Your Health and a Changing Climate: Newsletter - Volume 6, January 2008

Impacts And Adaptation Research

Health Canada - Advancing Heat and Health Initiatives

Over the past 20 years there have been many examples of the loss of life that can result from heat waves.

Communities across Europe and North America have learned that 'heat can kill' and those most vulnerable are the elderly, children, those with low incomes and people suffering from chronic diseases (e.g., diabetes, cardiovascular conditions). The summer of 2003 was one of the hottest on record for Western Europe. In France, between August 1 and 20 temperatures exceeded 40°C, leading to over 14,000 deaths, with the vast majority being seniors.⁶ The extreme nature of the event caught France, as well as the rest of Europe, unprepared. There were no heat wave response plans, and individuals were unaware of how to protect themselves (e.g., re-hydration). The summer of 2007 has also produced a series of heat waves across North America, Europe and Asia, which again has devastated communities and resulted in loss of life.

The Working Group I Report ("The Physical Science Base") for the 4th Assessment Report by the International Panel on Climate Change, released on February 2, 2007, forecasts that many regions of Canada should expect higher temperatures, with heat waves increasing in frequency and intensity. Heat waves will become an increasingly important health risk factor for communities and individuals in Canada.

Over the past three years the Climate Change and Health Office (CCHO), as part of the Safe Environ ments Pro - gramme in the Healthy Environments and Consumer Safety Branch of Health Canada, has supported a number of heat-related initiatives, such as the Heat Health Warning Workshop - see pg. 10. As well, CCHO has collaborated with a variety of stakeholders to pursue research, raise awareness and advance best practices for adapting to our changing climate. Health Canada is currently engaging in two heat-initiatives which include:

• a research project with the Public Health Department of Montreal to identify the optimal method(s) for determining heat thresholds for warning systems; and
• collaboration with the Health Care Network of Southeastern Ontario (HCNSEO), a voluntary network of health service organisations, to undertake a desktop heat wave simulation exercises. The simulation brings together a wide-cross section of health care providers and emergency responders for the purpose of testing and promoting regional, collaborative approaches to emergency management.

CCHO is also developing a strategic framework on heat in order to more effectively help Canadians address the health risks from extreme temperatures, and to develop risk management options, tools and best practices. The strategic framework will be developed in collaboration with various stakeholders in Canada and internationally.

These initiatives represent ways in which Health Canada is working with health professionals and stakeholders to better understand the potential impacts of heat on human health and how we can help Canadians and their communities cope with, and adapt to, the effects of a changing climate on their health and well-being.

Human Health in a Changing Climate: A Canadian Assessment of Vulnerabilities and Adaptive Capacity

The Health Assessment, which is expected to be released in spring 2008, will assess the vulnerability of Canadians to the health risks associated with a changing climate. This peerreviewed report led by Health Canada will consist of a literature review of recent climate change and health research on air quality, natural hazards, and adaptive capacity issues. The Health Assessment report will include the following chapters, authored by Canadian experts in climate change and health issues:

• Forward and Introduction to Assessing Health Risks from Climate Change
• Methods for Assessing Health Risks from Climate Change
• Baseline Data for Assessing Health Risks from Climate Change
• Health Risks from Natural Hazards
• Health Risks from Air Pollution and Climate Change
• A Regional Climate Change and Health Impacts Assessment (the North and Quebec) which includes a Review of Adaptive Capacity in the Province of Quebec
• Adaptive Capacity of the Health Sector to the Health Impacts of Climate Change
• Literature Review of Infectious Diseases and the Impacts of Climate Change

To place an advance order for this report, please send an email to: Climatinfo@hc-sc.gc.ca

Canadian Climate Change Impacts and Adaptation Assessment

The Climate Change Impacts and Adaptation Directorate at Natural Resources Canada is coordinating a national scale scientific assessment of climate change impacts and adaptation in Canada. This assessment, undertaken from a regional perspective, examines the existing and growing body of impacts and adaptation knowledge, to address key questions regarding Canada's vulnerability to climate change, as well as potential future opportunities. Leading Canadian experts from government, academia and the private sector have participated in the Assessment to help guide the process and author the chapters.

The main goals of the Assessment are:

1. To assess the current state of knowledge regarding Canada's vulnerability to climate change.
2. To provide Canadians with an up-to-date source of information that can be used to inform decisionmaking and policy development.
3. To highlight what we know, and emphasize how much we have learned through research since the publication of the last national-scale assessment in 1998.
4. To identify knowledge gaps which need to be addressed.

Many Canadian workers routinely work in extremely hot environmental conditions, which often result from the nature of the industry itself. Many industries fail to understand the potential ramifications of heat stress, and there are few effective workplace heat stress management programs in place. The lack of preparedness is partly due to the fact that the risk of heat injury is perceived to be low. Although, the incidence of reported heat illness is low, the actual risk of heat-related injury is high. Heat stress impairs mental function, motor control and physical performance. The increased elevations in body temperature promote irritability, anger, and other emotional states, which can cause workers to overlook safety procedures or lose attention during hazardous tasks.

Safety standards for workers in hot environments do exist and have been established to define acceptable exposure times, or to evaluate preventative measures. These standards are based upon various heat stress indices such as:

• the wet bulb globe temperature index;⁷ and
• the required sweating rate index.⁸

However, it has been demonstrated in numerous reports that these standards have an inherent limitation in their predictive ability. Under hot working conditions, it is important to provide an accurate means by which heat stress risk can be estimated. Underestimation can lead to higher numbers of heat-related disorders and injuries, while overestimation may lead to workers and supervisors disregarding recommended limits resulting in a breakdown of a heat stress management system. The major difficulty in devising a practical heat stress index stems from the complexity of heat stress and heat strain response. In order to improve or develop new heat stress control measures, a better understanding of the physiological response (or heat strain) of the individual during work performed in hot environments is needed.

Dr. Glenn Kenny and a team of researchers at the University of Ottawa's Laboratory of Human Bioenergetics and Environmental Physiology are in the process of implementing a multi-year research program to address many of these issues. The Laboratory of Human Bioenergetics and Environmental Physiology is one of the few research laboratories in the world that houses a fast-response direct calorimeter. Direct calorimetry is the standard for the evaluation of body heat storage. Consequently, Dr. Kenny and his team are uniquely positioned to study the effects of heat strain on thermal balance and body heat storage.

Dr. Kenny and his team plan to extend their research program beyond the workplace to include examinations of the interactions of temperature regulation, hostile environments, aging, obesity and diabetes. Ultimately, the goal is to support the development of preventative measures and guidelines for at-risk populations. This is especially important given;

• the impacts of climate change (increasing frequency and intensity of heat waves);
• the changing demographic (aging workforce); and
• the epidemiological (increasing incidence of obesity) nature of the Canadian public.

>>> For more information please contact Dr. G. Kenny at gkenny@uottawa.ca.

Assessing the Capacity of Individual Canadians to Adapt to the Health Impacts of Climate Change

The rapid rate of climatic change that is being observed will likely create new and unanticipated stresses on individual and community health and well-being in Canada, and could increase our vulnerability to the impacts of climate change.^9,10 Risks to health will come from increased environmental hazards linked to climate change such as:

• air pollution,
• extreme weather events (e.g., heatwaves),
• water- and food-borne contamination events and related outbreaks, and
• vector-borne infectious diseases.

Canadians are concerned about the potential health impacts of climate change. Sixty five percent (65%) of people surveyed in 2006 thought that greenhouse gases will have a worsening effect on health over the next few years.¹¹ Applying appropriate risk management principles, tools, and measures through adaptation strategies to address the health risks can reduce current and future vulnerability to climate variability and change.¹² Of primary importance for the development of effective adaptations to protect health is information on the current awareness and tolerance of risks from climate change and understanding how the perception of such risks influences individual behaviours. We also need information on the existence and scope of current adaptation measures (e.g., levels of emergency preparedness) for reducing such risks.¹³

A primary responsibility for adapting to the health impacts of climate change such as those associated with extreme weather events rests with individual Canadians.^14,15 The manner in which people perceive and respond to risks can constitute an important barrier to adaptation. ^15,16 We have little information on how Canadians perceive risks to health from climate change and on the extent to which individuals are taking necessary actions to protect themselves. Limited research suggests that many individuals are largely unprepared for emergencies.¹⁷ Citizens generally plan only for the immediate future, overestimate their ability to cope when disaster strikes, and rely heavily on emergency relief.¹⁸

Additionally, current adaptation measures such as smog alerts,^19,20 extreme heat advisories,²¹ and wind chill warnings¹³ may have limited influence in protecting the health of vulnerable populations (e.g., seniors, socially disadvantaged persons, etc.) in changing individual behaviour. Ineffective actions, or the absence of adaptations altogether, constitute important limitations on current capacity to reduce vulnerability to the potential impacts on the health of Canadians from climate change.

In the fall of 2007, the Climate Change and Health Office, with the financial support of Natural Resources Canada and under the guidance of Dr. Peter Berry (Principal Investigator), initiated research to assess the capacity of Canadians to adapt to the health impacts of climate change. The goal of this project is to obtain a baseline understanding of (1) current perceptions of health risks by Canadians related to climate change impacts and (2) current adaptations to protect health. Research results will then be disseminated to decision-makers, practitioners, and planners in the health sector and other relevant sectors, as appropriate.

>>> For more information please contact Dr. Peter Berry: Peter_Berry@hc-sc.gc.ca

A Scan of Municipal Heat/Health Warning Systems and Hot Weather Response Plans

The Clean Air Partnership recently conducted a scan of heat health warning systems and hot weather response plans across the Greater Toronto Area (GTA). The report found considerable variability in the scope and implementation of these systems. Of five Public Health Units in the GTA, two (the Region of Peel and the City of Toronto) have developed heat watch-warning systems based on the synoptic method developed by Dr. Larry Kalkstein. These watch warning systems are geographicallyspecific and accompanied by multistakeholder intervention plans. Halton Region issues heat alerts based on Environment Canada's Humidex Index while the other two regions in the GTA, Durham and York Region, have not yet implemented a heat alert system.

While upper and single-tier municipalities in the Province of Ontario are responsible for issuing heat alerts, intervention and mitigation efforts tend to fall to lower-tier municipalities. Across the GTA it was found that the majority of municipalities respond to heat informally and inconsistently. Lack of resources, uncertainty about the need for intervention strategies and a lack of direction from the regions were all cited as barriers to creating comprehensive protocols for responding to heat.

As a result of this variability in both heat alert triggers and intervention strategies depending on where the vulnerable populations are located across the GTA, the level of risk varies. The Clean Air Partnership Report recommends that a minimum standard for hot weather response be developed and implemented across the region. Further research is needed to identify an appropriate heat alert trigger as well as systematic evaluations of those systems in place.

>>> This report can be accessed at:www.cleanairpartnership.org/pdf/ heat_health_report.pdf

>>> For more information on the synoptic method please visitwww.as.miami.edu/geography/climatology.

For more information on the humidex method, please visitwww.weatheroffice.gc.ca/ mainmenu/faq_e.html.

Climate in Focus in Toronto

The Clean Air Partnership (CAP) in Toronto has recently released two more reports in a series of reports on climate change impacts and adaptation; Cities Preparing for Climate Change, and Time to Tackle Toronto's Warming. Cities Preparing for Climate Change is a study of six urban regions in Canada, the UK and the US, which have begun to integrate projections of climate change impacts into local government policies and programs. The study highlights the lessons learned that can be applied to other local governments, and outlines a framework for adaptation planning for urban centres.

CAP has also released Time to Tackle Toronto's Warming which is an analysis of options to cope with hotter summers and heat waves resulting from the combined effects of the urban heat island and climate change in the Toronto region. It focuses on three areas of action to reduce vulnerability to heat:

• changes in urban planning that reduce the urban heat island;
• programs that reduce heat-related illness; and
• activities that reduce electricity demand and hot weather strains on the power generation and transmission system.

>>> To view an electronic copy of Cities Preparing for Climate Change, visit: www.cleanairpartnership.org/ pdf/cities_climate_change.pdf

>>> The report entitled Time to Tackle Toronto's Warming may be accessed at: www.cleanairpartnership.org/ pdf/time_to_tackle_toronto_ warming.pdf