The heat is on

By Professor Jim McManus | 08 August 2022

The recent unprecedented heat tested us and our infrastructure to a limit we have not experienced before. Local councils implemented their emergency plans, some schools closed and there was widespread disruption to transport and business as people grappled to cope in temperatures that soared to the highest ever seen in the UK.

Directors of public health and their teams worked hard alongside colleagues in councils, the NHS, and the community to implement the Government’s heatwave response and disseminate key messages to help keep residents safe.

There was widespread sunburn, dehydration and heat exhaustion. This type of immediate heat-related illness can, largely be mitigated by ongoing public messaging about the benefits of staying out of the sun, changing routines, using sunscreen and increasing water intake. There are other adaptations which can be implemented, such as buildings being fitted with air conditioning and more trees planted in urban areas to cool the environment.

It just takes a quick look at hotter climes to see what other types of illness the future could hold. Changes in the climate will result in changes in vegetation and crop growth which could lead to shortages of certain foods and possibly greater incidence of malnutrition. Changes in rain patterns will create conditions where water-borne diseases thrive. Higher temperatures will cause the tick population to grow, having a knock-on effect of increasing incidence of tick-borne disease and there could also be a higher risk of zoonotic diseases such as malaria.

It means our health system will need to treat and manage a far more diverse set of diseases on a scale not previously seen in the UK and, as is the case now, there will be huge disparity of experiences and outcomes depending on wealth unless we tackle the health inequality gap. In fact, in some places, this is already happening.

Public health is not just about keeping people alive. It is about protecting and promoting people’s mental and physical health and wellbeing, along with that of their environment, and we need to take stock and learn lessons so next time – and make no mistake in that there will be a next time – we are in a better position to respond.

Disruption is unhelpful. Millions of people faced changes to their daily routine as a result of public transport cancellations or delays and school closures. Businesses and public services alike were forced to close early as the heat got too much and sadly, the risks associated with this type of disruption will always fall heaviest on the most vulnerable members of our society – those people who are unable to afford shelter or don’t have easy access to clean drinking water.

Intense high temperatures also provide unseen public health risks, such as displacement due to fires and increased numbers of people (especially young people whose schools may have closed) swimming in dangerous open water.

While our short-term response largely deals with the seen, it is these unseen risks that need to be considered to make sure we are better prepared in the long-term.

The carbon inherent transport, housing and other sectors are clearly key to this long-term response – both in slowing down climate change and achieving net zero, but also with supporting people to live through heatwaves.

We need to get out of our cars and use a public transport system designed for use alongside biking and walking.

For this to succeed, we need two things: first, public transport that is fit for purpose in hot temperatures, with tracks that don’t expand and runways that don’t melt. Second, we need better support and incentives for people to stop buying fossil fuel-burning vehicles.

Similarly, our housing stock needs to be better insulated to improve energy-efficiency, help keep us warm in winter and cool in summer.

However, a mass retrofit will require commitment and funding from central Government and while the current funding of £3.4bn is very welcome, it falls short of the £104bn needed.

As to the future, while achieving net zero by 2050 may not avert the effects of climate change completely, it will help. We must do everything we can, individually and as a society, to achieve it.

Directors of public health have two tasks ahead. One is the focus on short-term mitigation and keeping people alive and as well as possible in weather events like those of last month. The other is advocating for medium and long-term adaptation for a healthier, more sustainable environment.

To achieve this, we need shared leadership and partnership working at all levels to focus everyone’s mind on the overwhelming evidence that extreme heat events – as well as other major weather events – are happening more frequently and climate change is the cause. Only then can everyone – from central to local government, from national to local businesses and from communities to individuals – work to address the issues to keep us all safer, healthier – and cooler.

Professor Jim McManus is president of the Association of Directors of Public Health

@ADPHUK @jimmcmanusph

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