Written by: Dr. Michelle Deguara, Resident Specialist in Public Health Medicine
Rising temperatures are becoming an increasingly urgent public health issue in Malta and across Southern Europe. As climate change intensifies the duration, frequency, and severity of heatwaves, the health risks associated with them are becoming an urgent concern for everyone, especially for vulnerable population. In Malta, where prolonged summer heat is common, managing exposure and preventing heat-related illness is now a critical public health priority.
In recent years, heat has emerged as the deadliest weather-related hazard in Europe, surpassing floods, storms, and cold events. In summer of 2022 alone, over 61,000 excess deaths were attributed to heat across Europe. Heatwaves can rapidly impact large populations, triggering public health emergencies, excess deaths, and economic disruption.
Ageing populations and the growing burden of non-communicable diseases heighten the susceptibility of the population to the effects of extreme heat and prolonged exposure to hot weather. Urbanisation with poor infrastructure, limited greenspace, and heat-retaining materials continue to worsen the exposure to heat.
Despite these risks, awareness among health workers and the public remains insufficient. Health professionals must adapt their guidance, planning, and interventions to address rising heat exposure and prepare for surges in admissions during heatwaves.
“In recent years, heat has emerged as the deadliest weather-related hazard in Europe, surpassing floods, storms, and cold events”
In Malta, the Beat the Heat campaign by the Health Promotion and Disease Prevention Directorate offers practical and evidence-based strategies to safeguard vulnerable groups while providing clear guidance to both the public and healthcare professionals through a range of materials, resources, and training initiatives.
How to recognise heat related illness: From mild to life-threatening
The human body relies on several physiological mechanisms to maintain a stable internal temperature, including sweating and increased blood flow to the skin. But under extreme heat or prolonged exposure to high temperatures, especially when humidity is high or when hydration is inadequate, these systems can become overwhelmed.
This can lead to a spectrum of heat-related conditions which also extend to mental health strain and exacerbations of already existing physical and mental health conditions. Understanding the progression of heat-related illness is critical in addressing them.
- Dehydration: Marked by dry mouth, dark urine, fatigue, and dizziness.
- Heat Rash: Skin irritation from excessive sweating; often affects neck, chest, and skin folds.
- Heat Syncope: Fainting due to pooling of blood in the lower body.
- Heat Cramps: Painful muscle spasms, often the first sign of heat stress.
- Heat Exhaustion: Characterised by heavy sweating, weakness, nausea, and a fast pulse. If untreated, it can progress to heat stroke
- Heat Stroke: A medical emergency. Symptoms include confusion, fainting, slurred speech, very high body temperature (≥40°C), and either heavy sweating or dry skin. Heat stroke can be fatal. Immediate action is essential: call 112 and begin cooling measures.
Who is most at risk?
The beat the heat campaign emphasises targeted prevention for high-risk groups:
- Older adults
- Infants and young children
- Pregnant persons
- People suffering from chronic conditions such as heart disease, kidney disease, diabetes and lung conditions
- Those taking specific medications (e.g., diuretics, antihypertensives, antipsychotics)
- Outdoor workers
Therefore, caregivers, relatives, or friends of individuals vulnerable to heat-related illnesses should remain especially vigilant during periods of extreme heat and maintain regular communication, particularly when temperatures reach or exceed 40°C.
How to stay safe during heatwaves?
Hydration and environmental control are essential for heat health.
- Drink 2–3 litres of water per day
- Avoid going out between 11a.m. and 4p.m.
- Avoid alcohol, caffeine, and sugary drinks
- Prepare no-cook hydrating meals (e.g. salads) and limit use of ovens and stoves
- Use air conditioning when available; fans may help, but not above 35°C
- Schedule physical activity during cooler parts of the day
- Wear light, breathable clothing
- When going out apply SPF 30+ (or more) sunscreen, wear a hat and sunglasses
- Keep children, pets, and older adults out of parked cars
- If you or someone you know shows signs of heat-related illness, contact the 24/7 Telemedicine Client Support Centre at 21 231 231, or 112 in an emergency.
The effects of climate change on health are no longer hypothetical they are a reality and visible in emergency room visits, mortality data, and shifting disease patterns. Public health professionals have a duty to advocate for system-level changes that protect both vulnerable people and the public as Malta’s climate becomes more extreme. By recognising the signs of heat-related illness and taking action to protect ourselves and others, we can save lives.
Stay cool, hydrated, and informed.
Learn more on: https://hpdp.gov.mt/beattheheat
References
Ballester, J., Quijal-Zamorano, M., Méndez Turrubiates, R. F., Pegenaute, F., Herrmann, F. R., Robine, J. M., Basagaña, X., Tonne, C., Antó, J. M., & Achebak, H. (2023). Heat-related mortality in Europe during the summer of 2022. Nature Medicine, 29(7), 1857–1866. https://doi.org/10.1038/s41591-023-02419-z
European Environment Agency. (2024, November 13). The impacts of heat on health: Surveillance and preparedness in Europe. Climate-ADAPT. https://climate-adapt.eea.europa.eu/en/metadata/publications/heat-related-mortality-in-europe-during-summer-2022
Gallo, E., Quijal-Zamorano, M., Méndez Turrubiates, R. F., et al. (2024). Heat-related mortality in Europe during 2023 and the role of adaptation in protecting health. Nature Medicine, 30(11), 3101–3105. https://doi.org/10.1038/s41591-024-03186-1
World Health Organization. (2024, May 28). Heat and health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health
Beat the Heat. (2024). Protect yourself from extreme heat. Government of Malta. https://beattheheat.gov.mt
