The passive dissemination of advice on heat avoidance is insufficient for health protection during a heat wave, and vulnerable people need to be actively identified and cared for, argues a public health expert in this week's BMJ.
This summer Europe has again been affected by a major heat wave, writes Sari Kovats of the London School of Hygiene and Tropical Medicine. The UK has recently had its hottest month since records began in 1660 and England triggered its heat wave response plan for the first time. Yet little research has been carried out on the social and environmental determinants of heat-related mortality.
The elderly, the socially isolated, and those with heart conditions, diabetes or mental illness are among those at greatest risk of death during a heat wave.
Following the heat wave in 2003, public health measures implemented in Europe have centred almost exclusively on heat health warning systems that forecast high risk weather conditions to trigger public warnings. But, so far, no heat health system has been formally evaluated and the effectiveness of individual interventions is unknown, says Kovats.
The impact of heat waves also reveals important lessons about the care of the elderly and dispossessed in our society - both in the community and in social care, she writes. One of the striking things about the heat wave in France in 2003 was that the high mortality went undetected for so long. In the UK, several indicators of heat morbidity are now monitored routinely using data from GP practices and NHS Direct.
The EUROHEAT network, coordinated by World Health Organisation in Rome, and funded by the European Commission, is also developing good practice for health protection during heat waves as more countries develop heat health warning systems.
But an inter-agency approach is needed, she says. Heat wave systems also need to be better integrated within the disaster response agencies. Heat stress is also an occupational health problem, and health and safety agencies need to be prepared for the impact of hotter summers.
London's mayor is being particularly proactive with regard to climate change, and is developing a statutory adaptation strategy to ensure that the infrastructure is appropriate for future climates.
Climate change needs to be taken into account in health protection in Europe, she argues. It would be tragic if the main response to hotter summers is to install inefficient air conditioning and to miss the opportunity to develop effective and more equitable health protection measures for extreme weather, she concludes.