The Heatwave Warning
A city of 2 million people is forecast to experience five consecutive days above 42°C. Last summer's heatwave caused 180 excess deaths, concentrated among people over 75, people living alone, and outdoor workers. The city has an alert system that sends SMS messages, opens cooling centres in libraries, and advises people to stay indoors. Evaluation found the SMS reached 60% of residents but only 25% of those over 75, and cooling centre attendance was low. Outdoor workers, many on gig contracts, continued working because pay depends on completed jobs. Electricity demand is expected to spike, and some low-income households cannot afford air conditioning. The health department must decide how to allocate a limited emergency budget across the five days.
1. Explain why the current heat response under-performs for the highest-risk groups.
Read the worked answer
The response assumes people receive, understand and can act on advice. Each assumption fails for a different group.
Older people living alone: SMS reach is only 25% in this group, so the main channel misses them. They may also have reduced thirst and heat perception, mobility limits, and no one to check on them. Cooling centres require travel and may feel unfamiliar or unsafe.
Outdoor and gig workers: advice to stay indoors conflicts with income. When pay depends on completed jobs, a health message without income protection is not actionable. This is a structural conflict, not ignorance.
Low-income households: air conditioning is unaffordable, so the advice presumes a resource they lack. Electricity price spikes worsen this.
System level: a mass SMS is a universal intervention aimed at a population with unequal exposure and unequal capacity to respond. Low cooling-centre attendance is consistent with poor accessibility, not lack of need. The excess deaths are a marker of unmet need concentrated in groups the channel does not reach.
2. Propose how to allocate the emergency budget across the five days, and justify the priorities.
Read the worked answer
Priority 1 - Reach and check on isolated older people (largest share). Use council and community records and volunteer networks for door-knocking and phone trees, prioritising over-75s living alone. This directly addresses the 25% reach failure and the group with the highest mortality. Fund transport to cooling centres and keep centres open longer with water available.
Priority 2 - Protect outdoor and gig workers. Fund enforcement of mandatory rest and water breaks, and where feasible provide income support or shift timing to cooler hours. Without income protection, advice will be ignored; this is a structural fix.
Priority 3 - Affordability. Fund a crisis payment or cooling-room access for low-income households, and coordinate with energy providers to prevent disconnection.
Priority 4 - Communication. Add radio, community languages, pharmacies and GP practices to reach people SMS misses.
Justification: allocate where preventable death risk is highest and where the current system fails most. Universal messaging is cheap but ineffective alone; targeted outreach and structural protections address the causal pathways. State trade-offs: enforcement may be resisted, and door-knocking is labour-intensive, so prioritise by risk. Monitor daily: cooling-centre attendance, ambulance callouts, and door-knock contacts, and adjust over the five days.