Seite - 29 - in Biodiversity and Health in the Face of Climate Change

29 2.4 Climate Change and  Physical Health Climate is an inherent part of the natural systems that are associated with both bio- diversity and physical health. Therefore, climate change is similarly interconnected with the processes discussed in the previous two sections, particularly in the context of rapid changes that go beyond the pace of autonomous adaptive capacity and in the context of other drivers of change, such as urbanisation (Fisher et  al. 2017). Climate change has direct and indirect influences on the underlying mechanisms of processes discussed in the previous sections. Direct impacts on human health include, for example, the influence of higher temperatures on heat stress in urban dwellers. Indirect impacts include how climate change affects evaporative cooling in urban areas through which people’s exposure to high temperature events may be reduced. In this section, we consider the ways in which climate change affects phys- ical health and the role of the natural environment, both generally and through bio- diversity. Since biodiversity is also affected by climate change, the section ends with an assessment of climate impacts on the biosphere, particularly in terms of the functions and processes identified in the previous sections as being important for human health. There are numerous reviews of the deleterious effects of accelerated anthropo- genic climate change on natural systems and on human health, as well as those that point to some of the possible benefits. Reviews include the following direct/indirect and primary/secondary pathways (LWEC 2015; European Environment Agency 2017;  Fig. 2.5). • Health effects of heat and heat waves Heat-waves are estimated to have resulted in cumulative death rates of 129.0 people per million in Europe between 1991 and 2015, 24 times higher than the next highest most severe extreme weather-related hazards in terms of death rates (which are cold- and flood-related events at 5.3 and 6.4 people per million respec- tively;  European Environment Agency 2017). Heat-waves are well known to be associated with excess deaths particularly in older people, people with pre-existing health problems and people living in urban areas, for example based on analyses of the 2003 European heat-wave (Johnson et  al. 2004; Grize et  al. 2005; Poumadere et  al. 2005). Excess death rates have also been recorded in cities across the world, e.g. in Chicago, Melbourne and Moscow, including cities with populations already adapted to relatively high temperatures (Norton et  al. 2015; Burkart et  al. 2014). Evidence from the UK suggests that cardiovascular causes result in the larger num- ber of deaths, though tending to be more associated with atrial fibrillation or pulmo- nary heart disease compared to other heart diseases. Furthermore, excessive heat seems to be most strongly associated with causes of deaths related to the endocrine, nervous and urinary/renal systems (Arbuthnott and Hajat 2017). People with demen- tia and on some prescribed medications may also be susceptible to heat-related hospitalisation and mortality, possibly due to higher potential for dehydration and/ or reduced ability to sweat (Stollberger et  al. 2009). The frequency and severity 2 Biodiversity, Physical Health and  Climate Change: A  Synthesis of  Recent Evidence