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Climate change and heat-related mortality: will ‘summer crises’ become part of the NHS’s future?

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Falling leaves, Halloween… we associate many things with Autumn. In the world of health policy, it is often associated with early rumblings about a looming NHS ‘winter crisis’.

However, as climate change alters what different times of year look like across the globe, it’s worth reflecting on the health impact of the summer just gone. Temperatures are rising in Europe significantly faster than the global average – and one proxy we can use to explore the effect that this having on health and health systems is to look at mortality. In the summer of 2023, a study published in Nature Medicine estimated that almost 50,000 heat-related deaths occurred across the continent. This number is thought to be significantly lower than it could have been, thanks to various climate-adaption measures (such as installing air conditioning, planting trees or providing public information on how to endure heat waves) that have been enacted across Europe over the last two decades.

It would be a mistake to think these numbers only reflect the reality for the warmer countries of southern Europe. Indeed, cooler places like the UK, while experiencing a lower overall toll, face larger relative rises in deaths during heat waves. Over the summer of 2023, the UK Health Security Agency estimated there to had been more than 2,000 deaths associated with 5 separate periods of elevated temperatures. Similar figures have not yet been published for this year, and while the summer just passed was cooler than some in recent years, we can expect numbers like this to persist as our climate continues to change. Five of the top ten hottest summers on record in the UK have occurred since the year 2000.

An excess mortality figure in the range of 2–3,000 is still well below what this country experiences in winter. However, it is worth thinking about where we might be heading.

Predicting how these numbers may change going forward is immensely complicated, and certainly beyond the remit of this blog. And excess deaths are also just one of the ways climate change will have an impact on health – as there will also be major effects on things like air quality, infectious disease and emergency events like flooding. However, as our global warming continues, a range of possible future health scenarios are coming into view. The number of pressures we experience in summer are likely to become more and more acute as warming continues. Conversely, the pressures of winter could relax, as cold snaps become less common. Indeed, analysis by the ONS found that between 2000 and 2020, the number of deaths caused by cold winters was already in decline due to warmer temperatures.

These kinds of changes could have significant impacts on how to fund, plan and staff the NHS. Summer may one day be considered its own kind of particular challenge for the service in the way that winter is now – with all that that entails in terms of making available extra cash and resources.

Estates may need to be adapted to the realities of a different climate to the one they were designed for – buildings are typically built in the UK to retain heat, and this means they risk overheating (meaning they cease to function as intended) during heatwaves, as is already happening with increasing regularity in NHS settings. Plans will also be needed to deal with a potential reality when two out four seasons come with special challenges instead of just one.

We will also have to consider the impact of a reality where heat is a major health challenge, and the impact that will have on health inequalities in this country. Tackling this goes beyond the NHS. The ways that heat manifests as a health problem is unequally distributed – with factors like whether an area is urban or rural, housing quality and employment having a significant impact. Work will need to be done to address this, including at the legislative level. For example, unlike many other countries, the UK has no legislation around maximum temperatures for workplaces. Rectifying this could help reduce these inequalities, as could pulling other levers, including ones as simple as planting trees in urban areas.

More work is needed to map out exactly how we can plan for a future with a climate that is different to the one our health service was designed for. One thing’s for certain however: climate change, as Naomi Klein put it, ‘changes everything’ – and the health challenges of the UK will not be an exception.

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