HEALTH AND CLIMATE CHANGE: the “now and how” A policy action guide
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HEALTH AND CLIMATE CHANGE:
the “now and how”
A policy action guide - extracted text
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EUROPE
HEALTH AND CLIMATE CHANGE:
the “now and how”
A policy action guide
What is climate change? • ->
What climatic changes might Europe be facing? •••••>
Concerns and recommendations for policy action: the "now and how" •—>
Prerequisite capacities: linking, acting and communicating —>
Threat-based concerns and policy recommendations —>
Is Europe ready to adapt to the changing climate? —>
Conclusion
ENERGY, ENVIRONMENT AND SUSTAINABLE DEVELOPMENT
EUROPE
HEALTH AND CLIMATE CHANGE:
.,,
, ^cashL
the “now and how”
A policy action guide
ENERGY, ENVIRONMENT AND SUSTAINABLE DEVELOPMENT
This document presents a brief summary of the
ABSTRACT
particularly heat-waves, droughts and intense
results of the research project “Climate change
rainfall events. cCASHh identified a range of
and adaptation strategies for human health in
options that have been taken or could be taken
Europe” (cCASHh) (May 2001-July 2004).
by European policy-makers to prevent, prepare
coordinated by WHO and supported by the
and respond to the effects of weather and
Energy. Environment and Sustainable
climate variability on people’s health.
Development Programme in the frame of the
These measures arc classified into general and
Fifth European Union Framework Programme
specific. General measures include better
for Research and Development.
cooperation between health and climate
Current climate trends point to the likelihood
institutions, building capacity for action now
that southern Europe will become drier in the
and communication. The specific measures
future, while northern Europe is likely to
include information for the prevention of health
become warmer and wetter. Extreme events are
effects from heat stress, floods, vector, rodent
expected to increase in frequency and severity,
and food borne diseases.
Keywords
CLIMATE
GREENHOUSE EFFECT
METEOROLOGICAL FACTORS
NATURAL DISASTERS
DISEASE TRANSMISSION
RISK ASSESSMENT
POLICY MAKING
GUIDELINES
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2
103 4
FOREWORD J
It is now five years since the Intergovernmental Panel of Climate Change (IPCC) in 2001 concluded
on the basis of new and stronger evidence, that not only was most of the global warming
observed over the past 50 years attributable to human activities but that climate change
could affect human health. The effects can be direct - due to increased heat stress, floods
and storms - or indirect - causing changes in the ranges of disease vectors such as ticks
and water-borne pathogens, water and air quality and food availability and quality.
Health authorities had already expressed concern about climate change and its impact on human
health. Three years earlier, at the World Health Assembly in 1998, they had recognized
that climate change could be a potential threat to human health. In 1999, at the Third
Ministerial Conference for Environment and Health, ministers of health and environment
from the WHO European Region had acknowledged that “human-induced changes in the
global climate system and in stratospheric ozone pose a range of severe health risks and
potentially threaten economic development and social and political stability”. They also
called for national action by all countries to reduce and prevent as far as possible these
environmental changes and to limit the exposure of human populations in Europe to
climate change and increased ultraviolet irradiation, thus addressing the likely health
risks over the coming decades.
These statements posed a great challenge to WHO and to Member States. Scientific evidence
showed very clearly that climate change was already starting to occur, and even in the
best scenario the human population was going to face direct and indirect health effects
over the coming decades. Adaptation strategies were needed based on thinking about the
types of risks that European populations might face. With this in mind and in order to fill
this knowledge gap, we developed the network and the content of the “Climate change
and adaptation strategies for human health’’(cCASHh) project. The WHO and its
collaborators aimed to describe with facts and figures the early observed effects of
climate change on health and to identify public health measures to cope with the
additional risks. We also aimed to assess the benefits of acting sooner as opposed to
later, and to develop the necessary policies to support decision-makers in addressing
these issues.
During the project (2001-2004) the WHO European Region was hit by a major flood in 2002 and by a severe
heat-wave in 2003. Experience seemed to confirm what models had predicted. Although
one record heat-wave and flood do not prove that Europe is getting hotter or the weather
more extreme, the impacts made by these events highlighted shortcomings in existing
public health preparation and responses, particularly the lack of knowledge of effective
preventive measures and the few mechanisms in place to predict or prevent the health
effects, or even to detect them rapidly. I believe the cCASHh project has produced very
important results, both in the content and in the methods used. It shows that the
concurrent work of different disciplines in addressing public health issues can produce
innovative and useful results, providing an approach that can be followed on other public
health issues. The project has shown that information on potential threats and impacts
can be developed and can be extremely useful in preparing the public for adverse events
as well as facilitating the response when the events occur. This is a new dimension for
public health which reverses the traditional thinking: from describing what has already
occurred and identifying and reducing specific risk factors, to taking action on the basis of
prediction and early warning to prevent health consequences in large populations. We
hope this approach will be further developed and tested, particularly where emerging
environmental risks are concerned.
Health and Climate Change: the "now and how"
; Apotkv..
3
We would like to take this opportunity to express our gratitude to the many scientists and
stakeholders, including policy-makers at different levels, who contributed to the
development of the project. Without this constructive and extremely collaborative critical
mass the research results would have been less timely and perhaps less relevant. We
would also like to thank the European Commission Directorate General for Research for its
generous contribution and the attention and support with which it has followed the
implementation of the project.
This research has generated a number of conclusions and recommendations for action by
Member States and the international community. The challenge is now to translate these
actions into policy and to monitor their effectiveness and impact. With this in mind we
worked with Member States to include in the final Declaration of the Fourth Ministerial
Conference on Environment and Health held in Budapest in June 2004 recommendations
on the public health response to extreme weather events and a renewed commitment to
address in a proactive and anticipatory manner the consequences on health of climate
change.
We hope that the implementation of effective adaptation policies together with effective
mitigation actions will limit the impact of climate change and protect the health of present
and future generations. We believe this project has made a significant contribution to this
vital endeavour.
Roberto Bertollini,
Director, Special Programme on Health and Environment
WHO Regional Office for Europe
4
FOREWORD II
It is an honour for me to write a few introductory lines for this publication, which represents
the results of the research project “Climate change and adaptation strategies for human
health in Europe” (cCASHh) (May 2001-July 2004), coordinated by WHO and supported by
the Energy, Environment and Sustainable Development Programme in the frame of the
Fifth European Union Framework Programme for Research and Development.
cCASHh aimed to:
• identify the vulnerability of human health to adverse impacts of climate change;
♦ review current measures, technologies, policies and barriers to improving the adaptive
capacity of populations to climate change;
• identify the most appropriate measures, technologies and policies to successfully adapt
European populations to climate change; and
• provide estimates of the health benefits of specific strategies or combinations of
strategies for adaptation under different climatic and socioeconomic scenarios.
The flood events in 2002 and the heat-wave of August 2003 in Europe showed that no one
is on the safe side when it comes to the impacts of climate change. Though some may
dispute whether these extreme weather events are linked to global change, they revealed
in a rather drastic way our vulnerability and unpreparedness. Preparedness for extreme
weather events requires cooperation at all levels and throughout disciplines. The cCASHh
project was able to contribute timely results on both occasions. I would like to take the
opportunity to congratulate the consortium for this successful endeavour.
These types of research activities need an interdisciplinary approach, of which the
cCASHh project was a good example. Projects supported during the Sixth Framework
Programme and hopefully also during the Seventh Framework Programme continue and
further develop this important work.
Karin Zaunberger,
Project Officer, European Commission,
DG Research
European Commission
Health and Climate Change: the ■‘■'..t-.-. .nd ho.-.”
EXECUTIVE SUMMARY - POLICY BRIEF
The longer that greenhouse gas reduction measures are slowing to be in place, the
greater the need to understand how people and systems can effectively adapt to new
climate patterns and potential threats, and what needs to be done now to avoid the
human suffering and deaths that may result. This paper summarizes the findings of the
Climate change and adaptation strategies for human health in Europe (cCASHh) project,
coordinated by WHO to assess current health impacts of climate change and policy
responses to it.
Current trends, discussed in the cCASHh studies, point to the likelihood that southern
Europe will become drier in the future, while northern Europe is likely to become warmer
and wetter. Extreme events are expected to increase in frequency and severity,
particularly heat-waves, droughts and intense rainfall events.
During the cCASHh project (2001-2004) the WHO European Region was hit by a major
flood in 2002 and by a severe heat-wave in 2003. Lessons learned point to a need for
strengthening policies that will help societies better adapt to such extreme weather
changes. cCASHh European surveys confirmed that while the characteristics of the
population, access to health services and types of exposure are important determinants
of health outcomes, effective policies can make a difference.
The findings are organized in two sections. The first addresses some prerequisites of
adaptation, such as the need for better linkage between health and climate authorities
and enhancing policy-makers’ capacities to act and communicate. The second addresses
some specific policy-driven action options (how) to reduce the health impact of heat
waves and floods, and changes in the ranges of vectors, allergens and foodborne
diseases attributable to climate change (now).
Integration
lead time: decisions have long-term
effects; and there is a need to reverse
Addressing the health impacts of climate
trends that threaten adaptive capacity.
change requires integration of public
health and climate change knowledge.
Communication
Integration requires reciprocal
understanding of terminology, goals and
cCASHh surveys reveal a limited public or
methods. Beyond this it requires working
policy-maker appreciation of the risks of
together to achieve the goal of reducing
climate change and variability and what to
deaths, disease and disabilities.
do about them, partly because of the
perception that the problem is too big to
Action
manage, lies outside of the health sector
and its impacts are long-term. In particular
A key message from the research is that
there is a need for a more strategic
the measures considered in adapting to
approach to those at risk and those who
future climate change are not generally
can play a part in enhancing adaptability.
new. and that most of them build on well-
Crisis and risk communication experiences
established public health approaches. In
point to the counter-intuitive aspects of
general, early action was found to be most
uncertainty communication, namely, if one
possible and effective when: action
does not convey clarity and candour one
measures have already been shown to be
risks losing trust and worsening fear and
effective under current climate conditions;
insecurity.
severe impacts are possible; multisectoral
alliances, partnerships, and networks are in
place; adaptation measures have a long
6
Specific threat adaptation
populations, the use of insecticide-
Heat-waves
targeted to populations at risk as well as to
impregnated dog collars, and information
Surveys show that Europe is not well-
public health personnel. In order to detect
prepared to cope with “unexpected”
early signs of climate induced changes,
extreme thermal stress events. In western
active collaboration between veterinary
Europe alone, 35 000 excess deaths were
services and health services is essential.
reported in the 2003 heat-wave. There is
The measures currently available to
some evidence that mortality can be
control vector-and rodent-bome diseases
reduced by strengthening and
arc disease-specific and can be broadly
implementing early warning systems,
classified into diagnosis and treatment,
strengthening health system preparedness
vaccination, vector control, reservoir host
and response, planning cities and housing
control, information and health education
better and advising citizens.
and disease surveillance and monitoring.
Floods
Foodborne diseases
Floods are among the most common
Salmonellosis
natural events in Europe - causing deaths,
cCASHh studies on foodborne diseases
injuries, and diseases - and their frequency
show that, in general, cases of
and magnitude are expected to increase.
salmonellosis, increase by 5% to 10% for
Infectious disease outbreaks are rare;
each one-degree increase in weekly
however, there is incomplete information
temperature, for ambient temperatures
collection on short and long-lasting health
above about 5° C. The number of cases of
effects. Structural and non-structural flood
salmonella can be reduced by controlling
protection measures in many European
and monitoring along the food chain. The
countries have significantly reduced
level of implementation varies by
associated deaths over recent decades.
countries. High levels of control measures
Vector-borne diseases
and storage would be needed to confront
Lyme borreliosis and lick-borne
the potential climatic risks.
and more information on food handling
encephalitis (Ixodes ricinus)
cCASHh data and other studies have
Allergic diseases
shown that the tick transmitting Lyme
Evidence is growing that climate change
borreliosis and tiek-bome encephalitis
might facilitate the spread of particular
(TBE) (Ixodes ricinus) has spread into
plant species to new climatically suitable
higher latitudes (in Sweden) and altitudes
areas. Warming is likely to facilitate the
(in the Czech Republic) in recent decades
earlier onset and possibly longer duration
and has become more abundant in many
of flowering and pollen seasons for some
places. Some specific measures might
grasses and weeds.
need to be strengthened in risk areas, such
as TBE vaccination and raising awareness
The way forward
of collective and individual protection
measures, like wearing suitable clothing,
Political will and support for public health
and self-inspection after outdoor activities
approaches may be seen as a prerequisite
to remove ticks early.
to reducing health risks and instability.
Malaria
Identifying ways to reduce the causal
Although several models predicted a
factors of climate change - mitigation -
potential increase of malaria in Europe.
and effectively help populations and
there is agreement that the risk is very low
systems deal with risks and threats posed
under current socioeconomic conditions.
by climate change - adaptation -
Leishmaniasis
especially for vulnerable populations, can
There are some hypotheses that point to a
lead to a greater sense of security and
considerable potential for climate-driven
control and result in improved population
changes in Leishmaniasis distribution in
health. The health sector can and should
the future. Important control strategies
be at the heart of this.
include local control of sand fly
Health and Climate Change: the "now and how”
Apelie
7
INTRODUCTION
Whether it is climate change, avian flu, chemical safety, bio-terrorism or violence, people
across Europe and beyond are being bombarded with images and information that cause
fear and insecurity. Policymakers are challenged to develop responses that not only
identify priority risks and how they can be minimized but also to communicate
uncertainties and proposed actions to their populations in ways that enhance people’s
sense of security and health.
This document addresses public health policy challenges posed by climate change. While
some people “quietly” enjoy what they perceive as the benefits of climate change,
concerns and fears raised by extreme weather conditions and uncertainty about future
impacts add to global feelings of insecurity. This guide identifies a range of options that
have been taken or could be taken by European policy-makers to prevent, prepare and
respond to the effects of weather and climate variability on people’s health. As opposed to
many other publications on climate change and health, the focus here is on “now and
how.” What effects are we actually seeing now? How can policy-makers help their people
and systems effectively adapt to new climate threats and reduce associated human
suffering and deaths? What needs doing now and what can be safely delayed? How can
public health approaches help facilitate early warnings, shape effective responses, learn
from each other’s interventions and reframe public perceptions of climate change risk and
insecurity in the process?
This guide summarizes the findings and recommendations of the “Climate change and
adaptation strategies for human health” (cCASHh) project’(i) (Box i). cCASHh, funded by
the European Commission and coordinated by the World Health Organization Regional
Office for Europe, European Centre for Environment and Health (ECEH) Rome, studied
health impacts and policy implications of heat stress related mortality and morbidity,
foodborne (salmonellosis and campylobacteriosis), and vector-borne diseases.
A section on allergic disorders (2) is also included, drawing upon the work of the
European Phenology Network (EPN). Surveys, workshops, stakeholder consultations,
epidemiological studies, policy analysis, economic valuation and scenario development
‘Presented at the 11 th meeting of the Parties to the Climate Convention in Montreal, December, 2005
were carried out to learn the best ways for health systems to adapt to the new risks posed
by climate change.
The findings are organized in two sections. The first addresses some prerequisites of
adaptation, such as the need for better linkage between health and climate authorities
and enhancing policy-makers’ capacities to act and communicate. The second addresses
some specific policy-driven action options (how) to reduce the health impact
of heat-waves and floods, and changes in the ranges of vectors, allergens and foodborne
diseases attributable to climate change (now).
•••<• Box i. The cCASHh study questions
The cCASHh project aimed to describe with facts and figures the early observed effects of climate change
on health and to identify the available public health measures to cope with the additional risks (3).
Activities focused on answering the following 5 questions:
» What can be learned from observed health impacts of climate change and vulnerabilities?
• What strategies, policies and measures are currently available to reduce impacts of climate variability
and change?
• What are the damages/benefits?
• What are the projected health impacts?
• Which policy responses need to be strengthened or developed?
Health and Climate Change: the "inr.? and ho..'‘
Ap ..
9
WHAT IS CLIMATE CHANGE?
Climate change refers to a statistically
of anthropogenic greenhouse gases -
significant variation in either the mean
carbon dioxide (CO,), methane (CH4),
state of the climate or its variability that
nitrous oxide (N,O) and tropospheric
persists for extended periods (decades or
ozone (O,) - reached their highest
longer). The earth's climate system has
recorded levels in the 1990s. primarily due
demonstrably changed on both global and
to the combustion of fossil fuels.
regional scales since the pre-industrial era.
agriculture and land-use changes2.
with some of these changes attributable to
An increasing body of observations gives
human activities, particularly those that
a collective picture of a warming world
have increased the atmospheric
and other changes in the climate
concentrations of greenhouse gases and
system (4-6) (Figurel).
aerosols. The atmospheric concentrations
WHAT CLIMATIC CHANGES MIGHT EUROPE BE FACING?
Over the last 50 years there has been an
was hit by a major flood in 2002 and by a
increase in Europe's minimum and
severe heat-wave in 2003. Although one
maximum temperatures (7). changes in
record heat-wave and flood do not prove
precipitation characteristics and increases
that Europe is getting hotter or the weather
in the magnitude and frequency of extreme
more extreme, the impacts made by these
events such as high temperatures, heavy
events can be considered an early test of
precipitation and persistent drought (S).
current coping strategies (Box 2). Lessons
Current trends, discussed in the cCASHh
policies that will help societies better
learned point to the need for strengthening
studies, point to the likelihood that
adapt to such extreme climatic changes.
southern Europe will become drier in the
Lack of preparedness and weak response
future, while northern Europe is likely to
systems in the 2003 heat-wave resulted in
become warmer and wetter. Extreme
more than 35 000 excess deaths in Europe.
events are expected to increase in
In contrast, structural and non-structural
frequency and severity, particularly heat
flood protection measures in many
waves. droughts and intense rainfall
European countries have significantly
events. During the cCASHh project
reduced associated deaths over recent
(2001-2004) the WHO European Region
decades.
•' Glossary of the Intergovernmental Panel of Climate Change
10
FIGURE 1. PAST AND FUTURE CHANGES IN GLOBAL MEAN TEMPERATURE
Difference in (°C) from 1961-1990 average
GLOBAL AVERAGE NEAR-SURFACE TEMPERATURES, 1860-JULY 2003 FROM 1961 TO 1990 AVERAGE'
••••:• Box 2: Lessons from the 2003 heat event in France
A severe heat event in August 2003 resulted in an estimated 14 800 excess deaths in 13 French cities.
Meteo France issued warnings to the media, but authorities’ awareness of the heat-wave’s health
impacts was delayed. The common heat-related causes of this large number of deaths, mostly in the
elderly, were not detected promptly because data from emergency and medical services and from death
certificates were not commonly used for rapid detection. An inquiry by the General Directorate of Health
(DGS) concluded that the 2003 heat event was unforeseen and only detected belatedly, and highlighted
deficiencies in the French public health system, including too few experts, lack of preparation for a heat
event, poor definition of responsibility across public organizations and weak information exchange
mechanisms.
It was further noted that health authorities and crematoria and cemeteries were overwhelmed by the
influx of patients and bodies; few nursing homes were equipped with air-conditioning; and a large
number of elderly people were living alone without a support system and without guidelines for
appropriate responses to a heat event (9-10).
Since 2003, the French government has formulated short and medium-term actions to reduce health
impacts from heat events, including the development of a national heat health warning system,
sponsoring research on the risk factors associated with heat-event-related mortality, implementing a
health and environmental surveillance programme, and developing national and local action plans for
heat events (9).
1 "Hadley Centre for Climate Research, Exeter. United Kingdom ’’
Health and Climate Change: the "now and hov."
.
11
CONCERNS AND RECOMMENDATIONS FOR POLICY ACTION:
THE “NOW AND HOW”
Every epidemiologist knows that climatic
establishment of the first Chinese dynasty.
factors are important determinants of
the collapse of ancient civilizations in
human health and well-being. Rising
Egypt, the Indus watershed and
ambient temperatures, outside a
Mesopotamia, the discontinuity in ancient
population's comfort range may lead to
Greek civilization, and the decline of
thermal stress and weather-related
Mayan culture (11). cCASHh European
disasters - such as floods and storm surges
surveys confirmed that disease outcomes
- with significant loss of life and alter the
due to extreme weather events in any
range of many infectious diseases. Climate
given country were strongly dependent on
change can have direct impact via
the policy measures and actions in place to
exposure to hazardous meteorological
prevent, adapt to and address climate-
conditions and indirect impact via
related threats (12). While the
vector/rodcnt/water/or foodborne diseases
characteristics of the population, access to
and allergic disorders (11). The history of
health services and types of exposure are
human adaptation to climatic factors
important determinants of health outcomes
comprises great successes as well as
(see table 3 on adaptive capacity).
disastrous failures. On the one hand
effective policies can make a difference.
humans have successfully managed to live
The large differences in outcome from one
in nearly ever)' climatic zone on earth: on
country to another point to the potential to
the other hand, regional climatic shifts
learn from successful policy
have been linked to the rise and fall of
implementation and adapt effective policy
many great civilizations, including the
responses (13) (see figure 3).
PREREQUISITE CAPACITIES:
LINKING, ACTING AND COMMUNICATING
The cCASHh studies identified the need
and enhancing the capacity of decision
for certain core public health competencies
makers to act and communicate on climate
and capacities as prerequisites for effective
change-related threats. These activities can
hcalth/climate policy-making. They include
be carried out at different levels and time
strengthening collaboration and teamwork
scales: from international to local, from
between health and climate professionals
short-term to long-term (Box 3).
••• * Box 3. Summary of prerequisite capacities: Linking, acting
and communicating
Climate-health linkage: Many tables, one agenda
Capacity to take action
• When to act
• Overcoming obstacles to action
• International support and solidarity - “We are all in the same boat”
Communication- “Many voices, one song-sheet”
Climate-health linkages: Many tables one agenda
Public health and climate change
successfully implemented early warning
stakeholders share the goal of increasing
revealed how effective joint working is 115).
the ability of countries, communities and
individuals to cope with the challenges
Early warning systems are most effective
likely to arise because of climate
with:
variability and change (Box 4).
Addressing the health impacts of climate
change requires integration of public
health and climate change knowledge. For
the integration to be successful, the
climate change community must
understand how health is different (what
distinguishes it from other climate
sensitive systems or sectors), and the
public health community must understand
how climate change is different (what
distinguishes anthropogenic climate
change from other risk factors to human
population health) (14). Integration
requires reciprocal understanding of
• sufficiently accurate forecasts available
for the population of interest;
• robust understanding of the effects of
climate on health;
• effective response measures within leadtime provided by the warning;
• a community that is able to provide the
needed infrastructure and action;
• integration of “end-users" into planning
and communication; and
• monitoring, evaluating and adjusting of
systems as needed.
terminology, goals and methods. Beyond
this it requires working together to achieve
the goal of reducing deaths, disease and
disabilities. Lessons learned from some
Health and Climate Change: the "now and hov/'
? A policy a
13
Box 4. Mitigation and adaptation
In the terminology of climate change, mitigation refers to actions that limit the amount and rate of
climate change (the exposure) by constraining the emissions of greenhouse gases or enhancing their
sinks. Adaptation, in contrast, refers to any actions undertaken to avoid, prepare for or respond to the
detrimental impacts of observed or anticipated climate change. Mitigation and adaptation vary
significantly in their scope, types of actions, characteristic spatiotemporal scales and principal actors.
Mitigation is the only strategy that can reduce impacts of climate change on all systems and on a global
scale but it requires international cooperation and takes a long time to become fully effective because of
the inherent inertia of the climate system. Adaptation is limited to specific climate-related risks in human
systems on a local or regional level and over a shorter time.
Adaptation also refers to the process by which adaptive measures are implemented: it can be immediate
and intuitive (for example, buying a fan to cope with the heat), but it can also involve a long process of
information collection, planning, implementation and monitoring (for example, setting up early-warning
systems). The terms “autonomous adaptation” and “planned adaptation” are generally used to
distinguish between these two types, even though the distinction is not always sharp (14).
| Capacity to take action
Commonly posed policy-maker questions
contemplating taking action to reduce
are "when should 1 act?” and "how safe is
health risks posed by different climate
safe enough?” (13). The answer is, of
change factors. To make decision-making
course, that it depends upon the existing
even more complicated, these factors arc
risk criteria, the magnitude of the threat.
not static. Existing risk management
the applicable local social norms and the
policies and measures might appear
availability of cost-effective interventions.
sufficient at the current levels of risk, but
Many things need to be considered when
might become insufficient at higher levels
or when faced with more frequent and
intense events.
A key message from the research is that
the measures considered in adapting to
future climate change are. in general, not
new, and that most of them build on well-
established public health approaches.
Likely responses include:
• strengthening of effective surveillance
and prevention programmes;
• sharing lessons learned across countries
and sectors;
• introducing new prevention measures or
increasing existing measures;
• development of new policies to address
new threats (16,17).
Overcoming obstacles to action
When to act?
The cCASHh study provides some
Key obstacles to action include lack of
guidance here. In general, early action was
awareness of the potential health impacts
found to be most possible and important
of climate change, a perception that the
problem is too big and distant, a
when:
perception that solutions are outside of
• action measures have already been
health sector competence and response
shown to be effective under current
control, competing priorities, the lack of a
climate conditions;
strategic framework and disorganized top-
• severe impacts are possible (for
example, high mortality from heat
waves);
down initiatives. cCASHh studies
identified some ways different policy
makers have overcome these obstacles.
including raising awareness, prioritizing
• multisectoral alliances, partnerships and
action based on differential impact on
vulnerable populations, now and how
networks are in place;
• adaptation measures have a long lead
time (for example, changing
infrastructure to reduce the extent of an
urban heat island effect);
arguments for five key action areas (see
discussion below), practical advice on
integrating health and climate action, risk
management and communication and
community-based interventions.
• decisions have long-term effects (for
example, building settlements in areas
The cCASHh assessments identified
that are at risk of flooding); and
several effective community and
• there is a need to reverse trends that
threaten adaptive capacity.
neighbourhood level interventions aimed
at reducing the risks from climate change.
including taking care of the elderly during
heat-waves (15). neighbourhood flood
Delaying action can be a rational
evacuation plans (18). community-based
adaptation strategy if the risks are
risk communication of specific infectious
moderate and response measures can be
disease protection measures (19) and
introduced quickly when most needed or if
consideration of local knowledge and
the cost of adaptations are exceedingly
perspectives in the planning process.
photo by AP
high given the level of uncertainty.
Health and Climate Change: the "now and hov.
; Ap.<
15
International support and solidarity:
“We arc all in the same boat"
effects of climate change. Adaptation will
require additional research to predict the
impacts at regional levels in order to enable
National and local action can be
local and regional public and private sector
stimulated, learned from and supported
actors to develop cost-effective options/ This
from the outside. There arc numerous
has been addressed in the 2nd European
international legal and moral frameworks
Climate Change Programme, which expects
that allow direct or indirect action to
to develop a Green Paper on adaptation to
reduce the health impacts of climate
climate change for the European Union.
change. The most direct way of action is
through the United Nations Framework
There are numerous important indirect
Convention on Climate Change
instruments that might further enhance
(UNFCCC), which recognizes the need for
adaptation to climate change. For example
adaptation policies, stipulating that
the Convention on the Protection and use of
developed countries will assist in paying
Transboundary' Watercourses and
the adaptation costs of the most vulnerable
International Lakes has developed guidance
countries. At the European level, it is
for flood prevention and a protocol on water
recognized that there is a need to decrease
and health.
vulnerability and increase resilience to the
Communication: many voices, one song-sheet
Awareness-raising and information
namely, if one does not deal with
activities will be needed to better
uncertainties with clarity and candour one
communicate “real" threats and preventive
risks losing trust and worsening fear and
actions that can be taken by individuals to
insecurity.
reduce their risk of climate-sensitive
diseases. An important pan-European need
The choice of which polices and measures
is accurate and timely information for
to implement and the timing of their
citizens. In particular there is a need for a
implementation is best shaped by
more strategic approach to those at risk
responsible authorities with active
and those who can play a part in
participation of civil society, especially
enhancing adaptability. cCASHh surveys
those likely to be affected by the policy
reveal a limited public or policy-maker
choice.
appreciation of the risks of climate change
and variability and what to do about them.
partly because of the obstacles noted
above, that is. the perception that problem
is too big to manage, outside of the health
sector and the impacts are long-term.
There are many uncertainties, both
scientific and political, that must also be
communicated effectively. Policy-makers
often avoid this because it is seen as
revealing ignorance and weakness. Crisis
and risk communication experiences
(Box 5) point to the counter-intuitive
aspects of uncertainty communication;
' Communication from the European Commission to the Council of Europe, the European Parliament. the European Economic and Social
Committee, and the Committee of the Regions on Winning the Battle Against Global Climate Change (COM (2005) 35. Brussels 9.2.2005).
y Box 5. Climate change and health: communicating risk and uncertainties
(adapted from WHO Outbreak communication guidelines, 2005)
Communication, generally through the media, is a key feature of the climate change/health environment.
Unfortunately, examples abound of communication failures which have delayed action, undermined
public trust and compliance and unnecessarily prolonged economic, social and political turmoil. Some
key considerations, based on best practice examples are listed below.
Trust
The overriding goal is to communicate with the public in ways that build, maintain or restore trust. This is
true across cultures, political systems and levels of development. Trust in communicating with the public
is critical in both directions. Evidence shows that public panic is rare and most rare when people have
been candidly informed.
Announcing early
The parameters of trust are established in the first official announcement. This message’s timing.
candour and comprehensiveness may make it the most important of all communications.
Transparency
Maintaining the public’s trust throughout an event requires transparency (communication that is candid,
easily understood, complete and factually accurate). Transparency characterizes the relationship between
the event managers and the public. It allows the public to view the information-gathering, risk-assessing
and decision-making processes associated with outbreak control.
The public
Understanding the public is critical to effective communication. It is usually difficult to change pre
existing beliefs unless those beliefs are explicitly addressed. And it is nearly impossible to design
successful messages that bridge the gap between the expert and the public without knowing what the
public thinks.
• Early risk communication was directed at informing the public about technical decisions (known as the
“decide and tell" strategy). Today, risk communicators teach that crisis communication is a dialogue.
• It is the job of the communicator to understand the public’s beliefs, opinions and knowledge about
specific risks. This task is sometimes called “communications surveillance”.
• The public’s concerns must be appreciated even if they seem unfounded.
• Risk communication messages should include information about what the public can do to make
themselves safer.
Planning
Risk communication should be incorporated into climate change/health activities, whether extreme
planning for major events, advice on behavioural measures to prevent infectious diseases or all aspects
photo by WHO
of an outbreak response.
Health and Climate Change: the "now <inn ho.'.“
17
THREAT-BASED CONCERNS AND POLICY RECOMMENDATIONS
The cCASHh study assessed the impacts
diseases and allergic disorders (Figure 2)
of heat-waves and extreme events on
This section summarizes the results and
human health and the impacts of climate
describes "now" and "how" strategies.
change on vcclor/rodenl/foodborne
FIGURE 2. THE REALTIONSHIP BETWEEN REGIONAL WEATHER CHANGES, EXPOSURES AND HEALTH OUTCOMES
Regional weather changes
• Frequency and magnitude
of extreme weather
events
• Gradual changes of
temperature,
precipitation and other
• Lifestyle, behaviour
• Socioeconomic
development
• Land-use
• Ecosystems and habitats
• Agriculture
• Hydrology
• Urban planning and other
Health outcomes
• Deaths
• Cardiovascular diseases
• Respiratory diseases
• Injuries
• Infectious diseases
• Food and waterborne
diseases
• Mental health
• Allergic disorders
Adaptation in other sectors
and systems
Health system adaptation
Thermal stress: heat-waves
Why action now?
extreme thermal stress events (see table I
and Box 2) (20). In western Europe alone,
cCASHh surveys show that Europe is not
35 000 excess deaths were reported in the
well-prepared to cope with “unexpected”
2003 heat-wave. There appears to be a
TABLE 1. EXCESS MORTALITY IN AUGUST OF 2003 IN SELECTED AREAS AND
COUNTRIES (11)'
18
Country
Excess mortality
Baden-Wiirttemberg, Germany
1410
Belgium
Not significant
England and Wales
2091
France
14802
Italy
9704
Portugal
1854
Spain
3166
Switzerland
960
The Netherlands
650
' Studies used different
denominators and reference
periods to estimate excess
mortality
direct relationship between death rates and
increased mortality in that period has been
thermal stress that differs by climatic zone,
attributed toair pollution (45. 46j. There is
geographic area and demographic situation
some evidence that mortality can be
(15). In the United Kingdom a 250%
reduced by strengthening and implementing
increase in heat mortality has been
early warning systems, strengthening health
estimated for the 2050s, and in Portugal, it
system preparedness and response and
was estimated that by 2020s, heat
planning cities and housing. Only a few
mortality would range between 5.8-15.1
countries' have implemented heat-wave
deaths per 100 000 in comparison to a
prevention and response plans including
baseline of 5.4-6 deaths per 100 000 (21).
strategics for identifying vulnerable
subgroups, health monitoring, population
Risk groups and factors are identifiable.
advice, and financial incentives to
encourage vulnerability reduction. Studies
Deaths from heat stroke, cardiovascular,
carried out in the Czech Republic and Italy
renal, respiratory and metabolic disorders
have shown that people who are ill are
were reported in the over 65 age group.
particularly willing to pay more to reduce
People most at risk suffer from chronic
their exposure to heat-related impacts (15,
diseases, take certain medications and are
47, 48). Climatologists now consider it
not physically fit. Several environmental.
very likely that human influence on the
social and health-care-related risk factors.
climate system has at least doubled the
contribute to higher levels of mortality.
risk of heat-waves like that of 2003. of
most importantly living in the city, being
which associated mortality could have
alone, living on high floors. Early-summer
been an early signal of the health impacts
heat-waves are associated with higher
of climate change for which Europe is
mortality than late season heat-waves.
probably insufficiently prepared (49-51).
The increasing number of older people in
Europe and their increasing social
The costs of inaction are large.
isolation are likely to increase the size
of the population at risk from heat
A contingent valuation survey was carried
(20. 22-43).
out to estimate the benefits of reducing the
Housing with no cross ventilation or
survey questionnaire was administered to
shading devices is associated with excess
adults 30-75 years old in the Czech
risk of dying during heat-waves. The
mortality. One strong trend over the past 20
Republic and Italy. It was estimated for the
years is a decrease in ventilation - people
city of Rome, that the monetized mortality
close their windows due to the fear of
damages of the heat-waves in the absence
crime, outdoor noise and air pollution.
of planned adaptation programmes would
especially at night when ventilation is
be € 281 million for the year 2020 (in
important. Interestingly, there is little
2004 Euros) (52. 53).
evidence that morbidity is rising during
heat-waves although some increased
Policy action options: "How" strategies
emergency admission for renal and
respiratory diseases has been observed in
Policy options include early warning
the elderly and children in London (44).
systems, health system preparedness and
Stressful weather and high levels of air
response, urban planning and housing
pollutants have independent adverse effects
improvements.
on daily mortality. The atmospheric
A comprehensive early warning system
conditions during the 2003 heat-wave
should involve multiple agencies, such as
contributed to increase of tropospheric
city management, public health and social
ozone and particulates concentration in
services and emergency medical services
many areas of Europe and a part of the
(54). Poor communication between
’ A heal warning survey of meteorological agencies found that with the exception of Lisbon and Rome, no heat health wanting systems were
in place before 2003. After 2003. cities in France. Germany, Hungary. Italy, Spain and the United Kingdom introduced or developed heat
wave warning systems. A survey carried out with ministries of health throughout Europe found that only a few countries have implemented
heat-wave prevention anti response plans including strategies for identifying vulnerable subgroups, health monitoring, population advie,.
and financial incentives to encourage vulnerability reduction. In 2004, France, Italy. Portugal and the United Kingdom began to include
heat-related health indicators in computerized rapid surveillance systems.
Health and Climate Change: l :
.
hov,'
meteorological services and the health
related illness. Evidence points to the
agencies can prevent implementation of
importance of combining practical advice
effective systems. Hospitals, primary care
on action with risk warnings. Air pollutant
clinics and nursing homes should all be
reduction measures might need to be taken
prepared for heat-waves. An emergency
during heat-waves. Future climate should
plan should be drafted and piloted.
be taken into account in the construction
including education of doctors, nurses and
of new buildings and planning of new
other staff to identify heat problems and
parts of cities in order to provide as much
the most appropriate treatments. A
thermal comfort and protection against
personnel plan could also be developed so
extreme events as possible. An important
that extra staff is in place if needed.
component of this is to use optimum
methods and materials for space cooling.
behaviour during hot weather is an
The reliance on energy-intensive
essential component of heat-death
technologies such as air-conditioning is
prevention. Many governments in Europe
unsustainable and can be considered a
have issued advice on how to avoid heat-
maladaptation.
Why action now?
effects brought about by major
Floods are among the most common
of populations. Furthermore, there arc
photo by STR, Reuters
Education to advise people of appropriate
Floods
infrastructure damage, displacement
natural disasters.
indirect effects such as waterborne and
vector-bome diseases, exposure to
They cause loss of life and economic
chemical pollutants released into
damage in Europe. The frequency of great
floodwaters and food shortages (55).
floods increased during the twentieth
Interventions before, during and after
century, underscoring the need for
floods can reduce short and long term
measures to prevent their negative health
health impacts (see table 3).
impacts (55): deaths, injuries, diseases and
mental disorders during the flood event
and restoration, along with additional
20
Chronic health effects are possible but
a subject of debate, there is no doubt that
rarely quantified.
changes in land use and hydrology create
Exposure lo flooding reportedly results in
protection has disappeared.
multiplying effects when natural
long-term problems including increased
rates of anxiety and depression stemming
Policy action options: “How" strategies
from the experience itself, troubles
brought about by geographic
Prevention of floods and flood damage is
displacement, damage to the home or loss
mainly based on structural (dams, room
of with family possessions and stress in
for the river, etc.) and non structural (early
dealing with builders and other repair
warning, risk communication, etc.)
people in the aftermath. The persistence of
measures. Flood prevention plans
flood-related health effects is directly
normally include environmental impact
related to flood intensity. Hospitals,
assessments (flood plains).
ambulances, retirement homes, schools
communications strategies and land-use
and kindergartens in flood-prone areas are
regulations (56).
at risk and evacuation of patients and
vulnerable groups might represent a
further risk.
A cCASHh survey with ministries of
health throughout Europe found that
although all the respondent countries had
emergency intervention plans, no
governments had strategies to prevent
long-lasting health impacts from flooding
or offered financial incentives for citizens
to increase their ability to resist them (54).
Adverse health impacts from floods arise
from:
• characteristics of the flood itself
• the amount and type of property damage
• whether flood warnings were received
and acted upon
• the victims' previous flood experience
and risk awareness
• relocation and other household
Providing accurate information on safe
disruption
• difficulty in dealing with builders and
insurance companies
management of flood water during
evacuation and clean-up is essential. There
is a need to shift emphasis from disaster
• pre-existing health conditions and
response to risk management, to improve
Hood forecasting, to establish early warning
susceptibility
• anxiety over a flood recurrence
• financial concern
systems and to include health actors in the
communication fiow. Risk management in
this area must cover a broad field, including
• loss of security in the home and
• disruption of community life.
health impact assessment of Hood structural
measures, regulations concerning building
in Hood prone areas, insurance policies, etc.
The harmful effects of Hooding can be
Although the extent to which climate
reduced by building codes, legislation lo
change will affect the frequency and
relocate structures away from Hood-prone
intensity of extreme weather events is still
areas and planning appropriate land use
Health and Climate Change:
19 345
and migration measures. Short and long
the prompt response of public health
term health impacts can be reduced by
authorities in ensuring safe drinking water,
appropriate interventions (see table 2). In
medical assistance and an effective
the recent floods in Europe no major
emergency infrastructure. In countries
outbreak of communicable disease has
where such are not available infectious
been observed. This may be attributable to
disease outbreaks have been observed.
TABLE 2. HEALTH-SPECIFIC INTERVENTIONS TO REDUCE THE POTENTIAL IMPACTS OF FLOODS
Health outcome and preventive measures
Pre-flood activities
Intervention
Pre-flood awareness-raising campaigns, with messages
targeted to different groups
Emergency planning
Inter-institutional coordination activities
Infectious diseases and other physical health effects
Treatment of respiratory problems and skin rashes
Treatment for mould and other exposures
Treatment for strains and other effects of physical exertion
Vaccination (e.g. hepatitis A) of general population
Boil water notices and general hygiene advice
Outbreak investigations where appropriate
Enhanced surveillance
Mental health outcomes
Post-flood counselling
(anxiety and depression, etc.)
Medical assistance
Visits by health workers or social workers to vulnerable
people
Source: (18)
Vector-borne diseases
Why action now?
latitudes and altitudes and contribute to an
extended and more intense Lyme
photo by WHO
Lyme borreliosis and tick borne
encephalitis
borreliosis and TBE transmission season
in some areas.
Climate is an important determinant of the
geographic range of disease vectors, such
22
Leishmaniasis
as mosquitoes or ticks. cCASHh data and
While there is not current compelling
other studies have shown that the lick
evidence that sand fly and visceral
transmitting Lyme borreliosis and tick-
leishmaniasis distributions in Europe have
borne encephalitis (Ixodes ricinus) has
altered in response to recent climate
spread into higher latitudes (in Sweden)
change. cCASHh analysis points to a
(19,57) and altitudes (in the Czech
considerable potential for climate-driven
Republic) (58-66) in recent decades and
changes in leishmaniasis distribution in the
has become more abundant in many
future. Sand fly vectors already have a
places.
wider range than the pathogen
Based on the results of the extended
(L. infantum), and imported dogs infected
cCASHh reviews, it seems likely that
with it are common in central and northern
climate change in Europe will: facilitate
Europe. Once conditions make
the spread of Lyme borreliosis and tick-
transmission possible in northern latitudes,
borne encephalitis (TBE) into higher
the imported dog cases could act as a
source of new endemic foci. Climate-
favourable weather conditions, abundant
induced changes in sand fly abundance
mosquito vectors, infected migrating birds.
thus may increase the risk of the
local avian hosts, bridge vectors able to
emergence of new diseases in the region
feed on both birds and mammals and
(67).
susceptible population of equines and/or
Malaria
(69).
humans (as “dead-end" or occasional hosts)
Although several models predicted a
potential increase of malaria in Europe
Hantavirus
(see box 6). there is agreement that the
Hantavirus causes a rare infection that can
risk is very low under current
cause haemorrhagic fever with renal
socioeconomic conditions. Probably the
syndrome (HFRS). It is transmitted from
greatest risk is in those eastern European
rodent to rodent through body fluids and
countries where per capita health
excreta and only occasionally are humans
expenditure is relatively low. so that
infected. Theory suggests that changing
health services are less efficient at
climates have influenced rodents’
detecting and treating malaria cases and
migration patterns and the physiological
environmental measures to control
viral adaptation processes. However.
mosquito distribution are poorly
further research is needed to elucidate the
implemented (68).
relationships among climate change,
rodents, viruses and humans (70).
West Nile fever
There have been several hypotheses that
climate change contributes to the
re-emergence of West Nile fever in
Europe. However, it seems most likely
that this re-emergence is the result
of a combination of factors including
—Box 6. Malaria in Europe: is it realty a threat?
From a policy perspective, it is important to understand the various drivers of disease expansion and
retreat. A variety of recent modelling efforts have shown that, assuming no future human-imposed
constraints on malaria transmission, changes in temperature and precipitation could alter its geographic
distribution and intensity, with previously unsuitable areas of dense human population becoming
suitable for transmission (71,72).
Projected changes include an expansion in latitude and altitude, and, in some regions, a longer season
during which malaria may be present. Such changes could dramatically increase the number of people at
risk. The potential for malaria and other "tropical" diseases to invade southern Europe is commonly cited
as an example of the territorial expansion of risk. However, many of these diseases existed in Europe in
the past and have been essentially eliminated by public health programmes. For example, in the early
part of the twentieth century, malaria was endemic in many parts of southern Europe (68,73,74), but its
prevalence was reduced primarily via improved land drainage, better quality of housing construction and
higher levels of socioeconomic development, including better education and nutrition. Any role that
climate played in malaria reduction would have been small.
Note that this does not provide assurance that climate will not play a larger role in determining the
future range and intensity of malaria transmission.
Health and Climate Change: I
wro..'
Policy action options: “How" strategies
decades, but in recent years there have
been exciting advances in diagnosis.
The measures currently available to
treatment, and prevention. Important
control vector and rodent-borne diseases
control strategies include local control of
arc disease-specific and can be broadly
sandfly populations, the use of insecticide-
classified into diagnosis and treatment.
impregnated dog collars, and targeted
vaccination, vector control, reservoir host
information to populations at risk as well
control, information and health education
as to public health personnel.
and disease surveillance and monitoring.
In order to capture early signs of climate
Some specific measures might need to be
induced changes active collaboration
strengthened in risk areas, such as TBE
between veterinary' services and health
vaccination and raising the awareness on
services is essential.
collective and individual protection
measures, like wearing suitable clothing.
The European Region needs to be vigilant
and self- inspection after outdoor activities
on new potential climate sensitive diseases
to early remove ticks. Leishmaniasis
and the expansion of existing once, also in
control strategies have varied little for
relation with other environmental changes.
and waterborne diseases
Why action now?
that temperature influences the
Diarrhoeal diseases are one of the most
cases of salmonellosis in England and
important causes of ill health in Europe in
Wales. Poland, the Netherlands, the Czech
children, from foodbome and waterborne
Republic, Switzerland and Spain. Rates of
transmission of infection in about 35% of
infections. They are recognized to be
salmonellosis are declining in most
highly sensitive to climate, showing strong
countries in Europe, suggesting that
seasonal variations in numerous sites (75).
improvement of current measures will be
However, it is not possible to generalize
an effective adaptation to controlling
the effects of weather on the transmission
salmonella under warmer climate
of pathogens, which depend upon the local
conditions (76-78).
situation, the pathogen and numerous
environmental pathways. The effectiveness
Campylobacter infections
of national control programmes varies
The role of weather in triggering short
across countries, providing opportunities
term increases in Campylobacter infections
for decreasing current burdens of
has yet to be resolved. There are various
foodbome diseases.
potential transmission routes (water
supplies, bird activity, fly activity and
Salmonellosis
recreational contact) that could be affected
cCASHh studies on foodbome diseases
by weather. However, the effect of short
show that, in general, cases of
term increases in temperature on
salmonellosis, the most common food
Campylobacter transmission is, at most.
bome disease, raise by 5-10% for each
weak, in contrast to that consistently
one-degree increase in weekly
observed with salmonella transmission
temperature, for ambient temperatures
(76).
above about 5° C. The effect of
temperature is most apparent when the
I
in the week before the onset
illness is considered, thus indicating
that inappropriate food preparation and
rather than time of consumption is
mportimi factor. It was estimated
24
Cryptosporidiosis
Some notable outbreaks of waterborne
diseases such as cryptosporidiosis have
been associated with heavy rainfall (79).
photo by Emilio M. Dotto
Policy action options: “How” strategies
Transboundary Watercourses and
Important mechanisms to prevent
take all appropriate measures towards
foodborne and waterborne diseases are
achieving:
International Lakes calls upon countries to
surveillance and monitoring,
microbiological risk assessment, risk
management and risk communication.
The number of cases of salmonellosis can
be reduced by controlling and monitoring
along the food chain. The level of
implementation varies by countries. High
• adequate supplies of wholesome
drinking-water
• adequate sanitation sufficiently
protective of human health and the
environment
level of control measures would need to be
• effective protection of water resources
achieved with the potential climatic risks
used as sources of drinking-water and
and potentially information on storage and
their related ecosystems from pollution
food handling strengthened (75).
The drinking-water and recreational
protocol of the United Nations Economic
Commission for Europe (UNECE)
Convention on the Protection and Use of
• adequate safeguards for human health. —
against water-related diseases.,^
• effective systems for monitoring and
responding to outbreaks or incidents of
water-related diseases. !g|
Allergic disorders
Why action now?
sensitivity to it varies greatly across
The prevalence of asthma, allergic rhinitis.
growing season in Europe has increased
Europe, but the average length of the
allergic conjunctivitis and eczema in
by 10 or 11 days over the last 30 years. An
Europe increased during the second half of
earlier start and peak of the pollen season
the twentieth century. Sensitivity to pollen
are more pronounced in species that st;irt
allergens has also increased in many areas.
flowering earlier in the year. The duration
The geographical distribution of plants
of the season is extended in some summer
with allergenic pollen and allergic
and late-flowering species. Evidence js
Health and Climate Change: I
25
growing that climate change might
The relationships among changing
facilitate the geographical spread of
climate, allergens and allergic disorders
particular plant species to new climatically
need to be further clarified, but
suitable areas. Warming is likely to
precautionary action in improving pollen
facilitate earlier onset and may extend the
forecasting is advisable. Initial
duration of flowering and pollen seasons
suggestions include setting up a working
for some grasses and weeds. Some
group to look at the potential impact of
species, such as ragweed and mugwort,
global change on allergic disorders in
present particular risks for health, and
order to strengthen and systemize early
require land use measures, maintenance of
warning systems (80-83).
public areas or eradication.
FIGURE 3. PREREQUISITS, ADAPTABILITY, ADAPTATION POSSIBILITIES AND NECESSITIES
Prerequisits of adaptation
• Linkage between health and climate
• Capacity building
Strengthening of exisiting and
overcome obstacles;
Share lessons accross sectors and countries;
Revise standards;
International solidarity;
Local solidarity;
• Communication
Health sector adaptation
possibilities
• Implement effective
responses to early warning
• Strengthen health system
preparedness
• Risk management
• Strengthen disease
surveillance and health prtoection
measures
• Vector and host control
• Awareness raising and education
• Treatment and vaccination
Health driven
adaptation-mitigation
necessities
• Land - use change
• Urban planning
• Housing improvement
• Structural and non-structural measures
• Transport, energy and agriculture policies
Increasing "adaptability”
• Reducing inequalities
• Investment in health
protection and prevention
• Achieving/maintaining highest levels of
health care coverage
• Access to information and technology
IS EUROPE READY TO ADAPT TO THE CHANGING CLIMATE?
Experts surveyed within the cCASHh
coverage and high access to information.
study ranked income, equality, type of
Concerns were raised about a negative
health care system, and quick access to
impact on "adaptability” in parts of
information as most important factors
Europe with rising inequalities, falling
enabling effective response to climate
prevention investment and aging
change. Countries in the WHO European
populations (Table 3; Figure 3).
Region vary tremendously in their
response capacities (84). Those with the
highest adaptive capacities tend to have
high incomes, universal health care
26
TABLE 3. ADAPTIVE CAPACITY INDEX FOR 22 EUROPEAN AND CENTRAL ASIAN COUNTRIES. HIGHER INDEX VALUES MEAN HIGHER
ADAPTIVE CAPACITY6(W
For detailed information please access: http://\n\\vfeem.it/NR/rdonlyres/43CSESE0-DDC1 -402C-AA08-A62694C97FB7/1712! 10606 pdf
Health and Climate Change: the “now and how”
A
.
27
CONCLUSION
The cCASHh project has provided timely and critical information on "now and how"
strategies for health threats from climate change. Many conclusions have been drawn
from analysis of the health impacts of the 2002 floods and the 2003 heat-wave. This
information is being used to design new policies and improve measures to address
morbidity and mortality due to flooding and heat-waves. It is not apparent that
improvements are taking place quickly enough in those risk areas where no recent
disasters or emergencies have occurred.
While the “now and how” strategies outlined above have the potential to reduce the
health risks associated with global climate change, they are clearly no panacea. For some
diseases, no effective response measures arc available now. Even if effective responses
do exist, the availability of financial and other resources and the cultural acceptability of
required behavioural changes often pose insurmountable barriers to implementation.
Countries that already suffer from a considerable burden of climate-sensitive diseases
will generally be unable to successfully adapt to the increased risks associated with
climate change on their own. Hence any comprehensive long-term strategy for
minimizing the risks associated with global climate change requires the combination of
planned adaptation (now and how) and mitigation of climate change. International
burden-sharing is needed to distribute costs of adaptation according to the vulnerability
of countries to climate change.
The Ottawa Charter7 identified peace and security as a prerequisite for health. Current
experience points to the need to rethink this relationship. Political will and support for
public health approaches may be seen as requisites to reducing fear and insecurities.
Identifying ways to reduce the causal factors of climate change (mitigation) and
effectively help populations and systems deal with risks and threats posed by climate
change (adaptation), especially for vulnerable populations, can lead to a greater sense of
security and control and result in improved population health.
' Ottawa Charier for Health Promotion, First International Conference on Health Promotion. Ottawa. 21 November 1986
WHOIHPRIHF.PI95.1
28
ACKNOWLEDGEMENTS
This publication was developed by Franklyn Apfel and Bettina Menne based on the
information received from Anna Albcrini, Roberto Bcrtollini. Aline Chiabai. Milan Daniel,
Vlasta Danielova, Hans-Martin Fiissel, Kristie L. Ebi. Gerd Jcndritzky. Christina Koppc. Tom
Kosatsky, Sari Kovats, Bohumir Kriz, Elisabet Lindgren. Michael van Lieshout. Tanja Wolf
and Karin Zaunbergcr, and is based on the book Climate change and adaptation strategies for
hitman health edited by B. Menne and K. Ebi. It summarizes the final results of the project
Climate Change and Adaptation Strategies for Human Health IcCASHh-EVK2-2000-00070),
funded by the European Commission and coordinated by Bettina Menne and Roberto
Bcrtollini from WHO ECEH
Many experts have directly contributed to this project by steering the work, writing
background reports and articles and providing information and comments essential to its
development. We would like to thank very much Ben Armstrong, Matteo Albrizio. Martha
Anker. Annmaria Asp. Jiirgen Baumiiller. Ccstmir Benes. Arieh Bitan. Ian Burton, Diarmid
Campbell-Lendrum. Carlo Carraro. Dominique Charron, John Cowden. Clive Davies. Philippe
Desjeux, Julio Diaz, Sally Edwards. Michael Ejov. Jan Erhart, Michele Faberi. Marzio
Galcotti, Gretel Gambarelli. Andy Haines. Shakoor Hajat. George Havenith. Gloria
Hernandez, Jaroslava Holubova. Zdenek Hubalek, Charmaine Gauci. Peter Gerner-Smidt.
Norman Gratz, Simon Hales, Daniela Janovska, Thomas G.T. Jaenson. Adam Jirsa. Ricardo
Jorge, Richard J.T. Klein. Ivan Kott. Jan Kopccky, Zuzana Kristufkova. Katrin Kuhn. Kuulo
Kutsar. Milan Labuda, Gudrun Laschewski. Alberto Longo, Cesar Lopez. Lena Malmstrbm.
Wieslaw Magdzik. Andreas Matzarakis, Pirn Martens. Pierre Marty. Jan Matema. Fergus
Nicol. Glenn McGregor, Anthony McMichael. Paul McKeown. Rennie M D'Souza. Kassiani
Mcllou. Torsten Naucke. Antonio Navarra. Fergus Nicol. Paulo Jorge Nogueira. Sarah
O'Brien. Anna Paldy. Milan Pejcoch. Edmund Penning Rowsell. Hans Schmid. Scott Sheridan.
Paul Socket!. Sue Tapsell. Hiroko Takasawa. Christina Tirado. Jaroslav Valter. Antti Vaheri.
Theresa Wilson. Linda Wirdn, Wilfrid van Pelt and Kamil Zitek.
Many experts participated in the several workshops and through their contributions allowed
the project to grow. The coordinators would like to thank Lucien Abenhaim. Roger Aertsgeert.
Bastien Affellranger. Ingvar Andersson. Peter Baxter. Elena Borisova. Nick Brooks. Rui
Calado. Sergio Castellari. Tanja Cegnar. Claude Chastel, Jean-Claude Cohen. Susanna Conti.
Carlos Corvalan. Thomas Downing. Peter Duchaj. Andrea Ellis. Pascal Empereur-Bissonnet.
Agustin Estrada-Pena, Veronique Ezralty. Vytautas Gailius, Benedek Goncz. Duane Gubler.
Paolo Guglielmetti, Debarati Guha-Sapir. Cagatay Giiler, Katarina Halzlova, Juhani Hassi.
Madelcen Helmer, Marika Hjertqvist. Sona Horvathova, Michael Hubei. Lyubomir Ivanov,
Ilze Jansone, Geoff Jenkins. Anne-Marie Kaesbohrer, Wilhelm Kirch, Victor Kislitsin. Silvia
Kostelna, Zbigniew W Kundzewiez, Jan Kyncl. Marco Leonardi. Otto Malek, Alexander
Malyavin, Merylyn McKenzie Hedger. Paola Michelozzi,Thierry Michelon. Matthias Niedrig.
Buruhani Nyenzi, Mikko Paunio. Armin Petrascheck, Gunter Pfaff, Florin Popovici. Paul
Reiter, Stefania Salmaso, Christiana Salvi, Darina Sedlakova. John Simpson, Jolanta Skrule.
Alfred Spira, Jochen Suss. Viv Taylor Gee. Richard To!. Jaroslav Valter. Els Van Cleemput.
Thomas Voigt. Jaroslav Volf. Gary Yohe and Rudolf Zajac.
The coordinators would particularly like to thank Blessy Corda and Nicoletta di Tanno for
their continuous efforts in managing the project and developing and updating the website.
A warm thanks is also extended to all those institutions that supported the project, namely, the
London School of Hygiene and Tropical Medicine, the National Institute of Public Health of
the Czech Republic, Stockholm University. Fondazione Eni Enrico Mattei. Deutscher
Wetterdienst, the Potsdam Institute for Climate Impact Research and the International Centre
for Integrative Studies.
Health and Climate Change: the "no?.'and no .
-Aps...
29
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