Met Office, UCL, University of Birmingham, University of Bristol, University of Edinburgh, University of Leeds, University of Oxford HRSC0027
Written evidence submitted by the Met Office Academic Partnership (MOAP)
cross-institutional working group on Climate Change and Health
The Met Office Academic Partnership (MOAP), brings together research excellence from the Met Office and leading UK universities, while reaching scientists in other sectors including health, technology, artificial intelligence, and the social sciences, to advance weather and climate science.
MOAP institutions involved in this submission: University of Bristol (lead for Climate Change and Health), University of Birmingham, University of Edinburgh, University of Leeds, University of Oxford, UCL and the Met Office
This submission draws on research expertise in weather and climate science, epidemiology and social science, and includes both the current evidence base and ongoing research. Contributors would welcome the opportunity to provide further evidence to the committee. Further details of individual expertise are provided following the inquiry responses.
Executive Summary
Extensive evidence exists for the negative impact of extreme and moderate heat on UK health, both mortality and morbidity. Although extreme heat causes more serious health outcomes, the health outcomes of moderate heat are also considerable. Future UK climate projections show increases in the frequency of extremely hot days and nights and the UK has more days in the year of moderate heat therefore a dedicated UK Heat Resilience Strategy to facilitate adaptation to both extreme and moderate heat would be beneficial for future UK health outcomes.
Older people and those with underlying health conditions are most at risk from extreme and moderate heat, as are groups spending significant time outside (e.g. construction workers or the homeless). Further research and evaluation of heat-health warning systems, responsible messaging from traditional and social media, and cooling strategies are needed to identify the most effective approaches to reduce heat mortality.
Heat risk and vulnerability also vary across geographic scales, notably higher in urban compared to rural areas. Data informed decision-making tools can support government and local authorities to identify high risk groups and areas and plan effective adaptation and mitigation measures.
Effective urban planning and design, along with building regulation, can mitigate overheating risk and support communities to adapt to increasing temperatures. Green infrastructure is highly effective in minimising overheating risk and should be more widely adopted in urban planning and design. Heat resilience is regulated in new building design, however, retrofitting existing building stock must address overheating and ventilation risks in conjunction with winter energy efficiency.
This document will lay out responses to the following questions which are of interest to the committee:
Inquiry Responses
Most UK summers result in 1,000-3,000 heat-related deaths (Lo et al, 2022), 8,000-9,000 heat-related emergency hospital admissions (Rizmie et al, 2022), and an increase in accident and emergency department attendances (Corcuera Hotz & Hajat, 2020). In England and Wales, for each 1°C rise in temperature, a 2% increase in mortality has been reported (Gasparrini et al, 2012). These deaths are predominantly from cardiovascular failure and respiratory problems; both from overwhelming the thermoregulation within the body.
The effects of heat on morbidity can range from acute to medium and long-term. While extreme heat causes more serious health outcomes, moderate heat can also have serious negative impacts and the UK has more days in the year in moderate heat conditions (Jenkins et al, 2022). A determinantal heat-health link has been found in all administrative regions of the UK, even in the coldest UK climates like Scotland (Wan et al, 2022).
Heat ‘stress’ also amplifies mental health problems, including those related to domestic violence, alcoholism, sleep disorders, and concentration and accidents. In England and Wales, some evidence of an increased risk of suicide has been found (Page et al, 2007). The highest increase in injury risk is from drowning and assaults. There is also evidence for adverse pregnancy and birth outcomes with heat extremes (Chersich et al, 2020). Longer-term exposures of heat on health and compound heat-pollution effects are less studied, but there is some evidence of association with respiratory outcomes and comorbidities (Zafeiratou et al, 2021, Warkentin et al, 2023). Examples where there is a known link, but not accurate estimates of the change in risk with climate change, are related to long-term renal (kidney) problems, sleep-related risks such as dementia, and cancer-related risks, such as behavioural changes that lead to more UV exposure, although the latter is highly uncertain.
This MOAP cross-institutional working group on Climate and Health are currently reviewing published evidence and performing novel research through analysis of expert opinion data regarding UK weather and climate hazards, including heat and cold, and health outcomes that lead to mortality. We expect to publish this review over the next six months and experts from across the working-group would be pleased to offer further insight to the committee.
Specific communities that are at greater risk during both moderate and extreme heat events include older people, young children and those with underlying health conditions (Arbuthnott & Hajat, 2017). Older people, often considered as over 65 years of age in the literature, are far more at-risk than younger generations, with 1 in every 2,000 over 85’s dying from heat every year (Jenkins et al, 2022) . During the 2003 and 2013 UK heatwaves, a moderate increase in the number of NHS direct calls was seen for the younger age groups (0-4 and 4-14 years) (Smith et al, 2016), and an 11% increase in paediatric trauma admissions was found for every 5°C rise in temperature (Parsons et al, 2011). Those with underlying health conditions, also present increased risk during high heat events. Notable parts of this community that are most effected are those in care homes, physiatry hospitals, and prisons, although some of this evidence comes from countries outside the UK (Arbuthnott & Hajat, 2017). Research from the UK and elsewhere highlights that ‘outdoor’ communities, such as homeless people, the military, sports players and construction workers, have higher exposure to heat, and are therefore more commonly affected through negative health outcomes, normally related to heat stroke which leads to loss in productivity, morbidity, and mortality (Flouris et al, 2018). Some individuals who are at risk may not consider themselves to be so. Culturally, people living in the UK have a tendency to stick to habits and routines, so adaptation strategies, such as exercising at cooler times of the day, are often not adopted. Studies have shown heat to have physiological impacts on the study participants, despite them self-reporting to be broadly comfortable (Waldock et al, 2018; Gupta et al, 2021).
The trapping of heat in cities, known as the urban heat island effect, means that city mortality and morbidity is higher than rural mortality and morbidity, even when normalised by the local population. Estimates during one of the most extreme UK heatwaves (2003) suggest this city heat trapping effect could account for around 50% of the total mortality (Heaviside et al, 2016). Heat risk also varies across geographic communities shown in studies at both city (Met Office et al, 2022) and UK (Kennedy-Asser et al, 2022) scales. Across all 376 districts in England and Wales, those in London and south/southeast England were found to have an increased risk of cardiovascular heat-death for a 1 °C rise in temperature as compared to districts in the far north (Bennett et al, 2014).
In the UK, the policy-level healthcare response to heat is in the form of heat warning systems (HWS). In 2022, the hottest summer recorded in England, the first ever Level 4 Heat-Health Alert (HHA) was issued for a record number of days. 2022 also observed the highest heat mortality since the introduction of the Heatwave Plan for England, and the HHA system in 2004, with 2,985 excess deaths (UKHSA and ONS, 2023).
Many UK residents have positive or ambivalent feelings towards the prospect of hot summers that can suppress the effectiveness of heat health protection messaging and diminish uptake of heat protection behaviours (Lefevre et al, 2015), though there is evidence that concern about hot summers is increasing (Steentjes et al, 2020). Messaging highlighting the unpleasant aspects of hot weather have been found to increase intention to engage in heat protection behaviours (Bruine de Bruin et al, 2016).
Despite being most at risk, older people were least likely to take some personal or home protective measures during the 2013 heatwave (Khare et al, 2015). An Australian study characterised six sub-groups or ‘thermal personalities’ within older people, based on factors including personal characteristics, beliefs and house type, which were used to communicate potential adaptation options (University of Adelaide, 2021).
Encouraging behavioural changes during extreme heat events can provide low or no cost solutions to some risk factors. For example, in many UK houses, bedrooms are not the coolest rooms in the house, and during extreme events, sleeping in a cooler ‘safe haven’ room can offer respite (Drury et al. 2021).
Reducing misinformation can also save lives. The 2022 UK heatwave was a clear example of this, where, although well-informed and timely advice provided by the UK Government and trusted sources such as the Met Office and UK Health Security Agency were critical to keeping the population safe, some influential traditional media outlets and social media influencers accused meteorologists of being alarmist ‘harbingers of doom’, downplaying ill health from heat, and causing confusion in the general public (Mitchell and Lo, 2022).
A global review of heat-mortality attributed decreased heat sensitivity to factors including implementation of heat warning systems, increased awareness, and improved cooling strategies (Sheridan & Allen, 2018). However, evidence of the effectiveness of these systems and strategies, is limited and ambivalent. Further research and evaluation is warranted to understand their impact on heat-mortality and morbidity reduction.
Current UK health and safety guidance for workplace temperatures provides advice for minimum limits but not maximums. For employers it is important that extra precautions and provisions are made during moderate as well as extreme heat events, particularly for sectors where staff are physically active, working outside or wearing personal protective equipment (PPE).
In care settings precautions are required for both staff and residents (case study: Kennedy-Asser, 2022). Managers reported ensuring staff took longer breaks and spent time outside on hot days. Although this may represent a drop in productivity, it is likely more cost effective than installing cooling systems. Fluids taken in by residents are closely monitored and during periods of extreme heat drinks can substituted for ice lollies or other frozen drinks to ensure they are taking enough fluids and to keep them cool.
Ongoing projects from the UK Climate Resilience (UKCR) Programme (UKRI and Met Office) are quantifying climate risks to build resilience and generate usable outputs to directly support decision-making:
People aged over 65 years spend more than 80% of their time in residential environments or care settings, and people aged over 85 years more than 90% therefore, the indoor environment is a huge moderator of heat exposure in older populations. The ClimaCare project is developing methods to assess future overheating risk and the potential of passive strategies to reduce these risks (UKCR ClimaCare project, UCL).
As part of their current annual climate risk assessment and adaptation strategy, the Department for Education (DfE) are considering the impact of heat on loss of learning in schools. A novel Met Office framework using the CLIMADA open-source climate risk assessment platform (Dawkins et al, 2023) is being applied to school building stock modelling (UKCR ARID project, UCL) and combined with DfE building condition data (Condition Data Collection 2 (CDC2)), to assess current and future indoor temperature risk in schools and inform DfE policy planning.
Heat vulnerability is not routinely considered within urban planning and design. Consequently, new homes are built in neighbourhoods that may be prone to overheating, with inadequate public realm spaces that do not provide thermal regulation, using building materials that do not offer cooling. In Birmingham, the local authority and the University of Birmingham have co-developed a Climate Risk and Vulnerability Assessment (CRVA) mapping tool that identifies those areas of the city which are at higher risk of overheating (along with other climate risks). The CRVA is currently being used to understand whether ongoing and proposed developments increase or decrease the climate (and therefore overheating) risk and vulnerability of an area. In the future it will be used to target interventions in areas experiencing greater climate risk and ensure developments are more climate resilient. The CRVA approach uses open access datasets and can be replicated by local authorities in England using the same datasets, or more broadly using locally relevant datasets (Greenham et al, 2023; Ferranti et al, in review).
Street trees and urban green spaces can provide areas of respite from the heat and contribute to the overall lowering of temperatures within a city. Estimates for European cities suggest increasing tree coverage to 30% would reduce temperatures by 0·4°C and prevent 2,644 premature deaths (Iungman et al, 2023). Further evidence of green infrastructure for heat resilience is provided in section 3.
In London (Cool Spaces Initiative, 2023), and Madrid (Climate Shelters, 2023) designated and publicised ‘cool spaces’ including indoor spaces (some air conditioned) and outdoor areas with tree cover or alongside waterways, provide opportunity for refuge during heat events. In parts of Australia, local councils provided free travel for residents to local swimming pools (Dufty, 2022).
Spatial development plans set by devolved regional governments contain policies directly relating to heat resilience measures, including provision of shade, green spaces, and use of preferred cooling strategies. Local plans typically do mention adaptation to climate change, and heat as a risk, but are less likely to identify specific measures that may need to be taken.
Green infrastructure, including trees, green roofs, parks, gardens, within public and private settings, provides cooling in several ways (Vaz Monterio et al, 2019):
Green space and trees, and consequently cooling benefits, are not equally distributed across urban areas; more deprived areas have less green space (Chakraborty et al, 2019). The Trees and Design Action Group (TDAG) suggests practical steps to assess heat within urban planning and design, with a focus on the role of trees and green infrastructure (Ferranti et al. 2021).
Cool roofs, made from more reflective surfaces or as a green roof, are estimated to cool urban outdoor temperatures by 0.5 °C on average (Macintyre and Heaviside, 2019). Building energy modelling suggests that reflective roof surfaces make a large difference to indoor summer temperatures or cooling demand when added to poorly insulated roofs, but a well-insulated roof with a reflective coating appears to be most effective overall (Virk et al, 2015). However, reflected solar radiation can also reduce thermal comfort, particularly in the early-to-mid afternoon hours, implying that they cannot substitute for vegetation, green infrastructure or shade as a single urban cooling solution (Middel et al, 2020). Built structures providing shade are also effective (Turner et al, 2023).
Retrofitting to improve winter energy efficiency raises concern about the impacts on summertime overheating risk and unintended consequences of newly airtight buildings where sufficient ventilation is not maintained. Lower rates of air exchange coupled with solar gain can lead to a rise in overheating, humidity, mould and allergen prevalence, and infectious disease (Bouzarovski and Robinson, 2022), and these health problems may emerge in the future as critical for the UK population (MOAP, unpublished review). Retrofitting of homes should be holistic, considering how insulation can be improved whilst maintaining or improving ventilation, for example mechanical ventilation with heat recovery systems (Centre for Sustainable Justice, 2022).
For existing buildings, a simple and effective retrofit is to add external shutters to windows. A modelling study of the residential housing stock in the West Midlands estimated that external shutters could reduce the risk of heat mortality by around 40% (Taylor et al, 2018).
Air-conditioning provides a similar level of heat mortality reduction (Francesco et al, 2020) but is less likely to be sufficient to mitigate building-related heat stress as it is unaffordable to many households, especially in the context of high energy bills. Air conditioning also negates one of the overarching goals of energy efficiency policies, which is to reduce overall energy demand.
Overheating cannot be considered in isolation. If homes are tightly insulated and not well ventilated then other risks arise: such as mould and poor indoor air quality. A consultation on the Future Homes Standard led to proposals for a Future Buildings Standard (2021) which includes mitigation against overheating in residential buildings. Supporting documentation addresses overheating and also covers ventilation and limiting solar gains. However, requirements apply only to new residential buildings and most existing buildings do not meet the new standards (Climate Change Committee/ARUP, 2022). Existing buildings are largely not addressed by current policy.
Cooling needs are only included in the Standard Assessment Procedure (SAP) ratings for buildings that have fixed cooling systems. This means that the SAP does not address cooling needs for most buildings.
Enhancing heat resilience requires timely, reliable and accessible evidence to provide nuanced information about risks and resilience according to individual and household characteristics and indoor and outdoor exposure factors. Interactive web tools providing information on future changes to indicators of climate risk across the UK to supporting decision making are exemplars of co-ordination across sectors to tackle heat resilience.
i. Climate Risk Indicators (University of Reading & Met Office) provides information at scales ranging from the district to the four nations of the UK. Users can plot maps showing the variation in indicators across the UK and can plot and download time series for specific locations.
ii. Climate Risk and Vulnerability Assessment (CRVA) (University of Birmingham & Birmingham City Council) identifies those areas of the city which are at higher risk of overheating (along with other climate risks).
iii. Keep Bristol Cool Mapping Tool (Met Office, University of Manchester & Bristol City Council)
A dedicated UK Heat Resilience Strategy would support reducing mortality and morbidity associated with both extreme and moderate heat.
The latest UK climate projections show increases in the frequency of extremely hot days and nights, with a UK increase in hot days of between 5 and 39 days per year (Hanlon et al, 2021). Extremely hot nights, which are currently rare, are emerging as more common occurrences and the frequency of high daily temperatures increases systematically. Scotland, where high temperatures above 30°C are historically rare have substantially increased risk of such high temperatures (Undorf et al, 2020). Research in China suggests that combined hot day and nights have greater mortality then either individually (Wang et al, 2021) with such events becoming more common as global temperatures increase (Wang et al, 2020) suggesting the need to prepare for, as yet, unseen temperature extremes. A global analysis of county's that are most ‘at-risk' to extreme heat showed that we are often under-estimating the most extreme heatwaves in our climate analysis. In that study, led by the University of Bristol, it was showed that the UK has had one of the most exceptional events, the 2022 summer heatwave, so has a good ‘working memory’ of extreme heat (Thomson et al, 2023). Even stabilisation of global temperatures at 2°C above pre-industrial values will cause a substantial increase in the risk of extreme heatwaves, with estimates suggesting heat-related mortality of 3,000-4,000 being an average UK summer (Jenkins et al, 2022).
Biographical information of expert contributors
University Bristol (MOAP lead for Climate Change and Health)
Lead author and working group lead: Dann Mitchell is professor of climate science and leads the cross-UK academic partnership on temperature and health for the Met Office. He has published around 100 papers on climate extremes, and has worked in the IPCC and CCRA reports. He consults for Wellcome on climate and health, and has won the Royal Meteorological Society Adrian Gill price for advancing climate and health science.
Ed Atkins is a human geographer exploring the topic of ‘just transition’, or how sustainability and/or decarbonisation polices can be made fairer and more inclusive.
Alan Kennedy-Asser is a climate scientist and interdisciplinary researcher, having carried out extensive modelling, analysis and evaluation of UK heat extremes. In 2021-2022, he was an embedded researcher with Climate Northern Ireland investigating the impacts of heat on multiple sectors in the region.
Eunice Lo is a climate scientist with expertise in extreme heat and health outcomes, including the modelling of both for all recent UK heatwaves. Her modelling underpins the improved methodology in UKHSA’s annual heatwave mortality assessments (since 2022).
Caitlin Robinson is a quantitative human geographer whose research specialises in energy and climate related inequalities, in particular fuel poverty. She is currently a UKRI Future Leaders Fellow leading a project that investigates the distribution of ambient (air-energy-climate) forms of vulnerability in UK cities.
Chin Yang Shapland is a Biostatistician with expertise in causal inference and epidemiology. Currently working on extreme heat and health outcomes.
University of Birmingham
Emma Ferranti and Sarah Greenham are interdisciplinary researchers working at the intersection of infrastructure, the built environment, and green infrastructure. Together with colleagues at the University of Birmingham and within Birmingham City Council, they are embedding climate resilience within city planning and design, with a focus on Nature Based Solutions for Climate Resilience. They have previously provided recommendations to the Office of Road and Rail on Network Rail’s Weather Resilience and Climate Change Adaptation Plans, and undertaken climate resilience research for the UN, UK Government (UK-Aid), Transport for London, Network Rail, and others.
University of Edinburgh
Ruth Doherty is a Professor in Atmospheric Sciences with research interests in climate-chemistry interactions and modelling global, regional and urban-scale air pollution and its impact on human health.
Simon Tett is the Chair of Earth System Dynamics whose research has included attribution of temperature extremes due to human induced climate change.
University of Leeds
Andrea Taylor has expertise in psychology of decision making under risk and uncertainty, with a focus on risk communication. She applies behavioural science approaches to improve the communication of climate and weather information to different audiences.
Met Office
Laura Dawkins is an expert scientist in the Met Office UK Climate Resilience team, specialising in assessing and modelling climate risk and resilience. Recent areas of focus have included the assessment of heat related climate risk and renewable energy system resilience.
Brian Golding is a fellow in weather impacts, and was previously deputy director of Forecasting R&D, at the Met Office. He has experience in a wide variety of weather impacts including work with epidemiologists on weather & health connections. He is currently co-chair of the World Meteorological Organisation’s High Impact Weather project which aims to improve the effectiveness of weather-related warnings worldwide.
University of Oxford
Sara Khalid is an Associate Professor of Health Informatics at the University of Oxford and Senior Research Fellow in Biomedical Data Sciences. She heads the Planetary Health Informatics Lab at Oxford which studies international climate-health linked data using artificial intelligence to derive insights for climate-health adaptation for healthcare systems and personalised health.
Sarah Sparrow is a climate scientist based in the Oxford e-Research centre, and specialises in extreme events, and links to the energy sector. She is manager of the extreme climate outreach and attribution programme, climateprediction.net.
Mary Zhang is a social science researcher specialising in the intersectionality between climate vulnerability, gender and poverty and their impact on health and well-being. Her work has received funding from reputable funders and utilises advanced computational and statistical techniques.
UCL
Charles Simpson researches the health and economic impacts of climate at UCL The Bartlett. His research incorporates regional climate modelling, building energy modelling, and health impact assessment.
August 2023
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