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Malaysia is in the grip of a heatwave and experts are warning a strong El Niño could soon follow. Are we ready for what’s coming? On this episode of #ConsiderThis Melisa Idris speaks with Professor Dr Victor Hoe, Professor of Occupational and Public Health and Head of the Department of Social and Preventive Medicine at Universiti Malaya’s Faculty of Medicine.
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00:10Hi, welcome back to Consider This. I'm Melissa Idris. Now we've just heard that beyond this
00:16current heat wave, experts are now warning of a very strong El Nino phenomenon developing as
00:24early as June. So what does all of this mean for our health? The rising temperatures and
00:29the prolonged heat? Are we ready for what's coming, especially from a health perspective,
00:36a public health perspective? In joining me on the show to discuss this further, I have
00:40Professor Dr. Victor Ho, who is a Professor of Occupational and Public Health at University
00:44of Malaya. He is the head of the Department of Social and Preventive Medicine at UM's Faculty
00:50of Medicine. Dr. Victor, thank you so much for being on the show with me today. Can we start
00:55with basics first? The current heat wave that we're experiencing and any future extreme
01:01heat phenomenon, is that a public health issue? Why do you think that rising temperatures fundamentally
01:10should be looked through a public health lens? All right, firstly, thank you Melissa for inviting
01:15me to come to this show. I'm glad to be back again. All right, the main thing is that rising
01:20temperatures are public health issues because heat affects more than just comfort. All right,
01:25it can directly cause heat exhaustion and heat stroke. But it also worsens heart diseases,
01:30kidney stress, respiratory symptoms, diabetes, mental health problems, and even the risk of
01:36accident and injury. In other words, heat illness, hospital burden, loss of productivity,
01:43and preventable death are the things that it won't be affected. This is why heat should
01:48be treated as a health system and policy issue, not just a weather issue.
01:54Okay. All right. So we also not just have heat, but in Malaysia sometimes there's the issue
02:00of high humidity. And I do wonder how that affects our physiology. What actually happens to the human
02:08body when we are exposed to prolonged extreme heat and coupled that with high humidity? I'm wondering,
02:17is it enough for us to just, I guess, stay hydrated and drink lots of water?
02:21Oh, that's a very good question. I think that's a very important question in the context of Malaysia.
02:26Let me start by basically, have some basic explanation on what actually happened.
02:30The normal body cools itself mainly through sweating and evaporation. So the problem in high humidity is
02:36that sweat does not evaporate efficiently because sweat need to evaporate based on the differences in the
02:43humidity. So if it's a dry, if you're in a dry, high heat condition, if you're sweating, you actually
02:52reduce your heat much quicker than when you are in a high heat, high humidity situation like in
02:59Malaysia. So the body cannot release the heat as well. This means that core temperature can rise
03:04and even if someone is sweating a lot, the heart has to work harder, blood is redirected to the skin
03:10and the
03:11kidney can come under stress. So no, this is not about drinking water alone. Hydration matters, but so do
03:19shake, rest, reduce assertion, cooling, acclimatization, clothing, medication and early recognition of the
03:27symptom is important in the context. So in prolonged heat, the body move from a spectrum in a context that
03:34it may begin for heavy sweating, cramps, headache, fatigue, dizziness, irritability and reduced
03:41concentration. It can progress to heat exhaustion, but the person becomes weak, nauseated, dehydrated, and then
03:48it becomes a medical emergency in the context of heat stroke, where the body can no longer regulate
03:53temperature properly and the brain is affected. At this stage, you may see confusion, collapse,
03:58loss of consciousness and coma. So in the context of Malaysia, we must consider both heat and humidity
04:06and just sweating alone may not be adequate because the sweat does not evaporate and the
04:14evaporation is where you get a release of heat to the atmosphere or to the environment.
04:21So you mentioned heat exhaustion can eventually lead to heat stroke. Prof, when you said the core
04:31temperature of the body will rise, is there a maximum for the human body that can withstand?
04:39I mean, how does that work? What do we need to watch out for?
04:43Prof, basically it's difficult for us to measure core temperature to start with because core temperature,
04:49you need to measure from the inside the body itself. But from a perspective of what we call
04:56individual, you measure the surface temperature. Surface temperature is 37 more than 37 degrees,
05:0137 or 37.8 or 38 degrees, then you would like to be worried. That means the temperature cannot
05:07come down from 38. That means you're having some sort of feverish feeling. But the core temperature,
05:13you measure from the inside of the body. So the core temperature can rise up to 40 degrees,
05:17which is basically, that would be very dangerous. But at 38, you still can actually be controlled.
05:23Basically, we are actually at 37, 38 because we can actually control the temperature. But if it
05:29increases more than that, then it is very, very dangerous. So the core temperature is where your
05:33body, inside your body, so you measure with an internal thermometer to measure the core temperature.
05:40So who would be most vulnerable to when it comes to heat related health risks? I'm wondering, I mean,
05:48if you look at it, not just from your demographics, but from populations, our urban populations, for instance,
05:56more at risk for heat related health risks? Okay, so let us start with the basic. The most basic is
06:06that,
06:06of course, the older people, the young people, and the pregnant woman are the ones affected.
06:15All right, those are very, very general. Then we come to those people with chronic diseases,
06:19like cardiovascular disease, respiratory disease, kidney disease, mental health conditions are also
06:24affected. And those are on medication that affects sweating, blood pressure, hydration, and alertness
06:31also can be affected. Of course, you talk about whether urban is more is worse than rural. Well,
06:39it depends. But there's one condition in the urban setting, which is called urban heat island effect,
06:46where the actually the urban area is much more hotter compared to the rural area. And there's also the issue
06:53of the because we are especially in Klang Valley is even worse because we are in a valley where the
06:59heat
07:00actually, actually concentrate in the context, it doesn't it doesn't it doesn't get what got that
07:05circulated in the context is also a problem. But let us not forget, not just not just people, but workers,
07:13workers working outdoor, like our friend, our delivery riders, you know, we always call on them when we
07:19need them. But do we think of what happened when this heat increase? And when they come late, we are
07:24we are not happy. But farmers, construction workers, traffic personnel, migrant workers, people in low
07:31quality housing, we ask some of us are to leave think that because we are staying in in a in
07:38a in a
07:38big house, we are not much affected. But those in in PPRT in in low quality low housing where their
07:47house
07:47is quite small and the ventilation is not that good. And if you look at compared to what we have
07:52and what what what some people have, their roof also is very low. So so the ceiling is very low.
07:58So
07:58those also can affect the whole people are vulnerable. So it's not it's not just individual, but also from a
08:05social economic, from a social determinants. That's why the social determinants of health is important.
08:10These are people that are much more affected than many of us.
08:16Thank you, Dr Victor for pointing that out. I think it's so important to think about
08:22the socio economic factors that affect a person's ability to cope with the rising temperatures with
08:29extreme heat. Does Malaysia have anything that addresses that? Do we have a formal heat health
08:37action plan in place? Is there anything within our frameworks that will allow us to prepare for
08:42rising temperatures? Okay, one thing is Malaysia does not have a single standalone heat visible
08:48national heat action plan. But basically we have comprehensive but multi-sectorial framework.
08:55The first one is at the national level of national climate change policy. All right, so climate,
09:00we basically we're talking about bigger picture climate change serve as an umbrella framework. It
09:04is specifically integrated climate adaptation, risk-based planning, whole government coordination,
09:10including strengthening the institutional capacity for resilience across sector. Then we have what we call
09:16from the Ministry of Health, where they have a structured heat health risk management plan, which
09:21define a level for response to show surveillance for heat related illness operation plan across national and
09:28state and district level. And so I get the protection guidance for the vulnerable population.
09:33And the third, we have it from the Department of Occupational Safety and Health, which is the guideline for heat
09:39stress management at workplace. This is important in the context that you mentioned about humidity just now.
09:47All right, to measure humidity, the Department of Occupational Safety and Health have actually asked people to use the WBGT,
09:58temperature. And basically, measure both dry heat and wet heat. And that actually provides you with a much more
10:07global, much more standardized measure of what we call how hot is the situation. And this WBGT is not just
10:14used in Malaysia,
10:15not just used by workers do you know that in in in in uh fifa fifa world cup or those
10:23people they
10:23also use wbt as a measure whether you can play football or not you know how long you can play
10:29football how long rest you need to do so wbt is a very very interesting in a very important uh
10:36element of course in dodge also they talk about hierarchy of control measure and they talk about
10:42what is what is the responsibility of the workplace the workers you know how to reduce heat and how to
10:48how to actually work around that and of course as an occupational health physician i am very
10:54interested in ensuring workers are safe and of course there's many many methods you can do to
10:59actually still cook still in still have good productivity but have reduced risk i think
11:06there's many examples from many countries that we can actually look at so so in my um previous in the
11:11interview in the previous segment with a climatologist we talked about how malaysia may not
11:17take heat uh waves or rising temperatures as seriously as we do other phenomenons like floods
11:23and storms and and the like so what would you like uh policy makers to prioritize dr victor
11:31what would you like to see malaysia take seriously about heat um as a public health issue and also you
11:39know speaking to the public as we were preparing for extreme heat how do we approach this um prolonged
11:47hot periods um what would you like to advise our audience tonight i think i think the main thing about
11:53heat is that heat is a very important component in public health because if you get hot but you don't
12:02think that you don't think that you get exhaustion because because you are you are used to hot used to
12:08the used to the heat in that context you think you can react but sometimes it's so it's a silent
12:13thing
12:13that you may not be able to control it so what we need is that we need a clear inter
12:19integrated trigger
12:21level of alert to actually tell the people that when there is heat you need to do you need to
12:28you need to
12:29you need to action that you need to take so it cannot be a national
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