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
Comments