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Flooding and the public's health: looking beyond the short-term

Posted by: and , Posted on: - Categories: Climate change, Health Protection, Protecting the country's health

In the past month, windstorms and flooding have been knocking at our doors more frequently than we would like. Like an unwelcome guest, severe weather brings with it many problems and often ones that are not always easily visible.  It affects all of us in many different ways; from those experiencing flooding in their homes to those affected by working or travelling through flooded neighbourhoods. Strong winter storms and rain have the potential for serious disruption.  Here is a brief reminder of what has happened in the last month:

  • At the beginning of December, we saw one of the most serious coastal flood events for over 60 years, with 71 Severe Flood Warnings being issued, thousands evacuated and flooded and almost 400,000 properties left without power.
  • It was not long after that we saw 89 flood alerts in the two days prior to the Christmas holidays. Gusts of up to 80mph were experienced in exposed areas causing mass disruption of transportation, holiday travellers stranded and a number of homes flooded and without power on Christmas day. Five people sadly lost their lives over this period.
  • In the past week 21 severe flood alerts were issued as the south and west coast of England braced itself for significant coastal flooding in first weekend of 2014, and the River Severn broke its banks in Gloucestershire.

Our daily work in the Extreme Events department at PHE means that we are very much aware of the immediate impacts from flooding on health.  We have worked collaboratively with Defra, the Environment Agency, the Department of Health and other government departments to develop the National Flood Emergency Framework for England (a strategic reference point for all those involved in flood planning and response), and summarised the health impacts associated with flooding events both from direct and indirect exposure to flood waters.

In order to support the needs of those who are at risk of being flooded, or who are unfortunate enough to have been flooded, Public Health England and the Environment Agency put their heads together to come up with a leaflet for use as a single resource for use by all with shared messages to protect health.  We hope this makes it much easier for all those worried about being flooded, or who have been flooded, to know where to get help and how to mitigate the impact of future floods.

Our recent work with the World Health Organization to publish a comprehensive literature review on the health impacts of flooding in Europe has enabled an in-depth analysis of the health effects of flooding.  It is astonishing to realise that in the last ten years more than 3.4 million people have been affected by floods in the European region and there have been 1,000 reported deaths due to drowning, physical trauma, heart attacks, electrocution and fire.  Floods may also cause injuries, infectious disease outbreaks, chemical contamination, carbon monoxide poisoning (through the inappropriate indoor use of generators designed for outdoors during the clean-up), disruption of power and water supplies and difficulties accessing health services.

However, we have found that often only the immediate health effects from flooding are recognised and recorded.  It is not always easy to identify the longer-term health effects associated with flooding: displacement of the exposed population or time lag before health effects occur can make it difficult to definitively link an observed health effect at population level with a flood.

Qualitative evidence suggests that the negative effects on wellbeing may persist for months or even years after a flood incident and those at risk of repeated flooding may be particularly susceptible.  The mental health impact of living through flooding of a home or a loss of livelihood can have a profound effect on a person’s well-being.  Whilst it is possible to warn people of the direct, immediate health impacts, the challenge lies in assessing, monitoring and protecting against the long-term health impacts of flooding.

We need quantitative evidence of health impacts of flooding to assist us in conducting cost-benefit analyses and progress the case for increasing flood defences and flood insurance.  The question is how we gather this information. We are coming to the conclusion that the only way to do this is to establish a health register after a flood in order to identify who was exposed and prospectively follow-up health outcomes, understand health service use and tailor interventions.  However, we do not underestimate the challenges of such a major logistical undertaking, which would require substantial human and other resource, close partnership working and excellent communications. We are currently working on a protocol for a flooding specific health register. This builds on the principles developed for PHE’s generic major incident health register plan (to be issued shortly). We would welcome collaborations with colleagues at the front line to pilot the flooding specific protocol.

Reflecting on the spate of recent flooding across the UK at the beginning of a new year, flooding is likely one of our biggest challenges in the coming years.  Five million properties are at risk of flooding in England and one in six homes are potentially at risk of flooding in the UK. It will be a challenge that will require us to work together with flood planners, responders and communities.   What is certain, however, is that with the projected impacts of climate change  flooding will be an increasingly unwelcome presence in the lives of many in England making this work increasingly vital.

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  1. Comment by Bren posted on

    Hello Virginia and Angie,

    This is an excellent blog that has real depth of feeling and focus. It identifies practical aspects to an area that is both real and actual. I think the Insurance aspect remains one to keep a focus on too.

    Best wishes,


    • Replies to Bren>

      Comment by Virginia Murray posted on

      Thanks for your kind words, Bren. You're absolutely right: there are many issues of concern relating to recovery, including insurance and the ways it can both positively and negatively affect mental health in the aftermath of flooding. This will be a serious concern as part of this ongoing work to better understand the long-term health impacts of flooding.