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The effects of heat on health have been well documented, while less is known about the effects among agricultural workers. Our aim is to estimate the effects and impacts of heat on occupational injuries in the agricultural sector in Italy. Occupational injuries in the agricultural sector from the Italian national workers’ compensation authority (INAIL) and daily mean air temperatures from Copernicus ERA5-land for a five-year period (2014–2018) were considered. Distributed lag non-linear models (DLNM) were used to estimate the relative risk and attributable injuries for increases in daily mean air temperatures between the 75th and 99th percentile and during heatwaves. Analyses were stratified by age, professional qualification, and severity of injury. A total of 150,422 agricultural injuries were considered and the overall relative risk of injury for exposure to high temperatures was 1.13 (95% CI: 1.08; 1.18). A higher risk was observed among younger workers (15–34 years) (1.23 95% CI: 1.14; 1.34) and occasional workers (1.25 95% CI: 1.03; 1.52). A total of 2050 heat-attributable injuries were estimated in the study period. Workers engaged in outdoor and labour-intensive activities in the agricultural sector are at greater risk of injury and these results can help target prevention actions for climate change adaptation.

Heat-health early warning systems (HHWS) are an important collaborative activity between the meteorological and health communities. This study aimed to map the evidence on the socioeconomic assessment of HHWS and their effectiveness in terms of averting heat related health outcomes. It also aimed to map the technical, structural, and societal barriers and facilitators to implementation and use of HHWS. We use two methods: (i) a scoping review of literature on the economic assessment and health benefit of climate services for heat-health adaptation (ii) a set of interviews with climate service developers and providers in Europe and Africa to understand further technical and societal aspects as well as evaluation of such services. We find that HHWS can be a cost-effective adaptation option that can reduce heat-related mortality and morbidity, especially in vulnerable groups like the elderly. We find that challenges such as lack of long-term and reliable funding, difficulties in making the climate data relevant, comprehensible, and accessible to different end-users, cultural differences between climate and health professionals, and limited ability to assess the services’ real impact need to be accounted for while implementing these services.

We studied the potential synergy between air pollution and meteorology and their impact on mortality in nine European cities with data from 2004 to 2010. We used daily series of Apparent Temperature (AT), measurements of particulate matter (PM10), ozone (O3), and nitrogen dioxide (NO2) and total non-accidental, cardiovascular, and respiratory deaths. We applied Poisson regression for city-specific analysis and random effects meta-analysis to combine city-specific results, separately for the warm and cold seasons. In the warm season, the percentage increase in all deaths from natural causes per °C increase in AT tended to be greater during high ozone days, although this was only significant for all ages when all causes were considered. On low ozone days, the increase in the total daily number of deaths was 1.84% (95% CI 0.87, 2.82), whilst it was 2.20% (95% CI 1.28, 3.13) in the high ozone days per 1 °C increase in AT. Interaction with PM10 was significant for cardiovascular (CVD) causes of death for all ages (2.24% on low PM10 days (95% CI 1.01, 3.47) whilst it is 2.63% (95% CI 1.57, 3.71) on high PM10 days) and for ages 75+. In days with heat waves, no consistent pattern of interaction was observed. For the cold period, no evidence for synergy was found. In conclusion, some evidence of interactive effects between hot temperature and the levels of ozone and PM10 was found, but no consistent synergy could be identified during the cold season.

The European project PHASE aims to evaluate patterns of change in the temperature–mortality relationship and in the number of deaths attributable to heat in nine European cities in two periods, before and after summer 2003 (1996–2002 and 2004–2010). We performed age-specific Poisson regression models separately in the two periods, controlling for seasonality, air pollution and time trends. Distributed lag non-linear models were used to estimate the Relative Risks of daily mortality for increases in mean temperature from the 75th to 99th percentile of the summer distribution for each city. In the recent period, a reduction in the mortality risk associated to heat was observed only in Athens, Rome and Paris, especially among the elderly. Furthermore, in terms of heat-attributable mortality, 985, 787 and 623 fewer deaths were estimated, respectively, in the three cities. In Helsinki and Stockholm, there is a suggestion of increased heat effect. Noteworthy is that an effect of heat was still present in the recent years in all cities, ranging from +11% to +35%. In Europe, considering the warming observed in recent decades and population ageing, effective intervention measures should be promoted across countries, especially targeting vulnerable subgroups of the population with lower adaptive resources.

Many workers are exposed to the effects of heat and often to extreme temperatures. Heat stress has been further aggravated during the COVID-19 pandemic by the use of personal protective equipment to prevent SARS-CoV-2 infection. However, workers’ risk perception of heat stress is often low, with negative effects on their health and productivity. The study aims to identify workers’ needs and gaps in knowledge, suggesting the adaptation of measures that best comply with the needs of both workers and employers. A cross-sectional online questionnaire survey was conducted in Italy in the hottest months of 2020 (June–October) through different multimedia channels. The data collected were analyzed using descriptive statistics; analytical tests and analysis of variance were used to evaluate differences between groups of workers. In total, 345 questionnaires were collected and analyzed. The whole sample of respondents declared that heat is an important contributor to productivity loss and 83% of workers did not receive heat warnings from their employer. In this context, the internet is considered as the main source of information about heat-related illness in the workplace. Results highlight the need to increase workers’ perception of heat stress in the workplace to safeguard their health and productivity. About two-thirds of the sample stated that working in the sun without access to shaded areas, working indoors without adequate ventilation, and nearby fire, steam, and hot surfaces, represent the main injuries’ risk factors.

Background Analyses of coronavirus disease 19 suggest specific risk factors make communities more or less vulnerable to pandemic-related deaths within countries. What is unclear is whether the characteristics affecting vulnerability of small communities within countries produce similar patterns of excess mortality across countries with different demographics and public health responses to the pandemic. Our aim is to quantify community-level variations in excess mortality within England, Italy and Sweden and identify how such spatial variability was driven by community-level characteristics. Methods We applied a two-stage Bayesian model to quantify inequalities in excess mortality in people aged 40 years and older at the community level in England, Italy and Sweden during the first year of the pandemic (March 2020–February 2021). We used community characteristics measuring deprivation, air pollution, living conditions, population density and movement of people as covariates to quantify their associations with excess mortality. Results We found just under half of communities in England (48.1%) and Italy (45.8%) had an excess mortality of over 300 per 100 000 males over the age of 40, while for Sweden that covered 23.1% of communities. We showed that deprivation is a strong predictor of excess mortality across the three countries, and communities with high levels of overcrowding were associated with higher excess mortality in England and Sweden. Conclusion These results highlight some international similarities in factors affecting mortality that will help policy makers target public health measures to increase resilience to the mortality impacts of this and future pandemics.

Questo, senza politiche di disincentivo all’uso dell’auto privata, determinerà un aumento dei mezzi di trasporto in circolazione al cui inquinamento sono attribuibili, secondo l’Oms ogni anno nel mondo circa 400.000 decessi. Rispetto allo spostamento casa-lavoro nel periodo pre-pandemia, il 54% dei rispondenti utilizzava principalmente l’auto (come conducente). Il 36% dei rispondenti ha dichiarato di compiere il tragitto casa-lavoro esclusivamente in auto, mentre il 10% si spostava esclusivamente a piedi o in bici. Environ Sci Pollut Res Int 2022; 29: 16783-5. ■ Giannico OV, Baldacci S, Angelozzi A, et al. Interventi urbani per la promozione della salute. https://lc.cx/KN-gy2 [ultimo accesso 7 luglio 2023]. ■ Sustainable and healthy transport – Lancet countdown: https://lc.cx/TIab2c [ultimo accesso 7 luglio 2023].

Since 2004, the Italian Department for Civil Protection and the Ministry of Health have implemented a national program for the prevention of heat-health effects during summer, which to-date includes 34 major cities and 93% of the residents aged 65 years and over. The Italian program represents an important example of an integrated approach to prevent the impact of heat on health, comprising Heat Health Watch Warning Systems, a mortality surveillance system and prevention activities targeted to susceptible subgroups. City-specific warning systems are based on the relationship between temperature and mortality and serve as basis for the modulation of prevention measures. Local prevention activities, based on the guidelines defined by the Ministry of Health, are constructed around the infrastructures and services available. A key component of the prevention program is the identification of susceptible individuals and the active surveillance by General Practitioners, medical personnel and social workers. The mortality surveillance system enables the timely estimation of the impact of heat, and heat waves, on mortality during summer as well as to the evaluation of warning systems and prevention programs. Considering future predictions of climate change, the implementation of effective prevention programs, targeted to high risk subjects, become a priority in the public health agenda.