People in poor health

People in poor health are more sensitive to the impacts of climate change and extreme weather events

 

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Introduction

 

The impacts of climate change and extreme weather events can affect anyone, but those already in poor health potentially face more serious harm. Not all individuals in poor health are equally sensitive or equally vulnerable; different conditions may mean people are affected in different ways. Some people may also be more vulnerable due to other social or environmental factors. People experiencing multiple causes of vulnerability are the most extremely socially vulnerable.

 

The sensitivity of people in poor health to climate impacts can be compounded by other characteristics, such as age. Older people and babies/young children, for example, are particularly sensitive to extreme weather. Social factors also affect the ability of people to adapt to climate impacts and extreme weather events, including being on a low income, being a tenant, being socially isolated or living in certain types of housing. The Further Resources section provides a link to where you can get more information about who is socially vulnerable and why.

 

The following section shows how ill-health can make people particularly sensitive to climate impacts and related extreme weather. It should be noted that the specific vulnerabilities of individuals and communities will be affected by other personal, environmental and social factors which are explored in detail elsewhere in this website.

 

 

Groups sensitive to heatwaves

 

People with pre-existing health problems may be more likely to experience detrimental physical impacts such as dehydration during a heatwave event.1,2 Particular health problems of concern include chronic cardiovascular, respiratory illness, diabetes, renal diseases, nervous system disorders, Parkinson’s disease, emphysema and epilepsy. Furthermore, people who already have a high body temperature, for example as a result of an infection, are more susceptible to the effects of heat.

 

People with limiting long term illness may have diminished ability to adapt to high temperatures due to lower awareness of their circumstances or an inability to take action.3 Examples of people who may be disproportionately affected include people who are bed-bound, unable to leave home daily, or who are unable to care for themselves for other reasons.  

 

People with mental health disorders may not be able to cope with extreme heat or alter their physical environment when hot.4 People affected by mental health issues may be less likely to take effective precautions, recognise the symptoms of heat stress such as dehydration or know what to do in response. In addition, there is evidence that certain medications for the treatment of mental health conditions can make people more susceptible to the effects of heatwaves.5,6

 

People on medications that affect the body’s ability to sweat (renal function) or to perform its other normal temperature regulation functions will be more susceptible to the effects of heat.7 The National Health Service provides guidance on the medicines which can cause problems for patients during heatwaves,8 in addition to those associated with the treatment of mental health conditions.

 

Those in care homes are more reliant on others to deal with high temperatures. There is an association between dependency and the potential for adverse effects from heatwave events.9,10 Care home residents may experience greater exposure to heatwave events if indoor temperatures are not appropriately controlled or moderated, sufficient refreshments provided, and account taken of the different temperature preferences of residents.11 Institutional regimes can also exacerbate problems through being too rigid or due to difficulty in satisfying all of a building’s users’ needs, including staff.12,13 This underlines that it is not just the most fragile and dependent people within residential and care homes that require support during extreme weather events like heatwaves. Evidence suggests that some of the most independent and least physical fragile can be disproportionately affected, potentially as a result of staff concentrating on the most dependent residents and a lack of knowledge about symptoms and appropriate actions amongst the more independent residents.14,15

 

People who misuse alcohol or take illicit drugs may be unable to adapt quickly and be less likely to follow public health announcements during extreme weather events.16  

 

People who are homeless tend to have higher rates of ill-health compared to other people and a greater susceptibility to the effects of heatwaves. Homeless people tend to have higher rates of physical and mental illness, a greater difficulty in effectively managing illness and an increased likelihood to have substance dependencies and cognitive impairments. Homeless people also have other environmental and social factors which increase their vulnerability. They tend to be more exposed to heatwaves through spending a greater amount of time outdoors, often in urban areas where temperatures are higher. See the sections on Adapting Buildings and Green Infrastructure on how to address issues in the built and natural environment. Homeless people are also often socially isolated so are less likely to receive help if suffering from the effects of heat stress. As a result, heatwaves can cause mortality, a worsening of existing illness or lead to other forms of ill-health in this group. See the Heatwave Plan for England.

 

 

Groups sensitive to flooding

 

There are direct and indirect health impacts from flooding.17,18 A broad range of possible flood-related health outcomes can affect people before, during and after events (Figure 1). Their relative importance depends on the nature of the flooding itself, behavioural responses to it and a range of other environmental, social and personal risk factors, including pre-existing illnesses.19

 

 

 

Figure 1: Health outcomes associated with flooding, before (top) during (middle) and after (bottom).20

 

 

People who are temporarily or permanently ill are one of the groups expected to require specific help during a flood event. The National Flood Emergency Framework for England also highlights other groups including: children; older people; pregnant women; people with physical, sensory and cognitive impairments; homeless people; tourists; and people from different cultural and language backgrounds.21 Further Resources (in Section 6 above) has more information about some of these other groups.

 

Flooding may restrict an individual’s access to medicine, e.g. due to loss or damage, and make it difficult to obtain appropriate medical attention in an emergency. Flood events can directly impact local medical services and also affect the wider community given than it may be necessary for hospitals to postpone routine or other non-urgent medical treatments.22

 

People with limiting long term illnesses can be less able to prepare for, cope during and recover from flooding. Vulnerability can be particularly high during events; for example, power-cuts can impact on life support equipment, such as oxygen generators or ventilators, or affect people’s mobility given that they may be reliant on electric wheelchairs requiring recharging and/or access to lifts.23 Taking preparatory action is particularly important as more complex health care is now being delivered at home rather than in hospitals and medical centres often using more sophisticated and power-reliant equipment.24 Power cuts can also affect other services and be an outcome from heat-related events as well as flooding and other hazards like storms (Figure 2). The use of alternative energy sources, like inefficient or poorly managed generators can lead to other impacts, such as carbon monoxide hazards.25,26 Accessing clean drinking water may also present particular challenges for this group as is access to a water supply for people on home kidney dialysis. Those living with mental or physical disabilities require additional assistance in preparing for and recovering from flood events. However, these impacts are not just felt by individuals; the presence of a disabled family member puts additional pressures on others in households affected by extreme events and the recovery of these households may take longer.

 

People with mental health disorders may be less able to prepare for and respond to flooding. Conditions such as dementia or Alzheimer’s can change how a person views the dangers associated with a flood event and how they behave in response.27 Ad-hoc carers helping people during or immediately after events may not have sufficient information about an individual’s medical history and associated medical and care needs28 and not all vulnerable people are able to provide appropriate information to carers under these circumstances.

 

People who misuse alcohol or take illicit drugs may be unable to adapt quickly and be less likely to follow public health announcements during extreme weather events.29  

 

Figure 2: The direct and indirect impacts of power cuts on different aspects of health and wellbeing.30

 

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References

  1. Kovats, R.S., Hajat, S., and Wilkinson, P. (2004) Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK. Occupational and Environmental Medicine 61(11): 893-898.
  2. McGeehin, M.A. and Mirabelli, M. (2001) The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environmental Health Perspectives 109(supplement 2): 185-189.
  3. Defra (2012) UK Climate Change Risk Assessment: Evidence Report, London
  4. Reinhard, K., Rubin, C., Henderson, A., Wolfe, M., Kieszak, S., Parrott, C., Adcock, M. (2001) Heat-Related Death and Mental Illness During the 1999 Cincinnati Heat Wave. The American Journal of Forensic Medicine and Pathology 22(3): 303-307
  5. Page, L. A., S. Hajat, R. S. Kovats and L. M. Howard (2012). "Temperature-related deaths in people with psychosis, dementia and substance misuse." Br J Psychiatry 200(6): 485-490.
  6. Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B. Prognostic factors in heat wave related deaths: a meta-analysis. Archives of internal medicine. 2007 Nov 12;167(20):2170-6.
  7. Defra (2012) UK Climate Change Risk Assessment: Evidence Report, London
  8. NHS (2012) Which medicines could cause problems for patients during a heatwave?
  9. Kovats, R.S. and Ebi, K.L. (2006) Heatwaves and public health in Europe. European Journal of Public Health 16 (6): 592-599
  10. Poumadere, M., Mays, C., Le Mer, S. and Blong, R. (2005) The 2003 Heatwave in France: Dangerous Climate Change Here and Now Risk Analysis 25(6): 1483-1494
  11. Defra (2012) UK Climate Change Risk Assessment: Evidence Report, London
  12. Building comfort for older age: Designing and managing thermal comfort in low carbon housing for older people.
  13. Stafoggia M et al. (2008). Factors affecting in-hospital heat-related mortality: A multi-city case-crossover analysis. Journal of Epidemiology and Community Health, 62:209–215.
  14. Brown, S. and G. Walker (2008). "Understanding heat wave vulnerability in nursing and residential homes." Building Research and Information 36(4): 363-372.
  15. Anderson, M., C. Carmichael, V. Murray, A. Dengel and M. Swainson (2012). "Defining indoor heat thresholds for health in the UK." Perspect Public Health.
  16. Defra (2012) UK Climate Change Risk Assessment: Evidence Report, London
  17. World Health Organisation Europe (2013) Floods in the WHO European Region: health effects and their prevention
  18. Defra (2013) The National Flood Emergency Framework for England
  19. Lowe, D., Ebi, K.L. and Forsberg, B. (2013) Factors Increasing Vulnerability to Health Effects before, during and after Floods Int J Environ Res Public Health. 10(12): 7015–7067
  20. Lowe, D., Ebi, K.L. and Forsberg, B. (2013) Factors Increasing Vulnerability to Health Effects before, during and after Floods Int J Environ Res Public Health. 10(12): 7015–7067
  21. Defra (2013) The National Flood Emergency Framework for England
  22. Fernandez, L.S., Byard, D., Lin, C-C., Benson, S. and Barbera, J.A. (2002) Frail elderly as disaster victims: emergency management strategies. Prehospital and Disaster Medicine 17(2): 67-74
  23. Fernandez, L.S., Byard, D., Lin, C-C., Benson, S. and Barbera, J.A. (2002) Frail elderly as disaster victims: emergency management strategies. Prehospital and Disaster Medicine 17(2): 67-74
  24. Klinger C, Landeg O, Murray V. Power Outages, Extreme Events and Health: a Systematic Review of the Literature from 2011-2012. PLOS Currents Disasters. 2014 Jan 2. Edition 1
  25. Lowe, D., Ebi, K.L. and Forsberg, B. (2013) Factors Increasing Vulnerability to Health Effects before, during and after Floods Int J Environ Res Public Health. 10(12): 7015–7067
  26. Klinger C, Landeg O, Murray V. Power Outages, Extreme Events and Health: a Systematic Review of the Literature from 2011-2012. PLOS Currents Disasters. 2014 Jan 2. Edition 1
  27. Defra (2012) UK Climate Change Risk Assessment: Evidence Report, London
  28. Fernandez, L.S., Byard, D., Lin, C-C., Benson, S. and Barbera, J.A. (2002) Frail elderly as disaster victims: emergency management strategies. Prehospital and Disaster Medicine 17(2): 67-74
  29. Defra (2012) UK Climate Change Risk Assessment: Evidence Report, London
  30. (note permission required) Klinger C, Landeg O, Murray V. Power Outages, Extreme Events and Health: a Systematic Review of the Literature from 2011-2012. PLOS Currents Disasters. 2014 Jan 2. Edition 1

 

Climate Change is recognised as the biggest public health threat this century1

 

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Threat to public health

 

The Sustainable Development Strategy produced by the National Health Service and Public Health England in 2014 for the health, public health and social care system notes that “Health and social care organisations are at the forefront of action to address the health impacts of climate change and need to adapt to, and prepare for, these circumstances”2. Understanding the extent of this remit requires consideration of the ways that climate change  can influence health in the UK, including  through impacts on patterns of disease, patterns of exposure to disease (e.g. through changes in migration) and impacts on access to the basic necessities of life3. Where people and communities already struggle to afford basic necessities there is a greater possibility ofmore severe outcomes, and increasing health inequalities4. These issues are increasingly recognised, for example one of the key messages of the recent Marmot review is that “Tackling social inequalities in health and tackling climate change must go together” 5.

 

 

Building community resilience

 

Preparing for extreme weather events can help with effective use of resources and building community resilience.

  • Climate projections and associated analyses show that the frequency of heatwaves is increasing6. Evidence from the UK Climate Change Risk Assessment (CCRA) suggests that by the 2080s what we currently understand as a heatwave could occur most years and could even occur more than once a year in some regions.  However, changes will be felt much earlier than the 2080s. Regional assessments suggest that, on average, heatwave frequency could be six times higher by the 2050s alone. The pressures on health services dealing with emergency situations will be much greater. Heatwaves often do not occur in isolation and may be associated with other events such as droughts and wildfires, which have their own health consequences.
  • It is also anticipated that the emergency services will face greater pressure from expected changes in the frequency of flood events. Estimates from the CCRA suggest a further 0.9 to 2.3 million people could be at significant risk of river flooding by the 2080s resulting in more than doubling of the effort required by the emergency services without taking account of any change in costs associated with responding to more severe events7.
  • The financial costs associated with events are difficult to estimate, and do not take account of the full impacts on health and wellbeing that occur. Although costing tools exist, these are controversial and must be used with caution. Indeed, there are strong arguments pointing to fundamental flaws in current costing methods from the perspective of rebalancing inequalities – a key aim of the recent Sustainable Development Strategy. Costing methodologies can place lower values on the health impacts of those least responsible and most impacted by the effects of climate change – the poor and future generations – so that those who are worst affected count least. It is also important to consider that it is not always the funder of responses who is the beneficiary of savings.
  • See the Further Resources section for more information.

 

 

Duties and responsibilities

 

Local authorities and their partners in health and social care have statutory duties and other responsibilities in relation to the protection of people’s health. For instance:

  • The Health and Social Care Act 2012 puts local authorities at the centre of activities to improve health, with public health now brought into local government. This brings together the work of the NHS with those providing social care, housing, environmental health, leisure and transport services. The Act puts new duties on clinical commissioning groups to have regard to the need to reduce inequalities in benefits which can be obtained from health services including both NHS and public health functions. Important instruments for joining up actions to address climate risks and extreme weather events are the Joint Strategic Needs Assessments (JSNAs) and the associated strategies produced by Health and Wellbeing Boards. Health and Wellbeing Boards also have a duty to encourage health and care commissioners to work together to enhance the health and wellbeing of people in their area.
  • The Equality Act 2010 allows for positive action in favour of people in groups with protected characteristics. Protected characteristics include disabilities defined as “physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on normal day-to-day tasks”.
  • The Civil Contingencies Act 2004 identifies local authorities, along with the emergency services and NHS bodies as the key organisations who have a responsibility for developing plans for emergency situations. There is an explicit responsibility for helping ‘people who are less able to help themselves in the circumstances of an emergency’ by planning for the potential effects of an emergency, warning and informing both before and during events and facilitating support which can be provided through the commercial and voluntary sectors.8 Partnership working is given a strong emphasis and there is a requirement to work with other organisations in local resilience fora to develop responses to support civil protection.
  • The National Flood Emergency Framework provides a central reference point to assist local authorities and their partners in service delivery to work together to plan for flood events.9 It provides a number of core information resources, guidance on key actions such as interpreting flood warnings and communications and case studies from recent flood events.
  • The Heatwave Plan for England is non-statutory but provides a basis through which other obligations to produce adaptation plans can be developed. Its main purpose is to provide information which helps in the process of building more resilient communities to heatwaves. It sets out ways to prepare for heatwave events and what to do to avoid some of the most severe impacts from prolonged exposure to high temperatures.  Raising awareness among the wider public is one important goal. It also highlights the role of local NHS, public health and social care organisations in overseeing the care of people with particular susceptibilities, to help reduce the potential for over-exposure and to help ensure that service provision is sufficiently resilient to cope with the challenges associated with heatwaves.
  • Action on reducing health and social inequalities is central to the Sustainable Development Unit (SDU) for NHS England and Public Health England’s recent Sustainable Development Strategy10 (Figure 1). The strategy is an important reference point for actions in relation to statutory responses. The SDU also provides additional guidance on statutory and policy drivers for action.11

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Figure 3: The foundation for creating a virtuous cycle for achieving ‘sustainable, resilient, healthy places and people.12

 

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References

  1. Anthony Costello, Mustafa Abbas, Adriana Allen, Sarah Ball, Sarah Bell, Richard Bellamy, Sharon Friel, Nora Groce, Anne Johnson, Maria Kett, Maria Lee, Caren Levy, Mark Maslin, David McCoy, Bill McGuire, Hugh Montgomery, David Napier, Christina Pagel, Jinesh Patel, Jose Antonio Puppim de Oliveira, Nanneke Redclift, Hannah Rees, Daniel Rogger, Joanne Scott, Judith Stephenson, John Twigg, Jonathan Wolff, Craig Patterson (2009) The Lancet 373: 1693–733
  2. NHS Sustainable development Unit (2012) Adaptation to Climate Change for Health and Social care organisations “Co-ordinated, Resilient, Prepared”. Page 3
  3. Sotiris Vardoulakis and Clare Heaviside, The Health Effects of Climate Change in the UK, 2012, Health Protection Agency.
  4. Anthony Costello, Mustafa Abbas, Adriana Allen, Sarah Ball, Sarah Bell, Richard Bellamy, Sharon Friel, Nora Groce, Anne Johnson, Maria Kett, Maria Lee, Caren Levy, Mark Maslin, David McCoy, Bill McGuire, Hugh Montgomery, David Napier, Christina Pagel, Jinesh Patel, Jose Antonio Puppim de Oliveira, Nanneke Redclift, Hannah Rees, Daniel Rogger, Joanne Scott, Judith Stephenson, John Twigg, Jonathan Wolff, Craig Patterson (2009) The Lancet 373: 1693–733
  5. The Marmot Review Team (2010) Fair society, healthy lives.The Marmot Review. Page 9.
  6. Defra (2012) UK Climate Change Risk Assessment: Evidence Report, London
  7. Defra (2012) UK Climate Change Risk Assessment: Evidence Report, London
  8. Civil Contigencies Secretariat (2008) Identifying People Who Are Vulnerable in a Crisis: Guidance for Emergency Planners and Responders.
  9. Defra (2013) The National Flood Emergency Framework for England.
  10. Public Health England and the Sustainable Development Unit for NHS England (2014) Sustainable, Resilient, Healthy People & Places A Sustainable Development Strategy for the NHS, Public Health and Social Care system
  11. Public Health England and the Sustainable Development Unit for NHS England (2014) Statutory and Policy Drivers for Change presentation
  12. Public Health England and the NHS Sustainable Development Unit (2014) Sustainable, Resilient, Healthy People & Places. A Sustainable Development Strategy for the NHS, Public Health and Social Care system

 

The Climate Just map tool contains a series of maps which can be used to understand patterns of ill-health and wider sensitivities and susceptibilities across England, Scotland and Wales.

 

Credit: JRF/Liz Hingley

The Climate Just map tool contains a series of maps which can be used to understand the current patterns of people in poor health across England, Wales and Scotland. Some of the main geographical patterns for England are summarised below. The tool also allows users to overlay maps of potential exposure to flooding and heatwaves. See the map tool for the national maps for 2011 in your area, including updated and refined data on social flood vulnerability and flood disadvantage in England, Scotland and Wales.

 

The most recent Census suggests that the neighbourhoods with the highest proportion of people whose daily activities are limited a lot by a long term health problem tend to be in the north of England, and on the coast, particularly in the southwest. The neighbourhood in England with the highest proportion was located in East Lindsey (on the East Midlands coast) where 39% of the population reported that their daily activities were limited by a long term health problem or disability. The neighbourhoods with the lowest proportions were predominantly in the south, particularly in the London area.  Several of the least affected neighbourhoods were found in Kensington and Chelsea but the neighbourhood with the absolute lowest proportion (3%) was found in Manchester, contrasting with the general tendency for the urban areas of the North to have higher proportions of residents in ill-health.

 

The distribution of households containing at least one person whose daily activities are limited a lot by a long term health problems shows a similar pattern. In this case the highest proportion was found in a neighbourhood in Barnsley (44%) and the lowest in Leeds (5%).

See the map tool for more information on patterns in Englands, Scotland and Wales.

 

Assess the nature of the problem in your area

 

Identify locations with high proportions of people in your area whose activities are potentially affected by ill-health using the Climate Just map tool.

 

Identify the magnitude and likelihood of hazards associated with the changing climate, including flooding and heatwaves.

  • Consider how patterns of people in ill-health and more broadly sensitive to the impacts of climate change and extreme weather events compare with patterns of potential exposure to flooding and heatwaves.
  • Draw on existing risk assessments, adaptation tools such as the UKCP09 projections, UKCP18 which will update the UKCP09 projections and other local information (for example following the UKCIP Local Climate Impacts Profile (LCLIP) process).  See the Further Resources section for an example LCLIP for Greater Manchester.
  • Examine the impacts of extreme weather events including their location, timing, costs and the effectiveness of responses by recording local experiences to support continuous learning.

 

Review the case studies in the Further Resources section to see what others have done.

 

Use additional resources to identify particular sensitive and susceptible individuals, groups and locations. See the How can we do it section for more ideas about where to get information.

  • Use the Strategic Health Asset Planning and Evaluation (SHAPE) tool to access a range of health indicators at fine geographical scales (areas representing populations of 1000-3000). The SHAPE tool also includes overlays of areas potentially affected by flooding. See the Further Resources section for more information about the SHAPE tool.
  • Identify the location of sensitive groups in institutions, such as those in care homes and hospitals.
  • Identify where sensitive individuals live. The map portal provides information about where there are particularly high proportions of sensitive people, but it is also important to remember that all communities will have some sensitive people within them. 

 

Ensure that a full range of issues are incorporated into organisational risk registers.

 

Raise awareness of climate change to build adaptive capacity among sensitive individuals and groups.

  • Raise awareness among the wider public of the potential impacts on health from extreme weather events using existing guidance and public-orientated information bulletins. This should also include information about what preventative actions can be taken and the support available to assist people in making short and longer-term preparations. Support can include what needs to be done to sign up for telephone, text or email flood warning messages and how to join Priority Service Registers run by UK Energy companies to protect people reliant on medical equipment.1 Consider appropriate outreach activities for marginalised groups and those who are particularly susceptible to the impacts of high temperatures and the health impacts of flooding. In locations with a highly transient population, information may need to be more frequently issued or made available in different ways and there may be other particular needs for people who have only recently arrived to a local area.2 See the Further Resources section for more information about raising awareness.
  • Raise awareness among social and health care staff. There are also recommendations that climate change adaptation needs to be built into training programmes for those working in health and social care. It is important to ensure that all staff members, especially those in day-to-day contact with people with vulnerabilities, are aware of the issues and of appropriate adaptation measures so that they are considered as part of everyday working activities.3See the Further Resources section for links to advice for different staff groups:
    • Advice for health and social care practitioners: supporting vulnerable people before and during a heatwave.4
    • Advice for care home managers and staff: supporting vulnerable people before and during a heatwave.5
    • Advice available to Category 1 and 2 responders as part of the Flood Guidance Statements issued by the Flood Forecasting Centre at times of heightened likelihood of flooding.6

Develop local plans that reduce the impact of heat-waves and floods on sensitive individuals and which protect the systems through which care is delivered to them.7 It is recommended that plans build from national guidelines but are strongly tailored to specific local circumstances. Wider risk management activities are already well established for those with responsibilities for health and social care provision. Therefore plans should aim to make climate change adaptation part of general risk management and not just reserved for emergency situations.8 If this is achieved it helps to ensure that information is readily available when it is required, often when normal communication channels are particularly stretched. It also helps to establish measures which can help reduce exposure and build adaptive capacity but which require a longer time-frame to be effective.

  • Consider your specific legislative context. The following text relates primarily to England, but some of the equivalent context for Wales and Scotland with respect to flooding and health is included in our 'Why climate justice matters' presentation, where relevant. 
  • Joint Strategic Needs Assessments are a primary mechanism for highlighting local ambition on reducing climate-related burdens on health and can make the links on this agenda to inform local activities.9 The SDU and Environment Agency’s ‘Under the Weather’ toolkit10 is designed to help health and wellbeing boards and commissioners to increase resilience in a changing climate by integrating climate-related risks into JSNAs.
    • See the Further Resources section for a link to an example Joint Strategic Needs Assessment produced by the London Borough of Hackney.11
       
  • Sustainable Development Management Plans The Sustainable Development Unit (SDU) recommends that health and social care organisations develop SDMPs and that these include a specific section on climate adaptation and that this provides information on local risks and the processes for their management.12 This information can be used by coordinating bodies such as Health and Well-Being Boards and show how obligations are being delivered. These sections might also identify how measures are accounting for specific local circumstances and the potential for uneven impacts as a result of patterns of social vulnerability and socially vulnerable groups.
  • Specific adaptation plans. The research carried out as part of the Built Infrastructure for Older People’s Care in Conditions of Climate Change (BIOPICCC) project has fed into the development of the Sustainable Development Unit’s recommendations for developing an adaptation plan for building climate resilience.
  • See Section 5 'How can we do it?' for more information.
  • Encourage people with specific needs to make their own flood and heatwave plans either alone or with health care professionals. This can cover having a safe place for contact lists, information about prescriptions and care needs, a check list of personal items, instructions for safe operation of equipment, items to help with maintaining hygiene and other general guidance, e.g. as outlined by the National Flood Forum. Preparatory work can include signing up for flood messaging, heat wave alerts and registering on the Priority Service Registers run by UK energy companies. Awareness raising work might also help to identify and deal with any misconceptions about flooding.
  • Reduce exposure of the vulnerable individuals by considering ways that buildings and local environments can be better adapted over the longer term.
  • Enhance green space and green infrastructure in the design of health and social care facilities as well as more widely in urban areas in order to offset the impacts of flooding and reduce temperatures. See the Further Resources section about why this is important and appropriate measures which can be taken.

 

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Tools & resources

SHAPE tool

Strategic Health Asset Planning and Evaluation (NHS tool) for health providers

 

 

Tools & resources

BIOPICCC toolkit

Built Infrastructure for Older People’s Care in Conditions of Climate Change (Durham University)

Find out more

Neighbourhoods without much greenspace

References

  1. Klinger C, Landeg O, Murray V. Power Outages, Extreme Events and Health: a Systematic Review of the Literature from 2011-2012. PLOS Currents Disasters. 2014 Jan 2. Edition 1.
  2. London Climate Change Partnership (2011) London’s changing climate. In sickness and in health
  3. London Climate Change Partnership (2011) London’s changing climate. In sickness and in health
  4. Advice for health and social care practitioners: supporting vulnerable people before and during a heat-wave
  5. Advice for care home managers and staff: supporting vulnerable people before and during a heat-wave
  6. Flood Forecasting Centre, Flood Guidance Statement
  7. NHS Sustainable development Unit (2012) Adaptation to Climate Change for Health and Social care organisations “ Co-ordinated, Resilient, Prepared”
  8. London Climate Change Partnership (2011) London’s changing climate. In sickness and in health
  9. London Climate Change Partnership (2012) Linking Environment and Health
  10. SDU and Environment Agency (2014) Under the Weather Toolkit
  11. City and Hackney, Health and Wellbeing Profile 2011-12: Our Joint Strategic Needs Assessment

 

Actions to take

 

1. Review the recommended general actions. This includes information about raising awareness and partnership working.

2. Make use of health data and registers which are already held within local authorities and organisations with a role in service provision. Data sharing requires relevant approval, but subject to that being received, organisations involved in emergency planning could make use of local authority data on people receiving care and other types of support in order to ensure that their needs are appropriately considered.1

  • See the Further Resources section for an example of where this has been done. The Devon, Cornwall and Isles of Scilly Local Resilience Forum’s ‘Vulnerable People Tactical Framework’2 has involved identifying appropriate organisations working with vulnerable individuals and developing an ‘Information Sharing Protocol’ through which information about vulnerable people and sites such as hospitals and nursing homes can be shared during an emergency situation.

 

3. Consult guidance about how to incorporate climate change impacts into risk registers and other key strategies including local Joint Strategic Needs Assessments (JSNAs). Some of the equivalent context for Wales and Scotland with respect to flooding and health is included in our Why climate justice matters presentation, where relevant.

  • See the Further Resources section for links to guidance and examples. Guidance relating to risk registers has been produced by Lancashire County Council3 and there are examples of risk registers from local authorities from Blaby District Council4 and Greater Manchester5.
  • Assess the climate resilience of your local JSNA using the checklist at the back of the Environment Agency/SDU ‘Under the Weather toolkit’.6 Kent County Council has also produced guidance on JSNAs and sustainability.7

 

4. Make use of specific guidance for raising awareness among people in poor health and encouraging the development of wider personal plans either alone or with appropriate health-care professionals or voluntary groups

  • See the Further Resources section for links to:
    • Guidance on health and heatwaves, including heatwave alerts.8,9
    • National Flood Emergency Framework guidance on flood-related communications.10 Guidance covers the information requirements of different groups and different communication methods such as social media. 
    • Guidance for the wider public and front-line responders on flooding issues, answers to frequently asked questions, floods and mental health and cleaning up safely after an event.11
    • Information about the services of the Flood National Flood Forum12
    • Information about how to join Priority Service Registers run by UK energy companies.13

 

5. Consider how staff training events can be used to build up knowledge of the issues. This can include some of the resources noted elsewhere and dedicated information sources for Category 1 and 2 responders, such as through the Flood Guidance Statement.14

 

6. Consult guidance about health issues to consider after a flooding event has occurred.15

 

7. Develop a step-by-step programme of activities.

  • See the Further Resources section provides links to examples of what others have done. For example, Hertfordshire County Council produced guidance and identified and assessed twelve possible actions as part of their 2009 assessment of climate change impacts on health and adult care services. Bedford Borough Council has listed a set of specific recommendations targeted at organisations involved in health and social care,16 some of which are related to the recommendations provided by the NHS Sustainable Development Unit.

 

8. Work in partnership with others to protect the vulnerable people in poor health. Partnership working is a crucial part of any response to the challenges of climate change and extreme weather. Workshops are one way through which improved dialogue can be achieved, but in order to make meetings as effective as possible it is important to involve all relevant organisations. Wider discussions may also identify new opportunities to join up with existing initiatives or communication channels with target groups, such as through measures put in place to tackle the problem of fuel poverty and to ensure that such measures do not create problems with adapting to summer heatwaves.

  • See the Further Resources section for a link to an example of who to involve. The National Flood Framework lists organisations and agencies to work with in relation to a number of vulnerable groups.17 A list of organisations that should be considered is provided in the ‘Under the Weather’ toolkit.18   Local Resilience Forums also provide a good basis for collaboration and dialogue and provide a foundation for understanding pressures and opportunities across a range of organisations with shared goals and related responsibilities. 
  • Also see the Further Resources section for more information on partnership working.

 

9. Support and encourage local organisations to work with the voluntary and community sector to raise awareness of climate risks and promote personal adaptation strategies. Where possible, this should build on existing programmes and voluntary sector initiatives and pay particular attention to reaching marginalised communities.

  • See the Further Resources section to watch an interview about the responses that Equinox has implemented to help illicit drug users in hot weather.19
  • See the Further Resources section for a link the Snow Angels initiative.This aimed to reduce the physical and social isolation of sensitive individuals during cold weather but ideas could be extended to consider needs during other extreme weather events.
  • See the Further Resources for links to community resilience building tools, such as the Community Disaster Resilience Scorecard Toolkit20 (produced by the Australian Government but with content which can be applied in the UK) and resources produced by the Cabinet Office.

 

10. Use existing processes and good practice guidelines to help draw up adaptation plans for health and social care organisations. 

  • See the Further Resources section for a link to the Sustainable Development Unit’s information about the characteristics of a good adaptation plan in health and social care.21 Five steps are recommended in the Sustainable Development Unit’s report as follows:

Step 1: Find out who to involve from the organisations listed in Appendix 1.

Step 2: Find out what information is needed from the suggestions listed in Appendix 2.

Step 3: Assess the relative local importance of different potential impacts, investigate how they will affect the day-to-day running of essential services and systems and draw up possible responses to problems which may arise.

Step 4: Decide on a set of priorities for action. 

Step 5: Construct plans and initiate a regular monitoring and review process.

 

11. Ensure that preparedness for extreme events includes relevant infrastructure, such as buildings which are important for delivering health and social care so that patients and staff are protected from the impacts of events like heatwaves and flooding.22 Such buildings include hospitals, clinics and health centres, doctors’ surgeries, care centres, residential care and nursing homes, day centres and general care facilities.

  • See the Further Resources section for a link to the Health Technical Memorandum 07-07: Sustainable health and social care buildings23 and Health Building Note 00-07 Planning for a resilient healthcare estate24
  • See the Further Resources section to watch a video examining how existing National Health Service hospital buildings might be refurbished in order to become more resilient to the impacts of high temperatures.25
  • See the Further Resources section for other resources to support building resilience to flooding.

 

12. Explore ways in which changes can be made in how and where people work, the codes of practice used and the sorts of systems used to deliver services. Relatively simple back up measures may be helpful, such as the use of telephone follow ups in place of appointments if patient access is an issue during extreme events.26 Telehealth and telecare may also offer some opportunities through which the health and well-being of very ill patients or those who have limited mobility can be monitored.27 There is now an increasing availability of electronic devices which can support healthcare providers, for example through providing warning systems to carers or through triggering automated responses, e.g. the activation of fans at certain temperature thresholds. However, it is important to note that telecare systems like these have implications for socially just adaptation, given that they are only available to those who can afford them unless other means are found to financially support people on low incomes. There is also a need to consider how such systems will operate during the potential power cuts and related problems associated with extreme events (see Figure 2, in Section 1).

  • See Further Resources for a link to a report examining the benefits of telecare options.28
  • See the Further Resources section for links to examples of the services which can be offered, for example by Bournemouth29 or Taunton Deane Borough Council.30

 

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Find out more

People who are socially isolated

Document/report

Fuel Poverty Review

The Hills Report: an assessment of problems associated with measuring fuel poverty and a new alternative 

Document/report

Health and Wellbeing toolkit

Designed to help integrate adaptation into health and social care, Environment Agency 2014

References

  1. Houston, D., Werritty, A., Bassett, D., Geddes, A., Hoolachan, A. & McMillan, M. (2011) Pluvial (rain-related) flooding in urban areas : the invisible hazard, Joseph Rowntree Foundation, York.
  2. Devon, Cornwall and Isles of Scilly LRF (2012) Vulnerable People Tactical Framework
  3. Lancashire County Council guidance relating to risk registers
  4. Blaby District Council Adaptation Risk Register
  5. Greater Manchester Community Risk Register
  6. Environment Agency and SDU (2014) Under the Weather toolkit
  7. Kent County Council (2013) Joint Strategic Needs Assessment: A Guide to Integrating Sustainability
  8. NHS (2010) Heatwave: Looking after yourself and others during hot weather
  9. Heatwave Plan for England
  10. Defra (2013) The National Flood Emergency Framework for England
  11. Public Health England (2014) Flooding: Health Guidance and Advice
  12. National Flood Forum (2011) Ready for Flooding: Before, During and After
  13. Citizen's Advice Bureau, Self-help guide on the Priority Services Register for older and disabled people
  14. Flood Forecasting Centre, Flood Guidance Statement
  15. Public Health England and the Environment Agency, Flooding: Advice for the Public
  16. Bedford Borough Council recommendations for health and social care organisations (list near bottom of long webpage)
  17. Defra (2013) The National Flood Emergency Framework for England
  18. Environment Agency and SDU (2014) Under the Weather toolkit
  19. YouTube video: Equinox's response to climate change
  20. Torrens Resilience Institute (2012) Community Disaster Resilience Scorecard Toolkit
  21. NHS Sustainable development Unit (2012) Adaptation to Climate Change for Health and Social care organisations “Co-ordinated, Resilient, Prepared”.
  22. NHS Sustainable development Unit (2012) Adaptation to Climate Change for Health and Social care organisations “Co-ordinated, Resilient, Prepared”.
  23. Department of Health (2013) Environment and Sustainability Health Technical Memorandum 07-07: Sustainable health and social care buildings Planning, design, construction and refurbishment
  24. Department of Health (2014) Health Building Note 00-07: Planning for a resilient healthcare estate
  25. Video clip: refurbishing hospital buildings to reduce overheating. This work is part of an EPSRC-funded research project Design and Delivery of Robust Hospital Environments in a Changing Climate which was carried out by the Universities of  Cambridge, Loughborough and Leeds with the Open University.
  26. NHS Sustainable development Unit (2012) Adaptation to Climate Change for Health and Social care organisations “Co-ordinated, Resilient, Prepared”.
  27. London Climate Change Partnership (2011) London’s changing climate. In sickness and in health.
  28. Yeandle S. (2009) The Bow Group, Telecare a crucial opportunity to help save our health and social care system
  29. Bournemouth Borough Council telecare services available to older people
  30. Tauton Deane Borough Council telecare services

 

 

On this page:

 

 

 

Tools and resources
 

Name

Developer

Type of Resource

Under the Weather toolkit

Climate Ready/SDU

Toolkit

Local Climate Impacts Profile (LCLIP)

Designed to support the UKCIP Climate Adaptation Wizard, this tool supports local assessments of past weather-related events and their impacts as a basis for understanding the possible impacts of future weather-related events.

UKCIP

Guidance and Spreadsheets

Community Resilience: resources and tools

Aimed at local communities and the organisations working with them, this set of resources supports the process of understanding local needs and developing emergency plans based on those needs

Cabinet Office (UK)

Communities

Reports, checklists and case studies

Community Disaster Resilience Scorecard Toolkit includes materials to for local government and their partners in service delivery to work with in workshop settings.

Torrens Institute

Communities, guidance and check-lists

Ready For Flooding: Before, During and After

Practical advice and guidance for householders, including list of what to have in an emergency kit.

National Flood Forum

Householders, guidance and check-lists.

Citizen’s Advice Bureau self help guide on the Priority Services Register for older and disabled people

CAB

Web materials

Severe Weather Impacts Monitoring System (SWIMS)

A data collection tool to encourage learning about the impacts of and responses to past extreme weather events as the basis for improved future decision-making.

Kent County Council

Cross-cutting

Online Tool

Built Infrastructure for Older People’s Care in Conditions of Climate Change (BIOPICCC) Toolkit

Aimed at anyone with a role in supporting health and social care for older people. Resources cover understanding needs and protecting infrastructure.

Durham University

Health and Social Care

Online Tool

Cold Weather Plan for England (2013)

The plan provides the framework for action during specific periods of very cold weather. It includes an ‘equality analysis’ and other resources which can assist local decision-making

Public Health England/DH/NHS England and the Local Government Association

Health and social care sector

Reports and action cards.

Advice produced through the Heat-wave plan for England 2013

The heat-wave plan contains advice for a range of practitioners and the public

Public Health England/DH/NHS England and the Local Government Association

Advice for different groups

Public Health Outcomes Data Tool

A set of indicators and associated data about public health and health inequalities supporting the Public Health Outcomes Framework. Data Indicators are updated on a regular basis and available at a range of geographies across England

Public Health England

Health sector

Data

Strategic Health Asset Planning and Evaluation (SHAPE)

A mapping tool principally aiming to support strategic planning of health services and infrastructure but which has a role in providing more effective adaptation solutions.  Documentation on the use of SHAPE in the context of flooding is currently being developed. 

Department of Health

Health Sector

Online Tool

World Health Organisation cost analysis tool

A controversial tool aimed at the health sector. Read more about issues associated with using cost-benefit analyses to build resilience in our introduction.

WHO

Health sector

Guidance document

Advice for care home managers and staff: supporting vulnerable people before and during a heat-wave

 

Public Health England

Health sector

Guidance document

Information about the Flood Guidance Statement, including a user guide

Met Office and Environment Agency

Web pages

Advice for health and social care practitioners: supporting vulnerable people before and during a heat-wave

Public Health England

Health sector

Guidance document

Flooding and mental health: essential information for front-line responders

1. Flooding: advice for the Public

2. Health advice: general information about mental health 

3. Floods – how to clean up your home safely

4. Guidance on recovery from flooding: essential information for frontline responders

5. Flooding and mental health: essential information for front-line responders

6. Answers to frequently asked health questions about flooding.

Health Protection Agency

Health sector Guidance document

Six Steps to Flood Resilience

Designed to address the lack of easy-to-use guidance to support the use of novel flood resilience measures in planning, this resource provides a process to follow and resources for further information

Building Research Establishment, Manchester Metropolitan University and University of Manchester

Cross-cutting

Guidance document

 

Reports
 

Name

Author

Type of Resource

UK Climate Change Risk Assessment: Evidence Report, London

Defra

Report

Sustainable, Resilient, Healthy People & Places A Sustainable Development Strategy for the NHS, Public Health and Social Care system

Public Health England and the NHS Sustainable Development Unit (2014)

Report

Adaptation to Climate Change for Health and Social care organisations “Co-ordinated, Resilient, Prepared”

NHS Sustainable development Unit (2012)

Report

Health Building Note 00-07 Planning for a resilient healthcare estate good practice guidance and reasons for action

Department of Health (2014)

Report

Health Technical Memorandum 07-07: Sustainable health and social care buildings

Department of Health

Report

Telecare: a crucial opportunity to help save our health and social care system

Yeandle (2009)

Report

The Health Effects of Climate Change in the UK 2012

Vardoulakis & Heaviside (2012)

Report

Floods in the WHO European Region: health effects and their prevention: review of the evidence in Europe

World Health Organisation Europe (2013)

Report

 

Case studies and examples
 

Name

Developer

Type of Resource

Greater Manchester Local Climate Impacts Profile

Ecocities

Online example of an LCLIP

Example of a strategic plan aiming to provide a mechanism to assist in the identification of vulnerable people in an emergency

Devon, Cornwall and Isles of Scilly Local Resilience Forum

Online (downloadable)

Guidance for completing climate change adaptation risk template

Lancashire County Council

Online material (external)

Example of a Joint Strategic Needs Assessment

London Borough of Hackney

Online material (external)

Example of a risk register (District Council)

Blaby District Council

Online material (external)

Example of the use of telecare systems

Bournemouth Borough Council

Case study (external online)

Example of the use of telecare systems

Taunton Deane Borough Council

Case study (external online)

Based in Cheshire, Snow Angels is the result of a partnership between organisations involved in health, housing, environmental & emergency planning and the local community to provide community-based responses to extreme cold weather in a rural area.

Climate Just team with Snow Angels representatives

Case Study (internal)

 

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