Impact of Short-Term Exposure to Extreme Temperatures on Mortality: A Multi-City Study in Belgium

In light of climate change, health risks are expected to be exacerbated by more frequent high temperatures and reduced by less frequent cold extremes. To assess the impact of different climate change scenarios, it is necessary to describe the current effects of temperature on health. A time-stratified case-crossover design fitted with conditional quasi-Poisson regressions and distributed lag non-linear models was applied to estimate specific temperature-mortality associations in nine urban agglomerations in Belgium, and a random-effect meta-analysis was conducted to pool the estimates. Based on 307,859 all-cause natural deaths, the mortality risk associated to low temperature was 1.32 (95% CI: 1.21–1.44) and 1.21 (95% CI: 1.08–1.36) for high temperature relative to the minimum mortality temperature (23.1 °C). Both cold and heat were associated with an increased risk of cardiovascular and respiratory mortality. We observed differences in risk by age category, and women were more vulnerable to heat than men. People living in the most built-up municipalities were at higher risk for heat. Air pollutants did not have a confounding effect. Evidence from this study helps to identify specific populations at risk and is important for current and future public health interventions and prevention&nbsp;strategies.</p

Burden of disease attributable to risk factors in European countries: a scoping literature review

Objectives Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe; and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods. Methods We searched multiple literature databases, including grey literature websites and targeted public health agencies websites. Results A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available. Conclusions Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates

The EU and minimum Income protection: clarifying the policy conundrum

Should the EU be involved in the governance of minimum income protection, and if it should, in which role precisely? This question raises a complex policy conundrum. We focus on a proposal by the European Anti-Poverty Network (EAPN) for an EU Framework Directive on Minimum Income Protection, in order to examine three aspects of that policy conundrum: (1) the instrumental relevance of minimum income protection; (2) the unequal burden of the redistributive effort that would be required across the EU if the Union were to impose hic et nunc a minimum income guarantee of 60% or 40% of the median national income in all Member States; and (3) the impact on dependency traps, under the same hypothesis. We illustrate each of these observations empirically, using cross-nationally comparable data on income and living conditions (EU-SILC) and minimum income protection levels (CSB-MIPI). Since a harmonised minimum income scheme requires a significantly greater budgetary effort on behalf of some of the poorer Member States in Eastern and Southern Europe, it raises a complex question about the meaning of solidarity within the EU. Enhanced solidarity within Member States cannot be decoupled from enhanced solidarity among Member States – and vice versa. Simultaneously, the EU should put positive pressure on poorer and richer Member States to gradually improve the overall quality and efficiency of their welfare regimes. In this context, the prospect of gradually and flexibly introducing a more binding EU framework on minimum income protection may become realistic