1. Climate change, health and communication
Anna Paldy MD. PhD
Scientific adviser
National Public Health Institute

2. Underlying facts
Climate change and its impacts have been supported by evidence (IPCC ARs)
Impact of extreme weather events (incl. heat waves) is a great challenge
Adaptation to these effects has become a major issue (for public health and other sectors)
Awareness raising and communication are crutial for short- and long term adaptation

3. Projections of different scenarios
High-end climate scenarios project warming of 4–7°C (on average) over much of the global landmass by the end of the 21st century.
The hottest days will exceed present temperatures.
The number of people living in extreme conditions will increase.
The ability of the human body to maintain heat balance during physical activity is compromised for parts of the year.
Unprotected outdoor labour is no longer possible.
Other risks associated with high-end scenarios: impact on urban settlements, food production, and water resources.
The Lancet Volume 383, Issue 9924, 5–11 April 2014, 1185–1189

4. CLIMATE CHANGE ACTIONS PRESSURE STATE EXPOSURE EFFECT CONTEXT
Industrial processes which burn fossil fuels
Growing global population, Consumerism and consumption
ACTIONS
PRESSURE
Short term:
Emergency planning/heatwave plans
Smog-alert measures, early warnings
Long term
Policies addressing vehicle numbers and emissions (technological & fiscal)
Investment in cycle/walking infrastructure and green space provision and maintenance
Improved urban & traffic planning
Traffic-control measures
Subsidies for zero-emission vehicles
Increased carbon and GHG emissions from:
-Transport
- Agriculture , -Industry
STATE
Flooding
Extreme weather events
More frequent heatwaves
Allergenic plants (ragweed)
Vectors; resilience
EXPOSURE
High temperature
Contaminated water (chemical& bacterial)
Fast flowing water
Debris hazards
Damps and moulds in homes
Insecurity
Damaged social relations
Reduced individual choice
EFFECT
Drowning
Physical trauma and gastro-intestinal illness
Toxic and allergic illness
Mental health-stress, anxiety and depression
Mortality and hospital admissions
Reduced Wellbeing
Social, economic, behavioural etc..
CONTEXT

5. Mean temperature–mortality relationship in the years before 2003 (Period 1) (red line) and after 2003 (Period 2) (blue line) in 9 European cities
Barcelona change in turning point
Increase in effect cooler cities previously not exposed climate change we have to think of the consequences in terms of susceptible subgroups who these might be.
Decrease in effect in recent years and how again this affects the susceptible subgrups. Where is the change observed the most, what are the reasons? Interventions? Change in population characteristics
Source: de’Donato et al: Int. J. Environ. Res. Public Health 2015, 12, 15567–15583

6. Association of daily mortality and temperature,
Innovative decision making tools for low carbon development and climate resilience in Europe and Central Asia
REC/CAREC Joint Side Event, UN Climate Change Conference December 2015 (COP 21/CMP 11) December 2015, Observer room 03, Le Bourget, Paris
Association of daily mortality and temperature,
Hungary,
The association of daily total mortality (%) and the daily mean temperature (°C) can be characterized by a J shape curve at higher temperatures. The impact of heat is more prevalent in the elderly gorup over 65 years.
Characteristics of association of daily mortality (percent differences from mean total and above 65y mortality and daily mean temperature between 2000 and 2010 in Budapest.
Source: Assessment of heat-related mortality in Budapest from 2000 to 2010 by different indicators
János Bobvos, Balázs Fazekas, and Anna Páldy
IDŐJÁRÁS Vol. 119, No. 2, April– June, 2015, pp. 143–158

7. Mean temperature during the summer period, 2005-2014
Bobvos et al IDŐJÁRÁS Quarterly Journal of the Hungarian Meteorological Service
Vol. 121, No. 1, Januar – March, 2017, pp. 43–62

8. Mean excess mortality (%) on days above threshold temperature on NUTS4 level in Hungary, 2005-2014
The mean excess mortality during days over the threshold temperature increase by 14.9%.
In some small areas excess mortality was not detected, while in others it was over 30%.
There is no typical spatial distribution of heat related excess mortality.
Bobvos et al IDŐJÁRÁS Quarterly Journal of the Hungarian Meteorological Service
Vol. 121, No. 1, Januar – March, 2017, pp. 43–62

9. National average daily mortality and daily mean temperature , 2nd level heat alert marked by red, 3rd level marked by black
1 heat alert was issued in 2014 and 2016 with excess death cases of 320 resp. 370.
In 2012 and heatwaves tackled Hungary with excess death cases of 1660 resp
In 2015 the summer was extreme with 5 heatwaves during 34 days, daily excess mortality was higher by 17% meaning 1770 excess cases.

10. Heat alert- background
The heat health warning system in Hungary was elaborated within the PHEWE project (PHEWE , „Prevention of acute health effects of weather conditions in Europe”).
The Heat health warning system was based on the daily mortality and meteorological data of Budapest.
The Hungarian research group elaborated the 3- level warning system based on temperature thresholds defined in time series analysis of the Budapest data of

11. Heat alert- definition of cut off point
The alert threshold was defined as the daily mean temperature: 25⁰C, corresponding to the 90th percentile. Another argument to choose this threshold was that an excess death rate of 7% was detected at this cut off point.
This increase of mortality – above the acceptable risk level for the population, which is 1/ already requires actions of the public health authorities.

12. 3-level heat alert system in Hungary
1st level of warning (for internal use): the daily mean temperature is forecast ≥25oC for 1 day – excess mortality is likely 15%.
2nd level of warning: alert: when the Meteorological Service forecast daily mean temperature ≥25oC for at least 3 consecutive days with excess mortality of 15%. Alternatively the forecasted daily mean temperature is ≥27oC for 1 day with predicted excess mortality of 30%.
3rd level of warning: alarm: when the Meteorological Service forecast daily mean temperature ≥27oC for at least 3 consecutive days with excess mortality of 30%.

13. Forecast of heat wave probability, July 16, 2007 (elaborated by Euroheat)

14. Min of Human Resources

15. Tasks of Public Health Services
In the pre-summer period:
Prepare guidelines for the hospitals, social care services, educational services
During the summer period:
Keep contact with the Met. Office
Issue heat alert
Sustain a real-time surveillance system of the impact of heat waves (real-time mortality monitoring)
Evaluate the impact of heat waves

16. Recommendations for the General Practitioners
Warn the GPs about the heat alert
To control the health state of vulnerable patients
To control the emergency medicines stock
To keep the medicines in a refrigerator
To be updated about the heat related side effects of medicines
To be ready to give advices and information about the effects of heat for the population

17. Recommendations for social care institutions
Prepare/update heat-wave plans; control and document the implementation of measures.
Insulate buildings, install shades, and explore the possibility of air conditioning.
Monitor the actual health status of elderly people (medical care, active prevention of heat-related symptoms).
Prepare a special menu during heat waves.
Provide targeted advice in terms of daily routine, behaviour, clothing, liquid intake and time spent outdoors.

18. Recommendations for child care institutions
Increase the heat resilience of buildings.
Ensure appropriate ventilation, insulation, cooling and air conditioning.
Update heat-wave plans.
Prepare appropriate plans for children’s daily activities.
Install suitable devices for protection from heat outdoors.
Prepare a special menu during heat waves.

19. Recommendations for the Municipalities
Provide access to drinking water at public places
Frequent watering in the cities (roads, parks)
Provide a list of public shelters with air conditioning
Ascertain the electricity
Take care of homeless people, provide them drinking water
Open the public places supplied with air conditioning system
To regulate traffic, public transportation
To extend the opening hours of swimming pools

20. Advices for the general public during heatwaves
Follow your local health authority's recommendations.
Keep your home cool.
Keep out of the heat.
Keep the body cool and hydrated.
Help others.
Keep medicines below 25 °C.
Seek medical advice.
If you or others feel- seek help.
In case of emergency, call a doctor or ambulance.

21. Monitoring the effectiveness of heat alerts
Results of a representative questionnaire survey (1%o of the population in 2015) on the perception and actions of the population during HWs:
90% of the population takes some measures against heat during HWs.
People with university degree are the most active (93.5%) vs. people with lowest education (<=8 year) 83%
25% of those having health problems did not take any measures!
Conclusions:
The majority of population is active during HWs, spends money and time for adaptation
However there are still areas where the population expects joint actions of the municipalities and govennment agencies.

22. Thank you for your attention!