“The first heat wave of the year is the most dangerous and the one that causes the most health problems”

Cristina Linares (Madrid, 44 years old) is the co-director of the Climate Change, Health and Urban Environment Unit of the Carlos III Health Institute. She and she have spent years studying the health effects of extreme weather events, such as the early heat wave that is being experienced in mainland Spain and the Balearic Islands. Linares recalls that the deadly wave of 2003 in Europe – which caused 35,000 deaths (6,500 of them in Spain) – was a turning point. An alert system was launched for the vulnerable population that has helped reduce mortality in this type of phenomenon. But this doctor in Preventive Medicine and Public Health maintains that much more work still needs to be done on adaptation to face extreme events that climate change is making more frequent and harsher.

Ask. Is the number of heat waves in Spain increasing due to climate change?

Response. Yes. The frequency and intensity of heat waves in the last 20 years is much more relevant than it has been until now; waves and so-called extreme weather events in general. I have no doubt that this is due to the effect of climate change, although it seems that some sectors still doubt that isolated phenomena are due to climate change. But we are seeing that in the last decade, these extreme events, especially heat waves, but not only, are becoming more frequent and more intense.

P. Has the increase in heat waves that has occurred in Spain been linked to an increase in deaths from heat?

R. It has not been linked to an increase in heat deaths due to the implementation of public health prevention plans. There are more extreme heat events, but heat mortality is not increasing at the moment. As of 2004, prevention plans were put in place for phenomena of this nature. And in those prevention plans alert mechanisms were established in the autonomous communities. When certain levels of risk are exceeded, actions are launched to alert the different health systems and also the vulnerable population, which are traditionally the elderly and people with pathologies who take some drugs or with kidney pathologies, for example . These groups of special vulnerability are alerted so that they are not exposed to high temperatures.

P. Can it be said that we are better prepared in Spain for these extreme events now than two decades ago?

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R. I think from the point of knowledge, yes. Another thing is from the point of adaptation. Everyone knows that you have to protect yourself against the heat, and especially vulnerable groups. One way or another, people know that heat leads to illness and can lead to hospital admission and even death. But from the point of adaptation we still have a long way to go. Considering that these phenomena are going to be more and more frequent and that they are going to occur not only in the summer months, such as July and August, I consider that we are not prepared, especially in urban areas, which are the most vulnerable. A great deal of work would have to be done, for example, to create climate shelters for vulnerable groups and in the naturalization of cities to create green and blue zones to gradually adapt urban areas to excess temperatures… It is not enough just to alert the population and inform, but we must work on how to deal with these phenomena, because the temperature will continue to rise. The more we do to adapt our homes and our way of life to the climate, the easier and more bearable it will be to beat the heat.

P. What is a climate shelter?

R. They are areas where people from vulnerable groups whose homes are not well thermally insulated can spend a few hours a day to take refuge from this heat. A climate shelter can be a library or a shopping mall or even refrigerated transportation. There are endless possibilities that can be publicized and sponsored as climate shelters.

P. Was the 2003 heat wave a turning point in Europe regarding how these phenomena should be dealt with?

R. Yes, it was a turning point. There have been other heat waves before and after, like the one in 2005, but 2003 marked a turning point in how we deal with them and served to set those epidemiological thresholds in each area. We have been working for a long time and defending that meteorological thresholds are not the same as epidemiological thresholds. In other words, 43 degrees can be reached, but those 43 degrees do not have the same impact on the population of Córdoba as they do on other areas of Spain that are not well adapted to the heat. I believe that as of 2003 work began on the concept that heat waves affect us differently depending on our geographical area and the sociodemographic conditions of that area. It is not the same as having an older population or having a more rural or urban population. All this greatly influences when facing a heat wave from a health point of view. As of 2003, much progress has been made in information and dissemination, but there is still a need to start looking for solutions and tools. Mortality due to heat was reduced, but that does not mean that diseases do not increase or that vulnerable groups begin to be others.

P. For example? What other groups?

R. For example, pregnant women, who were not initially included in the groups of people vulnerable to heat. Everything focused a lot on the elderly, because they have always been the main risk group, but different studies have shown that heat waves can cause premature births and low birth weight in babies. Now, for example, we also have to work more on the active working population that is working during the hottest hours outside… And another issue that is not talked about much is that heat waves have also a lot of impact on mental health. The heat causes us states of irritability and that also often leads to greater consumption of alcohol or drugs. And all this greatly influences mental health. There are studies that relate the increase in heat waves to the increase in suicides in Japan. Those same studies have been replicated in Mexico and the United States and it has been seen that mental health problems worsen with heat waves.

P. And are there more problems of violence?

R. Yes, we did a study with the Ministry of the Interior in which heat was associated with gender violence. It was seen that when there are periods of heat there is a greater number of femicides and calls to 016. This is also marked by a set of characteristics, such as periods of heat occurring during vacation times, when the aggressor spends more time in house in physical contact with his victim. Or a bad rest at night.

P. Are early heat waves like the one we are experiencing now more dangerous for health?

R. The first heat wave of the year is the most dangerous and the one that causes the most health problems, especially when it happens very early, because we have barely reached the middle of June. This is so because the population in the first heat wave has not had time to assimilate that a heat wave is already taking place. And, socially, for example regarding clothing or habits, you are not prepared. There is a phenomenon known as the harvest effect, which indicates that the first heat wave that occurs in the year is the one that produces the most mortality and morbidity (with more hospital admissions) because there is a more susceptible population.

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