Climate change, health and
communication
Anna Paldy MD. PhD
Scientific adviser
National Public Health Institute
Underlying facts
Climate change and its impacts have been supported by evidence (IPCC
ARs)
Impact of extreme weather events (incl. heat waves) is a great challenge
Adaptation to these effects has become a major issue (for public health and
other sectors)
• Awareness raising and communication are crutial for short- and long term
adaptation
Projections of different scenarios
• High-end climate scenarios project warming of 4–7°C (on
average) over much of the global landmass by the end of the
21st century.
• The hottest days will exceed present temperatures.
• The number of people living in extreme conditions will
increase.
• The ability of the human body to maintain heat balance
during physical activity is compromised for parts of the year.
• Unprotected outdoor labour is no longer possible.
• Other risks associated with high-end scenarios: impact on
urban settlements, food production, and water resources.
The Lancet Volume 383, Issue 9924, 5–11 April 2014, 1185–1189
CLIMATE CHANGE
Industrial processes which burn fossil fuels
Growing global population, Consumerism and consumption
ACTIONS
PRESSURE
Short term:
Increased carbon and GHG emissions
from:
-Transport
- Agriculture , -Industry
Emergency planning/heatwave plans
Smog-alert measures, early warnings
STATE
Long term
•Flooding
•Extreme weather events
•More frequent heatwaves
•Allergenic plants (ragweed)
•Vectors; resilience
Policies addressing vehicle numbers and emissions
(technological & fiscal)
Investment in cycle/walking infrastructure and green
space provision and maintenance
EXPOSURE
•High temperature
•Contaminated water (chemical&
bacterial)
•Fast flowing water
•Debris hazards
•Damps and moulds in homes
•Insecurity
•Damaged social relations
•Reduced individual choice
Social, economic, behavioural etc..
CONTEXT
Improved urban & traffic planning
Traffic-control measures
Subsidies for zero-emission vehicles
EFFECT
•Drowning
•Physical trauma and gastro-intestinal illness
•Toxic and allergic illness
•Mental health-stress, anxiety and depression
•Mortality and hospital admissions
•Reduced Wellbeing
Mean temperature–mortality relationship in the years before 2003 (Period 1) (red
line) and after 2003 (Period 2) (blue line) in 9 European cities
Source: de’Donato et al: Int. J. Environ. Res. Public Health 2015, 12, 15567–15583
Association of daily mortality and temperature,
Hungary, 2000-2010.
The association of daily total mortality (%) and the daily mean temperature (°C) can
be characterized by a J shape curve at higher temperatures. The impact of heat is
more prevalent in the elderly gorup over 65 years.
Characteristics of
association of daily
mortality (percent
differences from mean
total and above 65y
mortality and daily
mean temperature
between 2000 and 2010
in Budapest.
Source: Assessment of heat-related mortality in Budapest from 2000 to 2010 by different indicators
János Bobvos, Balázs Fazekas, and Anna Páldy
IDŐJÁRÁS Vol. 119, No. 2, April– June, 2015, pp. 143–158
Mean temperature during
the summer period, 20052014
Bobvos et al IDŐJÁRÁS Quarterly Journal of the Hungarian Meteorological Service
Vol. 121, No. 1, Januar – March, 2017, pp. 43–62
Mean excess mortality (%) on days above threshold
temperature on NUTS4 level in Hungary, 2005-2014
The mean excess mortality during
days over the threshold temperature
increase by 14.9%.
In some small areas excess mortality
was not detected, while in others it
was over 30%.
There is no typical spatial distribution
of heat related excess mortality.
Bobvos et al IDŐJÁRÁS Quarterly Journal of the Hungarian Meteorological Service
Vol. 121, No. 1, Januar – March, 2017, pp. 43–62
National average daily mortality and daily mean temperature 2012-2016, 2nd level heat
alert marked by red, 3rd level marked by black
1 heat alert was issued in 2014 and 2016
with excess death cases of 320 resp. 370.
In 2012 and 2013 4 heatwaves tackled
Hungary with excess death cases of 1660
resp. 1140.
In 2015 the summer was extreme with 5
heatwaves during 34 days, daily excess
mortality was higher by 17% meaning 1770
excess cases.
Heat alert- background
• The heat health warning system in Hungary was
elaborated within the PHEWE project (PHEWE 20032005, „Prevention of acute health effects of weather
conditions in Europe”).
• The Heat health warning system was based on the daily
mortality and meteorological data of Budapest.
• The Hungarian research group elaborated the 3- level
warning system based on temperature thresholds
defined in time series analysis of the Budapest data of
1970-2000.
Heat alert- definition of cut off point
• The alert threshold was defined as the daily mean
temperature: 25⁰C, corresponding to the 90th percentile.
Another argument to choose this threshold was that an
excess death rate of 7% was detected at this cut off point.
• This increase of mortality – above the acceptable risk level
for the population, which is 1/100 000 - already requires
actions of the public health authorities.
3-level heat alert system in Hungary
• 1st level of warning (for internal use): the daily mean temperature is
forecast ≥25oC for 1 day – excess mortality is likely 15%.
• 2nd level of warning: alert: when the Meteorological Service
forecast daily mean temperature ≥25oC for at least 3 consecutive
days with excess mortality of 15%. Alternatively the forecasted daily
mean temperature is ≥27oC for 1 day with predicted excess
mortality of 30%.
• 3rd level of warning: alarm: when the Meteorological Service
forecast daily mean temperature ≥27oC for at least 3 consecutive
days with excess mortality of 30%.
Forecast of heat wave probability, July 16, 2007 (elaborated
by Euroheat)
http://www.euroheat-project.org/dwd/index.php
HHWS- flow of information
Min of Human
Resources
Differenciated
infformation based on
the forecast
report
chief medical
officer
Ministries
National Met.
Office -forecast
National Public
Health Center
National Civil
Protection
Office of CMODiv. of Rapid
Response
Nat Labor
Protection
Police
Office of CMO –Div of
Communication
information
Office of CMO Central
Duty
Nat. ambulance
S.
Terror
protection
CentreEK
County
Gov.
Agencies
COUNTY
COMMITTEE OF
CIVIL
PROTECTION
County CMO
Secretary
M
E
DI
A
County Police, Transport, etc. agencies
etc.
Health and soical
care institutions
Small area
PH Institutions
Local
COMMITTEES
OF CIVIL
PROTECTION
GPs
Collaborative agenceis at
small area level
GENERAL PUBLIC
Tasks of Public Health Services
In the pre-summer period:
• Prepare guidelines for the hospitals, social care services,
educational services
During the summer period:
• Keep contact with the Met. Office
• Issue heat alert
• Sustain a real-time surveillance system of the impact of heat
waves (real-time mortality monitoring)
• Evaluate the impact of heat waves
Recommendations for the General Practitioners
Warn the GPs about the heat alert
• To control the health state of vulnerable patients
• To control the emergency medicines stock
• To keep the medicines in a refrigerator
• To be updated about the heat related side effects of medicines
• To be ready to give advices and information about the effects of
heat for the population
Recommendations for social care institutions
• Prepare/update heat-wave plans; control and document the
implementation of measures.
• Insulate buildings, install shades, and explore the possibility of air
conditioning.
• Monitor the actual health status of elderly people (medical care,
active prevention of heat-related symptoms).
• Prepare a special menu during heat waves.
• Provide targeted advice in terms of daily routine, behaviour,
clothing, liquid intake and time spent outdoors.
Recommendations for child care institutions
• Increase the heat resilience of buildings.
• Ensure appropriate ventilation, insulation, cooling and air
conditioning.
• Update heat-wave plans.
• Prepare appropriate plans for children’s daily activities.
• Install suitable devices for protection from heat outdoors.
• Prepare a special menu during heat waves.
Recommendations for the Municipalities
•
Provide access to drinking water at public places
•
Frequent watering in the cities (roads, parks)
•
Provide a list of public shelters with air conditioning
•
Ascertain the electricity
•
Take care of homeless people, provide them drinking water
•
Open the public places supplied with air conditioning system
•
To regulate traffic, public transportation
•
To extend the opening hours of swimming pools
Advices for the general public during heatwaves
•
•
•
•
•
•
•
•
•
Follow your local health authority's recommendations.
Keep your home cool.
Keep out of the heat.
Keep the body cool and hydrated.
Help others.
Keep medicines below 25 °C.
Seek medical advice.
If you or others feel- seek help.
In case of emergency, call a doctor or ambulance.
Monitoring the effectiveness of heat alerts
Results of a representative questionnaire survey (1%o of the
population in 2015) on the perception and actions of the population
during HWs:
• 90% of the population takes some measures against heat during
HWs.
• People with university degree are the most active (93.5%) vs.
people with lowest education (<=8 year) 83%
• 25% of those having health problems did not take any measures!
Conclusions:
The majority of population is active during HWs, spends money and
time for adaptation
However there are still areas where the population expects joint
actions of the municipalities and govennment agencies.
Thank you for your attention!