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Vulnerabilities

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 (2).

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 (3).

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 (4).

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 (5).

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 (5).

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 East 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 (16,20).

Heatwaves

Extended heat waves will have serious health implications (16).

Adaptation strategies - Albania

Adaptation strategies in Albania include (1):

• Permanent control monitoring of the drinking water quality;
• Permanent control over water supply and sewerage systems affected by salt-water corrosion and intrusion in coastal areas;
• Permanent monitoring and drafting of a new law on air quality;
• Improvement of the solid wastes collection and treatment technology;
• Compilation of long term plans for the urban development;
• Elaboration of an reliable medical and statistical program that will help in finding the cause consequence (climate changes - health) correlations.

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 (15).

Urban greening can also reduce temperatures, protecting local populations and reducing energy demands (15). From an urban climate point of view, aside from the positive effect of shading, inner-city green spaces can only be effective as a measure to improve the urban thermal climate if an adequate water supply is ensured. Especially in dry periods when there is no link to the ground water level; a reduction in soil moisture cannot be offset by water transport from deeper soil layers, so adequate irrigation must be provided for green spaces. Otherwise, the positive thermal effects of green spaces resulting from transpiration will be reduced to a minimum or eliminated entirely (19).

Adaptation strategies - General - Infectious diseases

Possible measures to evaluate vector-borne and zoonotic diseases include surveillance and control programs, early warning systems, maternal and child health programs, and educational programs for individuals, communities, and health care workers on identifying and treating diseases (17).

For some diseases, early warning systems can be designed based on data collected from surveillance programs to provide timely interventions to reduce the magnitude or extent of a disease outbreak (18). Appropriately designed early warning systems can be adjusted over time toincorporate projected increases in climate variability and change, thus increasing future resilience (17).

Broadening the scope and increasing the capacity of public health institutions, particularly surveillance programs and environmental monitoring, could effectively address new and emerging risks (17).

Examples for water- and food-borne diseases include watershed protection laws, water quality regulations, regulations to control food-borne diseases and contaminants, surveillance and monitoring programs, and educational programs on food handling. Examples of adaptation options to climate change related risks of increased infectious disease outbreaks are (17):

Sectors Examples of climate change vulnerability/impacts Examples of adaptation options Agriculture Salmonella and campylobacter in poultry farms are temperature sensitive Altered animal husbandry practices such as eradication of pathogens in poultry flocks Nature
conservation Recreational exposure to ticks infected with tick-borne encephalitis virus and borrelia Vaccination and/or protective clothing Coastal
management Exposure to coastal waters during bathing at contaminated beaches Prevention of untreated sewage discharge into coastal waters due to combined sewer overflow during extreme rain events Communication Climate change misinformation by interest groups Social marketing and media advocacy targeting susceptible populations Civil
infrastructure Exposure to vector and water and food born diseases during and after flooding emergencies Weather-proofing of central infrastructure to minimize adverse impacts Emergency
services Slow response to climate-related outbreaks/disasters Strengthen response capacity in order to quickly contain an outbreak Energy Peak energy consumption and/or brownouts during heat waves Assure energy supply during extreme weather events Fishery Elevated water temperature has been linked to microbial contamination of shellfish (e.g. oysters) Restrict shellfish harvesting after rain events or high levels of indicator bacteria Health sector Lack of resources can expose vulnerable populations to infectious agents Target public health services to populations at risk Hunting Range shifts of disease vectors might create new risk  zones in hunting areas Minimize exposure with protective clothing Industry There are temperature-sensitive processes in the food industry that might be prone to contamination Stricter food regulations Land use Fragmentation of habitats results in wild life exposure which could result in pathogen transmission Habitat restoration Soil management Susceptible to erosion Divert storm flows from sensitive areas Transport Weather sensitive disruption of food supply chains Local food production Tourism Importation of tropical pathogens can result in sporadic  autochthonous transmission Surveillance and alert systems with immediate medical care Water resource
management High precipitation events can overwhelm the water treatment plants Upgrading the water treatment and distribution systems

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 Albania.

1. Republic of Albania, Ministry of Environment (2002)
2. WHO (2005), in: Behrens et al. (2010)
3. Randalph (2004)
4. Semenza and Menne (2009)
5. Hajat et al. (2003)
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. Lelieveld et al. (2012)
17. Ebi et al. (2013)
18. Kuhn et al. (2009), in: Ebi et al. (2013)
19. Goldbach and Kuttler (2013)
20. Lelieveld et al. (2013)