Health Protection through Adaptation and Resilience

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Health Protection through Adaptation and
Resilience
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Overview

• Climate change gradual change plus sudden
  events
• Adaptation and resilience
• Community health sector resilience
• Physical vs organisational measures
• Long-term planning vs response to events
• A framework for adaptation in health
• Examples from heatwaves and flooding

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Climate change gradual change sudden events

• Flooding, windstorms
• Vector-borne diseases
• Foodborne disease
• Waterborne disease
• Direct effects of rising temperatures
• Changes in air pollution
• Ultraviolet radiation

• The major areas identified in Health Effects of
  Climate Change in the UK, 2001/02 updated 2008

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• Adaptation Any adjustment in natural or human
  systems in response to actual or expected
  climatic stimuli or their effects, which
  moderates harm or exploits beneficial
  opportunities.
• Glossary of Terms used in the IPCC Fourth
  Assessment Report
• Resilience is the capacity of a system to absorb
  disturbance and reorganise while undergoing
  change, so as to still retain essentially the
  same function, structure, identity and
  feedbacks.
• Hopkins, R. (2008) The Transition Handbook. Green
  Books Ltd. (p.54)

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Are our health systems climate resilient?Hospital
impacts of heatwaves stories from the press

• Nurses and administrative staff walked out in
  protest at high temperatures in brand-new PFI
  hospital "We can't work in this- we're suffering
  from heat exhaustion and everything
• Angry relatives claimed hospital could not
  provide for its most vulnerable patients. People
  on strict nil by mouth diet were left to lie in
  pools of their own sweat without ice and proper
  air conditioning as their limbs swelled in the
  heat
• Hospital facing demands for an enquiry into how
  vital equipment was allowed to break down during
  recent heat-wave, forcing the cancellation of
  scores of operations
• Public Health (Pathology) Laboratory stopped work
  - machines failed in heat.
• Nurses on cardiac ward were in tears at their
  inability to keep patients as cool as they should
  have been
• Drugs may be vulnerable to extreme temperatures
  in summer  

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Scenario

• A mighty storm high winds, flooding, disruption
  to energy and transport networks
• Can you describe a resilient community?
• a resilient healthcare system?
• (physical organisational features)

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Health protection (adaptation)
Climate events
Know the projections

• PLANNING FOR RESPONSE TO ACUTE EVENTS
• Community response
• Emergency social services
• Healthcare systems

Understand the health implications
Health impacts
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Health protection (adaptation)
Climate events
LONG TERM PLANNING

• PLANNING FOR RESPONSE TO ACUTE EVENTS

• We need to get better at this!
• Engage with economic, transport spatial
  planning
• Use of health impact assessment

Health impacts
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A possible adaptation framework for health

• Research
• Scoping studies, health impact /adaptation
  assessments, climate scenarios, Risk assessment
  communication
• Data collection
• Surveillance monitoring early warning systems,
  forecasting, health indicators, predictive models
  
• Changing standards/developing plans
• Building design, heatwave plan, flood response,
  public health programmes
• Organisational development
• Sustainable Development (Good Corporate
  Citizenship)
• Partnership working
• Reflects cross disciplinary working
• Accept impacts
• Include climate risk costs into health policy
• Exploit opportunities
• Health benefits of climate change and climate
  policies

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Research climate scenarios

• UKCIP provides climate change scenarios
• Based on scenario UKCIP02 (to be updated as
• UKCIP08 and launched in Spring 2009), England
• is likely to face
• Hotter drier summers
• Milder wetter winters
• A significant decrease in soil moisture content
• More frequent extreme high temperatures
• More frequent extreme winter precipitation
• Increased storminess and wind speeds in winter
• Net sea level rise and increase in sea storm
  surge height

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Research health impact/ adaptation assessment

• Need to integrate into mainstream policy
• Stakeholder involvement is key
• Identifies adverse effects on human health
• Identifies vulnerable groups to target adaptation
  
• Also identifies opportunities

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Surveillance

• Provide early warning systems trend data
• Assess magnitude of impacts
• Provide research data on
• climate variables
• social conditions
• health indicators
• Improve predictive models to suggest vulnerable
  regions
• Evaluate adaptation strategies

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Possible surveillance and monitoring systems
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Surveillance using heatwaves as an example

• Of the temperature
• Of health impact
• Mortality
• Morbidity
• Health service use
• Syndromic

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Syndromic surveillance

• Pre laboratory/ confirmed diagnosis
• Early warning using real-time data
• Has received boost since bioterrorist concerns
• Many sub national schemes in the world few
  national
• Alternative utilities

Syndromic surveillance the analysis of medical
data to detect or anticipate disease outbreaks.
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Syndromic surveillance for climatic events

• Deaths
• Hospitalisations
• GP consultations
• Tele health calls ( e.g. NHS Direct)

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Heat health watch NHS Direct surveillance as an
example
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Heatwave calls
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Mortality in England during 2003 heat wave
Johnson et al.2005. Hlth Stats Q
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Developing plansGeneral principles for heat
action plans (WHO-Euroheat)

• Use existing systems and link to general
  emergency response arrangements
• Adopt a long term approach
• Be broad
• Communicate effectively
• Responses to heat-waves should not exacerbate
  climate change
• Evaluation essential

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Eight core elements of heat action plans (WHO)

• Agree a lead body
• To coordinate multi agency collaboration and to
  direct the response
• Accurate and timely alerting systems
• Heat Health Warning Systems - HHWS. To trigger
  warnings, determine action thresholds and
  communicate risks
• Reduce indoor heat exposure (medium and short
  term)
• Particular care for vulnerable population groups
• Preparedness of the health and social care system
• Staff training and planning, appropriate health
  care and the physical environment
• Heat-related health information plan
• what is communicated, to whom and when
• Long-term urban planning
• building design, energy and transport policies
• Real time surveillance and evaluation

The Climate Connection Integrate into fuel
poverty/ housing programmes, use Housing Health
Safety Rating System (HHSRS)?
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The Heatwave Plan for England

• Traffic light Heat-Health Watch system defines
  four levels of response
• Level ONE Summer preparedness and long-term
  planning
• Level TWO Alert and readiness
• Level THREE Heatwave action
• Level FOUR Heatwave emergency
• sets out responsibilities of health, social
  services other bodies to raise awareness of
  risks relating to severe hot weather
• spells out responsibilities at national and local
  level for alerting people once a heatwave
  forecast advising what to do during a heatwave

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Heatwaves long term planning
Managing high temperatures strategies
available at catchment scale neighbourhood
scale building scale
Shaw, R., Colley, M., and Connell, R. (2007)
Climate change adaptation by design a guide for
sustainable communities. TCPA, London
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Heatwaves long term planning
Chiswick Park, West London Solar gain is
minimised by planting large, semi-mature trees
and fixing external shades Photo by permission
of Rogers Stirk Harbour Partners
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Heatwaves long term planning

• Heat resilience measures need to be applied to
  existing as well as new build how can this be
  achieved??

• Through integration with fuel poverty programmes?
• Through application of the Housing Health and
  Safety Rating System?
• Your ideas?

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Second exampleflooding

• Pitt review 2008 - Lessons learned from the
  2007floods escalation of flooding risk and
  need for better flood resilience
• Emergency Preparedness Division - Preparedness
  for floods - Report on the lessons learned from
  the Summer 2007 flooding experiences from an
  Estates Facilities perspective
• HPA Guidelines-Information for residents whose
  homes have been flooded http//www.hpa.org.uk/floo
  ding/guidance.htm
• General advice on protecting against infection,
  specific advice about returning to a flooded
  home, electricals, drinking water, food
  preparation and storage
• The National Flood Forum- http//www.floodforum.or
  g.uk/
• Foresight Report into Flood and Coastal Defence,
  April 2004 - biggest health impacts from
  pollutants, foul water and mental health

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Flooding summer 2007

• Pitt Report learning lessons from the flooding
  2007
• Initiated by the Cabinet Office
• Review of the multiagency response
• Causes and consequences of the flooding
• 92 Recommendations!
• Change in society to take flooding and natural
  hazards more seriously
• http//www.cabinetoffice.gov.uk/thepittreview.aspx
  

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Health impacts of flooding - acute

• Chemical biological
• Release of pathogens from sewage treatment works
• Infectious disease
• Leptospirosis?
• Local sources of chemical contamination e.g.,
  COMAH sites
• Local risk assessment required
• Development of a risk assessment framework for
  potential chemical contamination during flood
  events
• CHaP report, Issue 12 May 2008
• http//www.hpa.org.uk/webw/HPAwebHPAwebStandard/H
  PAweb_C/1211266315288?p1158945066435

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Health impacts of flooding - acute

• Disruption to water and power supplies
• Access to clean drinking water
• Feeding bottle-fed babies
• Hygiene issues
• Clean-up
• Access to food (fridge and freezers?)
• Contamination of food in the home
• Summer vs winter flooding cold?
• Carbon monoxide use of generators in the home

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Health impacts of flooding - acute

• Vulnerable groups
• Old, families with young children infants,
  those with existing health problems
• May need access to medical care, medication,
  dialysis
• Will you need to evacuate?

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Health impacts of flooding medium-term

• Carbon monoxide
• Clean-up
• Contact with contaminated surfaces and sludges
• Use of chemicals to clean the home
• Leaks of chemicals in the home
• Soft tissue injuries becoming infected during
  clean up

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Health impacts of flooding medium-term

• Waste management
• Displacement
• Access to health care services
• Environmental concerns
• Safety of allotment-grown food after a flood
• Safety of playing fields
• Local risk assessments required, local sources of
  potential contamination important

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Health impacts of flooding long-term

• Increase in all-cause mortality (Bristol study)
• Health effects of damp housing
• Mould
• Respiratory illness
• Psychosocial
• Anxiety, stress, depression, relationship
  problems, displacement of communities and families

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Psychosocial needs flooding

• Epidemiological evidence that common mental
  disorders and PTSD increase after floods
• Pitt Review and media coverage highlighted
  anxiety and stress, but also fear, anger and
  resentment in flood victims
• Anecdotal evidence of increase in mental health
  issues from local authorities and PCTs
• Interventions need to be managed appropriately to
  protect long-term mental health

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Flooding surveillance July-August 2007
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Flooding surveillance NHS Direct/GP data 2007
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Flooding long term planning
Managing flood risk - strategies available
at catchment scale neighbourhood scale building
scale
Shaw, R., Colley, M., and Connell, R. (2007)
Climate change adaptation by design a guide for
sustainable communities. TCPA, London
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Flooding long term planning
Water detention basin
Permeable paving
Green roof
Neighbourhood scale sustainable urban
drainage Photos SUDSnet, University of Abertay
Dundee
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Flooding long term planning
Neighbourhood scale Malmo, Sweden An open water
system retains 70 of all rainfall onto the
site. Photo by Louise Lundberg, Scandinavian
Green Roof Institute
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Conclusions

• Key medium term concerns for the UK
• Floods
• Heatwaves
• Public health infrastructure and information
• Awareness of climate projections is core
  knowledge for Public Health
• Research and surveillance of health impacts is
  required
• Long term planning is as important as response to
  acute events

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References

• Health Effects of Climate Change in the UK
  (2001/02 updated 2008). Department of Health /
  Health Protection Agency
• UK Climate Impacts Programme (UKCIP)
  http//www.ukcip.org.uk/
• Heat-Health Action Plans Guidance (2008). WHO
  Euroheat http//www.euro.who.int/globalchange/Topi
  cs/20080403_2
• Heatwave plan for England (2008) Department of
  Health
• Shaw, R., Colley, M., and Connell, R. (2007)
  Climate change adaptation by design a guide for
  sustainable communities. TCPA, London
• Pitt review 2008 - Lessons learned from the
  2007 floods
• Slowing the flow a natural solution to flooding
  problems WWF Scotland

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The Climate Connection is a partnership for
public health action on climate change
The Climate Connection, c/o UKPHA, 94 White Lion
St, London N1 9PF UKPHA registered charity number
1078147 www.theclimateconnection.org