases in both pollen load (r=0·62, p=0·008) and pollen season duration (r=0·68, p=0·003) when averaged for all 17 locations. INTERPRETATION: Our findings reveal that the ongoing increase in temperature extremes (Tmin and Tmax) might already be contributing to extended seasonal duration and increased pollen load for multiple aeroallergenic pollen taxa in diverse locations across the northern hemisphere. This study, done across multiple continents, highlights an important link between ongoing global warming and public health-one that could be exacerbated as temperatures continue to increase. FUNDING: None.

Estimating the Health-Related Costs of 10 Climate-Sensitive U.S. Events During 2012.

Climate change threatens human health, but there remains a lack of evidence on the economic toll of climate-sensitive public health impacts. We characterize human mortality and morbidity costs associated with 10 climate-sensitive case study events spanning 11 US states in 2012: wildfires in Colorado and Washington, ozone air pollution in Nevada, extreme heat in Wisconsin, infectious disease outbreaks of tick-borne Lyme disease in Michigan and mosquito-borne West Nile virus in Texas, extreme weather in Ohio, impacts of Hurricane Sandy in New Jersey and New York, allergenic oak pollen in North Carolina, and harmful algal blooms on the Florida coast. Applying a consistent economic valuation approach to published studies and state estimates, we estimate total health-related costs from 917 deaths, 20,568 hospitalizations, and 17,857 emergency department visits of $10.0 billion in 2018 dollars, with a sensitivity range of $2.7-24.6 billion. Our estimates indicate that the financial burden of deaths, hospitalizations, emergency department visits, and associated medical care is a key dimension of the overall economic impact of climate-sensitive events. We found that mortality costs (i.e., the value of a statistical life) of $8.4 billion exceeded morbidity costs and lost wages ($1.6 billion combined). By better characterizing health damages in economic terms, this work helps to shed light on the burden climate-sensitive events already place on U.S. public health each year. In doing so, we provide a conceptual framework for broader estimation of climate-sensitive health-related costs. The high health-related costs associated with climate-sensitive events highlight the importance of actions to mitigate climate change and adapt to its unavoidable impacts.

Building Resilience to Climate Change: Pilot Evaluation of the Impact of India's First Heat Action Plan on All-Cause Mortality.

Background: Ahmedabad implemented South Asia's first heat action plan (HAP) after a 2010 heatwave. This study evaluates the HAP's impact on all-cause mortality in 2014-2015 relative to a 2007-2010 baseline. Methods: We analyzed daily maximum temperature (T max)-mortality relationships before and after HAP. We estimated rate ratios (RRs) for daily mortality using distributed lag nonlinear models and mortality incidence rates (IRs) for HAP warning days, comparing pre- and post-HAP periods, and calculated incidence rate ratios (IRRs). We estimated the number of deaths avoided after HAP implementation using pre- and post-HAP IRs. Results: The maximum pre-HAP RR was 2.34 (95%CI 1.98-2.76) at 47°C (lag 0), and the maximum post-HAP RR was 1.25 (1.02-1.53) estimated at 47°C (lag 0). Post-to-pre-HAP nonlagged mortality IRR for T max over 40°C was 0.95 (0.73-1.22) and 0.73 (0.29-1.81) for T max over 45°C. An estimated 1,190 (95%CI 162-2,218) average annualized deaths were avoided in the post-HAP period. Conclusion: Extreme heat and HAP warnings after implementation were associated with decreased summertime all-cause mortality rates, with largest declines at highest temperatures. Ahmedabad's plan can serve as a guide for other cities attempting to increase resilience to extreme heat.

Development of Ahmedabad's Air Information and Response (AIR) Plan to Protect Public Health.

Indian cities struggle with some of the highest ambient air pollution levels in the world. While national efforts are building momentum towards concerted action to reduce air pollution, individual cities are taking action on this challenge to protect communities from the many health problems caused by this harmful environmental exposure. In 2017, the city of Ahmedabad launched a regional air pollution monitoring and risk communication project, the Air Information and Response (AIR) Plan. The centerpiece of the plan is an air quality index developed by the Indian Institute of Tropical Meteorology’s System for Air Quality and Weather Forecasting and Research program that summarizes information from 10 new continuous air pollution monitoring stations in the region, each reporting data that can help people avoid harmful exposures and inform policy strategies to achieve cleaner air. This paper focuses on the motivation, development, and implementation of Ahmedabad’s AIR Plan. The project is discussed in terms of its collaborative roots, public health purpose in addressing the grave threat of air pollution (particularly to vulnerable groups), technical aspects in deploying air monitoring technology, and broader goals for the dissemination of an air quality index linked to specific health messages and suggested actions to reduce harmful exposures. The city of Ahmedabad is among the first cities in India where city leaders, state government, and civil society are proactively working together to address the country’s air pollution challenge with a focus on public health. The lessons learned from the development of the AIR Plan serve as a template for other cities aiming to address the heavy burden of air pollution on public health. Effective working relationships are vital since they form the foundation for long-term success and useful knowledge sharing beyond a single city.

Heat-related mortality in a warming climate: projections for 12 U.S. cities.

Heat is among the deadliest weather-related phenomena in the United States, and the number of heat-related deaths may increase under a changing climate, particularly in urban areas. Regional adaptation planning is unfortunately often limited by the lack of quantitative information on potential future health responses. This study presents an assessment of the future impacts of climate change on heat-related mortality in 12 cities using 16 global climate models, driven by two scenarios of greenhouse gas emissions. Although the magnitude of the projected heat effects was found to differ across time, cities, climate models and greenhouse pollution emissions scenarios, climate change was projected to result in increases in heat-related fatalities over time throughout the 21st century in all of the 12 cities included in this study. The increase was more substantial under the high emission pathway, highlighting the potential benefits to public health of reducing greenhouse gas emissions. Nearly 200,000 heat-related deaths are projected to occur in the 12 cities by the end of the century due to climate warming, over 22,000 of which could be avoided if we follow a low GHG emission pathway. The presented estimates can be of value to local decision makers and stakeholders interested in developing strategies to reduce these impacts and building climate change resilience.

Heat-related mortality in India: excess all-cause mortality associated with the 2010 Ahmedabad heat wave.

INTRODUCTION: In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8 °C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. METHODS: We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1-31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. RESULTS: The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest "summer" months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19-25, 2010), mortality rate ratios were 1.76 [95% CI 1.67-1.83, p<0.001] and 2.12 [95% CI 2.03-2.21] applying reference periods (May 12-18, 2010) from various years. CONCLUSION: The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June.

Development and implementation of South Asia's first heat-health action plan in Ahmedabad (Gujarat, India).

Recurrent heat waves, already a concern in rapidly growing and urbanizing South Asia, will very likely worsen in a warming world. Coordinated adaptation efforts can reduce heat's adverse health impacts, however. To address this concern in Ahmedabad (Gujarat, India), a coalition has been formed to develop an evidence-based heat preparedness plan and early warning system. This paper describes the group and initial steps in the plan's development and implementation. Evidence accumulation included extensive literature review, analysis of local temperature and mortality data, surveys with heat-vulnerable populations, focus groups with health care professionals, and expert consultation. The findings and recommendations were encapsulated in policy briefs for key government agencies, health care professionals, outdoor workers, and slum communities, and synthesized in the heat preparedness plan. A 7-day probabilistic weather forecast was also developed and is used to trigger the plan in advance of dangerous heat waves. The pilot plan was implemented in 2013, and public outreach was done through training workshops, hoardings/billboards, pamphlets, and print advertisements. Evaluation activities and continuous improvement efforts are ongoing, along with plans to explore the program's scalability to other Indian cities, as Ahmedabad is the first South Asian city to address heat-health threats comprehensively.

Climate change and respiratory health: current evidence and knowledge gaps.

Climate change is a key driver of the accelerating environmental change affecting populations around the world. Many of these changes and our response to them can affect respiratory health. This is an expert opinion review of recent peer-reviewed literature, focused on more recent medical journals and climate-health relevant modeling results from non-biomedical journals pertaining to climate interactions with air pollution. Global health impacts in low resource countries and migration precipitated by environmental change are addressed. The major findings are of respiratory health effects related to heat, air pollution, shifts in infectious diseases and allergens, flooding, water, food security and migration. The review concludes with knowledge gaps and research need that will support the evidence-base required to address the challenges ahead.