Vulnerabilities - Bosnia and Herzegovina

Bosnia and Herzegovina is particularly vulnerable to climate threats to human health because of the low adaptive capacity in the public health sector. The country lacks a uniform basis for statistical data on monitoring the incidence and mortality rates for specific diseases (5).

Direct impacts on health

Climate change that is primarily related to temperature change may result in the following health problems in Bosnia and Herzegovina (5):

• An increase in the number of those suffering from cardiovascular and cerebrovascular illnesses with subsequent disabilities of various degrees;
• An increase of the number of those suffering from respiratory illnesses (due to increase of air humidity, and indirectly through changes in the pollen calendar) (6);
• Deterioration of existing chronic illnesses (rheumatologic, immunologic, systematic) (7);
• An increase in the number of patients with psychological traumas (8);
• An increase in the mortality rate as a consequence of circulatory disturbances (cardiovascular and cerebrovascular illnesses), particularly as the result of heat waves and particularly among the elderly.

Indirect impacts on health

The population of Bosnia and Herzegovina may also be at risk for the following indirect impacts on health (5):.

• The combination of increases in temperature and pollution in south-eastern Europe as a whole would lead to an upsurge in respiratory illnesses, particularly among urban populations;
• Water shortages and damaged infrastructure would increase the risk of cholera and dysentery;
• Water pollution, already a major health hazard in the region, would become even worse as pollutants become more concentrated with reduction in river flows;
• Higher temperatures would affect the spread of vector-borne illness, increasing the incidence and extent of infectious diseases;
• Snow melt, especially in the case of rapid warming accompanied by rain, could cause violent flood waves. These are characteristic and frequent phenomena of the Danube and Tisza River catchment areas further north in Central Europe. In the Mediterranean, intense precipitation falling on small catchment areas may cause rapid onset floods. Recent floods in south-eastern Europe highlighted for the population the need for security, including the protection of residences.

Vulnerabilities - Overview

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).

Lyme borreliosis is the most important vector-borne disease in temperate zones of the northern hemisphere in terms of number of cases. In Europe, at least 85,000 cases are reported every year and prevalence is greater eastwards (10,11). The disease is prevalent in Bosnia and Herzegovina, Serbia, and Montenegro. Countries with annual incidences of over 20 per 100,000 include Lithuania, Estonia, Slovenia, Bulgaria, and the Czech Republic (10).

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 - Bosnia and Herzegovina

In the area of adaptive measures designed to protect human health possible measures include the following:

Awareness raising

• Work on educating and informing the general population about the possible consequences of exposure to changed climate conditions and possible symptoms;
• Work on educating and informing the general population about measures of self-protection and self-aid in the case of changed climate conditions with the aim of the best adaptation of human organisms possible;
• Education and information dissemination done via public media.

Buildings

• Special attention should be paid to types of construction materials when building housing and business premises and types of heat isolation. Outer blinds of constructions should be planned. Attention should be paid to the orientation of the construction.
• Plan existence of air conditioners and filters in building of all the planned housing and business buildings. Plan for individual or group related (few connected premises) regulation of temperature instead of systematic / central.
• Special attention to be paid to control of temperature and humidity for pre-school and school institutions as well as institutions specifically intended for the old and the sick.

Response

• Strengthen mechanisms for early warning and action (strengthen correlation between the public health and meteorology because of duly warning);
• Work and adopt a platform (IHR 2005) for early detection of illnesses and symptoms caused by climate change, and strengthen public health capacities with the formation of a complete infrastructure;
• Adopt long-term planning;
• Establish national “emergency systems;
• Encourage cooperation between the health sector and other sectors (establish certain necessary norms, and work with the transport, energy, construction, and other sectors).

Urban heat island – urban planning

When it comes to the regeneration of cities, it is necessary to use all of the achievements of modern technology that may help in adapting to climate change. With the use of new technologies, it is recommended to apply measures known to old builders – deep canopies, colonnades, entrenchment of buildings, natural shade by planting trees, application of protection elements against excessive sunlight (blinds, window shutters), etc. The way that public areas in towns are used, as well as their shaping, must consider climate change, and there should be aspirations to create green islands, with water surfaces, which decrease temperatures, but also to take into account types of plants for planting (5).

Planning of green surfaces may be one of the significant elements which can prevent occurrence of urban hot islands, decrease temperature in cities, as well as ease the process of adaptation to life with increased temperature. Above the grass surfaces, temperature may be 3-4 degrees lower than above traffic roads (9). For an easier and more pleasant life in cities, it is necessary to increase the standards of green surfaces in the cities, the recommendation being a minimum of 30% for new residential areas, and for the existing ones 10-20%, depending on the location compared to the central city zone (5).

It is necessary to foresee lines of trees for all the streets and to create smaller green oases in residential areas to make movement of the population at high temperatures easier. In city suburbs, it is necessary to establish bigger green facilities intended for residence, sport and recreation, as well as places where the population will be able to spend their free time (5).

In the construction of buildings, there should be a requirement to adhere to the principles of bio-climate: proper orientation of the building, level of insulation, space organization, inclination of the terrain, winds, micro-climatic conditions, shape of the building, roof, number and size of openings towards the four directions, and the selection of materials – application of renewed materials, protection from overheating (canopies, blinds…), greening of the plot, cleaning of the surface around the building, rain-water treatment, etc. ”Green” buildings, roofs and facades should be promoted. Finally, one of the most abused planning parameters should be precisely defined and controlled: distance between buildings, as well as parking (5).

Adaptation strategies - General - Heatwaves

The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (12) 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 (13). 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 (14).

The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (15). 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 (16).

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 (17). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (18).

More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (19).

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 (20). 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 (21).

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 Bosnia and Herzegovina.

1. WHO (2005), in: Behrens et al. (2010)
2. Randalph (2004)
3. Semenza and Menne (2009)
4. Hajat et al. (2003)
5. Vukmir et al. (2009)
6. Keser (2003); Santić et al. (2008), both in: Vukmir et al. (2009)
7. Jovanović (2007), in: Vukmir et al. (2009)
8. Sample et al. (2005); Hotujac et al. (2006), both in: Vukmir et al. (2009)
9. Pucar et al. (1994), in: Vukmir et al. (2009)
10. Lindgren et al. (2006), in: Tamer et al. (2008)
11. EUCALB (2008), in: Tamer et al. (2008)
12. IPCC (2012)
13. Health Canada (2010), in: IPCC (2012)
14. WHO (2007), in: IPCC (2012)
15. Bartzokas et al. (2010), in: IPCC (2012)
16. McCormick (2010b), in: IPCC (2012)
17. Luber and McGeehin (2008), in: IPCC (2012)
18. Semenza et al. (2008)), in: IPCC (2012)
19. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
20. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
21. Akbari et al. (2001), in: IPCC (2012)