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Extreme heat and urban health: how to adapt our cities to climate change

Heat waves and other events accentuated by climate change affect health, especially for the most socially vulnerable people. To counteract these effects, mitigation and adaptation plans for cities are designed based on scientific evidence, the implementation of which belongs to the local political sphere. Two experts in urban health and climate governance analysed these problems and their possible solutions in a briefing organised by SMC Spain.

19/05/2023 - 10:12 CEST

A thermometer reading 46 ºC in Bilbao in the middle of a heat wave in 2022. / EFE | Luis Tejido.

Heat waves such as the one experienced just a few weeks ago on the Iberian Peninsula, which scientific evidence attributes to climate change, are going to become increasingly frequent. These phenomena affect our health, according to studies such as the one recently published by the epidemiologist Manuel Franco, which evaluates the effect of heat waves on the incidence of cardiovascular diseases in adults in Madrid. This study concluded that the effect is worse in vulnerable populations and impoverished neighbourhoods, the researcher explained at a briefing organised by SMC Spain on 10 May.  

Franco and his team, who are dedicated to investigating the social factors that determine the health of populations and their inequalities, have used primary care data from the Heart Healthy Hoods project, funded by the European Research Council (ERC). "We have studied how heat waves from 2015 to 2018 were related to first cases of cardiovascular disease - myocardial infarction, stroke, angina, etc. -. We analysed it by socioeconomic level of the individual and by neighbourhood. We saw that those most at risk were immigrant men - who work more exposed to the heat, outdoors - and that the poorer the neighbourhood, the more cases of cardiovascular disease. Once again, the health effect of any exposure is not the same for everyone, but there is a social gradient of disease and, in this case, in Madrid, which is a particularly unequal city, we have more disease in those places and people with lower socio-economic status. Climate change and heat waves have more and more to do with common illnesses," said Franco.

Housing, poverty and health

The epidemiologist, a researcher at the universities of Alcalá and Johns Hopkins, highlighted another result of his work: "We have found more mortality from extreme temperatures in those who live in neighbourhoods with older housing, and this is important now that everyone is talking about housing, which is a key issue for climate change.

In cities, we have a public space dominated by motorised vehicles and asphalt, which accumulate heat during the day and release it at night

Marta Olazabal

The adaptation of buildings is part of the work carried out by Marta Olazabal, head of the Climate Change Adaptation Research Group at the Basque Centre for Climate Change (BC3) and an expert in urban climate governance. "We need to invest in insulation to improve thermal comfort conditions inside buildings," she said during the briefing. But this is only one of the measures to adapt to climate change in cities. "Before, the focus was on mitigation, on how to reduce emissions by improving transport and energy efficiency in buildings, and now, after the Paris agreement, the emphasis is on adaptation, in which, interestingly, the most important are also the building and mobility sectors," she said. 

"In cities, we have a public space dominated by motorised vehicles and asphalt, which accumulate heat during the day and release it at night, so we have tropical nights. The less shade and the less green infrastructure, the more heat islands we have, and this is one of the areas where it is imperative that action is taken at city level, not just with grass clippings, but with biodiversity, humidity, comfort zones, shading and tree species that require little water," she proposed.

Heat isolates older people

On hot nights, Franco recalled: "In qualitative, participatory studies, the citizens of Barcelona told us that the horror was 25ºC at night and spending several weeks without being able to sleep. This not only affects cardiovascular health, but also mental health; we found people disoriented, dazed, with nostalgia and depressive symptoms," he added. 

"The monstrous example we saw in both Madrid and Barcelona was when older people, over 70 years old, told you that in order to go out for a walk and socialise, they had to go for breakfast with their friends at 8am or for a drink at 10pm, and the rest of the day all they did was survive in their homes as best they could, some had air conditioning and others didn't," Franco continued.

Are climate shelters useful?

Olazabal, who has received a grant from the European Research Council (ERC) for her project IMAGINE Climate Change Adaptation in Urban Areas, is critical of the idea of relying on climate shelters: "They are measures of last resort. The reason why we need climate shelters is because the current building and public space is not able to protect people who, at home, in heat waves, live at over 35 degrees Celsius and that is unbearable, day and night. What we urgently need, because of the climate emergency, is to invest, to address the causes of energy poverty and building conditions in order to tackle the root of the problems," he insisted. 

"I am also very critical of this issue of climate shelters," Franco interjected. It sounds fantastic in a political headline, but what kind of climate shelter is a library that nobody went to before and nobody is going to go to, that doesn't serve either children or the elderly, who are the ones who really suffer from climate change? There is no point in having a place open 16 hours a day during August that nobody is going to use.

From science to local policy

Which Spanish cities are doing the best in the face of climate change? I like Barcelona's climate planning, its governance and how they integrate climate issues into their policies, not only climate, but also mobility and environmental sustainability," Olazabal said. Also Pontevedra, which has been working for years to improve mobility within the city, which has many benefits: emissions, sustainability, quality of life and adaptation to climate change, fewer cars, less asphalt, more green infrastructure, more thermal comfort outside and, therefore, more comfort inside buildings, better quality of life, wellbeing and health.

What science says is that the important thing is that you have a green, comfortable, shady public space within 300 metres that provides shelter, especially for the elderly, who are the ones who get sick and die the most from the heat

Manuel Franco

On the application of this type of measures in municipal politics, Olazabal left a message: "My impression is that green agendas are very much aligned with left-wing politics, and this is a mistake. The interest in well-being, health and environmental quality has to be transversal, democratic, for everyone, independent of political party. We are not managing this well in the municipal agendas".  

Franco, for his part, stressed that, in order to create green policies, it is essential to take into account inequality in access to adaptation measures: "It's no use saying that Madrid is the city with the most trees in Europe if they are concentrated in the Casa de Campo and El Pardo, because what effect does that have on the health of everyone else, who live in a dry asphalt wasteland? What science says is that what is important is that you have a green, comfortable, shady public space within 300 metres that provides shelter, especially for the elderly, who are the ones who get sick and die the most from the heat".

Plans for cities and strategies against gentrification

On existing regulations, Olazabal indicated that "in Europe there are strategic plans and Spain has a national plan. What is the difference between Spain and other European countries? There is more progress in adaptation in those countries that have a state regulation that obliges cities to have adaptation plans at a local level. Currently, the only legislation that has been transposed here applies to emission zones; in climate change adaptation there is no obligation for cities. The expert insisted on the importance of national legislation that obliges cities to design adaptation plans: "Perhaps in the first generation these plans do not have the desired quality, but in the second or third generation these plans are becoming more rigorous, more robust, knowledge is being generated to find out vulnerabilities, evaluate the state of buildings, see how people enjoy public space".  

According to Olazabal, "cities have to invest time and resources in citizen participation processes to see which interventions are best in each context. There are interventions that do not bring the desired benefits; gentrification processes also arise with an impact on the real estate market, rents go up and the most vulnerable people end up marginalised". "We are learning from other European cities, but there are not many experiences in Spain," he said.

Hay mecanismos financieros para para bloquear el incremento de los alquileres, medidas preventivas que tienen que acompañar todas estas intervenciones en las que se mejore el espacio público

Marta Olazabal

Asked about the gentrifying effect of urban green zones, the expert clarified her position: "What should not be criticised is the measure itself, that is, increasing green infrastructure is good, but we have to think about how these strategies are designed. The problem is that they are usually aimed at the same neighbourhoods, the same city centres, and it should be a strategic work of acupuncture of the city to distribute and improve accessibility. Some areas should not be saturated with all these green spaces, playgrounds and leisure areas, while other areas are left with all the motorised infrastructure that we do not want. In addition, there are financial mechanisms to block the increase in rents, preventive measures that have to accompany all these interventions in which public space is improved so that private agents do not use them for their own benefit, but so that everyone benefits".

The school should not be an oven

One group that particularly suffers the ravages of heat waves in Spain is the school community. "School playgrounds have been a square football pitch with two basketball hoops and when there is a heat wave they become unbearable. In addition to introducing green elements, shading and different materials so that they can be enjoyed, there is also something that is being done in some cities, not only promoted by local administrations, but also demanded by family associations, which is the training of the areas around school playgrounds to improve environmental quality and thermal comfort," Olazabal pointed out.

There has been talk of schools as weather shelters, but how can you call a place that is a tarmac a weather shelter?

Manuel Franco

"In the Barcelona Public Health Agency they have worked a lot on the design of the playground: more shade, more wet areas and trees, fountains, not asphalt. There is no national strategy for schools in this respect. There are city councils and associations that have this as a focus of action, not only for climate change, but also for environmental quality," Franco explained.  

"Public schools can take action if they have funding and there is a political decision. There has been talk of schools as climate shelters, but how are you going to call a place that is an asphalt pavement a climate shelter? I think schools can play that role if they are redesigned, and this is not very expensive," the epidemiologist continued.

Intervening to respond to the whole of society

Franco concluded with this reflection: "We cannot live with the idea that those of us who have air conditioning will be saved. That is absurd. What we are seeing is that there are more and more people affected, who are the most vulnerable due to work, age or socio-economic issues, and we have to respond to the social, energy and climate problem. Either we address this reality or what we are doing is saving ourselves, which is a way out that has happened many times in our society. I had the good fortune and the misfortune of living through Katrina in the United States, and those who had a 4x4 were saved; those who did not had one were not saved".

We cannot waste opportunities. We must work to defend neighbourhoods and cities for people

Marta Olazabal

To conclude, Olazabal insisted on the importance of long-term urban interventions: "We have to realise that if they decide to intervene in our street now, they are not going to do it again in 15 or 20 years. When I see a newly asphalted street where they have not included any kind of shading or green infrastructure, I say: 'What are we thinking about?' We are not aware of what is coming and what are the elements that are really going to provide us with quality of life. Any opportunity to intervene in public space is a unique opportunity to improve our social and environmental well-being over the next 20 years. We cannot waste any of these opportunities. We must work to defend neighbourhoods and cities for people.

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