Jo Jefferies May 31 2017

1. Rationale for heatwave planning and responseWhat are the effects of hot weather on health and what can we do about it? Jo Jefferies May 31 2017

2. What are the effects of heat on health? • temperatures in excess of approximately 25ºC are associated with excess summer deaths • a 3.3% increase in all-cause deaths has been observed in London for every 1˚C increase in temperature above 21.5˚C. • higher temperatures are associated with greater numbers of excess deaths; at 27ºC or over, those with impaired sweating mechanisms find it especially difficult to keep their bodies cool • respiratory and cardiovascular diseases are the main causes of illness and death during a heatwave Kovats et al, 2004

3. Heatwaves result in excess deaths! • The heat wave in France in August 2003 caused 14,802 deaths in a 20-day period • A major heat wave in Athens in 1987 was associated with more than 2000 deaths • During the six-day heatwave of 29th July to 3rd August 1995 in Greater London, there were 1096 deaths, an excess of 10.8% compared to the expected number • Death rates rise soon after temperature increases, with many deaths occurring in the first two days

4. Kovats & Hajat, 2008

5. Kovats et al, 2004 Hospital admissions in a heatwave Evidence for heat related increases in emergency admissions for respiratory and renal disease,in children under 5, and for respiratory disease in >75s

6. Heat-related deaths occur before people seek medical help The impact of heat on mortality is not reflected in admissions, supporting the idea that many heat-related deaths occur before people come to medical attention This emphasises the importance of long-term planning actions by LA and Health sector during Level 0 Year Round Planning phase In the 1995 heatwave; • Admissions for respiratory and renal disease showed an increase in response to higher temperatures • Admissions for children under 5 years old increased slightly during hot weather (0.24% for each degree increase) • In those aged >75, respiratory admissions increased by 10.86% for each degree above 23˚C Kovats et al, 2004

7. Heat-related deaths occur before people seek medical help The impact of heat on mortality is not reflected in admissions, supporting the idea that many heat-related deaths occur before people come to medical attention This emphasises the importance of long-term planning actions by LA and Health sector during Level 0 Year Round Planning phase In the 1995 heatwave; • Admissions for respiratory and renal disease showed an increase in response to higher temperatures • Admissions for children under 5 years old increased slightly during hot weather (0.24% for each degree increase) • In those aged >75, respiratory admissions increased by 10.86% for each degree above 23˚C Early warning is crucial Kovats et al, 2004

8. Who is most at risk?

9. Other risk groups • Older carers • Tourists • People attending large events • People fasting over Ramadan N.B. Although BAME people are not a increased risk per se, significant numbers of people from BAME communities live in urban areas and so may be adversely affected by the urban heat island effect

10. Why have a Heatwave Plan? Published annually since 2004, following the devastating pan-European heatwave in 2003 and builds on many years of experience of developing and improving the ability of the health sector and its partners to deal with significant periods of hot weather • avoid the adverse health effects of excessive heat by raising public awareness and triggering actions by those in contact with people who are most at risk • reduce pressures throughout the health and social care system

11. Heatwave Alert Levels

12. Heatwave Alert Levels • The alert levels have been set with thresholds known to cause ill health from severe hot weather. • Evidence shows that people gradually adapt to changing temperature patterns, and so heatwaves are a relative experience. • Therefore, thresholds vary for each region and risks to health appear to be greater earlier in the summer. • Although risk to health begins to increase at temperatures reach 25oC, the threshold temperatures are set at a 15-20% increased risk (15 to 20% above 25oC) and adjusted to take account of local adaptations. • They are to help ensure that staff and resources are fully prepared for hot weather periods that might impact on health and to raise awareness for those individuals who are more vulnerable to hot weather conditions.

13. Heatwave Alert Levels • The alert levels have been set with thresholds known to cause ill health from severe hot weather. • Evidence shows that people gradually adapt to changing temperature patterns, and so heatwaves are a relative experience. • Therefore, thresholds vary for each region and risks to health appear to be greater earlier in the summer. • Although risk to health begins to increase at temperatures reach 25oC, the threshold temperatures are set at a 15-20% increased risk (15 to 20% above 25oC) and adjusted to take account of local adaptations. • They are to help ensure that staff and resources are fully prepared for hot weather periods that might impact on health and to raise awareness for those individuals who are more vulnerable to hot weather conditions. The triggering threshold temperatures for South East England are 310C by day and 160C by night

14. What can local authorities do? 0. planning Work with partner agencies to incorporate long term plans to prepare for, and mitigate the impact of heatwaves • Use JSNA to identify the challenges posed by excess seasonal summer and winter deaths locally • HWBB can agree actions to reduce challenges identified e.g. through environmental action, housing and infrastructure changes, increased community engagement • Monitor progress against PHOF indicators linked to health effects of hot weather • 1.18 improving social connectedness • 2.13 encouraging physical activity • 3.01 addressing air pollution from particulate matter • 4.4 reducing mortality from cardiovascular disease • 4.7 reducing mortality from respiratory disease

15. PHOF indicators http://www.phoutcomes.info/

16. What can local authorities do? 1. preparedness • Work with internal and external partners to • ensure those working with vulnerable and under-served groups are aware of the risks of heatwave to health and of the heatwave plans • ensure that vulnerable and under-served groups are supported appropriately • Use a variety of methods to disseminate risk reduction messages • Engage community and voluntary sector to support those most at risk

18. What can local authorities do? 2. Heatwave forecast • Communicate public media messages – especially to vulnerable and under-served groups who are at increased risk • Communicate alerts to staff and ensure they are aware of heatwave plans • Implement business continuity to ensure services reach those at most risk • increase advice to health and social care workers working in community, care homes and hospitals

19. Public health core messages

20. What can local authorities do? 3. Heatwave Action • Communicate media alerts about keeping cool • Support organisations to reduce unnecessary travel • Review safety of public events • Mobilise community and voluntary support

21. What can local authorities do? 4. Major incident • Continue actions as per Level 3 unless advised to the contrary • Central government will declare a Level 4 alert in the event of severe or prolonged heatwave affecting sectors other than health and if requiring coordinated multi-agency action

22. What next? • Consider what actions you/ your team / your service or organisation can take; • Year round • At level 1 (June to September each year) • During a period of heatwave • Consider how you can work with others in your service on year round actions