Vulnerabilities in Hungary
Presently, 68% of the population of Hungary lives in urbanised areas and in a few years this rate is forecasted to reach 80%. It is therefore inevitable to assess the climate change related urban health problems. One of the most significant problems is the urban heat problem. Furthermore it is necessary to assess the cardiovascular morbidity with relation to forecasted extreme heat and the regional effects to the heat problems in large urban areas (1).
It was found that 5°C increase of the daily average temperature results in (8):
- 10% increase of the risk of death due to all possible causes;
- 12% increase of the risk of death due to cardio-vascular diseases;
- 15% increase of the number of emergency ambulance calls for heart complains and ”general indisposition”.
Heat waves combined with urban heat islands (10) can result in large death tolls with the elderly, the unwell, the socially isolated, and outdoor workers (11) being especially vulnerable. Heat waves thus pose a future challenge for major cities (12). For the city of Szeged, an urban heat island effect of around 3 °C has been measured in the summer and less than 2 °C in winter months (24).
In 2007 – in the most extreme summer so far experienced in Hungary – there were three heat waves in Hungary (a heat wave being defined as the 26.5°C daily mean temperature being exceeded during at least three subsequent days). In the period of the first and third ones of these waves excess mortality was less than 5%. In the second and heaviest heat wave record breaking daily mean temperatures of higher than 30°C were measured for five days in the period 16-24 July. The excess mortality rate (33%) of the ten-day heat wave was lower in Middle Hungary than in France during the heat wave of 2003. Nevertheless, during the five hottest days the excess mortality was 57%. At a national scale the estimated total excess death cases were calculated by the respective relationships as likely falling into the range of 600-800 (9).
There is agreement that the risk of a potential spread of malaria in Europe is very low under current socio-economic conditions, but some Eastern European countries might be at risk. In Eastern European countries, where per-capita health expenditure is relatively low, health services are less efficient in detecting and treating malaria cases, and the environmental measures to control mosquito distribution are poorly implemented. This could eventually contribute to the uncontrolled spread of the disease in these countries (4).
While climatic factors may favor autochthonous transmission, increased vector density, and accelerated parasite development, other factors (socioeconomic, building codes, land use, treatment, etc) limit the likelihood of climate related re-emergence of malaria in Europe (6).
Climate change to date is not necessarily the cause of the marked increased incidence of a variety of tick-borne diseases in many parts of Europe over the past two decades, however. This increase may also be due to the impact of biotic factors, such as increases in deer abundance and changing habitat structure, and of socio-political changes following the end of communist rule (5).
Leishmaniasis is a protozoan parasitic infection caused by Leishmania infantum that is transmitted to human beings through the bite of an infected female sandfly. Sandfly distribution in Europe is south of latitude 45⁰N and less than 800 m above sea level, although it has recently expanded as high as 49⁰N. Currently, sandfly vectors have a substantially wider range than that of L infantum, and imported cases of infected dogs are common in central and northern Europe. Once conditions make transmission suitable in northern latitudes, these imported cases could act as plentiful source of infections, permitting the development of new endemic foci. Conversely, if climatic conditions become too hot and dry for vector survival, the disease may disappear in southern latitudes. Thus, complex climatic and environmental changes (such as land use) will continue to shift the dispersal of leishmaniasis in Europe (6).
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 (7).
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 (7).
Anticipated climate impacts on air quality were assessed for the Czech Republic, Poland, Hungary and Bulgaria by simulating air quality for 3 decades: 1991−2000, 2041−2050, and 2091−2100 under the IPCC A1B scenario (23). In order to exclusively study climate impacts on air quality, the anthropogenic emissions were kept constant in all simulations at the values of the year 2000 for all considered time slices. The impacts of the simulated climate change on the air quality are rather weak for the mid-century (2041−2050). For the end-century (2091−2100), an increase in summer mean ozone was shown and a decrease in annual mean particulate matter with a diameter < 10 μm for all four countries. The main climate factors responsible for the projected changes were an increase in summer temperature and a decrease in summer precipitation for ozone, and an increase in winter precipitation for fine particulate matter (23).
It is likely that the process of warming will have an impact on hygienic conditions making them more vulnerable. Increased attention should be paid to the compliance with food safety regulations that should bring along increasing forced-control. Drinking water safety must have high priority as the water quality is highly impacted by both the dryness and drought and by the deluge-type rainstorms (9).
Serious drinking water born epidemics were launched in Hungary by abrupt and large rainstorms: In the period of 2-15 June 2006 a serious water-born epidemic was launched by storm-runoff in the City of Miskolc, causing 2890 identifi ed illnesses, including 212 clients needing hospital treatment (9).
Adaptation strategies - Hungary
The heatwave in 2003 has led to the development of heat health-watch warning systems in several European countries including Hungary (2,9).
Health-system preparedness planning is essential, by collaborating with weather services in providing accurate, timely weather-related health alerts and developing strategies to reduce individual and community exposures to heat, especially among vulnerable populations, planning health and social services and infrastructure, and providing timely information to the population (3).
In designing new buildings the principles of ‘rational air conditioning’ should be considered. In forming urban development concepts it is desirable to consider the avoidance of creating ‘urban heat islands’ (9).
Adaptation strategies - General - Heatwaves
The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (13) 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 (14). 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 (15).
The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (16). 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 (17).
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 (18). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (19).
More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (20).
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 (21). 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 (22).
The references below are cited in full in a separate map 'References'. Please click here if you are looking for the full references for Hungary.
- Hungarian Ministry of Environment and Water (2009)
- Kosatsky and Menne (2005), in: Alcamo et al. (2007)
- Matthies et al. (2008), in: EEA, JRC and WHO (2008)
- WHO (2005), in: Behrens et al. (2010)
- Randalph (2004)
- Semenza and Menne (2009)
- Hajat et al. (2003)
- Paldy et al. (2003, 2004, 2007), in: Farago et al. (2010)
- Farago et al. (2010)
- Basara et al. (2010); Tan et al. (2010), in: IPCC (2012)
- Maloney and Forbes (2011), in: IPCC (2012)
- Endlicher et al. (2008); Bacciniet al. (2011), both in: IPCC (2012)
- IPCC (2012)
- Health Canada (2010), in: IPCC (2012)
- WHO (2007), in: IPCC (2012)
- Bartzokas et al. (2010), in: IPCC (2012)
- McCormick (2010b), in: IPCC (2012)
- Luber and McGeehin (2008), in: IPCC (2012)
- Semenza et al. (2008)), in: IPCC (2012)
- Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
- Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
- Akbari et al. (2001), in: IPCC (2012)
- Juda-Rezler et al. (2012)
- Molnár et al. (2019)