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Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. However, the effect modification of greenspace on heat-related mortality has been typically focused on a localized area or single country. This study examined the heat-mortality relationship among different greenspace levels in a global setting., This publication was developed under Assistance Agreement No. RD83587101 awarded by the U.S. Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Research reported in this publication was also supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD012769. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Also, this work has been supported by the National Research Foundation of Korea (2021R1A6A3A03038675), Medical Research CouncilUK (MR/V034162/1 and MR/R013349/1), Natural Environment Research Council UK (Grant ID: NE/ R009384/1), Academy of Finland (Grant ID: 310372), European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655 and 874990), Czech Science Foundation (22-24920S), Emory University’s NIEHS-funded HERCULES Center (Grant ID: P30ES019776), and Grant CEX2018-000794-S funded by MCIN/AEI/ 10.13039/501100011033 The funders had no role in the design, data collection, analysis, interpretation of results, manuscript writing, or decision to publication.

Although the health effects of short-term exposure to ambient particles have been well documented, there is a need to update scientific knowledge due to the continuously changing profile of the air pollution mixture. Furthermore the effect of the severe economic crisis in Greece that started in 2008 on previously reported associations has not been studied. We assessed the change in mortality risk associated with short-term exposure to PM10 in Athens, Greece during 2001–12.Time-series data on the daily concentrations of regulated particles and all cause, cardiovascular and respiratory mortality were analyzed using overdispersed Poisson regression models, controlling for time-varying confounders such as seasonality, meteorology, influenza outbreaks, summer holidays and day of the week. We assessed changes in risk over time by inclusion of an interaction term between particles' levels and time or predefined periods, i.e. 2001–07 and 2008–12.While the related mortality risks increased over the analyzed period, the difference before and after 2008 was significant only for total mortality (p-value for interaction .03) and driven by the difference observed among those ≥75 years. An interquartile increase in PM10 before 2008 was associated with 1.51% increase in deaths among ≥75 years (95% Confidence interval (CI): 0.62%, 2.40%), while after 2008 with a 2.61% increase (95%CI: 1.72%, 3.51%) (p-value for interaction .01).Our results indicate that despite the decline in particles' concentration in Athens, Greece during 2001–12 the associated mortality risk has possibly increased, suggesting that the economic crisis initiated in 2008 may have led to changes in the particles' composition due to the ageing of the vehicular fleet and the increase in the use of biomass fuel for heating. Keywords: Air pollution, Mortality risk, Particulate matter, Short-term effects, Trends

Abstract The health effects of acute exposure to temperature extremes are established; those of long-term exposure only recently received attention. We performed a systematic review to assess the associations of long-term (>3 months) exposure to higher or lower temperature on total and cardiopulmonary mortality and morbidity, screening 3455 studies and selecting 34. The studies were classified in those observing associations within a population over years with changing annual temperature indices and those comparing areas with a different climate. We also assessed the risk of bias, adapting appropriately an instrument developed by the World Health Organization for air pollution. Studies reported that annual temperature indices for extremes and variability were associated with annual increases in mortality, indicating that effects of temperature extremes cannot be attributed only to short-term mortality displacement. Studies on cardiovascular mortality indicated stronger associations with cold rather than hot temperature, whilst those on respiratory outcomes reported effects of both heat and cold but were few and used diverse health outcomes. Interactions with air pollution were not generally assessed. The few studies investigating effect modification showed stronger effects among the elderly and those socially deprived. Comparisons of health outcome prevalence between areas reported lower blood pressure and a tendency for higher obesity in populations living in warmer climates. Our review indicated interesting associations between long-term exposure to unusual temperature levels in specific areas and differences in health outcomes and cardiovascular risk factors between geographical locations with different climate, but the number of studies by design and health outcome was small. Risk of bias was identified because of the use of crude exposure assessment and inadequate adjustment for confounding. More and better designed studies, including the investigation of effect modifiers, are needed.

Elevated urban temperatures and heatwaves are a serious threat to the health and wellbeing of the continuously growing urban population and are projected to worsen under climate change. For this reason well-informed disaster risk reduction (DRR) actions, where science and technology play a key role, are required. However insufficient communication between scientific and policy-making communities (known as the science-policy gap) hampers the use of science in DRR. Hence there is a strong need to interpret existing scientific knowledge into actionable knowledge, i.e. science that is useful, usable and used. This article presents a series of services and tools that build-upon existing scientific knowledge and aim to provide actionable knowledge to authorities and citizens for reducing the risks of elevated urban temperatures. The above were implemented in the context of the European Commission’s Thermal Risk rEduction Actions and tools for secURE cities (TREASURE) project, and address many of the goals and priorities for action set in the Sendai framework for disaster risk reduction (SFDRR) of the United Nations. A key policy-making user of the implemented services and tools is the City of Athens in Greece, which is one of the largest metropolitan areas in Europe.

Background It is known that on days with high temperatures higher mortality is observed and there is a minimum mortality temperature (MMT) point which is higher in places with warmer climate. This indicates some population adaptation to local climate but information on how quickly this adaptation will occur under climate change is lacking. Methods To investigate this, we associated daily mortality data with temperature during the warm period in 2004–2013 for London inhabitants born in five climatic zones (UK, Tropical, Sub-tropical, Boreal and Mixed). We fitted Poisson regression with distributed-lag non-linear models for each climatic zone group separately to estimate group-specific exposure-response associations and MMTs. We report relative risks of death comparing the 95th percentile (21 °C) and maximum (25 °C) of the temperature distribution in London with the zone-specific minimum mortality temperature. Results No heat-related mortality was observed for people born in countries with Sub-tropical and Mixed climates. We observed an increase of 26%, 35% and 39% in the risk of death at 25 °C compared to the MMT in people born in the UK (marine climate), Tropical and Boreal climate respectively. The temperatures with the lowest mortality in these groups ranged from 15.9 to 17.7 °C. Discussion Our findings imply that people born in different climatic zones do not adapt fully to their new environment within their lifetime. This implies that populations may not adapt readily to climate change and will suffer increased effects from heat. In the presence of climate change, policy makers should be aware of a delayed process of adaptation.

Legislation controlling vehicle emissions has been credited with a general downward trend in NOx (NO2+NO) concentrations in Europe since the 1990's. However, recent studies suggest that traffic (roadside) (TR) NO2 concentrations have not decreased as expected, and in some cases increased, most likely due to the use of oxidation catalysts and particle filters in diesel vehicles (EURO III, IV, V, VI). In this study we describe the time trends in NOx, NO2 and NO concentrations in 9 European cities comparing TR and urban background (UB) monitoring locations. In each city, we collected hourly city-specific NOx, NO, and NO2 data from one TR and one UB monitoring site for each year. We describe hourly, weekly, seasonal and inter-annual patterns for periods corresponding to the implementation dates of various EURO vehicle emission standards regulating NOx emissions. The diurnal patterns in all 9 cities strongly reflected morning and evening traffic. In addition, lower weekend concentrations were observed. The NOx concentrations from the TR sites remain unchanged in the majority of the cities over the study period. When stratified by 3 time periods according to the implementation of the EURO standards, an increasing NO2/NOx ratio in 7/9 cities with time was noted. However, over the same time period the NO/NO2 ratio decreased in 8/9 cities. A permanent inversion of the NO/NO2 ratio was observed to occur in 2003 in 5/9 cities. Our analyses of temporal and diurnal patterns of NOx in European cities show reductions in concentrations consistent with reductions in primary emissions likely arising from the implementation of successive EURO standards. The generally constant or increasing NO2 concentrations in the majority of the cities assessed over the study period underline the need of further regulative measures to meet the air quality standards and consequently to minimise adverse effects on human health. The ongoing collection and analysis of pollution concentrations across the EU is recommended to monitor trends in pollutants associated with adverse health effects.