Heat waves combined with urban heat islands (8) can result in large death tolls with the elderly, the unwell, the socially isolated, and outdoor workers (9) being especially vulnerable. Heat waves thus pose a future challenge for major cities (10).
Temperature increases and a higher incidence of heatwaves will result in increased illness and death, particularly in the elderly, from heatstroke, cardio-vascular and respiratory diseases. Such changes in climate could prove a significant multiplier effect in the Ukraine as cardiovascular disease is the leading cause of death in the country, accounting for 60% of all deaths, ischemic heart disease being the single biggest killer (5).
As the greatest warming is projected for winter this means a likely reduction in the number of deaths from the cold (6).
Food supplies and water quality could also be affected by increases in temperature and the incidence of heatwaves, further straining the health of the population. Occurrences of diarrhoeal and other bacterial diseases are very likely to rise as temperatures and water quality issues increase. Warming of near-shore waters, along with surface temperature rises in lakes and rivers, could increase incidences of toxic algal blooms and infectious bacterial diseases (7) posing a significant risk to human health.
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).
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).
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 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 - General - Heatwaves
The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (11) 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 (12). 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 (13).
The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (14). 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 (15).
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 (16). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (17).
More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (18).
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 (19). 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 (20).
The references below are cited in full in a separate map 'References'. Please click here if you are looking for the full references for Ukraine.
- WHO (2005), in: Behrens et al. (2010)
- Randalph (2004)
- Semenza and Menne (2009)
- Hajat et al. (2003)
- WHO (2005), in: Met Office Hadley Centre (2010)
- Met Office Hadley Centre (2010)
- Cruz et al. (2007), in: Met Office Hadley Centre (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)