Extreme heat illness and fatalities - prevalent but preventable

Associate Professor Shannon Rutherford has had a long career across government and research sectors focused on examining the links between environmental change and human health. Supported by the Cities Research Institute and Climate Action Beacon at Griffith University, her team use a transdisciplinary approach to better understand the health impacts of heatwaves and how, through applied research, we can develop new tools to prepare for and respond to them.

“The impacts of elevated temperatures on human health are well established and highly preventable. Now we need to bring together information that facilitates effective actions at different scales, from individuals in their households to whole communities. This includes equipping policy makers with data and decision-support towards tangible strategies and tools for increasing our heat risk resilience,” said Associate Professor Rutherford.

To facilitate action at the individual level, $2.35 million was awarded to the team’s Extreme Heat and Older Persons (Ethos) Project in 2021 by the Wellcome charitable foundation. Co-led by Dr Aaron Bach, Dr Sebastian Binnewies, and Dr Zhiwei Xu, the team have developed an individualised heat-health early warning system for older persons in Queensland, Australia. The system looks to overcome the limitations of existing population-based early warning systems that are unable to address personal heat-health threats and make targeted cooling recommendations that are effective, accessible, and acceptable to the user.

Physiological, psychological and socio-economic characteristics, including a reduced capacity to sweat, make older persons more vulnerable to heat-related illness and exacerbate pre-existing chronic health conditions prevalent in older populations.

Initially, the researchers surveyed people over 65 from across Queensland to better understand, for example, what they knew about heat health risks, whether they currently listened to heat warnings, what they considered to be accessible and acceptable ways to cool down, and whether they used technology. Feedback on the concept and design was also collected using design cafes involving users and policymakers to build the new warning system technology.

In the summer of 2023/24, the system was trialled through the placement of small sensors that monitor temperature and humidity inside and outside of 85 participants' homes across South East Queensland. In the event of increased heat, personalised cooling advice, matched to what they had access to, was sent to participants via a tablet-like device.

Participants were asked real-time feedback questions as they received warnings and interacted with the system to measure both the accessibility of the technology and the personalised solutions it provides. Early analyses suggest that participants found the system was easy to use, increased heat awareness, prompted changes in daily behaviours, increased the diversity of cooling strategies used and for some, sparked investment in household ventilation and cooling. More detailed investigations are ongoing.

The Ethos Project survey data also identified clear gaps in people’s understanding of environmental heat risks. For example, while 80% of participants had a chronic health condition, the cohort had a low understanding that this increased their risk of heat related health consequences.

“We found that doctors were not talking to their patients with chronic conditions about heat. This highlighted a gap that we need to address – if no one cares about heat waves and their health risks, they're not going to care about our system. They're not going to act if they don't think there is a problem,” said Associate Professor Rutherford.

These findings were taken to the Ethos Project steering committee, composed of representatives from organisations such as Queensland Health, Queensland Department of Environment and Science, Australian Red Cross, UnitingCare Queensland, and Council on the Aging. Some of the survey findings have gone on to influence Queensland policy.

“The Ethos team’s research findings and a Queensland Health review of communications being used in Queensland and other Australian states initiated new appendices being added to the 2023 Queensland Health Heatwave Management Sub-Plan. These include guidance for general practitioners and we also promoted conversations with doctors as part of the new Heatwave Preparation Checklist through Get Ready Queensland,” said Nicole Mandalios, Manager, Policy and Planning, Disaster Management Branch, Queensland Health. “We have received positive feedback on these inclusions, and they strengthen the aim of Queensland Health communications to increase the understanding of health-related risks for vulnerable persons.”

To equip both individuals and healthcare providers, the team also produced a series of information videos that are freely available and have been used as part of the BlueCare Heat Health Awareness campaign and on the Queensland Government Health and Safety website. The videos are also being displayed in the waiting rooms of Metro South Health Community Health Centres located in South Brisbane, QLD, Australia.

“The videos provide information to our patients and their carers on the importance of recognising the effects that heat can have on their health. Patients have commented that the videos are easy to follow and informative. They have also been used as an educational tool by clinicians visiting patients in their own homes,” said Lesley English, Executive Director, Community and Oral Health, Metro South Health.

By looking to address both structural and individual behaviour change, Associate Professor Rutherford and her colleagues are considering the most vulnerable in society and working to ensure that heat risk resilience strategies consider inequality. With heat related fatalities being preventable, their work will provide tangible actions across different levels that help people to prepare and respond to extreme heat events.