'Do Air Hygiene-related Forecasting and Early Warning Systems Reach Vulnerable Target Groups?'

Introduction: For more than a decade air related forecasting and early warning systems have been established in Germany. Their aim is to inform the general population and vulnerable groups (e.g. elderly, one-person household) on the current and predicted situation to prevent health damages by better individual adaptation. Recently these systems were expanded by the heat health warning system. From environmental health viewpoint it is of utmost interest to know if, when and how the information reaches the people. Important is also, whether the information is sufficient and understandable. For effective adaptation people need adequate information. Due to the fact that information about the reception of the air hygiene-related information systems already existing is missing, the Federal German Ministry for the Environment, Nature Conservation, Building and Nuclear Safety (BMUB) and the Federal Environment Agency (UBA) launched in 2012 a research investigation to evaluate selected forecasting and early warning systems at the national scale as contribution to health-related aspects of the National Adaptation Strategy on Climate Change. Following four systems are under investigation: (1) heat health warnings, because about 7,000 people died during the summer heat wave 2003; (2) UV index, because increased solar radiation could raise the risk for skin cancer; (3) pollen forecasting, because an increase of allergic reaction is associated with linger and shifted in time occurring biological aero allergens; and (4) tropospheric ozone forecasting, because more frequent summer high pressure weather conditions could favor ground-level ozone formation, which could cause breathing and pulmonary problems.

Methodology: How do we approach vulnerable population groups, which suffer from environmental burden, for example extreme air pollution events, and how can we improve their individual resilience as well as their adaptation capacity? Do we reach these groups of people at all? To answer these questions, we recently started a two years research investigation (2012-2014) to evaluate existing air hygienic and climate change associated information systems (for heat, solar UV radiation, pollen and tropospheric ozone) in Germany. Hence, a first German-wide representative telephone survey among 4,000 residents has been carried out during late summer 2013 in cooperation with local physicians. The project results should give guidance to improve the public's understanding of published information and to modify current risk communication concepts and strategies between health and environment administrations, to physicians and health care systems, to day care centres and foster homes, as well as to elderly singles.

First results: The study investigation has started with a baseline search on established information channels, multipliers and applied measures and scientific studies, followed by a first unrepresentative test phase among members of local health authorities which tested and estimated the usefulness of air hygiene-related warning systems. Great or some benefit is expected by the majority of asked representatives (75 % heat health warnings, 67 % solar UV radiation index, 44 % pollen forecasting, 56 % tropospheric ozone forecasting). The study was supported by both National and Regional Associations of Statutory Health Physicians. The main investigation was carried out as a national representative survey (computer assisted telephone interviews – CATI) of the general German population (app. 30 minute interviews of up to 4,000 German residents, aged 14 years and older; about 250 per Federal State), added by an additional questionnaire for vulnerable subgroups (n=400), each for heat, UV, pollen and ozone. The questionnaires used in this survey were pretested to assure understanding. First selected tentative results show no geographical gradient in Germany, e.g. between North and South or West and East. As most important environmental health information sources were identified: family/friends 88%, physician 88%, newspaper/journal 84%, health insurance 80% and TV 80%. Peoples' impression on the extent which of the four investigated air hygiene-related factors suffers most is quite diverse: UV radiation 46%, heat 41%, ozone 28% and pollen 21%. But the knowledge about the different forecasting and warning systems shows a different order: pollen 87%, heat 71%, ozone 54%, and UV index 29%. In general, deficits were identified, particularly concerning risk communication, acknowledging one main problem for vulnerable groups: despite the knowledge of expected health impacts during extreme weather events, e.g. heat, an adapted personal behavior is often ignored and missing. Therefore, the study wants further to indentify causal links between air quality information, forecasting, early warnings and the respective risk perception of people, particularly vulnerable groups. The willingness to adapt changes of the personal behavior due to the perceived risk depends on predisposing factors (such as individual knowledge, attitudes, beliefs and values before intervention that affect willingness to change), enabling factors (like individual or community information and help), and reinforcing factors (positive or negative effects or social support that encourage continuing the behavior).

Conclusion: To prevent public health damages and to strengthen the individual health literacy of the population it seems to be essential to adapt a strategy to cope with (extreme) air hygiene-related events and changes of human bioclimate.

Acknowledgement: As part of the German Environment Research Programme the study is financially granted by the Ministry for the Environment, Nature Conservation and Nuclear Safety (UFOPLAN2012; FKZ 371262207).

References: Sperk C. and Muecke H.-G., 2009 Klimawandel und Gesundheit: Informations- und Überwachungssysteme in Deutschland. ‚Umwelt & Gesundheit‘, 03/2009, ISSN 1862-4340. Hrsg. Umweltbundesamt, Dessau-Roßlau, Germany.