Climate change, which is reflected in an increase in the frequency and duration of so-called hot/cold waves, is affecting public health. Moreover, the nature and increasing intensity of these impacts are becoming increasingly evident. Much attention has been paid to this issue following several episodes of abnormal events, culminating at the beginning of the 21st century with the heatwave in Europe in the summer of 2003. Since then, adapting populations and urban structures to the impacts of climate change has become a major focus of national and metropolitan governments around the world, and many European governments have decided to set up Heat Wave Warning Systems (HWWS).
Heat-related deaths are frequent in summer, but many of these deaths are preventable. Additional deaths and exacerbation of climate-related diseases can be reduced by implementing a special Action Plan, including early warning of the onset of heat waves, mobilising health workers, informing the population about personal prevention measures, increasing the number of “cool rooms” for pensioners and other measures.
The effectiveness of such plans has already been demonstrated in a number of countries, where it has been possible to reduce the number of expected deaths. For example, in France in 2006, proactive action by the health system, which received timely information about the coming heatwave, reduced the number of forecasted additional deaths due to heat waves by 30%.
One of the key elements of climate change adaptation in terms of public health is effective action to reduce the impact of heat waves. The basic principles for developing heatwave action plans are defined in the WHO handbook “Action plans to protect public health from the effects of heat waves”.
In the Russian Federation, the guiding document for the development of action plans to protect public health from the effects of abnormal heat is the Ministry of Health and Social Development letter No. 14-3/10/2 — 3936 of 18 April 2012 “On the direction of the Action Plan to protect public health from the effects of abnormal heat”, which was based on the abovementioned WHO recommendations.
Key elements of action plans to protect public health from the effects of heat waves (WHO EWB Guidelines “Action plans to protect public health from the effects of heat waves”)
Eight key elements of action plans that determine their success are highlighted:
1. agreement on a lead agency (which should coordinate the cooperation mechanism between bodies and agencies and lead the response in the event of an emergency);
2. Reliable and timely notification systems (rapid notification systems to protect health from heat waves, including emergency alerts, definition of criteria for action and risk alerts);
3. A public information plan on the health impacts of heat waves (what information is disseminated, for whom and when);
4. Reducing the impact of indoor heat (medium- and short-term strategies, recommendations on how to keep indoor temperatures cool during a heatwave);
5. Providing special assistance to vulnerable groups;
6. ensuring the preparedness of the health and social protection system (planning and training of personnel, adequate medical services and infrastructure);
7. Long-term urban planning (involving an approach to the design of buildings and facilities and the implementation of energy and transport policies that should ultimately reduce the impact of heat waves);
8. real-time monitoring and evaluation.
In addition, monitoring and evaluating the implementation of the plan after each season and improving it as necessary is an essential element.
One of the main challenges in plans for adaptation to abnormal weather conditions is to establish criteria for them.
For settlements located in different climatic zones, there are appropriate temperature comfort values at which minimum mortality rates from climate-dependent causes are recorded. Warmer areas have higher and colder areas have lower optimum temperatures.
However, the relationship between temperature and mortality is not linear across the temperature range. For some causes of death (e.g., all-cause mortality and cardiovascular disease), it is a V- or U-shaped curve with a minimum at a certain point, the values around which can be called the temperature comfort zone. There is no generally accepted definition for it.
Therefore, the concept of heat is defined individually, not only for each climatic zone, but even for individual cities and metropolitan areas in particular. Periods of heat waves are rare phenomena, varying in character and impact even within the same area.
The list of people at risk during a heatwave is quite long. They are the elderly, chronically ill and with limited mobility, including bed-ridden patients, lonely people, people living on the upper floors of buildings and in buildings without lifts, children under four years old and infants. Low social status, poor housing quality, lack of air conditioning and physical and social isolation of older persons are also additional risk factors.
In large cities, the risk group also includes people living or working in “heat islands”, i.e. neighbourhoods in urban areas that heat up more than the surrounding area and retain the heat accumulated during the day throughout the night.
Many US and European cities have developed heatwave action plans for their authorities. They may include activities to be implemented in the medium term to prepare for the heatwave, such as equipping socially important facilities with air conditioning, as well as lists of actions to be taken during the heatwave warning period, depending on the allocated danger levels. The action plans are strategic framework documents defining goals and objectives, they delineate the powers and responsibilities of the different authorities, describe the mechanisms for their interaction during heat waves and define the list of preparatory activities.
Regional Action Plans to minimise harm from heat/cold waves and other adverse meteorological conditions began to be developed in Russia in 2009, when WHO initiated the project ‘Climate Change Impacts on Public Health and Assessment of Adaptive Capacity in the North of the Russian Federation’. One of the first was the Moscow City Action Plan, approved by the Mayor of Moscow in 2013.
The Moscow City Action Plan is based on the Model Action Plan for Protecting Public Health from the Effects of Abnormally Hot Weather, approved by Russian Government Order No. 1372-r of 20 September 2008, scientifically substantiated with regard to the specifics of the capital as part of the research work based on the assessment of the effects of abnormally hot weather in 2010.
A feature of the Moscow Action Plan is to take into account not only the average daily air temperature but also the level of air pollution. The plan establishes four levels of heat and air pollution hazards (depending on average daily air temperature, average daily PM10 and ozone concentrations) for public health. The hazard criteria are determined on the basis of an increase in the mortality rate if the above-mentioned indicators are exceeded (Table 1).
Table 1. Heat and air pollution hazard criteria and levels for Moscow city
Conditions for declaring a hazard level |
|||
Level of danger |
Average daily temperature, °C |
Daily average suspended solids concentration РМ10,
|
Daily average ozone concentration (eight-hour average ozone concentration),
|
| Low (acceptable, “green”) | Up to 21 | Up to 60 | Up to 53 (up to 100) |
| Level one (alert, “yellow”) | From 21 to 22 | From 61 to 100 | From 52 to 102 (from 100 to 130) |
| Level two (medium, “orange”) | From 22 to 23,6 | From 100 to 140 | Over 102 to 151 (from 131 to 160) |
| Level three (high, “red”) | From 23,6 | Over 140 | Over 151 (over 160) |
The plan provides for the participation of 18 executive authorities of Moscow, as well as the Russian EMERCOM Moscow and the Hydrometeorological Bureau of Moscow and the Moscow Region, in measures to reduce the negative impact of the heat wave on public health.
Mitigation measures include:
- informing the population in advance about the onset of the heatwave and the measures to protect against its negative consequences. Responsible: Department of Natural Resources and Department of Media and Publicity;
- work of the patronage service, increase of stocks, equipment of air-conditioned premises in the centres of social protection of the population. Responsible: Department of Social Protection;
- preparedness of the health care system for increased load, equipment of air-conditioned premises at the health care facilities and preparedness of pharmacies for purchase of protective means in case of smoke outbreak. Responsible: Department of Health of the City of Moscow;
- Formation of lists of public buildings ready to provide free access of population to air-conditioned premises. Responsible: prefectures.
The concept of medium-term measures includes improvement of forecasting quality, increasing the number of “cool zones” in social institutions, improvement of systems of normative air exchange and normative temperature in the rolling stock of ground public transport and metro and others.
The results of the Moscow City Action Plan could be felt by the citizens during the abnormal heatwave in 2022.
Abnormal heat wave in Moscow
The longest wave of abnormal heat in Moscow was observed in the summer of 2010 against a backdrop of wildfires. There were a total of 44 days with temperatures above 30 °C (the norm was four days), including 33 consecutive days (from 14 July to 15 August) in the capital. Temperatures exceeded 35 °C on 15 days (the norm was one day in four), including eight consecutive days (22 to 29 July). The hottest days were 28-29 July and 4 August, when mean daily temperatures exceeded 30 °C (the norm was 18.5 °C). There were 22 maximum daily temperature records, including two in June, 10 in July (+ monthly and absolute) and 10 in August (+ monthly).
The summer of 2022 was also one of the hottest and driest summers in Moscow. The average temperature in June was 18.8 °C (+2.2 °C anomaly), in July 20.7 °C (+2.5 °C anomaly) and in August 21.9 °C (+4.3 °C anomaly). And while the summer of 2022 as a whole was inferior to the record-breaking 2010, August 2022 was the hottest August on record for the capital, surpassing the previous record by 0.1 °C. Moscow experienced several heat waves over the season. Temperatures near or above 30 °C were seen in Moscow during the last five days of June, the first decade and the last five days of July. In August, more than 10 days the thermometers were close to 30 °C.
In June and August the weather was mainly determined by anticyclones, with dry weather. Moscow received 61% of normal rainfall in June. August was a dry month, with only 5% of normal rainfall. Precipitation was within the norm only in July.
As in summer 2010, most of August 2022 weather in Moscow was determined by a blocking anticyclone that swept central regions of European Russia and the Urals.
Prolonged periods of dry and hot weather in the European part of Russia caused wildfires in August.
The city is currently implementing the following measures to minimise the negative effects of the heatwave:
- information about the onset of the heat wave with doctors’ recommendations is posted on the mos.ru portal, in the media and on public transport facilities (warnings by the Ministry of Emergency Situations of Russia in Moscow, based on the criteria of the Central State Meteorological Service);
- social service centres have opened “cool rooms” (information is available on the mos.ru portal with telephone numbers);
- city polyclinics are equipped with coolers and air conditioning;
- some metro and MCC stations distribute drinking water;
- the majority of underground and surface transport rolling stock is air-conditioned;
- the roadway is watered on a frequent basis and the air is aerated.
- some metro and MCC stations distribute drinking water.
Sources:
1. Action plans to protect public health from the effects of heat waves. Handbook edited by F. Matthies, Gr. Bickler, N.C. Marin, S. Hales. World Health Organization, 2011, 66 pp.
2. WHO Regional Office for Europe. Public health and climate change adaptation policies in the European Union: final report. World Health Organization, Copenhagen 2018
3. Institute of National Economic Forecasting of RAS. Reports 1, 2, 3 on the results of the research work on the topic: “Development of scientific and methodological foundations of the system of informing the population under abnormal weather conditions and high atmospheric air pollution, development of air quality assessment system with gradations of danger to the population, including measures to reduce danger to the population from abnormal weather conditions and high atmospheric air pollution”, under the supervision of B.A. Revich. B.A. Revich, Moscow, 2012
4. Confalonieri, U.; Menne, B.; Akhtar, R.; Ebi, K.L.; Hauengue, M.; Kovats, R.S.; Revich, B.; Woodward, A. Human Health. In Climate Change 2007: Impacts, Adaptation and Vulnerability; Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change; Parry, M.L., Canziani, O.F., Palutikof, J.P., van der Linden, P.J., Hanson, C.E., Eds.; Cambridge University Press: Cambridge, UK, 2007; pp. 391-431.
5. Morgan G., Sheppeard V., Khalaj B. et al. Effects of bushfire smoke on daily mortality and hospital admissions in Sydney, Australia // Epidemiology. — 2010. — V. 21. — N. 1. — P. 1–9.
6. Fouillet A., Rey G., Wagner V., Laaidi K., Empereur-Bissonnet P., Le Tertre A. 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. International Journal of Epidemiology, 2008,37(2): 309-317.
Cover photo: Derek Yung / iStock
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