Heat waves in the UK: impacts and public health responses

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Public Health and Policy

Abstract

In August 2003, a severe heat wave resulted in the deaths of more than 14,000 people in France and of many more in neighbouring countries. The UK was fortunate in suffering less oppressive and less unrelenting temperatures, but there were still around 2,000 deaths. Because of global warming, the chance of experiencing a similar heat wave in Britain is increasing, and the lesson from France is that our public health systems may not have been well-prepared to respond to such a threat.
Prompted by the experience of France, the Department of Health launched a heat wave plan for England in 2004. Its provisions include public health warnings and targeted advice and actions to protect those at greatest risk. The study we propose is aimed at providing evidence to help improve how this heat wave plan can be most effective.
Our analyses will quantify the level of heat-related risk for different sections of the population, and so determine the degree to which vulnerability to heat waves is concentrated in high-risk groups that may be targeted by specific protection measures. We will also estimate the risk of dangerous heat waves occurring now and in future years, and assess how we can best detect evolving heat wave threats at an early stage.
A number of (mainly elderly) people and their carers will be interviewed to understand what knowledge they have about the risks and responses to heat waves. We will also assess the operation of the current heat wave plan through semi-structured interviews with key stakeholders, including health and social care professionals, community voluntary workers, and residential home managers. Its cost-effectiveness will be assessed using evidence about the change in the number of heat-deaths occurring during heat waves since the plan was implemented.
The results of the research will be discussed with policy makers and key public health professionals involved in heat wave planning to draw conclusions about how the needed responses of the health, social and other services can be improved.
The results will be made available to the public through non-technical web reports and participation of research team members in policy-focused meetings.

Technical Summary

This study is aimed at informing the development of public health responses to heat waves in the UK and in particular the further development of the heat wave plan for England. It will assess the form of heat wave interventions that are most likely to reduce public health impacts in the light of evidence about the distribution of population vulnerability and the cost-effectiveness of interventions.

It will entail the epidemiological analysis of heat-related health impacts and their effect modifiers; the qualitative assessment of heat-related behaviours of vulnerable members of the public; and an evaluation, including through cost-effectiveness analysis, of the current heat wave plan for England.

The principal objectives are: (1) To quantify for England the regional mortality risks associated with periods of high outdoor temperature and, through assessment of the modifiers of such risk, to characterize the degree to which vulnerability to heat episodes is concentrated in high risk groups that may be targeted by specific interventions; (2) To use results from (1) in combination with regional climate models to estimate the frequency of future heat wave events of given mortality impact; (3) To evaluate the use of real time health/health service data in the early detection and response to heat episodes; (4) To compare, using semi-structured interviews, the knowledge and attitudes of high-risk groups and their carers to the health impacts of heat waves and the factors likely to impede or promote protective responses to them; (5) To evaluate the current heat wave plan for England through analysis of quantitative outcome data, document analysis, and semi-structured interviews with key stakeholders in the heat plan cascade, including health and social care professionals, community voluntary workers, and residential home managers; (6) To estimate the impact of the heat wave plan for England in its first four years of implementation through the standardized comparison of the heat-related mortality in 2004-07 with that in pre-implementation years; (7) To estimate the cost-effectiveness of specific heat wave interventions using sensitivity analyses that vary assumptions about targeting and intervention efficacy.

The results will be discussed with policy makers and key public health professionals to draw conclusions from the research about the design of the heat wave action plan, including thresholds for alerts, methods of targeting high risk groups, preparedness/capacity planning, methods of communication, and the need for variation of the plans by social group.

Publications

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Abrahamson V (2009) Health and social care responses to the Department of Health Heatwave Plan. in Journal of public health (Oxford, England)

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Armstrong BG (2011) Association of mortality with high temperatures in a temperate climate: England and Wales. in Journal of epidemiology and community health

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Gasparrini A (2012) The effect of high temperatures on cause-specific mortality in England and Wales. in Occupational and environmental medicine

 
Title Invisible heat: 'Deep above' by Adam Chodzko 
Description Through our research on climate change and health, I supported an artwork initiative curated by Alice Sharp with initial funding from the Wellcome Trust, to develop artworks relating to climate change. One of the outputs of this initiative was a film by Adam Chodzko about psychology and climate change called 'Deep Above'. It premiered at the Watershed, Bristol, November 2015 alongside a series of debates and workshops. 
Type Of Art Artwork 
Year Produced 2015 
Impact The film has been taken on tour around the UK with screenings accompanied by debates with panels of artists, academics and scientists. These debates have focused on questions such as "The role of art and artists in considering climate change?" and "Can psychology help us to accept and act on the scientific evidence on climate change? The impact is impossible to quantify but it has helped raise debate about scientific evidence among new audiences. 
URL http://invisibledust.com/project/adam-chodzko-deep-above/
 
Description Heat Wave Plan for England
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description An Integrated framework for improving sustainability of indoor enviroment (PUrE Intrawise) (EPSRC Sustainable Urban Environments)
Amount £608,000 (GBP)
Funding ID EP/F007132/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 05/2008 
End 05/2011
 
Description Climate Resilience of Care Settings
Amount £251,957 (GBP)
Funding ID NE/S016767/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 02/2019 
End 01/2020
 
Description Department of Energy and Climate Change project. Quantifying the health impact of household energy efficiency improvements
Amount £162,000 (GBP)
Organisation Department of Energy and Climate Change 
Sector Public
Country United Kingdom
Start 01/2010 
End 03/2011
 
Description Evaluation Of The Implementation And Health-Related Impacts Of The National Cold Weather Plan For England (Policy Research Programme)
Amount £304,320 (GBP)
Funding ID PRP-IP-0612-0120308 
Organisation Department of Health (DH) 
Sector Public
Country United Kingdom
Start 08/2012 
End 12/2013
 
Description Evidence for policy action on health and climate change
Amount $996,722 (USD)
Funding ID R-2008-05023 
Organisation Children's Investment Fund Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2021 
End 03/2023
 
Description Governing the Climate Adaptation of Care Settings
Amount £758,352 (GBP)
Funding ID NE/T013729/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 04/2020 
End 08/2022
 
Description Health Protection Research Unit -- Environmental Change
Amount £3,956,896 (GBP)
Funding ID NIHR200909 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 03/2020 
End 03/2025
 
Description Health Protection Research Unit on Environmental Change and Health (Kovats et al)
Amount £2,000,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 03/2014 
End 03/2019
 
Description Health and economic impacts of urban heat islands and greenspace
Amount £499,962 (GBP)
Funding ID 216035/Z/19/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 09/2020 
End 03/2023
 
Description Health and economic impacts of urban heat islands and greenspace
Amount £518,125 (GBP)
Funding ID 216035/Z/19/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2020 
End 09/2023
 
Description NE/I007806/1 TRAFFIC POLLUTION AND HEALTH IN LONDON
Amount £183,495 (GBP)
Funding ID NE/I007806/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 01/2011 
End 08/2015
 
Description NE/I007938/1 AIR POLLUTION AND WEATHER-RELATED HEALTH IMPACTS: METHODOLOGICAL STUDY BASED ON SPATIO-TEMPORALLY DISAGGREGATED MULTI-POLLUTANT MODELS (EEHI)
Amount £1,547,649 (GBP)
Funding ID NE/I007938/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 04/2011 
End 11/2015
 
Description NICE Review of evidence on excess winter deaths and economic analysis
Amount £132,000 (GBP)
Organisation National Institute for Health and Care Excellence (NICE) 
Sector Public
Country United Kingdom
Start 03/2013 
End 09/2014
 
Description Statistical methods for investigatingandcontrolling for weather
Amount £331,000 (GBP)
Funding ID G0707030 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 06/2008 
End 09/2011
 
Description The health and equity impacts of climate change mitigation measures on indoor and outdoor air pollution exposure (HEICCAM)
Amount £507,898 (GBP)
Funding ID NE/V002090/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 08/2020 
End 08/2023
 
Description Wellcome Trust Sustaining Health: Sustainable Healthy Urban Environments (SHUE)
Amount £261,037 (GBP)
Funding ID 103908 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2014 
End 04/2017
 
Title Methods for quantifying temperature-health relationships 
Description Contribution to the advancement of methods for quantifying temperature-health impact relationships 
Type Of Material Model of mechanisms or symptoms - mammalian in vivo 
Year Produced 2013 
Provided To Others? Yes  
Impact Contribution to the scientific methods deployed for characterizing heat and cold-related impacts 
 
Description Building physics 
Organisation University College London
Department Bartlett School of Graduate Studies
Country United Kingdom 
Sector Academic/University 
PI Contribution Research collaboration (epidemiological modelling) with joint publication
Collaborator Contribution Joint (multi-disciplinary) research; provision of data and modelling expertise
Impact Multi-disciplinary: LSHTM (epidemiology) with UCL (building physics) Example papers Building Res & Info 2009; 37(5-6):583-597 Open House internat 2010; 35(2):49-59 Build Serv Engineer Res Tech; in press.
Start Year 2006
 
Description Weather-pollution spatio-temporal modelling 
Organisation University of Edinburgh
Department School of Geosciences Edinburgh
Country United Kingdom 
Sector Academic/University 
PI Contribution Research collaboration, with analysis and joint publication
Collaborator Contribution Partner in funding applications and research Provision of data for use in our epidemiological work
Impact Papers PMID: 20798017 PMID: 20102593 A multi-disciplinary collaboration between epidemiology (ourselves) and climate- and air-pollution modelling (Edinburgh)
Start Year 2007
 
Description American association for the Advancement of Science 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Presentation to session of the AAAS meeting (science to the public) with multiple questions and discussion afterwards; journalist (radio) interviews

Media coverage
Year(s) Of Engagement Activity 2008
 
Description British Council, Brazil 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Live web cast and questions and answers session, organized by Britisah Council and UNICENP, Curitiba, Brazil, with

Media coverage
Year(s) Of Engagement Activity 2007
 
Description Climate Change Mitigation and Health Benefits -- An FCDO-organized UK-Italy workshop in preparation for COP26 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact This was a workshop, organized by the Foreign Commonwealth and Development Office in collaboration with the government of Italy, to discuss policies to tackle climate change impact and to communicate climate action to the public. The workshop aimed to foster cooperation and exchange of policy best practices between Italy and the UK as a partnership in preparation for COP26 (The UN CLimate Change conference of the parties). The outcome was an agenda presented to the Italian and British governments in pursuit of their shared goals for the COP26 meeting.
Year(s) Of Engagement Activity 2021
 
Description Climate change and its impact on lung health: a focus on Europe 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact This was an advisory meeting convened by the Economist Intelligence Unit to inform its work on climate change and health. It entailed review of current evidence about climate change and respiratory health and consideration of policy implications, aiming to inform the Economist's publications in this domain. Resulted in a White paper published by the Economist (file:///C:/Users/PPEHPWIL/Downloads/climate-change-and-its-impact-on-lung-health-a-focus-on-europe.pdf).
Year(s) Of Engagement Activity 2021
URL https://impact.economist.com/sustainability/social-sustainability/climate-change-and-its-impact-on-l...
 
Description Danish Society for Environmental Epidemiology 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Health professionals
Results and Impact Keynote lecture on environmental impacts on health

Agreed mutual exchange with Danish research group
Year(s) Of Engagement Activity 2011
 
Description Department of Health heatwave seminars 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Health professionals
Results and Impact Several members attended Department of Health/HPA workshops on the Heat wave plan for England, presented outputs of our research and contributing to workshop activities, including on the development of the DH heat wave Plan

Evidence used in informing evolutionary development of DH Plan and guidance
Year(s) Of Engagement Activity 2009,2010
 
Description EPICOH keynote lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact Keynote lecture on climate change impacts to Epidemiology in Occupational Health European conference, Oxford

Substantial interest from audience and follow up for possible future research collaborations
Year(s) Of Engagement Activity 2011
 
Description IPCC International Expert Meeting on Human Settlement and Infrastructure 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Expert group considering issues relating to climate change vulnerability and responses related to human settlements as part of the Intergovernmental Panel on Climate Change consultation process. Kolkata, March 22-24, 2011

This was an evidence gathering symposium for IPCC reports
Year(s) Of Engagement Activity 2011
 
Description JASP public health meeting, Montreal 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Health professionals
Results and Impact Talk to a mixed public health, policy and scientific audience, and participation in subsquent discussions

Contribution to discussion on climate change and health policy development for Quebec
Year(s) Of Engagement Activity 2007
 
Description Media interview, CNN Asia 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This was a ten minute breakfast news interview at CNN Asia on the dual challenges of air pollution and climate change ahead of the Heads of States meeting of the Association of South East Asian (ASEAN) countries. The impact is difficult to judge, but it was intended as a contribution to public debate about key areas of public policy relating to environment and health.
Year(s) Of Engagement Activity 2015
 
Description Open meeting: Select Committee of the Senate of the Philippines 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact This was an open hearing/debate at the Senate of the Philippines (the Philippines parliament) on Balancing Energy, Health and the Climate Challenge. It was attended by a wide array of contributors, including senators, members of the public, NGOs, industry representatives and others to discuss key policy challenges relating to air pollution, climate change and other environmental health impacts in energy, transport, agriculture and other policy areas. My participation was sponsored by the Foreign and Commonwealth Office, and I spoke about evidence from our UK research alongside Chairpersons of Senate Committees on Energy, Climate Change, Health and Demography, as well as representatives of the Climate Change Commission, the Environmental Management Bureau, The World Health Organization, local campaigners of Health Care Without Harm-Asia, the UK Ambassador and others. It prompted a vigorous debate about policy development in the Philippines and Asia more generally, with particular focus on the run up to the UN Framework Convention on Climate Change meeting in Paris, in November 2015.
Year(s) Of Engagement Activity 2015
 
Description Policy-maker briefing, Jakarta, Indonesia 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This was a "Road-to-Paris public coffee morning", organized jointly by the UK Embassy and local officials to discuss matters relating to health aspects of climate change and air pollution ahead of the COP21 conference, and including a lunch meeting with the Indonesian President's Special Envoy for Climate Change. I gave the 'keynote talk' about research evidence. It is impossible to judge what weight it carried in the development of government strategy, but there was wide recognition of the the potential benefits for health of more sustainable development strategies in various areas of government policy. Audience was interested in hearing new evidence about potential health gains. That does not necessarily equate with any shift in policy positions, but it probably reinforced the UK's efforts.
Year(s) Of Engagement Activity 2015
 
Description Presentation to scientific conference: difficulties in elucidating UHI effects on mortality 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Talk provoked discussion about research methods and findings.

Interst from other research groups.
Year(s) Of Engagement Activity 2014
 
Description Public lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact 100 people attended a public lecture with questions and debate afterwards.
Annual Thomas Fresh lecture, hosted by Liverpool John Moores University

Public debate about climate change impacts and responses
Year(s) Of Engagement Activity 2011
 
Description Public lecture on climate change 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact 100 people attended this public lecture which was part of the "Klimagune Confererences:Taking a look at Climate Change", Bilbao, Spain, 21 Nov 2012

Public debate about responses to climate change
Year(s) Of Engagement Activity 2012
 
Description Public lecture, climate change, Bilbao 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Invited public lecture on climate change, organized by the Basque Centre for Climate Change (BC3)
"Why addressing climate change may be good for your health", Bilbao, 21 November 2012
Audience of approx. 100, mainly members of the public and local officials, with some academics.

Sbsequently interviewed by local journalists with reports in newspapers and local radio.
Year(s) Of Engagement Activity 2012
 
Description Symposium on climate change health impacts organized by the China Center for Disease Control and Shandong University Climate Change and Health Center on Climate change, Environment, and Health: From Risk Assessment to Action 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Shared mode (in-person and online) symposium on climate change and health aimed at debating emerging evidence and trends. International conributors and audience.
Year(s) Of Engagement Activity 2021
 
Description US Institute of Medicine's Roundtable 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Health professionals
Results and Impact Invited workshop participant, US Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine, focused on the 'intersection of sustainability and public health'. Woods Hole, 25-26 July 2011

Contribution to a workshop report/position paper for the Institute of Medicine.
Year(s) Of Engagement Activity 2011
 
Description WHO climate change toolkit meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Workshop on the WHO climate change toolkit (training material), hosted by the WHO European Centre for Environment and Health, Bonn. 5-6 Mar 2013.
Workshop of approx. 30 participants.


Workshop was aimed at the development of training materials on climate change and health for use by profvessionals and policy-makers across the European region.
Year(s) Of Engagement Activity 2013
 
Description WHO training workshop, Riga 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact Training workshop for the WHO Erueopean Region, with invited lecture on "Environment and health:a perspective for Europe", Riga, 19 Mar 2012.
Around 150 delegates -- mainly health professionals, policy makers and researchers from across the European region.


Wide interest among regional delegates.
Year(s) Of Engagement Activity 2012
 
Description Webinar/online discussion side event for 5th High-level Ministerial Conference Meeting of the Transport, Health and Environment Pan-European Programme (THE PEP) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact This was a side event for the 5th High-level Ministerial Conference Meeting of the Transport, Health and Environment Pan-European Programme (THE PEP). It was an online debate with international contributors and audience focusing on the topic of 'Transforming transport for health and climate protection: ensuring climate solutions for transport and mobility that are healthy and equitable'. I was a topic chair/moderator. It was a lively discussion around policy actions for climate change and health, with broad agreement on the types of actions that could benefit health and needed policy steps.
Year(s) Of Engagement Activity 2021
URL https://www.eltis.org/participate/events/pep-2021-side-events
 
Description Webinar: indoor air quality and health under the path to Net Zero 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact This was a moderated discussion on home energy efficiency and indoor air under the pathway to Net Zero, co-organized by the Health Protection Research Unit on Environmental Change and the HEICCAM research network. It debated the actions needed in the housing sector to address climate change adaptation and mitigation responses and the implicaitons for health, specifically relating to indoor air quality. The debate included academic experts and lay members.
Year(s) Of Engagement Activity 2021
URL https://www.eventbrite.co.uk/e/indoor-air-quality-and-health-under-the-path-to-net-zero-registration...