Heat waves: investigating the effects of high temperatures on health goes beyond calculating deaths

Throughout the summer we have experienced successive heat waves with record temperatures in Europe and Spain, to the point that last July average temperatures were reached on a global scale of more than 1.5 degrees above pre-industrial values. This should be an important wake-up call on the urgency of implementing adaptation measures that minimize the impacts that high temperatures have on health.

The count of deaths attributable to the effects of high temperatures, normally in terms of increased mortality, is essential as a public health surveillance tool. However, this should not become the only research objective. As with the health impact of air pollution, the effects that extreme heat has on mortality have been more than proven. We think that it is time to focus research on other objectives that generate efficient improvements in public health.

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The measures aimed at reducing emissions (mitigation) are extremely relevant in relation to the impacts of climate change on health, but they are insufficient to keep the planet’s average temperature below the safety thresholds proposed in the Paris Agreement. Therefore, adaptation and risk management are the basic tools that must be worked on to reduce population vulnerability to high temperatures.

Rehabilitate homes and create green areas. From the point of view of adaptation processes, local factors are key when it comes to reducing the impact on morbidity and mortality. It is necessary to know why the population of some places adapts better than others to heat waves, what variables influence and modify, as far as possible, those that can.

It is known that the climatic rehabilitation of homes and their better adaptation to withstand high temperatures reduce the impact of heat waves. Also, that the existence of green and blue zones in cities constitutes a great opportunity to reduce the impact of heat on health.

It is about directing research towards which urban and social factors can improve life within cities and how to implement them to achieve renaturation.

We must improve Prevention Plans. Another factor that has been key in our country when it comes to reducing the impact of heat waves on mortality have been the Prevention Plans for high temperatures, both state and regional or municipal, which must continue to be improved.

For this, it is necessary to decrease its geographic resolution. That is, descend from the provincial scale to the scale of isoclimatic areas (geographical areas with similar behavior of meteorological variables). In addition, it is necessary to determine the threshold temperatures for mortality attributable to heat waves for its implementation on this scale, which transcends administrative limits. The aim is to determine the impacts on health also at the local level. It is not effective not to consider local factors in the analysis of impacts if these factors are key, as the World Health Organization (WHO) reminds us.

In addition, it is necessary to improve the knowledge of the meteorological conditions that generate heat waves, depending on their origin, the risks of exposure and impacts vary. For example, heat waves of Saharan origin are associated with significant increases in particulate matter, whose effect on morbidity and mortality is sometimes greater than that of the temperature itself. On the contrary, heat waves whose generation is in the anticyclonic blockade, usually lead to increases in tropospheric ozone concentrations, with significant associated health effects.

Therefore, it is necessary to investigate the design of prevention plans that protect health and that integrate air pollution and heat waves, but also that consider the simultaneous occurrence of forest fires, exacerbation of droughts, vector-borne diseases (such as mosquitoes and ticks) and deepen the knowledge of waterborne and foodborne diseases. All these are risk factors aggravated in periods of high temperatures.

Outdoor workers are also vulnerable. In addition, knowledge of the groups of people especially vulnerable to heat waves, traditionally focused on the elderly and those with chronic illnesses, should be expanded, and research should be transferred to other population groups. We are talking, for example, about outdoor workers and people with disabilities, who can be affected differently in high-temperature situations. Pregnant women are also a particularly vulnerable group in heat waves.

It is necessary to determine which diseases are especially exacerbated by heat and, therefore, are likely to increase hospital admissions and mortality. It is known that the main ones are those of a chronic, respiratory and circulatory, neurological, renal and even endocrine and metabolic nature and even investigate the greater affectation of heat in different age groups (especially articulate prevention measures on the school-age population).

Even so, it is necessary to deepen this analysis and define action protocols at the care level that allow optimizing the management of risks and resources to minimize the effects on health, including mental health.

The importance of communicating it to the population. Finally, it is necessary to investigate how to transmit this information to the population, unifying alerts and messages and making them effective, as well as training professionals to respond to these risks. Here environmental education, health education, training of social and health personnel, community health networks, health literacy of patients, family members and caregivers, and the media play a decisive role.

In other words, there are many lines of action to continue working and researching, to follow the path of a positive adaptation to high temperatures because, although it is not intuitively appreciated, the impact of heat waves measured through the attributable risks on mortality in Spain, decreased in the period 2004-2013 in relation to 1983-2003. This decrease has a lot to do with various factors such as the implementation of public health prevention plans, socioeconomic, health and infrastructure improvements, mainly urban and in homes. Although the most important thing is the adequate transmission of information on the associated risks and its transformation into positive action for health.

Cristina Linares is co-director of the Reference Unit on Climate Change, Health and the Urban Environment of the Carlos III Health Institute.

Jesús de la Osa is co-coordinator of the Global Health Itinerary of the Aragonese Institute of Health Sciences IACS.

Julio Díaz is co-director of the Reference Unit on Climate Change, Health and the Urban Environment of the Carlos III Health Institute.

This article was originally published on the Science Media Centre.

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