ADPH Presidential blog: Reflections on the weather!

As we approach the August bank holiday, a traditionally wet and quintessentially British end to the summer, I wanted to take a moment to reflect on this summer’s unprecedented heat and what it means for our future public health.

As I recently wrote in the MJ, the past few weeks have tested us and our infrastructure to a limit we’ve never experienced before. Local councils implemented emergency plans, major incidents were declared by our fire services, train tracks buckled and road surfaces started to melt which, along with cancelled flights and power cuts all contributed to widespread disruption to transport, business and day to day life. 

There is no doubt that climate change is to blame. According to the Office for National Statistics, long-term trends show that the weather in the UK is getting both warmer, wetter and more extreme which means more hot weather and more floods. Meanwhile, the sea level around the UK has risen over 16cm since the turn of the last century, adding yet further pressure to the risk of flooding. 

There is much we can do and much we are doing. Short-term, heat-related illness like sunburn and heat stroke can, largely, be mitigated by public messaging to encourage changes in behaviour while planning adaptions at a local level such as planting more trees to cool the environment and soak up rainfall will also help. Nationally, agencies are working hard to further develop and implement flood and coastal erosion risk management plans to mitigate the effects of flooding and Defra has confirmed a raft of support for farmers struggling with the effects of drought.

Longer term of course, and in an effort to reverse the trends, the Government have pledged to decarbonize all sectors of the UK economy and achieve net zero by 2050. However, while all this goes on, Directors of Public Health are becoming increasingly concerned by the possibility of a myriad of health related issues which will require our health system to treat and manage a diverse set of diseases on a scale not previously seen in the UK.

Farmers, for example, have already warned of failing crops as a result of this year’s heat and any ongoing issues with our usual crop supply or changes to the types of crops we are able to grow are likely to result in increased food costs and the disappearance of large areas of useful farmland. The resulting struggle to finance healthy, more expensive, diets will not only affect deprived households most, but compound existing, unacceptable levels of malnutrition, adding yet more pressure on to our health and social care services. 

As well as causing problems with produce, the changing rain pattern will also create conditions where water borne diseases thrive while higher temperatures will cause the tick population to grow, increasing incidence of tick-borne disease.  There could also be a higher risk of zoonotic diseases such as malaria, up until now only usually seen abroad. 

Again, equity in access to affordable, effective and timely healthcare – already a huge issue – will become increasingly critical and unless our health system makes significant progress, disparities we are already seeing, will undoubtedly increase.

The impact of climate change on public health does not stop with nutrition and disease though and the unseen risks to public health need to be properly considered to make sure that we are better prepared in the long term. 

Disruption is, in and of itself, a public health issue with businesses and public services all grinding to a halt when people are faced with surviving extreme weather events and, yet again, it is the most vulnerable members of our society – those people who are unable to afford shelter or don’t have easy access to clean drinking water – who bear the brunt of such disruption.   

Intense high temperatures provide other unseen public health risks, such as displacement due to fires and increased numbers of people swimming in dangerous open water, some of which is polluted with sewage and a breeding ground for infection and disease. 

How then can we respond to this crisis in the long-term? 

Transport, housing and other, carbon inherent, sectors are clearly key to a long-term response – both in slowing down climate change and achieving net zero, and also with supporting people to live through heatwaves. 

We need to get out of our cars and use a public transport system designed for use alongside cycling and walking.  For this to succeed, we need several things. Firstly, we need public transport that covers the whole of the UK and is fit for purpose in hot temperatures, with tracks that don’t buckle and cables that don’t sag. It also needs to be fit for purpose in terms of capacity – bike storage should be integrated not just at stations, but on trains too. We also need better support and incentives for people to use public transport and to stop buying fossil fuel burning vehicles.  

Meanwhile, our housing stock needs to be better insulated to improve energy efficiency so that it helps keep us warm in winter and cool in summer. While there is a central will, the mass retrofit required will need a level of commitment and funding from Government way beyond what is currently being offered and there are too many new houses being built that fall far short of being future ready.

Ultimately, public health is about protecting and promoting people’s mental and physical health and wellbeing, along with that of their environment, and so, as Directors of Public Health, we have two tasks ahead. 

First is the focus on short term mitigation and keeping people alive and as well as possible in weather events like we have experienced this summer. As discussed, that is largely in hand and supported well both nationally and locally. 

Secondly though, we need to advocate strongly for medium and long-term adaptations for a healthier, more sustainable environment and in order to achieve that, we need shared leadership and partnership working at all levels. While achieving net zero by 2050 may not avert the effects of climate change completely, it will undoubtedly help and so we must do everything we can, individually and as a society, to help achieve it. That means true collaboration and cooperation between central and local governments, international, national and local businesses, community groups and individuals alike.