Interview of April 2, 2014 with Dr. Andreas Lauenroth
Is there such a thing as climate change?
Doubts about climate change still arise from time to time although the data is conclusive and the majority of international experts agree upon climate change caused by humans. I would like to point out two reasons that often lead to misunderstandings:
First: Climate change or the ambiguous term “global warming” which fortunately is not often used anymore, are not synonyms for “nice weather”. Climate change changes our climate and leads on average to a warming, so locally there could be more clouds or precipitation and this will altogether lead to more extreme occurrences of all sorts.
Second: Climate always has been changing. But appr. 13.000 years ago – after the last ice age - when humans started to practise agriculture and breed livestock, climate was quite consistent. In the last decade, climate started to change rapidly. 24 of the last 30 years were warmer than the average during the reference period. The earth has experienced similar rapid climate changes - but mostly towards colder temperatures - the human as a settled individual has not. And that’s why climate change is a great challenge for mankind. Many huge cities are located on rivers and coastlines and an increase of floods or rise of the sea level will therefore have severe consequences. Also, changing crop harvest through climate changes is a sensitive topic for a growing world population.
What health risks come with climate change?
Overall one can say that climate change does not create new diseases, but influences the geographical spreading and frequency scale of existing diseases. Relevant for Germany are mainly the influence of allergies, infectious diseases and heat- and cold stress. For example, the allergy-free period shortens because a lot of trees and grasses start blooming early during the year. And new sorts like ragweed that can cause allergies, might settle in Germany.
I would like to point out two infectious diseases: Ticks that spread diseases like borreliosis or the TBE virus – a form of meningitis – are probably going to be active earlier during the year and spread further north and into mountain ranges. That doesn’t necessarily mean that more cases of illness are going to occur but it also depends on how people are protecting themselves against ticks and it does increase the possibility of infections. But we do not need to be afraid of a nationwide occurrence of tropical diseases like malaria or dengue-fever because we control those through very good mosquito control efforts and a good medical care.
A direct threat is caused by heat waves because they are going to be more frequent, longer and more severe as before. During the heat wave of 2003, 1100 more people died than normally during that period. The death rate within the 75 years of age during severe heat stress in comparison to thermal comfort is 15-12% higher.
Why are older people especially affected by heat stress?
On one hand, older people are often more affected by diseases that interfere with the ability of the body to adjust to high temperatures. For example cardiac insufficiency, kidney diseases and chronic pulmonary diseases. Also the intake of some medication can affect the physical adjustment to heat.
On the other hand, older people are mostly less fit than the younger and that also influences the adaptability of the body. Because through physical activity the cardiovascular system and our ability to sweat is similarly demanded as the adjustment to heat. For example, blood vessels in arms and legs are widened and the heart is beating faster and stronger to circulate the blood within the body. When such functions are impaired, it also affects our adjustment to heat.
In what way age itself – even in fit and healthy older people – influences our ability to sweat and our cardiovascular system, is not entirely clear. On principle it seems that also within a healthy aging process, there is a certain decrease in sweat production and the performance of the cardiovascular system.
How can, for example, a family physician be involved in the process of heat-related damages?
At first, the doctor should be aware of the dangers caused by heat. Then he can try to integrate a good care into his normal treatment, which a lot of doctors already do in one way or another. In my study, in which I conducted discussions with family doctors about prevention possibilities for heat, I was able to identify four fields of action. Field 1 – practice process: Adjustments should be made to the practice process (i.e. appointments early in the morning or evening, offering of water at room temperature in the practice). Field 2 - Medication adjustment: The family doctor can – according to the individual situation of the patient - make adjustments to the medication. Field 3 - Clarification: Family doctors should inform patients and caring relatives about heat risks and preventive behaviour. Field 4 – Contact measures: Older people living alone can – depending on the individual state of health - depend on special support from persons of contact, for example shopping or the motivation to eat and drink. And a lot of studies prove, that the state of health of a person in a heat wave can deteriorate very fast. That’s why it is also important to regularly – at least twice a day - check on a person at risk. Even if family doctors can increase their number of house calls , they cannot be made solely responsible. But family doctors can sensitize the person affected and his social network (friends, neighbours etc) of such assistance measures or inform them about existing services like heat warnings of the German weather service.
How does such a heat warning system work?
The heat warning system is lead by the German weather service (DWD). Heat warnings are submitted when there is a wind chill temperature of 32° Celsius on two following days. These warnings are partially transmitted through the media. There is also a newsletter which one can order via the homepage of the DWD as well as a smartphone-App. If possible, all nursing homes in Baden-Württemberg are being informed by the health authorities about any heat warnings. Otherwise the heat warning of the DWD is relatively unknown. Contrary to other countries like England, Italy or France, the implementation of heat warnings as measures for health protection is relatively low. Kassel has a model project in which people at risk get support through a network of volunteer workers in case of heat waves. Here it was difficult to reach persons at risk that would profit from this program and the family doctor could be a promising contact person. But the doctors must have sufficient appreciation of the problem and there have to be enough resources, so a family doctor can economically implement such measures.
How can I personally protect myself from heat?
There are no magic tricks for heat protection but everyone can behave according to the weather. For everyone that means: lesser physical activities, keep break rooms cool, thin clothing, enough drinking and perishable foods should be stored in the refrigerator. Younger people should drink a lot and avoid hard work or sports in the sun. The amount of fluid supply for people with heart or kidney diseases and very old people should be arranged with their doctor. It is important to know, that fluid supply is not only covered by fluids but also by foods with a high water content, ideally with enough salt. Especially with people in need of care it is not easy to encourage them to drink. It is also important for people at risk to actively keep their body temperature low, for example through cooling foot and arm baths or cooling calve compressions and it can be very useful to control body and room temperatures. And relatives, neighbours and friends of very old people should regularly keep in touch and when they allow it, support them in straining daily routines. But it is important to respect their wishes of autonomy.
Alina Vandenbergh studies medicine at the Heidelberg University since 2008. She became a scholarship holder of the NAR Kolleg and a PhD student at the Institute of Public Health under the leadership of Prof. Rainer Sauerborn, in 2012 and works thereon the effects of climate change on health. In her thesis, she researches the possibilities of prevention of health risks during heat waves and focuses on family physicians as central participants in health care of the ambulatory sector.