Background Many countries have developed heat-health watch and warning systems (HHWWS) or early-warning systems in an attempt to mitigate the health consequences of extreme heat events. HHWWS usually focus on the four hottest months of the year and impose the same threshold over these months. However, according to climate projections, hot season is expected to extend and/or shift. Some studies demonstrated that health impacts of heat waves are more severe when the human body is not acclimatized to heat. In order to adapt those systems to potential heat waves occurring outside the hottest months of the season, this study proposes specific health-based monthly heat indicators and thresholds over an extended season from April to October in the northern hemisphere.
Methods The proposed approach, an extension of the HHWWS methodology currently adopted in the province of Quebec, Canada, was developed in the Greater Montreal area (current population 4.3 million) based on historical health and meteorological data over the years. This approach consists of determining excess mortality episodes and then choosing indicators and thresholds that may involve excess mortality.
Results We obtain thresholds for the maximum and minimum temperature couple (in °C) that range from (23 and 12, respectively) in April, to (32 and 21) in July and back to (25 and 13) in October. The resulting HHWWS is flexible, with health-related thresholds taking into account the seasonality as well as the monthly variability of temperatures in the threshold definition process for an extended summer season.
Conclusions This adaptive system has the potential to prevent, by data-driven health alerts, heat-related mortality outside the typical July-August months of heat waves. The proposed methodology is general and can be applied or adapted to other regions and situations.