2. How Are These Systems Unique?  A custom-made system is developed for each urban area, based on specific meteorology for each locale, as well as urban structure and demographics  These systems are based on actual weather-health relationships, as determined by daily variations in human mortality  These systems are based on much more than just temperature and humidity

3. World Meteorological Organization Showcase Projects Center for Climatic Research, University of Delaware Participating Cities: - Dayton/Cincinnati, USA - New Orleans, USA - Philadelphia, USA - Phoenix, USA - Rome, Italy - Shanghai, China - Toronto, Canada - Washington, USA - Five additional cities, Southern USA - Chicago/St. Louis, New for 2003

4. Maximum Temperature vs. Daily Mortality: New York and Jacksonville, Florida New YorkJacksonville

5. Maximum Temperature Health Thresholds Boston 30ºC Atlanta 32ºC Dallas40ºC Denver34ºC Phoenix44º C

6. Cook County, Illinois: July ‘95

7. Steps in System Development  Step 1: Determine air masses daily over a city using newly-developed Spatial Synoptic Classification (SSC)  Step 2: Are any of these air masses ‘offensive’?  Step 3: What aspects of the offensive air mass make it most detrimental to human health?

8. SSC Air Mass Types DPDry Polar (cP) DMDry Moderate (Pacific) DTDry Tropical (cT) MPMoist Polar (mP) MMMoist Moderate (Overrunning) MT Moist Tropical (mT) MT+Moist Tropical Plus TRTransition between air masses ---------------- Sheridan, S.C., 2002: The redevelopment of a weather-type classification scheme for North America. Int’. J. Climatology. Kalkstein et al., 1996, A New Spatial Synoptic Classification: Application to Air Mass Analysis. Int. J. Climatology.

9. Characteristics of Pittsburgh Air Mass Types

10. Removing Non-Climatological Noise from the Mortality Data

11. Phoenix’s Rising Mortality

12. Mean Deaths in Rome by Day standardization is important

13. Results: Offensive Air Mass Types Moist Tropical Plus (MT+): –Very warm, humid –High overnight temperatures Dry Tropical (DT): –Hot, dry –High solar load Dry Tropical Plus (DT+; Phoenix only): –Extremely hot, dry –High solar load

14. Mean Mortality Increases Location (Freq)DT (DT+)MT+ Cincinnati (8%)+4.4 (15%)+1.8 (6%) New Orleans (2%)None+3.7 (9%) Phoenix (1%)+2.7 (7%)None Rome (11%)+6.2 (14%)+5.0 (12%) Shanghai (12%)None+42.4 (16%) Toronto (7%)+4.2 (11%)+4.0 (10%)

15. Mean Anomalous Mortality by Weather Type, Rome

16. Mean Anomalous Mortality by Weather Type, Shanghai

17. Likelihood of Excess Mortality Toronto

18. Development of Forecast Algorithms: Within-Air Mass Category Mortality Variations

19. ROME MT+ mortality decreases through summer

20. ROME DT mortality vs. morning temperature

22. In Toronto, When a DT or MT+ Air Mass is Forecast, Three Levels of Advisory are Possible:

27. Year-to-Year Variability: Toronto

29. Summary of Watches/Warnings Under NWS System and Air Mass System, Summer 2001 New Orleans, Louisiana

30. Toronto: 2001 Results Alerts June 29 th (DT 71%) July 23 rd (MT+ 88%) July 24 th (MT+ 84%) Aug 5 th (DT 65%) Emergencies June 15 th (MT+ 96%) Aug 6 th (DT 91%) Aug 7 th (DT 93%) Aug 8 th (DT 97%) Aug 9 th (DT 99%) Four day run of heat emergencies Aug 6-9 would have only occurred two other times in the 46 years for which data was provided.

31. Steps That can be Taken When Alerts or Emergencies are Called 1.NWS alerts appropriate city agency (e.g., Department of Health, Office of Aging, etc.) 2.City develops (or already has in place) intervention plans 3.Effectiveness of system can be monitored in three manners, and improvements are implemented if there are shortcomings: --forecasting effectiveness (false positives or negatives) --accuracy in estimating health impacts of offensive weather --noting if we are saving lives.