Vulnerabilities - Direct and indirect effects

Climate change can affect human health through a wide range of direct and indirect effects. The direct effects on human health are a consequence of temperature changes (especially extreme heat waves), increased frequency and intensity of the occurrence of extreme weather conditions and increasing penetration of the short-wave part of the ultraviolet spectrum to the surface of the Earth. Those components of the environment that were modified by climate change (air pollution, changes in the occurrence of infectious diseases, food production, social and economic changes, etc.) have indirect effects (1).

Vulnerabilities - Tick-borne diseases

Climate change may substantially increase the occurrence of tick-borne encephalitis and Lyme’s borreliosis, and the occurrence of diseases transmitted by vectors in connection with increased average air temperatures. Infections transmitted by ticks will spread to areas where they did not formerly occur, including areas at higher altitudes. The increase in temperature will aggravate the risk of gradual spreading of different species of ticks and blood-sucking insects, acting as transmitters of infections. Repeated introduction of Mediterranean ticks by the dogs of tourists and spreading of the vehicles of Leishmaniasis, which has already been found in southern Germany, have been observed (1).

In 1993 the incidence of tick-borne encephalitis (TBE) showed a sharp rise in central Europe and has remained high since, with some slight fluctuation. This increase is clearly evident in the Czech Republic and it could be roughly characterised as twofold in 1993-2001 in comparison with 1984-1992 (5,240 versus 2,441 human cases). As yet in the Czech Republic, the TBE increase has been manifested by (3):

• higher number of cases in areas well known for TBE occurrence in humans;
• re-emergence in areas where TBE human cases were not observed, or only sporadically, for a long time;
• emergence of TBE in places unknown previously (including highly elevated areas).

From research it was concluded that the increased TBE incidence rates reported in 1993 and afterwards are attributable to a more abundant occurrence of I. ricinus ticks and that their higher abundance is due to modified climatic conditions in the last decade (3).

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 (4). The upsurge of TBE in the 1980-90s in Central and Eastern Europe generally has been attributed to socio-economic factors (human behavior) rather than temperature (27).

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 (8,9). 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 (8).

Vulnerabilities - Mosquito-borne diseases

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 (5).

Vulnerabilities - 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 (5).

Vulnerabilities - Pollen allergies

Another of the consequences of elevated temperatures consists in greater occurrence of pollen grains and fungus spores in the air; the number of pollen grains increases exponentially with maximum daily temperatures, while the number of fungus spores increases with increasing daily minimal temperatures (1).

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 (12,28). Under the current climate, surface urban heat island effects, defined as the difference between mean land surface temperatures for urban and rural areas, have been reported for the city of Brno of 4.2 and 6.7 °C for two summer days (26).

While most summer heat waves over the period since 1986 were associated with significantly elevated mortality in the Czech Republic, this was not the case for three out of the four heat waves in 2003. The relatively weak mortality response was particularly noteworthy for the most severe heat wave which occurred in the first 10 days of August 2003 and resulted in enormous excess mortality in some western European countries (2).

A mortality displacement effect and short-term adaptation to heat contributed to the reduced mortality impacts of the heat waves that followed after previous relatively warm periods. However, the decreased mortality response of the 2003 heat waves compared to previous heat waves in the 1990s is also likely to have arisen from positive health-care and other socio-economic changes in the post-communist central European region over the past decade, as well as a better public awareness of heat-related risks due to enhanced media coverage and regular biometeorological forecast and warnings (2,7).

Vulnerabilities - Air quality

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 (23). 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 (23).

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 (6).

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 (6).

Adaptation strategies - Czech Republic

Early-warning system for tick activity

An early warning system was developed in the Czech Republic for tick-borne encephalitis (TBE), which has been a notifiable disease since late 1950s. Since 1971, all reported TBE cases are laboratory confirmed. The incidence of TBE demonstrated a significant increasing trend in the country since the early 1990s, and the seasonal variations in TBE are related to climate variations (24). The emerging disease situation led the Centre for Epidemiology and Microbiology (CEM) at The National Institute of Public Health (SZU) in Prague in collaboration with the Czech Hydrometeorological Institute (CHMI) to develop in 2000 an early-warning system for tick activity and, hence disease risk. It consists of forecasts that predict daily tick activity several days to a week in advance, published twice a week at the websites of CEM and CHMI (25). This system has been implemented in 2007 (1).

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).

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 the Czech Republic.

1. Ministry of the Environment of the Czech Republic (2009)
2. Kyselý and Kříž (2008)
3. Daniel et al. (2004)
4. Randalph (2004)
5. Semenza and Menne (2009)
6. Hajat et al. (2003)
7. Kysely and Plavcova (2010)
8. Lindgren et al. (2006), in: Tamer et al. (2008)
9. EUCALB (2008), in: Tamer et al. (2008)
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)
23. Juda-Rezler et al. (2012)
24. Daniel et al. (2011), in: Ebi et al. (2012)
25. Ebi et al. (2012)
26. Dobrovolný (2013)
27. Šumilo et al. (2008, 2009), in: IPCC (2014)
28. Urban et al. (2019)