IPCC Report.pdf - Adam Curry

Chapter 9Case Studiesneed for other, novel measures such as modification of the urban formto reduce exposure (Bernard and McGeehin, 2004; O’Neill et al., 2009;Reid et al., 2009; Hajat et al., 2010; Silva et al., 2010). Thus the outcomesfrom the two European heat waves of 2003 and 2006 are extensive andare considered below. They include public health approaches to reducingexposure, assessing heat mortality, communication and education, andadapting the urban infrastructure.9.2.1.5.1. Public health approaches to reducing exposureA common public health approach to reducing exposure is the HeatWarning System (HWS) or Heat Action Response System. The fourcomponents of the latter include an alert protocol, community responseplan, communication plan, and evaluation plan (Health Canada, 2010).The HWS is represented by the multiple dimensions of the EuroHeatplan, such as a lead agency to coordinate the alert, an alert system, aninformation outreach plan, long-term infrastructural planning, andpreparedness actions for the health care system (WHO, 2007). TheEuropean Network of Meteorological Services has created Meteoalarmas a way to coordinate warnings and to differentiate them acrossregions (Bartzokas et al., 2010). There are a range of approaches usedto trigger alerts and a range of response measures implemented oncean alert has been triggered. In some cases, departments of emergencymanagement lead the endeavor, while in others public health-relatedagencies are most responsible (McCormick, 2010b).As yet, there is not much evidence on the efficacy of heat warningsystems. A few studies have identified an effect of heat preparednessprogramming. For example, the use of emergency medical services duringheat wave events dropped by 49% in Milwaukee, Wisconsin, between1995 and 1999; an outcome that may be partly due to heat preparednessprogramming or to differences between the two heat waves (Weisskopfet al., 2002). Evidence has also indicated that interventions in Philadelphia,Pennsylvania, are likely to have reduced mortality rates by 2.6 lives perday during heat events (Ebi et al., 2004). An Italian intervention programfound that caretaking in the home resulted in decreased hospitalizationsdue to heat (Marinacci et al., 2009). However, for all these studies, it isnot clear whether the observed reductions were due to the interventions.Questions remain about the levels of effectiveness in many circumstances(Cadot et al., 2007).Heat preparedness plans vary around the world. Philadelphia,Pennsylvania – one of the first US cities to begin a heat preparednessplan – has a ten-part program that integrates a ‘block captain’ systemwhere local leaders are asked to notify community members of dangerousheat (Sheridan, 2006; McCormick, 2010b). Programs like the Philadelphiaprogram that utilize social networks have the capacity to shape behaviorsince networks can facilitate the sharing of expertise and resourcesacross stakeholders; however, in some cases the influence of socialnetworks contributes to vulnerability (Crabbé and Robin, 2006). Otherheat warning systems, such as that in Melbourne, Australia, are basedsolely on alerting the public to weather conditions that threaten olderpopulations (Nicholls et al., 2008). Addressing social factors inpreparedness promises to be critical for the protection of vulnerablepopulations. This includes incorporating communities themselves intounderstanding and responding to extreme events. It is important that topdownmeasures imposed by health practitioners account for communitylevelneeds and experiences in order to be more successful. Greaterattention to and support of community-based measures in preventing heatmortality can be more specific to local context, such that participationis broader (Semenza et al., 2007). Such programs can best address thesocial determinants of health outcomes.9.2.1.5.2. Assessing heat mortalityAssessing excess mortality is the most widely used means of assessingthe health impact of heat-related extreme events. Mortality representsonly the ‘tip of the iceberg’ of heat-related health effects; however, it ismore widely and accurately reported than morbidity, which explains itsappeal as a data source. Nonetheless, assessing heat mortality presentsparticular challenges. Accurately assessing heat-related mortality faceschallenges of differences in contextual variations (Hémon and Jougla, 2004;Poumadere et al., 2005), and coroner’s categorization of deaths (Nixdorf-Miller et al., 2006). For example, there are a number of estimates ofmortality for the European heat wave that vary depending on geographicand temporal ranges, methodological approaches, and risks considered(Assemblée Nationale, 2004). The different types of analyses used toassess heat mortality, such as certified heat deaths and heat-relatedmortality measured as an excess of total mortality over a given timeperiod, are important distinctions in assessing who is affected by theheat (Kovats and Hajat, 2008). Learning from past and other countries’experience, a common understanding of definitions of heat waves andexcess mortality, and the ability to streamline death certification in thecontext of an extreme event could improve the ease and quality ofmortality reporting.9.2.1.5.3. Communication and educationOne particularly difficult aspect of heat preparedness is communicatingrisk. In many locations populations are unaware of their risk and heatwave warning systems go largely unheeded (Luber and McGeehin, 2008).Some evidence has even shown that top-down educational messagesdo not result in appropriate resultant actions (Semenza et al., 2008). Thereceipt of information is not sufficient to generate new behaviors or thedevelopment of new social norms. Even when information is distributedthrough pamphlets and media outlets, behavior of at-risk populationsoften does not change and those targeted by such interventions havesuggested that community-based organizations be involved in order tobuild on existing capacity and provide assistance (Abrahamson et al.,2008). Older people, in particular, engage better with preventioncampaigns that allow them to maintain independence and do not focuson their age, as many heat warning programs do (Hughes et al., 2008).More generally, research shows that communication about heat495