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Health Spain

Vulnerabilities - Heat stress

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).

During heat-waves like the one in 2003, people who are accustomed to high temperatures suffer less than people who aren’t. In Madrid daily mortality starts to increase when temperature rises above 36,5°C, in Seville we see an effect at 41°C, but in Lisbon daily mortality is already on the rise at 34°C. In Lisbon more people died than in Madrid. At least 35,000 Europeans, and maybe even over 44,000 (4, 8), died as a result of the record heat-wave in August 2003. France suffered the worst losses, with almost 15,000 casualties. Heat-waves are a silent killer, affecting the elderly, the very young and the chronically ill (1,8)

In Spain the excess 2003 summer mortality may relate in part to the lower than expected level of mortality there during the winter of 2002-2003, leading to a larger than expected pool of people in fragile health by summer 2003 (9).

Vulnerabilities - Vector-borne diseases

The prospect has raised the spectre of the rapid “Africanisation” of the Iberian peninsula, particularly in the south and along the Mediterranean coastline, as a hotter and drier climate turns swathes of an already arid country into desert and beats a path for the entry of sub-tropical diseases so far unknown in Spain such as dengue, Rift Valley fever and malaria (2).

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).

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 (6).

Vulnerabilities - 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 (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).

Adaptation strategies - Spain

After the summer of 2003 a national plan for the prevention of health effects of extreme temperatures has been made, to inform the people about health risks. Also, a website has been made with information on climate change and health impacts (3).

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 (5).

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 Spain.

  1. Verschoor (2009a)
  3. Government of Spain. Quinta Comunicación Nacional de España
  4. Swedish Commission on Climate and Vulnerability (2007)
  5. Matthies et al. (2008), in: EEA, JRC and WHO (2008)
  6. Semenza and Menne (2009)
  7. Hajat et al. (2003)
  8. Kosatsky (2005)
  9. Simón et al. (2005)
  10. Basara et al. (2010); Tan et al. (2010), in: IPCC (2012)
  11. Maloney and Forbes (2011), in: IPCC (2012)
  12. Endlicher et al. (2008); Bacciniet al. (2011), both in: IPCC (2012)
  13. IPCC (2012)
  14. Health Canada (2010), in: IPCC (2012)
  15. WHO (2007), in: IPCC (2012)
  16. Bartzokas et al. (2010), in: IPCC (2012)
  17. McCormick (2010b), in: IPCC (2012)
  18. Luber and McGeehin (2008), in: IPCC (2012)
  19. Semenza et al. (2008)), in: IPCC (2012)
  20. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
  21. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
  22. Akbari et al. (2001), in: IPCC (2012)