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Health Malta

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Vulnerabilities - Overview

A general increase in ambient temperature will favour the spread of some vector borne diseases such as malaria, which was endemic in Malta in the past, as well as leishmaniasis, cholera and food borne diseases (1).

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 (2).

Vector-borne diseases

The occurrence of vector-borne diseases such as Leishmaniasis and Typhus in Malta has decreased over the past decades. The establishment of new species on the islands, and the possibility of increasing transmission of vector-borne diseases as a result of changes in habitat conditions because of climate change, remains a concern however. Currently, the most important climate change related vector-borne diseases of concern in Malta are Chikungunya fever and Dengue fever (13). 

Sand-fly-borne diseases

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 (2).

Adaptation strategies - Malta

The proposed adaptation and mitigation measures include (1):

  • better architectural design to minimise heat gains and maximise cool indoor environments;
  • rescheduling of work hours and leisure activities;preparation of a hot weather contingency plan to safeguard persons at risk;
  • improved surveillance programmes against tropical diseases;
  • food hygiene;
  • identification and setting up of the required emergency infrastructure to implement the Hot Weather Contingency Plan, possibly with the involvement of Local Councils and NGOs;
  • creation of public awareness and educational campaigns focusing on the adverse effects of climate Change.

Adaptation strategies - General - Heatwaves

The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (3) 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 (4). 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 (5).

The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (6). 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 (7).

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 (8). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (9).

More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (10).

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 (11). 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 (12).


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

  1. Republic of Malta, Ministry for Rural Affairs and the Environment and the University of Malta (2004)
  2. Semenza and Menne (2009)
  3. IPCC (2012)
  4. Health Canada (2010), in: IPCC (2012)
  5. WHO (2007), in: IPCC (2012)
  6. Bartzokas et al. (2010), in: IPCC (2012)
  7. McCormick (2010b), in: IPCC (2012)
  8. Luber and McGeehin (2008), in: IPCC (2012)
  9. Semenza et al. (2008)), in: IPCC (2012)
  10. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
  11. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
  12. Akbari et al. (2001), in: IPCC (2012)
  13. Climate Change Committee for Adaptation, Malta (2010)