Heatwaves: a healthcare problem of our making

Problem

Climate change is increasingly impacting upon the health of human populations, which is due, in part, to an increased number of extreme weather events, such as heatwaves. In 2003, the devastating effects of heatwaves were brought into focus where at least seven western European countries experienced excess mortality in the order of tens of thousands. This study aims to explore the reaction of Government organisations to extreme weather events such as this and to determine whether the plans put in place have been effective in reducing heat-based mortality.

Approach

Databases including Web of Knowledge, Science Direct, JSTOR and Pubmed were systematically searched using the following terms: heatwave; climate change; plan; action planning; mortality; morbidity; effectiveness; outcomes; Europe; UK; 2003; 2006; 2013. Articles must have been subject to peer review, have been relevant to the topic and could contain qualitative or quantitative data. Government policy documents and several frontline staff working at GP surgeries were also consulted.

Findings

The World Health Organisation and EU Commission sponsored the development of a set of recommendations to mitigate the adverse effects of heat; these now underpin Public Health England’s Heatwave Plan. Holistic analysis of European heatwave plans is generally lacking, however, in 2006, western Europe experienced a second severe heatwave. Comparisons between the observed and expected mortality rates in France during this period show that there were approximately 4400 fewer deaths than expected. Whilst some of this might be due to learning from experience, the preventative measures put in place by the French Government, together with the heat health recommendations, are likely to have played a role in reducing the magnitude of morbidity and mortality. In addition, analysis of England’s heatwave data shows that since its introduction in 2004, the Heatwave Plan has helped significantly reduce the number of deaths per heatwave day in several age categories and it has increased awareness of heat protective behaviours, such as wearing sun cream, using electric fans, and staying hydrated. Uptake of these behaviours, and other recommendations, however, have not been universal and there remain several challenges to improving the effectiveness of the Heatwave Plan. These include promoting awareness of the heatwave plan amongst healthcare professionals, improving risk-aversion, communication strategies and local coordinated care strategies and providing better support for vulnerable populations.

Consequences

Humans are especially sensitive to heat stress, and with the number of very hot days expected to increase non-linearly with each degree of mean global temperature rise, higher morbidity and mortality rates are inevitable. Whilst evidence exists to suggest that the heatwave plans are in part achieving their aims, they are also failing several areas of the population. To further reduce excess mortality, new initiatives will be required to better promote the importance of the heatwave plan.