As our earth continues to warm, extreme heat events are becoming more frequent and severe, leading to significant health risks to communities around the globe. Populations such as pregnant and postpartum women, infants, and health workers are some of the groups most heavily impacted.
Exposure to heat stress during pregnancy significantly raises the risk of complications such as pre-eclampsia, stillbirth and preterm birth. While the effects on health workers aren’t as well studied, they can sometimes work in uncomfortably hot conditions that could have impacts such as lack of motivation, impact on quality of care and effects on their physical and mental health.
Heat Action Day, which was held on 2 June, provided an opportunity to highlight the increasing impacts of extreme heat and raise awareness of programmes and actions addressing the climate crisis to try to ‘Beat the Heat.’ For Heat Action Day, we reflected on the HIGH Horizons project and the advancements made over the past 21 months.
HIGH Horizons, managed by Ghent University, has made significant progress in advancing research and innovations which directly address the impacts of heat on health. HIGH Horizons aims to understand the risks of heat, identify methods to monitor impacts as well as find ways to reduce CO2 emissions and develop interventions that protect individuals and communities.
Find out more about our project’s progress to date:
Indicators
HIGH Horizons has made significant progress to identify and select indicators for quantifying and monitoring the global, EU and national-level health impacts of extreme heat among pregnant and postpartum women, newborns and infants. The World Health Organization (WHO) has convened an external expert group to guide the selection process and underlying analysis of data needed. From these consultations, the WHO and other HIGH Horizons consortium members developed a conceptual framework that shows the pathways, factors and impacts of heat on maternal, newborn and child health (MNCH). With the framework we can map existing MNCH indicators to the different components and pathways to determine what is currently already being measured and where there are gaps.
The University of Graz published a scoping review on heat indices used in perinatal and maternal health. In addition, Wits RHI also conducted a systematic review and meta-analysis which updates on previous research on heat indicators for newborns and mothers, this is helping to inform gaps and feed into the future work of HIGH Horizons.
Using historical birth registry data and health facility data, the HIGH Horizons team conducted cross country analyses of heat exposure and preterm births in Greece, Italy, Kenya, Sweden and South Africa to provide further evidence for the impact of heat exposure on pregnancy.
In January 2024, HIGH Horizons held national workshops in Johannesburg, South Africa and Harare, Zimbabwe. Led by our partners Wits RHI and CeSHHAR respectively, we consulted with relevant stakeholders on the feasibility of integrating indicators to monitor the progress and impact of heat on MNCH and discussed how to align with country processes for integrating heat into existing MNCH monitoring efforts.
Early Warning System
HIGH Horizons has developed the first prototype of a personalised Early Warning System (EWS) that delivers heat stress warnings and setting-specific messages to pregnant women, mothers of children under 1 year of age and health workers which will be tested in South Africa, Sweden and Zimbabwe. The prototype, ClimApp-MCH, is developed by Lund University together with TNO, the Netherlands Organisation for Applied Scientific Research, and adapted from ClimApp, a smartphone application that was developed and applied in an earlier EU-funded project.
The team has preliminarily identified thresholds to trigger heat-health risk warnings. The thresholds will be revised based on new data analysis and WHO-organised expert panel opinions.
With support from colleagues at the London School of Hygiene & Tropical Medicine (LSHTM), the team is finalising a qualitative participatory study on message development for the EWS. This study consists of a range of methods in which women, health workers and other members of the community share their experiences of living in extreme heat. One such method is Photovoice with women, a pictorial participatory research method, through which women developed messages that resonated with their experiences and their contexts. See a preview of the ClimApp-MCH prototype below.
Adaptation interventions to reduce heat impacts on health workers
Measurements of heat exposures in the maternity wards of four healthcare facilities in South Africa, Sweden and Zimbabwe, began in the autumn of 2023 and continue under the supervision of the Technical University of Denmark.
The baseline assessment of heat impacts on health workers is led by LSHTM and comprises a multi-pronged mixed methods study. The baseline assessment was fully completed in the hot season in South Africa and Zimbabwe and is currently being conducted in the cold season. Based on the preliminary findings of these assessments, HIGH Horizons is currently co-developing evidence-informed and context-specific climate adaptation interventions in health facilities in South Africa and Zimbabwe. In the meantime, our teams at Wits RHI and CeSHHAR have been working and collaborating with health facilities to maintain relationships and buy-in from stakeholders to support co-designing and implementation of identified interventions.
Mitigation interventions to reduce Health Facility Carbon Emissions
Since January 2023, HIGH Horizons has been measuring carbon emissions across eight health facilities in Kenya, South Africa and Zimbabwe. Led by the Aga Khan Health Services Kenya, carbon emissions were calculated using the Excel-based Carbon Management Tool, developed by the Aga Khan Development Network, which offers a comprehensive methodology for measuring carbon emissions within healthcare organisations.
With support from Burnet Institute, HIGH Horizons developed a modelling tool, CARBOMICA, (CARBOn Mitigation Intervention for healthCare fAcilities), which assists in the strategic allocation of resources to optimise the reduction of carbon emissions at the above health facilities. The team are also applying CARBOMICA to support the identification and selection of mitigation interventions at health facilities in Kenya, South Africa and Zimbabwe. Stakeholders in the implementing countries will be engaged to take joint decisions on the integrated adaptation and mitigation interventions.
Biomarkers of heat impacts on MNCH
The University of Thessaly (UTH) ‘hopped on’ the HIGH Horizons project officially in April 2023. The project is investigating heat-related biomarkers, looking at the effects of heat exposure on adverse health outcomes at birth. The UTH team is a cross-disciplinary group who, since April 2023, have completed the study protocol, related questionnaires and data record forms as well as setting up a biobank and securing ethical approval. They are a welcome addition to the HIGH Horizons team.
Pilot testing for this study began in February 2024. Hospitals from three cities in Greece (Athens, Larissa and Ioannina) have started recruitment. The participation of a hospital in Cyprus is anticipated after receiving ethics approval. The UTH team is currently reviewing the results of the pilot testing to make any needed adjustments; they are also working on finalising the protocols for biomarkers testing.