Heat Health Watch Research Articles

고온건강경보시스템 기준 설정에 관한 연구( I ) - 기준 설정 및 검증 -

This study investigates the standard, duration period and excess mortality of extreme heat using the stand- ardized daily mortality data from 1991 to 2004, establishing a standard threshold Criteria for Heat Health Watch Warning System in Korea. It ultimately aims to provide the guidance in building up Heat Health Watch Warning System for Korea by suggesting the standard to quantify thermal stress from heat. The standard thresh- old Criteria for Heat Health Watch Warning System for Seoul metropolitan city takes into account both daily maximum temperature and daily maximum heat index(HI) and consists of four phases; caution, extreme caution, danger, and extreme danger. Extreme caution phase and danger phase are used as the advisory and warning of extreme heat, respectively. Since the nationwide distribution of the frequency of extreme heat day and the excess mortality rate shows little difference across regions, the standard threshold Criteria for Heat Health Watch Warning System for Seoul metropolitan city can be used for other regions.

Models for mortality associated with heatwaves: update of the Portuguese heat health warning system

AbstractIn Portugal a Heat Health Watch Warning exists since 1999—the íCARO Surveillance System. It is a system for monitoring heatwaves with potential impacts on population's morbidity and mortality, which is set in motion every year between May and September. This system was based on a model for the relation between heat and mortality calibrated with the district of Lisbon data for the big heatwaves of June 1981 and July 1991.The occurrence of 2003's big heatwave brought opportunity for updating existing models.The fact that this heatwave has been particularly long and had characteristics that were not described in the previously known heatwave episodes also allowed the chance to investigate the mechanism of the relation between occurrence of extreme heat and mortality.The aim of this work was to update the existing íCARO model and contribute to increase the knowledge on the phenomena of the heatwave's impact on mortality.Thus, four models were assayed, that represent four distinct proposals for reference temperature's thresholds and in the generalization of the main used variable accumulated thermal overcharge (ATO).All the assayed models showed a good adaptation to the observed mortality data for the district of Lisbon for the three known big heatwaves.It is concluded that the rational generalized accumulated thermal overload (GATO) adapts well to the relation between heat and mortality. The best model was chosen as the one that considered a dynamic threshold that follows the ascending phase of the temperatures of summer until reaching its maximum level in the end of the month of August remaining thereafter constant until the end of the summer, thus recurring to a rational of population's adaptation to heat, contrarily to what happens to air temperatures that decrease at end of the summer. Copyright © 2007 Royal Meteorological Society

Evaluation of the French Heat Health Watch Warning System

P-502 Objectives: Following the heat wave in August 2003, a heat health watch warning system (HHWWS) was developed, essentially based on a biometeorological indicator and integrated into a national action plan. This study's objective was to evaluate that system in 2004 and 2005 in order to pinpoint the strengths and to propose some scientific and organisational improvements. Methods: The evaluation was carried out in the Institute running the system and with external partners (working group associating the National Weather Bureau and a research laboratory in Climate and Health, consultants, international workshop). This evaluation took into account the following areas: scientific aspects, efficiency of the system and its cost, organisation, cooperation between the different partners, simplicity, flexibility, traceability, adaptability. Results: The evaluation demonstrated it was necessary to revise the alert thresholds, to take into account the uncertainties due to the meteorological forecasts, to integrate qualitative criteria such as atmospheric pollution and to change some meteorological stations which were not very representative. Despite the difficulty for the partners to well understand the biometeorological indicator, the system proved to be quite simple, adaptable even during the working period, well traceable (data, information) and based on good relations between the different partners. The use of health data proved to be heavy, needing a better automation. Concerning the efficiency, the number of alert propositions was high (74) compared to the real over thresholds (25), because of the meteorological forecasts uncertainties and also because of the qualitative criteria taken into account besides the main indicator: this is an indication of quite a protective system. Conclusion: This evaluation allowed to improve the system at a scientific and organisational level. Further improvements should be done, in particular using air masses as possible indicators. But the evaluation has still shown that each country is specific in terms of available data, human resources, financial resources, objectives, and that it might not be useful to try to define a single system adaptable everywhere.

The Development of Heat Health Watch Warning Systems for Five European Cities: Results From the European Union PHEWE Project

WS2-05 Abstract: The general aim of the PHEWE project is to assess the association between weather and acute health effects (daily mortality and hospital admissions) during the warm season in Europe and to provide information for public health policy on preventive and adaptive actions. One such adaptive action is the development of Heat Health Watch Warning Systems (HSWWS) for the prediction and warning of heat-related mortality. This paper describes the climate science issues associated with the development of experimental HSWWS for London, Paris, Barcelona, Rome, and Budapest and specifically addresses the issue of predictability of weather forecast variables and mortality. Furthermore, the paper highlights the fact that no one single climate-based system for the prediction of heat-related mortality can be applied universally across the 5 experimental cities.

A Rapid Surveillance System of Daily Mortality During Summer in Italy

P-568 Abstract: Results from several studies show heat waves produce an increase in daily mortality with a short lag of few days. In Italy, since 2004, a national project of the Department for Civil Protection was implemented for the prevention of heat health effects. The program includes city-specific heat health watch warning systems (HHWWS) and the implementation of a daily mortality surveillance system. The aim of this innovative system is to provide real time mortality data in order to identify increases in mortality associated to heat waves rapidly. Between the 1st of June and the 30th of September daily mortality surveillance systems are operational in all regional capitals and in other Italian cities with more than 200,000 inhabitants. Every day, the local mortality registry offices electronically transmit deaths occurred in the previous 24–48 hours to the National Centre for Prevention of Heat Health Effects. Anonymous information on gender, age, municipality of residence and death are collected. Daily quality control is performed to guarantee the completeness of the database. A city-specific mortality baseline is defined on the basis of the time series of deaths available accounting for month and day of the week. The difference between baseline and daily mortality is calculated by gender and age groups (0–64, 65–74, 75+) to estimate the potential daily excess of deaths associate to high temperature. In most cases, mortality counts are complete within 72 hours providing a high quality database which is readily usable. Since the implementation of the system in 2004, daily excess mortality was observed mainly in the population over 75 years of age. Results from the HHWWS and data from the daily mortality surveillance system allow to identify real peaks in mortality occurring in the resident population. The immediate identification of excess mortality during summer allows for the detection of summer heath emergencies and the activation of rapid heath care response plans. Furthermore, daily mortality data are included in forecasting models to predict expected mortality associated with temperature taking into account the death counts of previous days. Moreover, the daily mortality trend is useful to validate HHWWS and in the evaluation of prevention programs.

French Heat Health Watch Warning System: Validation of Temperature Thresholds

French Heat Health Watch Warning System: Validation of Temperature Thresholds

Evaluation of the Communication of the Heat-Health-Watch-Warning System in Hungary

P-508 Introduction: Within the PHEWE project Hungary set up a 3 level heat health watch warning system (HWWS) in 2004 based on the analysis of the Budapest mortality and meteorology database 1970–2000. Parallel the Institute triggered a communication campaign on health impact and adaptation methods. Several communication tools were used for raising the awareness of heat-wave, like distribution of leaflets in GP rooms, pharmacies. As for mass media, a 20-second video clip advertisement was broadcasted on the National Geographic Channel in August 2005, and leading health experts gave interviews about heat-related illness. Social activities like bottles of mineral water were distributed for the drivers stuck in traffic jams. To see the pitfalls of communication, a nationwide market research was launched in November, 2005. Material and method: We made a telephone-survey in the five biggest towns in Hungary. Sample size: 2500 over 18 years having a dwelling with telephone. The questionnaire contained 10 questions aimed to assess the knowledge and awareness of the people about heat, adaptation methods and heat-alert system. Results: Evaluation was divided into four parts. 1) Awareness of heat: Generally people could mention one harmful impact but people aging 30-59y could say more than two impacts. Most of them mentioned hypertension (27%), heatstroke 11%) skin problems (31%), cardiovascular diseases in 22%. Half of the interviewees considered support for elderly of high importance. 2) Preventions: 4/5 of the people took preventive steps but only 1/5 of them could tell exactly how: drinking liquid (20%), sit in shade (17%), in a room with air-conditioning (16%). 3) Communication plan: 25% of the interviewees, mostly between 45–59 years, saw any advertisement. Most of them in the television (78%), daily newspapers (57%), street boards (41%). 4) HHWWS: Large number of interviewees (59%) heard about the announcement of “heat-alarm” and found the guidance informative (42%) and suitable (39%). 2/5 of them would like to know more about heat-wave by the following communication tools: television (92%), radio (76%), regional newspaper (67%). Conclusion: Although the campaign lasted during summer, people are not satisfactory aware of the impact and adaptation methods. Based on the results and within the National Climate Strategy our aim is to launch a Climate-health Prevention Strategy and a “Buddy” Network to prevent health impacts and spread adaptation methods by involving the population in 2006. The PHEWE project is supported by the European Commission, DG Research within the 5th Framework programme, contract N° QLK4-CT-2001-00152.

France’s heat health watch warning system

In 2003, a Heat Health Watch Warning System was developed in France to anticipate heat waves that may result in a large excess of mortality. The system was developed on the basis of a retrospective analysis of mortality and meteorological data in fourteen pilot cities. Several meteorological indicators were tested in relation to levels of excess mortality. Computations of sensibility and specificity were used to choose the meteorological indicators and the cut-offs. An indicator that mixes minimum and maximum temperatures was chosen. The cut-offs were set in order to anticipate events resulting in an excess mortality above 100% in the smallest cities and above 50% in Paris, Lyon, Marseille and Lille. The system was extended nationwide using the 98th percentile of the distribution of minimum and maximum temperatures. A national action plan was set up, using this watch warning system. It was activated on 1st June 2004 on a national scale. The system implies a close cooperation between the French Weather Bureau (Météo France), the National Institute of Health Surveillance (InVS) and the Ministry of Health. The system is supported by a panel of preventive actions, to prevent the sanitary impact of heat waves.

Summary of the mortality impact assessment of the 2003 heat wave in France

France experienced a record-breaking heat wave between 2 and 15 August 2003. All the French regions were affected by this heat wave, which resulted in an excess of 14 800 deaths between 1 and 20 August. The increase in the number of excess deaths followed the same pattern as the increase in temperatures. No deviance from the normal death rate was observed in the month of August during the last third of the month, nor during the following three months. There was a clear discrepancy in the impact of the heat wave from city to city. If the effect of duration of consecutive days with high minimal temperatures and deviance with the seasonal normal temperature was patent, this could not explain all of the observed variability of the death incidence. The victims were mainly elderly women older than 75 years. In terms of relative risk and contribution to the global toll, deaths linked to heat were the most important. Based on these results, the French government developed a Heat Health Watch Warning System and set up a preventive action plan for each region in 2004.

THE PHEWE PROJECT - ASSESSMENT AND PREVENTION OF ACUTE HEALTH EFFECTS OF WEATHER CONDITIONS IN EUROPE

ISEE-235 Abstract: The PHEWE project is a three-year pan-European collaboration between experts in the fields of epidemiology, meteorology, and public health from 17 cities. The general aim of the project is to assess the acute health effects of weather, both during warm and cold seasons in various European countries with widely differing climatic conditions. Specific objectives are to investigate the association between meteorological variables and acute health effects (mortality, hospital admissions) in these cities, and to use these results to develop preventive strategies. The project is broken down into eight work packages, led by different project partners supported by three working groups (epidemiology and statistics, meteorology, and public health). The database includes mortality data from 17 cities and hospital admission data from 12 cities for the available years between 1990 and 2000. For each city a large number of meteorological variables were collected, complex indicators were calculated, and a synoptic index developed. The short-term effect on mortality/morbidity is evaluated through city-specific and pooled time series analysis, addressing the following issues: threshold levels of weather variables, form of the dose-response curve, latency time between exposure and effect, and specific air masses associated with health effects. The interaction between weather and air pollutants is evaluated specifically. Health impact assessment is planned to quantify the effect in the different populations. A heat/health watch warning system to predict oppressive weather conditions and alert the population is being developed in a subgroup of cities. Another relevant aspect is the elaboration of strategies to minimise adverse health effects in Europe, and guidelines for public health interventions. After the first 18 months the European database has been completed and meteorological analysis of the single cities has been performed. City-specific analysis of the association between weather and health effects has been conducted. Three cities are currently experimenting with heat health watch warning systems; a survey of current preventive policies has been produced. Results of the short-term effects of temperature and humidity on mortality and hospital admissions will be presented. The study establishes the scientific basis for evaluating the health effects of global warming, and addresses the interaction between climatic conditions and air pollution. The specific focus on effect modification, considering variables associated with city-specific population characteristics, climate and environmental conditions is an important contribution to the knowledge in the field of weather and health.

THE IMPACT OF THE 2003 HEAT WAVE ON MORTALITY AND HOSPITAL ADMISSIONS IN ENGLAND

ISEE-300 Introduction: During August 2003 England, along with the rest of Europe, experienced sustained high temperatures. From the 4th to the 13th August 2003 daytime maximum temperatures across much of England were above 30°C and in many areas temperature records were broken. Ozone exposure was also in excess of normal levels. This paper provides the first preliminary quantitative estimates of the impact of the heat wave on mortality and hospital admissions in England, by region and by selected age groups. Methods: The episode was defined as the 4th to the 13th of August based on the pattern of observed sustained increase in daily Central England Temperatures (CET) above average levels for the period 1971–2000. Information on the daily number of deaths and hospital admissions was collected for Government Office Regions and for selected age groups. The number of deaths and hospital admissions, attributable to the heat wave, were calculated by comparing observed 2003 data with a baseline of the five previous years over the same period. Results: During the episode there were an estimated 2,045 more deaths in England and Wales than for the same period between 1998 and 2002. Most of the excess deaths were concentrated in the south east of England, particularly in London. Increased mortality was seen in all age groups, but most notably in the over 75s. However, hospital admissions in London showed no increase for those under the age of 75. The greatest increase in mortality above expected levels was found for regions with prolonged anomalous temperatures. High ozone levels in these regions may also have contributed to increased mortality. Discussion: In terms of the impact on human health, the summer of 2003 ranks alongside those of 1995 and 1976. This paper is unique in providing a quick response to the summer 2003 heat wave, and bringing together information from a variety of different sources. The results have implications in terms of more sophisticated future analyses, public health policies and the development of heat-health watch warning systems.

HEAT WATCH/WARNING SYSTEMS SAVE LIVES

Introduction The Philadelphia Hot Weather-Health Watch/Warning System was initiated in 1995 to alert the city's population to take precautionary actions when hot weather posed risks to health. This system is the basis for a number of other heat-health watch warning systems being instituted in cities worldwide. This is the first attempt to calculate the number of lives saved and the economic benefit of these systems in reducing heat related mortality. Methods Two types of hot weather patterns, maritime tropical and dry tropical, have been historically associated with elevated mortality in Philadelphia; we refer to these weather patterns as ‘heatwaves.’ Our analyses included daily data for all such heatwaves during 1995–1998, plus up to three additional days after the end of each heatwave. The three days following a heatwave were included because mortality effects can lag heatwaves by up to three days. We estimated the number of lives saved and the economic benefit of this system. We focused on excess mortality in people 65 years of age and older. For the days in our sample, mortality data were obtained from the National Center for Health Statistics for the Philadelphia SMSA. Excess mortality was defined as reported mortality minus mortality predicted by a historical trend line developed over the period 1964–1988. We develop a statistical explanation of excess mortality using the following explanatory variables: daily weather variables, the duration in days of each heatwave, the daily sequence number indicating the time of the 139-day summer season on which each heatwave commenced (Time of Season), the classification of each heatwave day as maritime tropical or dry tropical, and an indicator variable to show whether a heatwave warning was issued (Warning Indicator). Weather data for the time period 1995–1998 included temperature at 5AM, and temperature and dew point at 5PM. Results There were 45 days during 1995–1998 when warnings were issued (or the effect of warnings persisted over the three-day lag after the warning ended). We explained excess mortality during heatwaves using linear regression, and found two variables convincingly associated with mortality: the Time of Season when a particular heatwave started, and a Warning variable indicating whether or not a heatwave warning had been issued. The estimated coefficient of the Warning variable was about −2.6, suggesting that when a warning was issued, 2.6 lives were saved, on average, for each warning day and for three days after the warning ended. Therefore, we estimated that the warning system saved a total of 117 lives. We also estimated the dollar costs of the system, and reviewed the literature on the value of life. Conclusions We estimated that the net dollar benefits of the system were on the order of $468 million over the three-year period.