Editing IPCC:AR6/WGII/Chapter-7 (section)

==== 7.4.2.4 Adaptation Options for Heat-Related Morbidity and Mortality ====

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Adaptations options for heat refer to strategies implemented at short time scales such as air conditioning and HAPs, including heat warning systems and longer-term solutions such as urban design and planning and NbS (Table 7.4).

'''Table 7.4 |''' Summary of adaptation options for key health risks associated with heat.

{| class="wikitable"
|-
! '''Key risk'''

! '''Geographic region'''

! '''Consequence that would be considered severe, and to whom'''

! '''Hazard conditions that would contribute to this risk being severe'''

! '''Exposure conditions that would contribute to this risk being severe'''

! '''Vulnerability conditions that would contribute to this risk being severe'''

! '''Adaptation options with high potential for reducing risk'''

! '''Selected key references'''

|-
| Heat-related mortality, morbidity and mental illness

| * Global but especially where temperature extremes beyond physical and mental health and thermal comfort threshold levels are expected to increase

| * Substantial increase in heat-related mortality and morbidity rates, especially in urban centres (heat island effect) and rural areas (outside workers), outdoors in general (sports and related activities) and for people suffering from obesity, weak cardiovascular capacity /physical fitness
* Increased risk of respiratory disease and CVD mortality
* Loss of economic productivity
* Substantial increase in mental illness compared to base rate

| * Substantial increase in frequency and duration of extreme heat events, especially in cities where heat will be exacerbated by UHI effects
* Unintended increases in urban temperatures from anthropogenic heat (vehicles, air conditioning, urban metabolism)
* Increased number of days with high temperatures in non-urban settings such as agricultural areas

| * Large increases in urban heat and population heat exposure driven by demographic change (e.g., aging) and increasing urbanisation
* Exposure will increase amongst agricultural and construction workers

| * Mortality/morbidity: Increases in the number of very young and elderly and of those with other health conditions such as lack of physical fitness, obesity, diabetes and associated comorbidities; lack of adaptation capacity
* Mental illness: Lack of air conditioning; lack of access to healthcare systems and services

| * Heat warning systems.
* Improved building and urban design (including green and blue infrastructure) and passive cooling systems, acknowledging that not all will have access to air conditioning
* Broader understanding of heat hazard and better access to public health systems for the most vulnerable
* Application where possible of renewable energy sources
* Communication around drinking water; availability of clean water via simple effective water purification systems in low water quality settings; water spray cooling
* Mental health support

| [[#Benmarhnia--2016|Benmarhnia et al. (2016)]] ; [[#Chen--2019|Chen et al. (2019)]] ; [[#Jay--2021|Jay et al. (2021)]] ; [[#Heo--2019b|Heo et al. (2019b)]] ; [[#Martinez-Solanas--2019|Martinez-Solanas and Basagana (2019)]] ; [[#Morabito--2021|Morabito et al. (2021)]] ; [[#Schwingshackl--2021|Schwingshackl et al. (2021)]]

|}

To date, air conditioning is the main adaptation approach for mitigating the health effects of high temperatures, especially in relation to cardiorespiratory health ( [[#Madureira--2021|Madureira et al., 2021]] ). However, air conditioning may constitute a maladaptation because of its high demands on energy and associated heat emissions, especially in high-density cities ( [[#Eriksen--2021|Eriksen et al., 2021]] ; [[#Magnan--2016|Magnan et al., 2016]] ; [[#Schipper--2020|Schipper, 2020]] ), and also lead to ‘heat inequities’ as this is not an affordable or practical option for many ( [[#Jay--2021|Jay et al., 2021]] ; [[#Turek-Hankins--2021|Turek-Hankins et al., 2021]] ). HAPs link weather forecasts with alert and communication systems and response activities, including public cooling centres, enhanced heat-related disease surveillance and a range of individual actions designed to reduce the health effects of extreme heat events such as seeking shade and altering the pattern of work ( [[#McGregor--2015|McGregor et al., 2015]] ). While well-designed and operationalisable HAPs possess the potential to reduce the likelihood of mortality from extreme heat events ( ''medium confidence'' ) ( [[#Benmarhnia--2016|Benmarhnia et al., 2016]] ; [[#Heo--2019b|Heo et al., 2019b]] ; [[#Martinez-Solanas--2019|Martinez-Solanas and Basagana, 2019]] ; [[#Martinez--2019|Martinez et al., 2019]] ; [[#De’Donato--2018|De’Donato et al., 2018]] ), full process and outcome-based evaluations of HAPs and their constituent components are lacking ( [[#Boeckmann--2014|Boeckmann and Rohn, 2014]] ; [[#Chiabai--2018b|Chiabai et al., 2018b]] ; [[#Boeckmann--2014|Boeckmann and Rohn, 2014]] ; [[#Nitschke--2016|Nitschke et al., 2016]] ; [[#Diaz--2019|Diaz et al., 2019]] ; [[#Benmarhnia--2016|Benmarhnia et al., 2016]] ; [[#Heo--2019a|Heo et al., 2019a]] ; [[#Heo--2019b|Heo et al., 2019b]] ; [[#Ragettli--2019|Ragettli and Roosli, 2019]] ). Evaluations of heatwave early warning systems as a component within HAPs show inconsistent results in terms of their impact on predicting mortality rates ( [[#Nitschke--2016|Nitschke et al., 2016]] ; [[#Benmarhnia--2016|Benmarhnia et al., 2016]] ; [[#Heo--2019a|Heo et al., 2019a]] ; [[#Heo--2019b|Heo et al., 2019b]] ; [[#Ragettli--2019|Ragettli and Roosli, 2019]] ; [[#Martinez--2019|Martinez et al., 2019]] ; [[#De’Donato--2018|De’Donato et al., 2018]] ; [[#Weinberger--2018b|Weinberger et al., 2018b]] ), indicating climate-based heat warning systems, which use a range of heat stress metrics ( [[#Schwingshackl--2021|Schwingshackl et al., 2021]] ), are not sufficient as a stand-alone approach to heat risk management ( ''high confidence'' ). To support HAP and heat risk-related policy development, identification and mapping of heat vulnerability ‘hot spots’ within urban areas have been proposed ( [[#Chen--2019|Chen et al., 2019]] ; [[#Hatvani-Kovacs--2018|Hatvani-Kovacs et al., 2018]] )

''A multi-sectoral approach, including the engagement of a range of stakeholders will'' likely ''benefit the response to longer-term heat risks through the implementation of measures such as climate-sensitive urban design and planning that mitigates UHI effects'' ( ''high confidence'' ) ''( [[#Ebi--2019|Ebi, 2019]] ; [[#Jay--2021|Jay et al., 2021]] ; [[#Alexander--2016|Alexander et al., 2016]] ; [[#Levy--2016|Levy, 2016]] ; [[#Masson--2018|Masson et al., 2018]] ; [[#McEvoy--2019|McEvoy, 2019]] ; [[#Pisello--2018|Pisello et al., 2018]] )'' . In the shorter-term, potentially localised solutions can include awnings, louvers, directional reflective materials, altering roof albedo, mist sprays, evaporative materials, green roofs and building facades and cooling centres ( [[#Jay--2021|Jay et al., 2021]] ; [[#Macintyre--2019|Macintyre and Heaviside, 2019]] ; [[#Spentzou--2021|Spentzou et al., 2021]] ; [[#Takebayashi--2018|Takebayashi, 2018]] ). NbS to reduce heat that offer co-benefits for ecological systems include green and blue infrastructure (e.g., urban greening/forestry and the creation of water bodies) ( [[#Koc--2018|Koc et al., 2018]] ; [[#Lai--2019|Lai et al., 2019]] ; [[#Shooshtarian--2018|Shooshtarian et al., 2018]] ; [[#Ulpiani--2019|Ulpiani, 2019]] ; [[#Zuvela-Aloise--2016|Zuvela-Aloise et al., 2016]] ; [[#Hobbie--2020|Hobbie and Grimm, 2020]] ). The implementation of climate-sensitive design and planning can be constrained by governance issues ( [[#Jim--2018|Jim et al., 2018]] ) and the benefits are not always evenly distributed among residents. Implementation of climate-sensitive design and NbS does, however, need to be carried out within the context of wider public health planning because water bodies and moist vegetated surfaces provide suitable habitats for a range of disease vectors ( [[#Nasir--2017|Nasir et al., 2017]] ; [[#Tian--2016|Tian et al., 2016]] ; [[#Trewin--2020|Trewin et al., 2020]] ). Solutions recommended for managing exposure to heat in outdoor workers include improved basic protection (including shade and planned rest breaks), heat-appropriate personal protective equipment, work scheduling for cooler times of the day, heat acclimation, improved aerobic fitness, access to sufficient cold drinking water and on-site cooling facilities and mechanisation of work ( [[#Morabito--2021|Morabito et al., 2021]] ; [[#Morris--2020|Morris et al., 2020]] ; [[#Varghese--2020|Varghese et al., 2020]] ; [[#Williams--2020|Williams et al., 2020]] ).

Most adaptation options were developed in high- and middle-income countries and typically require significant financial resources for their planning and implementation. Studies are needed of the benefits of indigenous and non-Western approaches to managing and adapting to extreme heat risk. Recently published reviews of approaches to heat adaptation outline the nature and limitations of a range of cooling strategies with optimal solutions for a number of settings recommended ( [[#Jay--2021|Jay et al., 2021]] ; [[#Turek-Hankins--2021|Turek-Hankins et al., 2021]] ).

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