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Health Macedonia

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Heat stress

It is noticeable that the average total mortality is higher in the colder period of the year, 7% higher than the average total mortality, and 13% higher than the average total mortality in the warmer period of the year. The most common reasons for mortality during the colder period of the year are cardiovascular, cerebrovascular, circulatory, and respiratory diseases. Climate change is projected to increase heat stress mortality in the summer, particularly among the elderly poor (1).

Vector-borne diseases

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 (2).

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 (3).


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 (4).

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 (4).

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 EastEMME 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 (15).

Adaptation strategies - Macedonia

Both, by strengthening and implementation of an Weather Early Warning System, as well as preparedness and response of the healthcare system services on the one hand and by adequate physical planning and housing on the other, the reduction of mortality among the people is feasible. The system should include the implementation of preventive and action plans for heat waves and inclusion of strategies for the identification of vulnerable groups. Also public health monitoring and citizens’ campaign promotion is needed with an explanation that inactivity is, in the end, the most expensive option (1).

Adaptation strategies - General - Heatwaves

The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (5) 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 (6). 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 (7).

The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (8). 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 (9).

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 (10). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (11).

More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (12).

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 (13). 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 (14).


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

  1. Republic of Macedonia, Ministry of Environment and Physical planning (2008)
  2. WHO (2005), in: Behrens et al. (2010)
  3. Randalph (2004)
  4. Hajat et al. (2003)
  5. IPCC (2012)
  6. Health Canada (2010), in: IPCC (2012)
  7. WHO (2007), in: IPCC (2012)
  8. Bartzokas et al. (2010), in: IPCC (2012)
  9. McCormick (2010b), in: IPCC (2012)
  10. Luber and McGeehin (2008), in: IPCC (2012)
  11. Semenza et al. (2008)), in: IPCC (2012)
  12. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
  13. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
  14. Akbari et al. (2001), in: IPCC (2012)
  15. Lelieveld et al. (2012)