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Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat., Competing Interests: Declaration of interests OJ reports grants from Tennis Australia, Cricket Australia, National Health and Medical Research Council, Multiple Sclerosis Australia, and Wellcome Trust, outside the submitted work. AC reports grants from the New South Wales Department of Planning, Industry, and Environment and National Health and Medical Research Council during the conduct of the study. JV reports Speaker Honorariums from Northern Arizona University, Climate 2020: Seven Generations for Arizona (Flagstaff, AZ, USA) in November, 2019 and Aquarium of the Pacific, The Effects of Earth's Health on Human Health (Long Beach, CA, USA) in March, 2020. All other authors have no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects. However, excess deaths and many heat-related health risks are preventable, with appropriate heat action plans involving behavioural strategies and biophysical solutions. Extreme heat events are becoming permanent features of summer seasons worldwide, causing many excess deaths. Heat-related morbidity and mortality are projected to increase further as climate change progresses, with greater risk associated with higher degrees of global warming. Particularly in tropical regions, increased warming might mean that physiological limits related to heat tolerance (survival) will be reached regularly and more often in coming decades. Climate change is interacting with other trends, such as population growth and ageing, urbanisation, and socioeconomic development, that can either exacerbate or ameliorate heat-related hazards. Urban temperatures are further enhanced by anthropogenic heat from vehicular transport and heat waste from buildings. Although there is some evidence of adaptation to increasing temperatures in high-income countries, projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase., Competing Interests: Declaration of interests AC reports grants from the New South Wales Department of Planning, Industry, and Environment and National Health and Medical Research Council during the conduct of the study. OJ reports grants from Tennis Australia, Cricket Australia, National Health and Medical Research Council, Multiple Sclerosis Australia, and Wellcome Trust, outside the submitted work. JV reports speaker honorariums from Northern Arizona University, Climate 2020: Seven Generations for Arizona—Flagstaff, AZ, November, 2019, and Aquarium of the Pacific, The Effects of Earth's Health on Human Health, Long Beach, CA, March, 2020. All other authors have no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Extreme weather and climate events, such as heat waves, cyclones, and floods, are an expression of climate variability. These events and events influenced by climate change, such as wildfires, continue to cause significant human morbidity and mortality and adversely affect mental health and well-being. Although adverse health impacts from extreme events declined over the past few decades, climate change and more people moving into harm's way could alter this trend. Long-term changes to Earth's energy balance are increasing the frequency and intensity of many extreme events and the probability of compound events, with trends projected to accelerate under certain greenhouse gas emissions scenarios. While most of these events cannot be completely avoided, many of the health risks could be prevented through building climate-resilient health systems with improved risk reduction, preparation, response, and recovery. Conducting vulnerability and adaptation assessments and developing health system adaptation plans can identify priority actions to effectively reduce risks, such as disaster risk management and more resilient infrastructure. The risks are urgent, so action is needed now.

The aim of building climate resilient and environmentally sustainable health care facilities is: (a) to enhance their capacity to protect and improve the health of their target communities in an unstable and changing climate; and (b) to empower them to optimize the use of resources and minimize the release of pollutants and waste into the environment. Such health care facilities contribute to high quality of care and accessibility of services and, by helping reduce facility costs, also ensure better affordability. They are an important component of universal health coverage. Action is needed in at least four areas which are fundamental requirements for providing safe and quality care: having adequate numbers of skilled human resources, with decent working conditions, empowered and informed to respond to these environmental challenges; sustainable and safe management of water, sanitation and health care waste; sustainable energy services; and appropriate infrastructure and technologies, including all the operations that allow for the efficient functioning of a health care facility. Importantly, this work contributes to promoting actions to ensure that health care facilities are constantly and increasingly strengthened and continue to be efficient and responsive to improve health and contribute to reducing inequities and vulnerability within their local settings. To this end, we propose a framework to respond to these challenges.

Climate change impacts on the Canadian food system pose risks to human health. Little attention has been paid to the climate change, food security, and human health nexus, resulting in a number of knowledge gaps regarding food system components that are most vulnerable to climate change. The lack of understanding of key dynamics and possible future impacts challenges the ability of public health officials and partners in other sectors to prepare Canadians for future health risks. A series of literature reviews were conducted to establish the relationship between climate change, food security, and human health, and to identify vulnerabilities within the Canadian food system. Evidence suggests that key activities within the food system are vulnerable to climate change. The pathways in which climate change impacts travel through the food system and affect the critical dimensions of food security to influence human health outcomes are complex. Climate-related disruptions in the food system can indirectly impact human health by diminishing food security, which is a key determinant of health. Human health may also be directly affected by the physical effects of climate change on the food system, primarily related to the impacts on nutrition and foodborne illnesses. In this study, we propose a novel analytical framework to study and respond to the climate change, food security, and human health nexus. This work is intended to help public health officials, researchers, and relevant stakeholders investigate and understand current and future risks, and inform adaptation efforts to protect the health of Canadians.

Climate change is increasing risks to the mental health of Canadians. Impacts from a changing climate may outstrip the ability of Canadians and their health-sustaining institutions to adapt effectively and could increase poor mental health outcomes, particularly amongst those most marginalized in society. A scoping review of literature published during 2000-2017 explored risks, impacts, and vulnerabilities related to climate change and mental health. In this commentary, the authors present a new assessment of evidence from this scoping review and highlight factors that influence the capacity to adapt to the mental health consequences of a changing climate. Findings from this assessment reveal eleven key factors that influence the capacity to adapt: social capital; sense of community; government assistance; access to resources; community preparedness; intersectoral/transdisciplinary collaboration; vulnerability and adaptation assessments; communication and outreach; mental health literacy; and culturally relevant resources. Attention to these factors by Canadian decision makers can support proactive and effective management of the mental health consequences of climate change., Competing Interests: The authors declare no conflict of interest.

A climate change and health vulnerability and adaptation assessment was conducted in Dominica, a Caribbean small island developing state located in the Lesser Antilles. The assessment revealed that the country's population is already experiencing many impacts on health and health systems from climate variability and change. Infectious diseases as well as food and waterborne diseases pose continued threats as climate change may exacerbate the related health risks. Threats to food security were also identified, with particular concern for food production systems. The findings of the assessment included near-term and long-term adaptation options that can inform actions of health sector decision-makers in addressing health vulnerabilities and building resilience to climate change. Key challenges include the need for enhanced financial and human resources to build awareness of key health risks and increase adaptive capacity. Other small island developing states interested in pursuing a vulnerability and adaptation assessment may find this assessment approach, key findings, analysis, and lessons learned useful.

Climate change is increasing risks to human health and to the health systems that seek to protect the safety and well-being of populations. Health authorities require information about current associations between health outcomes and weather or climate, vulnerable populations, projections of future risks and adaptation opportunities in order to reduce exposures, empower individuals to take needed protective actions and build climate-resilient health systems. An increasing number of health authorities from local to national levels seek this information by conducting climate change and health vulnerability and adaptation assessments. While assessments can provide valuable information to plan for climate change impacts, the results of many studies are not helping to build the global evidence-base of knowledge in this area. They are also often not integrated into adaptation decision making, sometimes because the health sector is not involved in climate change policy making processes at the national level. Significant barriers related to data accessibility, a limited number of climate and health models, uncertainty in climate projections, and a lack of funding and expertise, particularly in developing countries, challenge health authority efforts to conduct rigorous assessments and apply the findings. This paper examines the evolution of climate change and health vulnerability and adaptation assessments, including guidance developed for such projects, the number of assessments that have been conducted globally and implementation of the findings to support health adaptation action. Greater capacity building that facilitates assessments from local to national scales will support collaborative efforts to protect health from current climate hazards and future climate change. Health sector officials will benefit from additional resources and partnership opportunities to ensure that evidence about climate change impacts on health is effectively translated into needed actions to build health resilience.

Vulnerability and adaptation assessments can provide valuable input to foster climate-resilient health systems. However, these assessments often do not explore the potential health risks of climate change far outside the range of recent experience with extreme weather events and other climate-related hazards. Climate and health stress tests are designed to increase the capacity of health systems and related sectors to manage potentially disruptive climate-related shocks and stresses. Stress tests focus on hypothetical scenarios, during which it would be difficult for the health system to maintain its essential function of providing services to protect population health. The stress test explores approaches to effectively manage acute and chronic climate-related events and conditions that could directly impact health systems, and climate-related events in non-health sectors that can indirectly impact health outcomes and/or health system function. We provide detailed methods and guidance for conducting climate and health stress tests, centering on three primary activities: (1) preparing and scoping the stress test; (2) successfully conducting the stress test; and (3) communicating the results to key stakeholders to facilitate policy and programmatic reforms.

Extreme weather events have revealed the vulnerability of health care facilities and the extent of devastation to the community when they fail. With climate change anticipated to increase extreme weather and its impacts worldwide-severe droughts, floods, heat waves, and related vector-borne diseases-health care officials need to understand and address the vulnerabilities of their health care systems and take action to improve resiliency in ways that also meet sustainability goals. Generally, the health sector is among a country's largest consumers of energy and a significant source of greenhouse gas emissions. Now it has the opportunity lead climate mitigation, while reducing energy, water, and other costs. This Special Report summarizes several initiatives and compares three toolkits for implementing sustainability and resiliency measures for health care facilities: the Canadian Health Care Facility Climate Change Resiliency Toolkit, the U.S. Sustainable and Climate Resilient Health Care Facilities Toolkit, and the PAHO SMART Hospitals Toolkit of the World Health Organization/Pan American Health Organization. These tools and the lessons learned can provide a critical starting point for any health system in the Americas.

Droughts have been recorded all across Canada and have had significant impacts on individuals and communities. With climate change, projections suggest an increasing risk of drought in Canada, particularly in the south and interior. However, there has been little research on the impacts of drought on human health and the implications of a changing climate. A review of the Canadian, U.S. and international literature relevant to the Canadian context was conducted to better define these impacts and adaptations available to protect health. Drought can impact respiratory health, mental health, illnesses related to exposure to toxins, food/water security, rates of injury and infectious diseases (including food-, water- and vector-borne diseases). A range of direct and indirect adaptation (e.g., agricultural adaptation) options exist to cope with drought. Many have already been employed by public health officials, such as communicable disease monitoring and surveillance and public education and outreach. However, gaps exist in our understanding of the impacts of short-term vs. prolonged drought on the health of Canadians, projections of drought and its characteristics at the regional level and the effectiveness of current adaptations. Further research will be critical to inform adaptation planning to reduce future drought-related risks to health.

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator's guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.

In an article that first appeared in Canadian Healthcare Facilities magazine, Kent Waddington, communications director, and Linda Varangu, Executive Director, at the Canadian Coalition for Green Health Care, and Peter Berry, senior policy analyst, and Jaclyn Paterson, environmental health specialist, at Health Canada, examine, in the light of the increasing frequency of extreme weather events, some of the latest thinking on the topic in Canada, and reflect on the initiatives taken by a number of the country's healthcare facilities to prepare for such incidents, and mitigate their impact.

Objectives: This study aimed at developing a list of key human health indicators for quantifying the health impacts of climate change in Canada., Methods: A literature review was conducted in OVID Medline to identify health morbidity and mortality indicators currently used to quantify climate change impacts. Public health frameworks and other studies of climate change indicators were reviewed to identify criteria with which to evaluate the list of proposed key indicators and a rating scale was developed. Total scores for each indicator were calculated based on the rating scale., Results: A total of 77 health indicators were identified from the literature. After evaluation using the chosen criteria, 8 indicators were identified as the best for use. They include excess daily all-cause mortality due to heat, premature deaths due to air pollution (ozone and particulate matter 2.5), preventable deaths from climate change, disability-adjusted life years lost from climate change, daily all-cause mortality, daily non-accidental mortality, West Nile Disease incidence, and Lyme borreliosis incidence., Conclusions: There is need for further data and research related to health effect quantification in the area of climate change.

Objectives: Many public health adaptation strategies have been identified in response to climate change. This report reviews current literature on health co-benefits and risks of these strategies to gain a better understanding of how they may affect health., Methods: A literature review was conducted electronically using English language literature from January 2000 to March 2012. Of 812 articles identified, 22 peer-reviewed articles that directly addressed health co-benefits or risks of adaptation were included in the review., Results: The co-benefits and risks identified in the literature most commonly relate to improvements in health associated with adaptation actions that affect social capital and urban design. Health co-benefits of improvements in social capital have positive influences on mental health, independently of other determinants. Risks included reinforcing existing misconceptions regarding health. Health co-benefits of urban design strategies included reduced obesity, cardiovascular disease and improved mental health through increased physical activity, cooling spaces (e.g., shaded areas), and social connectivity. Risks included pollen allergies with increased urban green space, and adverse health effects from heat events through the use of air conditioning., Conclusions: Due to the current limited understanding of the full impacts of the wide range of existing climate change adaptation strategies, further research should focus on both unintended positive and negative consequences of public health adaptation.

Background: Climate change is among the major challenges for health this century, and adaptation to manage adverse health outcomes will be unavoidable. The risks in Ontario - Canada's most populous province - include increasing temperatures, more frequent and intense extreme weather events, and alterations to precipitation regimes. Socio-economic-demographic patterns could magnify the implications climate change has for Ontario, including the presence of rapidly growing vulnerable populations, exacerbation of warming trends by heat-islands in large urban areas, and connectedness to global transportation networks. This study examines climate change adaptation in the public health sector in Ontario using information from interviews with government officials., Methods: Fifty-three semi-structured interviews were conducted, four with provincial and federal health officials and 49 with actors in public health and health relevant sectors at the municipal level. We identify adaptation efforts, barriers and opportunities for current and future intervention., Results: Results indicate recognition that climate change will affect the health of Ontarians. Health officials are concerned about how a changing climate could exacerbate existing health issues or create new health burdens, specifically extreme heat (71%), severe weather (68%) and poor air-quality (57%). Adaptation is currently taking the form of mainstreaming climate change into existing public health programs. While adaptive progress has relied on local leadership, federal support, political will, and inter-agency efforts, a lack of resources constrains the sustainability of long-term adaptation programs and the acquisition of data necessary to support effective policies., Conclusions: This study provides a snapshot of climate change adaptation and needs in the public health sector in Ontario. Public health departments will need to capitalize on opportunities to integrate climate change into policies and programs, while higher levels of government must improve efforts to support local adaptation and provide the capacity through which local adaptation can succeed.

Objective: It is now recognized that climate change affects human health. The question is how to adapt. This article examines mainstreaming climate considerations into public health programs and the utility of climate change and health adaptation frameworks, using Ontario, Canada, as a case study., Methods: A literature review identified climate change and health adaptation frameworks for comparison with the Ontario Public Health Standards. Key informant interviews gauged the extent to which climate change risks are currently considered in policy and planning., Results: Ontario's Public Health Standards already require many of the risk management activities identified in climate change and health adaptation frameworks. However, public health officials require additional information about linkages between climate change and health to manage risks., Conclusions: Risk management activities such as population health assessments, surveillance and public education and outreach can address many key risks related to climate hazards when information about the risks, vulnerable populations and time scales is made available to health officials. The development, analysis and transfer of this information should be considered a priority at all levels within the public health sector.

We used data from nationally representative surveys conducted in the United States, Canada and Malta between 2008 and 2009 to answer three questions: Does the public believe that climate change poses human health risks, and if so, are they seen as current or future risks? Whose health does the public think will be harmed? In what specific ways does the public believe climate change will harm human health? When asked directly about the potential impacts of climate change on health and well-being, a majority of people in all three nations said that it poses significant risks; moreover, about one third of Americans, one half of Canadians, and two-thirds of Maltese said that people are already being harmed. About a third or more of people in the United States and Canada saw themselves (United States, 32%; Canada, 67%), their family (United States, 35%; Canada, 46%), and people in their community (United States, 39%; Canada, 76%) as being vulnerable to at least moderate harm from climate change. About one third of Maltese (31%) said they were most concerned about the risk to themselves and their families. Many Canadians said that the elderly (45%) and children (33%) are at heightened risk of harm, while Americans were more likely to see people in developing countries as being at risk than people in their own nation. When prompted, large numbers of Canadians and Maltese said that climate change can cause respiratory problems (78-91%), heat-related problems (75-84%), cancer (61-90%), and infectious diseases (49-62%). Canadians also named sunburn (79%) and injuries from extreme weather events (73%), and Maltese cited allergies (84%). However, climate change appears to lack salience as a health issue in all three countries: relatively few people answered open-ended questions in a manner that indicated clear top-of-mind associations between climate change and human health risks. We recommend mounting public health communication initiatives that increase the salience of the human health consequences associated with climate change.

Health Canada reviewed national and international literature to develop a framework that identifies best practices for developing and implementing Heat Alert and Response Systems (HARS) to protect citizens from extreme heat events. A comparative case study was conducted based upon the framework and the experiences of two Canadian jurisdictions that piloted many of the best practices in the development of new HARS. Table-top exercises, heat-health vulnerability assessments, and community consultations were used to inform the development and implementation of HARS plans. Implementation of the framework by local authorities revealed different and unique challenges facing rural and urban communities in protecting people from extreme heat events. Opportunities within each pilot for taking effective public health adaptive actions that draw upon existing strengths and resources were also identified. Key aspects of HARS development including those related to education and engagement, development of an alert protocol, creation of a heat response plan, and identification of communication activities should be tailored to the needs of individual communities or regions and be informed by specific characteristics related to existing and future vulnerability.

General warming and extreme weather events associated with climate change are expected to negatively impact water utilities. Water utilities will need to adapt to continue providing safe drinking water and wastewater services. In 2012, the Canadian Water and Wastewater Association (CWWA) conducted a survey of 53 water utility officials to understand the expert perceptions of climate change risks and preparedness of Canadian utilities for current and future impacts. Results indicated that there is low awareness among water utility officials (30%) of thepossible impacts of climate change on water utilities, and more than half have not conducted climate change vulnerability assessments (65%) and do not have operational plans to address climate change impacts (56%). Officials from smaller utilities, which are considered to be more vulnerable to impacts, were of those less aware of these risks and reported taking fewer preparedness activities. Efforts to prepare water utilities for climate change impacts in Canada would benefit from education of utility officials about possible climate change risks, encouraging assessments of vulnerabilities, and increased training with new adaptation tools and resources.

Extreme weather events have revealed the vulnerability of health care facilities and the extent of devastation to the community when they fail. With climate change anticipated to increase extreme weather and its impacts worldwide--severe droughts, floods, heat waves, and related vector-borne diseases--health care officials need to understand and address the vulnerabilities of their health care systems and take action to improve resiliency in ways that also meet sustainability goals. Generally, the health sector is among a country's largest consumers of energy and a significant source of greenhouse gas emissions. Now it has the opportunity lead climate mitigation, while reducing energy, water, and other costs. This Special Report summarizes several initiatives and compares three toolkits for implementing sustainability and resiliency measures for health care facilities: the Canadian Health Care Facility Climate Change Resiliency Toolkit, the U.S. Sustainable and Climate Resilient Health Care Facilities Toolkit, and the PAHO SMART Hospitals Toolkit of the World Health Organization/Pan American Health Organization. These tools and the lessons learned can provide a critical starting point for any health system in the Americas. [ABSTRACT FROM AUTHOR]

Land plants have adapted to survive under a range of wind climates and this involve changes in chemical composition, physical structure and morphology at all scales from the cell to the whole plant. Under strong winds plants can re-orientate themselves, reconfigure their canopies, or shed needles, leaves and branches in order to reduce the drag. If the wind is too strong the plants oscillate until the roots or stem fail. The mechanisms of root and stem failure are very similar in different plants although the exact details of the failure may be different. Cereals and other herbaceous crops can often recover after wind damage and even woody plants can partially recovery if there is sufficient access to water and nutrients. Wind damage can have major economic impacts on crops, forests and urban trees. This can be reduced by management that is sensitive to the local site and climatic conditions and accounts for the ability of plants to acclimate to their local wind climate. Wind is also a major disturbance in many plant ecosystems and can play a crucial role in plant regeneration and the change of successional stage. [ABSTRACT FROM AUTHOR]