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OCR for page 185
7
Thermal Stress
INTRODUCTION
This chapter addresses problems of indoor environmental quality as-
sociated with the thermal environment of buildings, how climate change
could induce alterations in the frequency or severity of problems, and some
of the means available to mitigate adverse conditions. Thermal stress is a
particular threat to certain populations whose health, economic situation,
or social circumstances make them vulnerable to exposure to temperature
extremes or the consequences of such exposure. The text thus focuses its
discussion of health effects on these vulnerable populations.
National Academies reports note that the first decade of the 21st cen-
tury was 0.8°C (1.4°F) warmer than the first decade of the 20th century
(NRC, 2010). Associated with that temperature rise have been observations
that heat waves have become longer and more extreme and that cold spells
have become shorter and milder. Because climate models suggest that those
trends will continue and intensify, much of the information presented in the
chapter relates to issues involving prolonged exposure to high temperature.
The climate change research that the committee relied on is summarized
in Chapter 2. Studies of building ventilation—which plays a large role in
determining indoor thermal conditions—are addressed in Chapter 8.
MANAGEMENT OF THE INDOOR THERMAL ENVIRONMENT
Buildings must protect occupants against extremes in outdoor tempera-
tures. This section addresses the management of the indoor thermal envi-
185
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186 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
ronment, focusing on amelioration of high or prolonged heat conditions.
Temperature fluctuations and prolonged exposure to low temperatures may
also have health consequences. Generally, warmer conditions may lower
the risk of health consequences among segments of the population that
have difficulty in paying for heating during winter (Curriero et al., 2002;
McGeehin and Mirabelli, 2001), but it should be noted that this benefit
might be offset by circumstances in which weather extremes result in the
loss of power for extended periods (MMWR, 1998).
Thermal Comfort Indoors
The American Society of Heating, Refrigerating and Air-Conditioning
Engineers (ASHRAE) defines human thermal comfort as “the state of mind
that expresses satisfaction with the surrounding environment” (ASHRAE,
2004). Although comfort is a subjective evaluation, survival and health are
affected by temperature, humidity, and individual factors (such as clothing,
air speed, metabolic rate, and health) related to the generation, dissipation,
and retention of body heat. In addition to outdoor temperature, humidity,
and solar radiation, comfort is influenced by whether a building has air con-
ditioning and whether occupants have control over the temperature (Nicol
and Humphreys, 2002). Acclimatization plays a role; people who live in
areas where high heat and humidity are common are better able to tolerate
such conditions than those who do not (de Dear and Brager, 1998). And
thermal comfort is influenced by radiant heat transfer from surrounding ob-
jects: people near hot or cold surfaces feel warmer or cooler independently
of the air temperature (EPA, 2009b).
“Typical” indoor temperature varies by season, locale, building type,
and the economic circumstances of the occupants, although commercial
spaces, such as offices, are often maintained at a more consistent year-
round temperature than residences. ASHRAE’s Thermal Environmental
Conditions for Human Occupancy Standard 55-2004 characterizes the
indoor summer comfort range1 as about 74–83°F (23–28°C) and the win-
ter comfort range2 as about 67–79°F (19–26°C), depending on the relative
humidity. ASHRAE separately defines acceptable temperature ranges for
naturally ventilated spaces as a function of outdoor temperatures spanning
about 50–93°F (10–34°C).
1 More specifically, the range when occupants are dressed in clothing typically “worn when
the outdoor environment is warm” (ASHRAE, 2004).
2 When occupants are dressed in clothing typically worn when the outdoor environment
is cool.
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187
THERMAL STRESS
Effects of Climate Change on the Indoor Thermal Environment
Little research has addressed specifically the potential effects of climate
change on the indoor thermal environment. The major issues surrounding
this topic and some information addressing it are outlined below.
Indoor temperature is a function of outdoor temperature, the amount
of solar radiation striking the structure, building insulation and ventilation
characteristics, factors that influence the ability of the structure to dissi-
pate stored heat, intentional sources of heat (heating, ventilating, and air-
conditioning [HVAC] systems), and other indoor sources of heat (artificial
lighting, cooking appliances, occupant metabolic heat, and the like). Scott
and Huang (2007) found that the demand for cooling energy increases by
5–20% for every 1°C (1.8°F) increase in outdoor temperature, depend-
ing on the assumptions used.3 Greater use of air conditioning for cooling
implies more electricity demand, which is likely (at least in the short term)
to be met through heavier use of fossil fuels, including coal, which in turn
may lead to higher emissions of air pollutants, including the greenhouse
gases that have been implicated in increased outdoor temperatures (IPCC,
2007). The positive feedback loop that characterizes those relationships is
depicted in Figure 7-1.
The US Climate Change Science Program’s literature review concluded
that “temperature increases with global warming would increase peak de-
mand for electricity in most regions of the country” but that research results
varied and were influenced by such factors as “whether the study allows
for changes in the building stock and increased market penetration of air
conditioning in response to warmer conditions” (Scott and Huang, 2007).
Indoor relative humidity, another component of the thermal environment,
is a part of the issue. In areas of the country where hot and humid outdoor
conditions become more common, air-conditioning units may run longer
to restore or maintain comfortable indoor humidity.
Potential increases in the magnitude and frequency of peak electricity
demand due to heat waves and in the occurrence of extreme weather events
have also led to concerns over power outages that could leave building oc-
cupants without sources of conditioned air. The 1995 Chicago (Changnon
et al., 1996) and 1999 New York City (USGCRP, 2009) heat waves were
accompanied by extended and widespread power outages. Electric-grid
infrastructure disruptions after Hurricanes Katrina and Rita left some ar-
eas of the southern United States without power for weeks during the late
summer of 2005.
3 The same study found that demand for heating energy decreases by 3–15% for every 1°C
(1.8°F) increase in outdoor temperature. Cooling uses electricity almost exclusively whereas
heating uses various energy sources; this complicates the evaluation of the implications of these
changes on overall power-generation demands.
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188 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
higher outdoor
temperatures
increased
greater use of AC
production of
greenhouse gases
more burning of
larger electrical
fossil fuels to
power demands
generate power
FIGURE 7-1 The relationship between outdoor temperature, air-conditioning use,
electric-power demand, and greenhouse-gas generation.
EFFECTS OF HEAT EXPOSURE
Healthy people can physically adapt to changes in ambient tempera-
ture within some limits. However, when temperatures push the upper end
of those limits or are combined with other factors—such as high humid-
ity, strenuous activity, or prolonged exposure—physiologic compensation
mechanisms can be overwhelmed. The National Weather Service’s (NWS’s)
Heat Index—a measure of perceived temperature derived from the ambient
temperature and relative humidity and based on work originally conducted
by Steadman (1979)—is an imperfect but useful tool in determining poten-
tial health threats (Metzger et al., 2010). Figure 7-2 illustrates heat-index
values for a range of temperature and humidity combinations and indicates
the corresponding NWS health-threat level.
A 2011 review by Anderson and Bell examined the determinants of mor-
tality in heat waves through an empirical analysis of 43 events in US cities
over the years 1987–1995. Mortality increased an average of 3.74% (95%
Confidence Interval [CI] 2.29–5.22%) on heat wave days versus non-heat
wave days. The largest effect was observed in the Northeast and Midwest US
census regions, the smallest in the South, even though the longest heat waves
occurred in that region. Analyses also found that heat waves at the beginning
of the warm weather months had greater mortality effects (5.04%, nation-
ally) than those later in the season (2.65%). The investigators speculated
that these results were due to behavioral and physiological acclimatization.
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189
THERMAL STRESS
FIGURE 7-2 National Weather Service Heat-Index values and corresponding health-
threat levels (NWS, 2010).
Figure 7-2.eps
bitmap
Physiologic Vulnerability to Heat Events
A number of biological factors influence the ability of people to adapt
to high temperature conditions or withstand extended exposure to them.
These factors are identified and discussed below.
As people age, their ability to cope with external environmental stressors
decreases. That is based on both physiologic and social factors: decreased
organ function, interactions between medications and heat-compensation
mechanisms, overall poor health status, isolation, and decreased access to
support services.
There are stark physiologic differences between younger adult and
elderly populations. Decreased organ function is a major issue. The pe-
ripheral nervous system is affected by the aging process: myelin sheaths
deteriorate, and myelinated and unmyelinated nerve fibers are lost. The
peripheral nervous system tells the body to feel hot and cold. It also regu-
lates internal processes, such as heart rate and contraction and expansion
of blood vessels, to maintain proper blood pressure and the body’s reaction
to stress. Decreased sensation may limit a person’s ability to recognize that
she or he needs to take steps to decrease body temperature. Sweat produc-
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190 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
tion and sweat-gland functioning, which are coping mechanisms to reduce
the body’s core temperature, are also regulated by the peripheral nervous
system. The number of sweat glands does not decrease with age, but sweat
production does, and this makes it difficult to reduce the body’s core tem-
perature (Verdú et al., 2000).
The overall health status of the elderly is poorer than that of other
age groups. The elderly exhibit higher rates of chronic ailments, including
cardiovascular diseases, diabetes, chronic obstructive pulmonary disease,
diabetes, renal disease, and neoplasms (Khalaj et al., 2010; Pearlman and
Uhlmann, 1988; Reid et al., 2009). Cardiovascular disease has been identi-
fied as the most important risk factor for heat stroke in the elderly (Kenney
and Munca, 2003), but other chronic illnesses, such as those mentioned
above, are also known to increase the risk of heat stroke (Khalaj et al.,
2010).
Some medications, including over-the-counter supplements, may have
adverse thermoregulatory effects. Psychotropic drugs have been associated
with a higher risk of hospitalization of the elderly due to hyperthermia
(Lopez and Goldoftas, 2009). Nonsteroidal anti-inflammatory drugs, such
as aspirin—which is commonly taken for myocardial-infarction preven-
tion—block prostaglandins, which aid in controlling body temperature and
blood pressure (Carmichael and Shankel, 1985). Anticholinergics inhibit
sweat production; younger persons also use these medications, but their
sweating process is not affected, changes having been noted only in those
who were about 80 years old or older (Kenney and Munca, 2003). Other
medications, such as diuretics, limit cutaneous vasodilation and pose a high
risk of dehydration, a particular concern during heat stress (Kenney and
Munca, 2003).
Those suffering from chronic diseases are also at risk. Research in-
dicates that obesity, hypertension, diabetes, and cardiovascular disease
increase susceptibility to the effects of extreme heat.
Obesity is a recognized public-health concern. Few studies have looked
specifically at obese or overweight persons and heat waves, but some in-
formation is available. Obesity was a comorbidity in the 2003 European
heat wave (Vandentorren et al., 2006); this is not surprising given that fa-
tal heat strokes occur at a rate 3.5 times higher in those who are obese or
overweight than in those of normal weight (Kenny et al., 2010). That may
be because of a lowered capacity of heat dissipation due to a low ratio of
body surface area to body mass, which hinders sweat evaporation (Kenny
et al., 2010). Adipose tissue also stores heat more efficiently than other tis-
sues, such as muscle, and subcutaneous fat restricts conductive heat transfer
(Kenny et al., 2010).
According to the Centers for Disease Control and Prevention, the
prevalence of hypertension is about 30% in the United States (Fryar et al.,
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191
THERMAL STRESS
2010). A study of the elderly in Baltimore, Maryland, found that 50% of
those who experienced adverse heat symptoms during the summer months
had a history of hypertension (Basu and Samet, 2002). Hypertension was a
common comorbidity factor in those who died from heat effects during the
Chicago 1995 heat wave (Dematte et al., 1998). Impairments of circulation,
such as those which occur in people who have hypertension, may reduce
blood flow to the dermis, and this may weaken temperature regulation by
reducing heat transfer from the core to the skin (Carberry et al., 1992;
Kenny et al., 2010).
Diabetes occurs in about 10% of the US population (Fryar et al., 2010),
and studies have shown that those who have diabetes suffer disproportion-
ately during extreme heat events compared with the general population
(Kenny et al., 2010). Circulatory changes, such as vessel dilation and vas-
cular reactivity, are greatly compromised in those who have diabetes (Kenny
et al., 2010; Petrofsky et al., 2005; Stansberry et al., 1997). Neuropathy,
which is common in diabetic people, impedes sweat responses (Fealy et al.,
1989; Kenny et al., 2010). Diabetic people also may have fluid and elec-
trolyte disturbances, which affect glucose regulation (Semenza, 1999); this
was seen in a heat wave in New York and St. Louis in 1966, where those
who had diabetes had increased mortality (Schuman, 1966).
Cardiovascular diseases afflict about 12% of Americans (CDC, 2010).
Although there are few studies of cardiovascular disease and heat, some
links have been found between increased mortality during heat waves and
the presence of cardiovascular diseases (Hoffmann et al., 2008; Kenny
et al. 2010; Klinenberg, 2002). Like other diseases that disrupt cardio-
vascular flow, cardiovascular diseases impair body-temperature regulation.
Mortality in those who had cardiovascular diseases was 30% higher dur-
ing the 2003 European heat wave than during other “normal” heat days
(Hoffmann et al., 2008). Cardiovascular disease was prominent among the
chronic diseases blamed for the excess mortality in France during the 2003
heat event (Fouillet et al., 2006; Vandentorren et al., 2006), and the same
was observed during the 1995 Chicago heat wave (Klinenberg, 2002).
Economic and Social Vulnerability to Heat Events
Several studies have examined how economic and social circumstances
influence vulnerability to death and disease associated with heat-wave
events. Shonkoff and colleagues (2009) published a review of the literature
focused on the disparate effects of climate change in California on groups
of lower socioeconomic status. Heat waves in that state and others resulted
in increased emergency-department visits for acute renal failure, diabetes,
cardiovascular disease, electrolyte imbalance, and nephritis (Knowlton et
al., 2009; Kovats and Hajat, 2008). Children 4 years old and younger and
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192 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
people over 65 years old were at greatest risk. Other investigators have
found that low-income black Americans are disproportionately affected
(Basu and Ostro, 2008; Medina-Ramon et al., 2006; O’Neill et al., 2003).
Analysis has shown that it is unlikely that this was a result of racial dif-
ferences in physiology but rather a consequence of lower socioeconomic
status, the physical settings that they live in, and their greater exposure to
high temperatures (Basu and Ostro, 2008).
The poor are more likely to be living in homes that do not have air
conditioning. According to the American Housing Survey (AHS), about half
of those living below the national poverty line do not have air conditioning
in their homes (USCB, 2009). The elderly may lack the financial resources
to make the necessary modifications to adapt to the heat, such as install-
ing air-conditioning units. Low socioeconomic status also has more subtle
effects. Those living in lower-income areas may experience higher rates of
crime. In the Chicago 1995 heat wave, some elderly people restricted venti-
lation in their homes by not opening windows for fear of crime (Klinenberg,
2002). Fear of crime leads people to stay in their homes, and this increases
mortality in heat events (Klinenberg, 2002; Lopez and Goldoftas, 2009).
People of lower socioeconomic status who have chronic health problems
are disproportionately affected by medical conditions because of their lack
of access to care and of the resources needed to manage their diseases ef-
fectively (Phelan et al., 2004). People of low socioeconomic status who
belong to some minority groups are also less likely to have access to private
transportation, so their ability to move to community sites that have air
conditioning is restricted. Disparities in air-conditioning access contributed
to the difference in heat-wave mortality, which was nearly twice as high
in minority-group residents in Los Angeles as the average in Los Angeles
(Kovats and Hajat, 2008).
Social isolation is a large factor in predicting heat morbidity, particu-
larly among the elderly. According to the US Census Bureau, about 25%
of the general population and 32% of the elderly population live alone
(Klinenberg, 2002). Physical impairments and mobility restriction due to
age and other limitations may prevent people—particularly those who live
on upper floors—from leaving their home and reaching cooling centers set
up by the community (Lopez and Goldoftas, 2009). In the 1995 Chicago
heat wave, several trends due to social isolation were discovered. For ex-
ample, 73% of heat-related deaths were in people over 65 years old, and
those who lived alone were at additional risk for death (Klinenberg, 2002;
Semenza et al., 1996); and those who did not leave their homes at least
once a day and did not have access to transportation had higher mortality
(Semenza et al., 1996). Similar trends were found in the 1999 Chicago heat
wave (Naughton et al., 2002).
The so-called heat-island effect may also be a factor in higher heat-
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THERMAL STRESS
related morbidity and mortality found in urban areas than in rural areas
(Hajat et al., 2007; Martinez et al., 1989). It involves circumstances in
which urban areas are hotter than surrounding rural areas because of the
presence of large numbers of buildings, parking lots, and other infrastruc-
ture that has a great ability to store solar energy (Basu and Samet, 2002;
Luber and McGeehin, 2009). It is more common in locales that have rela-
tively few green spaces. A heat island absorbs and stores heat during the
day and radiates it during the night, sustaining higher temperatures and
intensifying the effects of heat waves (Luber and McGeehin, 2009). Green
spaces are associated with decreased heat-related morbidity and mortality
that are due to heat-island effects and the overall lack of direct shading for
residents (Kilbourne et al., 1982; Reid et al., 2009; Tan et al., 2007).
Shonkoff and colleagues’ (2009) review paper describes an unpublished
analysis by Morello-Frosch and Jesdale (2008), who found a positive dose–
response relationship between the presence of impervious surfaces and high
community poverty and a negative dose–response relationship between
the amount of tree cover and the extent of community poverty in four
California urban areas. That suggested the potential for a greater burden
of heat-island exposure of low-income populations than of higher-income
populations. The relationship was also observed by researchers in Phoenix,
Arizona, who found that elderly, minority-group, and low-income residents
were at the highest risk for exposure to extreme heat (Ruddell et al., 2010).
The lack of access to air conditioning thus directly influences the risk of
high heat exposure and heat-related morbidity and mortality. It also plays
an important role in home ventilation, which affects exposure to air pollut-
ants and overall indoor air quality apart from temperature.
Air-Conditioning Prevalence and Use
Air conditioning has been the primary means of moderating high tem-
peratures in buildings in the United States since the 1950s. The fraction
of homes in the United States that have air conditioning has risen steadily
over the past 40 years, from 46.9% of year-round units4 in 1973 to 87.4%
in 2005 (Eggers and Thackeray, 2007). The type of air-conditioning unit
has shifted over that time. In homes, central air-conditioning systems5 were
present in 16.8% of year-round units in 1973, to 33.2% in 1985, 47.0% in
1995, and 65.4% in 2005. Only 12.6% of year-round units were without
4 Year-round units are defined by the Census Bureau as “those intended for occupancy at
any time of the year, even though they may not be in use the year round” (USCB, 2004).
5 A central air-conditioning system is one that “uses ducts to distribute cooled and/or dehu-
midified air to more than one room or uses pipes to distribute chilled water to heat exchangers
in more than one room, and which is not plugged into an electrical convenience outlet” (266
CMR 2.00 Definitions, Massachusetts Office of Consumer Affairs & Business Regulation).
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194 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
FIGURE 7-3 Percentages of year-round units in the United States with central air-
Figure 7-3.eps
conditioning systems, one or more room units, or no air conditioning, 1985–2005
(Eggers and Thackeray, 2007, derived bitmap
from American Housing Survey data).
any form of air conditioning by 2005. Figure 7-3 illustrates changes in the
prevalence and type of air conditioning in residences over the past 25 years.
There are substantial variations in air-conditioning system prevalence
in different parts of the country. AHS data for 2005 indicate, unsurpris-
ingly, that air-conditioning is more common in the southern and south-
western United States than elsewhere6 and in the parts of the country that
typically have the most cooling degree days and the fewest heating degree
days.7 Figure 7-4 details those data.
The climate zone and census region that encompass California ex-
hibit relatively lower penetration of air-conditioning units than might be
expected. Many homes in California are not equipped with air condition-
ing, because coastal temperatures are relatively mild during summer (Basu
and Ostro, 2008). The reduced use of air-conditioning equipment is also
influenced by the state energy and efficiency programs that include “cool
community” standards for shading (Brown and Koomey, 2003).
In addition to the increase in air-conditioning units, the hours during
which air conditioning is used have increased over the years. The Depart-
6 The southern and southwestern parts of the United States were experiencing rapid growth
in new construction at this time, and this accounts in part for the greater prevalence of air
conditioning.
7 Cooling degree days are used to estimate how hot the climate is and how much energy may
be needed to keep buildings cool. Cooling degree days are calculated by subtracting a balance
temperature from the mean daily temperature and summing only positive values over an entire
year. Heating degree days are used to estimate how cold the climate is and how much energy
may be needed to keep buildings warm. Heating degree days are calculated by subtracting the
mean daily temperature from a balance temperature and summing only positive values over
an entire year. The balance temperature used can vary but is usually set at 65°F (18°C), 68°F
(20°C), or 70°F (21°C) (EPA, 2009b).
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195
THERMAL STRESS
Fraction of Homes, %
No
cooling Cooling
equipment equipment
Overall 16 84
Climate Zone
1 29 71
2 18 82
3 13 87
4 23 77
5 4 96
Census Region
Northeast 19 81
Midwest 8 92
West 43 57
South 3 97
FIGURE 7-4 Percentage use of cooling equipment in US housing units by climate
Figure 7-4.eps
zone and census region, 2005 (EIA, 2010a,b for data; EIA, 2007 for figure).
NOTE: The data used in this table differ from those used to generate Figure 7-3,
vector with bitmap map & key
which were based on year-round units only.
ment of Energy’s Residential Energy Consumption Survey found that 33%
of residences that had central air conditioning and 11% of residences that
had window or wall units reported using an air conditioner “all summer”
in 1981 (DOE, 2000). By 1997, those figures had risen to 52% and 21%,
respectively (DOE, 2000), and in 2005, 61% and 30% (DOE, 2008). Col-
lectively, 73% of residences that had any form of air conditioning reported
using it either “all summer” or “quite a bit” in 2005 (DOE, 2008).
Most central air conditioners in residences have no outside air intakes,
unlike the window and wall units that they sometimes supplanted. Instead,
they rely on the infiltration of outdoor air through windows and doors and
on loose construction. Climate change may stimulate the implementation of
energy-efficiency (also called weatherization) measures that limit such infil-
tration and may lead to inadequate ventilation, as discussed in Chapter 8.
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198 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
weather events lead to blackouts or if economic strains make fuel poverty8
more common. This may be a particular issue for elderly populations be-
cause physiological changes associated with the aging process make them
more vulnerable to the effects of cold (Press, 2003).
Evidence indicates that cold weather is associated with an excess of
mortality (Analitis et al., 2008; Anderson and Bell, 2009; Donaldson and
Keatinge, 1997; Huynen et al., 2001; Kloner et al., 1999). Potential causes,
in cases where hypothermia can be ruled out, include cardiovascular death
due to higher blood pressures resulting from lower core body temperatures
(Barnett, 2007; Barnett et al., 2005; Danet et al., 1999; Donaldson et al.,
1997; Medina-Ramón and Schwartz, 2007; Press, 2003). An increase of
plasma fibrinogen during the winter has also been found to increase in-
stance of ischemic heart disease (Woodhouse et al., 1994). And O’Neil
and colleagues (2003) found an association between cold temperatures
and respiratory-disease mortality in a hierarchical model that factored
geographic location and socioeconomic variables.
Cold weather is not anticipated to be a climate change issue and cold
weather exposures are not further explored in this chapter. However, two
other chapters of this report address issues indirectly related to climate
change, cold-weather conditions and health: Chapter 4 discusses adverse
exposures associated with extreme weather events, including the use of
unvented space heaters, back-up electrical power generators, and biofuel
stoves indoors, and Chapter 6 talks about the influence of seasonality on
the availability and spread of infectious agents.
CLIMATE-CHANGE ADAPTATION AND MITIGATION MEASURES
Protection from the adverse effects of heat exposure requires the ability
to lower core temperature and often involves maintaining or moving to a
temperate space. Many cities, for example, have heat-emergency plans that
include cooling centers where people can seek shelter. Approaches for creat-
ing or maintaining a safe thermal environment are outlined below.
Heating, Ventilating, and Air-Conditioning Approaches
Demonstration projects and research suggest that innovations in the de-
sign of mechanical systems and buildings may yield reduced HVAC-system
energy use while enhancing occupant comfort, health, and productivity.
They include both mature and newly developed technologies:
8 Fuel poverty is defined as spending more than 10% of income on heating a home to an
adequate level of warmth (Press, 2003)
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199
THERMAL STRESS
• M
ixed-mode or hybrid mechanical systems that support natural
ventilation (Axley, 2001; WHO, 2009).
• E
conomizer-cycle HVAC (Fisk and Seppänen, 2007).
• W
ater-based cooling systems, including fan-coil, radiant, and in-
duction systems (Costelloe and Finn, 2003).
• H
igh efficiency, low-pressure–drop filtration (Fisk, 2009).
• D
isplacement ventilation (Schiavon, 2009).
• P
assive stack and solar chimney systems (Russell et al., 2005).
• G
eothermal heat exchangers (Eicker and Vorschulze, 2009).
• E
arth-tube exchangers (Darkwa et al., 2011; Zmeureanu and Wu,
2007).
Mudarri’s Environmental Protection Agency white paper (2010) notes
that HVAC approaches like those vary in their ease of implementation:
some constitute straightforward upgrades of existing systems, and others
can be achieved only through building renovation or are feasible only for
new construction. The cost effectiveness of the measures is strongly linked
to the price of energy.
Building-Design and Setting Approaches
Architects, builders, and city planners have several tools at their dis-
posal for influencing the amount of heat absorbed by buildings and the
amount dissipated by them. Some are ancient and of established efficacy.
Traditional construction in warm climates—including the American South-
west, southern Europe, and the Middle East—has long used light, reflective
colors for exteriors. Synnefa et al. (2007) estimated that increasing roof re-
flectivity from its current 10–20% to 60% through the use of cool-colored
materials and coatings could reduce cooling-energy use by more than 20%.
Models developed by Akbari and colleagues (2001) suggest that introducing
additional trees and reflective or light-colored building and road surfaces
to urban environments would not only lower energy use but would lessen
heat-island effect. Installation of green roofs composed of soil substrate and
plants (Oberndorfer, et al. 2007) and regionally and seasonally appropriate
use of landscape elements and trees to block summer sunlight but permit
winter solar heating have also been shown to reduce cooling and heating
loads and peak energy demands (Akbari, 2002) and to lower concentrations
of air pollutants (Nowak et al., 2006; Yang et al., 2008).
Building-performance simulation (BPS) tools constitute another ap-
proach to managing heat through passive, low-energy means. BPS models
estimate energy and mass flows in buildings as functions of the character-
istics of a building and the space around it. Reinhart et al. (2010), in a
presentation before the committee, noted the utility of such simulations in
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200 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
understanding how neighboring buildings may affect heating loads and lo-
cal wind patterns and thus influence whether natural ventilation can be used
successfully. Climate-change projections can be married to BPS models to
estimate the benefits of particular building or site modifications in mitigat-
ing the effects of climate change.
Passive Survivability
Passive survivability is a term coined by Alex Wilson (2005) to de-
scribe “a building’s ability to maintain critical life-support conditions in
the event of extended loss of power, heating fuel, or water, or in the
event of extraordinary heat spells.” Interest in the concept may have been
stimulated in part by reports of deaths in sealed buildings that were left
without power in the wake of Hurricane Katrina. The elements of passive
survivability include provision for natural ventilation even if a building was
designed to operate with a mechanical HVAC system; resilience in the face
of extreme weather; high levels of insulation and other high-performance
building-envelope features; minimization of cooling loads through build-
ing geometry, landscaping, and thermal mass; passive solar heating; and
natural daylight (GSA, 2010; Wilson, 2006). Santamouris et al. (2007)
note that such features are especially important in low-income housing,
where residents are more likely to suffer from heat stress and poor indoor
environmental quality.
Passive survivability has gained currency in the General Services Ad-
ministration (GSA), which manages buildings for the federal government.
Testimony from its administrator in 2007 indicated that GSA was undertak-
ing initiatives to address facility passive survivability (Doan, 2007), and its
2010 Facilities Standards for the Public Buildings Service identified it as a
best-practice strategy (GSA, 2010).
Synthesis
A number of techniques for reducing the health risks and productivity
costs associated with uncomfortable or unsafe indoor thermal environ-
ments are available. They include both well-established low-technology
passive strategies and cutting-edge design and technology innovations.
Many of the approaches identified above yield additional benefits, includ-
ing lower energy use and costs (with concomitantly reduced generation of
greenhouse gases) and better building ventilation, which is associated with
lower incidence of respiratory and other health problems. The best passive
approaches for a given building will depend on its age, location, and use
and on the resources available to implement changes.
Warmer outdoor conditions and more frequent and severe weather
OCR for page 201
201
THERMAL STRESS
events will stimulate greater interest in using those techniques to mitigate
effects or adapt to changing conditions. Climate change may also affect the
economics of implementation as the price of energy increases and as the
human and social costs of inaction become untenable.
CONCLUSIONS
On the basis of its review of the papers, reports, and other information
presented in this chapter, the committee has reached the following conclu-
sions regarding the health effects of alterations in indoor environmental
quality due to thermal conditions:
• T
hermal stress has well-documented adverse health effects, and is
responsible for excess mortality among exposed persons.
• H
ealth, economic, and social factors make certain populations
particularly vulnerable to exposure to temperature extremes and
to the adverse consequences of such exposure, and may limit their
ability to mitigate or seek shelter from health-threatening condi-
tions. The elderly, those in poor health, and the poor are especially
at risk. Those populations experience temperature extremes almost
exclusively in indoor environments.
• A
ir conditioning provides protection from the heat, and some types
also offer protection from high concentrations of outdoor pollut-
ants. However air conditioning is associated with higher reported
prevalences of some ailments, perhaps because of contaminants in
HVAC systems. No general conclusion can thus be drawn about
the effect of air conditioning on adverse biologic or chemical ex-
posures indoors.
• L
ittle research has addressed the effects of climate change on build-
ing energy use and occupant health. Available information indi-
cates that changing conditions may have the following effects:
o Buildings that are currently ventilated naturally will need to use
some form of air conditioning.
o Buildings that have air conditioning will need to use it more
often, reducing natural ventilation.
o People in buildings that do not have air conditioning will be
exposed to extreme heat conditions more often.
• M
any buildings in warm zones of the United States already have air
conditioning. However, there is concern that peak energy demands
during extreme heat events and an increased frequency of extreme
weather events may result in more frequent power outages that ex-
pose large numbers of persons to potentially dangerous conditions
indoors.
OCR for page 202
202 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
• T
emperate indoor conditions (70–72°F or 21–22°C) are associated
with higher office and school productivity than colder or warmer
environments.
• S
everal technologies and building-design and -siting approaches
can provide control of the indoor environment with lower energy
costs and greater health benefits than systems typically in use today.
No approach will work in all circumstances; the best strategies will
depend on building use and on local and occupant circumstances.
• N
o matter which approach is used to maintain safe indoor envi-
ronmental conditions, it is important to ensure that the conditions
are sustained when failures in building systems or power outages
disable mechanical ventilation—something that may happen more
often if climate change leads to more instances of extreme weather
conditions or unsustainable loads on the electric grid due to ex-
treme outdoor temperatures
REFERENCES
Akbari H, Pomerantz M, Taha H. 2001. Cool surfaces and shade trees to reduce energy use
and improve air quality in urban areas. Solar Energy 70(3): 295-310.
Akbari H. 2002. Shade trees reduce building energy use and CO2 emissions from power
plants. Environmental Pollution 116(1S):S119-S126.
Aldous MB, Holberg CJ, Wright AL, Martinez FD, Taussig LM, Group Health Medical As-
sociates. 1996. Evaporative cooling and other home factors and lower respiratory tract
illness during the first year of life. American Journal of Epidemiology 143(5):423-430.
Analitis A, Katsouyanni K, Biggeri A, Baccini M, Forsberg B, Bisanti L, Kirchmayer U,
Ballester F, Cadum E, Goodman PG, Hois A, Sunyer J, Tjittanen P, Michelozzi P. 2008.
Effects of cold weather on mortality: Results from 15 European cities within the PHEWE
project. American Journal of Epidemiology 168(12):1397-408.
Anderson BG, Bell ML. 2009. Weather-related mortality: How heat, cold, and heat waves
affect mortality in the United States. Epidemiology 20(2):205-213.
ASHRAE (American Society of Heating, Refrigerating and Air-Conditioning Engineers). 2004.
ANSI/ASHRA Standard 55-2004: Thermal environmental conditions for human occu-
pancy. Atlanta, GA: ASHRAE.
Axley JW. 2001. Application of natural ventilation for U.S. commercial buildings—Climate
suitability design strategies & methods modeling studies. Gaithersburg, MD: National
Institute of Standards and Technology.
Barnett AG, Dobson AJ, McElduff P, Salomaa V, Kuulasmaa K, Sans S. 2005. Cold periods
and coronary events: An analysis of populations worldwide. Journal of Epidemiology &
Community Health 59(7):551-557.
Barnett AG. 2007. Temperature and cardiovascular deaths in the US elderly: Changes over
time. Epidemiology 18(3):369-372.
Basu R, Samet JM. 2002. Relation between elevated ambient temperature and mortality: A
review of the epidemiologic evidence. Epidemiologic Reviews 24(2):190-202.
Basu R, Ostro BD. 2008. A multicounty analysis identifying the populations vulnerable to
mortality associated with high ambient temperature in California. American Journal of
Epidemiology 168(6):632-637.
OCR for page 203
203
THERMAL STRESS
Bell ML, Dominici F. 2008. Effect modification by community characteristics on the short-
term effects of ozone exposure and mortality in 98 US communities. American Journal
of Epidemiology 167(8):986-997.
Bell ML, Ebisu K, Peng RD, Dominici F. 2009. Adverse health effects of particulate air pollu-
tion modification by air conditioning. Epidemiology 20(5):682-686.
Brown, RE, Koomey JG. 2003. Electricity use in California: Past trends and present usage
patterns. Energy Policy 31(9):849-864.
Carberry PA, Shepherd AM, Johnson JM. 1992. Resting and maximal forearm skin of blood
flow are reduced in hypertension. Hypertension 20:349-355.
Carmichael J, Shankel SW. 1985. Effects of non-steroidal anti-inflammatory drugs on pros-
taglandins and renal function. The American Journal of Medicine (6 Pt 1):992-1000.
CDC (Centers for Disease Control and Prevention). 2010. Heart disease. http://www.cdc.gov/
nchs/fastats/heart.htm (accessed January 6, 2011).
Changnon SA, Kunkel KE, Reinke BC. 1996. Impacts and responses to the 1995 heat wave: A
call to action. Bulletin of the American Meteorological Society 77:1497-1506.
Costelloe B, Finn D. 2003. Indirect evaporative cooling potential in air–water systems in
temperate climates. Energy and Buildings 35(6):573-591.
Curriero FC, Heiner KS, Samet JS, Zeger S, Patz JA. 2002. Temperature and mortality in
eleven cities of the eastern United States. American Journal of Epidemiology 155:80-87.
Danet S, Richard F, Montaye M, Beauchant S, Lemaire B, Grauz C, Cottel D, Marécaux N,
Amouyel P. 1999. Unhealthy effects of atmospheric temperature and pressure on the
occurrence of myocardial infarction and coronary deaths. A 10-year survey: The Lille-
World Health Organization MONICA project (Monitoring trends and determinants in
cardiovascular disease). Circulation 100(1):E1-E7.
Darkwa J, Kokogiannakis G, Magadzire CL, Yuan K. 2011. Theoretical and practical evalua-
tion of an earth-tube (E-tube) ventilation system. Energy and Buildings 43(2-3):728-736.
de Dear R, Brager GS. 1998. Developing an adaptive model of thermal comfort and prefer-
ence. ASHRAE Transactions 104(1):145-167.
Dematte JE, O’Mara K, Buescher J, Whitmey CG, Forsythe S, McNamee T, Adiga RB,
Ndukwu IM. 1998. Near-fatal heat stroke during the 1995 heat wave in Chicago. Annals
of Internal Medicine 129(3):173-181.
Doan L. 2007. Administration’s response to climate change and energy independence. State-
ment of Lurita Doan, Administrator, U.S. General Services Administration, Before the
Committee on Transportation and Infrastructure, U.S. House of Representatives, May
11, 2007. http://www.gsa.gov/portal/content/102626 (accessed February 24, 2011).
DOE (Department of Energy). 2000. Trends in residential air-conditioning usage from 1978
to 1997. http://www.eia.doe.gov/emeu/consumptionbriefs/recs/actrends/recs_ac_trends.
html (accessed February 8, 2011).
DOE. 2008. 2005 Residential energy consumption survey Table HC2.7 Air conditioning usage
indicators by type of housing unit, 2005. http://www.eia.doe.gov/emeu/recs/recs2005/
hc2005_tables/hc7airconditioningindicators/excel/tablehc2.7.xls (accessed February 8,
2011).
Donaldson G, Robinson D, Allaway S. 1997. An analysis of arterial disease mortality and
BUPA health screening data in men, in relation to outdoor temperature. Clinical Science
92:261-268.
Donaldson GC, Keatinge WR. 1997. Early increases in ischaemic heart disease mortality dis-
sociated from and later changes associated with respiratory mortality after cold weather
in south east England. Journal of Epidemiology & Community Health 51(6):643-648.
ED (Department of Education). 2007. Public school principals report on their school facilities:
Fall 2005 statistical analysis report. National Center for Education Statistics. http://nces.
ed.gov/pubs2007/2007007.pdf (accessed February 9, 2011).
OCR for page 204
204 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
Eggers FJ, Thackeray A. 2007. 32 Years of housing data. Report prepared for US Depart-
ment of Housing and Urban Development, Office of Policy Development and Research.
Bethesda, MD: Econometrica, Inc.
EIA (US Energy Information Administration) 2007. Commercial buildings energy consump-
tion survey. Washington, DC: EIA.
EIA. 2010a. Air conditioning characteristics by climate-zone, 2005. http://www.eia.gov/
emeu/recs/recs2005/hc2005_tables/hc6airconditioningchar/pdf/tablehc9.6.pdf (accessed
July 18, 2011).
EIA. 2010b. Air conditioning characteristics by type of housing unit, 2005. http://www.
eia.gov/emeu/recs/recs2005/hc2005_tables/hc6airconditioningchar/pdf/alltables.pdf (ac -
cessed July 18, 2011).
Eicker U, Vorschultze C. 2009. Potential of geothermal heat exchangers for office building
climatisation. Renewable Energy 34:1126-1133.
EPA (US Environmental Protection Agency). 2009a. Heat island effect: Glossary. http://www.
epa.gov/hiri/resources/glossary.htm (accessed February 24, 2011).
EPA. 2009b. Indoor air quality tools for schools reference guide. Washington, DC: EPA.
Fealy RD, Low PA, Thomas JE. 1989. Thermoregulatory sweating abnormalities in diabetes
mellitus. Mayo Clinic Proceedings 64:617-628.
Fisk WJ, Seppänen OA. 2007. Providing better indoor environmental quality brings economic
benefits. Published in Proceedings of Climate 2007. Well Being Indoors, June 10–14,
2007, Helsinki. Paper A01. http://eetd.lbl.gov/ied/sfrb/pdfs/performance-1.pdf (accessed
February 9, 2011).
Fisk WJ. 2009. Climate change, energy efficiency, and IEQ: Challenges and opportunities for
ASHRAE. Berkeley, CA: Lawrence Berkeley National Laboratory.
Fouillet A, Rey G, Laurent F, Pavillon G, Bellec S, Guihenneue-Jouyaux C, Clavel J, Jougla
E, Hémon D. 2006. Excess mortality related to the August 2003 heat wave in France.
International Archives of Occupational and Environmental Health 80:16-24.
Fryar CD, Hirsch R, Eberhardt MS, Yoon SS, Wright JD. 2010. Hypertension, high serum
total cholesterol, and diabetes: Racial and ethnic prevalence differences in U.S. adults,
1999-2006. NCHS Data Brief (36):1-8.
GSA (US General Services Administration). 2010. Facilities standards for the public service
buildings P100. Washington, DC: GSA.
Hajat S, Kovats RS, Lachowycz K. 2007. Heat-related and cold-related deaths in England
and Wales: Who is at risk? Occupational and Environmental Medicine 64(2):93-100.
Hoffmann B, Hertel S, Boes T, Weiland D, Jockel, KH. 2008. Increased cause-specific mortality
associated with 2003 heat wave in Essen, Germany. Journal of Toxicology and Environ-
mental Health A 71:759-765.
Hummelgaard J, Juhl P, Sæbjörnsson KO, Clausen G, Toftum J, Langkilde G. 2007. Indoor
air quality and occupant satisfaction in five mechanically and four naturally ventilated
open-plan office buildings. Building and Environment 42(12):4051-4058.
Huynen MM, Martens P, Schram D, Weijenberg MP, Kunst AE. 2001. The impact of heat
waves and cold spells on mortality rates in the Dutch population. Environmental Health
Perspectives 109(5):463-470.
IPCC (International Panel on Climate Change). 2007. Chapter 9. Understanding and attribut-
ing climate change. In Climate change 2007—The physical science basis. Contribution
of Working Group I to the Fourth Assessment Report of the Intergovernmental Panel
on Climate Change, edited by Solomon S, Qin D, Manning M, Chen Z, Marquis M,
Averyt KB, Tignor M, Miller HL. Cambridge, United Kingdom and New York, NY, USA:
Cambridge University Press. http://www.ipcc.ch/pdf/assessment-report/ar4/wg1/ar4-wg1-
chapter9.pdf (accessed February 9, 2011).
OCR for page 205
205
THERMAL STRESS
Kenney WL, Munce TA. 2003. Invited review: Aging and human temperature regulation.
Journal of Applied Physiology 95(6):2598-2603.
Kenny GP, Yardley J, Brown C, Sigal R, Jay O. 2010. Heat stress in older individuals and
patients with common chronic diseases. CMAJ: Canadian Medical Association Journal
182(10):1053-1060.
Khalaj B, Lloyd G, Sheppeard V, Dear K. 2010. The health impacts of heat waves in five
regions of New South Wales, Australia: A case-only analysis. International Archives of
Occupational and Environmental Health 83(7):833-842.
Kilbourne EM, Choi K, Jones S, Thacker SB. 1982. Risk factors for heatstroke. A case-control
study. Journal of the American Medical Association 247(24):3332-3336.
Klinenberg E. 2002. Heat wave: A social autopsy of disaster in Chicago (Illinois). Chicago:
The University of Chicago Press.
Kloner RA, Poole WK, Perritt RL. 1999. When throughout the year is coronary death most
likely to occur? A 12-year population-based analysis of more than 220 000 cases. Cir-
culation 100(15):1630-1634.
Knowlton K, Rotkin-Ellman M, King G, Margolis HG, Smith D, Solomon G, Trent R, English
P. 2009. The 2006 California heat wave: Impacts on hospitalizations and emergency
department visits. Environmental Health Perspectives 117(1):61-67.
Kovats RS, Hajat S. 2008. Heat stress and public health: A critical review. Annual Review of
Public Health 29:41-55.
Lan L, Wargocki P, Lain Z. 2010. Quantitative measurement of productivity loss due to ther-
mal discomfort. Energy and Buildings 43(5):1057-1062.
Lopez R., Goldoftas, B. 2009. The urban elderly in the United States: Health status and the
environment. Reviews on Environmental Health 24:47-57.
Luber G, McGeehin M. 2009. Climate change and extreme heat events. American Journal of
Preventative Medicine 35(5):429-435.
Martinez BF, Annest JL, Kilbourne EM, Kirk ML, Lui K-J, Smith ZM. 1989. Geographic
distribution of heat-related deaths among elderly persons. Use of county-level dot maps
for injury surveillance and epidemiologic research. Journal of the American Medical As-
sociation 262(16):2246-2250.
McGeehin MA, Mirabelli M. 2001. The potential impacts of climate variability and change on
temperature-related morbidity and mortality in the United States. Environmental Health
Perspectives 109(2):185-189.
Medina-Ramón M, Schwartz J. 2007. Temperature, temperature extremes, and mortality: A
study of acclimatization and effect modification in 50 United States cities. Occupational
& Environmental Medicine 67:827-833.
Mendell MJ, Lei-Gomez Q, Mirer AG, Seppänen O, Brunner G. 2008. Risk factors in heating,
ventilating, and AC systems for occupant symptoms. Indoor Air 18:301-316.
Metzger KB, Ito K, Matte TD. 2010. Summer heat and mortality in New York City: How hot
is too hot? Environmental Health Perspectives 118(1):80-86. Comment in 118(1):A35.
MMWR (Morbidity and Mortality Weekly Report). 1998. Community needs assessment
and morbidity surveillance following an ice storm—Maine, January 1998. MMWR
47:351-354.
Morello-Frosch R, Jesdale B. 2008. Unpublished impervious surface and tree cover data. Data
for this analysis were derived from: US Geological Survey’s National Land Cover Data-
set 2001. http://www.mrlc.gov/nlcd.php (accessed June 20, 2007); and ESRI’s ArcMap
census boundary files http://www.census.gov/geo/www/cob/bdy_files.html (accessed
June 6, 2008).
Mudarri D. 2010. Public health consequences and cost of climate change impacts on indoor
environments. Washington, DC: US Environmental Protection Agency.
OCR for page 206
206 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
Naughton MP, Henderson A, Mirabelli MC, Kaiser R, Wilhelm JL, Kieszak SM, et al. 2002.
Heat-related mortality during a 1999 heat wave in Chicago. American Journal of Pre-
ventative Medicine 22(4):221-227.
Nicol JF, Humphreys MA. 2002. Adaptive thermal comfort and sustainable thermal standards
for buildings. Energy and Buildings 34(6):563-572.
Nowak D, Crane D, Stevens J. 2006. Air pollution removal by urban trees and shrubs in the
United States. Urban Forestry and Urban Greening 4:115-123.
NRC (National Research Council). 2010. America’s climate choices: Advancing the science of
climate change. Washington, DC: The National Academies Press.
NWS (National Weather Service). 2010. NOAA’s National Weather Service heat index. http://
www.nws.noaa.gov/om/heat/heatindex.shtml (accessed January 25, 2011).
Oberndorfer E, Lundholm J, Bass B, Coffman RR, Doshi H, Dunnett N, Gaffin S, Kohler M,
Liu KKY, Rowe B. 2007. Green roofs as urban ecosystems: Ecological structures, func-
tions, and services. BioScience 57(10):823-833.
O’Neill MS, Zanobetti A, Schwartz J. 2003. Modifiers of the temperature and mortality as-
sociation in seven US cities. American Journal of Epidemiology 157:1074-1082.
Patz JA, McGeehin MA, Bernard SM, Ebi KL, Epstein PR, Grambsch A, Gubler DJ, Reiter P,
Romieu I, Rose JB, Samet JM, Trtanj J. 2000. The potential health impacts of climate
variability and change for the United States: Executive summary of the report of the
Health Sector of the U.S. National Assessment. Environmental Health Perspectives
108(4):367-376.
Pearlman RA, Uhlmann RF. 1988. Quality of life in chronic diseases: Perceptions of elderly
patients. Journal of Gerontology 43(2):M25-M30.
Petrofsky JS, Lee S, Patterson C, Cole M, Stewart B. 2005. Sweat production during global
heating and during isometric exercise in people with diabetes. Medical Science Monitor
11:CR515-CR521.
Phelan, JC, Link BG, Diez-Roux A, Kawachi I, Levin B. 2004. Fundamental causes of social
inequalities in mortality: A test of the theory. Journal of Health and Social Behavior
45(3):265-285.
Press V. 2003. Fuel poverty and health. London, UK: National Heart Forum.
Preziosi P, Czernichow S, Gehanno P, Hercberg S. 2004. Workplace air-conditioning and health
services attendance among French middle-aged women: A prospective cohort study. In-
ternational Journal of Epidemiology 33:1120-1123.
Reid CE, O’Neill MS, Gronlund CJ, Brines SJ, Brown DG, Diez-Roux AV, Schwartz J. 2009.
Mapping community determinants of heat vulnerability. Environmental Health Perspec-
tives 177(11):1730-1736.
Reinhart C, Holmes S, Park C. 2010. Climate change & (solar) architecture. Presentation
before the Committee on the Effect of Climate Change on Indoor Air Quality and Public
Health on June 7, 2010.
Ruddell DM, Harlan SL, Grossman-Clarke S, Buyantuyev A. 2010. Risk and exposure to
extreme heat in microclimates of Phoenix, AZ. In Geospatial contributions to urban
hazard and disaster analysis, edited by Showalter PS, Lu Y. London, NY: Springer Dor-
drecht Heidelberg.
Russell M, Sherman M, Rudd A. 2005. Review of residential ventilation technologies. Berkeley,
CA: Ernest Orlando Lawrence Berkeley National Laboratory.
Sahakian N, Park J, Cox-Ganser J. 2009. Respiratory morbidity and medical visits associated
with dampness and air-conditioning in offices and homes. Indoor Air 19(1):58-67.
Santamouris M, Pavloua K, Synnefaa A, Niachoua K, Kolokotsab D. 2007 Recent progress on
passive cooling techniques—Advanced technological developments to improve survivabil-
ity levels in low-income households. Energy and Buildings 39(Special Issue S1):859-866.
OCR for page 207
207
THERMAL STRESS
Schiavon S. 2009. Energy saving with personalized ventilation and cooling fan. Doctoral dis-
sertation, Padua: University of Padua Department of Applied Physics.
Schuman SH. 1967. Patterns of urban heat wave deaths and implications for prevention:
Data from New York and St Louis during July, 1966. Environmental Research 5:59-75.
Scott MJ, Huang YJ. 2007. Effects of climate change on energy use in the United States. In
Effects of climate change on energy production and use in the United States, edited by
Wilbanks TJ, Bhatt V, Bilello DE, Bull SR, Ekmann J, Horak WC, Huang YJ, Levine MD,
Sale MJ, Schmalzer DK, Scott MJ. Synthesis and Assessment Product 4.5. U.S. Climate
Change Science Program, Washington, DC, pp. 8-44.
Semenza J. 1999. Excess hospital admissions during the July 1995 heat wave in Chicago.
American Journal of Preventative Medicine 16(4):269-277.
Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL. 1996.
Heat-related deaths during the July 1995 heat wave in Chicago. New England Journal
of Medicine 335(2):84-90.
Shonkoff SB, Morello-Frosch R, Pastor M, Sadd J. 2009. Draft Paper: Environmental health
and equity impacts from climate change and mitigation policies in California: A review
of the literature. California Climate Change Center.
Stansberry KB, Hill MA, Shapiro SA, McNitt PM, Bhatt BA, Vinik AI. 1997. Impairment of
peripheral blood flow responses in diabetes resembles an enhanced aging effect. Diabetes
Care 20:1711-1716.
Steadman RG. 1979. The assessment of sultriness. Part I: A temperature-humidity index based
on human physiology and clothing science. Journal of Applied Meteorology 18:861-873.
Synnefa A, Santamouris M, Akbari H. 2007. Estimating the effect of using cool coatings on
energy loads and thermal comfort in residential buildings in various climatic conditions.
Energy and Buildings 39(11):1167-1174.
Tan J, Zheng Y, Song G, Kalkstein LS, Kalkstein AJ, Tang X. 2007. Heat wave impacts
on mortality in Shanghai, 1998 and 2003. International Journal of Biometeorology
51(3):193-200.
USCB (US Census Bureau). 2004. Housing vacancies and home ownership (CPS/HVS). http://
www.census.gov/hhes/www/housing/hvs/annual97/ann97def.html (accessed February 24,
2011).
USCB. 2009. American Housing Survey (AHS). http://www.census.gov/hhes/www/housing/
ahs/ahs09/ahs09.html (accessed February 24, 2011).
USGCRP (US Global Change Research Program). 2009. Global climate change impacts in the
United States. New York: Cambridge University Press.
Vandentorren S, Bretin P, Zeghnoun A, Mandereau-Bruno L, Croisier A, Cochet C, Ribéron
J, Siberan I, Declercq B, Ledrans M. 2006. August 2003 heat wave in France: Risk
factors for death of elderly people living at home. European Journal of Public Health
16:583-591.
Verdú E, Ceballos D, Vilches JJ, Navarro X. 2000. Influence of aging on peripheral nerve func-
tion and regeneration. Journal of the Peripheral Nervous System 5(4):191-208.
WHO (World Health Organization). 2009. Natural ventilation for infection control in health-
care settings. Geneva: WHO Press.
Wilson A. 2005. Passive survivability. Environmental Building News. December 1. http://
www.buildinggreen.com/auth/article.cfm/2005/12/1/Passive-Survivability/ (accessed Feb-
ruary 23, 2011).
Wilson A. 2006. Passive survivability: A new design criterion for buildings. Environmental
Building News. May 1. http://www.buildinggreen.com/auth/article.cfm/2006/5/3/Passive-
Survivability-A-New-Design-Criterion-for-Buildings/ (accessed February 23, 2011).
OCR for page 208
208 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH
Woodhouse PR, Khaw KT, Plummer M, Foley A, Meade TW. 1994. Seasonal variations of
plasma fibrinogen and factor VII activity in the elderly: Winter infections and death from
cardiovascular disease. Lancet 343(8895):435-439.
Yang J, Yu Q, Gong P. 2008. Quantifying air pollution removal by green roofs in Chicago.
Atmospheric Environment 42(31):7266-7273.
Zmeureanu R, Wu X. 2007. Energy and exergy performance of residential heating systems
with separate mechanical ventilation. Energy 32:187-195.
