Extreme Weather and Climate Change: Population Health and Health System Implications
Kristie L. Ebi1, Jennifer Vanos2, Jane W. Baldwin3, Jesse E. Bell4, David M. Hondula5, Nicole A. Errett6, Katie Hayes7, Colleen E. Reid8, Shubhayu Saha9, June Spector6,10, Peter Berry11
1Center for Health and the Global Environment, University of Washington, Seattle, Washington 98195, USA
2School of Sustainability, Arizona State University, Tempe, Arizona 85287, USA
3Lamont-Doherty Earth Observatory, Columbia University, Palisades, New York 10964, USA
4Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
5School of Geographical Sciences, Arizona State University, Tempe, Arizona 85287, USA
6Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington 98195, USA
7Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5S 2S2, Canada
8Geography Department, University of Colorado, Boulder, Colorado 80309, USA
9Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA
10Department of Medicine, School of Medicine, University of Washington, Seattle, Washington 98195, USA
11Faculty of Environment, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
Abstract
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
[email protected] .AUTHOR CONTRIBUTIONSK.L.E. conceptualized the article; K.L.E., J.V., J.W.B., J.E.B., D.M.H., N.A.E., K.H., C.E.R., S.S., J.S., and P.B. contributed to the writing, editing, revising, and finalizing of the manuscript.
HHS Public AccessAuthor manuscriptAnnu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Published in final edited form as:Annu Rev Public Health. 2021 April 01; 42: 293–315. doi:10.1146/annurev-publhealth-012420-105026.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
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.
Keywords
climate change; climate variability; extreme events; population health; health systems
1. INTRODUCTION
Worldwide, in 2019, there were 396 disasters1 that killed 11,755 people, affected 95 million
others, and cost nearly US$130 billion (28). Asia was the most affected continent with
40% of the events, 45% of the deaths, and 74% of all people affected. Floods and storms
accounted for 68% of the number of affected people worldwide. Anthropogenic greenhouse
gas (GHG) emissions, land use change, and other activities impacting the global energy
balance are altering the frequency and intensity of many extreme weather and climate
events, with some regions experiencing increases in heat waves, floods, and droughts (84).
Events influenced by climate change, particularly wildfires, also are increasing.
Risks from extreme weather and climate events arise from the intersection of the physical
hazard (e.g., wind and rain), the extent of exposure to the hazard, the vulnerability of
individuals and communities, and the capacity to prepare for, manage, and recover from
extreme events.
A disaster generally is defined as a sudden, calamitous event that disrupts the functioning
of a community or society and that exceeds its ability to cope using its own resources (81).
The occurrence of an extreme event is not required for a community or region to experience
extreme impacts, such as large increase in mortality; an extreme impact can arise from a
moderately strong event when it occurs in a highly vulnerable population. The converse
also is true, that an extreme event may not result in extreme impacts when communities are
prepared.
Roughly 20% of disasters in 2019 occurred in North America, including the Caribbean and
Central America, for total damages of US$55 billion, of which US$29 billion were insured
(130). Loss events included Hurricane Dorian, which caused billions of dollars in damage,
especially in the Bahamas, in late August to early September. Heavy losses that year also
resulted from severe weather, floods, and a winter storm in the United States. A mixture of
snowmelt triggered by unusually high temperatures in March and storms with torrential rain
led to sustained and extensive flooding in Nebraska, South Dakota, Iowa, and Mississippi
(49).
1Natural disasters are not solely the consequence of biophysical, meteorological, or climatological events; human activities, such as placement of infrastructure and movement of people into vulnerable regions, also are required.
Ebi et al. Page 2
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
Overall, the numbers and costs of disasters have been increasing for several decades due to
increases in exposure (more people moving into harm’s way and increases in the values of
property and infrastructure at risk), vulnerability of people and infrastructure, and climate
change (170). Since 1980, the United States has experienced 265 weather and climate
disasters in which the overall damages reached or exceeded US$1 billion; the total costs
were greater than US$1.775 trillion (132), with an estimated 14,223 deaths (an average of
356 per year), although the numbers of deaths are likely an underestimate (178).
Beyond the damage to infrastructure, extreme weather events and disasters can affect the
health and well-being of individuals and can have catastrophic impacts on communities
and health systems. People can suffer from a wide range of physical effects (e.g., heat
exhaustion, injuries in severe storms, and respiratory illnesses from molds due to floods)
as well as longer-term impacts on mental health. Health systems and facilities can be
affected by impacts on patients and health care staff, medical and nonmedical supplies,
facility operations, and critical infrastructures. To prepare for climate change, health-sector
and emergency-management officials—as well as urban planners, neighborhood services
staff, and others—require information about how hazards are projected to change, possible
future exposures of people and property, likely changes in population health and health care
infrastructure vulnerabilities, and needed capacities to prepare for and manage the events
and their aftermath.
We review (a) the current impacts and projected risks of climate change on the health of
populations and health systems from extreme weather and climate events and from wildfires,
(b) the value of disaster management to reduce health risks from these changes, and (c)
adaptation and mitigation measures that can explicitly address climate change in policies and
planning processes.
2. EXTREME EVENTS INFLUENCED BY CLIMATE CHANGE
Global land surface air temperature has risen 1.53°C since the preindustrial period of 1850–
1900, with considerable variation in regional warming; this increase is much larger than the
observed warming combined over land and oceans (0.87°C) (84). Climate models project
robust differences in regional climate characteristics, including extremes.
Detection and attribution analytic methods are increasingly being applied to determine
the effects of climate change on the frequency and/or magnitude of extreme events. For
example, in mid-September 2019, torrential rainfall from Tropical Storm Imelda caused
large-scale flooding in Southeast Texas, affecting an estimated 6.6 million people and
resulting in rescues of over 1,000 people and 5 deaths (171). The recorded precipitation at
the station with the highest total amount of rainfall from this event would be expected only
approximately once every 1,200 years.
The 2019 Intergovernmental Panel on Climate Change Special Report on Climate Change
and Land (84) concluded that warming since the period 1850–1900 has resulted in an
increased frequency, intensity, and duration of extreme events in most land regions,
including the following observations:
Ebi et al. Page 3
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
• The intensity of heavy precipitation events increased across the globe.
• The frequency and intensity of droughts increased in some regions (including the
Mediterranean, West Asia, many parts of South America, much of Africa, and
Northeastern Asia).
• Desertification in some dryland areas (including in sub-Saharan Africa, parts of
East and Central Asia, and Australia) was associated with increased land-surface
air temperature and evapotranspiration and decreased precipitation amounts in
interaction with climate variability and human activities.
• The frequency and intensity of dust storms increased over the last few decades
due to land use and land cover changes and climate-related factors in many
dryland areas, such as the Arabian Peninsula and broader Middle East and
Central Asia.
Further, climate change is projected to continue and exacerbate these trends, including the
following:
• The frequency, intensity, and duration of extreme heat events are projected to
continue to increase through the twenty-first century, with all regions expected to
experience unprecedented temperatures.
• The frequency and intensity of extreme rainfall events are projected to increase
in many regions.
• The frequency and intensity of droughts are projected to increase, particularly in
the Mediterranean region and southern Africa.
There is a range of possible futures for each additional unit of global warming. For example,
regional projections of annual maximum temperatures across climate models where the
Earth warms 1.5°C under a scenario of high GHG emissions indicate there may be little
change in the single hottest day in a year in many regions if realized warming falls into
the lower quartile of projections (154). Alternatively, increases of 3°C to 5°C in maximum
temperatures could occur over most regions in the upper quartile of projections. With Earth
projected to warm 1.5°C between 2030 and 2052, the next few decades could be similar
to today in many parts of the world; or regions could experience significant and very rapid
warming. These projections have implications for the frequency and duration of extreme
heat events; the extent of increases in precipitation, including from hurricanes; and the rate
of sea-level rise that affects the health of future populations (particularly but not exclusively
in coastal regions) and their health systems.
2.1. Tropical Cyclones or Hurricanes
Tropical cyclones (TCs) that make landfall are among the most dramatic and costly
disasters. They have different names depending on the basin where they occur (hurricanes
in the northern Atlantic and northeastern Pacific, typhoons in the northwestern Pacific,
and cyclones in the southern Pacific or Indian Ocean) but are the same meteorological
phenomena. They cause strong winds and flooding from intense rainfall and a surge of ocean
water that causes dramatic damage to buildings and infrastructure along coastlines, often
Ebi et al. Page 4
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
including widespread utility outages. TCs have cost the United States close to US$1 trillion
since 1980 (157). Low- and middle-income countries (LMICs) have suffered smaller total
economic losses, but the losses are often a larger proportion of their nations’ economies and
arguably have greater consequences for well-being (67).
Alongside physical damages, TCs are highly detrimental to human health (107). From 1963
to 2012, there were 2,544 deaths in the United States (~50 per year) directly caused by
the forces of TCs (e.g., drowning in floods caused by storm surge or extreme rainfall, or
physical trauma caused by windborne debris) (142). A comparable number of TC-related
deaths are indirectly caused in individuals with preexisting conditions exacerbated by the
stress or strain of a storm. Hurricane Katrina alone caused 520 direct deaths and 565 indirect
deaths (143). Accounts of individual TCs clearly indicate upticks in a variety of other health
problems that do not necessarily result in death, including injuries, diseases, skin infections,
and mental health impacts (e.g., 43, 73, 87, 141). New data sets of TC exposure history are
increasing possibilities for robust, long-term epidemiological studies of these diverse health
impacts from TCs (e.g., preterm birth; see 161) that will enhance our ability to predict and
prepare for future TC health impacts.
A confounding challenge in projecting future TC impacts is the relatively low confidence in
projections of TC changes with climate change. Projections suggest the most intense TCs
will likely increase in frequency and exhibit higher precipitation rates; however, there is
uncertainty whether the overall number of TCs may increase or decrease, with different
trends projected depending on the modeling approach (46, 103, 154). However, other
trends are clearly heightening TC risks to individuals and communities. Exposure to TCs
is increasing as people move to and settle along coastlines (57), and potential damages from
storm surge are increasing with sea-level rise (113).
2.2. Compound Events
Complicating projections of extreme-event impacts is the fact that many disasters
are the result of combinations of extremes (sometimes called compound, interacting,
interconnected, or cascading events) (140, 154). Compound extreme events consist of two or
more events interacting across time and/or space, such as back-to-back extreme heat events
or an extreme heat event coincident with a drought (184). The range of compound extremes
that might endanger human health is large. The study of compound extremes is a nascent
and rapidly evolving research area. In many cases, understanding of present and projected
risks of a particular compound extreme event is lacking, including key societal drivers of
vulnerability (144). We highlight a few types of compound climatic extreme events.
Heat waves are exacerbated when combined with other extreme events. Heat waves can
enhance buildup of ozone and other pollutants, leading to combinations of heat and air
pollution dangerous for human health (4, 111). A particularly striking example is the
combination of high temperatures, wildfire, and smoke that results in high levels of air
pollution across broad geographic areas. In recent summers, the western United States has
been afflicted with multiple episodes; these are projected to become increasingly common in
the future because of climate change (114).
Ebi et al. Page 5
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
Positive feedback loops also occur between heat waves and droughts that heighten
temperature and desiccation (76, 185). Certain types of atmospheric waves can cause
multiple simultaneous heat waves distributed across the Earth; this may increase the risk
of multiple breadbasket failures (105). Many of the most impactful heat waves in terms
of mortality might be better understood as the combination of a number of heat extremes
occurring in sequence, separated by short cooler breaks—a temporally compound heat wave
event. The proportion of heat wave hazards coming from these temporally compound heat
waves is robustly projected to increase with global warming (7).
Past events highlight the dangers of compound extreme events involving TCs or extreme
precipitation and related flooding. For example, in 2005, Hurricane Katrina led to massive
flooding in New Orleans (153). Only a few weeks later, Hurricane Rita rebreached
weakened levees, leading to flooding once again. The nonlinear impacts of these
events likely exceeded vulnerability thresholds associated with protective infrastructures.
Significant research remains to understand the dynamics of such compound hydrological
extremes and to quantify risks to populations and communities (144).
3. POPULATION HEALTH AND HEALTH SYSTEM RISKS FROM EXTREME
EVENTS INFLUENCED BY CLIMATE CHANGE
There is high annual variability in the numbers of deaths from all disasters, with an average
of 60,000 deaths annually over the last decade, or 0.1% of all global deaths (148), with an
irregular and overall declining trend. Most of these deaths were in a few intensive disasters,
indicating that while the events may not be preventable, much of the loss of life can be
avoided through improved forecasts and early warnings, more resilient infrastructure, and
improved disaster risk management. However, there is a concern with climate change that
future events may be too large or intense for effective preparation.
The next sections summarize population health and health system risks from high ambient
temperatures, droughts, floods, and wildfires, followed by a discussion of the mental health
risks associated with extreme events influenced by climate change.
3.1. High Ambient Temperatures
The range of health effects of high ambient temperatures include discomfort, severe illnesses
requiring hospital care, mortality, and interactions with and modifications of work patterns,
recreation, and other activities.
3.1.1. Morbidity and mortality from heat waves.—At the global scale, the number
of hot days and nights has increased since the 1950s, while cold days and nights decreased
(154). Rising temperatures are directly connected to human health through heat-related
illnesses (e.g., heat exhaustion, heat syncope, and heat stroke) and death, with each
individual’s risk highly dependent on their exposure, location, and susceptibility. There
is a wide range of heat tolerance within populations and across regions. The human body
can physiologically adapt to heat to a certain extent depending on individual factors, local
climate, and types of heat exposure. Physiological factors (e.g., age, sex, preexisting illness,
Ebi et al. Page 6
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
and medication or drug use) (23, 98) and behavioral or contextual factors (e.g., employment,
activity, clothing, income, and housing type) (6, 118) are known to affect thermoregulation
across day-to-day or hour-to-hour heat exposures. For example, in Maricopa County,
Arizona, 47% (93/197) of heat deaths in 2019 involved drug use as a cause of death or
contributing factor (124). Extreme heat events can disrupt health systems and services, for
example, through a surge in patient volumes, by closing operating theatres in high heat and
humidity conditions, or through impacts on health care professionals and patients (156).
Reducing risks to health from current and projected high temperatures—outdoors and
indoors—depends not only on physiological acclimatization but also on planned adaptation
by public health officials in concert with partners in other sectors. Heat action plans and
early warning systems that include a proactive response to assist vulnerable populations
and build awareness among the public and key stakeholders can lead to the adoption
of protective behaviors and reduction in morbidity and mortality (75, 156). Common
components of heat action plans and warning systems include opening of public cooling
shelters, targeted messaging, wellness checks, and water distribution (e.g., 9, 19). A study
by Eisenman et al. (44) found that as temperatures increased, heat-related mortality was
lower in census tracts with more publicly accessible cool spaces in Maricopa County,
Arizona. These and other preventative measures that may reduce heat exposures and increase
coping capacity as the climate warms are important for protecting health. Over longer time
scales, communities can be modified or designed with new or altered technologies and
infrastructures (e.g., cool facades, green roofs, shade structures, and reflective surfacing) to
reduce heat exposures in urban areas (119, 172). Heat-health adaptation measures can be
cost-effective and reduce utilization of health systems (61) but should be developed and
updated based on information about projected climate conditions (74).
Heat-related mortality has been declining in many industrialized countries in recent decades
(56). For example, deaths attributed to heat across 105 cities in the United States declined by
almost 63% from 1987 to 2005 (12). However, the extent to which continued declines could
be realized (or reversals avoided) largely depends on implementing effective adaptation
strategies (60). Heat-related mortality trends and optimal adaptation pathways or measures
differ by country based on culture, infrastructure, technology, and communication, among
other factors. Few studies have assessed heat-related mortality in LMICs due to lack of data
(56, 63, 134); over half of existing studies are from China (56%) or other Asian countries
(14%). LMICs typically have low-resource environments [including a lower prevalence of
air conditioning (AC)] and more often rely on altering behaviors and personal cooling to
stay safe (O. Jay, K. Ebi, P. Berry, C. Broderick, R. DeDear, et al., submitted manuscript).
These behaviors may include application of ice or ice towels, dousing skin, or saturating
clothing with water with added ventilation (fans) (26). Yet the effectiveness of these
actions depends on the climate context. For example, evaporative cooling with fans is more
effective in humid locations, whereas self-dousing and/or wetting of clothing when using
fans are preferable strategies in certain dry climates (128). Although AC use is growing
exponentially as the most popular heat-exposure reduction strategy globally (11), it is costly
and financially inaccessible for many of the most vulnerable, is energy intensive, emits
waste heat into the environment (150), and can increase the risk of power outages.
Ebi et al. Page 7
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
Heat-reduction interventions may have economic and educational cobenefits. Park (137)
found that high school student test performance was reduced by 14% on days with high
(~32.2°C) outdoor temperatures compared to optimal (22.2°C) outdoor temperatures in
New York state. Hot school days may also disproportionately impact minority students,
accounting for ~5% of the racial achievement gap in the United States, in part because of
inadequate access to AC (138).
Finally, there is growing evidence linking extreme heat and rising temperatures to increased
hospitalizations for mood and behavioral disorders (22, 175) and evidence of increased
risk of suicide related to heat waves and rising temperatures (17, 34, 99). These risks are
projected to increase with further warming. Burke et al. (17) estimated that under a high
GHG emission pathway, there could be 9,000 to 40,000 additional suicide deaths throughout
Mexico and the United States by 2050. Mechanisms for how high temperatures impact
mental health remain poorly understood, with various nonclimatic confounders to consider
(e.g., macroeconomics and social factors); yet, biologically, there may be side effects from
thermoregulation and neurological responses to heat that adversely affect mental health (17).
3.1.2. Occupational health.—Individuals working under heat stress are more likely
to experience physiological heat strain (51) and heat-related illness, and exertional heat
stroke and death can occur in young, otherwise healthy workers performing heavy physical
labor (64). A global meta-analysis by Flouris et al. (51) found individuals working a single
shift under heat stress conditions were four times more likely to experience occupational
heat strain than in thermoneutral conditions (based on 11,582 workers across 9 studies),
with ~0.7°C higher core temperatures (1,090 workers, 17 studies) and 14.5% higher urine
specific gravity (a measure of solute concentration) (691 workers, 14 studies). In the
United States between 2000 and 2010, 359 occupational heat-related deaths were reported
(annual mean fatality rate 0.22 per 1 million workers), with agricultural and construction
workers at particularly high risk (64). Indoor workers subject to inadequate ventilation and
workers exposed to point heat sources are also at risk (152). Occupational heat stress is
hypothesized to contribute to the global epidemic of chronic kidney disease of unknown
etiology (177) and can lead to adverse birth outcomes among heat-exposed pregnant workers
(106). Working populations with the most social and economic disadvantages are often
more exposed to heat and may lack adequate health care access or other means to address
exposures and health effects (122).
The risk of adverse occupational health effects is likely to increase as the frequency and
severity of extreme heat waves increase (83). In a study of US agricultural workers,
climate change at its current pace is projected to double crop worker heat risk by the
mid-century and triple by the end-of-century, absent extensive restructuring of agricultural
labor (164). Increasing temperatures from local land use changes can magnify the impacts
of climate change, for example, in the setting of industrial clearing of tropical forests where
communities depend on subsistence agriculture and other outdoor work (183) and in areas
with growing urban heat island effects (152). In tropical and mid-latitude areas of the world,
Dunne et al. (38) estimated that heat stress has already reduced labor capacity by 10%
relative to the 1970s and projected a reduction of 40% by the year 2100 under a pathway
Ebi et al. Page 8
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
of high GHG emissions. Further decreases in labor productivity and associated economic
impacts are projected, assuming adherence to occupational heat stress guidelines (38, 51).
3.1.3. Recreation.—High temperatures can also adversely affect people engaging in
outdoor sports and recreation and represent a growing challenge for the sports industry
(136). Heat is a leading cause of sudden death among athletes, and exertional heat illnesses
cause thousands of debilitating health outcomes annually (18). For large events facing
extreme heat (e.g., Tokyo Olympics), weather and climate data should be integrated into
the decision-making process for event schedules and venue locations (79). Unpredictable
disruptions from extreme weather may cost billions of dollars given the years of planning,
hundreds of thousands of people involved, and global media attention, yet such safety
precautions may help avoid serious risk to athletes (158). Coordination among local
stakeholders in emergency medicine, public health, and events/operations is necessary
to ensure that localized preparedness plans (e.g., identification of hot spots such as sun-
exposed locations, expected crowds, and midday events) systematically provide adequate
support for both athletic and social activities.
3.2. Droughts
The frequency and intensity of droughts are increasing with rising global temperatures and
changing precipitation patterns (165). These trends and associated risks are expected to
continue to intensify with climate change (77). Internationally, over the last two decades,
droughts affected more than one billion people (27). Africa is a quintessential setting for
examination of the roles that drought can play in human health and society, as droughts there
have led to mass migration, conflict, and devastating famine (54, 58). In the United States
since 1980, droughts classified as billion-dollar disasters were estimated to have caused
3,865 deaths, with most of the deaths due to heat waves accompanying drought (132).
Because of the difficulty in defining the beginning and end of a drought, the causal pathways
connecting droughts to health outcomes can be complex and difficult to monitor (10, 117).
The most commonly identified pathway is a reduction in water availability for societal
uses, both in quantity and quality as concentrations of pollutants increase (129). Stagnant,
warm waters from drought produce ideal conditions to promote growth of many freshwater
pathogens (32). Simultaneously, sudden heavy rains during drought conditions can increase
the likelihood of flooding.
Droughts are slowly evolving, and the disruptions to human systems can last for long
periods with slow recoveries that can have delayed health impacts (159), such as through
agricultural losses and environmental degradation (47). Increased particulate matter (PM) in
the atmosphere resulting from drought and high winds can also lead to respiratory health
issues and death (10, 29). These conditions can contribute to the spread of pathogens causing
respiratory illnesses (such as coccidioidomycosis and meningitis; see 25, 53). Drought has
also been linked to mental health issues and conflict (59, 173).
Ebi et al. Page 9
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
3.3. Floods
Based on the Emergency Events Database, from 1969 to 2018, 10,009 extreme weather
events that resulted in disasters caused over two million deaths and just under four
million cases of disease (83). Floods (47%) and storms (30%) were the most common
extreme weather events worldwide over the period 1969–2018, with an increasing trend
(97). Globally, most direct weather-related deaths were caused by storms (39%), droughts
(34%), and floods (16%). Drowning is the most common cause of death after the onset of
flooding (139). Morbidity continues for more than 10 days after a severe flooding event. A
comprehensive review of the health impacts of worldwide flood and storm disasters between
1985 and 2014 concluded that the health impacts of these extreme events differ (151). The
health impacts include increases and sometimes decreases in
• Injuries, especially wounds, and carbon monoxide and gasoline poisoning after
storms;
• Cases of infectious and parasitic diseases, such as gastrointestinal illness,
respiratory infections, and skin or soft tissue infections, after storms and floods;
• Exacerbations of noncommunicable diseases after storms and floods;
• Increased contact with health services after floods; and
• Cardiopulmonary (floods) and skin complaints (storms and floods).
The results indicate increased needs for emergency and routine health care services.
Differential vulnerabilities increase risks during and after floods and storms. During
Hurricane Harvey (Texas, 2017), physical health problems primarily affected individuals
who did not evacuate. Disparities exist in disaster-related flooding exposure. Older adults
were more likely to live in a household exposed to flooding from Superstorm Sandy (New
York, 2012) (109). Socioeconomic disparities also were present, with poorer residents
having higher risk. Increases in posttraumatic stress disorder (PTSD), depression, and
anxiety are associated with flooding (131, 174) and hurricanes (135). Floods also can
decrease health-related quality of life (149).
Health care access and infrastructure can be severely affected by floods, including loss of
records, impacts on water supplies and laboratory functions, reduced access to health care,
and evacuation, with subsequent consequences for the communities served (21, 139). Health
care access was particularly reduced for persons living in households where someone lost
their job after Hurricane Harvey (50).
3.4. Wildfires
Many parts of the world have seen increases in the length of the wildfire season and
increases in burned area (92). While there are many drivers of these increases (including
historical wildfire suppression and increased intrusion of humans into wildland areas),
climatic changes, including drought, have been implicated as a major contributor to changes
in fire season length and acres burned (1, 179). These trends are projected to continue
under a range of global climate models, with particular agreement among models in the
mid-to-high latitudes (127). Globally, the mortality burden from wildfire smoke is estimated
Ebi et al. Page 10
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
to range between 260,000 and 600,000 (90); however, this estimate could now be considered
an underestimate given increases in population globally and increases in extreme wildfires in
North America, Australia, Brazil, and other locations since that study’s publication in 2012.
Wildfire smoke emits a variety of chemicals, including PM (suspended solid and liquid
particles) and gases such as carbon dioxide, carbon monoxide, nitrogen oxides, and volatile
organic compounds. Additionally, many of these chemicals react to form more PM and
ground-level ozone (85). Most studies of the population-health impacts downwind from
wildfires focus on PM10 and PM2.5, as data on these are readily available and there is
a robust literature on the health impacts of these particles. More research is needed to
understand the health impacts of other components of wildfire smoke.
Wildfire smoke exposure is most consistently associated with adverse respiratory health
outcomes (20, 145), with the clearest evidence for exacerbations of asthma whether
measured in hospitalizations, emergency department visits, or physician visits (15, 55,
160). Many studies find that lung function among people with asthma does not decline
with exposure to wildfire smoke (112, 145), but there is some evidence of lung function
decline of nonasthmatics (86, 100). These contradictory findings could be due to higher
medication usage among those with asthma, thus protecting them from exacerbations during
exposure. Many (15, 45) but not all (91) studies that investigate the relationship between
wildfire smoke exposure and refills of rescue medications often used for asthma report
significant positive associations. Associations between wildfire smoke exposure and other
respiratory endpoints are not as consistent, but there is increasing evidence of associations
for exacerbations of COPD and respiratory infections (145).
Wildfire smoke may impact specific cardiovascular endpoints such as out-of-hospital cardiac
arrests (33, 93) and emergency department visits, particularly among the elderly (180).
Studies with sufficient statistical power demonstrate a small but significant increase in
mortality (37, 48, 89, 123). Additionally, there is increased interest in whether wildfire
smoke affects birth outcomes. Babies whose gestation coincided with a wildfire had a
significant but small decline in birth weight (78). An observed decline in birthweight
was significantly associated with wildfire PM2.5 across multiple fire seasons in Colorado,
with increased risk of preterm birth, gestational diabetes, and gestational hypertension (2).
Further, wildfires are associated with adverse mental health (16, 35).
Understanding the populations that are most affected by wildfire smoke exposure is
important for targeting public health adaptations to increased wildfires under a changing
climate, yet very few epidemiological studies have investigated differential risk (104). There
are higher rates of emergency department visits for asthma among females compared to
males (55, 160). Studies investigating differential impacts by age are not consistent except
for studies of asthma exacerbations that showed the highest risks for the elderly, followed
by working age adults, and the lowest risks among children (15). Very few studies have
investigated differential impacts of wildfire smoke by race, ethnicity, or socioeconomic
status (SES) (104, 145), but there is some evidence of stronger associations between
wildfire smoke and visits to the emergency department and hospitalizations in lower-SES
neighborhoods (146).
Ebi et al. Page 11
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
Two studies projected the health risks of air pollution from wildfires under climate change,
with one focused on the western United States (115) and the other on the continental United
States (52). The latter study projected that overall PM2.5 concentrations would decrease
owing to decreases in emissions from anthropogenic sources but that fire-related PM2.5
emissions could offset some of these gains in some regions. The net result projected under
high GHG emissions is that fire smoke could be the dominant source of annual average
PM2.5 exposure in all regions by the year 2100. Although PM2.5 mortality is projected to
decrease by 2100, the proportion of deaths due to wildfire-associated PM2.5 could increase
(52).
Wildfires can present many challenges to health systems and impact the operations of
health facilities through increased stress on services, health risks to staff and patients, and
damage to infrastructure and operations (e.g., smoke inundation of hospitals and clinics). In
2017, severe wildfires in the interior region of British Columbia, Canada, affected 19 health
facilities or sites and led to the evacuation of 880 patients, caused the displacement of 700
health professionals, and cost the Interior Health Authority CAN$2.7 million.
3.5. Mental Health
Extreme events and disasters can exacerbate or compound preexisting mental health needs
or trigger new mental ill-health outcomes, acute or chronic and long-term (24). Substantive
socioeconomic implications from destruction to homes, businesses, and communities can
lead to financial stressors and community strain that can increase the likelihood for domestic
or community-based violence (24). At the same time, many people exposed to extreme
events demonstrate resiliency and experience very little to no mental distress (14). People
exposed to extreme events also may experience a mixture of affirmative mental health
outcomes like compassion, growth, and altruism as communities band together in the
wake of a disaster and challenging mental health outcomes like stress, fear, anxiety, and
compassion fatigue (71).
Climate change–related hazards (e.g., drought, sea-level rise, melting permafrost, and
extreme weather events) affect well-being (24, 71). Impacts to mental well-being include
a loss of a sense of place, referred to as solastalgia, and anxiety and grief related to a
changing climate, often referred to as ecoanxiety, climate anxiety, climate trauma, ecogrief,
or climate grief (3, 24, 30). These experiences are often framed as normative responses, so
it is important to look broadly at the full range of mental health outcomes related to climate
change and not to necessarily pathologize these outcomes (70). Those most at risk are those
who already experience health inequities based on the social, environmental, and biological
determinants of health (70).
Enhancing mental health literacy, access to mental health care and culturally relevant care,
and a sense of community, as well as integrating mental health indicators into climate
change and health assessments, support psychosocial adaptation to a changing climate
(70). The cobenefits of climate change mitigation for mental well-being include active
transportation that enhances mood and increased green space that can reduce stress levels
and promote well-being through connections with the natural environment (80).
Ebi et al. Page 12
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
4. INCREASING THE RESILIENCE OF HEALTH SYSTEMS
A global adaptation gap exists in efforts by health-sector officials to prepare for climate
hazards such as weather-related disasters (166). Multiple opportunities exist to increase the
climate resiliency of health systems and health facilities (182). Ministries and departments
of health generally have programs with responsibility for managing disaster risks. However,
these programs were developed without explicitly incorporating climate change (e.g.,
considering the implications of projections of future impacts), meaning they may be ill-
equipped to manage the health risks associated with increases in the frequency and intensity
of extreme events. Furthermore, some climate-related hazards, like extreme heat, fall outside
of the official or perceived domains of responsibility for professional disaster management
agencies or are approached through a distributed governance model with no designated
lead entity (68). The key policy levers for health-sector decision makers are climate change
adaptation, GHG mitigation, and disaster risk management. To date, cross-sector adaptation
efforts have been largely incremental, adjusting existing systems while maintaining their
core structure and function. However, given the limitations of these systems to meet the
increasing demands associated with experienced impacts or anticipated climate-related risks,
transformational adaptations that seek to fundamentally change these systems are necessary
(133).
Disaster risk management is often considered separately from adaptation, although there
is growing integration between them to maximize protection of populations and health
systems (8). Successful incorporation of climate change requires developing, implementing,
evaluating, and modifying policies and programs to increase their effectiveness for what will
be a very different future.
4.1. Adaptation and Mitigation
A major focus of adaptation is on promoting development of climate-resilient health systems
(182). Building blocks of such systems include (a) a knowledgeable health workforce with
the tools needed to promote climate resilience; (b) health information systems that support
effective management of the health risks of extreme events; (c) effective service delivery,
including preparation for emergencies; and (d) adequate financing (40). Preparing health
systems for climate extremes and disasters requires robust information about current impacts
and projected risks to inform adaptation planning (182). A critical step is developing
a health national adaptation plan (HNAP) or subnational plan, including conducting a
vulnerability and adaptation assessment (181). An HNAP helps ensure that the health risks
of climate change are prioritized at community to national levels of decision-making to
reduce vulnerabilities and build needed capacity and resilience. The process of developing
an HNAP should be integrated with adaptation planning in other sectors (e.g., disaster risk
management committees, hydro-meteorological services, agriculture, and water) and with
development planning processes (181).
Vulnerability and adaptation assessments should include analyses of the ability of health
systems and services to withstand extreme events and disasters; stress tests can provide
information to officials to facilitate preparing for and managing more severe climate
change–related shocks and stresses (39). The health impacts of extreme events can
Ebi et al. Page 13
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
compound until a tipping point is reached, resulting in significant changes in the affected
system and more severe population-health outcomes. This was illustrated in 2017 when
Hurricane Maria resulted in an estimated 4,645 excess deaths in Puerto Rico, with a third of
those deaths from delayed or interrupted health care (101).
Health-sector officials have a wide scope to help reduce the future magnitude and pattern
of extreme weather and climate events through the reduction of GHGs given the large
carbon footprint of health-related activities related to energy, food, anesthetic gases, and
transportation (94). In addition, significant health cobenefits (e.g., better respiratory and
cardiovascular health through improved air quality) that help build resiliency can accrue
through well-designed GHG mitigation efforts (65).
4.2. Disaster Risk Management
Disaster risk management includes “strategies, policies, and measures to improve the
understanding of disaster risk, foster disaster risk reduction and transfer, and promote
continuous improvement in disaster preparedness, response, and recovery practices” (168).
Health-emergency management policies and actions to reduce risks from climate-related
hazards can contribute to adaptation and resiliency-building efforts if they are informed
by climate change considerations and information. Opportunities to integrate disaster risk
management and climate change adaptation include alignment of financing strategies and
mechanisms; development of dual- or multipurpose government policies and strategies;
integration of both disaster risk management and adaptation into national and international
organizations, institutions, and programs; application of widely adopted disaster risk
management participatory hazard assessment approaches; and promotion of locally led
interventions or frameworks that comprehensively address disasters from all hazards and
environmental problems (82). Examples of specific disaster risk management measures that
may concurrently foster climate change adaptation include heat wave warning and response
programs, infrastructure resilience, and overall disaster preparedness (167).
Disaster risk management strategies should consider local context and place emotional
and cognitive experiences and identities that link people to places (13). Place attachment
has both positive and negative relationships with natural environmental risk perception
and risk coping, which have the potential to influence the effectiveness of disaster risk
management strategies (13). For example, strong place attachment is negatively associated
with willingness to evacuate and relocate (13).
Community-based disaster risk management strategies are necessary to address community-
specific risks, integrate priorities for vulnerable groups, and acknowledge community
assets and coping strategies (155). Given the importance of implementing adaptation
measures at the local level, local public health agencies are uniquely positioned to build
resilience (95, 96). Public health actors are well positioned to address climate change
due to their professional responsibilities, experience, and expertise (8). Prior to a disaster,
community-focused public health strategies can reduce climate disaster risk by reducing
human vulnerability (96). Furthermore, public health activities implemented in the context
of disasters—including rapid needs assessments, surveillance, and epidemiologic studies—
will become more important as the frequency of climate-related hazards increases (5).
Ebi et al. Page 14
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
An opportunity for state and local health departments to engage in climate change adaptation
activities is to build on existing all-hazards disaster preparedness and response capacity (36).
A key action to close the health adaptation gap related to heat and weather extremes is
to integrate disaster risk management into all health policies and to integrate health into
disaster risk management plans and strategies (166). Additional collaborative opportunities,
partnership, communication (within and across sectors), resources, authority, training, and
capacity for state and local health department engagement in climate change adaptation
activities are necessary (36).
4.3. Economic Considerations
Cross-disciplinary efforts combining population health, economics, and climate to value
the adverse risks of exposures and benefits of adaptation strategies are a priority (83).
While the reported estimates of economic losses associated with extreme weather events
nationally (132) and globally (130) are huge, they provide limited information on the health
impacts. The challenges in attributing health consequences to specific extreme events and/or
variability in meteorological factors (e.g., temperature, precipitation, and humidity) limit
economic valuation.
To assess the direct health costs associated with extreme events, studies used a combination
of cost-of-illness measures (financial costs of utilizing medical care and pharmaceuticals)
and willingness-to-pay-based estimates (e.g., value of statistical life) (147). Studies using
reported medical diagnoses to estimate the changes in morbidity and/or mortality associated
with a sample of climate-sensitive extreme events reported substantial health care costs
(110). A statistical approach to determine the attributable fraction of morbidity and mortality
associated with a specific environmental exposure, mostly extreme temperature (116), can
be used in conjunction with climate and demographic projections to estimate future health
care costs (108). Estimates of the economic burden in these studies are useful in informing
local-level decision-making to prevent adverse outcomes (176).
Extreme temperatures impact health outcomes like labor productivity that have welfare
implications for families, labor wages, and economies (102). Computable general
equilibrium models can assess the economy-wide impacts of future climate scenarios based
on a broader suite of human welfare indicators, such as nutrition (69). There is growing
evidence of the economic impact of hurricanes on hospital evacuations and health care
facilities (163).
In spite of the uncertainty and assumptions around capturing the health benefits and costs
of climate impacts and solutions embedded across different sectors of the economy, these
analyses provide critical inputs to policy decisions (66). The economic perspective is useful
in choosing among alternatives given resource constraints. Coupled with spatially resolved
information on the risk of climate hazards and vulnerable populations, this prioritization
of health interventions could aid public health practitioners in implementing targeted
interventions (120). Complementary to the health cobenefits of adaptation and mitigation
strategies, health interventions related to water and sanitation could have larger societal
benefits (121).
Ebi et al. Page 15
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
While the success of efforts to reduce GHGs and avoid increases in extreme weather
events are uncertain, the projected economic benefits of avoided mortality are significant
(169). From an equity perspective, it is important to note that the economic consequences
for specific hurricane-affected communities could be substantial even though the
macroeconomic consequences may appear small in these large-scale assessments of climate
impacts (31).
5. CONCLUSIONS
The coming decades will be characterized by increases in the frequency and intensity of
many types of extreme weather and climate events, with the potential for significant impacts
on populations and health care systems worldwide. Rigorous research conducted before,
during, and after disasters can improve assessments of population health and health system
vulnerabilities and capacities and help evaluate the effectiveness of integrated disaster
risk management and adaptation strategies (126). Such strategies can be cost-effective;
examples include city-level early warning systems (42), community intervention programs
(88), individual-level occupational health interventions (162), and initiatives to build health
facility resilience (72). The evidence base of additional health interventions that can cost-
effectively reduce the health risks of extreme events needs to be expanded.
A major challenge is the mismatch between research needs and the funding priorities of
major health institutions and organizations (142). Overall funding for health adaptation is
negligible (<1% of international climate adaptation finance). This led the 2018 Adaptation
Gap Report to conclude “there is a significant global adaptation gap in health, as efforts
are well below the level required to minimize negative health outcomes” (166, p. XIV).
Research funding to understand and manage the health risks of climate change is even
smaller (41, 62). Underlying reasons include the original framing of climate change as an
environmental problem instead of as a whole-of-society challenge. Although the situation is
changing, there is a tendency for health funders and health systems to continue to consider
climate change as one of many environmental issues, such as nitrogen deposition in our
waterways, where any additional cases of morbidity and mortality could be managed in the
normal course of business by health care and public health institutions. Because the health
risks of a changing climate are not new, funders do not see the need for additional research
and intervention. Climate change is not yet consistently viewed as core to population health
and is not widely considered a current, urgent issue. Another reason funding is so low is
that health funders and institutions take a primarily reductionist, top-down perspective to
health issues, focusing on proximate, individual-level risk factors (125). This medical-model
view of population health has been highly successful in understanding and controlling many
major causes of preventable morbidity and mortality but will be insufficient to protect health
and well-being in the face of the significant social and environmental changes expected
over the coming decades (41). Changing these mindsets through education and capacity
building is vital. Investments in research, adaptation implementation, and evaluation guided
by decision maker needs can increase resilience, helping to protect the most vulnerable
individuals and health care infrastructure while addressing inequities in disaster risk, even as
the climate changes.
Ebi et al. Page 16
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
DISCLOSURE STATEMENT
The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of this review.
LITERATURE CITED
1. Abatzoglou JT, Williams AP. 2016. Impact of anthropogenic climate change on wildfire across western US forests. PNAS 113(42):11770–75 [PubMed: 27791053]
2. Abdo M, Ward I, O’Dell K, Ford B, Pierce JR, et al. 2019. Impact of wildfire smoke on adverse pregnancy outcomes in Colorado, 2007–2015. Int. J. Environ. Res. Public Health 16(19):3720
3. Albrecht G, Sartore GM, Connor L, Higginbotham N, Freeman S, et al. 2007. Solastalgia: the distress caused by environmental change. Australas. Psychiatry 15(Suppl. 1):S95–98 [PubMed: 18027145]
4. Analitis A, Michelozzi P, D’Ippoliti D, De’Donato F, Menne B, et al. 2014. Effects of heat waves on mortality: effect modification and confounding by air pollutants. Epidemiology 25:15–22 [PubMed: 24162013]
5. Anderson WA. 2009. Disaster Risk Management in an Age of Climate Change: A Summary of the April 3, 2008 Workshop of the Disasters Roundtable Washington, DC: Natl. Acad. Press
6. Ashley CD, Luecke CL, Schwartz SS, Islam MZ, Bernard TE. 2008. Heat strain at the critical WBGT and the effects of gender, clothing and metabolic rate. Int. J. Ind. Ergon 38(7–8):640–44
7. Baldwin JW, Dessy JB, Vecchi GA, Oppenheimer M. 2019. Temporally compound heat wave events and global warming: an emerging hazard. Earth’s Future 7(4):411–27
8. Banwell N, Rutherford S, Mackey B, Chu C. 2018. Towards improved linkage of disaster risk reduction and climate change adaptation in health: a review. Int. J. Environ. Res. Public Health 15(4):793
9. Berisha V, Hondula D, Roach M, White JR, McKinney B, et al. 2017. Assessing adaptation strategies for extreme heat: a public health evaluation of cooling centers in Maricopa County, Arizona. Weather Clim. Soc 9(1):71–80
10. Berman JD, Ebisu K, Peng RD, Dominici F, Bell ML. 2017. Drought and the risk of hospital admissions and mortality in older adults in western USA from 2000 to 2013: a retrospective study. Lancet Planet. Health 1(1):e17–25 [PubMed: 29057392]
11. Biardeau LT, Davis LW, Gertler P, Wolfram C. 2020. Heat exposure and global air conditioning. Nat. Sustain 3(1):25–28
12. Bobb JF, Peng RD, Bell ML, Dominici F. 2014. Heat-related mortality and adaptation to heat in the United States. Environ. Health Perspect 122(8):811–16 [PubMed: 24780880]
13. Bonaiuto M, Alves S, De Dominicis S, Petruccelli I. 2016. Place attachment and natural hazard risk: research review and agenda. J. Environ. Psychol 48:33–53
14. Bonanno GA. 2004. Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? Am. Psychol 59:20–28 [PubMed: 14736317]
15. Borchers-Arriagada N, Horsley JA, Palmer AJ, Morgan GG, Tham R, Johnston FH. 2019. Association between fire smoke fine particulate matter and asthma-related outcomes: systematic review and meta-analysis. Environ. Res 179:108777 [PubMed: 31593836]
16. Brown MRG, Agyapong V, Greenshaw AJ, Cribben I, Brett-Maclean P, et al. 2019. After the Fort McMurray wildfire there are significant increases in mental health symptoms in grade 7–12 students compared to controls. BMC Psychiatry 19(1):18 [PubMed: 30630501]
17. Burke M, González F, Baylis P, Heft-Neal S, Baysan C, et al. 2018. Higher temperatures increase suicide rates in the United States and Mexico. Nat. Clim. Change 8(8):723–29
18. Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, et al. 2015. National Athletic Trainers’ Association position statement: exertional heat illnesses. J. Athl. Train 50(9):986–1000 [PubMed: 26381473]
19. Casanueva A, Burgstall A, Kotlarski S, Messeri A, Morabito M, et al. 2019. Overview of existing heat-health warning systems in Europe. Int. J. Environ. Res. Public Health 16(15):2657
Ebi et al. Page 17
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
20. Cascio WE. 2018. Wildland fire smoke and human health. Sci. Total Environ 624:586–95 [PubMed: 29272827]
21. Chambers KA, Husain I, Chathampally Y, Vierling A, Cardenas-Turanzas M, et al. 2020. Impact of Hurricane Harvey on healthcare utilization and emergency department operations. West. J. Emerg. Med 21(3):586–94 [PubMed: 32421505]
22. Chan EYY, Lam HCY, So SHW, Goggins WB III, Ho JY, et al. 2018. Association between ambient temperatures and mental disorder hospitalizations in a subtropical city: a time-series study of Hong Kong Special Administrative Region. Int. J. Environ. Res. Public Health 15(4):754
23. Cheshire WP, Fealey RD. 2008. Drug-induced hyperhidrosis and hypohidrosis. Drug Saf 31(2):109–26 [PubMed: 18217788]
24. Clayton S, Manning C, Krygsman K, Speiser M. 2017. Mental health and our changing climate: impacts, implications, and guidance Rep., Am. Psychol. Assoc., ecoAmerica, Washington, DC. https://www.apa.org/news/press/releases/2017/03/mental-health-climate.pdf
25. Coopersmith EJ, Bell JE, Benedict K, Shriber J, McCotter O, Cosh MH. 2017. Relating coccidioidomycosis (valley fever) incidence to soil moisture conditions. GeoHealth 1(1):51–63 [PubMed: 29124249]
26. Cramer MN, Huang M, Moralez G, Crandall CG. 2020. Keeping older individuals cool in hot and moderately humid conditions: wetted clothing with and without an electric fan. J. Appl. Physiol 128(3):604–11 [PubMed: 32027545]
27. CRED (Cent. Res. Epidemiol. Disasters). 2015. The human cost of natural disasters 2015: a global perspective Rep., CRED, Brussels, Belg. https://www.emdat.be/human_cost_natdis
28. CRED (Cent. Res. Epidemiol. Disasters), USAID (US Agency Int. Dev.). 2020. Disaster year in review 2019. Cred Crunch Newsl 58, Cent. Res. Epidemiol. Disasters, Brussels. https://cred.be/sites/default/files/CC58.pdf
29. Crooks JL, Cascio WE, Percy MS, Reyes J, Neas LM, Hilborn ED. 2016. The association between dust storms and daily non-accidental mortality in the United States, 1993–2005. Environ. Health Perspect 124(11):1735–43 [PubMed: 27128449]
30. Cunsolo A, Ellis NR. 2018. Ecological grief as a mental health response to climate change-related loss. Nat. Clim. Change 8(4):275–81
31. Dellink R, Lanzi E, Chateau J. 2019. The sectoral and regional economic consequences of climate change to 2060. Environ. Resour. Econ 72(2):309–63
32. Delpla I, Jung AV, Baures E, Clement M, Thomas O. 2009. Impacts of climate change on surface water quality in relation to drinking water production. Environ. Int 35(8):1225–33 [PubMed: 19640587]
33. Dennekamp M, Straney LD, Erbas B, Abramson MJ, Keywood M, et al. 2015. Forest fire smoke exposures and out-of-hospital cardiac arrests in Melbourne, Australia: a case-crossover study. Environ. Health Perspect 123(10):959–64 [PubMed: 25794411]
34. Dixon PG, Sinyor M, Schaffer A, Levitt A, Haney CR, et al. 2014. Association of weekly suicide rates with temperature anomalies in two different climate types. Int. J. Environ. Res. Public Health 11(11):11627–44 [PubMed: 25402561]
35. Dodd W, Howard C, Rose C, Scott C, Scott P, et al. 2018. The summer of smoke: ecosocial and health impacts of a record wildfire season in the Northwest Territories, Canada. Lancet Glob. Health 6(Suppl. 2):S30
36. Doubleday A, Errett NA, Ebi KL, Hess JJ. 2020. Indicators to guide and monitor climate change adaptation in the US Pacific Northwest. Am. J. Public Health 110(2):180–88 [PubMed: 31855485]
37. Doubleday A, Schulte J, Sheppard L, Kadlec M, Dhammapala R, et al. 2020. Mortality associated with wildfire smoke exposure in Washington state, 2006–2017: a case-crossover study. Environ. Health 19:4 [PubMed: 31931820]
38. Dunne JP, Stouffer RJ, John JG. 2013. Reductions in labour capacity from heat stress under climate warming. Nat. Clim. Change 3(6):563–66
39. Ebi K, Berry P, Hayes K, Boyer C, Sellers S, et al. 2018. Stress testing the capacity of health systems to manage climate change-related shocks and stresses. Int. J. Environ. Res. Public Health 15(11):2370
Ebi et al. Page 18
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
40. Ebi KL, Berry P, Bowen KJ, Campbell-Lendrum D, Cissé G, et al. 2019. Health system adaptation to climate variability and change Backgr. Pap., Glob. Comm. Adapt., Rotterdam, Neth./Washington, DC. https://cdn.gca.org/assets/2019-12/HealthSystemAdaptationToClimateVariabilityandChange.pdf
41. Ebi KL, Semenza JC, Rocklöv J. 2016. Current medical research funding and frameworks are insufficient to address the health risks of global environmental change. Environ. Health 15:108 [PubMed: 27835959]
42. Ebi KL, Teisberg T, Kalkstein L, Robinson F, Weiher R. 2004. Heat watch/warning systems save lives: estimated costs and benefits for Philadelphia 1995–98. Bull. Am. Meteorol. Soc 85(8):1067–73
43. Edwards TD, Young RA, Lowe AF. 2007. Caring for a surge of Hurricane Katrina evacuees in primary care clinics. Ann. Fam. Med 5(2):170–74 [PubMed: 17389543]
44. Eisenman DP, Wilhalme H, Tseng C-H, Chester M, English P, et al. 2016. Heat death associations with the built environment, social vulnerability and their interactions with rising temperature. Health Place 41:89–99 [PubMed: 27583525]
45. Elliott CT, Henderson SB, Wan V. 2013. Time series analysis of fine particulate matter and asthma reliever dispensations in populations affected by forest fires. Environ. Health 12:11 [PubMed: 23356966]
46. Emanuel K, Sundararajan R, Williams J. 2008. Hurricanes and global warming: results from downscaling IPCC AR4 simulations. Bull. Am. Meteorol. Soc 89(3):347–68
47. Falkenmark M, Rockström J. 2008. Building resilience to drought in desertification-prone savannas in Sub-Saharan Africa: the water perspective. Nat. Resour. Forum 32(2):93–102
48. Faustini A, Alessandrini ER, Pey J, Perez N, Samoli E, et al. 2015. Short-term effects of particulate matter on mortality during forest fires in Southern Europe: results of the MED-PARTICLES project. Occup. Environ. Med 72(5):323–29 [PubMed: 25691696]
49. Flanagan PX, Mahmood R, Umphlett NA, Haacker E, Ray C, et al. 2020. A hydrometeorological assessment of the historic 2019 flood of Nebraska, Iowa, and South Dakota. Bull. Am. Meteorol. Soc 101(6):E817–29
50. Flores AB, Collins TW, Grineski SE, Chakraborty J. 2020. Disparities in health effects and access to health care among Houston area residents after Hurricane Harvey. Public Health Rep 135(4):511–23 [PubMed: 32539542]
51. Flouris AD, Dinas PC, Ioannou LG, Nybo L, Havenith G, et al. 2018. Workers’ health and productivity under occupational heat strain: a systematic review and meta-analysis. Lancet Planet. Health 2(12):e521–31 [PubMed: 30526938]
52. Ford B, Val Martin M, Zelasky SE, Fischer EV, Anenberg SC, et al. 2018. Future fire impacts on smoke concentrations, visibility, and health in the contiguous United States. GeoHealth 2(8):229–47 [PubMed: 32159016]
53. Ford H, Wright J. 1994. Bacterial meningitis in Swaziland: an 18 month prospective study of its impact. J. Epidemiol. Community Health 48(3):276–80 [PubMed: 8051527]
54. Freeman L 2017. Environmental change, migration, and conflict in Africa: a critical examination of the interconnections. J. Environ. Dev 26(4):351–74
55. Gan RW, Liu J, Ford B, O’Dell K, Vaidyanathan A, et al. 2020. The association between wildfire smoke exposure and asthma-specific medical care utilization in Oregon during the 2013 wildfire season. J. Expo. Sci. Environ. Epidemiol 30:618–28 [PubMed: 32051501]
56. Gasparrini A, Guo Y, Hashizume M, Kinney PL, Petkova EP, et al. 2015. Temporal variation in heat-mortality associations: a multicountry study. Environ. Health Perspect 123(11):1200–7 [PubMed: 25933359]
57. Geiger T, Frieler K, Bresch DN. 2018. A global historical data set of tropical cyclone exposure (TCE-DAT). Earth Syst. Sci. Data 10(1):185–94
58. Gladstone R 2019. U.N. aid chief warns of looming ‘horror’ as Somalia again faces famine. New York Times, Jun. 5. https://www.nytimes.com/2019/06/05/world/africa/africa-famine-united-nations-somalia.html
59. Gleick PH. 2014. Water, drought, climate change, and conflict in Syria. Weather Clim. Soc 6(3):331–40
Ebi et al. Page 19
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
60. Gosling SN, Hondula DM, Bunker A, Ibarreta D, Liu J, et al. 2017. Adaptation to climate change: a comparative analysis of modeling methods for heat-related mortality. Environ. Health Perspect 125(8):087008 [PubMed: 28885979]
61. Gosselin P, Mehiriz K, Tardif S, Lemieux M. 2018. Téléphone santé: un automate d’appel aux résultats prometteurs lors de vagues de chaleur ou de smog. Bull. d’information en santé environ, Oct. https://www.inspq.qc.ca/sites/default/files/documents/bise/bise_article_sata_final.pdf
62. Green D, Pitman A, Barnett A, Kaldor J, Doherty P, Stanley F. 2017. Advancing Australia’s role in climate change and health research. Nat. Clim. Change 7(2):103–6
63. Green H, Bailey J, Schwarz L, Vanos J, Ebi K, Benmarhnia T. 2019. Impact of heat on mortality and morbidity in low and middle income countries: a review of the epidemiological evidence and considerations for future research. Environ. Res 171:80–91 [PubMed: 30660921]
64. Gubernot DM, Anderson GB, Hunting KL. 2015. Characterizing occupational heat-related mortality in the United States, 2000–2010: an analysis using the census of fatal occupational injuries database. Am. J. Ind. Med 58(2):203–11 [PubMed: 25603942]
65. Haines A, McMichael AJ, Smith KR, Roberts I, Woodcock J, et al. 2009. Public health benefits of strategies to reduce greenhouse-gas emissions: overview and implications for policy makers. Lancet 374(9707):2104–14 [PubMed: 19942281]
66. Hallegatte S, Henriet F, Corfee-Morlot J. 2011. The economics of climate change impacts and policy benefits at city scale: a conceptual framework. Clim. Change 104(1):51–87
67. Hallegatte S, Vogt-Schilb A, Bangalore M, Rozenberg J. 2017. Unbreakable: Building the Resilience of the Poor in the Face of Natural Disasters Washington, DC: World Bank Publ.
68. Hamstead Z, Coseo P, AlKhaled S, Boamah EF, Hondula DM, et al. 2020. Thermally resilient communities: creating a socio-technical collaborative response to extreme temperatures. Build. Cities 1(1):218–32
69. Hasegawa T, Fujimori S, Takahashi K, Yokohata T, Masui T. 2016. Economic implications of climate change impacts on human health through undernourishment. Clim. Change 136(2):189–202
70. Hayes K, Berry P, Ebi KL. 2019. Factors influencing the mental health consequences of climate change in Canada. Int. J. Environ. Res. Public Health 16(9):1583
71. Hayes K, Poland B. 2018. Addressing mental health in a changing climate: incorporating mental health indicators into climate change and health vulnerability and adaptation assessments. Int. J. Environ. Res. Public Health 15(9):1806
72. Health Care Without Harm. 2018. Safe haven in the storm: protecting lives and margins with climate-smart health care Rep., Health Care Without Harm, Reston, VA. https://noharm-uscanada.org/sites/default/files/documents-files/5146/Safe_haven.pdf
73. Hendrickson LA, Vogt RL, Goebert D, Pon E. 1997. Morbidity on Kauai before and after Hurricane Iniki. Prev. Med 26(5):711–16 [PubMed: 9327481]
74. Hess JJ, Ebi KL. 2016. Iterative management of heat early warning systems in a changing climate. Ann. N.Y. Acad. Sci 1382(1):21–30 [PubMed: 27788557]
75. Hess JJ, Lm S, Knowlton K, Saha S, Dutta P, et al. 2018. Building resilience to climate change: pilot evaluation of the impact of India’s first heat action plan on all-cause mortality. J. Environ. Public Health 2018:7973519 [PubMed: 30515228]
76. Hirschi M, Seneviratne SI, Alexandrov V, Boberg F, Boroneant C, et al. 2011. Observational evidence for soil-moisture impact on hot extremes in southeastern Europe. Nat. Geosci 4(1):17–21
77. Hoegh-Guldberg O, Jacob D, Taylor M, Bindi M, Brown S, et al. 2018. Impacts of 1.5°C global warming on natural and human systems. In Global warming of 1.5°C: an IPCC special report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, ed. Masson-Delmotte V, Zhai P, Pörtner HO, Roberts D, Skea J, et al., pp. 175–311. Rep., Intergov. Panel Clim. Change, Geneva. https://www.ipcc.ch/site/assets/uploads/sites/2/2019/06/SR15_Full_Report_High_Res.pdf
78. Holstius DM, Reid CE, Jesdale BM, Morello-Frosch R. 2012. Birth weight following pregnancy during the 2003 Southern California wildfires. Environ. Health Perspect 120(9):1340–45 [PubMed: 22645279]
Ebi et al. Page 20
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
79. Hosokawa Y, Vanos J. 2020. Extreme heat and health at Tokyo-2020ne: the need for scientific coalition across sectors. Temperature 7(2):111–13
80. Hunter MR, Gillespie BW, Chen SY-P. 2019. Urban nature experiences reduce stress in the context of daily life based on salivary biomarkers. Front. Psychol 10:722 [PubMed: 31019479]
81. IFRC (Int. Fed. Red Cross Red Crescent Soc.). 2020. What is a disaster? IFRC https://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster/
82. IPCC (Intergov. Panel Clim. Change). 2012. Managing the risks of extreme events and disasters to advance climate change adaptation: special report of the Intergovernmental Panel on Climate Change, ed. Field CB, Barros V, Stocker TF, Qin D, Dokken DJ, et al. Rep., Intergov. Panel Clim. Change, Cambridge, UK. https://www.ipcc.ch/report/managing-the-risks-of-extreme-events-and-disasters-to-advance-climate-change-adaptation/
83. IPCC (Intergov. Panel Clim. Change). 2014. Climate change 2014: synthesis report. Contribution of Working Groups I, II and III to the fifth assessment report of the Intergovernmental Panel on Climate Change, ed. Pachauri RK, Meyer LA. Rep., Intergov. Panel Clim. Change, Geneva. https://www.ipcc.ch/site/assets/uploads/2018/05/SYR_AR5_FINAL_full_wcover.pdf
84. IPCC (Intergov. Panel Clim. Change). 2019. Summary for policymakers. In Climate change and land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems, ed. Shukla PR, Skea J, Calvo Buendia E, Masson-Delmotte V, Pörtner H-O, et al., pp. 3–36. Rep., Intergov. Panel Clim. Change, Geneva. https://www.ipcc.ch/site/assets/uploads/sites/4/2020/02/SPM_Updated-Jan20.pdf
85. Jaffe DA, O’Neill SM, Larkin NK, Holder AL, Peterson DL, et al. 2020. Wildfire and prescribed burning impacts on air quality in the United States. J. Air Waste Manag. Assoc 70(6):583–615 [PubMed: 32240055]
86. Jalaludin B, Smith M, O’Toole B, Leeder S. 2000. Acute effects of bushfires on peak expiratory flow rates in children with wheeze: a time series analysis. Aust. N. Z. J. Public Health 24(2):174–77 [PubMed: 10790937]
87. Jiao Z, Kakoulides SV, Moscona J, Whittier J, Srivastav S, et al. 2012. Effect of Hurricane Katrina on incidence of acute myocardial infarction in New Orleans three years after the storm. Am. J. Cardiol 109(4):502–5 [PubMed: 22154089]
88. Jing LI, Xin XU, Jun W, Yun Z, Song XP, et al. 2016. Analysis of a community-based intervention to reduce heat-related illness during heat waves in Licheng, China: a quasi-experimental study. Biomed. Environ. Sci 29(11):802–13 [PubMed: 27998386]
89. Johnston FH, Hanigan I, Henderson S, Morgan G, Bowman D. 2011. Extreme air pollution events from bushfires and dust storms and their association with mortality in Sydney, Australia 1994–2007. Environ. Res 111(6):811–16 [PubMed: 21601845]
90. Johnston FH, Henderson SB, Chen Y, Randerson JT, Marlier M, et al. 2012. Estimated global mortality attributable to smoke from landscape fires. Environ. Health Perspect 120(5):695–701 [PubMed: 22456494]
91. Johnston FH, Webby RJ, Pilotto LS, Bailie RS, Parry DL, Halpin SJ. 2006. Vegetation fires, particulate air pollution and asthma: a panel study in the Australian monsoon tropics. Int. J. Environ. Health Res 16(6):391–404 [PubMed: 17164166]
92. Jolly WM, Cochrane MA, Freeborn PH, Holden ZA, Brown TJ, et al. 2015. Climate-induced variations in global wildfire danger from 1979 to 2013. Nat. Commun 6:7537 [PubMed: 26172867]
93. Jones CG, Rappold AG, Vargo J, Cascio WE, Kharrazi M, et al. 2020. Out-of-hospital cardiac arrests and wildfire-related particulate matter during 2015–2017 California wildfires. J. Am. Heart Assoc 9(8):e014125 [PubMed: 32290746]
94. Karliner J, Slotterback S, Boyd R, Ashby B, Steele K, Wang J. 2019. Health care’s climate footprint: how the health sector contributes to the global climate crisis and opportunities for action. Eur. J. Public Health 30(Suppl. 5):ckaa165.843
95. Keim ME. 2008. Building human resilience: the role of public health preparedness and response as an adaptation to climate change. Am. J. Prev. Med 35(5):508–16 [PubMed: 18929977]
Ebi et al. Page 21
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
96. Keim ME. 2011. Preventing disasters: public health vulnerability reduction as a sustainable adaptation to climate change. Disaster Med. Public Health Prep 5(2):140–48 [PubMed: 21402799]
97. Keim ME. 2020. The epidemiology of extreme weather event disasters (1969–2018). Prehosp. Disaster Med 35(3):267–71 [PubMed: 32290884]
98. Kenney WL, Craighead DH, Alexander LM. 2014. Heat waves, aging, and human cardiovascular health. Med. Sci. Sports Exerc 46(10):1891 [PubMed: 24598696]
99. Kim Y, Kim H, Gasparrini A, Armstrong B, Honda Y, et al. 2019. Suicide and ambient temperature: a multi-country multi-city study. Environ. Health Perspect 127(11):117007 [PubMed: 31769300]
100. Kim Y, Knowles S, Manley J, Radoias V. 2017. Long-run health consequences of air pollution: evidence from Indonesia’s forest fires of 1997. Econ. Hum. Biol 26:186–98 [PubMed: 28460366]
101. Kishore N, Marqués D, Mahmud A, Kiang MV, Rodriguez I, et al. 2018. Mortality in Puerto Rico after Hurricane Maria. N. Engl. J. Med 379(2):162–70 [PubMed: 29809109]
102. Kjellstrom T, Kovats RS, Lloyd SJ, Holt T, Tol RSJ. 2009. The direct impact of climate change on regional labor productivity. Arch. Environ. Occup. Health 64(4):217–27 [PubMed: 20007118]
103. Knutson TR, McBride JL, Chan J, Emanuel K, Holland G, et al. 2010. Tropical cyclones and climate change. Nat. Geosci 3(3):157–63
104. Kondo MC, De Roos AJ, White LS, Heilman WE, Mockrin MH, et al. 2019. Meta-analysis of heterogeneity in the effects of wildfire smoke exposure on respiratory health in North America. Int. J. Environ. Res. Public Health 16(6):960
105. Kornhuber K, Coumou D, Vogel E, Lesk C, Donges JF, et al. 2020. Amplified Rossby waves enhance risk of concurrent heatwaves in major breadbasket regions. Nat. Clim. Change 10(1):48–53
106. Kuehn L, McCormick S. 2017. Heat exposure and maternal health in the face of climate change. Int. J. Environ. Res. Public Health 14(8):853
107. Lane K, Charles-Guzman K, Wheeler K, Abid Z, Graber N, Matte T. 2013. Health effects of coastal storms and flooding in urban areas: a review and vulnerability assessment. J. Environ. Public Health 2013:913064 [PubMed: 23818911]
108. Lay CR, Mills D, Belova A, Sarofim MC, Kinney PL, et al. 2018. Emergency department visits and ambient temperature: evaluating the connection and projecting future outcomes. GeoHealth 2(6):182–94 [PubMed: 32159014]
109. Lieberman-Cribbin W, Gillezeau C, Schwartz RM, Taioli E. 2020. Unequal social vulnerability to Hurricane Sandy flood exposure. J. Expo. Sci. Environ. Epidemiol 10.1038/s41370-020-0230-6
110. Limaye VS, Max W, Constible J, Knowlton K. 2019. Estimating the health-related costs of 10 climate-sensitive US events during 2012. GeoHealth 3(9):245–65 [PubMed: 32159045]
111. Lin M, Horowitz LW, Payton R, Fiore AM, Tonnesen G. 2017. US surface ozone trends and extremes from 1980 to 2014: quantifying the roles of rising Asian emissions, domestic controls, wildfires, and climate. Atmos. Chem. Phys 17(4):2943–70
112. Lipner EM, O’Dell K, Brey SJ, Ford B, Pierce JR, et al. 2019. The associations between clinical respiratory outcomes and ambient wildfire smoke exposure among pediatric asthma patients at National Jewish Health, 2012–2015. GeoHealth 3(6):146–59 [PubMed: 32159037]
113. Little CM, Horton RM, Kopp RE, Oppenheimer M, Vecchi GA, Villarini G. 2015. Joint projections of US East Coast sea level and storm surge. Nat. Clim. Change 5(12):1114–20
114. Liu JC, Mickley LJ, Sulprizio MP, Dominici F, Yue X, et al. 2016. Particulate air pollution from wildfires in the Western US under climate change. Clim. Change 138(3–4):655–66 [PubMed: 28642628]
115. Liu JC, Mickley LJ, Sulprizio MP, Yue X, Peng RD, et al. 2016. Future respiratory hospital admissions from wildfire smoke under climate change in the Western US. Environ. Res. Lett 11(12):124018
116. Liu Y, Saha S, Hoppe BO, Convertino M. 2019. Degrees and dollars—health costs associated with sub-optimal ambient temperature exposure. Sci. Total Environ 678:702–11 [PubMed: 31078861]
Ebi et al. Page 22
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
117. Lynch KM, Lyles RH, Waller LA, Abadi AM, Bell JE, Gribble MO. 2020. Drought severity and all-cause mortality rates among adults in the United States: 1968–2014. Environ. Health 19:52 [PubMed: 32423443]
118. Maller CJ, Strengers Y. 2011. Housing, heat stress and health in a changing climate: promoting the adaptive capacity of vulnerable households, a suggested way forward. Health Promot. Int 26(4):492–98 [PubMed: 21307023]
119. Mandal J, Fu Y, Overvig AC, Jia M, Sun K, et al. 2018. Hierarchically porous polymer coatings for highly efficient passive daytime radiative cooling. Science 362(6412):315–19 [PubMed: 30262632]
120. Marinucci GD, Luber G, Uejio CK, Saha S, Hess JJ. 2014. Building resilience against climate effects—a novel framework to facilitate climate readiness in public health agencies. Int. J. Environ. Res. Public Health 11(6):6433–58 [PubMed: 24991665]
121. Markandya A, Chiabai A. 2009. Valuing climate change impacts on human health: empirical evidence from the literature. Int. J. Environ. Res. Public Health 6(2):759–86 [PubMed: 19440414]
122. Marsh B, Milofsky C, Kissam E, Arcury TA. 2015. Understanding the role of social factors in farmworker housing and health. New Solut. J. Environ. Occup. Health Policy 25(3):313–33
123. Matz CJ, Egyed M, Xi G, Racine J, Pavlovic R, et al. 2020. Health impact analysis of PM2.5 from wildfire smoke in Canada (2013–2015, 2017–2018). Sci. Total Environ 725:138506 [PubMed: 32302851]
124. MCDPH (Maricopa Cty. Dept. Public Health). 2020. Heat-associated deaths in Maricopa County, AZ: final report for 2019. Rep, Maricopa Cty. Dept. Public Health, Phoenix, AZ. https://www.maricopa.gov/ArchiveCenter/ViewFile/Item/4959
125. McMichael AJ. 1993. Planetary Overload: Global Environmental Change and the Health of the Human Species Cambridge, UK: Cambridge Univ. Press
126. Miller A, Yeskey K, Garantziotis S, Arnesen S, Bennett A, et al. 2016. Integrating health research into disaster response: the new NIH disaster research response program. Int. J. Environ. Res. Public Health 13(7):676
127. Moritz MA, Parisien M-A, Batllori E, Krawchuk MA, Van Dorn J, et al. 2012. Climate change and disruptions to global fire activity. Ecosphere 3(6):49
128. Morris NB, English T, Hospers L, Capon A, Jay O. 2019. The effects of electric fan use under differing resting heat index conditions: a clinical trial. Ann. Intern. Med 171(9):675–77 [PubMed: 31382270]
129. Mosley LM. 2015. Drought impacts on the water quality of freshwater systems; review and integration. Earth-Sci. Rev 140:203–14
130. Re Munich. 2019. NatCatSERVICE: the Natural Catastrophe Loss Database Munich, Ger. Retrieved Novemb. 28. https://www.munichre.com/en/risks/extreme-weather.html#Explore%20our%20solutions
131. Munro A, Kovats RS, Rubin GJ, Waite TD, Bone A, et al. 2017. Effect of evacuation and displacement on the association between flooding and mental health outcomes: a cross-sectional analysis of UK survey data. Lancet Planet. Health 1(4):e134–41 [PubMed: 28944321]
132. NOAA (Natl. Ocean. Atmos. Adm.) NCEI (Natl. Cent. Environ. Inf.). 2020. Billion-dollar weather and climate disasters: overview. National Oceanic and Atmospheric Administration National Centers for Environmental Information https://www.ncdc.noaa.gov/billions/
133. Noble IR, Huq S, Anokhin YA, Carmin J, Goudou D, et al. 2014. Adaptation needs and options. In Climate change 2014: impacts, adaptation and vulnerability. Part A: global and sectoral aspects. Contribution of Working Group II to the fifth assessment report of the Intergovernmental Panel on Climate Change, ed. Field CB, Barros VR, Dokken DJ, Mach KI, Mastrandrea MD, pp. 833–68. Rep., Intergov. Panel Clim. Change, Cambridge, UK/New York. https://www.ipcc.ch/site/assets/uploads/2018/02/WGIIAR5-Chap14_FINAL.pdf
134. Odhiambo Sewe M, Bunker A, Ingole V, Egondi T, Oudin Åström D, et al. 2018. Estimated effect of temperature on years of life lost: a retrospective time-series study of low-, middle-, and high-income regions. Environ. Health Perspect 126(1):17004
Ebi et al. Page 23
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
135. Orengo-Aguayo R, Stewart RW, de Arellano MA, Suárez-Kindy JL, Young J. 2019. Disaster exposure and mental health among Puerto Rican youths after Hurricane Maria. JAMA Netw. Open 2(4):e192619 [PubMed: 31026024]
136. Orr M, Inoue Y. 2019. Sport versus climate: introducing the climate vulnerability of sport organizations framework. Sport Manag. Rev 22(4):452–63
137. Park J 2020. Hot temperature and high stakes. J. Hum. Resour 10.3368/jhr.57.2.0618-9535R3
138. Park RJ, Goodman J, Hurwitz M, Smith J. 2020. Heat and learning. Am. Econ. J. Econ. Policy 12(2):306–39
139. Paterson DL, Wright H, Harris PNA. 2018. Health risks of flood disasters. Clin. Infect. Dis 67(9):1450–54 [PubMed: 30986298]
140. Pescaroli G, Alexander D. 2018. Understanding compound, interconnected, interacting, and cascading risks: a holistic framework. Risk Anal 38(11):2245–57 [PubMed: 29906307]
141. Picou JS, Hudson K. 2010. Hurricane Katrina and mental health: a research note on Mississippi Gulf Coast residents. Sociol. Inq 80(3):513–24 [PubMed: 20827859]
142. Rappaport EN. 2014. Fatalities in the United States from Atlantic tropical cyclones: new data and interpretation. Bull. Am. Meteorol. Soc 95(3):341–46
143. Rappaport EN, Blanchard BW. 2016. Fatalities in the United States indirectly associated with Atlantic tropical cyclones. Bull. Am. Meteorol. Soc 97(7):1139–48
144. Raymond C, Horton RM, Zscheischler J, Martius O, AghaKouchak A, et al. 2020. Understanding and managing connected extreme events. Nat. Clim. Change 10(7):611–21
145. Reid CE, Brauer M, Johnston FH, Jerrett M, Balmes JR, Elliott CT. 2016. Critical review of health impacts of wildfire smoke exposure. Environ. Health Perspect 124(9):1334–43 [PubMed: 27082891]
146. Reid CE, Jerrett M, Tager IB, Petersen ML, Mann JK, Balmes JR. 2016. Differential respiratory health effects from the 2008 northern California wildfires: a spatiotemporal approach. Environ. Res 150:227–35 [PubMed: 27318255]
147. Remoundou K, Koundouri P. 2009. Environmental effects on public health: an economic perspective. Int. J. Environ. Res. Public Health 6(8):2160–78 [PubMed: 19742153]
148. Ritchie H, Roser M. 2014. Natural disasters. Our World in Data https://ourworldindata.org/natural-disasters
149. Robin C, Beck C, Armstrong B, Waite TD, Rubin GJ, Oliver I. 2020. Impact of flooding on health-related quality of life in England: results from the National Study of Flooding and Health. Eur. J. Public Health 30(50):942–48 [PubMed: 32227174]
150. Salamanca F, Georgescu M, Mahalov A, Moustaoui M, Wang M. 2014. Anthropogenic heating of the urban environment due to air conditioning. J. Geophys. Res. Atmos 119(10):5949–65
151. Saulnier DD, Brolin Ribacke K, Von Schreeb J. 2017. No calm after the storm: a systematic review of human health following flood and storm disasters. Prehosp. Disaster Med 32(5):568–79 [PubMed: 28606191]
152. Schulte PA, Bhattacharya A, Butler CR, Chun HK, Jacklitsch B, et al. 2016. Advancing the framework for considering the effects of climate change on worker safety and health. J. Occup. Environ. Hyg 13(11):847–65 [PubMed: 27115294]
153. Seed RB, Nicholson PG, Dalrymple RA, Battjes J, Bea RG, et al. 2005. Preliminary report on the performance of the New Orleans levee systems in Hurricane Katrina on August 29, 2005. Rep. UCB/CITRIS 05/01, Cent. Inf. Technol. Res. Interest Soc, Univ. Calif. Berkeley, Berkeley, CA. https://www.berkeley.edu/news/media/releases/2005/11/leveereport_prelim.pdf
154. Seneviratne S, Nicholls N, Easterling D, Goodess CM, Kanae S, et al. 2012. Changes in climate extremes and their impacts on the natural physical environment. In Managing the risks of extreme events and disasters to advance climate change adaptation: special report of the Intergovernmental Panel on Climate Change, ed Field CB, Barros V, Stocker TF, Qin D, Dokken DJ, et al., pp. 109–230. Rep, Intergov. Panel Clim. Change, Cambridge, UK. https://www.ipcc.ch/site/assets/uploads/2018/03/SREX-Chap3_FINAL-1.pdf
155. Shaw R 2016. Community-based disaster risk reduction. Oxford Research Encyclopedia of Natural Hazard Science https://oxfordre.com/naturalhazardscience/view/10.1093/acrefore/9780199389407.001.0001/acrefore-9780199389407-e-47
Ebi et al. Page 24
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
156. Shumake-Guillemot J, Amir S, Anwar N, Arrighi J, Böse-O’Reilly S, et al. 2020. Protecting health from hot weather during the COVID-19 pandemic Tech. Brief, Glob. Heat Health Inf. Netw., Geneva
157. Smith AB. 2020. U.S. billion-dollar weather and climate disasters, 1980 – present (NCEI accession 0208268) Data Set, Natl. Ocean. Atmos. Adm. Natl. Cent. Environ. Inf., Silver Spring, MD, retrieved Novembr. 28. https://www.ncei.noaa.gov/access/metadata/landing-page/bin/iso?id=gov.noaa.nodc:0209268
158. Smith KR, Woodward A, Lemke B, Otto M, Chang CJ, et al. 2016. The last Summer Olympics? Climate change, health, and work outdoors. Lancet 388(10045):642–44 [PubMed: 27533426]
159. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. 2013. Health effects of drought: a systematic review of the evidence. PLOS Curr. Disasters, June 5. 10.1371/currents.dis.7a2cee9e980f91ad7697b570bcc4b004
160. Stowell JD, Geng G, Saikawa E, Chang HH, Fu J, et al. 2019. Associations of wildfire smoke PM2.5 exposure with cardiorespiratory events in Colorado 2011–2014. Environ. Int 133:105151 [PubMed: 31520956]
161. Sun S, Weinberger KR, Yan M, Anderson GB, Wellenius GA. 2020. Tropical cyclones and risk of preterm birth: a retrospective analysis of 20 million births across 378 US counties. Environ. Int 140:105825 [PubMed: 32485474]
162. Takakura J, Fujimori S, Takahashi K, Hijioka Y, Hasegawa T, et al. 2017. Cost of preventing workplace heat-related illness through worker breaks and the benefit of climate-change mitigation. Environ. Res. Lett 12(6):64010
163. Tex. Hosp. Assoc. 2017. Texas Hospital Association Hurricane Harvey analysis: Texas hospitals’ preparation strategies and priorities for future disaster response Spec. Rep., Tex. Hosp. Assoc., Austin
164. Tigchelaar M, Battisti DS, Spector JT. 2020. Work adaptations insufficient to address growing heat risk for US agricultural workers. Environ. Res. Lett 15(9):094035 [PubMed: 33133229]
165. Trenberth KE, Dai A, Van Der Schrier G, Jones PD, Barichivich J, et al. 2014. Global warming and changes in drought. Nat. Clim. Change 4(1):17–22
166. UN Environ. Progr. (UNEP). 2018. The adaptation gap report 2018 Rep., United Nations Environ. Progr., Nairobi, Kenya. https://wedocs.unep.org/bitstream/handle/20.500.11822/27114/AGR_2018.pdf
167. UN Int. Strategy Disaster Reduct. 2008. Climate change and disaster risk reduction Brief. Note, United Nations Int. Strategy Disaster Reduct., Geneva
168. UN Off. Disaster Risk Reduct. 2020. Disaster risk reduction & disaster risk management. PreventionWeb https://www.preventionweb.net/risk/drr-drm
169. US EPA (US Environ. Prot. Agency). 2017. Multi-model framework for quantitative sectoral impacts analysis: a technical report for the fourth national climate assessment Rep., US EPA, Washington, DC. https://cfpub.epa.gov/si/si_public_record_Report.cfm?Lab=OAP&dirEntryId=335095
170. USGCRP (US Glob. Change Res. Progr.). 2018. Fourth national climate assessment, Vol. 2: Impacts, risks, and adaptation in the United States Rep, US Glob. Change Res. Progr., Washington, DC. https://nca2018.globalchange.gov/downloads/NCA4_2018_FullReport.pdf
171. van Oldenborgh GJ, van der Wiel K, Philip S, Kew S, Sebastian A, et al. 2019. Rapid attribution of the extreme rainfall in Texas from Tropical Storm Imelda Rapid Anal., World Weather Attrib., R. Neth. Meteorol. Inst., De Bilt, Neth. https://www.worldweatherattribution.org/rapid-attribution-of-the-extreme-rainfall-in-texas-from-tropical-storm-imelda/
172. Vanos JK, Herdt AJ, Lochbaum MR. 2017. Effects of physical activity and shade on the heat balance and thermal perceptions of children in a playground microclimate. Build. Environ 126:119–31
173. Vins H, Bell J, Saha S, Hess J. 2015. The mental health outcomes of drought: a systematic review and causal process diagram. Int. J. Environ. Res. Public Health 12(10):13251–75 [PubMed: 26506367]
Ebi et al. Page 25
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
174. Waite TD, Chaintarli K, Beck CR, Bone A, Amlôt R, et al. 2017. The English national cohort study of flooding and health: cross-sectional analysis of mental health outcomes at year one. BMC Public Health 17:129 [PubMed: 28129752]
175. Wang X, Lavigne E, Ouellette-Kuntz H, Chen BE. 2014. Acute impacts of extreme temperature exposure on emergency room admissions related to mental and behavior disorders in Toronto, Canada. J. Affect. Disord 155(1):154–61 [PubMed: 24332428]
176. Watkiss P, Hunt A. 2012. Projection of economic impacts of climate change in sectors of Europe based on bottom up analysis: human health. Clim. Change 112(1):101–26
177. Weaver VM, Fadrowski JJ, Jaar BG. 2015. Global dimensions of chronic kidney disease of unknown etiology (CKDu): a modern era environmental and/or occupational nephropathy? BMC Nephrol 16(1):145 [PubMed: 26282933]
178. Weinberger KR, Harris D, Spangler KR, Zanobetti A, Wellenius GA. 2020. Estimating the number of excess deaths attributable to heat in 297 United States counties. Environ. Epidemiol 4(3):e096 [PubMed: 32613153]
179. Westerling AL, Hidalgo HG, Cayan DR, Swetnam TW. 2006. Warming and earlier spring increase western US forest wildfire activity. Science 313(5789):940–43 [PubMed: 16825536]
180. Wettstein ZS, Hoshiko S, Fahimi J, Harrison RJ, Cascio WE, Rappold AG. 2018. Cardiovascular and cerebrovascular emergency department visits associated with wildfire smoke exposure in California in 2015. J. Am. Heart Assoc 7(8):e007492 [PubMed: 29643111]
181. WHO (World Health Organ.). 2014. WHO guidance to protect health from climate change through health adaptation planning Rep., World Health Organ., Geneva. https://apps.who.int/iris/bitstream/handle/10665/137383/9789241508001_eng.pdf
182. WHO (World Health Organ.). 2015. Operational framework for building climate resilient health systems Rep., World Health Organ., Geneva. https://apps.who.int/iris/bitstream/handle/10665/189951/9789241565073_eng.pdf
183. Zeppetello LV, Parsons L, Spector J, Naylor R, Battisti D, et al. 2020. Large scale tropical deforestation drives extreme warming. Environ. Res. Lett 15(8):084012
184. Zscheischler J, Martius O, Westra S, Bevacqua E, Raymond C, et al. 2020. A typology of compound weather and climate events. Nat. Rev. Earth Environ 1:333–47
185. Zscheischler J, Seneviratne SI. 2017. Dependence of drivers affects risks associated with compound events. Sci. Adv 3(6):e1700263 [PubMed: 28782010]
Ebi et al. Page 26
Annu Rev Public Health. Author manuscript; available in PMC 2022 April 17.
Author M
anuscriptA
uthor Manuscript
Author M
anuscriptA
uthor Manuscript
- Abstract
- INTRODUCTION
- EXTREME EVENTS INFLUENCED BY CLIMATE CHANGE
- Tropical Cyclones or Hurricanes
- Compound Events
- POPULATION HEALTH AND HEALTH SYSTEM RISKS FROM EXTREME EVENTS INFLUENCED BY CLIMATE CHANGE
- High Ambient Temperatures
- Morbidity and mortality from heat waves.
- Occupational health.
- Recreation.
- Droughts
- Floods
- Wildfires
- Mental Health
- INCREASING THE RESILIENCE OF HEALTH SYSTEMS
- Adaptation and Mitigation
- Disaster Risk Management
- Economic Considerations
- CONCLUSIONS
- References
