Development of key indicators to quantify the health impacts of climate change on Canadians.

OBJECTIVES: This study aimed at developing a list of key human health indicators for quantifying the health impacts of climate change in Canada. METHODS: A literature review was conducted in OVID Medline to identify health morbidity and mortality indicators currently used to quantify climate change impacts. Public health frameworks and other studies of climate change indicators were reviewed to identify criteria with which to evaluate the list of proposed key indicators and a rating scale was developed. Total scores for each indicator were calculated based on the rating scale. RESULTS: A total of 77 health indicators were identified from the literature. After evaluation using the chosen criteria, 8 indicators were identified as the best for use. They include excess daily all-cause mortality due to heat, premature deaths due to air pollution (ozone and particulate matter 2.5), preventable deaths from climate change, disability-adjusted life years lost from climate change, daily all-cause mortality, daily non-accidental mortality, West Nile Disease incidence, and Lyme borreliosis incidence. CONCLUSIONS: There is need for further data and research related to health effect quantification in the area of climate change.

Health co-benefits and risks of public health adaptation strategies to climate change: a review of current literature.

OBJECTIVES: Many public health adaptation strategies have been identified in response to climate change. This report reviews current literature on health co-benefits and risks of these strategies to gain a better understanding of how they may affect health. METHODS: A literature review was conducted electronically using English language literature from January 2000 to March 2012. Of 812 articles identified, 22 peer-reviewed articles that directly addressed health co-benefits or risks of adaptation were included in the review. RESULTS: The co-benefits and risks identified in the literature most commonly relate to improvements in health associated with adaptation actions that affect social capital and urban design. Health co-benefits of improvements in social capital have positive influences on mental health, independently of other determinants. Risks included reinforcing existing misconceptions regarding health. Health co-benefits of urban design strategies included reduced obesity, cardiovascular disease and improved mental health through increased physical activity, cooling spaces (e.g., shaded areas), and social connectivity. Risks included pollen allergies with increased urban green space, and adverse health effects from heat events through the use of air conditioning. CONCLUSIONS: Due to the current limited understanding of the full impacts of the wide range of existing climate change adaptation strategies, further research should focus on both unintended positive and negative consequences of public health adaptation.

An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality.

BACKGROUND: Water and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality? METHODS: Data for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR). RESULTS: Under-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39-0.86), p = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR. CONCLUSIONS: Our analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key strategies.