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Extreme events and vulnerable people: Harnessing science to practice
A research project of the Department of Sociology.
This was a collaborative project between researchers at Durham University and the Extreme Events and Health Protection team in Public Health England (PHE). This project builds on approaches developed from the Built Infrastructure for Older People's Care in Conditions of Climate Change (BIOPICCC) project, conducted at Durham University and Heriot-Watt University and was a 3-year project (November 2009 - October 2012) funded by the EPSRC, as part of a research programme on Adaptation and Resilience in a Changing Climate. BIOPICCC developed strategic and practical approaches to service resilience for older people during extreme weather events (storms, floods, and heatwaves), the incidence of which is increasing as a result of climate change, as well as cold spells which continue to present a significant risk.
A key output from BIOPICCC was the BIOPICCC Toolkit comprising a series of resources to assist local authorities, partner organisations, and neighbourhood and community groups with local level resilience planning. This project is a step towards developing the existing BIOPICCC toolkit to assist the communication of public health messages across local systems, and to understand how these are being interpreted and what the potential barriers (if any) are to embedding these in local practice.
Under the 2004 Civil Contingencies Act, there is a duty to warn and inform the public before, during and after an emergency. Public Health England (PHE), which is an executive agency of the Department of Health, publishes annual heatwave and cold weather plans (see for example https://www.gov.uk/government/publications/heatwave-plan-for-england) which aim to, ‘prepare for, alert people to, and prevent, the major avoidable effects on health during periods of severe heat or cold in England.’
Both heatwave and extreme cold weather have significant impacts on mortality and morbidity in the UK. Since 2002-03 there have been on average 26,500 excess winter deaths a year, with the UK having approximately twice the rate of excess deaths of colder countries such as Finland, and severe winter weather has caused significant disruption to services in recent years. The 2003 heatwave caused approximately 2000 excess deaths in England, with heat also associated with other health hazards such as ozone air pollution (PHE, 2014). Floods are known to cause significant harm to mental health (according to the international literature), and may, more rarely, be associated with drowning, infectious diseases and carbon monoxide poisoning.
The advice and guidance about year-round planning and preparedness for EWEs is based on scientific and evidence-based knowledge developed by PHE and other government agencies, such as the Environment Agency, Defra and the DCLG. This advice and guidance recommends a series of steps to reduce risks from EWEs for:
- the NHS, local authorities, social care, and other public agencies
- professionals working with people at risk
- individuals, local communities and voluntary groups.
However, the extent to which this guidance is disseminated and filters across health and social care systems is not fully understood. The dissemination may be complicated by developments including the continued fragmentation of public service delivery since the 1980s following the introduction of ‘new public management’ reforms, involving the outsourcing of services, and the reductions in public sector funding following the 2007/08 financial crisis. More recently, the Health and Social Care Act 2012 provides both challenges and opportunities, including the need to re-establish local networks following changes in governance arrangements, in order to implement the extreme weather events agenda.
This project explored the implementation of PHE guidance at different levels of practice (‘middle manager’ and local care delivery managers) in adult health and social care systems and sought to address potential gaps in understanding about how far PHE guidance is cascaded across local systems. We were particularly interested in how PHE advice and guidance is interpreted and used locally, identifying potential barriers to implementation, and considering how this agenda can be incorporated into existing routine health and social care practice. In so doing, we adopted an approach that recognises that every area is different and what works well in one place may not work in another. Consequently, the project sought to transfer knowledge from PHE through a range of tools build on the approach developed through the BIOPICCC research project and have been designed to be adaptable and to help with planning for local conditions.
The central aim of the project was to enhance dissemination of PHE guidance to local authorities and health and social care organisations for long-term planning and preparedness for extreme weather events (such as heatwave, cold weather or flooding). As such the project’s aims and objectives are outlined below.
- To harness science from the PHE evidence base about the health effects of EWE to improve local risk assessment and decision-making
- To enhance the translation of evidence to support decision-making and build resilience through improved continuity of health and social care in relation to EWE.
- To adapt for PHE aims and objectives some elements of the BIOPICCC approach, designed to engage actors in different agencies responsible for extreme weather resilience, and at different levels of these organizations
- To develop a process cascade (multi-scale and cross-sector) to help embed PHE advice and guidance about extreme weather events in local stakeholders’ agendas for policy and action.
- To ensure that local stakeholders understand the importance of identifying the risks and working to ensure continuity of services for vulnerable populations during extreme weather events.
Discussion groups with practitioners and policy makers.