PURE-Climate: Identifying and Adapting to Climate Change as a Modifiable Risk Factor for Human Health - ABSTRACT
Climate change is the largest global health challenge of the 21st century. Although direct and indirect effects of
climate change threaten health worldwide, the impacts will be particularly severe in low and middle-income
countries (LMICs). There is an alarming absence of research on climate-driven exposures and human health in
LMICs, and how to adapt and build resilience to these climate hazards. We will address these research gaps
by leveraging the infrastructure and ongoing data collection in the Prospective Urban and Rural Epidemiology
(PURE) study, a prospective cohort of 200,000 adults across 998 urban/rural communities in 27 low, middle,
and high-income countries. We will leverage this existing data and infrastructure to establish PURE-Climate, a
global study of climate change and human health. Aim 1 will determine the direct impacts of acute climate-
driven exposures (e.g. extreme temperatures, floods, storms) on diverse health outcomes (e.g.
hospitalizations, CVD incidence, mortality) and determine vulnerability and resilience factors. We will quantify
associations between acute climate-driven hazards and diverse health outcomes using a case-crossover
design and over a decade of prospective data collected for PURE individuals. Acute hazards will be assessed
using state-of-the-art geospatial methods for each PURE community. Aim 2 will evaluate the indirect impacts of
chronic climate-driven exposures on mortality and NCDs, determine pathways of influence, and assess
vulnerability and resilience factors. We will apply long-term meteorological data and global climate re-analysis
datasets to examine the indirect impacts of climate exposures on mortality and NCD incidence using
prospective data collected in PURE. To further understand indirect pathways, adaptation, and vulnerably and
resilience factors we will implement a climate-health survey to individuals living in PURE communities
experiencing diverse climate-driven changes. Aim 3 will identify community-level opportunities and barriers for
increasing climate resilience by conducting focus groups with 12 PURE communities and develop a Building
Resilience Against Climate-Disaster Effects (BRADE) framework for low-resource settings. The PURE-Climate
grant will provide quantitative and qualitative information on how climate change influences human health,
especially in LMICs, and demonstrate how these impacts can be reduced through adaptation and local climate
resilience. Finally, the PURE-Climate study will build capacity for future climate change and health research
within LMICs.
