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Floods are the most common natural disaster in Europe. The adverse human health consequences of flooding are complex and far-reaching: these include drowning, injuries, and an increased incidence of common mental disorders. Anxiety and depression may last for months and possibly even years after the flood event and so the true health burden is rarely appreciated (1).

Effects of floods on communicable diseases appear relatively infrequent in Europe. The vulnerability of a person or group is defined in terms of their capacity to anticipate, cope with, resist and recover from the impact of a natural hazard. Determining vulnerability is a major challenge. Vulnerable groups within communities to the health impacts of flooding are the elderly, disabled, children, women, ethnic minorities, and those on low incomes (1).

Air quality

Air quality is expected to become poorer in the Eastern Mediterranean and the Middle East. Whereas human-induced emissions in most of Europe are decreasing, they are increasing in Turkey and the Middle East, which affect ozone and particulate air pollution, leading to excess morbidity and mortality. In the northern parts of the Eastern Mediterranean and the Middle East increasing dryness will likely be associated with fire activity and consequent pollution emissions. Furthermore, this region has many large cities, including several megacities in which air quality is seriously degraded (12,14).


Extended heat waves will have serious health implications (12). For urban areas in Greece the impact of climate change on health conditions has been estimated for 2021–2050 compared with1961–1990, based on a mid-line scenario for carbon dioxide emissions and economic growth (SRES A1B). The results show that (13)

  • changes in the number of days with temperature exceeding 35°C are expected to have an impact in population discomfort in the urban areas. This parameter will increase in Greek cities, probably by 10 to 20 additional hot days per year;
  • the number of warm nights per year, defined as nights where night-time temperature is above 20°C, will generally increase, probably by about an extra month per year;
  • approximately 5 to 15 extra days per year will require cooling (air conditioning);
  • practically all urban areas in Greece will experience 15 (±8) fewer days requiring heavy heating per year.

Heat stress

Heat stress is not determined by air temperature only. Other parameters, like humidity, wind speed and insolation, also determine how we experience a hot day. These parameters can be combined into heat stress indices that, better than temperature alone, reflect thermal comfort. For the city of Athens, the trends of 4 commonly used heat stress indices have been quantified for the period 1960 - 2017 on an hourly basis. Two of these indices are simple two-parameter indices, based on a combination of air temperature and humidity: the Heat Index (HI) and the Humidex (HD). These indices are being used operationally by the US National Weather Service and the Environment Canada Service, respectively. The other two indices reflect the physiological response of the human body to the actual weather conditions: the Universal Thermal Climate Index (UTCI) and the Physiologically Equivalent Temperature (PET) (15).

The results show that the population of Athens is exposed to a significant, increasing risk of heat stress since the 1960s, which is maximized in the last two decades. This increase, expressed in the time per year that the inhabitants of Athens are exposed to conditions of extreme heat stress, varies from 0.3%/decade to 0.9%/decade, depending on the index. Despite this statistically significant trend over the entire study period, a decline is observed during the last decade (15).

Also during the nighttime hours, when the human body should cool down, the population is exposed to significantly higher heat stress levels in recent decades compared to the past ones. In fact, the time people are exposed to high heat stress has increased at a faster rate for nighttime than for daytime conditions (15).

The increase in the time per year of high heat stress conditions results from trends in the timing of heat stress conditions. The occurrence of the first heat stress conditions has shifted to earlier in the year. The occurrence of the last heat stress conditions has shifted to later in the year. As a result, the period of heat exposure has expanded (15).

Adaptation strategies - General - Heatwaves

The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (2) and are summarized below. They include public health approaches to reducing exposure, assessing heat mortality, communication and education, and adapting the urban infrastructure.

1. Public health approaches to reducing exposure

A common public health approach to reducing exposure is the Heat Warning System (HWS) or Heat Action Response System. The four components of the latter include an alert protocol, community response plan, communication plan, and evaluation plan (3). The HWS is represented by the multiple dimensions of the EuroHeat plan, such as a lead agency to coordinate the alert, an alert system, an information outreach plan, long-term infrastructural planning, and preparedness actions for the health care system (4).

The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (5). There are a range of approaches used to trigger alerts and a range of response measures implemented once an alert has been triggered. In some cases, departments of emergency management lead the endeavor, while in others public health-related agencies are most responsible (6).

2. Assessing heat mortality

Assessing excess mortality is the most widely used means of assessing the health impact of heat-related extreme events.

3. Communication and education

One particularly difficult aspect of heat preparedness is communicating risk. In many locations populations are unaware of their risk and heat wave warning systems go largely unheeded (7). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (8).

More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (9).

4. Adapting the urban infrastructure

Several types of infrastructural measures can be taken to prevent negative outcomes of heat-related extreme events. Models suggest that significant reductions in heat-related illness would result from land use modifications that increase albedo, proportion of vegetative cover, thermal conductivity, and emissivity in urban areas (10). Reducing energy consumption in buildings can improve resilience, since localized systems are less dependent on vulnerable energy infrastructure. In addition, by better insulating residential dwellings, people would suffer less effect from heat hazards. Financial incentives have been tested in some countries as a means to increase energy efficiency by supporting those who are insulating their homes. Urban greening can also reduce temperatures, protecting local populations and reducing energy demands (11).


The references below are cited in full in a separate map 'References'. Please click here if you are looking for the full references for Greece.

  1. Hajat et al. (2003)
  2. IPCC (2012)
  3. Health Canada (2010), in: IPCC (2012)
  4. WHO (2007), in: IPCC (2012)
  5. Bartzokas et al. (2010), in: IPCC (2012)
  6. McCormick (2010b), in: IPCC (2012)
  7. Luber and McGeehin (2008), in: IPCC (2012)
  8. Semenza et al. (2008)), in: IPCC (2012)
  9. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
  10. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
  11. Akbari et al. (2001), in: IPCC (2012)
  12. Lelieveld et al. (2012)
  13. Giannakopoulos et al. (2011)
  14. Lelieveld et al. (2013)
  15. Katavoutas and Founda (2019)

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