How hot weather kills: the rising public health dangers of extreme heatBMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1741 (Published 14 July 2022) Cite this as: BMJ 2022;378:o1741
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The feature article "How hot weather kills: the rising public health dangers of extreme heat" covered the incidence of heat stress, parthenogenesis, risks among vulnerable populations in terms of persons' age, co-morbidities, level and duration of exposure etc. and the mortality statistics from various countries across the globe. It dwelt upon the various strategies that have been adopted by different nations like EuroHEAT project, Heat Health Action Plan (HHAP), Action Alliance for Heat Protection Berlin project etc. and its results. In the entire discussion there were references to the latest report of Intergovernmental Panel on Climate Change (IPCC), which has sounded an ominous warning for the very survival of living organisms in this planet earth. The impending extreme weather events - floods, droughts, heatwaves and their consequential impacts on ecosystems essential for the health of life forms - are at risk of irreversible change is too frightening to be imagined . The IPCC’s diagnosis is clear: climate change is the leading threat to health and well-being globally, and our window to act is rapidly closing. The only appropriate response is immediate, unequivocal action .
For proactive action against climate change, 'the rich nations' lack of urgency to form climate adaptation fund is violation of principles of equity, when poor nations are more vulnerable for the damages . It is fact that eleven years after developed countries committed to delivering US$100 billion a year to help poor nations deal with climate change, they have fallen short of the target both in terms of quantity and, more importantly, quality of the finance earmarked for climate action. This shortfall, experts say, will disproportionately affect South Asia . Also, 'despite their promises, developed countries have not committed new and additional funds to developing countries to help them deal with climate change, found a new report released on June 23. Instead, developed countries are diverting funds meant for development – including those meant for poverty eradication – for the climate cause. The June 23 report by the Climate Change and Resilience Information Centre (CARE), an international humanitarian aid organisation, found that these countries have diverted as much as $103 billion in this manner. This is a problem because it takes funds away from activities that would have helped countries achieve specific Sustainable Development Goals (SDG), which are also key to tackling climate change in a just and equitable manner' .
Worsening environment due to global warming is aggravated so much in British Columbia that Dr. Kyle Merritt, an emergency physician working there, has used a new name for a disease entity called 'Climate change'  as a cause of death of an elderly woman who died under extreme heat. This terminology has already set off a new debate in the medical fraternity and may take time for universal acceptance in medicine. But what about the billion-dollar business of insurance companies across the world, who have so far shielded their liabilities behind the specific clause called the 'Act of God'. This helps them to avoid making payment for damages for injuries caused by natural events like flood etc. for example. It would be interesting to watch how this new diagnosis 'climate change' unfolds itself in health insurance and tort jurisprudence.
1. Sally Howard, Geetanjali Krishna. How hot weather kills : the rising public health dangers of extreme heat. BMJ 2022;378:o1741
2. IPCC Sixth Assessment Report. Climate Change 2022 : Impacts, Adaptation and Vulnerability. https://www.ipcc.ch/report/ar6/wg2/
3. Editorial. An unequivocal call to climate action for the health sector. BMJ 2022;376:o680
4. Editorial. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. BMJ 2021;374:n1734
5. Lou del Bello. Little climate finance for South Asia, rich nations break promise. Dec 10, 2020. https://indiaclimatedialogue.net/2020/12/10/little-climate-finance-for-s...
6. Athira Perinchery. The Wire. Despite Talk of New Funds, Rich Nations Are Only Diverting Development Aid.23 June 2022.https://thewire.in/environment/despite-talk-of-new-funds-rich-nations-ar...
7. Stuti Mishra. Independent. Canadian becomes world's first patient to be diagnosed as suffering from 'climate change'. 08 November 2021.https://www.independent.co.uk/climate-change/news/canada-climate-change-...
Assistant Professor Psychiatry ,
Al-Falah School of Medicine and Research Centre,
Dhauj, Faridabad, Haryana, India
Competing interests: No competing interests
Several years ago when I was doing my PhD at University of Cambridge, I was surprised to find out the paucity of air-conditioning in the UK. In Asian countries, air-conditioning is a must and can easily be found almost everywhere. Obviously, it is eco-friendly to avoid the use of air-conditioning. However, the UK government should at least come out with a feasible plan to adapt the buildings to heatwaves. For instance, while must air conditioners use chlorofluorocarbons as their refrigerant, some air coolers use water instead and can be seen as more eco-friendly. Moreover, solar energy can be used to power the air conditioner.
Moreover, the government should advocate the health benefits of sunscreen as British people simply love heat and summer too much, and they don't even bother to wear sunscreen.
Competing interests: No competing interests
Re: How hot weather kills: the rising public health dangers of extreme heat. With Record High Temperatures, Children with Autism in China Need More Support
Sally Howard and Geetanjali Krishna precisely suggest that increasing frequencies of heatwaves around the world are a rising public health challenge . Like many places hit by extreme heat recently (e.g., England, France, India, Pakistan, Spain, and the United States) [2-3], China has issued more than 15,000 high-temperature warnings in the past several weeks and 71 weather stations recorded the highest temperatures ever . In July, Shanghai’s sweltering temperature reached almost 41°C, the hottest day since its records of 1873 . The unprecedented high temperatures pose a unique health risk specifically for more than 10 million individuals with autism (including 2 million children), who may not have attracted enough attention in the discussion of health and climate changes. A heatwave plan is urgently needed to promote health and well-being of this population.
Beyond common medical conditions caused by extreme heat (e.g., exhaustion and heatstroke), individuals with autism often have sensory sensitivities  affecting their ability to regulate temperature; their heat intolerance may be part of sensory difficulties. Our recent interviews with parents and professional care providers suggest, after exposure to high temperatures, children with autism are significantly more likely to have rapid and unstable mood shifts and present strong behavioural, emotional, and communication challenges. In addition, limited outdoor opportunities greatly affect children’s routines and space for daily activities, further intensifying their stress and anxiety .
Sweltering temperatures also make parents’ caregiving much more difficult. Some Chinese parents complain about transportation safety because, due to the discomfort of hot air, children are not willing to wear the helmet or struggle with it when taking electric bike rides. Many parents, therefore, have to keep children at home, which substantially increases childcare responsibilities and considerably interferes with their work.
Even professional care providers encounter severe difficulties in service delivery. Exacerbated by the heat, behavioral, emotional, and communication challenges of children make it more challenging for practitioners to provide high-quality services. Furthermore, service facilities and infrastructures may not be equipped well to handle the extreme weather. Some agencies have to scale back the serving capacity due to power outage, and others have to increase their budget to accommodate extra utility costs. One interviewed agency reports the absence of at least two-thirds of children in high-temperature days.
All of these barriers together may impose a high risk for health and development of children with autism in China. The interruption of healthcare and early intervention for children during heatwaves may have long-term impacts on health. Given the size of the autism population in China and the significant impacts of climate change on health, this public health challenge has to be tackled through a well-designed, well-specified, and well-implemented health policy plan. This will also inform health policies for other populations in the context of climate changes. With record high temperatures, children with autism need more support.
1. Howard S, Krishna G. How hot weather kills: the rising public health dangers of extreme heat. BMJ 2022;378:o1741. https://doi.org/10.1136/bmj.o1741.
2. Jain Y, Jain R. India and Pakistan emerge as early victims of extreme heat conditions due to climate injustice. BMJ 2022;377:o1207. https://doi.org/10.1136/bmj.o1207.
3. Hussain, Z. UK heatwave piles further pressure on stretched NHS services. BMJ 2022;378:o1834. https://doi.org/10.1136/bmj.o1834.
4. Wang, W. Hotter, longer and more widespread heat waves scorch China. New York Times, July 26, 2022. https://www.nytimes.com/2022/07/26/world/asia/china-heat-wave.html#:~:te....
5. Zhen, L. China heatwave brings record high temperatures to Shanghai and other cities. South China Morning Post, July 14, 2022. https://www.scmp.com/news/china/politics/article/3185316/china-heatwave-....
6. Kendall T, Megnin-Viggars, O, et al. Management of autism in children and young people: summary of NICe and SCIE guidance. BMJ 2013;347:I4865. https://doi.org/10.1136/bmj.I4865.
7. Zachor D, Vardi S, et al. The effectiveness of an outdoor adventure programme for young children with autism spectrum disorder: a controlled study. Developmental Medicine & Child Neurology 2017;59(5): 550-556.
Competing interests: No competing interests