In the next fifty years, climate change will affect everything, including the environmental epidemiology field. The Czech Republic should not miss the boat, says environmental epidemiologist Tomáš Janoš.

How did you become interested in climate change in your scientific work?

I was interested in climate change and the impacts of extreme temperatures on human health for most of my doctorate but I found space for this topic only at the very end. I noticed that in southern European countries, research on the impact of temperature on health is advancing, while Central and Eastern Europe is lagging. So, I thought exploring whether high and low temperatures have similar effects here would be interesting. At that time, I contacted colleagues from the Institute for Global Health in Barcelona, who have extensive experience with research on this topic. Then, I went to Spain with Czech data to learn how to process and analyze them. The topic intrigued me during my three months there, so I decided to write my own project and focus more on this direction.

In October 2023, a study on the relationship between mortality rates and extreme temperatures was published based on your work. Are you still dealing with this topic?

Yes, in connection with extreme temperatures, I also started to examine ambulance dispatches in the Czech Republic, which have not yet been explored on the national level in Europe. Such research examines different socio-economic groups and locations, which is important because temperatures vary from place to place. We have written a scientific article on this topic, which we hope to publish by the end of the year. Interestingly, not just elderly people, but also small children, teenagers, and young adults are at high risk. I also have a project studying the impact of short-term temperature fluctuations in combination with polluted air, such as smog, on the number of work accidents, especially among outdoor workers. I will be doing research for another two years, again with people from Barcelona, who are trying to create a European-wide database of work accidents, which already includes the Czech Republic, among others.

Is it difficult to get data for this type of research?

Data on deaths is obtained through excellent cooperation with the Institute of Health Information and Statistics of the Czech Republic. On the other hand, data on ambulance dispatches are much more difficult to obtain because of their sensitivity. We get them for certain territorial units, ambulance dispatches for example for districts, which is a terribly large territorial unit. If we went lower, we would get to the numbers of one, two dispatches a day, from which it would already be possible to deduce who it was specifically on a smaller territory. Also, not in all countries have data on ambulance dispatches collected and a database is made. Here, the information is again collected by the Institute of Health Information and Statistics of the Czech Republic from insurance companies, so a summary can be made. However, not in all countries does it work so comprehensively.

So you work more with a summary of data, how do you find out that the dispatches were related to the temperature?

In general, attributing something to the weather is extremely difficult, something like that is not often even part of the diagnosis. Then there are epidemiological models that calculate with daily temperature and dispatches, and when they see some fluctuation that cannot be explained by anything else, they attribute it to the temperature. So we just get specific numbers and we do the calculations through models.

As for extreme temperatures in cities in general, can the aforementioned health risks be systematically prevented?

Definitely. Mortality studies for example show that in greener cities it is generally cooler by one to two degrees, which can save several lives a year. Furthermore, a network of fountains can be built, where a person can cool down. In Barcelona, for example, they have so-called climate refuges. It is a network of places where people from can hide in case of a heat wave. It’s nothing special, they are usually air-conditioned public places like supermarkets, libraries or museums, for which a map is created. Thanks to it, people find out where they can go in case of need and where they will be accepted. Therefore, it is important to inform the public and communicate the existence of refuges well, especially to populations which are at a higher risk, such as the elderly, and lower socioeconomic groups, for example by distributing leaflets. In Spain, they also created an early warning system, which several days in advance reports how high is the probability that due to high temperatures a certain number of people will die. Although it sounds morbid, it allows public institutions, such as hospitals and rescue services, to prepare for such a risk.

As for communication with the public, do you cooperate with other organizations or other public actors?

As an expert, I cooperate externally for example with Klimatická koalice, which is a platform of Czech non-profit organizations dealing with climate protection. One of their recent activities is the education of medical students in the field of climate change and how it can affect human health, because it is completely missing in the curriculum. The idea is that older people, for whom climate change poses the highest risk in terms of health, but at the same time tend to underestimate it the most, could draw information from doctors, who are a trustworthy authority for them.

And what does such cooperation bring to you as a scientist?

From my point of view as a scientist, it is often difficult to get the information to the right place where it will have an effect. Organizations like Klimatická koalice, Fakta o klimatu or the Institute for Czech Policy EUROPEUM help me a lot in this. When we published the study, thanks to the fact that I sent the information about it to everyone I knew would be interested in it, several public or media outputs were created. I probably wouldn’t be able to get it into awareness like this myself.

So do you have to initiate the first dissemination of information yourself?

Yes, we as scientists are not pushed into popularizing science much. It is usually more our own interest and it is not part of our performance. Communication is important and should be taken care of. In science, we often pat ourselves on the back, what a great article we published, but when you come to ordinary people outside the scientific sphere, they are interested in information, not the impact of the journal. Of course, at the beginning there must be a quality scientific study, but the actual effect should not be forgotten. Another thing is that it is difficult to communicate a complex problem well and convey it in a few sentences. To do it well, you need to educate yourself. But in practice, there is no time to do either.

What is it like to communicate the topic of climate change from the perspective of science?

There is definitely interest in the climate among the public, but when you say climate, it acts like a red rag. It evokes in people things that they will not be able to do or something for which others will condemn them. Moreover, I am afraid that over time it will rather worsen. At the same time, I think that people are interested in climate protection and the environment, we are just at it again, that it is necessary to communicate it all better.

How does the scientific community react to the topic of climate change? Is there interest there too?

I feel that the interest is primarily abroad so far. The impacts of it probably do not affect the Czech Republic so much yet, but it certainly awaits us. In the next fifty years, climate change will affect everything, including environmental epidemiology. I am dealing with a very limited section of the whole issue, but there are many more aspects. Through new invasive species, it will be necessary to change the way pesticides are used, there will be an increase in the incidence of infectious diseases, floods, cloudbursts, the change will affect air research, food safety or migration. We should not close our eyes to such a complex and difficult to explain problem as climate change. Whole research groups are devoted to it at foreign institutes, so the Czech Republic should not miss the boat.