title: Impact of climate change on the domestic indoor environment and associated health risks in the UK.
abstract: There is growing evidence that projected climate change has the potential to significantly affect public health. In the UK, much of this impact is likely to arise by amplifying existing risks related to heat exposure, flooding, and chemical and biological contamination in buildings. Identifying the health effects of climate change on the indoor environment, and risks and opportunities related to climate change adaptation and mitigation, can help protect public health. We explored a range of health risks in the domestic indoor environment related to climate change, as well as the potential health benefits and unintended harmful effects of climate change mitigation and adaptation policies in the UK housing sector. We reviewed relevant scientific literature, focusing on housing-related health effects in the UK likely to arise through either direct or indirect mechanisms of climate change or mitigation and adaptation measures in the built environment. We considered the following categories of effect: (i) indoor temperatures, (ii) indoor air quality, (iii) indoor allergens and infections, and (iv) flood damage and water contamination. Climate change may exacerbate health risks and inequalities across these categories and in a variety of ways, if adequate adaptation measures are not taken. Certain changes to the indoor environment can affect indoor air quality or promote the growth and propagation of pathogenic organisms. Measures aimed at reducing greenhouse gas emissions have the potential for ancillary public health benefits including reductions in health burdens related heat and cold, indoor exposure to air pollution derived from outdoor sources, and mould growth. However, increasing airtightness of dwellings in pursuit of energy efficiency could also have negative effects by increasing concentrations of pollutants (such as PM2.5, CO and radon) derived from indoor or ground sources, and biological contamination. These effects can largely be ameliorated by mechanical ventilation with heat recovery (MVHR) and air filtration, where such solution is feasible and when the system is properly installed, operated and maintained. Groups at high risk of these adverse health effects include the elderly (especially those living on their own), individuals with pre-existing illnesses, people living in overcrowded accommodation, and the socioeconomically deprived. A better understanding of how current and emerging building infrastructure design, construction, and materials may affect health in the context of climate change and mitigation and adaptation measures is needed in the UK and other high income countries. Long-term, energy efficient building design interventions, ensuring adequate ventilation, need to be promoted.
authors.affiliation: Environmental Change Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK; Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; Division of Environmental Health and Risk Management, School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Electronic address: sotiris.vardoulakis@phe.gov.uk.
authors.forename: Sotiris
authors.initials: S
authors.lastname: Vardoulakis
authors.affiliation: Environmental Change Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK. Electronic address: Sani.Dimitroulopoulou@phe.gov.uk.
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Dimitroulopoulou
authors.affiliation: Environmental Change Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK; Division of Environmental Health and Risk Management, School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Electronic address: John.Thornes@phe.gov.uk.
authors.forename: John
authors.initials: J
authors.lastname: Thornes
authors.affiliation: Department of Biology, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China. Electronic address: laikaman@hkbu.edu.hk.
authors.forename: Ka-Man
authors.initials: KM
authors.lastname: Lai
authors.affiliation: UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment Energy and Resources, University College London, 14 Upper Woburn Place, London WCIH ONN, UK. Electronic address: j.g.taylor@ucl.ac.uk.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Public Health England Toxicology Unit, Department of Medicine, Imperial College London, London W12 0NN, UK. Electronic address: Isabella.Myers@phe.gov.uk.
authors.forename: Isabella
authors.initials: I
authors.lastname: Myers
authors.affiliation: Environmental Change Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK; Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; Division of Environmental Health and Risk Management, School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Electronic address: Clare.Heaviside@phe.gov.uk.
authors.forename: Clare
authors.initials: C
authors.lastname: Heaviside
authors.affiliation: UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment Energy and Resources, University College London, 14 Upper Woburn Place, London WCIH ONN, UK. Electronic address: a.mavrogianni@ucl.ac.uk.
authors.forename: Anna
authors.initials: A
authors.lastname: Mavrogianni
authors.affiliation: UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment Energy and Resources, University College London, 14 Upper Woburn Place, London WCIH ONN, UK. Electronic address: clive.shrubsole.09@ucl.ac.uk.
authors.forename: Clive
authors.initials: C
authors.lastname: Shrubsole
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. Electronic address: zaid.chalabi@lshtm.ac.uk.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Chalabi
authors.affiliation: UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment Energy and Resources, University College London, 14 Upper Woburn Place, London WCIH ONN, UK. Electronic address: michael.davies@ucl.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Davies
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. Electronic address: Paul.Wilkinson@lshtm.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Wilkinson
mesh_terms: D000368:Aged; D016902:Air Pollution, Indoor / Q000032:analysis* / Q000517:prevention & control; D002248:Carbon Monoxide / Q000032:analysis; D057231:Climate Change; D004784:Environmental Monitoring / Q000379:methods*; D006798:Housing / Q000592:standards*; D006801:Humans; D008962:Models, Theoretical; D010316:Particle Size; D052638:Particulate Matter / Q000032:analysis; D011634:Public Health; D011886:Radon / Q000032:analysis; D018570:Risk Assessment; D006113:United Kingdom; D014691:Ventilation
chemical_list: D052638:Particulate Matter; D002248:Carbon Monoxide; D011886:Radon
keywords: Adaptation; Air quality; Climate change; Mould; Overheating; Public health