• Battisti, D. S., and R. L. Naylor, 2009: Historical warnings of future food insecurity with unprecedented seasonal heat. Science, 323, 240244, https://doi.org/10.1126/science.1164363.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bennett, J. E., M. Blangiardo, D. Fecht, P. Elliott, and M. Ezzati, 2014: Vulnerability to the mortality effects of warm temperature in the districts of England and Wales. Nat. Climate Change, 4, 269273, https://doi.org/10.1038/nclimate2123.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gao, Y., L. R. Leung, J. Lu, and G. Masato, 2015: Persistent cold air outbreaks over North America in a warming climate. Environ. Res. Lett., 10, 044001, https://doi.org/10.1088/1748-9326/10/4/044001.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Giorgi, F., 2006: Climate change hot spots. Geophys. Res. Lett., 33, L08707, https://doi.org/10.1029/2006GL025734.

  • Giorgi, F., and X. Bi, 2005: Updated regional precipitation and temperature changes for the 21st century from ensembles of recent AOGCM simulations. Geophys. Res. Lett., 32, L21715, https://doi.org/10.1029/2005GL024288.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Giorgi, F., and P. Lionello, 2008: Climate change projections for the Mediterranean region. Global Planet. Change, 63, 90104, https://doi.org/10.1016/j.gloplacha.2007.09.005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hochman, A., T. Harpaz, H. Saaroni, and P. Alpert, 2018a: The seasons’ length in 21st century CMIP5 projections over the Eastern Mediterranean. Int. J. Climatol., 38, 26272637, https://doi.org/10.1002/joc.5448.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hochman, A., P. Mercogliano, P. Alpert, H. Saaroni, and E. Bucchignani, 2018b: High-resolution projection of climate change and extremity over Israel using COSMO-CLM. Int. J. Climatol., 38, 50955106, https://doi.org/10.1002/joc.5714.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hochman, A., and Coauthors, 2018c: Evaluation of regional COSMO-CLM climate simulations over the Eastern Mediterranean for the period 1979–2011. Int. J. Climatol., 38, 11611176, https://doi.org/10.1002/joc.5232.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hochman, A., P. Alpert, M. Negev, Z. Abdeen, A. Mohsen Abdeen, J. G. Pinto, and H. Levine, 2020: The relationship between cyclonic weather regimes and seasonal influenza over the eastern Mediterranean. Sci. Total Environ., 750, 141686, https://doi.org/10.1016/j.scitotenv.2020.14168.

    • Search Google Scholar
    • Export Citation
  • Kodra, E., K. Steinhaeuser, and A. R. Ganguly, 2011: Persisting cold extremes under 21st-century warming scenarios. Geophys. Res. Lett., 38, L08705, https://doi.org/10.1029/2011GL047103.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kuglitsch, F., A. Toreti, E. Xoplaki, P. Della-Marta, C. S. Zerefos, M. Türkeş, and J. Luterbacher, 2010: Heat wave changes in the Eastern Mediterranean since 1960. Geophys. Res. Lett., 37, L04802, https://doi.org/10.1029/2009GL041841.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lange, M., 2019: Impacts of climate change on the Eastern Mediterranean and the Middle East and North Africa region and the water–energy nexus. Atmosphere, 10, 455, https://doi.org/10.3390/atmos10080455.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lelieveld, J., Y. Proestos, P. Hadjinicolaou, M. Tanarhte, E. Tyrlis, and G. Zittis, 2016: Strongly increasing heat extremes in the Middle East and North Africa (MENA) in the 21st century. Climatic Change, 137, 245260, https://doi.org/10.1007/s10584-016-1665-6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mirsaeidi, M., H. Motahari, M. T. Khamesi, A. Sharifi, M. Campos, and D. E. Schraufnagel, 2016: Climate change and respiratory infections. Ann. Amer. Thorac. Soc., 13, 12231230, https://doi.org/10.1513/AnnalsATS.201511-729PS.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Negev, M., S. Paz, A. Clermont, N. G. Pri-Or, U. Shalom, T. Yeger, and M. S. Green, 2015: Impacts of climate change on vector borne diseases in the Mediterranean Basin—Implications for preparedness and adaptation policy. Int. J. Environ. Res. Public Health, 12, 67456770, https://doi.org/10.3390/ijerph120606745.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nieuwenhuijsen, M. J., and H. Khreis, 2016: Car free cities: Pathway to healthy urban living. Environ. Int., 94, 251262, https://doi.org/10.1016/j.envint.2016.05.032.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Patz, J. A., D. Campbell-Lendrum, T. Holloway, and J. A. Folley, 2005: Impact of regional climate change on human health. Nature, 438, 310317, https://doi.org/10.1038/nature04188.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Peretz, C., A. Biggeri, P. Alpert, and M. Baccini, 2011: The effect of heat stress on daily mortality in Tel Aviv, Israel. National Security and Human Health Implications of Climate Change, H. J. S. Fernando, Z. Klaić, and J. L. McCulley, Eds., Springer, 241–252.

    • Crossref
    • Export Citation
  • Peterson, T. C., and Coauthors, 2013: Monitoring and understanding changes in heat waves, cold waves, floods and droughts in the United States: State of knowledge. Bull. Amer. Meteor. Soc., 94, 821834, https://doi.org/10.1175/BAMS-D-12-00066.1.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Robine, J. M., S. L. K. Chueng, S. L. Roy, H. V. Oyen, C. Griffiths, J. P. Michel, and F. R. Hermann, 2008: Death toll exceeded 70,000 in Europe during the summer of 2003. C. R. Biol., 331, 171178, https://doi.org/10.1016/j.crvi.2007.12.001.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Salah, I., I. Abbasi, A. Warburg, N. Davidovitch, and B. Kotler, 2020: The spatial and temporal distribution, species composition, and host preference of phlebotomine sand flies in the Bethlehem District of Palestine. Acta Trop ., 203, 105327, https://doi.org/10.1016/j.actatropica.2019.105327.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Samuels, R., and Coauthors, 2017: Evaluation and projection of extreme precipitation indices in the Eastern Mediterranean based on CMIP5 multi model ensemble. Int. J. Climatol., 38, 22802297, https://doi.org/10.1002/joc.5334.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ulbrich, U., and Coauthors, 2013: Past and current climate changes in the Mediterranean region. Regional Assessment of the Climate Change in the Mediterranean: Air, Sea and Precipitation and Water, A. Navarra and L. Tubiana, Eds., Advances in Global Change Research, Vol. 50, Springer, 9–51, https://doi.org/10.1007/978-94-007-5769-1.

    • Crossref
    • Export Citation
  • Watts, N., and Coauthors, 2015: Health and climate change: Policy responses to protect public health. Lancet, 386, 18611914, https://doi.org/10.1016/S0140-6736(15)60854-6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Watts, N., and Coauthors, 2017: The Lancet countdown: Tracking progress on health and climate change. Lancet, 389, 11511164, https://doi.org/10.1016/S0140-6736(16)32124-9.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Watts, N., and Coauthors, 2018: The 2018 report of the Lancet countdown on health and climate change: Shaping the health of nations for centuries to come. Lancet, 392, 24792514, https://doi.org/10.1016/S0140-6736(18)32594-7.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • WHO, 2016: Preventing disease through healthy environments: A global assessment of the burden of disease from environmental risks. World Health Organization Rep., 176 pp., www.who.int/quantifying_ehimpacts/publications/preventing-disease/en/.

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Interdisciplinary Regional Collaboration for Public Health Adaptation to Climate Change in the Eastern Mediterranean

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  • 1 Department of Tropospheric Research, Institute of Meteorology and Climate Research, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
  • | 2 Department of Geophysics, Porter School of Environmental and Earth Sciences, Tel-Aviv University, Tel-Aviv, Israel
  • | 3 Institute for BioEconomy, CNR, Rome, Italy
  • | 4 Italian Aerospace Research Center (CIRA), and REHMI Division, Centro Euro-Mediterraneo sui Cambiamenti Climatici, Capua, Italy
  • | 5 Abdus Salam International Center for Theoretical Physics, Trieste, Italy
  • | 6 Nature Palestine Society, Ramallah, Palestine
  • | 7 School of Public Health, Ben-Gurion University, Beer-Sheva, Israel
  • | 8 Environmental Predictions Department, Climate and Atmosphere Research Centre (CARE-C), Cyprus Institute, Nicosia, Cyprus
  • | 9 Department of Tropospheric Research, Institute of Meteorology and Climate Research, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
  • | 10 Texas Transportation Institute, Texas A&M University, College Station, Texas
  • | 11 Braun School of Public Health and Community Medicine, Hadassah, Hebrew University, Jerusalem, Israel
  • | 12 Climate Simulations and Predictions Division, Centro Euro-Mediterraneo sui Cambiamenti Climatici, Bologna, Italy
  • | 13 School of Public Health, University of Haifa, Mt. Carmel, Israel
  • | 14 Nature Palestine Society, Ramallah, Palestine
  • | 15 Damour For Community Development, Ramallah, Palestine
  • | 16 Abdus Salam International Center for Theoretical Physics, Trieste, Italy
Free access

This article is licensed under a Creative Commons Attribution 4.0 license (http://creativecommons.org/licenses/by/4.0/).

Corresponding author: Assaf Hochman, assaf.hochman@kit.edu

This article is licensed under a Creative Commons Attribution 4.0 license (http://creativecommons.org/licenses/by/4.0/).

Corresponding author: Assaf Hochman, assaf.hochman@kit.edu

Public Health and Water Resources—Adaptation to Climate Change in the Eastern Mediterranean

What: A first workshop on climate change, health impacts, and adaptation over the eastern Mediterranean assembled scientists from six countries working on climate science, public health, and policy formulation and encouraged discussions and collaborations under the umbrella of the Regional Climate Change Adaptation Center (RCCAC) in the face of regional conflict.

When: 27–28 January 2020

Where: Trieste, Italy

The World Health Organization has estimated that in 2012 approximately 23% of all deaths worldwide were attributed to changeable environmental factors, which may be potentially influenced by climate change (WHO 2016). In addition, the Lancet Commission on Health and Climate Change determined that “climate change could be the greatest public health threat of the twenty-first century” (Watts et al. 2015, 2017, 2018). There is clear evidence that climate change in the last 50 years has affected human health (e.g., Patz et al. 2005; Peretz et al. 2011; Mirsaeidi et al. 2016). Specifically, in the whole Mediterranean region, climate change leads to alterations in the mean, variability, seasonality, and extremes in one or more climatic variables, such as temperature, precipitation, humidity, and aerosols (Ulbrich et al. 2013), thus may influence the incidence of various climate sensitive diseases.

The Eastern Mediterranean is identified as a “hot spot” for climate change (Giorgi 2006). It is located on a transition zone between temperate climate in the north and semi-arid and arid climate in the south. As such, it can strongly be influenced in different ways by climate change, depending on the season and region. Some aspects of climate change in this vulnerable region include the following:

The purpose of the workshop was to gain novel insights into what is to be expected in the region with respect to climate change and what responses and mitigation strategies are required from the various public health sectors.

Workshop

The introductory presentation set out the aims of the seminar and gave some examples for successful interdisciplinary regional collaborations (e.g., Hochman et al. 2020). The first half of the workshop was devoted to current developments and analysis of observed and projected climate change over the eastern Mediterranean. One important point made was that current climate change projections indicate that there will be significant changes in the relative length of summer and winter in the region in the coming decades, and that this will have health implications for the population. All studies with different downscaling approaches applied to the region agree in the tendency toward more extreme weather in the course of the twenty-first century (e.g., Samuels et al. 2017). The urgent need to make use of convection-permitting high-resolution modeling at seasonal/decadal scales to enable better predictions of the extent, intensity, and likelihood of extreme events such as heat waves and/or cold spells was stressed (e.g., Hochman et al. 2018c). While adequate representation of such high-impact weather events is not sufficiently well described by current models, high-quality and denser environmental observations are also required, especially in the currently sparsely monitored regions of the eastern Mediterranean. The proposed high-resolution simulations will provide more accurate predictions of climate change at the regional and local scales, which in turn can be used as inputs for epidemiological models. These modeling efforts may enable better prediction and understanding of the potential impacts climate change will have on public health in the region.

The second half of the workshop was devoted to discussions about the public health systems in Israel, Palestine, and Jordan. This included a detailed view of specific hazards, which are advancing, a fact that may be at least partially related to climate change. These include the spread of species hitherto not recorded in the eastern Mediterranean, such as the presence of leishmaniasis in areas of Palestine and Israel, where it was previously not found (e.g., Salah et al. 2020) and problems relating to the continuous rise in pollution caused by transport emissions (e.g., Nieuwenhuijsen and Khreis 2016). Public health and policy scientists stressed that climate change is expected to affect public health directly through physical influences such as extreme heat waves and cold spells (e.g., Peretz et al. 2011), and indirectly through the effect on chronic and infectious diseases. Furthermore, extreme weather conditions are known to increase the incidence of certain illnesses, such as cardiovascular and respiratory diseases, and climate change affects the occurrence and behavior of infectious and vector-borne diseases (e.g., Negev et al. 2015). The practical problems facing local health systems were also a subject of discussion, including underfunding, lack of preparation for dealing with climate-related illnesses, and the adverse effect of regional political conflict (e.g., Lange 2019).

Since the full effects of climate change on public health are currently not completely understood, recommendations in the public sector are still based on the allocation of resources for preparatory measures that will have a positive effect on public health, irrespective of climate change. These interventions include improvement in air quality, the construction of green neighborhoods, and support for healthy lifestyles. Recommendations call for real-time surveillance and coordinated response to extreme events alongside gradual changes in temperature and precipitation, which may lead to the outbreak of new diseases. In parallel, the recommendations call for strengthening the preparedness of the health systems in the region through personnel training and distribution of information and guidelines to both employees and the public. At present, no practical measures have been specifically implemented for appropriate adaptation of the public health systems to climate change in the region.

Outcomes

From the workshop presentations and discussions, certain knowledge gaps were identified. These gaps mainly relate to the impact of climate change on the occurrence of infectious diseases and vector-borne diseases, and extreme weather-related mortality and morbidity. Very little research is currently available in this context, and scientists call for strengthening the database and research initiatives in these directions. Four main research questions immediately relevant for the eastern Mediterranean countries, under current and future changing climate conditions, were identified:

The participants concluded that appropriate public health adaptation to climate change can only be properly met by real interdisciplinary regional collaborations. Indeed, learning from some of the economically more advanced countries already implementing interventions, such as Germany and Italy, may considerably speed up the process. The participants showed interest in pursuing the different scientific goals identified in the near future and will present their findings in subsequent workshops and to policy and decision-makers. It is anticipated that detailed projects will be developed, enabling relevant research to be undertaken, under the auspices of the Regional Climate Change Adaptation Center (RCCAC).

Acknowledgments

The workshop was made possible thanks to support from the Abdus Salam International Centre for Theoretical Physics, Trieste, Italy. A. Hochman and S. Helgert thank the Helmholtz Association for support. We thank Joaquim G. Pinto for comments on an earlier version of this manuscript. We would like to sincerely thank Mrs. Pandora Malchose as the local organizer. AH drafted the first version of the manuscript. This activity is part of a project funded by the European Union.

References

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    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bennett, J. E., M. Blangiardo, D. Fecht, P. Elliott, and M. Ezzati, 2014: Vulnerability to the mortality effects of warm temperature in the districts of England and Wales. Nat. Climate Change, 4, 269273, https://doi.org/10.1038/nclimate2123.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gao, Y., L. R. Leung, J. Lu, and G. Masato, 2015: Persistent cold air outbreaks over North America in a warming climate. Environ. Res. Lett., 10, 044001, https://doi.org/10.1088/1748-9326/10/4/044001.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Giorgi, F., 2006: Climate change hot spots. Geophys. Res. Lett., 33, L08707, https://doi.org/10.1029/2006GL025734.

  • Giorgi, F., and X. Bi, 2005: Updated regional precipitation and temperature changes for the 21st century from ensembles of recent AOGCM simulations. Geophys. Res. Lett., 32, L21715, https://doi.org/10.1029/2005GL024288.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Giorgi, F., and P. Lionello, 2008: Climate change projections for the Mediterranean region. Global Planet. Change, 63, 90104, https://doi.org/10.1016/j.gloplacha.2007.09.005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hochman, A., T. Harpaz, H. Saaroni, and P. Alpert, 2018a: The seasons’ length in 21st century CMIP5 projections over the Eastern Mediterranean. Int. J. Climatol., 38, 26272637, https://doi.org/10.1002/joc.5448.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hochman, A., P. Mercogliano, P. Alpert, H. Saaroni, and E. Bucchignani, 2018b: High-resolution projection of climate change and extremity over Israel using COSMO-CLM. Int. J. Climatol., 38, 50955106, https://doi.org/10.1002/joc.5714.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hochman, A., and Coauthors, 2018c: Evaluation of regional COSMO-CLM climate simulations over the Eastern Mediterranean for the period 1979–2011. Int. J. Climatol., 38, 11611176, https://doi.org/10.1002/joc.5232.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hochman, A., P. Alpert, M. Negev, Z. Abdeen, A. Mohsen Abdeen, J. G. Pinto, and H. Levine, 2020: The relationship between cyclonic weather regimes and seasonal influenza over the eastern Mediterranean. Sci. Total Environ., 750, 141686, https://doi.org/10.1016/j.scitotenv.2020.14168.

    • Search Google Scholar
    • Export Citation
  • Kodra, E., K. Steinhaeuser, and A. R. Ganguly, 2011: Persisting cold extremes under 21st-century warming scenarios. Geophys. Res. Lett., 38, L08705, https://doi.org/10.1029/2011GL047103.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kuglitsch, F., A. Toreti, E. Xoplaki, P. Della-Marta, C. S. Zerefos, M. Türkeş, and J. Luterbacher, 2010: Heat wave changes in the Eastern Mediterranean since 1960. Geophys. Res. Lett., 37, L04802, https://doi.org/10.1029/2009GL041841.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lange, M., 2019: Impacts of climate change on the Eastern Mediterranean and the Middle East and North Africa region and the water–energy nexus. Atmosphere, 10, 455, https://doi.org/10.3390/atmos10080455.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lelieveld, J., Y. Proestos, P. Hadjinicolaou, M. Tanarhte, E. Tyrlis, and G. Zittis, 2016: Strongly increasing heat extremes in the Middle East and North Africa (MENA) in the 21st century. Climatic Change, 137, 245260, https://doi.org/10.1007/s10584-016-1665-6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mirsaeidi, M., H. Motahari, M. T. Khamesi, A. Sharifi, M. Campos, and D. E. Schraufnagel, 2016: Climate change and respiratory infections. Ann. Amer. Thorac. Soc., 13, 12231230, https://doi.org/10.1513/AnnalsATS.201511-729PS.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Negev, M., S. Paz, A. Clermont, N. G. Pri-Or, U. Shalom, T. Yeger, and M. S. Green, 2015: Impacts of climate change on vector borne diseases in the Mediterranean Basin—Implications for preparedness and adaptation policy. Int. J. Environ. Res. Public Health, 12, 67456770, https://doi.org/10.3390/ijerph120606745.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nieuwenhuijsen, M. J., and H. Khreis, 2016: Car free cities: Pathway to healthy urban living. Environ. Int., 94, 251262, https://doi.org/10.1016/j.envint.2016.05.032.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Patz, J. A., D. Campbell-Lendrum, T. Holloway, and J. A. Folley, 2005: Impact of regional climate change on human health. Nature, 438, 310317, https://doi.org/10.1038/nature04188.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Peretz, C., A. Biggeri, P. Alpert, and M. Baccini, 2011: The effect of heat stress on daily mortality in Tel Aviv, Israel. National Security and Human Health Implications of Climate Change, H. J. S. Fernando, Z. Klaić, and J. L. McCulley, Eds., Springer, 241–252.

    • Crossref
    • Export Citation
  • Peterson, T. C., and Coauthors, 2013: Monitoring and understanding changes in heat waves, cold waves, floods and droughts in the United States: State of knowledge. Bull. Amer. Meteor. Soc., 94, 821834, https://doi.org/10.1175/BAMS-D-12-00066.1.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Robine, J. M., S. L. K. Chueng, S. L. Roy, H. V. Oyen, C. Griffiths, J. P. Michel, and F. R. Hermann, 2008: Death toll exceeded 70,000 in Europe during the summer of 2003. C. R. Biol., 331, 171178, https://doi.org/10.1016/j.crvi.2007.12.001.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Salah, I., I. Abbasi, A. Warburg, N. Davidovitch, and B. Kotler, 2020: The spatial and temporal distribution, species composition, and host preference of phlebotomine sand flies in the Bethlehem District of Palestine. Acta Trop ., 203, 105327, https://doi.org/10.1016/j.actatropica.2019.105327.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Samuels, R., and Coauthors, 2017: Evaluation and projection of extreme precipitation indices in the Eastern Mediterranean based on CMIP5 multi model ensemble. Int. J. Climatol., 38, 22802297, https://doi.org/10.1002/joc.5334.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ulbrich, U., and Coauthors, 2013: Past and current climate changes in the Mediterranean region. Regional Assessment of the Climate Change in the Mediterranean: Air, Sea and Precipitation and Water, A. Navarra and L. Tubiana, Eds., Advances in Global Change Research, Vol. 50, Springer, 9–51, https://doi.org/10.1007/978-94-007-5769-1.

    • Crossref
    • Export Citation
  • Watts, N., and Coauthors, 2015: Health and climate change: Policy responses to protect public health. Lancet, 386, 18611914, https://doi.org/10.1016/S0140-6736(15)60854-6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Watts, N., and Coauthors, 2017: The Lancet countdown: Tracking progress on health and climate change. Lancet, 389, 11511164, https://doi.org/10.1016/S0140-6736(16)32124-9.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Watts, N., and Coauthors, 2018: The 2018 report of the Lancet countdown on health and climate change: Shaping the health of nations for centuries to come. Lancet, 392, 24792514, https://doi.org/10.1016/S0140-6736(18)32594-7.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • WHO, 2016: Preventing disease through healthy environments: A global assessment of the burden of disease from environmental risks. World Health Organization Rep., 176 pp., www.who.int/quantifying_ehimpacts/publications/preventing-disease/en/.

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