[Excess mortality in people over 65 years old during summer heat waves in Marseille. Comparison before and after a preventive campaign]

Science Policy to Advance a Climate Change and Health Research Agenda in the United States

Climate change is thought to be one of the greatest public health threats of the 21st century and there has been a tremendous growth in the published literature describing the health implications of climate change over the last decade. Yet, there remain several critical knowledge gaps in this field. Closing these gaps is crucial to developing effective interventions to minimize the health risks from climate change. In this commentary, we discuss policy trends that have influenced the advancement of climate change and health research in the United States context. We then enumerate specific knowledge gaps that could be addressed by policies to advance scientific research. Finally, we describe tools and methods that have not yet been fully integrated into the field, but hold promise for advancing the science. Prioritizing this advancement offers the potential to improve public health-related policies on climate change.

Is planned adaptation to heat reducing heat-related mortality and illness? A systematic review

BACKGROUND

Extreme heat is an important public health risk. Climate change will likely increase the temperatures humans are exposed to through exacerbated heat wave intensity and frequency, possibly increasing health risks from heat. To prevent adverse effects on human health, heat prevention plans and climate change adaptation strategies are being implemented. But are these measures effectively reducing heat-related mortality and morbidity? This study assesses the evidence base in 2014.

METHODS

We conducted a systematic review of peer-reviewed published literature. We applied a combined search strategy of automated search and journal content search using the electronic databases PubMed, Web of Knowledge, Biological Abstracts, CAB Abstracts and ProQuest Dissertation & Theses A&I. Quality appraisal was conducted using CASP checklists, and we identified recurrent themes in studies with content analysis methodology. We conducted sub-group analyses for two types of studies: survey and interview research on behavioral change and perception, and observational studies with regression.

RESULTS

30 articles were included in the review. The majority of studies (n = 17) assessed mortality or morbidity reductions with regression analysis. Overall, the assessments report a reduction of adverse effects during extreme heat in places where preventive measures have been implemented. Population perception and behavior change were assessed in five studies, none of which had carried out a pre-test. Two themes emerged from the review: methodological challenges are a major hindrance to rigorous evaluation, and what counts as proof of an effective reduction in adverse health outcomes is disputed.

CONCLUSIONS

Attributing health outcomes to heat adaptation remains a challenge. Recent study designs are less rigorous due to difficulties assigning the counterfactual. While sensitivity to heat is decreasing, the examined studies provide inconclusive evidence on individual planned adaptation measures.

Correlates of hot day air-conditioning use among middle-aged and older adults with chronic heart and lung diseases: the role of health beliefs and cues to action

Extreme ambient heat is a serious public health threat, especially for the elderly and persons with pre-existing health conditions. Although much of the excess mortality and morbidity associated with extreme heat is preventable, the adoption of effective preventive strategies is limited. The study reported here tested the predictive power of selected components of the Health Belief Model for air-conditioning (AC) use among 238 non-institutionalized middle-aged and older adults with chronic heart failure and/or chronic obstructive pulmonary disease living in Montréal, Canada. Respondents were recruited through clinics (response rate 71%) and interviews were conducted in their homes or by telephone. Results showed that 73% of participants reported having a home air conditioner. The average number of hours spent per 24-hour period in air-conditioned spaces during heat waves was 14.5 hours (SD = 9.4). Exploratory structural equation modeling showed that specific beliefs about the benefits of and drawbacks to AC as well as internal cues to action were predictive of its level of use, whereas the perceived severity of the effects of heat on health was not. The findings are discussed in light of the need to adequately support effective response to extreme heat in this vulnerable population.

Quantification of the heat wave effect on cause-specific mortality in Essen, Germany

The impact of high temperatures on mortality is well known, but not all deaths that occur during heat waves can be explained by this effect. We evaluated whether an additional mechanism caused by periods of sustained heat without nightly cooling influenced mortality during the European heat wave in 2003 and whether this mechanism is different for varying causes of death. We obtained daily counts of total and cause-specific mortality for Essen, Germany, for the years 2000-2006. We used time-series regression methods to separate a possible additional effect of sustained heat from the temperature effect and included air pollution, influenza epidemics, long-term and seasonal trends, days of week and bank holidays as covariates. The maximum daily relative risk of all-cause mortality during the heat wave was 1.28 (95% CI 1.06-1.53). The maximum relative risks of cardiovascular and neoplastic mortality were 1.25 (95% CI 0.95-1.65) and 1.35 (95% CI 1.00-1.82), respectively. The effect on respiratory mortality was delayed; the maximum relative risk was 1.66 (95% CI 1.19-2.23) 6 days after the heat wave. We found that periods with sustained heat especially affected respiratory mortality, whereas for cardiovascular and neoplastic mortality no distinct influence could be shown.

Heatwaves and public health in Europe

Public health measures need to be implemented to prevent heat-related illness and mortality in the community and in institutions that care for elderly or vulnerable people. Heat health warning systems (HHWS) link public health actions to meteorological forecasts of dangerous weather. Such systems are being implemented in Europe in the absence of strong evidence of the effectiveness of specific measures in reducing heatwave mortality or morbidity. Passive dissemination of heat avoidance advice is likely to be ineffective given the current knowledge of high-risk groups. HHWS should be linked to the active identification and care of high-risk individuals. The systems require clear lines of responsibility for the multiple agencies involved (including the weather service, and the local health and social care agencies). Other health interventions are necessary in relation to improved housing, and the care of the elderly at home and vulnerable people in institutions. European countries need to learn from each other how to prepare for and effectively cope with heatwaves in the future. Including evaluation criteria in the design of heatwave early warning systems will help ensure effective and efficient system operation.

Média et santé publique : l’exemple de la canicule pendant l’été 2003 en France

BACKGROUND

The summer of 2003 was the hottest for France in the last 50 years with record day and nighttime temperatures. INSERM statistics estimated that 14,802 heat-related deaths occurred during August 2003 heat wave in France. In the aftermath of this crisis, we thought that it was useful to analyze how the French media dealt with public health during the period from June 1 to August 31, 2003. The objective was to analyze French coverage of public health information during the August 2003 heat wave.

METHODS

Manual and computerized analysis of newspaper and radio reports published from June 1 to August 31, 2003. Articles were obtained by searching the EUROPRESS database. Text analysis was performed using the ALCESTE software package.

RESULTS

A total of 1,599 articles were analyzed. Few articles contained warnings about heat exposure and preventive measures. Public health policy was relegated to third place after business and ecology themes. The special problems of the high-risk populations were not mentioned until after the rising death toll was known and emphasis was placed on the implications of the crisis in the political process. The findings of this study show the poor performance of public health policy in France and that media must be given guidance to fulfil its role in providing public health information.

CONCLUSION

This crisis discloses the absence of public health culture in France and involves the "social exclusion" related to a breakdown of social cohesion. More cooperation is needed between the media and public health professionals to avoid future heat-wave and other public health crises. France must develop a public health culture to promote involvement of both the community and individuals in public health issues.