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Introduction

 

Extreme heat warnings have historically been welcomed by the general public in the United Kingdom, largely due to their perceived infrequency. However, with these hot-spells anticipated to become longer, more common, and more extreme, it is vital that we prepare for the increased risk to public health that will inevitably come hand-in-hand with these expected changes. It is alarming that whilst the government is committed to 30-year plans in the pursuit of decarbonising our energy industry, it is paying such little attention to the very immediate risks that climate change already poses to the public.

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The Increasing Risks of Heatwaves

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2018 recorded the hottest summer on records for England, and the joint hottest summer for the entire United Kingdom, and this is made all the more alarming by a recent study which claimed that the likelihood of these intense heatwaves is now thirty-times higher than it would be in a ‘natural climate’. The same study suggests that depending on global decisions surrounding greenhouse gas emissions ‘we could reach a point in the future when we can expect a hot summer like that of 2018 to occur every year’. The length of heatwaves has also doubled over the last 50 years, and if trends are expected to continue, we can only expect these heatwaves to become more severe in nature. This increased frequency, duration and severity of heatwaves makes the risks associated with them of even greater public concern.

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The recently-published ONS data for mortalities recorded in Q3 of 2018, combined with the same data for Q2, shows that in the period between the 25th of June and the 31st of July 2018, 1200 additional deaths were recorded nationwide compared to the trailing 5-year average. It was initially suggested that during the height of the heatwave, between the 25th of June and the 9th of July, an additional 650 deaths were registered compared to the average. However, the ONS data which has been made available since shows that this number was actually higher, with 722 additional deaths being recorded during that period. The exact causes of these deaths are unknown. However, the increased mortality risk, particularly for vulnerable persons, in periods of extreme heat is well-documented, particularly in periods where hot days are followed by hot nights. Data on the causes of deaths during this period will be published in Summer 2019, which will provide more detail into the ways that this heatwave may have led to increased risk of death.

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The main health concern in periods of high heat is heatstroke, where the internal temperature of the body has exceeded 40C. When a body’s brain cells experience a temperature of 42C the cells begin to die, and hence when a body’s natural processes of cooling are not working sufficiently, the effects can be rapid and extremely dangerous. Symptoms of heatstroke include dizziness, fatigue and nausea, which can easily be overlooked as minor if heatstroke is not taken into account as a possible cause. Even when heat-related illness is not lethal, it can still put additional strain on NHS services in hospitals and care homes. In this sense, periods of extreme heat could indirectly lead to a lower quality of care for patients suffering from non-heat-related illnesses, which poses a wider risk to public health. The chief executive of NHS Providers, Saffron Cordery, also noted that NHS infrastructure has not been adequately improved to regulate the temperatures inside NHS buildings, saying “the extreme heat has highlighted the shortcomings of ageing buildings, which are not designed or equipped to deal with these conditions”, which is important to keep in mind when planning improvements in public buildings in regard to insulation and heat. This is further noted by the Committee on Climate Change who say in their 2017 risk assessment that ‘modern healthcare facilities, designed to be thermally-efficient in cold weather, can have problems with thermal comfort during heatwaves for both patients and staff’. The same report highlights that ‘there are no comprehensive policies in place to adapt existing homes and other buildings to high temperatures’.

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Suggested Changes in Policy/Attitude

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Much discussion is taking place in the energy industry right now on how the way we heat our homes could change by the year 2050. However, this discussion must be had alongside a discussion as to how to prepare buildings for the increased frequency and severity of extreme heat episodes. The 2017 risk assessment even draws attention to the fact that cold-weather episodes, and the health risks associated with them, could become less common in the coming decades due to climate change, saying that ‘milder winters should reduce the costs of heating homes and other buildings… and reduce the number of winter deaths from cold’. They acknowledge that, despite this, ‘cold weather is expected remain a significant cause of death’; however, it is a worthy discussion point when approaching the issue of how we prepare to heat/cool our homes in years to come. Ideally, these issues would be approached concurrently, such that solutions to either problem do not counteract those of the other. For this reason, the energy industry must take into account the risks associated with extreme heat and the failures to counteract it when approaching the issue of heating our homes and other buildings.

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The impacts of a failure to introduce meaningful policy to upgrade buildings to the changing climate are exacerbated by a lack of awareness in regards to the health risks associated with periods of extreme heat. Counteractive measures, enabled by an increased awareness of what these measures are, why they are necessary, and who is most at risk, could have a very positive impact on reducing the number of fatalities that occur during heatwaves. The House of Commons Environmental Audit Committee published a report into adapting to heatwaves, and seems to acknowledge a need for adjustment of attitude. The emphasis, however, seems to focus on how to adapt during the actual heatwave, rather than encouraging making necessary changes to buildings in advance, saying ‘during periods of hot weather, the Met Office works closely with Public Health England (PHE) to provide direct public health messaging’, as well as providing information on the health impacts of heat online. Though these steps are positive, they alone will likely be insufficient to change public attitude given that engagement with this public messaging would only happen if the public were aware of the risks of overheating in advance. It seems as if the need for a change in attitude amongst the public is being largely overlooked. The report also acknowledges that the research undertaken suggests that ‘all new homes exceed the overheating threshold to some extent’ but that generally this can be counteracted with simple preventative measures such as ventilation and effective shade. This may well be true, but requires the public to be aware of the risks of overheating in the first place, as well as the efficacy of these methods in tackling that. In the case of producing better ventilation at night (where there can be additional risk as previously stated) the public may perceive leaving their windows open as too great a risk, particularly if they feel the risk of overheating is minimal. This could particularly be the case for elderly and other vulnerable individuals who feel more at risk of being burgled. It is not untrue that these sorts of preventative measures carry their own risks, and preparing for these risks separately in advance of a heatwave, installing metal barriers outside of windows, for example. A recent commentary on this issue from the Grantham Institute points to the need to adjust homes to these requirements in advance, saying ‘many deaths could be prevented if people’s homes had better ventilation, and windows were fitted with shutters or blinds. These are the kinds of modifications that need to be planned and carried out before a heatwave.’ In this sense, the government seems to be working under the assumption that they can continue with an attitude of crossing this bridge when they come to it, which is alarming given the scale of the issue from a public health standpoint.

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Emphasis on the need for behavioural changes in periods of extreme heat is also essential, and may be largely misunderstood in a country not used to dealing with intense heatwaves. The importance of wearing appropriate clothing, remaining hydrated, and avoiding over-activity cannot be overstated. The public’s perception of appropriate clothing in particular may be lacking. Contrary to popular belief, a reduction in the amount of clothing worn is not the ideal way to combat extreme heat, with many layers of light clothing providing room for air circulation as well as insulation from the sun itself. Individuals would be at a greater risk of overheating if they were unaware of this. Even changes in attitude towards eating, eating small amounts frequently and avoiding consuming large amounts of food at once, can aid in avoiding heatstroke as the body temperature will rise when large amounts of food are consumed.

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There is also a risk that the public may have a false perception for how to spot the symptoms of heatstroke and, more importantly, how to effectively provide aid to someone suffering from it. Though some methods for cooling the body down come naturally (for example, finding shade, resting), other methods such as covering the individual with cold water can actually be ineffective as it reduces the body’s natural processes for losing excess body heat through the skin. In this scenario, though the individual may feel some immediate relief, there would little relief of the condition itself, and the individual would be better off being covered in temperate water which would aid rather than limit the body’s natural processes of cooling the body. Forcing a change in public attitude is always difficult, and will likely happen largely over time as these heatwaves become more common. However, it is in the period before the public changes its perception naturally that people will be most at risk, and thus it is in the government’s best interest to prompt these changes in attitude sooner rather than later.

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As mentioned, additional risk occurs at night for both practical reasons (risk/reward of opening windows for ventilation) and biological reasons (the effects of heatstroke being fatigue, light-headedness, etc. which could easily be overlooked or ignored in a state of sleep). These risks particularly extend to the elderly and those suffering from pre-existing conditions. It would therefore seem appropriate that adequately advising carers on the specific dangers presented by heatwaves and how to prevent them was considered a high priority before these events occur. Similarly, healthcare professionals should be advising patients of the risks presented during heatwaves and what steps may be necessary well in advance of the heatwaves occurring, ideally during the later spring months.

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Conclusion

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Approaching the issue of climate change, the government has undertaken a plethora of commitments in regard to reducing carbon emissions in an attempt to minimise its effects. However, little thought has been put into preparing for the immediate threat that the changing climate poses. It is alarming, given the strong evidence of how dangerous these events can be and the new frequency of these risks, that the government refuses to allocate the responsibility of raising awareness surrounding the risks of climate change to a single government department, instead believing that responding to individual threats when necessary is the more effective approach. This negates the need for advanced preparation and any acknowledgement of the increased frequency of these issues. The government’s attitude to this issue appears to reflect a form of climate change denial in refusing to accept that we live in a climate that is different to the past and that the public must be instructed as to how to properly prepare for living in this new climate. All evidence suggests that these heatwaves could not only become more frequent but more severe and enduring in nature. If we are to attribute approximately 1200 deaths to the heatwave in 2018, we must accept that these sorts of issues could be recurring and more severe in nature. In Japan, the heatwave of summer 2018 was declared a national emergency, with many deaths being recorded; temperatures of over 40C were recorded for the first time in history in Japan’s capital, Tokyo. It is paramount that the UK government acknowledges that risks of similar changes in climate are probable in the UK, and that, given our blasé attitude towards heat as a nation, we are at an additional risk to countries more used to dealing with extreme heat. The report by the Grantham Institute points out that were such a high number of mortalities recorded in the UK as a result of flooding, that ‘there would rightly be an outcry, particularly if many of the deaths could have been avoided’. The government must stop attempting to overlook this issue, and approach it as the inevitable public health issue that it is.

 

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