Pre-existing health conditions during a heat wave can lead to heat-related illnesses and death. These conditions include cardiovascular disease, diabetes, kidney disease, emphysema and epilepsy, cerebrovascular disease, lung disease, conditions mental health (Reid et al., 2009), obesity (Luber and McGeehin, 2008) and alcoholism (Kilbourne et al., 1982). People taking certain medicaments primarily associated with aging (McGeehin and Mirabelli, 2001, Gauthier et al., 2005), people with health problems and unable to take care of themselves (Semenza et al., 1996) are also vulnerable to the adverse effects of heat.
Intensive physical activity, be it sports or outdoor work, increase the period of exposure to heat and direct sunlight, which in case of heat wave is harmful to health. Moreover, the professionals who by the nature of their work are exposed to the heat (bakery, laundry, restauration) may experience discomfort and health problems during heat waves. Health recommendations of the National Heat Wave Plan 2014 specify that physical exercise and sport result in increased energy expenditure, an increase in body temperature that can be regulated by sweat evaporation. This leads in turn to dehydration, which in its turn causes decline in performance. Any abnormal rise in the ambient temperature will lead to a growing dehydration. Moreover, the regulation of body temperature in humid conditions will become more complicated, which may result in heatstroke.
The analysis of the mortality during the 2003 heat wave demonstrated that 70% of victims had medical antecedents, more often cardiovascular disease and/or psychological disorders. (Poumadère et al., 2005)
Considering scientific evidence and the results of analysis of 2003 heat wave, the situation in Plaine Commune might seem somewhat alarming. The access even to basic health care is rather limited on the territory, it is a key issue for the west and north of Seine-Saint- Denis department (especially Pierrefitte, Stains, La Courneuve, Epinay-sur-Seine, Aubervilliers, Villetaneuse) (ARS 2011)
In terms of access to health care, the population of Plaine Commune is rather precarious, including immigrants, the unemployed, the Roma community, the groups which have a strong presence in Plaine Commune, basically all the population groups that have limited access to medical insurance. A significant number of patients in precarious conditions turn to the Hospital of St. Denis, where 33% of patients are eligible for a special health insurance, emergency and critical care. Moreover, PASS Saint-Denis supports a significant number of patients (670 patients and more than 4,000 PASS issued in 2009) and home care and guidance center Doctors of the World in Saint-Denis has a population of migrants and precarious patients experiencing significant difficulties in access to prevention and care delays. As revealed by a study conducted in Aubervilliers, the “diabetes epidemic” is increasingly obvious, diabetes is a rather common condition with more than 3000people ill out of a total number of 13,522 that were surveyed. (ARS 2011)
Ile-de-France, including Plaine Commune, is particularly concerned with the challenge posed by health concerns of Roma community. For the organization Doctors of the World, which provide medical service to the Roma community of Saint-Denis, the health status of the community is a concern: in 2009, 90% of the population did not have an insurance. (ARS 2011). Immunization coverage is very low and only affects 8-12% of patients. Diabetes and lung disease are almost untreated and illnesses in their acute state without proper health care become chronic. Maternal and child health has deteriorated: only one in 10 women are followed during pregnancy, child immunization for measles, mumps and rubella is very low, exposing the population to epidemic outbreaks. (ARS 2011)
Fig. 22 Distribution of general practitioners on the territory of Plaine Commune. Source: CPAM, 2013, as cited in Artelia, RCT, Plaine Commune (2014)
According to the evidence of ARS Ile-de- France (Agence Régionale de Santé – (fr.) Regional Health Agency), there’s a rising concern for healthcare on the territory of Plaine Commune, as the number of doctors of general practice is not sufficient. ARS signals that certain territories of the department of Seine-Saint-Denis are “medical deserts”, the medical workers of the territory are therefore overloaded with patients, which incites them to search for another working place with less pressure, so the population of Plaine Commune is left with less and less doctors (Fig.22 ). Aubervilliers is one of such “medical deserts” with only 69 general practitioners per 100 000 inhabitants, compared to 101 GP per 100 000 inhabitants in Seine-Saint-Denis and 109 GP in France (ARS IdF, 2013)
In order to provide a better and more equal access to health care, ARS Ile de France has launched a new program to facilitate the installation of general practitioners in the areas with insufficient medical service supply and where medical care is not affordable for local population. The first contract with a general practitioner in the framework of this program was signed in Aubervilliers in 2013. Yet these measures are not sufficient to cover the demand for doctors in case of a heat wave.