As the chill of winter approaches, everyone needs to prepare for the colder temperatures, Councillor David Fothergill discusses how a long-term strategic approach is needed by health and wellbeing boards, integrated care systems, directors of public health and commissioners to assess needs and to commission, plan and implement interventions, to reduce deaths attributed to periods of extreme cold.
Although winter weather and snow can be fun for some, these weather conditions are also associated with an increase in illness and injuries.
Cold weather increases the risk of heart attacks, strokes, lung illnesses, flu and other diseases. People slip and fall in the snow or ice, sometimes suffering serious injuries. Some groups, such as older people, very young children, and people with serious medical conditions are particularly vulnerable to the effects of cold weather.
Mortality is significantly higher during the winter months (December to March in the UK) compared to other seasons, although the number of additional deaths vary annually. This period also sees a substantial increase in respiratory illnesses and other illnesses which are exacerbated by exposure to cold.
Determination of the number of deaths attributed to cold weather is complex. According to UKHSA estimates, 5,533 deaths in winter 2022 to 2023 could be attributed to periods of extreme cold.
in winter 2022 to 2023 could be attributed to periods of extreme cold
Cold-associated deaths due to extreme cold weather are predicted to peak around 2030, with deaths from moderate cold peaking in the 2050s. Therefore, cold weather will continue to present a burden of mortality for England in the coming years.
The reasons for increased winter mortality are often complex and interlinked, and include:
- individual vulnerability, for example age and pre-existing medical conditions
- circulating infectious diseases, particularly flu and norovirus
- attitudes to cold and associated behaviours, for example ability to look after oneself in cold weather
- seasonal factors, for example snow and ice
- housing and economic factors – poor quality housing, particularly cold home
- homeless people/street sleepers are vulnerable to the cold due to exposure to outdoor temperatures, and other factors which increase vulnerability to cold.
The human body responds to cold exposure in different ways Importantly, effects are seen even at temperatures that might be considered relatively mild (4°C to 8°C). We can distinguish between direct and indirect effects of cold weather on health. Direct effects occur when cold exposure leads directly to a health impact. Indirect effects on health from cold usually only occur when other factors are also present that influence a health impact.
Direct effects include:
- heart attack
- stroke
- respiratory disease
- influenza
- falls and injuries
- hypothermia
Indirect effects include:
- snow and ice causing disruption to healthcare services which in turn affects whether people can access care
- cold homes and fuel poverty which are linked with poor mental health and social isolation
- reduced education and employment success, both of which are linked to poorer health outcomes over the long-term
- carbon-monoxide poisoning
Many of these deaths are preventable and there are actions which can be taken by the NHS, social care, public health and other agencies throughout the year, in response to forecast or actual severe winter weather to minimise any harm to health.
As councillors it’s really important to reinforce that the harm to health associated with cold weather is not inevitable.
It is clear that whilst actions taken by health and social care sector during cold weather may relieve part of the health burden, there is a strong argument for a multi-agency approach to reducing the wider determinants of winter deaths and disease such as socioeconomic inequalities, fuel poverty and housing energy efficiency.
This is not something that can be tackled in the winter alone and requires a long-term strategic approach by health and wellbeing boards, integrated care systems, directors of public health and commissioners to assess needs and to commission, plan and implement interventions."
Some councils have carried out scrutiny reviews focussing on preparedness for winter pressures on health services (such as accident and emergency services) and road gritting during freezing conditions. Whilst these are important topics, falling levels of family incomes, rising levels of fuel poverty and isolation of older people means that the effects of cold weather can be hidden.
The community and voluntary sector can help reduce vulnerability and to support the planning and response to cold weather, particularly through identifying and engaging vulnerable people. NHS and local authority commissioners and providers, should take opportunities for closer partnership working with these groups.
For more information check out GOV.UK's Adverse Weather and Health Plan.
Councillor David Fothergill
Chairman
Community Wellbeing Board