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Climate change affects human health, however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-5 induced warming, during the period 1991-2018. Across all study countries, we find that 37.0% (range 20.5-76.3%) of heat-related deaths can be attributed to anthropogenic climate change, and that increased mortality is evident on every continent. Burdens varied geographically, but were on the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public 10 health impacts of climate change.

A remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March–April 2020. Excess mortality particularly affected  ≥ 65 year olds (91% of all excess deaths), but also 45–64 (8%) and 15–44 year olds (1%). No excess mortality was observed in 0–14 year olds.

OBJECTIVE To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide. DESIGNTwo stage time series analysis.SETTING 406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network. POPULATIONDeaths for all causes or for external causes only registered in each city within the study period. MAIN OUTCOME MEASURESDaily total mortality (all or non-external causes only). RESULTSA total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m 3 increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/ m 3 ) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m 3 ), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively. CONCLUSIONSResults suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.Cite this as: BMJ 2020;368:m108 http://dx. WHAT IS ALREADY KNOWN ON THIS TOPICStudies on the short term association between ground level ozone and mortality have been mostly performed in a few locations, in limited geographical areas, and using various designs and modelling approaches Although most of the studies found positive associations, results are heterogeneous, and a critical comparison across different countries and regions is made difficult by the limited statistical power and differences across studies Estimates of the association are usually reported as relative risks, a summary measure that does not quantify the actual health impact and makes it difficult to evaluate comparative health benefits of different regulatory limits WHAT THIS STUDY ADDSThis large multi-country study found increased mortality risks associated with exposure to ozone across locations and countries, with an average 0.18% per 10 µg/m3, reinforcing the evidence of a potential causal association Risk estimates were translated in measures of excess mortality, and it was found that more than 6000 deaths each year, corresponding to 0.20% of the total mortality, would have been avoided in the...

Objectives: Weekly monitoring of European all-cause excess mortality, the EuroMOMO network, observed high excess mortality during the influenza B/Yamagata dominated 2017/18 winter season, especially among elderly. We describe all-cause excess and influenza-attributable mortality during the season 2017/18 in Europe. Methods: Based on weekly reporting of mortality from 24 European countries or sub-national regions, representing 60% of the European population excluding the Russian and Turkish parts of Europe, we estimated age stratified all-cause excess morality using the EuroMOMO model. In addition, age stratified all-cause influenza-attributable mortality was estimated using the FluMOMO algorithm, incorporating influenza activity based on clinical and virological surveillance data, and adjusting for extreme temperatures. Results: Excess mortality was mainly attributable to influenza activity from December 2017 to April 2018, but also due to exceptionally low temperatures in February-March 2018. The pattern and extent of mortality excess was similar to the previous A(H3N2) dominated seasons, 2014/15 and 2016/17. The 2017/18 overall all-cause influenza-attributable mortality was estimated to be 25.4 (95%CI 25.0-25.8) per 100,000 population; 118.2 (116.4-119.9) for persons aged 65. Extending to the European population this translates into over-all 152,000 deaths. Conclusions: The high mortality among elderly was unexpected in an influenza B dominated season, which commonly are considered to cause mild illness, mainly among children. Even though A(H3N2) also circulated in the 2017/18 season and may have contributed to the excess mortality among the elderly, the common perception of influenza B only having a modest impact on excess mortality in the older population may need to be reconsidered.