Module 5: Reductions in heat exposure: types of intervention and evidence of effectiveness

3.1         Introduction

There is substantial literature and good practices on how to address or prevent heat-related health effects. However, the literature on the evidence of these interventions is poor. At the same time, a lot is developed and being implemented at three levels on which one can address climate change-related health problems: at the individual level (micro), at the level of the building or the organisation (meso) and at the level of the community/municipality (macro).  Besides these three levels, we also distinguish interventions aimed at the short term (in order to reduce the health risks at periods of extreme heat) and aimed at the long term (in order to prevent health risks at periods of extreme heat). 

Nowadays, heat health action plans (HHAPs) are developed and implemented by both national and local governments. HHAPs are supposed to provide tailored advice, implement specific prevention measures and actively monitor those during heat waves and to evaluate the results and adapt the action plan according to these results. 

3.2         Interventions at the Individual and interpersonal level

At the individual level interventions to treat illnesses related to heat are aimed at adaptive behavior and the introduction of products that stimulate cooling (see also table 3.1). But actually, we want them to prevent, but also, in that case, adaptive behavior is crucial: search for shadow places (in the house or cool spots in the neighbourhood), wear light clothes, drink enough/extra, cool scarfs, open the windows at night and close them during days, stay inside the building, use shutters inside/outside, look after each other). Besides that, providing information and giving advice are important interventions too. Neighbours, family, caretakers and care providers play an active role in all interventions as mentioned.

Nb Maybe we can integrate parts from the interview with the elderly and the focus group with eldery some cases as an illustration

 Table 3.1             Spectrum of heat-related illnesses and their treatment

Source: Sorensen, C., Hess, J  (2022). Treatment and Prevention of Heat-Related Illness. In:  N Engl J Med 2022; 387:1404-1413

 3.3.  Interventions in the physical (building and dwelling) environment

Exposure to heat happens frequently indoors. Indoor exposure to overheating occurs through a combination of building and dwelling characteristics, occupancy profiles and behavioural factors.  While some of the characteristics of a building that can lead to overheating cannot be modified (such as the location), there are significant possibilities to prevent or decrease the chance of overheating. Passive cooling interventions such as solar shading, opening the windows at night, cooling by air through narrow openings in the building, shading of the roof, and cooling by vaporising water can result in health protection from heat while minimizing energy consumption.  A wide range of active cooling technologies is available. Air conditioning is very effective but has a number of drawbacks, including equity of access and environmental and social impacts, and may be a clear example of a non-sustainable technology. The promotion of sustainable technologies is recommended.

 3.4   Interventions taken by Care and welfare organisations

Residences and care organisations have heat health plans in order to guide their professionals in taking good care of people and themselves during periods of (extreme) heat. Health professionals should be alert to heat illness risk factors, diagnosis and management. But also interventions on buildings and the built environment are options they use to protect their professionals and patients from heat. In general, the promotion of a sustainable health care system/organisation may in the long term be the most effective scenario. 

 3.5   Heat health action plans by the (local) Government

Heat health action plans are available at the local, regional and national levels. They are also related to each other (As figure 3.1 illustrates).

Insert here figure 5 (page 29 from WHO report) here

Heat health action plans should be linked with climate change policies as well as with disaster/emergency response policies, environmental policies and health policies. This may result in more synergy and gains. For example, urban management interventions such as developing green spaces reduce thermal stress and are therefore good examples of how it relates to public health benefits. Tools for intersectoral action are lacking to allow public health agencies to influence urban management decisions in order to protect health from heat. In a Heat health action plan, all activities are combined in a coordinated way. Both activities in case of immediate action as activities to prevent heat-related effects from happening.

Insert table 2 (page 42 WHO report)  here!!

 

Tasks:

Obligatory:

Sorensen, C., Hess, J  (2022). Treatment and Prevention of Heat-Related Illness. In:  N Engl J Med 2022; 387:1404-1413. gure 5 (page 29 WHO report) at this paragraph.

Chapters 5 and 7 from the WHO Report Heat and 

Health in the WHO European Region: updated evidence for effective prevention (2021). https://www.who.int/europe/publications/i/item/9789289055406

 Suggestion:

https://www.ipcc.ch/report/ar6/wg2/chapter/chapter-7