Heat and Health in a CRM Framework Glenn McGregor School of Environment University of Auckland, NZ Climate Risk Management Meeting Guayaquil, Ecuador October 10 12, 2011
Heat Illness
Human Biometeorology THE ATMOSPHERIC ENVIRONMENT heat humidity temperature wind radiation air pollution infraredt particles light liquids UV gases gerd.jendritzky@dwd.de DWD 2003
Human Biometeorology The Thermal Environment A D I R Q RE Q L E KM E Q H M Q Sw E E R R gerd.jendritzky@dwd.de DWD 2002
Temp Condition 44 heat stroke, brain damage 41 Fever, very heavy exercise 38 normal resting condition 36 shivering 35 severe shivering 33 reduced consciousness ventricle fibrillation 31 14 31 death 14 lowest measured temperature with full recovery Heat Cramps Heat Exhaustion Heat Stroke Core Temperature
Heat Tolerance & Water Balance Dehydration(%) and Effects 2% thirst 4% + dry mouth 6% + increased heart rate + increased body temperature 8% + swollen tongue, difficult speech, reduced mental and physical performance 12% recovery only after IV or rectal fluid administration 14% fast temperature increase, death
Observed Health Impacts of Heat
Global Significance of Heat In North America, Europe and Australia there are more deaths annually from heat compared to other hazards
Global Heat Wave Climates (based on regions recorded in EM DAT 1990 2006) Nth Am Dfb Dfa Cfa Euro Nth Afr Dfb Dfa Csa Csb Cfa Cfb Aust Csb Cfa Cfb Cwa Asia Aw Bsh Cwa Cfa Tropical Arid Temperate Cold Polar
Relationship between cold, heat and mortality Cold Mortality Heat Keatinge et al., 2000: British Med. J. Temperature
Heat Load Mortality Relationship: Europe 130 125 Optimum Temperatures shown for London and Madrid relative mortality (% ) 120 115 110 105 The Netherlands Baden Württemberg Lisbon London Budapest Madrid London (22oC) 100 Madrid (30oC) 95 3 2 1 0 1 2 3 thermal load category a measure of heat
Tmax Anomaly, Jan 29, 2009 New Zealand
Tmin Anomaly, Jan 29, 2009
Ambulance Call Out a 37% increase in those 75 years or older; an 8 fold increase in direct heat related presentations (46% being aged 75 years and over); an almost 3 fold increase in patients dead on arrival (69% being 75 years or older).
Melbourne January 2009: Mortality There were 374 excess deaths over what would be expected: a 62% increase in total all cause mortality The greatest number of deaths occurred in those 75 years or older; a 64% increase Reportable deaths in those 65 years and older more than doubled.
Managing Heat Waves
Risk Management Cycle
Heat Plans: Essential Elements Establishment of collaborative mechanisms between bodies and institutions, and a lead body to coordinate responses; An accurate and timely alert system; Strategies to reduce individual and community exposure to heat; Particular care for vulnerable populations; Provision of health care, social services and infrastructure; Heat related health information strategies; Real time surveillance, evaluation and monitoring Source: Improving Public Health Responses to Extreme Weather/Heat Waves EuroHEAT Meeting Report, Bonn, March 2007
Possible Flow of Information Between Lead Agency and Other Actors in Heat Plan Lead Body: Regional Health Authority Real time surveillance system Accurate and timely alert system (HHWS): National Weather Service Health sector: hospitals, care homes GPs, pharmacies Local government Social services Retirement homes Schools and kindergartens Civil protection Transport Utilities Media General public, Vulnerable population groups Source:WMO Guidance Notes on HHWS (in prep)
Source:WMO Guidance Notes on HHWS (in prep) Operation of a Typical HHWS
HHWS in Europe. Source: EU EuroHeat Final Report http://www.euro.who.int/ data/assets/pdf_file/0018/112473/e91350.pdf
Time Scales in Meteorology short range: < = 3 days [hour day] HHWS medium range: < = 10 (15) days [day] monthly range: <= 1 month [week] seasonal range: <= 3 7 months [month season] annual range: <= 12 (13) months [season]
Probabilistic heat forecast (July 2007)
Managing Heat Through Urban Design and Planning
Cool Roofs Roof Albedo
Façade Greening
Green Roofs
Diurnal Temperature Cycle Over Various Flat Roof Types
Cool Pavements
Conclusions Heat waves are a pervasive natural hazard (a silent killer) that can exact a heavy toll on human systems affecting health, livelihoods and infrastructure and also ecosystem services. European 2003 and Melbourne 2009 heat waves serve as good examples of the health effects of heat waves The Risk Management Cycle provides an appropriate context for managing heat risk Heat Plans are a way of managing heat risk.; the climate information component of heat plans is the heat health warning system (HHWS) HHWS warnings are issued when a threshold temperature is exceeded; threshold temperature represents the temperature above which health effects are known to increase. HHWS use short range (1 5 day) forecasts but medium range (5 15 day) forecasts may offer valuable longer lead information A longer term strategy for managing heat risk is climate sensitive building, urban design and town planing.
HEAT WAVES AND HEALTH: GUIDANCE ON WARNING SYSTEM DEVELOPMENT PREPARED BY COMMISSION FOR CLIMATOLOGY EXPERT TEAM ON CLIMATE AND HEALTH (ET4.1) For Publication By THE WORLD METEOROLOGICAL ORGANIZATION AND THE WORLD HEALTH ORGANIZATION
Thanks
Mapping Heat Vulnerability
Conceptualizing Vulnerability ƒ (hazard, sensitivity, adaptation) radiation elevation, wind land use outdoor heat orientation ventilation heat protection indoor heat exposure to heat exposure to air pollution, noise vulnerability demographics health status sensitivity adaptation capacity behaviour access to support access to resources access to information mobility
Relationship Between Temperature and Mortality (top) and Ambulance Callout (bottom)
Proxies of Risk Factors Extracted From the Census
Map of 10 VI Classes
Surface Temperature During August 2003 Heatwave
Association Between Areas of High Vulnerability and High Surface Temperature (proxy of urban heat island)
Is The Vulnerability Index a Good Predictor of Mortality/Morbidity? Do areas with high VI scores have high mortality and/or ambulance call out for a group of very hot days and all summer days? VI better indicator of ambulance call out for all summer days Age better indicator of mortality for heat wave days
The increase of risk for increasing vulnerability scores and increasing age score when compared to class 1. The trend by vulnerability class for mortality is continuous. For the age score class, the mortality shows a similar trend, which is even stronger.
Conclusions Health is sensitive to heat (climate) especially during extreme (acute) heat events The understanding of the heat health association has reached a level where science can be converted into effective policy Health Warning: to be effective the mainstreaming of climate information into health planning is dependent on engaging with stakeholders in the heat health problem