Report from the symposium on heat and health

A symposium organized by the WHO Country office in Croatia and the Andrija Štampar School of Public Health (a WHO collaborating center for primary health care) took place in Zagreb on 14 May 2011 on the subject heat and health. Forty-two postdoctoral students (residents of family medicine mainly from Zagreb but also from various parts of Croatia) participated.

Opening

The symposium was opened by a welcome speech given by Prof. Mladenka Vrcić-Keglević welcoming all the participants to the symposium. She stressed the importance of knowing how heat can have influence human health and how we can expect it to influence our patients. Prof. Vrcić-Keglević mentioned that this is a pilot symposium, basing on the experience of which future symposia will be organized and that because of this it is important for the participants to give feedback by filling out the evaluation forms.  The participants were also welcomed by the director of the Andrija Štampar School of Public Health Prof. Jadranka Božikov, who also stressed the importance of climate change, heat and its impact onto the health of patients. She also informed the participants about the activities of the School of Public Health and the tradition of family medicine postgraduate studies organized here since 1960. Dr Antoinette Kaić-Rak, Head of the WHO Country Office in Croatia, welcomed all the participants on behalf of the WHO Country office in Croatia, wishing them a fruitful participation in the workshop, and continued to give the first presentation of the day.

The impact of heat on health

The first presentation of the total of nine presentations was given by Dr Antoinette Kaić-Rak. In her presentation Dr Kaić-Rak focused on climate change and health. She reminded the participants that this subject was the main focus of World Health Day in 2008 and announced that WHO has already decided on the main topic of the next World Health Day: the health of elderly people. Dr Kaić-Rak noted that the WHO/Europe Region comprises 53 countries, and that in the past three decades there have been over a thousand events in Europe related to climate change, among which are heat waves, floods, droughts, air pollution, lack of water and decrease in crops, but also changes in the presence of vectors of diseases. Heat waves, reminded Dr Kaić-Rak, increase mortality between 1 and 4% for each degree of temperature increase. The 2003 heat wave took 70 000 lives. It is estimated that additional 86 000 deaths a year will be caused by the increase in temperature by 3°C  in the period from 2071–2100 in the European Union (EU).

As far as other consequences from climate changes are concerned, more floods are to be expected as well as additional rainfall. An increase in floods during winter can be expected in northwest Europe while sudden, unexpected flooding is estimated to become a future problem in all of Europe. Coastal flooding will pose a threat to over 1.6 million people in the EU. Climate change also influences the health safety of food, the production of which is estimated to decrease in southeast and central Asia. High temperatures are also favorable for development of bacteria but vector-borne diseases such as malaria, leishmanisis and Lyme borrieliosis are also more present in Europe, shifting further to higher altitudes.

There is less and less drinking water which increases water contamination. Water quality is in danger, sea cleanliness is in danger and so is the health safety of seafood. There are also more and more cases of allergies, and an increase in bronchitis and chronic obstructive pulmonary disease (COPD) as a result of air pollution. All the above mentioned influences the length of our life expectancy. We have to bear in mind that various populations are influenced by climate changes, thus there are vulnerable populations who are more easily negatively influenced by climate change such as high temperatures:  elderly peole (above the age of 75), those suffering from chronic illnesses, women and small children.

Heat-health action plans

Next, Dr Kaić-Rak gave a presentation in place of the absent Dr Franziska Matthies on heat-health action plans, explaining the basic concept of how heat-health action plans are implemented and coordinated in the field and generally on the collaboration mechanism between various key institutions, which is the particular care necessary to take care of the vulnerable populations, urban energy planning and on the monitoring and evaluation of these plans. Dr Kaić-Rak also informed the participants that there is a Euroheat project made software which forecasts future heat waves, that is the possibility (in percentages) of heat waves for the part of the world/country one selects. The participants as family doctors were reminded that it is them who are in charge of raising awareness of their patients to the dangers of impact of heat on their health, particularly those who are under heightened risk. They should also be able to identify who these vulnerable patients are, monitor their therapy and educate them on possible consequences of heat on their health and which measures to undertake to live through hot periods. There was a fruitful discussion on vulnerable population, substitution of lost fluids and side-effects of drugs during hot weather. Reducing indoor temperatures should be done during hot weather, using shades, fans and mobile vaporation coolers and air conditioning. Homes for the elderly should also have a room available in which temperature is always under 25°C where patients can rest during hot weather. Also it should be noted that high temperatures have a negative influence on certain medications, which should be stored at adequate temperatures.

This block of presentations was finished by the third presentation, given by Dr Kaić-Rak, on Guidelines on implementing heat and health action plans, which informed the participants of the symposium with the results of the study conducted in 2007 in European cities on heat waves, their intensity and impact on human health.  The participants were reminded that the results of this study show that vulnerable populations are persons above the age of 75, women and small children, and naturally those with chronic illnesses. The participants were also reminded on which diseases that increase the risk of death during heat waves, Family medicine doctors should educate their patients under risk from death from heat waves on how to cool their homes, how to avoid exposure to heat, how to ensure adequate hydration and what to do if one has a health condition and if someone needs help.

Dr Inge Heim gave a presentation on the proposal of the Heat and Health Action Plan in the Republic of Croatia, giving a detailed account of how it was drafted, saying that the timeframe in which we can expect to have most patients suffering from influences of high temperatures is the period from 1 May–15 September. During this period, health services need to be particularly prepared for, and Dr Heim noted that the main collaborative work of the health sector is with the Croatian Meteorology Institute, who issues heat wave warnings. The participants were informed what the responsibilities of each institutions and doctors of family medicine are, depending on the level of the heat waves. This presentation was followed by a fruitful discussion on implementation of the action plan on the local level.

Heat health and ecology

Prof. Jagda Doko Jelinić gave a presentation on climate change and human health with a focus on the ecological side of this issue. Prof. Doko Jelinić noted the importance of having these subjects included into postgraduate studies. Prof. Doko Jelinić reminded that a global ecological issue is global warming and the increase in temperatures caused by climate changes. The increase of global temperatures will continue, there will be more and more hot days and our population will be more exposed to heat waves. This century shows the most number of hot years recorded so far. All this has an impact on health.

High concentration of greenhouse gasses results in warming and the prognosis is not optimistic. There are more and more natural disasters due to the global warming and climate change and also influences other changes that have an impact on human health. Prof. Doko Jelinić also gave an account of the events during the 2003 heat wave in Paris, mentioning that a large number of people live in such buildings, that their construction heightens temperature, very many people were on vacation at that time (many doctors as well) and there were not enough young people to help the predominantly old population of Paris.

Prof. Doko noted that those living in urban areas are most affected during heat waves because of the lack of green surfaces and that one of the measures for urban areas would be ensuring more green surfaces, such as having plants on top of buildings, which is being done in some countries. Participants were also reminded of how to protect themselves from heat, and to the fact that air conditioning units need regular maintenance. This presentation was followed by a discussion on the implementation of the heat health action plans. It was also noted that one should be prepared year through also for situations where in winter the temperatures also were seen to suddenly rise from below zero temperatures to +15°C.

Weather forecasting and health

Dr Ksenija Zaninović from the Croatian Meteorology Institute gave a very interesting presentation on the impact of extreme thermic conditions on mortality in Croatia. She presented the results of her research in Zagreb, Rijeka, Split and Osijek. The research sought to see which weather conditions presented an increase in mortality. She showed a highly interesting interdisciplinary approach that was used in conducting this study where daily monitoring of weather conditions and mortality data from the Croatian Statistics Bureau and Census data were used. She also explained how bioprognosis is modeled using the equation of balance of human body and the environment. She explained how weather forecast is made using models, for three days ahead on the basis on which the Meteorology Institute can issue warnings for the population or raise alert if heat waves are approaching and inform the responsible authorities to take action.

Bioprognosis

Dr Spomenka Junačak presented her study results on the influence of bioprognosis on the number of visits to family medicine doctors. She made a five week study of the symptoms with which patients visit the practice she works at, and found that those corresponded highly with the symptoms mentioned in the bioprognosis issued by the Meteorology Institute. Her results are interesting because half of the patients who came with symptoms given in the bioprognosis did indeed follow the bioprognosis news and the other half did not. She presented the participants of the study with each of the symptoms given in the bioprognosis and the ones the patients had when visiting.

Sunstroke

The next presentation was given by prof. Vrcić-Keglević on heat impact on humans, for example patients who suffer from consequences of prolonged exposure to the sun and high temperatures.  One of these patients had a mild case of sunstroke while the other suffered from very serious consequences of prolonged heat exposure, and being a chronically ill person, unfortunately died. The participants had a fruitful discussion on the example of these patients on what was done to help them and what should have been done differently. They were thus reminded what to do in particular situations of heat exposure, what symptoms indicate which measures to be undertaken and what advice they can give to their patients.

Heat-health of the chronically ill

This presentation was continued by another given by Prof. Vrcić-Keglević  on behalf of the absent Dr Hrvoje Tiljak which focused particularly on chronically ill patients and heat. This presentation dealt concretely with chronically ill patients, given the fact that they are a vulnerable population for heat-caused death. In this presentation the participants were reminded that they should be familiar with the patients’ health condition but also with their living conditions. The majority of the population live in cities, in inadequate architectural structures which heat up easily, their socioeconomic status does not always allow them to invest in air conditioning systems and they do not always have the opportunity of having a room in their apartments that is not exposed to heat all day. Family doctors should be very familiar with the medications their patients use and warn and educate their patients on the effects of heat on their therapy. They should educate their patients on how they can help themselves, what their individual risks are and when it is necessary to seek medical help. Thanks to the media and the more and more present bioprognosis, our patients have a good awareness on unwanted effects of heat on their health, but education and awareness raising on this issue should not cease, but continue and improve.

At the end of the symposium the participants filled in the announced evaluation form to give input for future symposia.