Co-developed Environmental Solutions to Mitigate the Impact of Temperature Extremes on the Health of Vulnerable Populations

极端温度对生理和认知的影响一般都是已知的，主要是对健康人群，但关于影响在英国人口多样性中的差异知之甚少；特别是那些患有多种健康状况的人，包括神经疾病，他们可能受到最大的影响，而且针对哪些干预措施(如绿地)针对性不强或根本不存在。此外，我们没有工具来整合现有数据，以便在国家和必要的个人和家庭层面上了解温度-健康风险，从而了解如何确定干预措施的目标。更广泛地说，在气候和人口变化的不确定未来下，缺乏证据来指导政策，以应对健康不平等、城市规划和气候变化缓解/适应等双重挑战。热浪增加是气候变化的一个强劲方面，与健康相关的死亡人数也随之增加。与寒冷有关的死亡率随着总体变暖而下降，但仍远远超过与高温有关的死亡人数的增加，随着人口老龄化，与寒冷有关的疾病和死亡率的总体负担仍将居高不下。大多数关于健康结果的研究都集中在过高的死亡率上，并仅限于广泛的脆弱群体。然而，健康结果要微妙得多，与身心健康有关，并因神经和精神疾病等潜在疾病而加剧，暴露与特定环境的温湿度阈值有关。因此，我们对最脆弱者的健康风险(包括长期结果)的理解存在重大差距，以及这如何与社会经济梯度和流动性驱动的温度危险的可变性与室外/室内暴露之间的相互作用有关。因此，我们设想开发新的知识和工具，用于准确的风险评估和有针对性的干预，重点是受影响不成比例的群体。通过这样做，我们将改变我们对与温度相关的健康结果不平等的驱动因素的理解，并建议利用这一点来为提高气候目标的政策和实现气候目标的途径提供信息。我们将通过一个雄心勃勃但可行的高度多学科的项目来实现我们的愿景，该项目对于解决这个复杂的问题是必要的。我们的目标是改变我们对温度影响英格兰和威尔士脆弱人口健康结果的风险的理解，特别关注当前和未来情况下的健康不平等，并确定环境解决方案，直接满足总体筹资目标。我们的方法是多尺度的，在空间和时间上都有很高的粒度：(A)将国家规模的风险评估与详细的城市案例研究联系起来，以了解街道/建筑和弱势群体层面的风险；以及(B)确定风险如何随着未来气候、人口结构、流动性和健康状况的变化而变化。国家范围的评估将揭示极端气候如何在气候梯度和土地类型之间演变，我们将探索健康结果的多样性，并确定可能导致更高风险的景观配置和社会经济因素，从而确定对未来变化具有弹性的潜在缓解措施。社区参与将梳理出环境和基于社区的干预措施的影响和可接受性的细微差别。这将通过早期预警、规划和政策的风险降低工具，反馈到国家范围内，以提供缓解方面的信息。我们的方法将提供比目前更细微、更知情和更准确的风险评估，从而能够确定有针对性的干预措施，在最需要的地方减少风险。

The physiological and cognitive impacts of extreme temperatures are known in general and mostly for healthy populations, but little is known about how impacts differ across the diversity of the UK population; in particular, those with multiple health conditions, including neurological, who are likely to be the most impacted, and for which interventions (e.g. green spaces) are poorly targeted or non-existent. Furthermore, we do not have tools to integrate available data to understand temperature-health risks nationally and at the necessary individual and household level, and therefore how to target interventions. More broadly, the evidence is lacking to guide policy on the coupled challenges of health inequalities, urban planning and climate change mitigation/adaptation, under uncertain futures of climate and demographic change.Increases in heatwaves are a robust aspect of climate change, with associated increases in health-related deaths. Cold-related mortality has declined with overall warming, yet still far outweighs the increase in heat-related deaths, and the overall burden of cold-related illness and mortality will remain high with an ageing population. Most research on health outcomes has focused on excess mortality rates and limited to broad vulnerability groupings. Health outcomes are, however, much more nuanced, being related to both physical and mental health and exacerbated by underlying conditions including neurological and mental ill health, with exposure related to context specific temperature-humidity thresholds.Therefore, there are significant gaps in our understanding of health risks (including long-term outcomes) for the most vulnerable, and how this relates to the interplay between variability of temperature hazards and outdoor/indoor exposure as driven by socio-economic gradients and mobility. We therefore envisage developing new knowledge and tools for precise risk assessment and targeted interventions, focused on disproportionately impacted groups. By doing so, we will transform our understanding of the drivers of inequalities in temperature related health outcomes and propose using this to inform policy on levelling up and pathways to climate targets.We will realise our vision through an ambitious but feasible, highly multidisciplinary project that is necessary to address this complex problem. Our aim is to transform our understanding of the risk of temperature impacts on health outcomes for vulnerable populations of England and Wales with particular focus on health inequalities, currently and for future scenarios, and identify environmental solutions, directly addressing the overarching funding call objective. Our approach is multi-scale, with high granularity in both space and time: a) linking national scale risk assessment with detailed urban case studies to understand risks at the level of streets/buildings and vulnerable groups; and b) identifying how risks change with future changes in climate, demographics, mobility and health status. National scale assessment will reveal how extremes evolve across climatic gradients and land types, and we will explore the diversity of health outcomes and identify landscape configurations and socio-economic factors that are likely to lead to higher risks, and therefore potential mitigations that are resilient to future change. Community engagement will tease out the nuances of impacts and acceptability of environmental and community-based interventions. This will feed back to the national scale to inform on mitigation, via risk reduction tools for early warning, planning and policy. Our approach will provide a far more nuanced, informed and precise risk assessment than currently exists that will allow targeted interventions to be identified, providing risk reduction where most needed.