The Cambridge study says that though HFAs do not damage the ozone layer, they are nonetheless potent greenhouse gases and contribute to overall global warming.
It recommends a switch from metered-dose inhalers containing HFAs to what it describes as effective alternatives such as dry powder inhalers or aqueous mist inhalers.
“Climate change is a huge and present threat to health that will disproportionately impact the poorest and most vulnerable on the planet”
The researchers were mainly examining the use of inhalers in the UK and the costs to the country’s National Health Service (NHS). Some countries have already switched to non-HFA inhalers.
“In 2017, around 50 million inhalers were prescribed in England, of which seven out of ten were metered-dose inhalers, compared to only one in ten in Sweden”, says the study.
The researchers say they found that the output of greenhouse gases from metered-dose inhalers was between 10 and 37 times that of dry powder inhalers.
“At 2017 prescription levels, replacing one in ten metered-dose inhalers in England with the cheapest equivalent dry powder inhalers could lead to a reduction in drug costs of £8.2 million (US$10.6m) annually and would reduce carbon dioxide-equivalent emissions by 58 kilotonnes.”
“At the individual level each metered-dose inhaler replaced by a dry powder inhaler could save the equivalent of between 150 and 400kg of CO2 annually, which is similar to many actions that environmentally-concerned individuals are taking at home already, such as installing wall insulation, recycling or cutting out meat.”
Zero carbon aim
The researchers stress that patients shouldn’t stop using inhalers, but should discuss their treatment with their doctor. Patients should ensure inhalers are used correctly and properly disposed of.
“Climate change is a huge and present threat to health that will disproportionately impact the poorest and most vulnerable on the planet, including people with pre-existing lung disease”, says Dr James Smith, consultant in public health at the University of Cambridge.
“Our study shows that switching to inhalers which are better for the environment could help individuals and the NHS as a whole, and reduce their impact on the climate significantly.
“This is an important step towards creating a zero carbon healthcare system fit for the 21st century.”
They combed the records of Brazil’s hospitals, matched them against temperature readings and found that for every 1°C increase in temperature, there was a 2.5% increase in hospital admissions for undernutrition.
Undernutrition is defined as “inadequate intake of energy and nutrients to meet an individual’s needs to maintain good health.” That is: with extremes of heat come the ravages of hunger. The researchers also found that the very young and the very old were the most vulnerable.
Undernutrition is a global public health concern, especially in the low- and middle-income nations. In 2016, around 420 million adults of 20 years and more, and 192 million children and adolescents between 5 and 19, were underweight.
Of children under 5 years of age, 150 million were stunted, and 52 million were wasted. Around 45% of deaths of children under 5 were associated with undernutrition.
“The malnourished are more often from the poorest communities: they cannot stay indoors with the air-conditioning switched on”
And now the climate emergency, which brings with it ever greater extremes of heat, could make a global problem even worse.
Quite how dangerous heat and dangerous hunger are linked is uncertain, but the researchers report in the Public Library of Science journal PLOS Medicine that they have confirmed that the link is a real one.
Yuming Guo of Monash University in Australia and colleagues gathered data from the 5,570 cities in Brazil’s unified health system from January 2000 to December 2015. However, they included data only from the 1,814 cities – with more than 78% of Brazil’s population, in five regions – that could produce 16 complete years of records.
They had already established that hospital admissions rose with the thermometer. This time they established that one in six of the hospitalisations for undernutrition – that is, 37,129 cases – could be attributed to heat exposure. This proportion had risen from 14% in 2000 to 17.5% in 2015, during which time average temperatures rose by 1.1°C.
These are long-term consequences. What the latest study does is put a measure to the short-term effect of heat upon illness linked to undernourishment. How the connection works is – the scientists concede – “not well understood.”
They suggest that high temperatures could reduce appetites, provoke more alcohol consumption, or reduce motivation to shop and cook, which would make any existing under-nutrition even worse. They also think that the sweltering heat could worsen already-impaired digestion and increase the frequencies of gastroenteritis.
Less healthy targeted
And, of course, those already undernourished are less healthy and less able to naturally regulate their own body temperatures. Finally, the malnourished are more often from the poorest communities: they cannot stay indoors with the air-conditioning switched on.
There could be many factors. But one thing is clear: heatwaves most harm those already less healthy because of undernutrition. By 2050, climate change could reduce global food supplies by more than 3% and cause around 30,000 underweight-related deaths.
But, the researchers warn, this now looks like an under-estimate, because it does not take into account the short-term and direct effects of temperature rise on future undernutrition-related morbidity and mortality.
“This direct, short-term effect will be increasingly important with global warning,” the scientists warn.
Dr Saffron O’Neill is an associate professor in geography at the University of Exeter. Between 2012 and 2017 she held an Economic and Social Research Council Future Research Leader Fellowship on “Visualising climate change”. This article first appeared on the Carbon Brief website.
As the northern hemisphere summer comes to an end, it seems a fitting time to reflect on how the news media has reported on this year’s summer heat and heatwaves.
In the early summer heatwaves in the UK, many news outlets chose to represent stories about extreme heat as something to be enjoyed: images of sunbathing on the beach amongst colourful parasols, or splashing around in city fountains.
Many of these articles were juxtaposed with headlines that belied the seriousness of the coming weather. Just two examples of many: “Hell is coming” Mail Online, in a story accompanied by a picture of a woman splashing in a fountain by the Eiffel Tower. A live-text discussion on the Guardian website entitled “Heatwave: Paris suffers 42.6C hottest day ever” was illustrated by people enjoying the hot weather on Brighton Beach.
This commitment to headlines of heatwave suffering alongside jolly holiday snaps shows no signs of being a one-off trend. Before, during and after the record-breaking August Bank Holiday, numerous newspapers followed suit.
A Mirror headline from Thursday last week spoke of “Met Office health warnings for 33C bank holiday heatwave”, yet it was illustrated by another holidaymakers-on-busy-beach photograph. A Daily Telegraph article on Tuesday carried the headline “Climate warning as more summer records tumble” in the print edition and was illustrated by nuns on a beach and children playing in water. And a Sunday Telegraph piece in its print edition advising that “Heat could tip A&E units into queues chaos, warn doctors” is accompanied by an image of families canoeing.
Of course, summer holidays are meant to be enjoyed – and as anyone who has ever lived in the UK knows, Brits in particular seem to love a good-news weather story (almost as much as a bad-weather story). But where were the images of people struggling in the heat?
Although there has been a rapid increase in the visual coverage of climate impacts in media stories, often lacking from the visual narrative around heatwaves are the less enjoyable aspects. These might include the significant transportation failures as railway lines buckled, the severe health impacts on older folks and vulnerable people, the effects of extreme heat on animals and food production, and the lack of buildings and infrastructure well-adapted to offer a comfortable environment to their occupants during extreme heat.
For many going about their daily lives during these heatwaves, life was not all fountain frolics and sunbathing.
An unbearably hot train commute compounded by delays and cancellations, farmersstruggling to keep their animals cool enough for days on end, hospital emergency departments coping with an influx of heat-related illness, struggling to get a baby to sleep in a hot and stuffy bedroom: people struggling to go about their daily lives because of the weather. These could be examples of compelling and relatable visuals with which to illustrate stories of extreme heat.
Therefore, finding – and using – more effective ways to visually communicate about an increasingly hot future is a pressing issue.
Why do visuals matter?
A diversity of evidence points towards how media representations play an important role in how we think, feel and act on climate change.
Much research has focused on analysing how the media represent climate change through text, mainly through work examining the text of newspaper articles. Yet this work fails to take account of the role of visual images.
A growing group of experts working on climate change visuals is showing that the images used to communicate about climate change play a key role in shaping readers’ thoughts and feelings about the issue.
Yet, the images of climate change that the media tend to favour are restricted to a fairly narrow range of themes. And many of these fail to increase either a sense of saliency or a sense of self-efficacy. For example, a common way of illustrating climate news is using photographs of politicians, yet these images strongly undermine saliency. Conversely, images which increase a sense of self-efficacy, such as images of energy futures, are rare in the media. This is true across a range of countries, from the US, UK and Australia to Austria, Switzerland and Germany.
Opportunities for change
There has been little work examining how media organisations select and use images for weather and climate news.
What little there is suggests that there is a disconnection between journalists writing news stories and picture editors and others selecting images to go alongside them. As a result, visual and text-based narratives often pull in different directions, and can even advance contradictory claims – much as can be seen in the heatwave news reporting.
But this is not to lay blame at the feet of journalists, editors or media organisations. Climate change is a complex and amorphous issue – so how can we improve how it is represented visually?
We know from empirical evidence that it is often not very helpful to try to “scare” people into action with dread-inducing images, in this case, of extreme heat. But images of ice creams and holidays don’t do much to progress the visual lexicon of heatwave risk either.
Rather, researchers and academics need to work with media organisations, image libraries and communication practitioners to craft a more diverse and engaging set of visuals from which to illustrate and imagine climate change.
Earlier this summer, I was involved in a Twitter thread commenting on a BBC News article, “Climate change: UK’s 10 warmest years all occurred since 2002”, which was illustrated with an image of people sunbathing under colourful parasols on a UK beach.
To the credit of the BBC, the image was subsequently changed to one of a train shimmering through heat haze. In a more concerted effort, the communications specialists at Climate Outreach have created the Climate Visuals project, a growing library of evidence-based images for effective climate engagement. I hope that this, and other initiatives like this one, will be the start of a conversation to create a more diverse and engaging visual discourse for imagining and adapting to our climate changed future.
That is: the number of days in which the apparent temperature – a notional balance of thermometer-measured heat and maximum humidity – could reach or surpass 40.6°C will increase dramatically, and the days when individuals could be at risk could in some scenarios multiply 50-fold.
The scientists selected this “apparent” temperature of 40.6°C because it is significantly beyond the natural temperature of the human body, which must then be kept cool by perspiration. This is possible in arid climates.
But as humidity goes up – and with each 1°C rise in temperature, the capacity of the air to hold moisture rises by 7% – cooling by perspiration becomes less efficient.
So at this notionally-defined apparent temperature, people who cannot retreat to air-conditioned or cooler, shadier places could die. Heat kills: researchers recently counted 27 ways in which extreme temperatures could claim lives.
“If we follow the Paris Agreement, we’ll halve the number of people at risk in 2090, which is encouraging”
European scientists report in the journal Earth’s Future that they considered the hazard for just one, rapidly-growing continent: Africa. They selected 173 cities of more than 300,000 people in 43 nations across a range of climates, from Algiers on the Mediterranean to the burgeoning monsoon cities of the equatorial west coast, such as Lagos and Kinshasa, the drier east African states, and the relatively mild townships of Southern Africa.
They then considered how much cities might grow, by migration or birth-rate increases, and how they might develop. Then they factored in a range of climate scenarios and looked at possible forecasts for the years 2030, 2060 and 2090.
They found that because of population growth, the numbers of days on which people could be at risk – measured in person-days (one person working for one full day) – would in any case increase.
“In the best case, 20 billion person-days will be affected by 2030, compared with 4.2bn in 2010 – a jump, in other words, of 376%” said Guillaume Rohat, of the University of Geneva, who led the study. “This figure climbs to 45bn in 2060 (up 971%) and reaches 86bn in 2090 (up 1947%).
And that is the best-case scenario. When the researchers factored in the steepest population increases, the most rapid growth of the cities and the worst disturbances in climate, the figures rose more sharply. By 2030, 26 billion, a fivefold increase, could be at risk, 95bn in 2060 and 217 bn in 2090. This is an increase of 4967%, or nearly 50-fold.
The researchers assumed that not everybody in their 173 cities would be exposed to dangerous levels of heat. Were that to happen, the number of person-days could hit 647 billion. But the researchers made a conservative estimate of one in three people who would be exposed to a minimum temperature of 40.6°C.
Research of this kind makes assumptions about how the climate is going to change, and separately about how nations are going to develop, how populations are going to grow and change, and how governments are going to respond to the climate emergency, and the authors recognise the problems.
The sample is biased towards the larger cities. Their calculations don’t include predictions for capital investment. But the researchers say their conclusions are if anything conservative. They do not, for instance, factor in the notorious urban heat island effect that tends to make cities 3°C or more hotter than the surrounding countryside, and therefore even more dangerous.
The good news to emerge from the study is that concerted action, by governments and civic authorities, can reduce the risk. Were nations to stick to an agreement made by 195 of them in Paris in 2015, and keep global temperature rise to “well below” 2°C, the final exposure hazard would be reduced by 48%.
“This proves that if we follow the Paris Agreement, we’ll halve the number of people at risk in 2090, which is encouraging,” said Rohat.
“We can see the importance of the UN Sustainable Development Goals: access to education, a drop in the number of children per woman, developments in the standard of living and so on.”
The impacts of climate change and extreme weather on public health is an area of growing concern. Extreme weather has affected human lives and sustainable development on every continent around the globe in 2018, a World Meteorological Organization (WMO) report has found.
U.N. Secretary-General Antonio Guterres called the report a “wake-up call”, during a press conference in New York. Where he implored world leaders to take practical action on climate change saying that they shouldn’t “come with a speech” but instead, “come with a plan.”
“The average number of people exposed to heatwaves has increased by some 125 million since the beginning of the century, with deadly consequences,” Guterres said. “The combination of extreme heat and air pollution is proving increasingly dangerous, especially as heatwaves will become longer, more intense and more frequent.”
Extreme weather and climate events accounted for most of the natural hazards that affected nearly 62 million people during the year, according to the WMO’s annual State of the Climate report. Over 35 million people were affected by flooding, and more than 1,600 deaths were related to heatwaves and wildfires in Europe, Japan and the U.S., the report
showed. WMO Secretary-General, Petteri Taalas, cited the devastation caused by cyclone Idai, which hit Mozambique, Malawi and Zimbabwe in March, as an example of the need for action.
“Idai’s victims personify why we need the global agenda on sustainable development, climate change adaptation and disaster risk reduction,” said Taalas in a statement.
The report includes input from U.N. agencies, national meteorological and hydrological services, and scientific experts.
Extreme temperatures can have a significant impact on the
risk of developing cardiovascular complications, a new study suggests. Researchers
from Ludwig Maximilian University in Munich, Augsburg University Hospital and
Nördlingen Hospital, found that high temperatures are a contributing factor to
heart attack rates, and suggests climate change may have increased the risk.
It has long been assumed that severe spikes in temperature
increase the risk of heart attack. “In the case of very high and very low
temperatures in particular, this has been clearly demonstrated. In this latest
study, we wanted to see to what extent the heat and cold-related heart attack
risk has changed over the years,” explains Dr. Kai Chen, researcher at the
Institute of Epidemiology at Helmholtz Zentrum München.
The research team looked at over 27,000 heart attack
patients between 1987 and 2014. The individual heart attacks were compared
against meteorological data on the day of the attack and adjusted for a range
of additional factors, such as the day of the week and socioeconomic status. “Our
analysis showed that, over the last few years, the risk of heat-induced heart
attack with increasing average daily temperature has risen compared to the
previous investigation period,” explains Chen.
Individuals with diabetes or hyperlipidaemia were
particularly at risk over the latter period. The researchers suspect that this
is partly a result of global warming, but that it is also a consequence of an
increase in risk factors such as diabetes and hyperlipidaemia, which have made
the population more susceptible to heat.
“Our study suggests that greater consideration should
be given to high temperatures as a potential trigger for heart attacks; especially
in view of climate change,” explains lead researcher Dr. Alexandra
Schneider. “Extreme weather events, like the 2018 heat waves in Europe,
could in future result in an increase in cardiovascular disease. At the same
time, there is likely to be a decrease in cold-related heart attacks here in
Germany. Our analysis suggests a lower risk in the future, but this lower risk
was not significant and very cold days will continue to represent a potential
trigger for heart attacks.”
Kai Chen, Susanne Breitner, Kathrin Wolf, Regina Hampel, Christa Meisinger, Margit Heier, Wolfgang von Scheidt, Bernhard Kuch, Annette Peters, Alexandra Schneider, A Peters, H Schulz, L Schwettmann, R Leidl, M Heier, K Strauch. Temporal variations in the triggering of myocardial infarction by air temperature in Augsburg, Germany, 1987–2014. European Heart Journal, 2019; DOI: 10.1093/eurheartj/ehz116
Climate change is already damaging people’s health in a number of ways from deadly heatwaves across the globe to increasing instances of dengue fever in the tropics.
The 2018 report of the Lancet Countdown: Tracking Progress on Health and Climate Change, produced by 150 experts from 27 universities and institutions including the World Health Organization (WHO) and the World Bank, also shows climate change can negatively affect nutrition, mental health, and people’s capacity to work outdoors.
During the press conference marking the report’s launch, authors highlighted that the combination of rising temperatures, leading to higher A&E and hospital admissions due to heat-related illness, and extreme weather event, which can damage infrastructure, could overwhelm health services.
WHO director-general Tedros Adhanom Ghebreyesus said about the report “The findings are clear and the stakes could not be higher, we cannot delay action on climate change. We cannot sleepwalk through this health emergency any longer.”
Nick Watt, the executive director of the Lancet Countdown, added “These are not things happening in 2050 but are things we are already seeing today. We think of these as the canary in, ironically, the coalmine.”
According to the report, 153 billion hours of work were lost in 2017 due to extreme heat. 80% of it in agriculture and almost half of the losses happened in India, which is equal to roughly 7% of its whole working population. Compared to the year 2000, 157 million more vulnerable people were exposed to heatwaves in 2017 and 18 million more than in 2016.
The temperature increase is not just dangerous because the heat itself affects human health directly, it also exacerbates urban air pollution. With 97% of cities in low- and middle- income countries not meeting WHO air quality guidelines, this adds even more pressure to health systems.
Prof. Kris Ebi, Professor of global health and of environmental and occupational health science, University of Washington, said “Increased mortality in extreme heatwaves is not something that may happen, it’s happening now and will continue as global temperatures continue to rise. There is abundant evidence that communities are not prepared for the ongoing increases in the frequency, intensity, and duration of heatwaves. Actions are needed right now, matched with investments, such as implementing early warning systems for heatwaves, including mapping vulnerable populations and providing interventions designed to increase resilience during hot weather.”
Of the 478 global cities surveyed in the report, 51% were expecting climate change to seriously compromise their public health infrastructure. 65% said they have either already completed or are currently doing climate change risk assessments but spending on climate adaptation for health is estimated to be just 4·8% (£11·68 billion) of all adaptation spending which is woefully inadequate, the report warns.
High temperatures do more than raise tempers and stoke conflicts. They are also linked to depression, mental instability and a higher suicide risk.
A new study suggests that hot weather’s adverse effects on some people can include a heightened suicide risk. While the rise is numerically small today, the increase in extreme heat expected later this century could have starker consequences.
They found that a 1°C rise above average temperatures could be linked to a tiny increase – just 0.68% – in suicides in the US and by 2.1% south of the border. The rise is small. But it means that if the pattern of heat extremes predicted under all global warming scenarios continues to 2050, then there could be an additional 21,000 acts of suicide.
The same study, in Nature Climate Change, also identified a tendency to respond depressively: in such hot spells, people who used the social media platform Twitter were more likely to employ telltale words such as “lonely” or “trapped” or “suicidal”.
“Suicide is one of the leading causes of death globally, and suicide rates in the US have risen dramatically over the last 15 years”
The Californian scientists looked at official death records county by county in the US from 1968 to 2004, and across municipalities in Mexico from 1990 to 2010. They then matched these with temperature records by day and by month for those locations.
They also checked 600 million Twitter updates that could be identified as coming from a particular place and combed them for evidence of what they call “depressive feelings.” And they found a link between temperature and low spirits, as well as between temperature and suicide rates.
If extended to temperatures likely by 2050, suicide rates could increase in the US by 1.4% and in Mexico by 2.3%. And that could add up to an extra 9,000 deaths at the very least, or as many as 44,000.
“Suicide is one of the leading causes of death globally, and suicide rates in the US have risen dramatically over the last 15 years. So better understanding of the causes of suicide is a public health priority.”
“We’ve been studying the effects of warming on conflict and violence for years, finding that people fight more when it’s hot,” said Dr Hsiang. “Now we see that, in addition to hurting others, some individuals hurt themselves. It appears that heat profoundly affects the human mind and how we decide to inflict harm.”
And Dr Burke said: “Hotter temperatures are clearly not the only, nor the most important, risk factor for suicide. But our findings suggest that warming can have a surprisingly large impact on suicide risk, and this matters for both our understanding of mental health as well as for what we should expect as temperatures continue to warm.”
The NHS England reported that during the July 2018 heatwave a total of 2.176 million people visited a hospital A&E unit, walk-in centre, or urgent treatment centre putting emergency departments under lots of pressure to cope with the influx of patients.
The latest NHS monthly performance figures show that July 2018 was exceptionally busy with 27.1% more patients admitted than in July 2017. It is believed that the heatwave led to an increase in admissions, mostly people with breathing conditions, like asthma, or people who had become dehydrated due to the heat.
The heatwave, however, is not solely to blame. Doctors spoke out to say that while the record temperatures were a key factor in the surge of attendances, missed waiting time targets showed the NHS is understaffed and underfunded. Chris Hopson, chief executive of NHS Providers, said the figures showed the health service was “running at boiling point all year round.”
Speaking to The Guardian, Dr Taj Hassan, the president of the Royal College of Emergency Medicine, which represents A&E doctors, said “The recent heatwave will have had an impact, but this should not be used to excuse inappropriate resourcing. It should also not come as a surprise that whatever the weather conditions, working in a continually under-resourced and declining system has consequences – all of which are detrimental to our patients.”
He also pointed out that wards and waiting rooms had gotten unbearably hot during the heatwave making longer waiting times hard to cope with and adding to the pressure on staff to deliver safe and effective care.
NHS England made a statement saying that “thanks to hard work of staff 9 in 10 people were seen, treated and admitted or discharged within four hours.”
However, if this summer is a taste of what is to come, it is clear the UK health system will need take decisive measures to adapt to a changing climate. Excessive heat can be detrimental to human health and as temperatures start to rise, so will the number of people who require medical care.
The NHS will have to provide enough resources and staffing in order to cope with the increased demand, especially in summer. Additionally, NHS facilities will need upgrading so that people who come in with heat-related illnesses don’t have to wait in unbearable heat to be seen.
A recently released report by Sustainable Energy for Allfinds that 1.1 billion people around the world face immediate risks from insufficient access to cooling. According to the report, access to cooling is an important emerging opportunity in climate adaptation innovation.
Rachel Kyte, CEO and Special Representative to the United Nations Secretary-General for Sustainable Energy for All, said “In a world facing continuously rising temperatures, access to cooling is not a luxury – it’s essential for everyday life. It guarantees safe cold supply chains for fresh produce, safe storage of life-saving vaccines, and safe work and housing conditions.”
The study shows that access to cooling is very much tied to wealth. Of the 1.1 billion people at immediate risk, 470 million are in poor rural areas and 630 are in hotter, poor urban slums. These people are also concentrated in nine countries across Asia, Africa and Latin America: India, Bangladesh, Brazil, Pakistan, Nigeria, Indonesia, China, Mozambique and Sudan.
Cities, communities, and country leaders are asked to consider cooling action plans in order to close the access to cooling gap. Additionally, the Kyte points out that for companies that produce HFC-free, affordable air conditioning devices there is an enormous market opportunity out there.
In addition to the 1.1 billion rural and urban poor at immediate risk, the report identifies 2.3 billion people from the increasingly affluent lower-middle class, on the brink of being able to afford air conditioning, and 1.1 billion belonging to the established middle class, many of whom own air conditioning units but may able to upgrade them to more efficient ones.
This also ties into findings recently presented in a report completed by Acclimatise with UNEP FI and sixteen leading international banks. The report focuses on climate-related physical risks and opportunities to the banking sector. One of the examples named is an increased demand for loans for home improvements in order to cool houses where it was previously unnecessary.
While cooling is increasingly becoming a necessity, it is also a very energy-intensive measure. Increased cooling from HFCs and using fossil fuel powered energy can lead to more warming. In Mumbai alone, 40% of power use comes from air conditioning. Thus, phasing out HFCs, for instance through the Kigali Amendment, and the continued investment in renewable energy sources should remain priorities.
At the same time, urban development and real estate have the opportunity to radically rethink how buildings and cities can be designed in order to optimize cooling. In India, for example, 75% of the buildings required by 2030 have yet to be built, offering a massive opportunity to be innovative and provide cooler cities and housing.