| Background:Extreme temperatures are the of great importance global health threat in the 21st century.In the context of climate change,the frequency,intensity,duration and spatial range of extreme temperatures increased,which may significantly increase the risk of morbidity or mortality from various climate-sensitive diseases such as cardiovascular,cerebrovascular,respiratory and vector-borne diseases.To address rising climate-sensitive health risks in the context of global warming,the World Health Organization(WHO)called on nations worldwide to build climate resilient health systems,develop tailored health response strategies,enhance the capacity of health systems to continue to be efficient and responsive to improve population health in the context of climate change.It following two principle ways:(i)reduction of population vulnerability,and(ii)development of health system capacities.Furthermore,WHO takes a comprehensive,multisectoral,and transdisciplinary approach to facilitate coordinated temperature resilient health system.However,current studies on extreme temperatures and health vulnerability in the context of global warming have failed to systematically assess the role of health system capacity during temperature extremes exposure.However,previous studies have considered more environmental exposures than population exposure to extreme temperatures,resulting in a lack of understanding of vulnerable population exposure to extreme temperatures and its association with health outcomes worldwide.However,few studies have considered the health system capacities and its interaction with health demands of vulnerable population or other aspects,and thus cannot provide theoretical evidence for the development or implementation of health response strategies and measures for extreme temperatures.Objective:Based on the quantitative analysis of the association between extreme temperature or population exposure to extreme temperature and disease burden in 171 countries,focusing on assessing the interaction between each aspects and their indicators,and revealing the adaptation strategies of health systems to response to climate change,so as to cope with the health problems caused by extreme temperature in the context of climate change,and to develop corresponding health adaptation strategy to provide quantitative evidence and suggestions.Methods:First,based on the conventional extreme temperature index,this study measures the population exposure to extreme temperatures to assess the exposure of vulnerable population during extreme temperatures.Based on meteorological,socioeconomic status and International Health Regulations(IHR)capacity data for 171 countries from 2010 to 2019,this study applied two-way fixed effected model and dynamic panel models to estimate the extreme temperatures or population exposure to extreme temperatures,and their contemporary and cumulative associations with disease burden attributed to non-optimal temperatures.Secondly,considering the possible influence of economic and social development,subsample analysis was conducted for different country types to explore whether there were differences in extreme temperatures exposure and health effects between subsample groups.Finally,considering the possible interaction between multiple aspects,the decision making trial and evaluation laboratory(DEMATEL)method were used to analyze the interaction among aspects,identify the driving force and the most influential aspect.And then according to the interaction between aspects,build a coordinated temperature resilient health system and provide evidence for health adaptation strategies.Results:1.Association between extreme temperature or population exposure to extreme temperature and burden of disease attributed to non-optimal temperatures:(1)Global population exposure to extreme temperatures showed a significant increase over the study period,with most countries showing an increase in population exposure and temperature attributable disease burden fluctuating over time.The attributed disease burden mainly stemmed from cardiovascular diseases,which contributed to approximately 14%and 66%of the disease burden at high and low temperatures,respectively.Compared to highincome countries and aging countries,low-income and middle-income countries and non-aging countries had a much higher median and quartile value of extreme heat and population exposure to extreme heat,but a lower level of extreme cold and population exposure to extreme cold.The disease burden attributed to non-optimal temperature exhibited a pattern similar to that of the distribution of extreme temperatures exposure by income group and aging group.(2)Extreme temperatures or populations exposure to extreme temperatures were both positively and significantly associated with death rate and years of life lost(YLL)rate attributed to non-optimal temperatures,after controlling for socioeconomic status,medical resources,air quality,and climate characteristics(p<0.01).The cumulative effects of extreme cold or population exposure to extreme cold(frost days:Coef.=0.452,95%CI:0.448-0.456;older population:Coef.=0.703,95%CI:0.697-0.709;children:Coef.=0.726,95%CI:0.720-0.732)were significantly larger than the contemporary effects(frost days:C oef.=0.070,95%CI:0.0570.083;older population:Coef.=0.067,95%CI:0.047-0.087;children:Coef.=0.067,95%CI:0.048-0.087).(3)Extreme heat and cold and their population exposure increased the disease burden of cardiovascular and chronic respiratory diseases,and the effect size on cardiovascular diseases was stronger than that of chronic respiratory diseases.(4)The health effects of extreme temperatures exposure differ in countries according to income or aging level.The effects of extreme cold or population exposure to extreme cold on the burden of disease were significantly lower in high-income countries and aging countries than in low-income and middle-income countries and non-aging countries,whereas the health effects of extreme heat or population exposure to extreme heat were not significantly different among them.2.Health response strategies to extreme temperatures:(1)The results of exploratory factor analysis and reliability analysis showed,the enforced coordinated temperature resilient health system included five aspects:high temperaturesensitive risks(HTR),low temperature-sensitive risks(LTR),low temperature exposure(LTE),health system capacities(HSC),and vulnerability factors(VF).(2)After taking sociodemographic into consideration,HSC was listed as a causal aspect,and LTE was also the most influential aspect;LTR was not only associated with LTE,but also interacted with HTR,HSC,and VF.Giving consideration to population exposure to extreme temperatures,low temperature exposure continued to be the most influential aspect,while HTR,HSC and VF were grouped to causal aspects.Moreover,there was not direct interaction among HTR,HSC and VF.Conclusion:1.Increased exposure to extreme temperatures leads to a corresponding increase in mortality and YLL rates.Furthermore,the cumulative effects of extreme cold were greater than the contemporary effects.2.The population distribution of extreme temperature varied by country.Extreme cold affected more people in high-income countries,while extreme heat occurred more in lowincome and middle-income countries.And low-income and middle-income countries should invest more in enhancing the capacity to adapt to extreme cold.3.The enforced coordinated temperature resilient health system framework has identified five aspects:HTR,LTR,LTE,HSC,and VF.4.Four features should be attributed to temperature-resilient health system:an emphasis on improving the capacity of health systems,with special attention to cold exposures and its disease burden,enhanced cross-sectoral collaboration,and country-specific flexibility in responding to extreme temperature exposures. |
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