Periodic Reporting for period 3 - EXHAUSTION (Exposure to heat and air pollution in EUrope – cardiopulmonary impacts and benefits of mitigation and adaptation)
Reporting period: 2022-06-01 to 2024-01-31
Extreme heat is a key climate change risk in Europe. Extreme temperatures increase the rates of death (mortality) and can exacerbate a range of diseases (morbidity). In particular, this applies to death and disease related to cardiovascular and respiratory diseases (CVD and RD), which together constitute cardiopulmonary diseases (CPD).
The health effects of extreme heat are interlinked with air pollution in several ways. Air pollution is currently the largest environmental killer in Europe. Previous studies indicate that there are interaction effects of extreme heat and air pollution on CPD outcomes. Also, extreme heat may increase air pollution levels, e.g. linked to large-scale (synoptic) meteorological features. Increasing temperatures may also lead to increased emissions of air pollutants from anthropogenic and natural sources, including from wildland fires. In an increasingly warming world, episodes of extreme heat and high levels of air pollution are likely to occur simultaneously, could occur more often, last longer, and become more intense – causing increasing health risks.
The vulnerability to environmental stressors such as extreme temperatures and air pollution can differ widely among population groups due to complex causal pathways and differential vulnerability associated with contextual and individual factors. To develop climate change adaptation policies, a detailed understanding of the predominant vulnerability factors in different communities and regions is needed.
The overall objective of EXHAUSTION was to quantify changes in cardiopulmonary death and disease due to extreme heat and air pollution (including from wildfires) under selected climate scenarios while including a diverse set of adaptation mechanisms and strategies, calculate the associated costs, and identify effective strategies for minimizing adverse impacts. A core objective was also to disseminate results to the general public and key decision- and policy-makers across Europe, providing a tool to increase European resilience towards climate change.
The health effects of extreme heat are interlinked with air pollution in several ways. Air pollution is currently the largest environmental killer in Europe. Previous studies indicate that there are interaction effects of extreme heat and air pollution on CPD outcomes. Also, extreme heat may increase air pollution levels, e.g. linked to large-scale (synoptic) meteorological features. Increasing temperatures may also lead to increased emissions of air pollutants from anthropogenic and natural sources, including from wildland fires. In an increasingly warming world, episodes of extreme heat and high levels of air pollution are likely to occur simultaneously, could occur more often, last longer, and become more intense – causing increasing health risks.
The vulnerability to environmental stressors such as extreme temperatures and air pollution can differ widely among population groups due to complex causal pathways and differential vulnerability associated with contextual and individual factors. To develop climate change adaptation policies, a detailed understanding of the predominant vulnerability factors in different communities and regions is needed.
The overall objective of EXHAUSTION was to quantify changes in cardiopulmonary death and disease due to extreme heat and air pollution (including from wildfires) under selected climate scenarios while including a diverse set of adaptation mechanisms and strategies, calculate the associated costs, and identify effective strategies for minimizing adverse impacts. A core objective was also to disseminate results to the general public and key decision- and policy-makers across Europe, providing a tool to increase European resilience towards climate change.
The merits and legacy of the EXHAUSTION project are manyfold. The project has advanced the science related to the integrated assessment of climate change and health effects and associated socioeconomic costs, reflected by the high number of peer reviewed journal papers, new models and model modules developed, and open access climate datasets (incl at the Copernicus Climate Data Store). The project has demonstrated how interdisciplinary collaboration and co-design of knowledge products can advance communication approaches, create engagement and reach a broad audience. Finally, the results and outreach activities in the project are having lasting impacts through impacts on policy making processes, such as those related to new Air Quality Standards for Europe and the development of the upcoming Horizon Europe research agenda. EXHAUSTION consortium partners have already been engaged in several joint research proposals, building on the work in EXHAUSTION, which are expected to lead to continued collaboration and further scientific advancements in the future.
Major scientific advancements and results of EXHAUSTION are related to the following: 1) Exposure-response functions for the relationship between ambient temperature and mortality and hospitalization are established for the European population. 2) Evidence on strong interactive effects between temperature and air pollutants on mortality have been established for Europe, pointing to particularly strong modifying effects for respiratory endpoints and for particulate air pollution (PM2.5) effects on heat-related mortality. 3) Evidence on the impact of a range of contextual and individual vulnerability factors on the heat-health relationship have been established for Europe, pointing to particularly strong modifying effects of urban characteristics (high population density, lack of green space, air pollution). People with chronic pre-existing diseases and the elderly were shown to be at higher risk. 4) High-resolution projections of health relevant meteorological indices and air pollutants have been established, including for cities. 5) A new fire forecasting model has been developed and applied to historical periods and to three CESM scenarios (SSP126, SSP245, SSP370) 2015-2099 to produce global emission time series. Fire emission data were applied in global simulations and to regional European runs. 6) Evidence on increasing contribution of fire emissions to PM2.5 pollution over Europe and associated increased fire-attributable health effects was established. 7) Projections for temperature-related mortality in Europe at city, country, and regional level for the three scenarios towards 2100 has been established, showing a net increase (i.e. the net effect of decreased cold-related deaths and increased heat-related deaths) of more than 2 million excess deaths attributable to climate change for SSP370. For SSP126, projections indicate that lives claimed by climate change would peak around 2060 and could sum to about 0.73 million lives by 2100. 8) Findings related to the modifying effects of PM2.5 for heat-related deaths were used to estimate the benefit achieved from complying with WHO’s Air Quality Guidelines: 150,000 heat-related deaths can be avoided over the next 25 years if the WHO AQG are achieved in Balkan and Mediterranean. 9) The economic consequences of the health effects of increasing temperatures over Europe were estimated by the means of empirical relationships (work presenteeism and sick leaves) and by modelling techniques. Using bottom-up modelling (EVA model) and exposure-response functions based on the city level data, historical and future heat-health burden was estimated and monetized (via VSL), indicating that the annual cost of heat-related cardiopulmonary deaths could reach up to nearly 3% of the national GDP for some countries by the mid-century. The GRACE model, a computable general equilibrium model frequently employed in various climate change studies ahead of the EXHAUSTION project, was further developed by adding a module enabling analyses of health-related impacts of climate change on the labor market. The model was implemented for three countries, Norway, UK and Italy. The cost of health services is anticipated to rise in all three countries, whereas socioeconomic impacts generally showed large variations.
Major scientific advancements and results of EXHAUSTION are related to the following: 1) Exposure-response functions for the relationship between ambient temperature and mortality and hospitalization are established for the European population. 2) Evidence on strong interactive effects between temperature and air pollutants on mortality have been established for Europe, pointing to particularly strong modifying effects for respiratory endpoints and for particulate air pollution (PM2.5) effects on heat-related mortality. 3) Evidence on the impact of a range of contextual and individual vulnerability factors on the heat-health relationship have been established for Europe, pointing to particularly strong modifying effects of urban characteristics (high population density, lack of green space, air pollution). People with chronic pre-existing diseases and the elderly were shown to be at higher risk. 4) High-resolution projections of health relevant meteorological indices and air pollutants have been established, including for cities. 5) A new fire forecasting model has been developed and applied to historical periods and to three CESM scenarios (SSP126, SSP245, SSP370) 2015-2099 to produce global emission time series. Fire emission data were applied in global simulations and to regional European runs. 6) Evidence on increasing contribution of fire emissions to PM2.5 pollution over Europe and associated increased fire-attributable health effects was established. 7) Projections for temperature-related mortality in Europe at city, country, and regional level for the three scenarios towards 2100 has been established, showing a net increase (i.e. the net effect of decreased cold-related deaths and increased heat-related deaths) of more than 2 million excess deaths attributable to climate change for SSP370. For SSP126, projections indicate that lives claimed by climate change would peak around 2060 and could sum to about 0.73 million lives by 2100. 8) Findings related to the modifying effects of PM2.5 for heat-related deaths were used to estimate the benefit achieved from complying with WHO’s Air Quality Guidelines: 150,000 heat-related deaths can be avoided over the next 25 years if the WHO AQG are achieved in Balkan and Mediterranean. 9) The economic consequences of the health effects of increasing temperatures over Europe were estimated by the means of empirical relationships (work presenteeism and sick leaves) and by modelling techniques. Using bottom-up modelling (EVA model) and exposure-response functions based on the city level data, historical and future heat-health burden was estimated and monetized (via VSL), indicating that the annual cost of heat-related cardiopulmonary deaths could reach up to nearly 3% of the national GDP for some countries by the mid-century. The GRACE model, a computable general equilibrium model frequently employed in various climate change studies ahead of the EXHAUSTION project, was further developed by adding a module enabling analyses of health-related impacts of climate change on the labor market. The model was implemented for three countries, Norway, UK and Italy. The cost of health services is anticipated to rise in all three countries, whereas socioeconomic impacts generally showed large variations.
Through the deployment of a true multidisciplinary approach, the project has progressed beyond the state of the art in several research and application domains. Specifically, EXHAUSTION has contributed to filling key knowledge gaps and advance on the following topics: 1) Incorporate adaptation in the modelling of future health burden attributable to climate change, including via the temperature - air pollution interaction effects, 2) advanced high-resolution modelling of heat and air pollution, including from wildfires, and 3) modelling of socio-economic costs, including via impacts in the labour market. As evident from the results (see above), the project has made substantial progress towards advancing on these topics. By quantifying the impact on heat-related health effects of a range of vulnerability factors, EXHAUSTION has enabled advanced assessment of adaptation policies. In the long run this will contribute to increased European resilience towards climate change