Romania

Health Romania

Vulnerabilities in Romania

Winter wind chill and summer thermal stress 

Both an index for winter wind chill and an index for summer thermal stress showed a significant upward trend over the entire country for the period 1962−2010 (except for some areas for winter wind chill), with a significant upward shift around the mid-1980s. The strong increase in the frequency of extremely high values for summer thermal stress indicates an increased risk to human health during summers in Romania since the mid-1980s. At the same time, however, the upward trend in winter wind chill indicates a decreased risk of human health during winters in Romania. These changes seem to be mainly a consequence of global warming (16). 

Heat waves lead to the short term increase of the number of deaths or the aggravation of certain chronic conditions (especially the cardiovascular and respiratory ones). The most affected areas by the heat waves are especially the urban areas, where the green spaces decreased, and the concrete urban constructions and the street asphalt lead to the intense absorption of solar radiation, which is accumulated and released during the night. In the same time, the urban transportation also contributes to these effects, under the circumstances in which the number of cars increased annually, significantly in Romania (5).

Longer summers lead to the increase of the exposure to the UV radiations, with direct effects on skin health (skin cancer), while the stress on agriculture may influence the nutritional status especially to children and poor population (5).

Urban heat island effect

For Iași city (a population of almost 300,000 inhabitants) the urban heat island effect has been quantified from observations. On average, the mean air temperature in the centre of the city is 0.8 °C higher than in its rural surroundings. This effect for Iaşi city is strongest during calm summer nights, when the inner city is 2.5-3 °C warmer (17).

Mosquito-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 (1).

Tick-borne diseases

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 (2).

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 (3).

Floods

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).

Adaptation strategies - Romania

The following adaptation strategies have been proposed (5):

• performing epidemiological studies on the influence of the climate change effects on health in Romania;
• development of methodologies to forecast major health problems related to climate change effects, taking also into account the social and economic circumstances;
• development of surveillance methods and early detection systems of the impact of the extreme heat waves on the health condition;
• promotion of intervention programmes to control climate change health effects and contagious diseases.

Adaptation strategies - General - Heatwaves

The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (6) 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 (7). 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 (8).

The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (9). 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 (10).

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 (11). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (12).

More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (13).

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 (14). 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 (15).

References

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

1. WHO (2005), in: Behrens et al. (2010)
2. Randalph (2004)
3. Semenza and Menne (2009)
4. Hajat et al. (2003)
5. Ministry of Environment and Forests (2010)
6. IPCC (2012)
7. Health Canada (2010), in: IPCC (2012)
8. WHO (2007), in: IPCC (2012)
9. Bartzokas et al. (2010), in: IPCC (2012)
10. McCormick (2010b), in: IPCC (2012)
11. Luber and McGeehin (2008), in: IPCC (2012)
12. Semenza et al. (2008)), in: IPCC (2012)
13. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
14. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
15. Akbari et al. (2001), in: IPCC (2012)
16. Dobrinescu et al. (2015)
17. Sfîcă et al. (2018)