Health Effects of Climate Change in the UK 2012 Current evidence, recommendations and research gaps Sotiris Vardoulakis and Clare Heaviside (Editors) Cover artwork provided by Will Stahl-Timmins European Centre for Environment and Human Health, University of Exeter Medical School Health Effects of Climate Change in the UK 2012 Edited by Sotiris Vardoulakis and Clare Heaviside Preface I There is substantial evidence that climate change is affecting many aspects of the world around us. Weather patterns are shifting, extreme weather is becoming more commonplace and temperatures in most parts of the world are rising. For at least ten years now, the UK has been giving serious consideration to the risks climate change could pose to our health. In 2002 the Department of Health published The Health Effects of Climate Change in the UK, one of the first reports of its kind internationally, informed by the UKCIP98 climate projections. In 2008, DH and the Health Protection Agency jointly published an updated version of that study, based on the revised UKCIP02 climate projections. These reports have been highly regarded and helped to shape policies to prepare for the challenges ahead. I am glad that the HPA agreed to produce this timely update as the science around climate change is constantly evolving. In 2009 the latest long-range climate projections for the UK (UKCP09 from the UK Climate Impacts Programme) were published, updating those produced in 2002, in order to inform the UK’s first Climate Change Risk Assessment (CCRA), required by the Climate Change Act (2008), covering 11 sectors across society. This HPA report complements the Health Sector report of the CCRA by providing scientific evidence of the wider risks to public health from climate change in the UK. Next year the public health landscape changes, with the HPA moving to Public Health England and more involvement of local authorities in public health decision making. This report will help provide valuable evidence towards local protection of the public’s health, with, for example, many actions to combat heatwaves already covered in our National Heatwave Plan. As well as preparing for the health impacts of climate change, we are also able to help prevent the worst of these impacts as urgent action to reduce individual and corporate carbon footprints continues. We can then also reap the health benefits of a low-carbon society, with cleaner air and more active, healthier lifestyles to help combat obesity, cancer and heart disease. A win-win we can all engage in. Professor Dame Sally Davies Chief Medical Officer Department of Health 1 Preface II Human beings are remarkably adaptable. Over the millennia they have spread across the globe to live in virtually every climate our planet has to offer. But during the coming years humans will have to adapt further still as our climate changes. Floods across the UK in 2007 and the heatwave of 2003 are a stark illustration of the devastating effects that extreme weather events can have. The heatwave during the summer of 2003 resulted in over 2,000 excess deaths across England and Wales, and the 2007 floods caused by heavy rains led to 13 deaths and more than £3 billion pounds worth of damage to the UK infrastructure. Both of these events are covered in this report. Though it cannot be said with certainty that these events were a direct consequence of climate change; it is clear that events of this kind are becoming more frequent, and they provide a glimpse of what could become even more severe events in the future. For those in health protection, planning for those climate-related changes and, where possible, adapting to their likely effects, is critical. This is why this new report is so vital – it is an extensive update to reviews published in 2002 and 2008; and it draws on climate projections for the UK published in 2009 (UKCP09), the UK’s first Climate Change Risk Assessment, published in January 2012, and recent evidence published by the Intergovernmental Panel on Climate Chance (IPCC) and other organisations. It gives those in the health and social care sectors the information they need to make informed decisions about the pressures of climate change on public health. It also reminds policy makers of the need to consider how steps to mitigate the effects of climate change may lead to unintended consequences that need other direct action. And, it identifies areas where more research is needed to provide qualitative and quantitative evidence of the direct and indirect effects of climate change, looking in particular at vulnerable populations and regions. I would like to take this opportunity to thank all those who have lent their considerable expertise to this report. Glancing at the list of chapter titles illustrates the broad range of experts who have contributed to the report – and I am extremely grateful for the work they have done. In addition, I would like to give special thanks to Sotiris Vardoulakis and Clare Heaviside, the editors of the report, without whose tireless work it would not have been completed. For many years debate has focused on whether our climate is changing. Today the question is no longer whether the climate is changing, but what can be done. My hope is that this report will become the major reference for helping to mitigate and adapt to the impacts climate change will have on UK public health. Dr David L. Heymann Chairman Health Protection Agency 2 Report Editors Dr Sotiris Vardoulakis (Health Protection Agency) Dr Clare Heaviside (Health Protection Agency) Contributing Authors Dr Ruth Doherty (University of Edinburgh) Dr Bernd Eggen (Health Protection Agency) Professor Sir Andy Haines (London School of Hygiene and Tropical Medicine / Health Protection Agency) Dr Shakoor Hajat (London School of Hygiene and Tropical Medicine) Dr Mathew Heal (University of Edinburgh) Dr Clare Heaviside (Health Protection Agency) Dr Nezahat Hunter (Health Protection Agency) Professor Roy Kennedy (University of Worcester) Dr Sari Kovats (London School of Hygiene and Tropical Medicine) Dr Ka-Man Lai (University College London) Dr Iain Lake (University of East Anglia) Dr Steve Leach (Health Protection Agency) Jolyon Medlock (Health Protection Agency) Professor Virginia Murray (Health Protection Agency) Dr Gordon Nichols (Health Protection Agency) Dr John O’Hagan (Health Protection Agency) Dr Matt Smith (University of Worcester) Carla Stanke (Health Protection Agency) Dr David Stevenson (University of Edinburgh) Professor John Thornes (Health Protection Agency / University of Birmingham) Dr Sotiris Vardoulakis (Health Protection Agency) Dr Massimo Vieno (Centre for Ecology and Hydrology) 3 Acknowledgements Chapters of this report have been reviewed by: Professor Ross Anderson (Kings College London) Professor Ben Armstrong (London School of Hygiene and Tropical Medicine) Dr Graham Bickler (Health Protection Agency) Professor Jeroen Buters (Center of Allergy and Environment, ZAUM, Munich, Germany) A/Professor Keith Dear (Australian National University) Professor Michael Depledge (European Centre for Environment and Human Health, Exeter Medical School, University of Exeter) Professor Brian Diffey (Newcastle University) Dr Gavin Donaldson (University College London) Professor Carmen Galan (University of Cordoba, Spain) Dr Tim Gant (Health Protection Agency) Dr Clare Goodess (University of East Anglia) Dr Dominic Hames (HR Wallingford) A/Professor David Harley (Australian National University) Professor Stuart Harrad (University of Birmingham) Dr Elizabeth Haworth (University of Oxford) Sarah Hübner (WHO Regional Office for Europe) Professor Patrick Kinney (Columbia University, NY) Dr Karine Laaidi (French Institute for Public Health Surveillance, InVS, France) Dr Felicity Liggins (UK Met Office) A/Professor Robyn Lucas (Australian National University) Corinne Mandin (Scientific and Technical Centre for Building, CSTB, France) Professor Robert Maynard CBE (University of Birmingham) Dr Paul McKeown (National Disease Surveillance Centre, Ireland) Professor Anthony McMichael (Australian National University) Dr Jill Meara (Health Protection Agency) Isabella Myers (Health Protection Agency) Dr David Pencheon (NHS Sustainable Development Unit) Professor Sarah Randolph (University of Oxford) Dr Gerald Rockenschaub (WHO Regional Office for Europe) Dr Michael Sanderson (UK Met Office Hadley Centre) John Stedman (AEA Technology) Professor David Strachan (St George’s Hospital Medical School) Professor Richard Wall (University of Bristol) Dr Ann Webb (University of Manchester) Reviewers’ comments have been extremely valuable in improving this report. However, the final report remains the responsibility of the authors. The editors would like to acknowledge Dr Louise Newport and Agatha Ferrao (Department of Health) for their support and feedback throughout the preparation of this report. The editors also thank Dr Jill Meara, Dr Giovanni Leonardi, Professor Anthony Kessel and Dr John Cooper (HPA) for their encouragement and support in relation to this publication, and Matthew Pardo (HPA Press Office) for help with Communications. 4 Executive Summary The original Health Effects of Climate Change in the UK report, published by the Department of Health in 2002 was one of the earliest attempts at quantifying the health effects of climate change for the UK. In 2008, a further update was published by the Department of Health and the Health Protection Agency, based on new climate change projections for the UK. The present report has been prepared on