Health education and a co-ordinated response system to support vulnerable people during heat waves
Correspondence to: Keren Stuart, School of Population Health and Clinical Practice L11, Terrace Towers Building, 178 North Terrace Mail Drop DX 650 205, University of Adelaide SA 5005; e-mail: email@example.com
Professor Gavin Mooney, School of Public Health, University of Sydney, NSW 2006; e-mail: firstname.lastname@example.org
DISCLAIMER: Australian Red Cross is a national society within the International Red Cross & Red Crescent Movement and, as such, must abide by the movement's Fundamental Principles, being humanity, impartiality, neutrality, independence, voluntary service, unity and universality. The material in this publication cannot be used in ways or in forums or for purposes that conflict with these Principles.
Climate change is expected to increase the frequency, duration and intensity of heat waves in Australia over the next 50 years.1 Heat waves have caused more deaths in Australia than any other natural disaster in the past century.2 Heat-related deaths are predicted to double in Australia from a 1990–99 baseline1 by 2020 if preventive and adaptive measures are not implemented.3
Those most at risk are the elderly, who have a reduced capacity for thermoregulation, those with cardiovascular disease,4 diabetes, renal disease,5 chronic respiratory problems4 and those with mental health problems.6 The principal cause of heat-related deaths are dehydration,7 cardiovascular events and respiratory problems in the elderly.4,7
Deaths from heat waves are preventable if response systems are in place and individuals adapt their behaviours.8 The greatest protective factor to prevent heat-related deaths is the use of an air-conditioner.9 The use of a fan is not protective in preventing deaths.9 Those most at risk are individuals who live alone and the elderly.9 It is plausible that without social contact, the effects of heat-related illness can go unnoticed.10 The effects of over exposure to heat can progress to heat stroke in as little as 24 hours, therefore a system to check on the welfare of those most at risk every few hours is essential.8,9
Australian Red Cross is involved in educational and preventive approaches to reduce heat-related illness, hospital admissions and mortality among vulnerable populations. A preventive approach offered by the Red Cross is ‘Telecross REDi’, a phone call up to three times a day to check on people's welfare and offer advice on how to stay cool during a heat wave. In order to plan an effective Telecross REDi program, a small survey was conducted.
Twenty Red Cross clients were interviewed in their homes and asked questions to assess their adaptive and preventive behaviours during a heat wave, their knowledge of adverse heat-related health effects, their level of preparedness and their perception of a heat wave as an emergency event. Following the questions, the Telecross REDi service was explained to participants and two further questions were asked to determine whether the participants intended to change their behaviours before and during the next heat wave.
The results of the survey indicate that while many perceive a heat wave as an emergency, only a few might actually plan for a heat wave. The participants reacted to a heat wave by adapting their behaviours as a result of feeling hot. The fact that a majority of the participants did not know any of the signs of heat stress/stroke/exhaustion illustrates the need for awareness and health education. Alarmingly, 25% of participants did not have an air-conditioner in their home during the last heat wave.
A strategy to offer heat-coping advice and to check on the welfare of the vulnerable and socially isolated during a heat wave is vital. Results from two studies9,11 have shown that community preparation for a heat wave reduces mortality. The decrease in mortality is attributed to the education of the community about the risks of heat-related illnesses, the heat warning systems implemented, and the preventive measures governments and community organisations set up.9,11 In relation to the Telecross REDi strategy, the World Health Organization advises that actively contacting people to check on them and give advice on how to stay cool is more effective than simply giving people brochures to read.12
The authors would like to thank the staff at Red Cross for their help and guidance and the participants for their valuable time and the helpful information that is essential in shaping the Telecross REDi and health education programs.
- 1 et al. Health Impacts Studied. Chap 7. In: Human Health and Climate Change in Oceania: A Risk Assessment 2002. [Internet]. Canberra ( AUST ) : Commonwealth Department of Health and Ageing; 2003 [cited 2009 Aug 9]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/2D40%2037B384BC05F6CA256F1900042840/$File/env_climate7172.pdf. , , , , , ,
- 2 South Australian State Emergency Service [homepage on the internet]. Community Safety: Heat Wave Information Guide [Internet]. Adelaide ( AUST ) : SA SES;1998 [cited 2009 Aug 9]. Available from: http://www.ses.sa.gov.au/site/community_safety/heatwave_information.jsp.
- 3 ParryML, CanzianiOF, PalutikofJP, van der LindenPJ, HansonCE, editors. Australia and New Zealand [Internet]. Chapt 11. In: IPCC Fourth Assessment Report: Climate Change 2007. Cambridge ( UK ) : Cambridge University Press; 2007 [cited 2009 Sep 1]. p. 507–40. Available from: http://www.ipcc.ch/pdf/assessment-report/ar4/wg2/ar4-wg2-chapter11.pdf.
- 4 Climate change and human health: present and future risks. Lancet. 2006;367(9513):859–69. , , .
- 5 The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. Int J Epidemiol. 2008;37(6):1359–65. , , , , , .
- 6 The effect of heat waves on mental health in a temperate Australian city. Environ Health Perspect. 2008;116(10):1369–75. , , , , , .
- 7 Heat waves and dehydration in the elderly [editorial]. BMJ. 2009:b2663. , , .
- 8 Relation between elevated ambient temperature and mortality: a review of the epidemiologic evidence. Epidemiol Rev. 2002;24:190–202. , .
- 9 et al. Heat-related mortality during a 1999 heat wave in Chicago. Am J Prev Med. 2002;22(4):221–7. , , , , , ,
- 10 Heat-related illness: current status of prevention efforts. Am J Prev Med. 2002;22(4):328–9. .
- 11 et al. Has the impact of heat waves on mortality changed in France since the European heat wave of summer 2003? A study of the 2006 heat wave. Int J Epidemiol. 2008;37(2):309–17. , , , , , ,
- 12 et al. Improving Public Health Responses To Extreme Weather/Heatwave – EUROHEAT Technical Summary [Internet]. Copenhagen ( DNK ) : WHO Regional Office for Europe; 2009 [cited 2009 Aug 20]. Available from: http://www.euro.who.int/_data/assets/pdf_file/0010/95914/E92474.pdf. , , , , , ,
This letter makes the useful point that all too few of those vulnerable to heat waves, especially among the elderly, have any sort of plan to deal with such emergencies. The Red Cross scheme to check on those most at risk and to offer advice is clearly good health policy. At this level one can only congratulate the Red Cross.
Standing further back, however, the letter draws attention to the fact that, with climate change, heat waves in Australia will be more frequent and worse. From its website1 it is clear that the Red Cross sees the need for adaptive strategies for the vulnerable across the globe.
What is not clear, however, is whether the Red Cross in Australia is explicitly campaigning to back the government in its efforts to reduce the impact of climate change. Some of the resources it might allocate to helping those individuals at risk from heatwaves might well be better devoted to such campaigning.
Prevention, in this instance of more heatwaves, might be a very good buy!
- 1 Australian Red Cross, Around the world development program. [cited 2011 Jul 3]. http://www.redcross.org.au/default.asp.