2nd DRAFT MOOC FOR CAREGIVERS

Introduction

A Heat-Health Action Plan (HHAP) is a strategy developed by governments, public health agencies, and other relevant organizations to address the health impacts of extreme heat events. HHAPs aim to minimize the negative effects of heatwaves on vulnerable populations and reduce the overall health risks associated with high temperatures.

The key components of a typical HHAP may include:

1. Early warning systems: HHAPs often include the development and implementation of heatwave early warning systems to provide timely alerts and information to the public, healthcare providers, and other relevant stakeholders. These systems can help trigger appropriate actions and interventions during extreme heat events.

Early warning systems are a crucial component of Heat-Health Action Plans (HHAPs). These systems are designed to detect and forecast extreme heat events in advance, allowing for timely and appropriate actions to be taken to mitigate the health impacts.

Here are some key aspects of early warning systems within HHAPs:

1.1. Meteorological monitoring: Early warning systems rely on meteorological data to identify and monitor heatwave conditions. Meteorological agencies use various tools, such as weather forecasting models, satellite data, and ground-based measurements, to track temperature patterns and identify potential heatwave events.

1.2. Heatwave thresholds: Early warning systems establish specific temperature thresholds that, when exceeded, trigger heatwave alerts. These thresholds may vary depending on the local climate and the population's vulnerability. For example, a heatwave alert may be issued when the temperature is expected to exceed a certain value for a certain duration (e.g., consecutive days with temperatures above 35°C).

1.3. Heatwave forecasting: Meteorological agencies use weather models and historical data to forecast the occurrence and intensity of heatwave events. Heatwave forecasts can provide valuable information on the duration, timing, and spatial extent of extreme heat, allowing authorities to prepare and activate response measures.

1.4. Communication and dissemination: Early warning systems ensure that heatwave alerts and related information reach the appropriate stakeholders and the public in a timely manner. Communication channels may include public announcements, media releases, social media platforms, mobile apps, and direct communication with healthcare providers and community organizations. This enables individuals, healthcare professionals, and relevant agencies to take necessary precautions and actions.

1.5. Response triggers: Heatwave alerts generated by early warning systems act as triggers for activating response measures outlined in the HHAP. These measures may include activating cooling centers, implementing public health campaigns, adjusting work schedules, ensuring availability of medical services, and providing guidance on protective actions like staying hydrated, seeking shade, and using cooling methods.

By implementing effective early warning systems, HHAPs aim to enhance preparedness and response capabilities, reduce the health risks associated with extreme heat, and ultimately save lives during heatwave events.

2. Risk assessment and monitoring: HHAPs involve assessing the vulnerability of different population groups to extreme heat and identifying high-risk areas. This allows for targeted interventions and resource allocation. Monitoring systems are also put in place to track heatwave-related health indicators and gather data for evaluation and future planning.

Risk assessment and monitoring are important components of Heat-Health Action Plans (HHAPs) to identify vulnerable populations and areas at higher risk during extreme heat events. Here are the key aspects of risk assessment and monitoring within HHAPs:

2.1. Vulnerability assessment: HHAPs involve assessing the vulnerability of different population groups and areas to the health impacts of extreme heat. This assessment considers factors such as age (e.g., elderly and children), pre-existing health conditions, socioeconomic status, housing conditions, access to cooling resources, and outdoor occupational exposure. Identifying vulnerable populations helps prioritize interventions and resource allocation.

2.2. Spatial analysis: HHAPs often utilize spatial analysis techniques to identify geographical areas that are more susceptible to the adverse effects of extreme heat. This analysis may involve mapping factors like population density, land surface temperatures, urban heat island effects, green spaces, and social vulnerability indexes. Mapping allows for targeted interventions and allocation of resources to high-risk areas.

2.3. Health surveillance: HHAPs incorporate health surveillance systems to monitor heat-related illnesses and other health impacts during heatwave events. These systems may track emergency room visits, hospital admissions, heat-related deaths, and other health indicators. Monitoring heat-related health outcomes provides valuable data for evaluating the effectiveness of interventions and guiding future planning.

2.4. Environmental monitoring: HHAPs may include environmental monitoring of temperature, humidity, and other meteorological factors. Monitoring stations strategically placed across different areas provide real-time data on local weather conditions, helping to identify and respond to heatwave events promptly.

2.5. Data sharing and collaboration: Effective risk assessment and monitoring within HHAPs require collaboration and data sharing among various stakeholders, including public health agencies, meteorological departments, environmental agencies, and healthcare providers. Sharing relevant data and information allows for a comprehensive understanding of the risks and supports evidence-based decision-making.

By conducting risk assessments and implementing monitoring systems, HHAPs can identify vulnerable populations and areas, monitor the health impacts of extreme heat, and take proactive measures to protect public health during heatwave events. These actions contribute to reducing the overall health risks associated with extreme heat and improving the resilience of communities.

3. Communication and public outreach: HHAPs emphasize the importance of effective communication and public education to raise awareness about the risks of extreme heat and provide guidance on protective measures. This includes disseminating heatwave alerts, heat safety messages, and information on cooling centers or other available resources.

Communication and public outreach are critical components of Heat-Health Action Plans (HHAPs) to raise awareness, provide guidance, and ensure that the public and relevant stakeholders have access to vital information during extreme heat events. Here are key aspects of communication and public outreach within HHAPs:

3.1. Public awareness campaigns: HHAPs include public awareness campaigns aimed at educating individuals and communities about the risks associated with extreme heat and promoting protective measures. These campaigns may involve the distribution of informational materials, public service announcements, social media campaigns, and community engagement events.

3.2. Heatwave alerts and warnings: HHAPs establish systems to issue heatwave alerts and warnings to the public. These alerts are typically based on meteorological thresholds and trigger appropriate actions. They are disseminated through various channels, including media outlets, official websites, social media platforms, mobile applications, and emergency notification systems.

3.3. Heat safety information: HHAPs provide clear and concise information on heat safety measures to help individuals protect themselves during heatwave events. This information includes guidance on staying hydrated, seeking shade or cool places, wearing appropriate clothing, using sunscreen, and recognizing the signs of heat-related illnesses. It is disseminated through multiple communication channels and targeted to reach diverse populations.

3.4. Collaboration with healthcare providers and community organizations: HHAPs foster collaboration with healthcare providers, community organizations, and other stakeholders to ensure that heat health messages are effectively communicated. Healthcare providers play a crucial role in delivering heat safety information to their patients, especially those at higher risk. Community organizations can help disseminate information within their networks and provide support to vulnerable populations.

3.5. Language and accessibility considerations: HHAPs recognize the importance of language and accessibility in communication efforts. Information and resources are made available in multiple languages to cater to diverse communities. Efforts are made to ensure that the information is accessible to individuals with disabilities, including providing materials in alternative formats and utilizing accessible communication channels.

3.6. Evaluation and feedback: HHAPs incorporate mechanisms for evaluating the effectiveness of communication strategies and collecting feedback from the public. This feedback helps refine communication efforts and ensure that messages are reaching the intended audience effectively.

By implementing robust communication and public outreach strategies, HHAPs aim to increase public awareness, empower individuals to take appropriate actions during heatwave events, and foster community resilience. Effective communication plays a vital role in preventing heat-related illnesses and reducing the overall health impacts of extreme heat.

4. Coordination and collaboration: HHAPs promote collaboration among various stakeholders, such as public health agencies, emergency management departments, healthcare providers, social services, community organizations, and meteorological agencies. This collaboration ensures a coordinated response and enhances the effectiveness of heat-health interventions.

Coordination and collaboration are crucial aspects of Heat-Health Action Plans (HHAPs) to ensure a comprehensive and effective response to extreme heat events. Here are key elements of coordination and collaboration within HHAPs:

4.1 Multi-sectoral collaboration: HHAPs involve collaboration among various sectors and stakeholders, including government agencies, public health departments, emergency management organizations, meteorological services, healthcare providers, community organizations, social services, and academia. Each sector brings its expertise and resources to collectively address the challenges of extreme heat.

4.2 Ιnteragency coordination: HHAPs establish mechanisms for interagency coordination to ensure a cohesive and synchronized response. This coordination involves regular communication, information sharing, and collaboration among different agencies responsible for health, emergency management, meteorology, environmental protection, and other relevant sectors. It helps align efforts, avoid duplication, and optimize resource allocation. 

4.3. Data sharing and integration: HHAPs emphasize the importance of data sharing and integration among different agencies and organizations. Sharing meteorological, health, and vulnerability data enables a comprehensive understanding of the risks and helps inform decision-making. Integrated data systems allow for real-time monitoring, early warning systems, and effective response coordination.

4.4. Stakeholder engagement: HHAPs actively engage stakeholders in the development, implementation, and evaluation of the plan. This includes engaging community organizations, advocacy groups, businesses, educational institutions, and the public. Stakeholder engagement ensures that diverse perspectives and needs are considered, builds trust, and fosters ownership of the plan within the community.

4.5 Clear roles and responsibilities: HHAPs clarify the roles and responsibilities of different agencies and organizations involved in the response to extreme heat events. This includes identifying lead agencies, defining specific tasks and functions, and establishing protocols for communication and decision-making. Clear delineation of roles promotes efficient and coordinated actions during heatwave events.

4.6. Joint exercises and drills: HHAPs may include joint exercises and drills involving relevant stakeholders to test response capabilities and enhance coordination. These exercises simulate heatwave scenarios and allow agencies to practice their roles, test communication channels, identify gaps, and refine response plans. Regular exercises promote coordination and improve response readiness.

4.7 Information sharing platforms: HHAPs establish platforms for sharing information and resources among stakeholders. This may include dedicated websites, portals, or communication channels where agencies can access up-to-date information, guidelines, best practices, and resources. Information sharing platforms facilitate coordination, ensure consistency in messaging, and promote collaboration.

By promoting coordination and collaboration, HHAPs leverage the collective efforts and expertise of various stakeholders to effectively respond to extreme heat events. Collaboration helps streamline actions, optimize resource utilization, enhance community resilience, and reduce the health impacts of extreme heat.

5. Heatwave response and intervention strategies: HHAPs outline specific actions and interventions to be implemented during heatwave events. These may include increasing the availability of cooling centers, modifying working hours or practices in outdoor industries, providing additional support to vulnerable populations (such as the elderly, children, and those with chronic illnesses), and ensuring access to safe water and sanitation.

Heatwave response and intervention strategies are integral components of Heat-Health Action Plans (HHAPs) designed to protect individuals and communities during extreme heat events. These strategies aim to reduce heat-related health risks and promote resilience. Here are key elements of heatwave response and intervention strategies within HHAPs:

5.1. Cooling centers and shelters: HHAPs often establish cooling centers or shelters in areas where vulnerable populations reside or congregate. These facilities provide a safe and cool environment during heatwave events, offering respite from high temperatures for those who may not have access to air conditioning or suitable living conditions. Cooling centers may also provide hydration stations and essential services.

5.2. Public communication and education: HHAPs prioritize public communication and education campaigns to raise awareness about heat-related risks and promote preventive measures. These campaigns may involve disseminating heat safety information through various channels, including social media, websites, public service announcements, and community outreach activities. The aim is to inform individuals about the importance of staying hydrated, seeking shade, wearing appropriate clothing, and recognizing heat-related illnesses.

5.3. Modifying work practices and schedules: HHAPs may recommend or enforce modifications to work practices and schedules during extreme heat events, particularly for outdoor occupations. This may involve adjusting working hours to avoid peak heat, providing shaded areas or rest breaks, and implementing heat safety protocols in industries like construction, agriculture, and outdoor labor. These measures help reduce occupational heat stress and protect workers' health.

5.4. Vulnerable population support: HHAPs focus on providing targeted support to vulnerable populations, such as the elderly, children, pregnant women, individuals with chronic illnesses, and low-income communities. This may include outreach programs, home visits, and collaborations with social services to ensure individuals have access to necessary resources, including fans, air conditioners, and transportation to cooling centers.

5.5. Emergency medical services: HHAPs emphasize the availability of emergency medical services during heatwave events. This includes ensuring adequate staffing of emergency rooms, ambulances, and other healthcare facilities to address heat-related illnesses. Protocols may be established for early recognition, assessment, and treatment of heat-related conditions to prevent complications and reduce the impact on the healthcare system.

5.6. Green infrastructure and urban planning: HHAPs may incorporate strategies related to green infrastructure and urban planning to mitigate the urban heat island effect. These strategies include increasing green spaces, implementing cool roof initiatives, promoting tree planting, and improving urban design to enhance shade and airflow. Such measures can help reduce local temperatures and provide natural cooling during heatwave events.

5.7. Collaboration with community organizations: HHAPs collaborate with community organizations, non-profit groups, and faith-based organizations to ensure a comprehensive response. These partnerships facilitate the dissemination of heat safety information, the identification of vulnerable individuals, and the provision of support services during extreme heat events.

By implementing these heatwave response and intervention strategies, HHAPs aim to reduce heat-related morbidity and mortality, enhance community resilience, and promote the well-being of individuals during extreme heat events.

It's important to note that the specific details of HHAPs can vary depending on the geographical location and the severity of heatwave risks. Therefore, it's recommended to refer to the HHAPs developed by your local or national authorities to understand the specific measures and strategies in place for your region.

Survey responses: status of HHAP governance

The governance of HHAPs can be examined further by comparing national and regional approaches and published examples of current practices. 

One such comparison was undertaken in a survey conducted by the WHO Regional Office for Europe in 2019, which investigated governance and institutional arrangements for HHAPs. This survey of HHAP administrators, national and local focal points and experts is the most comprehensive effort to date by WHO to assess the status of public health preparedness for high temperatures in the Region.

The survey featured several sets of questions to mine information on HHAPs established at each national, subnational or local level. The definition used for the existence of an HHAP was that (i) the document title stated that it specifically addressed heat-wave response, and (ii) it was approved as a formal document. Of a total of 35 countries participating in the survey:

16 indicated the existence of a national HHAP (Austria, Belgium, Croatia, France, Germany, Hungary, Italy, Malta, the Netherlands, North Macedonia, Portugal, Slovenia, Spain, Sweden, Switzerland and the United Kingdom);
• 10 indicated, explicitly, that they did not have a national HHAP in place (Denmark, Cyprus, Estonia, Finland, Israel, Montenegro, Norway, Poland, Serbia and Turkmenistan);
• 6 indicated the existence of subnational HHAPs (Belarus, Belgium, Czechia, Italy, Spain and Switzerland);

• 10 indicated the existence of local HHAPs (Albania, Belgium, Bulgaria, Germany, Greece, Kazakhstan, Lithuania, the Netherlands, the Russian Federation and Ukraine).
This report presents an analysis of the 16 responses from countries with national HHAPs in terms of implementation of the elements recommended by the framework of the 2008 WHO guidance (Matthies et al., 2008).
While management practices at one location or setting may not be applicable elsewhere due to the range of different health systems and their organization across the Region, the findings of the survey provide valuable insights. Longer-term evaluations of a number of governance approaches are needed to show whether the examples in place are indeed best practices.

2.2.1 Economic and human resources

Several HHAPs in the Region are not adequately resourced. Among the 16 countries that reported the existence of a national HHAP, only 37% of the survey respondents thought that their HHAPs were supported by the necessary financial and human resources, whereas 56% said those resources were insufficient. Areas where respondents felt that most resources were needed to include training for staff in hospitals, nursing homes and care centres for homeless people; helping vulnerable people at home; adapting schools to heat; locating the most isolated people; and conducting research on epidemiology and prevention.
Most national HHAPs (almost 90%) were funded through internal allocation of resources from the lead agency’s own budget; only 10% received earmarked funding from parent organizations or external budgets (such as those for climate change adaptation) for operation of the HHAP. The idea that more  resources were needed to reduce risk in domestic and care settings was a recurrent one, as was (in cases where resources were deemed insufficient) that idea the lack of resources could even threaten the continuity of the HHAPs themselves.
Yet investing in public health is demonstrably good business. Interventions that address the environmental and social determinants of health, build  resilience and promote healthy behaviours are shown to be particularly cost-effective (WHO Regional Office for Europe, 2015). HHAPs are a good example of this, yielding high economic benefits compared to their costs. In a recent assessment, cost–benefit ratios for existing heat-wave warning systems in Europe were estimated at 11 times the amount invested for London, United Kingdom, 308 times for Prague, Czechia, and 913 times for Madrid, Spain; those ratios increased extensively in the near future under all climate scenarios (Hunt et al., 2017).
Indeed, human health costs from climate change – and specifically those from increased heat – constitute a large proportion of the calculated economic impacts from climate change in Europe (Ciscar et al., 2014).

2.2.2 Actors, roles and responsibilities

Asked about the status of implementation of the core elements of their national HHAPs, almost 100% of the survey respondents assessed their designation of a “lead agency” as fully or partly implemented. Those who assessed implementation as partial were mostly countries that have devolved HHAP implementation to subnational authorities (provinces, Länders, cities, municipalities or cantons in Austria, Belgium, Germany, Malta, Slovenia, Sweden and Switzerland), and thus do not have designated lead response agencies at the national or federal level. Most also listed multiple subnational activities or systems for heat–health prevention at the subnational level, with which they coordinated.
Most HHAPs specify roles and responsibilities for national and federal authorities (exceptions are made for fully decentralized systems).
Meteorological agencies are generally in charge of issuing heat warnings and informing the agency leading the health response (usually a national public health agency or ministry of health; sometimes a subnational health agency).
Almost 70% of national HHAPs also specify roles and responsibilities for subnational authorities, but the level of such specification decreases as implementation gets closer to the target populations, with 56% for local or city authorities and 38% for other stakeholders (including nongovernmental organizations (NGOs) such as the Red Cross/Red Crescent) – see Fig. 4.