Background:Residents of urban heat islands, particularly older adults, experience significant health impacts during heat waves. In the context of ongoing climate and demographic change, the development and implementation of adaptation strategies are essential. Thus we investigated applied adaptation strategies by senior citizens. Methods and materials:Four types of research areas were defined based on socio-economic factors and amount of greenery. From September to November 2011, a total of 901 individuals were surveyed on heat-related issues across four study areas in Vienna. Face-to-face interviews were carried out with residents of senior citizens' homes (≥65 years; n=200), while telephone interviews were conducted with older adults in private homes (≥65 years; n=401) and a control group (18-55 years; n=300). Additional expert interviews were conducted to identify discrepancies between recommended heat-protective behaviours and the actual practices. In a second wave two years later, older residents living in urban heat islands (≥65 years; n=200) in socio-economically advantaged and disadvantaged Viennese areas were asked regarding heat symptoms and protection measures. Results:The most common effects of heat, regardless of age, were fatigue and sleep disturbances. While physical measures in hot weather such as drinking more fluids were taken regardless of symptoms, indoor measures increased with increasing heat-related symptoms. Outdoor strategies were used more frequently when symptoms were less severe. Overall, 70% of residents in senior citizens' homes, 66% in private households and 54% of the control group stayed mainly indoors during hot weather. In heat islands, 80% of respondents rated their homes as hot to extremely hot during a heatwave, with residents of socio-economically disadvantaged districts reporting more heat-related complaints. Discussion and conclusions:Older adults who have difficulty adapting to heat are at greater risk not only for health problems but also for social isolation. Individuals most impacted by the heat tend to retreat from public spaces and stay more indoors. While this may provide some relief if it is cooler indoors, it also increases the risk of social isolation, which in turn heightens vulnerability during heat waves. Creating heat-resilient residential areas and neighbourhoods is a vital public health challenge to reduce health inequalities among older populations.

Vulnerability to heat and cold is influenced by many characteristics. This study analyzed determinants of vulnerability at the district level in the whole of Austria. Daily deaths (1970-2020) and daily temperatures per district were entered into time series models using negative binomial General Additive Models controlling for long-term and seasonal trends and for the day of the week. District-wise effect estimates of 111 districts in total were entered into linear meta-regression models seeking determinants of inter-district variation in heat and cold vulnerability. Generally, temperature effects on the daily number of deaths were highly significant in all districts, with higher death rates occurring when the same-day temperature exceeded a clear threshold and higher death rates with declining temperature averaged over the previous 14 days, in that case not showing any clear threshold effect. A higher heat vulnerability was observed for more densely populated areas, especially for the city of Vienna, for districts with a higher percentage of singles, of homeless people, of unemployed, and of migrants. Surprisingly, a higher percentage of outdoor workers seemed to be protective. Higher cold vulnerability was found for an increasingly autochthonous population, for districts with a higher employment rate, with more commuters, more agricultural workers, and more green spaces.

Relaxation breaks during the school day are important for pupils in order to remain cognitively receptive and not stressed. The question arises as to which break environments are more or less suitable for providing mental health benefits. The study compared the cognitive performance and mental wellbeing effects of short-term breaks in different indoor school rooms and outdoor public green spaces on adolescent pupils from three schools in Vienna, Austria, during the vegetated season. Seventy-eight high school pupils participated in a field experiment measuring state of mind (Nitsch scale), cognitive performance (d2-R Test of Attention), and perceived health benefits and restorativeness in classrooms, break rooms and public green spaces before and after a 30-minute break. Regardless of the environment visited, pupils reported higher health benefits and a better state of mind. A higher cognitive performance after the break was also measured. In terms of perceived health benefits, state of mind and cognitive performance, the experiments did not demonstrate that public green spaces were more effective than the indoor classrooms and break rooms. Pupils from the 'greenest' school performed best in cognitive performance tests.

Tropospheric ozone is an air pollutant that poses a public health problem in Europe. Climate change could increase the formation of ozone. Applying past and predicted annual total (all-cause) mortality data and modeled daily ozone concentrations, we performed a nationwide health impact assessment estimating annual ozone-related (attributable) deaths in Austria. Different approaches were compared. Estimates were based on maximal 1-h averages of ozone. Until the decade from 2045 till 2055, more people will die in Austria because of the demographic trends. Therefore, more deaths will also be attributable to ozone. Higher greenhouse gas emission scenarios (e.g. Representative Concentration Pathway RCP8.5 compared to RCP2.6) will lead to more ozone-related deaths, mostly due to the national emission of ozone precursors (a difference of 250-340 cases per year, depending on the model), but to a lesser extent because of global climate change. Increases in attributable deaths will be affected mostly by national, not global mitigation measures. National emission reduction will certainly have a strong and beneficial effect on local atmospheric chemistry, air quality, and public health.

Previous research has shown that biophysical and social characteristics of urban green spaces (UGS) and individual factors may play a role in preferences for restorative environments. However, little is known about the trade-offs between (bio)physical and social characteristics of UGS on different health-related psychological benefits between different population groups. This exploratory study used an image-based discrete choice experiment, in which 298 adolescent pupils, 159 university students, and 142 adults were asked which urban green spaces they would prefer for general recovery, stress reduction, and concentration improvement. Each of the 128 green space scenarios depicted different attributes of varying levels of recreational infrastructure, numbers of trail users, distances between forest vegetation and trail, traffic noise, background scenery, both in winter and in summer. The results indicate that visitor numbers and traffic noise strongly influenced green space preferences for all study groups, but groups differed in terms of their preferences and trade-offs for the psychological benefits. The biophysical environment was less important for adolescent pupils, while recreational infrastructure was less important for the adults. There were group differences in stated preferences for general recovery, stress reduction, and concentration enhancement. Implications for urban green space planning are presented.

Abstract The Alpine region in Central Europe and its populations in principle face the same types of threats to their health due to climate change as those in other parts of the world. But special geographical and climatic aspects of that region warrant closer and special examination of the connections between health and climate change in the Alps. These include small-scale variation, in some instances steep mountain slopes, and, above all, a larger-than-average increase in near-surface temperatures. To that end, there are main pathways between climate change and health: “Direct effects” describe rather short-term health effects of extreme weather events. Such events have occurred in the past, and therefore ample epidemiological evidence is available for the assessment of their impact. With climate change, such extreme events are predicted to change in frequency and intensity. “Indirect effects” refer to a more complex pathway where long-term changes of various natural and anthropogenic systems in reaction or adaptation to climate change exert adverse or sometimes also beneficial impacts on health. Such systems include ecosystems in which, for example, the prevalence of disease vectors or the allergenicity of pollen will change. But agriculture and forestry or the built environment are also affected by climate change and in turn affect the health of people. “Distant effects” are also rather indirect in nature. But in this pathway, changes due to climate change in other parts of the world affect the health in the Alpine region. Increasing migration into the Alpine region and changing migration patterns are important examples of this pathway. In some instances, most importantly regarding mental health, there is still a need for more studies focusing on the Alpine environments. But apart from these especially understudied topics, as the climate crisis evolves, there is generally a need for continuous research on the health effects of climate change and the potential of health promotion to create co-benefits.

Climate change is a threat to health and social security of billions of people. Health and quality of life are increasingly affected in many ways due to the climate crisis. Rising global temperatures are resulting in increasingly frequent and severe extreme weather events, contributing to further increase in inequality, discrimination, and injustice overall and in health care specifically. Furthermore, climatic conditions are also becoming increasingly suitable for the transmission of infectious diseases and their spread into new regions. Socio-economically disadvantaged regions with weak health infrastructure (e.g. Global South) will be hardly able to cope without specific support. The overriding imperative is to achieve reductions in greenhouse gas emissions from transport, energy and food production at global, national and regional levels to mitigate negative health impacts. The 2015 Paris Agreement must also be seen as crucial health agreement. Our paper aims to highlight ethical aspects of climate change in the health sector.

Abstract Background Numerous models point to notable discrepancies between internal attitudes and environmental protection behaviour. Especially in regards to the high social value of climate protection, the question arises to what extent the commitment to environmental protection is not just a socially desirable “lip service”. A snap survey was conducted among participants of climate demonstrations in Vienna to find out whether they differ from other groups not only in their interest in environmental issues, but in particular in their personal commitment. Methods A total of 331 participants (below 16y) were surveyed (177 Fridays4Future participants, 41 visitors of non-climate-related mass events, 113 medical students). The survey regarding interest in climate and personal commitment to environmental protection was conducted using an 11-point Likert scale. Results Participants of the climate demonstrations described higher values regarding their interest in climate protection, their interest in environmental protection as well as their personal commitment to environmental protection. All differences between the pairwise mean-group comparisons were significant in the expected direction (lowest values: visitors of non-climate-related events; p < 0.017). Results concerning flight renunciations already made showed large differences between the groups (Pearson Chi-Square: 71.913; df = 4; p < 0.001): Around 5 times more participants of climate demonstrations than visitors to other mass events reported that they had already refrained from flying in the past year. In contrast, there were no differences with regard to the statement that they had not yet renounced flights, but intended to do so in the future. Discussions Differences with regard to renunciations already made indicate that values expressed by the groups are also mirrored in actual behaviour. Considering the magnitude of differences and control response our results are unlikely to be explained by socially desired response behaviour. Key messages • First short survey on to quantify group differences regarding refrainment of air travels. • Climate activists showed considerably higher commitment regarding personal sacrifices.

Zusammenfassung Der Klimawandel ist eine Gefahr für Gesundheit und soziale Sicherheit von Milliarden von Menschen. Gesundheit und Lebensqualität werden unter dem Einfluss der Klimakrise zunehmend auf vielfältige Weise beeinträchtigt. Der Anstieg der globalen Temperaturen hat häufigere, stärkere Extremwetterereignisse zur Folge, die insgesamt und speziell in der Gesundheitsversorgung zur weiteren Aggravierung von Ungleichheit, Diskriminierung und Ungerechtigkeit beitragen. Zudem begünstigen die klimatischen Bedingungen die Übertragung zahlreicher Infektionskrankheiten und ihr Vordringen in neue Regionen. Sozio-ökonomisch benachteiligte Gebiete mit schwacher Gesundheitsinfrastruktur, etwa im globalen Süden, werden am wenigsten in der Lage sein, ohne gezielte Unterstützung die Folgen der Klimakrise zu bewältigen. Oberstes Gebot ist es, die Verringerung der Treibhausgasemissionen in den Bereichen Verkehr, Energie- und Nahrungsmittelproduktion zu erreichen – auf globaler, nationaler und regionaler Ebene, um negative Gesundheitsfolgen zu mildern. Das Pariser Übereinkommen (2015) ist daher auch als entscheidendes Gesundheitsabkommen zu begreifen. Der Fokus dieses Beitrages liegt auf ethischen Aspekten des Klimawandels im Gesundheitsbereich.

Previous research has found higher levels of heatwave mortality and morbidity among urban residents with a migration background because of their social, health and environmental conditions. The purpose of the study was to investigate and compare heat induced changes in the outdoor recreation behaviours of Turkish migrants with those of non-migrants on hot days in Vienna. Specifically, the study compared coping behaviours due to heat such as inter-area, intra-area, temporal and activity displacement between migrants and non-migrants. The study interviewed 400 migrants and non-migrants in four public green spaces of different area sizes and asked about their outdoor recreation motives and activities, as well as behavioural changes, due to summer heat. Results show that migrants have different motives for visiting urban green spaces on hot days, and that they visit these less frequently on hot days compared to non-migrants. While both groups shift their outdoor uses more to shady areas and the cooler times of the day, more migrants visit green spaces in the afternoon, perform more energetic recreational activities, and use sunnier sites more frequently than non-migrants on hot days. Few migrants and non-migrants stated that they would visit alternative green spaces when it is hot. The results indicate that migrants’ behaviours result in higher heat exposure, while making less use of the opportunities larger green spaces such as forests can provide for heat relief. Recommendations on how green and city planners could reduce heat related health risks for both study groups are presented.

Conventional banana farming is pesticide-intensive and leads to high exposure of farmworkers. Ecuador is the world’s biggest exporter of bananas. In this field study in 5 communities in Ecuador, we recorded potentially pesticide-associated subjective health symptoms in farmworkers and compared pesticide users to workers in organic farming. With one exception, symptom rates were always higher in the pesticide-exposed group. Significance was reached in 8 out of 19 investigated symptoms with the highest odds ratios (and smallest p-values) for local irritation like skin and eye irritation (OR = 3.58, CI 1.10–11.71, and 4.10, CI 1.37–12.31, respectively) as well as systemic symptoms like dizziness (OR = 4.80, CI 1.55–14.87) and fatigue (OR = 4.96, CI 1.65–14.88). Moreover, gastrointestinal symptoms were reported more frequently by pesticide users: nausea (OR = 7.5, CI 1.77–31.77) and diarrhea (OR = 6.43, CI 1.06–30.00). The majority of farmworkers were not adequately protected from pesticide exposure. For example, only 3 of 31 farmworkers that had used pesticides recently reported using gloves and only 6 reported using masks during active spraying. Improved safety measures and a reduction in pesticide use are necessary to protect the health of banana farmworkers.

In epidemiological studies, both spatial and temporal variations in nitrogen dioxide (NO2) are a robust predictor of health risks. Compared to particulate matter, the experimental evidence for harmful effects at typical ambient concentrations is less extensive and not as clear for NO2. In the wake of the “Diesel emission scandal—Dieselgate”, the scientific basis of current limit values for ambient NO2 concentrations was attacked by industry lobbyists. It was argued that associations between NO2 levels and medical endpoints were not causal, as NO2 in older studies served as a proxy for aggressive particulate matter from incineration processes. With the introduction of particle filters in diesel cars, NO2 would have lost its meaning as a health indicator. Austria has a high percentage of diesel-powered cars (56%). If, indeed, associations between NO2 concentrations and health risks in previous studies were only due to older engines without a particle filter, we should expect a reduction in effect estimates over time as an increasing number of diesel cars on the roads were outfitted with particle filters. In previous time series studies from Vienna over shorter time intervals, we have demonstrated distributed lag effects over days up to two weeks and previous day effects of NO2 on total mortality. In a simplified model, we now assess the effect estimates for moving 5-year periods from the beginning of NO2 monitoring in Vienna (1987) until the year 2018 of same and previous day NO2 on total daily mortality. Contrary to industry claims of a spurious, no longer valid indicator function of NO2, effect estimates remained fairly stable, indicating an increase in total mortality of previous day NO2 by 0.52% (95% CI: 0.35–0.7%) per 10 µg/m3 change in NO2 concentration.

Banana farming represents an important segment of agricultural production in Ecuador. The health of farmworkers might be compromised by the extensive use of pesticides in plantations applied under poorly regulated conditions. Due to an increased awareness of pesticide-related problems for nature, as well as for worker and consumer health, ecological farming has been established in some plantations of Ecuador. We set out to investigate the occupational health of workers in both conventional and ecological farming. Nuclear anomalies in buccal epithelial cells were used as short-term indicators for genotoxicity and a potentially increased cancer risk in the two groups of farmworkers. By application of the Buccal Micronucleus Cytome Assay (BMCA), we found the frequency of micronuclei in conventional pesticide using farmworkers significantly increased by 2.6-fold, and other nuclear anomalies significantly increased by 24% to 80% (except pyknosis with a non-significant increase of 11%) compared to the farmworkers on ecological plantations. These results demonstrate that ecological farming may provide an alternative to extensive pesticide use with significantly reduced indicators of cancer risk. In conventional farming, improvements in education and instruction regarding the safe handling of pesticides and protective equipment, as well as regulatory measures, are urgently needed.

COVID-19 is an infectious disease caused by a novel coronavirus, which first appeared in China in late 2019, and reached pandemic distribution in early 2020 The first major outbreak in Europe occurred in Northern Italy where it spread to neighboring countries, notably to Austria, where skiing resorts served as a main transmission hub Soon, the Austrian government introduced strict measures to curb the spread of the virus Using publicly available data, we assessed the efficiency of the governmental measures We assumed an average incubation period of one week and an average duration of infectivity of 10 days One week after the introduction of strict measures, the increase in daily new cases was reversed, and the reproduction number dropped The crude estimates tended to overestimate the reproduction rate in the early phase Publicly available data provide a first estimate about the effectiveness of public health measures However, more data are needed for an unbiased assessment

COVID-19 is an infectious disease caused by a novel coronavirus, which first appeared in China in late 2019, and reached pandemic distribution in early 2020. The first major outbreak in Europe occurred in Northern Italy where it spread to neighboring countries, notably to Austria, where skiing resorts served as a main transmission hub. Soon, the Austrian government introduced strict measures to curb the spread of the virus. Using publicly available data, we assessed the efficiency of the governmental measures. We assumed an average incubation period of one week and an average duration of infectivity of 10 days. One week after the introduction of strict measures, the increase in daily new cases was reversed, and the reproduction number dropped. The crude estimates tended to overestimate the reproduction rate in the early phase. Publicly available data provide a first estimate about the effectiveness of public health measures. However, more data are needed for an unbiased assessment.