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Combating the risks of increasingly hot summers in the UK: Findings from the PIRU evaluation of the Heatwave Plan for England

27 May 2020
Lorraine Williams, Bob Erens, Stefanie Ettelt, Shakoor Hajat, Tommaso Manacorda and Nicholas Mays
In the midst of a coronavirus pandemic, the awareness of planning and preparedness for crises has never been more important. Images of local communities working together to support care home residents trapped by the floods of Storm Dennis contrast with more recent images of care home workers struggling to keep residents and themselves safe from Covid-19.The year 2020 has become a testing time for public health services and communities. The risk of heatwaves adds another layer.

Heatwaves are often referred to as ‘silent killers’. They may not have the same visibility as other emergencies such as storms or floods, nor be as deadly to a population as a virus pandemic.They are, nevertheless, a cause of much premature death and ill health; a severe heatwave occurring in the summer of 2003 accounted for over two thousand excess deaths in the UK. National heatwave plans go some way to safeguard people who are most at risk, especially those in health and care facilities, but there remain a number of groups who are still unaware of their heat-health risks and who do not follow public health advice.

As we enter the summer period in England, the risk of increasingly severe hot weather as a result of global warming presents an additional threat to people’s health, and provides a rationale for having clearly defined national and local strategies for managing heatwaves. This is especially important as heatwaves have been shown to have a significant impact on the health of older and more socially isolated people, and those with chronic respiratory and cardiovascular diseases.

Severe heat places an extra strain on the body to regulate temperature, and this risk increases with age, leading to heat-related conditions such as dehydration, heat cramps or, more seriously, heatstroke. It also accelerates other chronic conditions and can result in hospitalisation or death, even within the first day or two of a heatwave. It is agreed that many heat-related deaths and illnesses could be prevented with good preparation, responsive care, and individual behavioural change. However, despite England having a national plan to reduce the adverse health impacts from heatwaves, significant excess deaths and illness still occur, placing an extra burden on health and social care systems. For example, in 2019, the deaths of almost 900 people were attributed to high summer temperatures.

A heatwave plan (HWP) has been in place in England since 2004. We identified gaps in the system in how some potentially vulnerable groups were identified and protected during the heat-health alert period, particularly older people with health problems who were not in regular contact with health or social care services, many of whom may be living on their own. Many health and care managers relied on general public health information, through national or local media, to reach these groups, and assumed that recipients would act on that advice.

Most people had positive views of hot weather, and for many it was something they looked forward to as it invoked feelings of good health and well-being. In addition, most adults did not feel that hot weather posed a risk to themselves. As a result, protective measures were often not taken, even those that people felt were effective, such as staying out of the heat and in the shade. Younger adults were most likely to underestimate their risks and ignore public health advice on sunbathing and drinking alcohol in hot weather.

Similar results were found among people who were most vulnerable to the effects of heat, particularly in their perceptions of risk. For example, only 40% of participants aged 75 or older saw themselves personally at risk of hot weather. According to many of those interviewed, risk was associated with physical and mental frailty, not age itself, and there was some resistance, even resentment, to any ‘vulnerable’ label that may be applied to them in this context, as they did not consider themselves ‘frail’. Participants felt that hot weather increased their risk of sunburn and skin cancer, however there was much less awareness of the thermoregulatory risk of hot weather, and how this risk increased with age. Security and cost, in addition to self-perception of risk, were key considerations for this group. For example, many did not open windows at night for fear of intruders, or use an electric fan due to the cost of running one. The expectation that any period of hot weather would likely be over quickly was often weighed against any discomfort experienced.

As we move towards more frequent hotter summers, developing systems of identifying, reaching, and supporting our most at-risk communities will increase in importance. As a first step we recommend that Public Health England revise their advice and publicity to improve public awareness of the risks of hot weather. Messages should be tailored to the information needs and media usages of different population groups, and take account for the finding that many people do not self-identify as vulnerable, and therefore should focus more on the risks of hot weather, and help people self-assess their own risk more realistically without the label of ‘vulnerability’.

The published report can be accessed here>>