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  1. Abstract

    Manual outdoor work is essential in many agricultural systems. Climate change will make such work more stressful in many regions due to heat exposure. The physical work capacity metric (PWC) is a physiologically based approach that estimates an individual's work capacity relative to an environment without any heat stress. We computed PWC under recent past and potential future climate conditions. Daily values were computed from five earth system models for three emission scenarios (SSP1‐2.6, SSP3‐7.0, and SSP5‐8.5) and three time periods: 1991–2010 (recent past), 2041–2060 (mid‐century) and 2081–2100 (end‐century). Average daily PWC values were aggregated for the entire year, the growing season, and the warmest 90‐day period of the year. Under recent past climate conditions, the growing season PWC was below 0.86 (86% of full work capacity) on half the current global cropland. With end‐century/SSP5‐8.5 thermal conditions this value was reduced to 0.7, with most affected crop‐growing regions in Southeast and South Asia, West and Central Africa, and northern South America. Average growing season PWC could falls below 0.4 in some important food production regions such as the Indo‐Gangetic plains in Pakistan and India. End‐century PWC reductions were substantially greater than mid‐century reductions. This paper assesses two potential adaptions—reducing direct solar radiation impacts with shade or working at night and reducing the need for hard physical labor with increased mechanization. Removing the effect of direct solar radiation impacts improved PWC values by 0.05 to 0.10 in the hottest periods and regions. Adding mechanization to increase horsepower (HP) per hectare to levels similar to those in some higher income countries would require a 22% increase in global HP availability with Sub‐Saharan Africa needing the most. There may be scope for shifting to less labor‐intensive crops or those with labor peaks in cooler periods or shift work to early morning.

     
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  2. Abstract

    Most studies projecting human survivability limits to extreme heat with climate change use a 35 °C wet-bulb temperature (Tw) threshold without integrating variations in human physiology. This study applies physiological and biophysical principles for young and older adults, in sun or shade, to improve current estimates of survivability and introduce liveability (maximum safe, sustained activity) under current and future climates. Our physiology-based survival limits show a vast underestimation of risks by the 35 °C Twmodel in hot-dry conditions. Updated survivability limits correspond to Tw~25.8–34.1 °C (young) and ~21.9–33.7 °C (old)—0.9–13.1 °C lower than Tw = 35 °C. For older female adults, estimates are ~7.2–13.1 °C lower than 35 °C in dry conditions. Liveability declines with sun exposure and humidity, yet most dramatically with age (2.5–3.0 METs lower for older adults). Reductions in safe activity for younger and older adults between the present and future indicate a stronger impact from aging than warming.

     
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  3. Heat is a dangerous hazard that causes acute heat illness, chronic disease exacerbations, adverse pregnancy outcomes, and a range of injuries. Risks are highest during extreme heat events (EHEs), which challenge the capacity of health systems and other critical infrastructure. EHEs are becoming more frequent and severe, and climate change is driving an increasing proportion of heat-related mortality, necessitating more investment in health protection. Climate-resilient health systems are better positioned for EHEs, and EHE preparedness is a form of disaster risk reduction. Preparedness activities commonly take the form of heat action plans (HAPs), with many examples at various administrative scales. HAP activities can be divided into primary prevention, most important in the pre-event phase; secondary prevention, key to risk reduction early in an EHE;and tertiary prevention, important later in the event phase. After-action reports and other postevent evaluation activities are central to adaptive management of this climate-sensitive hazard.

     
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  4. The health of the planet and its people are at risk. The deterioration of the global commons—ie, the natural systems that support life on Earth—is exacerbating energy, food, and water insecurity, and increasing the risk of disease, disaster, displacement, and conflict. In this Commission, we quantify safe and just Earth-system boundaries (ESBs) and assess minimum access to natural resources required for human dignity and to enable escape from poverty. Collectively, these describe a safe and just corridor that is essential to ensuring sustainable and resilient human and planetary health and thriving in the Anthropocene. We then discuss the need for translation of ESBs across scales to inform science-based targets for action by key actors (and the challenges in doing so), and conclude by identifying the system transformations necessary to bring about a safe and just future. Our concept of the safe and just corridor advances research on planetary boundaries and the justice and Earth-system aspects of the Sustainable Development Goals. We define safe as ensuring the biophysical stability of the Earth system, and our justice principles include minimising harm, meeting minimum access needs, and redistributing resources and responsibilities to enhance human health and wellbeing. The ceiling of the safe and just corridor is defined by the more stringent of the safe and just ESBs to minimise significant harm and ensure Earth-system stability. The base of the corridor is defined by the impacts of minimum global access to food, water, energy, and infrastructure for the global population, in the domains of the variables for which we defined the ESBs. Living within the corridor is necessary, because exceeding the ESBs and not meeting basic needs threatens human health and life on Earth. However, simply staying within the corridor does not guarantee justice because within the corridor resources can also be inequitably distributed, aggravating human health and causing environmental damage. Procedural and substantive justice are necessary to ensure that the space within the corridor is justly shared. We define eight safe and just ESBs for five domains—the biosphere (functional integrity and natural ecosystem area), climate, nutrient cycles (phosphorus and nitrogen), freshwater (surface and groundwater), and aerosols—to reduce the risk of degrading biophysical life-support systems and avoid tipping points. Seven of the ESBs have already been transgressed: functional integrity, natural ecosystem area, climate, phosphorus, nitrogen, surface water, and groundwater. The eighth ESB, air pollution, has been transgressed at the local level in many parts of the world. Although safe boundaries would ensure Earth-system stability and thus safeguard the overall biophysical conditions that have enabled humans to flourish, they do not necessarily safeguard everyone against harm or allow for minimum access to resources for all. We use the concept of Earth-system justice—which seeks to ensure wellbeing and reduce harm within and across generations, nations, and communities, and between humans and other species, through procedural and distributive justice—to assess safe boundaries. Earth-system justice recognises unequal responsibility for, and unequal exposure and vulnerability to, Earth-system changes, and also recognises unequal capacities to respond and unequal access to resources. We also assess the extent to which safe ESBs could minimise irreversible, existential, and other major harms to human health and wellbeing through a review of who is affected at each boundary. Not all safe ESBs are just, in that they do not minimise all significant harm (eg, that associated with the climate change, aerosol, or nitrogen ESBs). Billions of people globally do not have sufficient access to energy, clean water, food, and other resources. For climate change, for example, tens of millions of people are harmed at lower levels of warming than that defined in the safe ESB, and thus to avoid significant harm would require a more stringent ESB. In other domains, the safe ESBs align with the just ESBs, although some need to be modified, or complemented with local standards, to prevent significant harm (eg, the aerosols ESB). We examine the implications of achieving the social SDGs in 2018 through an impact modelling exercise, and quantify the minimum access to resources required for basic human dignity (level 1) as well as the minimum resources required to enable escape from poverty (level 2). We conclude that without social transformation and redistribution of natural resource use (eg, from top consumers of natural resources to those who currently do not have minimum access to these resources), meeting minimum-access levels for people living below the minimum level would increase pressures on the Earth system and the risks of further transgressions of the ESBs. We also estimate resource-access needs for human populations in 2050 and the associated Earth-system impacts these could have. We project that the safe and just climate ESB will be overshot by 2050, even if everybody in the world lives with only the minimum required access to resources (no more, no less), unless there are transformations of, for example, the energy and food systems. Thus, a safe and just corridor will only be possible with radical societal transformations and technological changes. Living within the safe and just corridor requires operationalisation of ESBs by key actors across all levels, which can be achieved via cross-scale translation (whereby resources and responsibilities for impact reductions are equitably shared among actors). We focus on cities and businesses because of the magnitude of their impacts on the Earth system, and their potential to take swift action and act as agents of change. We explore possible approaches for translating each ESB to cities and businesses via the sequential steps of transcription, allocation, and adjustment. We highlight how different elements of Earth-system justice can be reflected in the allocation and adjustment steps by choosing appropriate sharing approaches, informed by the governance context and broader enabling conditions. Finally we discuss system transformations that could move humanity into a safe and just corridor and reduce risks of instability, injustice, and harm to human health. These transformations aim to minimise harm and ensure access to essential resources, while addressing the drivers of Earth-system change and vulnerability and the institutional and social barriers to systemic transformations, and include reducing and reallocating consumption, changing economic systems, technology, and governance. 
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    Free, publicly-accessible full text available October 1, 2025
  5. Abstract Children (<5 years) are highly vulnerable during hot weather due to their reduced ability to thermoregulate. There has been limited quantification of the burden of climate change on health in sub-Saharan Africa, in part due to a lack of evidence on the impacts of weather extremes on mortality and morbidity. Using a linear threshold model of the relationship between daily temperature and child mortality, we estimated the impact of climate change on annual heat-related child deaths for the current (1995–2020) and future time periods (2020–2050). By 2009, heat-related child mortality was double what it would have been without climate change; this outweighed reductions in heat mortality from improvements associated with development. We estimated future burdens of child mortality for three emission scenarios (SSP119, SSP245 and SSP585), and a single scenario of population growth. Under the high emission scenario (SSP585), including changes to population and mortality rates, heat-related child mortality is projected to double by 2049 compared to 2005–2014. If 2050 temperature increases were kept within the Paris target of 1.5 °C (SSP119 scenario), approximately 4000–6000 child deaths per year could be avoided in Africa. The estimates of future heat-related mortality include the assumption of the significant population growth projected for Africa, and declines in child mortality consistent with Global Burden of Disease estimates of health improvement. Our findings support the need for urgent mitigation and adaptation measures that are focussed on the health of children. 
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  6. Introduction: The incidence of diarrhea, a leading cause of morbidity and mortality in low-income countries such as Nepal, is temperature-sensitive, suggesting it could be associated with climate change. With climate change fueled increases in the mean and variability of temperature and precipitation, the incidence of water and food-borne diseases are increasing, particularly in sub-Saharan Africa and South Asia. This national-level ecological study was undertaken to provide evidence linking weather and climate with diarrhea incidence in Nepal. Method: We analyzed monthly diarrheal disease count and meteorological data from all districts, spanning 15 eco-development regions of Nepal. Meteorological data and monthly data on diarrheal disease were sourced, respectively, from the Department of Hydrology and Meteorology and Health Management Information System (HMIS) of the Government of Nepal for the period from 2002 to 2014. Time-series log-linear regression models assessed the relationship between maximum temperature, minimum temperature, rainfall, relative humidity, and diarrhea burden. Predictors with p-values < 0.25 were retained in the fitted models. Results: Overall, diarrheal disease incidence in Nepal significantly increased with 1 °C increase in mean temperature (4.4%; 95% CI: 3.95, 4.85) and 1 cm increase in rainfall (0.28%; 95% CI: 0.15, 0.41). Seasonal variation of diarrheal incidence was prominent at the national level (11.63% rise in diarrheal cases in summer (95% CI: 4.17, 19.61) and 14.5% decrease in spring (95% CI: −18.81, −10.02) compared to winter season). Moreover, the effects of temperature and rainfall were highest in the mountain region compared to other ecological regions of Nepal. Conclusion: Our study provides empirical evidence linking weather factors and diarrheal disease burden in Nepal. This evidence suggests that additional climate change could increase diarrheal disease incidence across the nation. Mountainous regions are more sensitive to climate variability and consequently the burden of diarrheal diseases. These findings can be utilized to allocate necessary resources and envision a weather-based early warning system for the prevention and control of diarrheal diseases in Nepal. 
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  7. Abstract

    Exposure to high ambient temperatures is an important cause of avoidable, premature death that may become more prevalent under climate change. Though extensive epidemiological data are available in the United States, they are largely limited to select large cities, and hence, most projections estimate the potential impact of future warming on a subset of the U.S. population. Here we utilize evaluations of the relative risk of premature death associated with temperature in 10 U.S. cities spanning a wide range of climate conditions to develop a generalized risk function. We first evaluate the performance of this generalized function, which introduces substantial biases at the individual city level but performs well at the large scale. We then apply this function to estimate the impacts of projected climate change on heat‐related nationwide U.S. deaths under a range of scenarios. During the current decade, there are 12,000 (95% confidence interval 7,400–16,500) premature deaths annually in the contiguous United States, much larger than most estimates based on totals for select individual cities. These values increase by 97,000 (60,000–134,000) under the high‐warming Representative Concentration Pathway (RCP) 8.5 scenario and by 36,000 (22,000–50,000) under the moderate RCP4.5 scenario by 2100, whereas they roughly double under the aggressive mitigation scenario RCP2.6. These results include estimates of adaptation that reduce impacts by ~40–45% as well as population increases that roughly offset adaptation. The results suggest that the degree of climate change mitigation will have important health impacts on Americans.

     
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