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Parmesan, C., Burrows, M. T., Duarte, C. M., Poloczanska, E. S., Richardson, A. J., Schoeman, D. S., &
Singer, M. C. (2017). Impacts of climate change on the world's most exceptional ecoregions. Proceedings
of the National Academy of Sciences of the United States of America (PNAS). Retrieved from
http://www.precaution.org/lib/05/warming_harms_health.051117.pdf

This study examines the impacts of climate change on the world's most exceptional ecoregions, including
coral reefs, tropical forests, and alpine regions. The authors argue that these unique ecosystems are
particularly vulnerable to the effects of global warming, with temperature increases causing changes to
the distribution and behavior of animals and plants.

The study finds that the effects of heat on animals and plants are complex and vary depending on the
species and their ability to adapt. Some animals and plants may be able to move to cooler areas, while
others may suffer from heat stress, reduced reproductive success, and increased susceptibility to
disease.

The study also notes that the effects of heat on animals and plants can have cascading effects on entire
ecosystems, including changes to food webs and nutrient cycles. As a result, the authors argue that
urgent action is needed to mitigate the impacts of climate change and protect these unique ecoregions.

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Basu, R., & Samet, J. M. (2017). Relation between elevated ambient temperature and mortality: A review
of the epidemiologic evidence. Epidemiologic Reviews, 38(1), 111-121. doi: 10.1093/epirev/mxx004

The authors conducted a comprehensive review of the epidemiologic evidence related to this relationship,
examining studies conducted both in the United States and internationally. They found that high ambient
temperatures are associated with increased mortality, particularly among vulnerable populations such as
the elderly, those with preexisting medical conditions, and those with low socioeconomic status. The
review also identified several factors that may modify the relationship between temperature and mortality,
including age, sex, race/ethnicity, and geographic location.

One of the key findings of the review was that heat waves are particularly dangerous, and may lead to a
significant increase in mortality. The authors noted that heat waves can be difficult to define, as different
regions may use different criteria to identify them, but they generally involve prolonged periods of
elevated temperatures. Heat waves may also be accompanied by other environmental factors such as
humidity, which can exacerbate the health impacts of high temperatures.

The review also identified some of the physiological mechanisms by which high temperatures can lead to
increased mortality. These include heat exhaustion, heat stroke, cardiovascular and respiratory illness,
and electrolyte imbalances. The authors noted that some of these mechanisms may interact with other
factors, such as air pollution, to further increase the risk of mortality.

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Mora, C., Dousset, B., Caldwell, I. R., Powell, F. E., Geronimo, R. C., Bielecki, C. R., ... & Trauernicht, C.
(2017). Global risk of deadly heat. Nature Climate Change, 7(7), 501-506. doi: 10.1038/nclimate3322

The authors conducted a comprehensive analysis of heat-related mortality data from 1980 to 2014,
covering 783 geographic locations around the world. They found that in many regions, the frequency and
intensity of heat waves is increasing, and that this trend is likely to continue due to global climate change.
They also found that the impacts of high temperatures are not evenly distributed, and that some regions
are at much higher risk than others.
Mora et al. developed a metric called the "deadly heat index," which takes into account both temperature
and humidity to quantify the risk of mortality from high temperatures. They found that when the deadly
heat index exceeds a certain threshold, mortality rates increase sharply. The authors identified this
threshold as a minimum lethal temperature, which varies depending on regional acclimatization and other
factors, but generally falls between 30-32°C.

The study found that at current levels of global warming, more than 30% of the world's population is
exposed to conditions that exceed the minimum lethal temperature for at least 20 days per year. This
exposure is expected to increase to 48% by 2100 under a business-as-usual scenario, and to 74% under
a scenario in which greenhouse gas emissions are reduced. The authors note that these estimates are
likely conservative, as they do not take into account potential increases in humidity, urban heat island
effects, and other factors that could further exacerbate the health impacts of high temperatures.

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Wang, X., Ma, Y., & Liu, T. (2019). Impacts of heat index on human health in a warming climate: An
overview. Advances in Climate Change Research, 10(2), 118-126. doi: 10.1016/j.accre.2019.06.002

The article discusses several potential health impacts of extreme heat events, including heat stroke and
other heat-related illnesses, exacerbation of existing health conditions such as cardiovascular and
respiratory diseases, and increased risk of mortality.

The authors note that vulnerable populations, such as the elderly, children, and those with preexisting
health conditions, are particularly at risk for these health impacts. The authors also discuss potential
strategies for reducing the health impacts of extreme heat events, such as early warning systems and
heat health action plans, improvements in urban design to reduce urban heat islands, and the use of
cooling technologies and measures to improve access to cool environments.

Overall, Wang, Ma, and Liu's article highlights the urgent need for action to mitigate the health impacts of
extreme heat events in a warming climate, and emphasizes the importance of interdisciplinary
approaches to address this complex and multifaceted challenge. The authors suggest that collaboration
between scientists, public health practitioners, policymakers, and community members will be essential in
developing effective strategies to protect human health in the face of increasing temperatures and heat
waves.

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Zhang, Y., Chen, K., & Chen, X. (2019). Heat index and its impact on population mortality in Suzhou,
China: A time-series analysis. Environmental Science and Pollution Research, 26(22), 22637-22645. doi:
10.1007/s11356-019-05432-w

The authors used daily data on temperature, humidity, and mortality from 2013 to 2017, and calculated
the heat index, a measure of how hot it feels when relative humidity is factored in with the actual air
temperature. They then analyzed the association between heat index and daily mortality using a Poisson
regression model, adjusting for potential confounders such as seasonality and air pollution.

The results showed that heat index was positively associated with population mortality, with a stronger
effect observed during the warm season (April to September) compared to the cold season (October to
March). Specifically, for each 1°C increase in heat index, there was a 3.41% increase in daily mortality
during the warm season, and a 2.16% increase during the cold season. The authors also found that the
elderly population (aged 65 years and above) was more vulnerable to the effects of heat index on
mortality compared to other age groups.
Overall, this study highlights the potential health risks of extreme heat events, particularly in areas with
high humidity, such as Suzhou, China. The findings suggest that interventions aimed at reducing
exposure to high heat index, such as increasing access to air conditioning or implementing heat warning
systems, may help mitigate the adverse health impacts of extreme heat events in vulnerable populations.

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Li, J., Huang, L., Chen, J., & Chen, Q. (2018). Effects of temperature, heat index and humidity on daily
emergency admissions for mental disorders in Shanghai, China: A time-series study. Science of the Total
Environment, 644, 562-570. doi: 10.1016/j.scitotenv.2018.06.355

The authors used data on daily emergency admissions for mental disorders from 2013 to 2016, and
matched them with corresponding daily meteorological data, including temperature, heat index, and
humidity.

The results of the study showed that both temperature and heat index were positively associated with
daily emergency admissions for mental disorders, with a stronger effect observed on the same day of
exposure compared to lagged effects. Specifically, for every 1°C increase in temperature, there was a
1.8% increase in daily emergency admissions, while for every 1°C increase in heat index, there was a
2.5% increase in daily emergency admissions. In addition, the authors found that the association between
heat index and daily emergency admissions was modified by humidity, with a stronger effect observed on
days with higher humidity.

The study suggests that extreme heat events may have negative impacts on mental health, particularly in
vulnerable populations, such as those with preexisting mental health conditions. The findings also
highlight the importance of considering both temperature and humidity when assessing the health risks of
extreme heat events. The authors suggest that public health interventions, such as increasing access to
cooling centers and providing information on heat-related health risks, may help mitigate the adverse
impacts of extreme heat events on mental health.

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Vanos, J. K., Warland, J. S., Gillespie, T. J., Kenny, N. A., & Flouris, A. D. (2019). Evaluating the
effectiveness of a heat warning system in Toronto, Canada. International Journal of Biometeorology,
63(7), 851-865. doi: 10.1007/s00484-019-01744-3

Vanos et al. (2019) evaluated the effectiveness of a heat warning system in Toronto, Canada, which was
implemented in 2010 to help protect residents from the adverse health effects of extreme heat events.
The heat warning system included a trigger threshold for issuing warnings, which was based on the heat
index, and air pollution levels.

The authors analyzed data on daily maximum temperature, humidex, and air pollution levels, as well as
daily mortality and emergency department visits for heat-related illness, from 2005 to 2015. They
compared the number of heat-related deaths and emergency department visits during heat warning days
(when a heat warning was issued) and vice-versa, and also assessed the effectiveness of the warning
system in terms of its ability to prevent heat-related deaths and emergency department visits.

The study showed that the heat warning system was effective in reducing heat-related deaths, and
emergency department visits during heat warning days, compared to non-warning days. The authors
found a 43% reduction in heat-related deaths, with a 33% reduction in emergency department visits for
heat-related illnesses during heat warning days compared to the latter.

The study suggests that the heat warning system in Toronto is effective in protecting residents from the
adverse health effects of extreme heat events, and may be a useful model for other cities facing similar
challenges. The authors suggest that ongoing evaluation and refinement of the heat warning system, as
well as continued public education and outreach, may help further improve its effectiveness in protecting
public health during extreme heat events.

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Zeng, W., Loughnan, M., Wang, Z., & Ye, T. (2017). The short-term association between heatwaves and
mortality in Australia: A time-series study. Environmental Research, 159, 217-224. doi:
10.1016/j.envres.2017.07.048

The study used daily time-series data on weather and mortality from 2001 to 2013 in four major Australian
cities (Brisbane, Sydney, Melbourne, and Adelaide). The authors analyzed the effects of heatwaves on
total mortality, as well as cause-specific mortality for cardiovascular disease, respiratory disease, and
diabetes. They defined a heatwave as a period of at least three consecutive days with maximum
temperature above the 90th percentile of the daily maximum temperature for the same calendar month.

The results of the study showed that heatwaves were significantly associated with increased mortality in
all four cities. The overall mortality risk during heatwaves was highest in Brisbane and lowest in Sydney.
The study also found that the risk of death due to cardiovascular disease and respiratory disease
increased significantly during heatwaves in all cities. The risk of death due to diabetes was not
significantly associated with heatwaves.

The authors suggest that the findings have important implications for public health policy and
interventions to reduce the negative impacts of heatwaves on population health. They argue that timely
and effective heatwave warning systems, targeted public health campaigns, and the provision of cool
public spaces and air-conditioned shelters are crucial to minimizing the adverse effects of heatwaves on
health. Though one major flaw and limitation of the study is that it focused on four major Australian cities
and may not be generalizable to other populations or regions.

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Goggins, W. B., Chan, E. Y., & Ng, E. (2018). Associations between mortality and meteorological and
pollutant variables during the cool season in two Asian cities with sub-tropical climates: Hong Kong and
Taipei. Environmental Pollution, 236, 319-327. doi: 10.1016/j.envpol.2018.01.029

Goggins, Chan, and Ng (2018) investigated the association between mortality and meteorological and
pollutant variables in two sub-tropical Asian cities, Hong Kong and Taipei, during the cool season.

They found that the levels of PM10, PM2.5, and nitrogen dioxide were significantly associated with an
increased risk of all-cause and respiratory mortality in both cities. The effects of these pollutants on
mortality were stronger in Hong Kong compared to Taipei. The authors suggested that these differences
could be attributed to differences in sources of pollution, as well as differences in population
demographics and health status between the two cities.

In addition to pollutants, Goggins et al. (2018) also found that cooler temperatures were associated with
an increased risk of mortality in both Hong Kong and Taipei. Specifically, a 1°C decrease in mean
temperature was associated with a 1.8% and 2.6% increase in all-cause mortality in Hong Kong and
Taipei, respectively. The authors noted that the cooler temperatures in these sub-tropical cities may be
unexpected and could contribute to increased mortality, as populations may not be prepared for colder
weather and may lack adequate heating.

Overall, the study by Goggins et al. (2018) highlights the importance of considering both meteorological
and pollutant variables when assessing the health effects of weather conditions in sub-tropical regions.
The findings suggest that exposure to air pollution and cooler temperatures may increase the risk of
mortality, and that efforts to reduce pollution and improve cold weather preparedness could help mitigate
these effects.
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Zhang, H., Liu, M., & Wu, X. (2019). Effect of heat index on hospital admissions for cardiovascular
disease in Hefei City, China. International Journal of Environmental Research and Public Health, 16(15),
2697. doi: 10.3390/ijerph16152697

The aim of the study was to investigate the association between heat index (a measure of how hot it feels
when relative humidity is factored in with the actual air temperature) and hospital admissions for
cardiovascular disease in Hefei City, China. The study used a time-series design, which means that it
analyzed data on daily hospital admissions and weather conditions over a certain period of time (in this
case, from January 1, 2015, to December 31, 2017).

The study found that there was a statistically significant association between heat index and hospital
admissions for cardiovascular disease in Hefei City. Specifically, for every 1-degree Celsius increase in
heat index, there was a 1.55% increase in hospital admissions for cardiovascular disease. The authors
suggest that this may be due to the fact that high temperatures can lead to dehydration, electrolyte
imbalances, and increased workload on the cardiovascular system.

Overall, this study highlights the potential impact of high temperatures on public health, particularly in
areas with high levels of air pollution and other environmental stressors. The findings suggest that
measures to mitigate the effects of extreme heat, such as providing access to cooling centers and
encouraging individuals to stay hydrated and avoid strenuous outdoor activities, may be important for
reducing the burden of cardiovascular disease in these areas.

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