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HomeHealthcareHeatwaves & Chronic Illness: A Looming Public Health Crisis

Heatwaves & Chronic Illness: A Looming Public Health Crisis

Heatwaves serve to exacerbate episodes of extreme heat, thereby engendering a profound peril to the collective public health through the augmentation of the incidence rates of non-communicable maladies

Climate change exacerbates heatwaves, posing significant risks to public health by increasing the prevalence of non-communicable diseases (NCDs). Extended exposure to extreme heat amplifies cardiovascular and respiratory issues, and worsens conditions like diabetes. Vulnerable groups encompasses the elderly, children, and marginalized communities.

Addressing these challenges requires a multifaceted approach, incorporating urban planning, healthcare readiness, and community engagement to mitigate NCD risks. It is imperative to take immediate action alongside implementing long-term climate resilience measures to protect public health amid rising temperatures.

During an exclusive exchange with The Interview World, Dr. Poornima Prabhakaran, Director of the Centre for Health Analytics Research and Trends at Trivedi School of Biosciences, Ashoka University and Senior Research Scientist, Centre for Chronic Disease Control, delved into the impact of heatwaves on chronic diseases, particularly cardiovascular and respiratory ailments. She highlighted the influence of climate change on heatwaves in India and underscored the importance of public health strategies to tackle the challenges posed by heatwaves and chronic illnesses. Here are the key insights from her interview.

Q: How do heatwaves specifically impact individuals with chronic illnesses? Are there particular chronic illnesses that are more adversely affected by heatwaves? If so, which ones and why?

A: Beyond a certain threshold, soaring mercury levels pose hazardous threats to all. However, those with chronic illnesses, such as cardiovascular diseases, obesity, diabetes, kidney diseases, respiratory ailments, and mental health issues, are particularly vulnerable to climate extremes.

Under severe heat conditions, a healthy heart undergoes extreme stress, potentially leading to life-threatening consequences for cardiac patients.

Dehydration emerges as a significant concern, as it can result in hypotension (low blood pressure) and compromise kidney function. Additionally, it disrupts various metabolic processes. In severe cases, dehydration can progress to rhabdomyolysis, causing the breakdown of muscle tissue that releases harmful by-products, overwhelming the kidneys and leading to kidney failure.

During very high summer temperatures, there is an observable increase in heat strokes. This life-threatening condition fails the body’s temperature regulation system. This manifests in a core body temperature exceeding 104°F (40°C). Without prompt medical intervention, heatstroke can result in organ damage and even death. Obese individuals are particularly susceptible to heat strokes. Excess body fat acts as an insulator, which imped the body’s natural ability to shed heat and regulate temperature.

Other groups significantly affected by extreme heat include very young children, the elderly, pregnant women, farmers, outdoor workers, impoverished communities with limited access to cooling, homeless individuals, athletes, and those on specific types of medication.

Q: How does extreme heat affect cardiovascular diseases and their management?

A: When temperatures soar, the heart faces increased strain, compelling it to work harder and faster – sometimes pumping two to four times more blood per minute compared to cooler days. This heightened demand can elevate the risk of irregular heartbeats, heart attacks, and cardiac failure.

Normally, the body copes with mild heat by augmenting blood flow to the skin, facilitating heat dissipation through sweating and radiation. Yet, in the face of intense heat, the body resorts to a higher heart rate for compensation. Heat exposure also heightens the risk of blood clot formation and disrupts blood electrolyte balance, compounding potential issues.

The body’s natural response to heat and inflammation can further strain the cardiovascular system. In severe cases, these factors can precipitate arterial plaque rupture, culminating in strokes or heart attacks.

Thus, preemptive measures become imperative. Strategies such as remaining indoors during peak heat, ensuring adequate ventilation, maintaining proper hydration, abstaining from aerated drinks and spicy foods, avoiding tobacco, and donning breathable cotton attire to shield against the sun are crucial. Additionally, we must warrant prompt medical attention at the onset of heatstroke or heat cramps.

Q: In what ways do heatwaves influence respiratory conditions such as asthma or COPD?

A: During heatwaves, we’ve noted a concerning surge in air pollution due to hot, stagnant air conditions. The intensified sunlight in summer leads to elevated levels of ground-level ozone, smog, and nitrogen dioxide. These pollutants form when sunlight reacts with emissions from vehicles, industrial facilities, garbage burning, stubble burning, forest fires, wood fires, and various other sources, posing severe risks to individuals with respiratory diseases.

For those living with asthma or Chronic Obstructive Pulmonary Disease (COPD), extreme hot weather exacerbates their condition. Hot air, smoke, and smog act as lung irritants, damaging the airways and triggering immediate breathing difficulties. Moreover, they contribute to the development of chronic respiratory problems and can even result in premature death.

Heat exposure significantly increases the metabolic rate, the body’s process of converting energy into usable forms. This heightened energy demand can be life-threatening for individuals with COPD or advanced lung disease. Their compromised respiratory systems may struggle to meet the body’s increased metabolic needs during hot weather, potentially leading to serious complications.

Typical symptoms of distress due to heat include persistent cough, breathlessness, difficulty breathing, heightened allergic reactions, and chest discomfort.

Q: What impact do heatwaves have on diabetes management and control?

A: Diabetes wreaks havoc on the body’s delicate blood sugar regulation system. Adding insult to injury, scorching temperatures introduce yet another layer of complexity, compounding the challenges and heightening the susceptibility of individuals with diabetes.

During heatwaves, multiple factors conspire to render diabetics particularly vulnerable. Sweating, a crucial mechanism for temperature regulation, triggers fluid loss, leading to dehydration. Consequently, insulin efficiency diminishes, hindering the body’s ability to clear excess sugar from the blood.

Moreover, soaring temperatures prompt increased blood flow to the skin, diverting circulation away from insulin-sensitive tissues. This exacerbates sugar management issues, exacerbating the struggle to maintain control.

Notably, high temperatures alone can spike blood sugar levels, independently of other influences, exacerbating the situation further.

The plight of diabetic individuals extends beyond blood sugar regulation amid heat stress. Many also grapple with co-existing conditions such as heart disease, which can be exacerbated by the rigors of extreme heat.

Q: Are there specific recommendations for medication management during heatwaves for chronic illness patients?

A: We must store medications prescribed for chronic disease care in cool, dry places to maintain their effectiveness. Failure to do so renders them ineffective. This poses a significant challenge during frequent power outages following heatwaves. Particularly, medications like insulin can lose potency when exposed to high temperatures, a critical concern for diabetic patients relying on insulin to regulate their blood sugar levels.

Additionally, extreme heat can compromise medical devices, impacting medication delivery and overall performance. For instance, inhalers may fail to deliver medication properly if stored outside the manufacturer’s recommended temperature range. The heat can alter the propellant or the medication itself, reducing effectiveness. Similarly, blood sugar monitors, insulin pumps, and test strips can experience performance disruptions when exposed to excessive heat.

Awareness of these risks is crucial for patients using medical devices. They must take steps to safeguard their medications and devices and adhere to the manufacturer’s recommendations for storage temperatures. If patients have concerns about using their devices in hot weather, consulting a doctor for guidance is essential.

Moreover, certain drugs such as beta-blockers, loop diuretics, and anticholinergic medications prescribed for chronic diseases may induce heat-related side effects. Unfortunately, we lack sufficient data on this matter. Therefore, the patient’s physician is the best authority for managing medications in such cases.

Q: How prepared is the healthcare system in India to handle the impact of heatwaves on patients with chronic illnesses?

A: As climate change’s impacts become increasingly apparent, India is actively mobilizing to mitigate its effects. Various governmental institutions, private entities, non-profit organizations, and civil society groups have come together to develop Heat Action Plans (HAP) across the nation.

The pioneering initiative emerged in Ahmedabad following a severe summer in 2010. Since then, it has undergone refinements, evolving into a model for replication in other regions.

Under the National Program for Climate Change and Human Health, administered by the Ministry of Health and Family Welfare, states are mandated to craft their heat preparedness and surveillance plans. Additionally, extensive communication materials and guidelines have been disseminated to raise awareness and provide protection measures against heat-related illnesses.

The National Disaster Management Authority (NDMA) is actively conducting workshops on HAP in numerous states, emphasizing early warning systems and public education. Utilizing weather data, these workshops aim to predict heatwaves and educate vulnerable populations, such as children, the elderly, individuals with chronic illnesses, and outdoor workers, about the associated risks.

Efforts to bolster healthcare infrastructure are underway, with hospitals and local health facilities being equipped with essential supplies like ORS packets, life-saving medications, and specialized equipment. Some regions have also advocated for the establishment of heat stroke wards at the onset of the heatwave season.

Furthermore, Anganwadi staff are being trained as first responders for heat-related emergencies, receiving instruction on hydration protocols and the management of critical patients. Ambulances and mobile hospitals are strategically positioned to ensure prompt assistance when needed.

Q: What measures should healthcare facilities adopt to better support chronically ill patients during extreme heat events?

A: Healthcare providers must remain vigilant to the hazards of heat-related complications in ‘at-risk’ patients. Implementing a system to receive heat warnings from IMD and conducting pre-summer assessments of patients with chronic diseases is crucial. Here are some key considerations: ensuring adequate fluid intake and addressing potential barriers to staying hydrated, reviewing medications that may be impacted by heat or affect hydration needs, educating both patients and caregivers about heat stroke symptoms, preventive measures, and the importance of promptly seeking medical attention if symptoms arise, discussing access to air conditioning, fans, and cool showers, and informing patients about local/community heat response programs that offer assistance.

Advocating for broader access to protective measures such as air conditioning and cooling centers during a heatwave, particularly in vulnerable communities, is essential to diminish the overall risk of heat-related illness. However, realizing these initiatives requires additional hospitals, clinics, healthcare workers, and access to reasonably priced healthcare. Our healthcare facilities must have an adequate number of trained health workers to address critical emergencies, especially in villages and small towns. In these areas, a large vulnerable population faces significant challenges due to the distance from major cities, hindering access to timely care during the golden hour. Delays in treatment, often due to overwhelmed health facilities during sudden surges in emergencies, could have disastrous consequences, as witnessed during the pandemic. 

Q: What public health strategies can be implemented to protect individuals with chronic illnesses from the effects of heatwaves?

A: We must harness age-old wisdom while integrating modern best practices from across the globe.

Indigenous strategies, crafted to endure the sweltering Indian summers, encompass architectural ingenuity such as lofty ceilings and ample cross ventilation, alongside the embrace of verandas and porticos even in humble abodes. Freshwater ponds and lush, tree-lined outdoor spaces are woven into the fabric of adaptation. Attire is tailored to the climate, with lightweight, breathable fabrics like cotton or muslin, complemented by headgear for sun protection. Physical exertion is timed strategically, avoiding peak heat hours, while meals are adjusted for optimal nourishment and digestion – a testament to their longstanding efficacy as public health measures predating modern interventions.

Furthermore, the deployment of Heat Action Plans (HAPs) has fortified our defenses, orchestrating measures like the rescheduling of work shifts to sidestep blistering temperatures. Water kiosks dot towns and villages, supplemented by tanker deliveries, and fortified by the erection of cooling shelters. Statewide initiatives, such as cool roof technologies, have emerged as game-changers in this endeavor.

Moreover, state authorities must ensure widespread availability of oral rehydration salts and intravenous fluids at transportation hubs, alongside the establishment of emergency medical camps across heatwave-prone regions.

Amid heat-related afflictions like heat strokes, exhaustion, and dehydration, the summer also heralds the resurgence of gastroenteritis and vector-borne diseases. Vigilance against contaminated food and water is paramount, particularly for those grappling with chronic ailments. Thus, regular inspections of public eateries emerge as a vital safeguarding measure.

Q: How might climate change influence the frequency and intensity of heatwaves in India, and what does this mean for individuals with chronic illnesses?

A: India has long endured blistering summers, but recent years have seen heatwave conditions soar to unprecedented heights, resulting in a surge of heat-related fatalities. According to the National Disaster Management Authority, heat-related deaths in India numbered 24,223 between 1992 and 2015. Since March 1, 2024, data from the National Centre for Disease Control (NCDC) reveals 56 heat-related deaths and 16,344 suspected heat stroke cases, with fatalities from extreme heat exposure steadily climbing.

As climate change reshapes global weather patterns, India grapples with the consequences of rising temperatures, unseasonal rain, cloud bursts, flash floods, and frequent heatwaves. Unlike sparsely populated nations, India’s vast population renders it particularly susceptible to the adverse effects of climate change, with higher numbers inevitably translating to increased risks of disease and mortality during calamities.

In light of the escalating impacts of climate change, we must adopt a proactive approach to mitigate and adapt to these shifting climatic conditions. While the government bears a significant responsibility in ensuring the safety of all citizens and fostering a health-supportive environment, individuals with chronic illnesses must also take ownership of their well-being by adhering to medical advice.

Timely medication, adherence to prescribed diets, and moderate exercise during cooler periods are crucial for individuals managing chronic conditions. Any indication of exhaustion, pain, cramps, or fainting warrants immediate medical attention. Caregivers should promptly move the affected individual indoors or to a shaded area, ensuring they lie down with their feet slightly elevated. Rehydration and cooling measures, such as applying a wet cloth to the body, are vital. Persistent symptoms necessitate urgent transportation to a healthcare facility for further evaluation and treatment.

Q: What further research is needed to better understand and address the intersection of heatwaves and chronic illness in India?

A: India faces an escalating burden of chronic illnesses coupled with increasingly frequent heatwaves, necessitating a comprehensive understanding of their interconnection with public health. We must not overstate data collection and scientific inquiry in bridging this knowledge gap and crafting effective strategies.

While we possess a reasonable comprehension of how extreme temperatures exacerbate heart disease, worsen respiratory issues such as asthma and COPD, and potentially elevate the risk of kidney complications among the most vulnerable, the real challenge lies in tailoring solutions to suit India’s diverse societies dispersed throughout the nation. For instance, do the responses to heatwaves among fisherfolk in Odisha mirror those of mining communities in Chhattisgarh? What factors influence the body’s response to extreme weather conditions?

Presently, our understanding of the long-term ramifications of heat exposure on chronic disease development remains insufficient. Additional data is imperative to ascertain whether recurrent heatwaves contribute to the onset of chronic illnesses or expedite their progression.

Furthermore, research is essential to assess the efficacy of interventions designed to safeguard individuals with chronic conditions during heatwaves. This may entail examining heat management strategies for high-risk patients, evaluating the impact of telehealth consultations in mitigating heat exposure or gauging the effectiveness of public health awareness campaigns. Investing in research endeavors will enable the formulation of targeted preventive measures and enhance healthcare readiness for future heat events. Such initiatives are indispensable for protecting the health of millions of Indians grappling with chronic conditions.

A Looming Crisis of Heatwaves - Unveiling the Deadly Intersection of Climate Change and Health
A Looming Crisis of Heatwaves – Unveiling the Deadly Intersection of Climate Change and Health
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