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Exposure to heat and air pollution in EUrope – cardiopulmonary impacts and benefits of mitigation and adaptation

Periodic Reporting for period 1 - EXHAUSTION (Exposure to heat and air pollution in EUrope – cardiopulmonary impacts and benefits of mitigation and adaptation)

Reporting period: 2019-06-01 to 2020-11-30

Extreme heat is identified as a key climate change risk in Europe in the near and long term. Extreme temperatures increases 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 may be mutually amplifying effects of extreme heat and air pollution on CPD outcomes. Moreover, extreme heat may increase air pollution levels, which is linked to large-scale (synoptic) meteorological features. Increasing temperatures may also lead to increased 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 EXHAUSTION project aims to quantify the changes in cardiopulmonary mortality and morbidity 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. The results will be disseminated to the general public and key decision- and policy-makers across Europe, providing a tool to increase European resilience towards climate change.
EXHAUSTION started June 1st 2019, and is a four-year project. The finalized review reports cover 1) Climate change and air pollution interlinkages; 2) Current knowledge related to the exposure-response relationships between ambient temperature and cardio-respiratory health outcomes including long-term effects (the latter published in Science of the Total Environment); 3) Evidence on the health benefits of adaptive mechanisms. Regarding climate modelling, considerable work has been done preparing for downscaling of future climate and air quality to high resolution over Europe. E.g. spatial model performance over different regions of Europe have been evaluated with historical temperature data. Further, the evolution of eight health relevant Heat Stress Indicators (HSIs) has been estimated on a global scale from CMIP6 models and published in the journal Future Earth. Regarding prediction of wildfire risk and associated emissions and dispersal of air pollutants, model developments (IS4FIRES/SILAM) have taken place and a report on the developments has been finalized. Regarding the establishment of the quantitative relationship between temperature and cardiopulmonary health, potential interaction effects with air pollutants, and the role of individual and contextual vulnerability factors (effect modifiers), a draft protocol has been produced, where data availability and statistical models have been defined for the different analyses that will provide the quantitative relationships (so-called exposure-response functions). Moreover, a report describing the statistical approach and methods for deriving these relationships has been finalized. In addition to analyses in EXHAUSTION, these methods can be exploited by a broader research community to investigate exposure-response relationships. By combining population exposure projections based on the climate and air pollution modelling and the exposure-response relationships, EXHAUSTION will estimate the future exacerbation of CPD in European settings and attribute the change in CPD mortality to a changing climate. The project further estimates the socio-economic consequences of the health burden using two existing economic models. Effective communication, dissemination, and exploitation of project results are important elements in EXHAUSTION. During the reporting period the project has had an extensive national and international media coverage. Outputs include data visualisations, videos (disseminated on twitter, web platforms, and in presentations. The consortium has made considerable efforts regarding establishing collaboration with other projects within the field of climate change and health. A main exploitation output is the new H2020 CSA project ENBEL (2020-2023), led by CICERO, which coordinates a network of several international health and climate research projects. For further details on the work performed during the first 18 months, see the M18 Status Report available on the EXHAUSTION website (
EXHAUSTION’s ambition is to substantially advance the knowledge and develop new evidence regarding the links between climate change, extreme heat, air pollution, and human health in Europe, and the broader socio-economic consequences of these impacts. Through the deployment of a true multidisciplinary approach, the project will allow to go beyond the state of the art in several research and application domains. Specifically, EXHAUSTION aims to contribute 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, 2) incorporate temperature - air pollution interaction effects in the modelling of future health burden, and 3) modelling of socio-economic costs.
CPD is highly prevalent in Europe and increases with an ageing population. The current cost of CVD and RD in total in EU is estimated at nearly €600 billion. Given the high cost, avoiding an increase in these diseases, or even reducing it, will have a tremendous impact on society through saved healthcare costs and through improved quality-of-life and reduced suffering for very many people. The adaptation strategies identified by EXHAUSTION is expected to help avoid premature death and disease among vulnerable groups, including the elderly, infants, the chronically ill, and individuals with low socio-economic status, and thereby lower the burden of informal caretaking to the benefit of the individual and his/her immediate surroundings. The project is using its scientific publications as a basis for public outreach through popular- science articles, interviews and comments in traditional media (TV, radio, newspapers) and spread through social media. Output from EXHAUSTION will support evidence-based decision-making, and the consortium will continue to engage with policy makers and other stakeholders. Thus, the project’s results are important input to policy making and will have great impact on European policy making. Finally, EXHAUSTION will impact science through the development of innovative research methodologies that link epidemiological research with research to develop adaptation strategies. This enables advanced assessment of the broader societal consequences and costs of climate change and will contribute to state-of-the-art European research.
Multi-model median evolution of yearly maximum values for eight heat stress indicators
Visualition # 1 in EXHAUSTION. Interlinkages between climate change and air pollution.
EXHAUSTION consortium at Kick-off meeting in Oslo, June 2019