A new toolkit for patients, providers and clinics provides guidance to prepare for or respond to weeks of prolonged heat, as well as more fires, hurricanes and other weather linked to climate change.
It suggests that patients with diabetes may have nerve damage in their feet, and need to avoid going barefoot on hot pavement or sand. People who take some heart medications that cause frequent urination may need to drink more water in the heat. And health clinics could consider sending individual heat alerts to patients who are older, very young, pregnant or those with chronic conditions that may flare as temperatures rise.
The online tip sheets and heat action plans are an attempt to close a gap: few providers consider heat when advising patients or making decisions about their care. One reason is a lack of clear, easily accessible information.
“In the context of climate shocks, we have to be sure we’re working to protect those most at risk first,” said Harvard's Dr. Ari Bernstein, who co-led work on the toolkit, "and keeping people safe from harms that are already here and will grow greater with time."
The National Weather Service says more than 28 million people in the U.S. were dealing with extreme heat in late July and more than half of them are more at risk for heat-related problems: children, the elderly and patients with a chronic disease.
For patients, the kit includes tip sheets and heat action plans, with specific recommendations for people with diabetes, asthma or COPD, and kidney disease. Many of the suggestions are the same for all patients: watch for heat alerts, stay hydrated, and talk to your provider about whether heat may affect prescribed drugs that you take. But some tips and actions vary by disease.
The toolkit urges providers to assess a patient’s heat risk by asking whether they work outdoors, have access to air conditioning and can afford to use it and understand any vulnerability they may face based on age, health conditions or medications.
Dr. Rebecca Rogers, a primary care physician at Cambridge Health Alliance who reviewed the toolkit, says physicians are already packing a lot into short visits.
“We’re really not going to have a choice anymore to have conversations with our patients about heat,” Rogers said, “so the more resources we can give to providers to have at their fingertips, to use in real time, will make these conversations much easier.”
Rogers says her health care system’s medical record doesn’t send alerts to patients who are most at risk for complications due to heat, “but that’s a really exciting idea to me.” Bernstein says more work is needed to individualize heat risks based on where patients live and other factors.
The fact sheets and action plans are based on input from surveys of community health center staff and others in 47 states. The project is co-led by Americares, a nonprofit that works on health care issues in low income communities.
Bernstein says it makes sense to focus on what’s useful for community health centers because they care for many of the people most in danger from the effects of climate change.
“The idea here is not to wait until people are dropping dead,” said Bernstein, who directs the Center for Climate, Health and the Global Environment at the Harvard T.H. Chan School of Public Health. “The idea here is to avoid preventable harm, and that’s a different view of resilience than we may have taken previously.”
For health centers, the toolkit offers advice about how to prepare for and manage urgent problems like a power outage as well as how to build long term resilience in the face of climate change. Community health centers operate with little spare cash and may need financial assistance to install back-up power systems, solar panels, plant more trees or install a green roof. Bernstein suggests a federal green fund for these clinics.
There are other online resources for providers, patients and health care facilities coping with longer periods of extreme heat. New York City’s health department posts guidance for providers. And earlier this month, the Biden administration launched Heat.gov, which offers health-related forecasts and ways to track groups of people most at risk for heat-related health problems.
These sites are part of growing effort to integrate heat into the decisions patients, providers and clinics make to improve health.