Initial concern about the possible effects of global warming on infections has declined with the realization that the spread of tropical diseases is likely to be limited and controllable. However, the direct effects of heat already cause substantial numbers of deaths among vulnerable people in the summer. Action to prevent these deaths from rising is the most obvious medical challenge presented by a global rise in temperature. Strategies to prevent such deaths are in place to some extent, and they differ between the United States and Europe. Air conditioning has reduced them in the United States, and older technologies such as fans, shade, and buildings designed to keep cool on hot days have generally done so in Europe. Since the energy requirements of air conditioning accelerate global warming, a combination of the older methods, backed up by use of air conditioning when necessary, can provide the ideal solution. Despite the availability of these technologies, occasional record high temperatures still cause sharp rises in heat-related deaths as the climate warms. The most important single piece of advice at the time a heat wave strikes is that people having dangerous heat stress need immediate cooling, eg, by a cool bath. Such action at home can be more effective than transporting the patient to hospital. Meanwhile, it must not be forgotten that cold weather in winter causes many more deaths than heat in summer, even in most subtropical regions, and measures to control cold-related deaths need to continue.
* Heat stress causes deaths among elderly people in summer.
* Cold causes larger numbers of deaths in winter, from arterial thrombosis and respiratory disease, and efforts to improve protection against cold should not be relaxed during global warming.
* Populations accustomed to heat or cold adjust to them, but record high temperatures for a locality during global warming have caused high mortality rates.
* Measures to prevent heat stress in vulnerable people need to be in place before unprecedented heat waves occur.