The policies of response to and prevention of heat waves in France in 2003 and in South Korea in 2018 were compared and reviewed to see how public health policy orientation was being expanded in connection with urban and social policies. The statistics of the patients with heat illness and resulted death in France in 2003 and South Korea in 2018 were analyzed. The results and limitations of the French and Korean responses to heat waves were compared and discussed. The heat wave in France in 2003 caused an excess death of 14,802. The 2018 heat wave in South Korea resulted in 4,526 cases of heat illness and 48 deaths. France’s National Heat wave Plan established in 2004 introduced the warning system and strengthened support for the vulnerable. The heat wave in South Korea in 2018 revealed the success and limitations of the national measures that have been gradually implemented since the mid-2000s. Both France and South Korea are making efforts in preventing heat illness and managing health risk through the warning systems, providing public and social support for the vulnerable, and expanding urban infrastructure. Paris puts priority on the long-term prevention of heat wave, in the wider context of climate change response, while Seoul shows a relatively strong point in immediate infrastructural expansion. In order to respond to the climate crisis and the following health risk, public health policies need to be contrived with deeper connection with urban social policies for sustainable development.
BACKGROUND: Natural disasters are typically associated with the emergence of infectious diseases. On 15 June 2010, severe storms caused flooding in the Var department (France). A rumour about increased risk of Staphylococcusaureus skin infections after bathing in the sea began to circulate on Internet a few days after the floods. The aim of this study was to compare the rumour with the true incidence of cases of infection. METHODS: Since 1999, we have been conducting a prospective survey of S. aureus skin infections in our hospital to study their clinical, laboratory and epidemiologic features. We compared data on cases of Staphylococcus skin infection recorded in our institution from 2008 to 2012. RESULTS: We found that there was no increase in S. aureus skin infections after the floods compared to the previous and subsequent years. CONCLUSION: We had a unique opportunity to check the rumoured increase in incidence of infectious disease with the true incidence. In our study, the fear of S. aureus skin infections following flooding proved to be unfounded.
Forest fires burn an average of about 440 000 ha each year in southern Europe. These fires cause numerous casualties and deaths and destroy houses and other infrastructure. In order to elaborate on suitable firefighting strategies, complex interactions between human and environmental factors must be taken into account. In this study, we investigated the spatiotemporal evolution in the burned area over a 50-year period (1970-2019) and its interactions with topography (slope aspect and inclination) and vegetation type in southeastern France by exploiting the geographic information system (GIS) databases. Data were analyzed for two 25-year periods (1970-1994 and 1995-2019), since a new fire suppression policy was put into place after 1994, which focused on rapid extinction of fires in their early phase. In the last 25 years, the burned area decreased sharply, and the geographic distribution of fires also changed, especially in regions where large fires occur (Var administrative division). Elsewhere, even though forest fires remain frequent, the total extent of the burned area decreased substantially. Fire hotspots appear closer to built-up areas in the west, are randomly distributed in the east, and they almost completely disappear in the central region of the study area where there is a history of large fires. Slope orientation presents an increasingly important role in the second period; south-facing slopes are preferred the most by fire, and north-facing slopes are preferentially avoided. Even though the slope inclination is less affected by the new firefighting strategy, low slope inclinations are even more avoided after 1994. The greatest proportion of the burned area is strongly associated with the location of sclerophyllous vegetation clusters which exhibit highly fire prone and expand in area over time. Natural grasslands are also preferred by fire, while broadleaved, coniferous, and mixed forest are increasingly avoided by fire.
INTRODUCTION: In France, a heat warning system (HWS) has been implemented almost two decades ago and rely on some official heat wave (HW) definitions. However, no study has compared the burden associated with a large set of alternative HW definitions to the official definitions. Such comparison could be particularly helpful to identify HW conditions for which effective HWS would minimize the health burden across various geographical contexts and possibly update thresholds to trigger HWS. The aim of this study is to identify (and rank) definitions that drive the highest health burden in terms of mortality to inform future HWS across multiple cities in France. METHODS: Based on weather data for 16 French cities, we compared the two official definitions used in France to: i) the Excess Heat Factor (EHF) used in Australia, and ii) 18 alternative hypothetical HW definitions based on various combinations of temperature metrics, intensity, and duration. Propensity score matching and Poisson regressions were used to estimate the effect of each HW exposure on non-accidental mortality for the May-September period from 2000 to 2015. RESULTS: The associations between HW and mortality differed greatly depending on the definition. The greatest burden of heat was 1,055 (95% confidence interval “CI”: [856; 1,302]) deaths per summer and was obtained with the EHF. The EHF identified HW with 2.46 (95% CI: [1.92; 3.58]) or 8.18 (95% CI: [6.63; 10.61]) times the global burden at the national level obtained with the climatological indicator of the French national weather service and the HW indicator of the French national HWS, respectively and was the most impactful definition pattern for both temperate oceanic and Mediterranean climate types. CONCLUSION: Identifying the set of extreme heat conditions that drive the highest health burden in a given geographical context is particularly helpful when designing or updating heat early warning systems.
OBJECTIVES: Between 2015 and 2019, 5700 excess deaths were observed during heatwaves in France. The summer of 2020 combined exceptionally high temperatures with the COVID-19 pandemic. The associated health impacts of this unique situation are described in this study. STUDY DESIGN: This is an observational study based on indicators of the French heat prevention plan. METHODS: Mortality and morbidity data during heatwaves were compared between 2020 and previous years, alongside COVID-19 in-hospital mortality. RESULTS: In total, 1921 additional deaths (+18.2%) were observed during the 2020 heatwaves, which is the largest number of deaths observed since 2003. Less than 100 deaths were attributed to COVID-19 during the heatwaves of 2020. CONCLUSIONS: Exceptionally high temperatures driven by climate change, combined with health inequities exacerbated by the COVID-19 outbreak, may have increased vulnerability to heat in 2020.
Heatwaves affect human health and should be more and more frequent because of global warming and could lead to increase mortality in general population, especially regarding cardiovascular mortality. During the summer 2019, Europe experienced a strong episode of heatwave. Telemonitoring of patients with heart failure (HF) provide an elegant tool to monitor closely the weights, and we assumed to be able to assess our hypothesis through a nationwide telemonitoring system. Here, we hypothesize that (i) there will be a change in patients’ weight during the heatwave and (ii) that the telemonitoring would enable us to follow these changes. The change in weight would be a surrogate for clinical worsening (with or without decompensated HF). Briefly, 1420 patients with a median age of 73.0 years and mean weight of 78.1 kg have been included in this analysis. The relationship between temperature and weight is very strong (P < 10(-7) ). The magnitude of the effect seems clinically relevant with a variation of 1.5 kg during a short period. This could expose patients to increased symptoms, HF decompensations, and poor outcomes. These results suggest a new way to implement weight telemonitoring in HF. This suggests also a direct impact of global warming on Human health, with acute episodes that are expected to occur more often, threatening patients with chronic diseases, especially patients with heart failure. In clinical practice, this urges to take into consideration the episodes of extreme heatwave and suggest that we have already useful tools including telemonitoring available in frail patients.
BackgroundWaterborne disease outbreaks (WBDO) associated with tap water consumption are probably underestimated in France.AimIn order to improve their detection, Santé publique France launched a surveillance system in 2019, based on the periodical analysis of health insurance data for medicalised acute gastroenteritis (mAGE).MethodsSpatio-temporal cluster detection methods were applied to mAGE cases to prioritise clusters for further investigation. These investigations determined the plausibility that infection is of waterborne origin and the strength of association.ResultsBetween January 2010 and December 2019, 3,323 priority clusters were detected (53,878 excess mAGE cases). They involved 3,717 drinking water supply zones (WSZ), 15.4% of all French WSZ. One third of these WSZ (33.4%; n = 1,242 WSZ) were linked to repeated clusters. Moreover, our system detected 79% of WBDO voluntarily notified to health authorities.ConclusionEnvironmental investigations of detected clusters are necessary to determine the plausibility that infection is of waterborne origin. Consequently, they contribute to identifying which WSZ are linked to clusters and for which specific actions are needed to avoid future outbreaks. The surveillance system incorporates three priority elements: linking environmental investigations with water safety plan management, promoting the systematic use of rainfall data to assess waterborne origin, and focusing on repeat clusters. In the absence of an alternative clear hypothesis, the occurrence of a mAGE cluster in a territory completely matching a distribution zone indicates a high plausibility of water origin.
In the context of complex public health challenges led by interdependent changes such as climate change, biodiversity loss, and resistance to treatment, it is important to mobilize methods that guide us to generate innovative interventions in a context of uncertainty and unknown. Here, we mobilized the concept-knowledge (CK) design theory to identify innovative, cross-sectoral, and cross-disciplinary research and design programs that address the challenges posed by tick-borne Lyme disease in France, which is of growing importance in the French public health and healthcare systems. Within the CK methodological framework, we developed an iterative approach based on literature analysis, expert interviews, analysis of active French research projects, and work with CK experts to contribute to design “an action plan against Lyme disease.” We produced a CK diagram that highlights innovative concepts that could be addressed in research projects. The outcome is discussed within four areas: (i) effectiveness; (ii) environmental sustainability in prevention actions; (iii) the promotion of constructive involvement of citizens in Lyme challenges; and (iv) the development of care protocols for chronic conditions with an unknown diagnosis. Altogether, our analysis questioned the health targets ranging from population to ecosystem, the citizen involvement, and the patient consideration. This means integrating social and ecological science, as well as the multidisciplinary medical patient journey, from the start. CK theory is a promising framework to assist public health professionals in designing programs for complex yet urgent contexts, where research and data collection are still not sufficient to provide clear guidance.
Ixodes ricinus ticks (Acari: Ixodidae) are the most important vector for Lyme borreliosis in Europe. As climate change might affect their distributions and activities, this study aimed to determine the effects of environmental factors, i.e., meteorological, bioclimatic, and habitat characteristics on host-seeking (questing) activity of I. ricinus nymphs, an important stage in disease transmissions, across diverse climatic types in France over 8 years. Questing activity was observed using a repeated removal sampling with a cloth-dragging technique in 11 sampling sites from 7 tick observatories from 2014 to 2021 at approximately 1-month intervals, involving 631 sampling campaigns. Three phenological patterns were observed, potentially following a climatic gradient. The mixed-effects negative binomial regression revealed that observed nymph counts were driven by different interval-average meteorological variables, including 1-month moving average temperature, previous 3-to-6-month moving average temperature, and 6-month moving average minimum relative humidity. The interaction effects indicated that the phenology in colder climates peaked differently from that of warmer climates. Also, land cover characteristics that support the highest baseline abundance were moderate forest fragmentation with transition borders with agricultural areas. Finally, our model could potentially be used to predict seasonal human-tick exposure risks in France that could contribute to mitigating Lyme borreliosis risk.
BACKGROUND: Scarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019. METHODS: Health indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs. RESULTS: Between 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion). CONCLUSION: The results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.
Acute aortic syndromes (AAS) have been related to significant circadian and seasonal conditions. We used time series analyses to study the impact of meteorological variations on AAS occurrence. We retrospectively assessed 140 patients presenting with AAS over a 6-year period in a French university hospital. Average daily temperature (T) and atmospheric pressure (AP) at the location of the event were collected within the previous 10 days, and their association with AAS investigated with generalized additive models. A decrease in temperature of more than 5?°C within the previous seven days was significantly associated with an increased risk of AAS occurrence (OR equal to 1.86 [1.06; 3.44]). Subgroup analysis revealed that the risk was only significant among normotensive individuals (n?=?41) free from blood pressure lowering medication (OR equal to 2.3 [1.05; 5.37]), but not among hypertensive individuals under blood pressure lowering medication despite a larger patient number (n?=?99). Similarly, only among the subgroup of normotensive individuals a decrease of AP between 2 and 4 kPa within the previous 3 days was associated with an increased risk of AAS (OR equal to 2.93 [1.1; 8.15]) and an increased between 2 and 4 kPa was associated with a decreased risk (OR equal to 0.59 [0.36; 1.00]). Variations of meteorological conditions (temperature and AP) within the previous week seem to have effects on triggering AAS especially among the population free from blood pressure lowering medication.
