Vulnerabilities

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 (5,6). 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 (5).

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).

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 (17,19).

Anticipated climate impacts on air quality were assessed for the Czech Republic, Poland, Hungary and Bulgaria by simulating air quality for 3 decades: 1991−2000, 2041−2050, and 2091−2100 under the IPCC A1B scenario (18). In order to exclusively study climate impacts on air quality, the anthropogenic emissions were kept constant in all simulations at the values of the year 2000 for all considered time slices. The impacts of the simulated climate change on the air quality are rather weak for the mid-century (2041−2050). For the end-century (2091−2100), an increase in summer mean ozone was shown and a decrease in annual mean particulate matter with a diameter < 10 μm for all four countries. The main climate factors responsible for the projected changes were an increase in summer temperature and a decrease in summer precipitation for ozone, and an increase in winter precipitation for fine particulate matter (18).

Heatwaves

Extended heat waves will have serious health implications (17).

Adaptation strategies - General - Heatwaves

The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (7) 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 (8). 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 (9).

The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (10). 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 (11).

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 (12). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (13).

More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (14).

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 (15). 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 (16).

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 Bulgaria.

1. WHO (2005), in: Behrens et al. (2010)
2. Randalph (2004)
3. Semenza and Menne (2009)
4. Hajat et al. (2003)
5. Lindgren et al. (2006), in: Tamer et al. (2008)
6. EUCALB (2008), in: Tamer et al. (2008)
7. IPCC (2012)
8. Health Canada (2010), in: IPCC (2012)
9. WHO (2007), in: IPCC (2012)
10. Bartzokas et al. (2010), in: IPCC (2012)
11. McCormick (2010b), in: IPCC (2012)
12. Luber and McGeehin (2008), in: IPCC (2012)
13. Semenza et al. (2008)), in: IPCC (2012)
14. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
15. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
16. Akbari et al. (2001), in: IPCC (2012)
17. Lelieveld et al. (2012)
18. Juda-Rezler et al. (2012)
19. Lelieveld et al. (2013)