“After days, weeks, without sleep, exhaustion turned into sadness, frustration and worry for myself and my family.” “I love walking around the city, I have my routines, and the only hours I could do it were very early or at night.” “I even spent the night on the beach to return home at dawn and still not be able to sleep.” These are some of the experiences shared with us by residents of El Raval, Barcelona, after a summer with three officially recognized heat waves. The study of health problems linked to extreme temperatures of the climate crisis is one of the main current concerns of international research centers and agencies and their research staff. And health problems associated with the climate crisis also include mental health disorders.
When we talk about mental health, it is very important to clarify a series of definitions. The WHO already defined Mental Health in 2004 thus: “The state of well-being in which an individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community.” Mental health disorders include highly prevalent, diagnosable and treatable illnesses such as depression, anxiety, and substance use disorders, as well as less prevalent but potentially very serious illnesses such as schizophrenia and bipolar disorder, among others.
As a doctor interested in research and trained in Madrid and Berlin, I was fascinated by chronic diseases on the one hand and psychosomatic disorders on the other. And so in 2002 I arrived at the Johns Hopkins School of Public Health where the first thing I did was walk around all the buildings and departments to understand the complexity of this type of research. And one of my biggest surprises was discovering how big and interesting it was. the department of mental healthone of the ten departments of the school. This last year the global project has begun Connecting Climate Minds with the aim of connecting people around the world to understand and respond to the deep interconnections between climate change and its effects on mental health, including groups in seven regions spanning the globe.
A very interesting aspect of this project, funded by the Wellcome Trust and coordinated by Imperial College London, has been the creation of a Global Research and Action Agenda on Climate Change and Mental Health where research and action complement each other and work hand in hand from a global perspective that also includes the study of the experiences of different affected populations around the world. And this project involves Pamella Collins, current director of the Department of Mental Health at Hopkins, a psychiatrist with 30 years of experience in international and interdisciplinary research in public health and serious mental illness.
At one of the project meetings, we discussed how the richest areas of the planet were experiencing simultaneous demographic and social processes such as inequality, ageing and the high proportion of people living alone. These processes influence the distribution, onset and treatment of mental health disorders in their inhabitants. And we discussed a concept that is used in environmental psychology in relation to the climate crisis and that I was not aware of: solastalgiaIt refers to the pain, the feeling of isolation caused by the lack of recognition, of “solace”, of our own home, our own territory. And I found it very interesting because this process appeared both in the El Raval project on heat waves and health, and in other studies on gentrification, touristification and urban health.
And what do the studies say?
A systematic review on the association between high temperatures and heat waves and mental health published in the magazine Public health in 2018 found 15 studies that in total showed that during heat waves the risk of suicide increased by 18%. Heat also increased hospital visits and admissions to psychiatric hospitals. Another systematic review and meta-analysis on climatic factors and mental disorders has been published in 2023 in the prestigious magazine Science of the Total EnvironmentThe authors included 88 studies in the joint analysis of data from previous studies and showed that heat waves and extremely high temperatures were associated with a 5% and 18% increased risk of mental illnesses such as schizophrenia, mood disorders, and neurotic disorders.
With all this scientific evidence I return to our neighborhoods and our neighbors. In a square in the central neighborhood of Tetuán in Madrid, some neighbors told us for the program The Green Beetle from RTVE called “The culture of heat”: “In summer there is no good time to go to the park to play, it is too hot in that park with no shade, no plants and no water source.” When you think about it twice, it really is an urban planning that punishes citizens more than it cares.
The heat in our cities and our health, including our mental health, is an area of research that is constantly developing. The magazine The Lancet published in 2021 a special series on heat and health in which they highlighted the importance of investigating the special situation of vulnerability with respect to the mental health of people with pre-existing illnesses who live in cities. Something that the participants from El Raval already told us about. And within this series, the different strategies of adaptation and health promotion were analyzed where green spaces in cities they play a very prominent role. In fact, scientific literature shows increasingly clear evidence between exposure to natural urban spaces, the reduction of urban heatthe decreased stress levels and the incidence of mental health disorders.
There are many recent advances in research, and they show how much remains to be understood. It is interesting to see how we are advancing both in science and in its translation into action, and into technical and political decisions.
As always in public health, scientific knowledge alone will not be enough. The media will have to improve the messages they convey on complex issues such as the climate crisis and mental health disorders. And citizens, from local, national and transnational organizations, will continue to demand that scientific knowledge be translated into actions that improve our health and well-being. The connection between environmental health and human health is becoming more evident every day, and we urgently need to protect both. In this case, protecting ourselves from the heat to protect our mental health.
Health depends on neighborhoods This section explains in a simple and friendly tone the concepts and advances in research in Urban Health, an area of Public Health that is necessarily interdisciplinary. Research in Urban Health aims to improve our cities in order to improve the health of the millions of people who live in the complex and unequal cities that today characterize life on our planet.
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