Elsevier

Maturitas

Volume 64, Issue 2, 20 October 2009, Pages 98-103
Maturitas

Review
Preventing heat-related morbidity and mortality: New approaches in a changing climate

https://doi.org/10.1016/j.maturitas.2009.08.005Get rights and content

Abstract

Due to global climate change, the world will, on average, experience a higher number of heat waves, and the intensity and length of these heat waves is projected to increase. Knowledge about the implications of heat exposure to human health is growing, with excess mortality and illness occurring during hot weather in diverse regions. Certain groups, including the elderly, the urban poor, and those with chronic health conditions, are at higher risk. Preventive actions include: establishing heat wave warning systems; making cool environments available (through air conditioning or other means); public education; planting trees and other vegetation; and modifying the built environment to provide proper ventilation and use materials and colors that reduce heat build-up and optimize thermal comfort. However, to inspire local prevention activities, easily understood information about the strategies’ benefits needs to be incorporated into decision tools. Integrating heat health information into a comprehensive adaptation planning process can alert local decision-makers to extreme heat risks and provide information necessary to choose strategies that yield the largest health improvements and cost savings. Tools to enable this include web-based programs that illustrate effective methods for including heat health in comprehensive local-level adaptation planning; calculate costs and benefits of several activities; maps showing zones of high potential heat exposure and vulnerable populations in a local area; and public awareness materials and training for implementing preventive activities. A new computer-based decision tool will enable local estimates of heat-related health effects and potential savings from implementing a range of prevention strategies.

Introduction

Heat-related mortality and morbidity occurs across industrialized and less developed nations. Heat-related mortality disproportionately affects lower socioeconomic status individuals, those without access to indoor air conditioning and the elderly [1]. With climate change, concern about increasing duration, intensity and frequency of heat waves [2] has added to the urgency of preparing properly to protect health during hot weather. This paper briefly reviews epidemiologic evidence on links between heat exposure and adverse health outcomes, discusses options for prevention of such outcomes, and describes the role of local authorities in implementing preventive activities. Next, we present an approach for developing a computer-based decision tool to enable local authorities to estimate how heat might impact the health of residents and to choose a range of potential strategies for mitigating these effects.

Section snippets

The epidemiology of heat and health

Excess mortality during hot weather has been reported in several epidemiological studies, and recent reviews assess that literature and the less extensive body of work on other health outcomes [1], [3], [4]. Other reports show associations between heat exposure and cause-specific hospital admissions [5], [6], [7], but these can be inconsistent with the mortality associations in the same communities [8], [9]. The heat-related epidemiology literature has utilized case–control, case-crossover,

Heat health warning systems

The differences between communities in terms of climate, geography, and demographics illustrate the need for locally tailored, short- and long-term intervention strategies. After the heat waves in Chicago during the 1990s and France during 2003 and 2006, improved access to cooling centers, increased air conditioning prevalence, and heat health warning systems have been implemented. A heat health warning system is a ‘system that uses meteorological forecasts to initiate acute public health

Decision tools

Decision tools can help communities better understand location-specific heat-health associations and vulnerabilities, and the available infrastructure for implementing prevention programs. Such tools ideally allow for use of community-specific information on heat-health associations, population characteristics, settlement patterns, transportation, energy use, climate and other factors.

A new decision tool for developing local heat illness prevention programs

As part of a similar multi-disciplinary collaboration between researchers and local governments, we propose to integrate information about heat health vulnerability, risk and adaptation options into a new computer-based interactive tool designed to guide local governments through a comprehensive adaptation planning and implementation process. This new tool, being developed by International Council for Local Environmental Initiatives (ICLEI)-Local Governments for Sustainability USA and

Discussion and conclusions

Ample evidence exists that exposure to high temperatures can result in a variety of adverse health effects, including death, and preventing such effects requires a range of intervention types. With climate change increasing the frequency of hot weather, among other effects, multiple collaborations worldwide are attempting to apply research results to prevention efforts that are both sustainable and effective at the local level.

Some of the challenges inherent in this type of work, and

Author contributions

All authors participated in the paper with contributions detailed next. Marie O’Neill, Jonathan Kish, Carina Gronlund and Jalonne White-Newsome made the first draft of the manuscript and prepared the figures. Rebecca Carter developed Table 1. Xico Manarolla, Rebecca Carter, Joel Schwartz and Antonella Zanobetti participated with the rest of the team in structuring the paper and developing the ideas described in the manuscript. All authors provided comments and suggestions and assisted with

Competing interest

All authors have seen and approved the final version and none of the authors have conflicts of interest to declare.

Funding information

Funding was provided by U.S. Environmental Protection Agency Science to Achieve Results (STAR) Program grant R832752010, and 1R18EH00348-01 from the U.S. Centers for Disease Control and Prevention, and the Graham Environmental Sustainability Institute at University of Michigan.

Provenance

Commissioned and externally peer reviewed.

References (50)

  • A. Costello

    Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission

    Lancet

    (2009)
  • P.L. Kinney et al.

    Approaches for estimating effects of climate change on heat-related deaths: challenges and opportunities

    Environ Sci Policy

    (2008)
  • R.S. Kovats et al.

    Heat stress and public health: a critical review

    Annu Rev Public Health

    (2008)
  • G.A. Meehl et al.

    More intense, more frequent, and longer lasting heat waves in the 21st century

    Science

    (2004)
  • S. Gosling et al.

    Associations between elevated atmospheric temperature and human mortality: a critical review of the literature

    Climate Change

    (2009)
  • M. O’Neill et al.

    Temperature extremes and health: impacts of climate variability and change in the United States

    J Occup Environ Med

    (2009)
  • K. Knowlton et al.

    The 2006 California heat wave: impacts on hospitalizations and emergency department visits

    Environ Health Perspect

    (2009)
  • P. Michelozzi et al.

    High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities

    Am J Resp Crit Care Med

    (2009)
  • A.L. Hansen

    The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia

    Int J Epidemiol

    (2008)
  • M. Nitschke et al.

    Morbidity and mortality during heatwaves in metropolitan Adelaide

    Med J Aust

    (2007)
  • R.S. Kovats et al.

    Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK

    Occup Environ Med

    (2004)
  • H. Frumkin et al.

    Climate change: the public health response

    Am J Public Health

    (2008)
  • A.J. McMichael

    International study of temperature, heat and urban mortality: the ‘ISOTHURM’ project

    Int J Epidemiol

    (2008)
  • P. Michelozzi et al.

    Temperature and summer mortality: geographical and temporal variations in four Italian cities

    J Epidemiol Commun Health

    (2006)
  • M.L. Bell

    Vulnerability to heat-related mortality in Latin America: a case–crossover study in Sao Paulo, Brazil, Santiago, Chile and Mexico City, Mexico

    Int J Epidemiol

    (2008)
  • Cited by (117)

    • Hot Days, the ability to Work and climate resilience: Evidence from a representative sample of 42,152 Indian households

      2022, Journal of Development Economics
      Citation Excerpt :

      The negative and significant coefficient on the interaction term in column 3 points again to electricity in the home having an important protective benefit. Much emphasis has been put on the role that cooling equipment might play in protecting individuals and populations against various impacts of high temperature including morbidity (O’Neill et al., 2009), mortality (Barreca et al., 2016), learning (Park et al., 2020) and student exam performance (Park, 2017). Barreca et al. (2016), for example, show that state-by-decade rates of air-conditioning penetration in the US predict the decline in the excess mortality caused by hot days.

    View all citing articles on Scopus
    View full text