Climate change, health and communica1on. Anna Paldy MD. PhD Scien1fic adviser Na1onal Public Health Ins1tute

Transcription

1 Climate change, health and communica1on Anna Paldy MD. PhD Scien1fic adviser Na1onal Public Health Ins1tute

2 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 Adapta1on to these effects has become a major issue (for public health and other sectors) Awareness raising and communica1on are cru1al for short- and long term adapta1on

3 Projec1ons 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 homest days will exceed present temperatures. The number of people living in extreme condi1ons will increase. The ability of the human body to maintain heat balance during physical ac1vity is compromised for parts of the year. Unprotected outdoor labour is no longer possible. Other risks associated with high-end scenarios: impact on urban semlements, food produc1on, and water resources. The Lancet Volume 383, Issue 9924, 5 11 April 2014,

4 CLIMATE CHANGE Industrial processes which burn fossil fuels Growing global population, Consumerism and consumption PRESSURE Increased carbon and GHG emissions from: -Transport - Agriculture, -Industry STATE Flooding Extreme weather events More frequent heatwaves Allergenic plants (ragweed) Vectors; resilience EXPOSURE High temperature Contaminated water (chemical& bacterial) Fast flowing water Debris hazards Damps and moulds in homes Insecurity Damaged social rela1ons Reduced individual choice Social, economic, behavioural etc.. CONTEXT EFFECT ACTIONS Short term: Emergency planning/heatwave plans Smog-alert measures, early warnings Long term Policies addressing vehicle numbers and emissions (technological & fiscal) Investment in cycle/walking infrastructure and green space provision and maintenance Improved urban & traffic planning Traffic-control measures Subsidies for zero-emission vehicles Drowning Physical trauma and gastro-intestinal illness Toxic and allergic illness Mental health-stress, anxiety and depression Mortality and hospital admissions Reduced Wellbeing

5 Mean temperature mortality rela1onship in the years before 2003 (Period 1) (red line) and aaer 2003 (Period 2) (blue line) in 9 European ci1es Source: de Donato et al: Int. J. Environ. Res. Public Health 2015, 12,

6 Associa1on of daily mortality and temperature, Hungary, The associa1on 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. Characteris1cs of associa1on 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

7 Bobvos et al IDŐJÁRÁS Quarterly Journal of the Hungarian Meteorological Service Vol. 121, No. 1, Januar March, 2017, pp Mean temperature during the summer period,

8 Mean excess mortality (%) on days above threshold temperature on NUTS4 level in Hungary, 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 spa1al distribu1on of heat related excess mortality. Bobvos et al IDŐJÁRÁS Quarterly Journal of the Hungarian Meteorological Service Vol. 121, No. 1, Januar March, 2017, pp

9 Na1onal average daily mortality and daily mean temperature , 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 In 2012 and heatwaves tackled Hungary with excess death cases of 1660 resp In 2015 the summer was extreme with 5 heatwaves during 34 days, daily excess mortality was higher by 17% meaning 1770 excess cases.

10 Heat alert- background The heat health warning system in Hungary was elaborated within the PHEWE project (PHEWE , Preven]on of acute health effects of weather condi]ons 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 1me series analysis of the Budapest data of

11 Heat alert- defini1on of cut off point The alert threshold was defined as the daily mean temperature: 25⁰C, corresponding to the 90 th percen1le. 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 popula1on, which is 1/ already requires ac1ons of the public health authori1es.

12 3-level heat alert system in Hungary 1 st level of warning (for internal use): the daily mean temperature is forecast 25 o C for 1 day excess mortality is likely 15%. 2 nd level of warning: alert: when the Meteorological Service forecast daily mean temperature 25 o C for at least 3 consecu1ve days with excess mortality of 15%. Alterna1vely the forecasted daily mean temperature is 27 o C for 1 day with predicted excess mortality of 30%. 3 rd level of warning: alarm: when the Meteorological Service forecast daily mean temperature 27 o C for at least 3 consecu1ve days with excess mortality of 30%.

13 Forecast of heat wave probability, July 16, 2007 (elaborated by Euroheat)

14 HHWS- flow of information Differenciated infformation based on the forecast chief medical officer Min of Human Resources report National Met. Office -forecast National Public Health Center Office of CMO- Div. of Rapid Response Ministries National Civil Protection Nat Labor Protection Police County Gov. Agencies Office of CMO Div of Communication Office of CMO Central Duty Div of PH in County Gov. Agencies County CMO information Nat. ambulance S. Terror protection CentreEK COUNTY COMMITTEE OF CIVIL PROTECTION Secretary M E DI A Health and soical care institutions GPs Small area PH Institutions County Police, Transport, etc. agencies etc. Local COMMITTEES OF CIVIL PROTECTION Collaborative agenceis at small area level GENERAL PUBLIC

15 Tasks of Public Health Services In the pre-summer period: Prepare guidelines for the hospitals, social care services, educa1onal services During the summer period: Keep contact with the Met. Office Issue heat alert Sustain a real-1me surveillance system of the impact of heat waves (real-1me mortality monitoring) Evaluate the impact of heat waves

16 Recommenda1ons for the General Prac11oners Warn the GPs about the heat alert To control the health state of vulnerable pa1ents 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 informa1on about the effects of heat for the popula1on

17 Recommenda1ons for social care ins1tu1ons Prepare/update heat-wave plans; control and document the implementa1on of measures. Insulate buildings, install shades, and explore the possibility of air condi1oning. Monitor the actual health status of elderly people (medical care, ac1ve preven1on of heat-related symptoms). Prepare a special menu during heat waves. Provide targeted advice in terms of daily rou1ne, behaviour, clothing, liquid intake and 1me spent outdoors.

18 Recommenda1ons for child care ins1tu1ons Increase the heat resilience of buildings. Ensure appropriate ven1la1on, insula1on, cooling and air condi1oning. Update heat-wave plans. Prepare appropriate plans for children s daily ac1vi1es. Install suitable devices for protec1on from heat outdoors. Prepare a special menu during heat waves.

19 Recommenda1ons for the Municipali1es Provide access to drinking water at public places Frequent watering in the ci1es (roads, parks) Provide a list of public shelters with air condi1oning Ascertain the electricity Take care of homeless people, provide them drinking water Open the public places supplied with air condi1oning system To regulate traffic, public transporta1on To extend the opening hours of swimming pools

20 Advices for the general public during heatwaves Follow your local health authority's recommenda1ons. 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.

21 Monitoring the effec1veness of heat alerts Results of a representa1ve ques1onnaire survey (1%o of the popula1on in 2015) on the percep1on and ac1ons of the popula1on during HWs: 90% of the popula1on takes some measures against heat during HWs. People with university degree are the most ac1ve (93.5%) vs. people with lowest educa1on (<=8 year) 83% 25% of those having health problems did not take any measures! Conclusions: The majority of popula1on is ac1ve during HWs, spends money and 1me for adapta1on However there are s1ll areas where the popula1on expects joint ac1ons of the municipali1es and govennment agencies.

22 Thank you for your amen1on!