There is a house in suburban Melbourne, it is probably 1973. In the front yard there is a large lilly pilly tree, at the top of the lilly pilly tree is a young boy. He is looking out over red heat shimmering tiled rooftops towards the bay. IT has been hot for days. He is keeping watch for the reported cool change. If only it would come soon, his parents in the darkened house below might stop arguing about the heat, and everything else, and everything will return to normal.

This week I spent in the great state of Western Australia, at the invitation of the National Climate Change Adaptation Framework’s Vulnerable Communities network, speaking at a forum on the human impacts of heatwave. Heatwave is a fascinating topic, it is our biggest killer in emergency management, much more than bushfire or floods, but  gets, until recently, little attention. Part of this, I think is cultural. Its Australia, right, summer, sun, sand, surf etc etc , so we expect it to be hot, sometimes its real hot. It is ingrained in our psyche.

Our Bureau of Meteorology defines heatwaves as three days of unusually high daytime and night time. The increased low overnight is one of the crucial parts of the definition, as it means that people don’t get a physiological respite overnight. This can start to put stress on the body. The three day threshold is also significant and when serious conditions can start to develop.

IN Chicago in 1995 a 6 day heatwave saw nearly 500 people die, over 1000 people admitted to hospital, and power failures throughout the city. In France in 2003, eight days of temperatures greater than 40C, saw  an estimated 15,000 people die. Occurring during the holiday period, France  generally shuts down, so formal and informal supports were not available. The 5 day Victorian Heatwave in January 2009 (just preceding the Black Saturday bushfires, saw power outages, and 374 people died. In 2015, a widespread heatwave, with record temperatures occurred with the failure of premonsoonal showers increasing heat. Over 2500 people died. I’ve heard the comment “Well, its not really that much of an issue because they were old/sick, so they probably were going to die anyway” But Eric Klinenberg, in his compelling  book Heatwave: A social autopsy of a disaster says, maybe but they weren’t going to die that week necessarily, and the heat hastens people to an earlier death.

Klinenberg recognises that it is not just a meteorological phenomena , it is a sociological condition he calls it a silent and invisible killer  of silent and invisible people. A biological representation of social faultlines. This is because those that die are generally more at risk, and don’t have the capacity to deal with or reduce the impacts. Mitigation measures (insulation, air conditioning), are expensive to install, and run, and as we heard from a brave woman prepared to tell her story of extreme poverty, when you are on the margins, your housing choices are poor (or non existent) and you do not have the finances to keep your electricity connected.

In extreme heatwaves  death can occur through heatstroke for anyone. Heat can also have an impact on those more at risk, babies, who are not able to regulate temperatures that well, older people who have a decreased thirst response, as well as a poorer sweat response. Medications and medical conditions can also exacerbate the impacts of heat.

There are both positive and negative social, with more people looking out for elderly and at risk neighbours, as a result of public awareness campaigns. Equally we see street life patterns change, as people do not go out during the heat of the day. Safe streets are active streets. Our guys in Adelaide talk about elderly clients considering moving to a cooler area as they can no longer cope with the extended heatwaves and can’t afford to upgrade their existing houses to better prepare for heatwaves. The increased risk to people living away from family members or friends – particularly in places with a high percentage of family members moving away for work, people who would not traditionally be vulnerable are becoming so as they age as they do not have family who can visit

The failure of technology and utilities can have a cascading effect, which i’ve spoken about more recently. Direct effect is loss of power, which means people’s means of mitigation is lost, and this can be critical for some. Also may mean that access is limited, lifts, doors etc. Loss of transport also exposes people to heat. Power black outs in SA – increased power blackouts have led to hugely increased distress and fear for vulnerable people around how they will cope without power.

Cities create urban heat islands, and while there are better places to be in cities during heatwaves, ( near the coast/rivers, or in leafy green suburbs), places without shade and greenery are likely to have temperatures up to 7C more than other areas. Urban planning encouraging medium density infill also increases the radiant heat through concreting previously open space. One thing we recommend is that people ‘go to a public area with air-conditioning such as a library of supermarket if your home air-conditioning is not adequate’ – this works for people living in the transport and facility resource rich inner city, but what about the sprawling suburbs  designed without  airconditioned public  facilities, so reliance is upon private shopping centres- which are designed to be driven to, or use poor public transport services (that is if the public transport is working, which often it is not when it is hot) . and the modus operandi is not to have people hanging around (unless they are spending money.

And then there’s things we don’t know… the longer term impacts are not studied. The cool change comes, and everything goes back to “normal” and there is no visible impact, other than maybe the morgue, the funeral home or cemetery being more busy than usual.

Preparedness is a key activity here, and needs to be integrated with other summer disaster preparedness activities. WE need to be talking about the issue, early, not when its hot or about to be hot, and convey it’s seriousness. Our South Australian team actively encourages clients of our Telecross redi service to undertake preparedness activities, and build personal support networks. The service will call people during declared heatwaves. Depending on a how people are going,  there may be follow up calls ( ie if a client indicates they are not well, not coping). Triggers are in place if the client cannot be reached, or indicates that they are unwell. These may be primary carer, home support agency, or finally Ambulance at last resort

And it’s a lifesaver. One elderly gentleman, who lived on his own for 22 years, was feeling the heat, so he did what he usually does in a heatwave, filled a bath and going into. Unfortunately the bath was somewhat slippery from soap, and he couldn’t haul himself out. While he was in the bath, the phone was ringing, but he couldn’t answer it. He ended up eventually getting himself head first out and, onto the floor. He was so exhausted that he lay there for sometime. He heard a knock on the door, and it was our volunteers, who had been sent around to check on him, when he didn’t answer the phone. An ambulance was called, and he was taken to hospital and his condition stabilised. He was told he was lucky to be here.

There’s been some good work done, like VCOSS’s report Feeling the Heat: Heatwaves and Social Vulnerability in Victoria (2013) and the NCCARF Policy Brief Managing Heatwave under climate change.At least we at starting to have the conversations like what we were on Wednesday, although it was a bit disappointing that there was nobody from the emergency services there there. It is an emergency, not a health issue, and needs to be treated that way. And there were some fabulously committed people there, which is truly heartening.

Thanks to Julia Goodall and Michael Arman for their thoughts on heatwave.