Vulnerabilities in Denmark

A number of infectious diseases are related to climatic conditions. Altered pollen production as a result of milder winters, etc., can mean that the number of people developing pollen allergies may rise, and the symptoms may worsen. Warmer summers will cause greater growth of toxic algae and some saltwater bacteria, which can pose a risk to people with weakened immune systems. In addition, warmer summers with more outdoor activity can increase the risk of bee or wasp stings and life-threatening allergic reactions to them (1,7).

More extreme rain can lead to greater runoff of health-damaging substances and micro-organisms. There may be an increased health risk associated with exposure to mixed rain and wastewater on land and in cellars, for example. There may also be a need to clarify how long the land should remain unused before re-allowing access as a recreational area, for example (1,7).

The combination of wetter winters, warmer summers and more extreme downpours may cause more moisture damage and mould growth in buildings as well as greater occurrence of dust mites in buildings, with the consequent health problems (1,7).

Cold-stress

Most European countries have between 5 and 30 % higher death rates in winter than in summer. Winter‑related mortality in many European populations has declined since the 1950s (3). Cold days, cold nights and frost days have become rarer, but explain only a small part of this reduction: improved home heating, better general health and improved prevention and treatment of winter infections have played a more significant role (4).

Tick-borne diseases

From a study on the distribution and prevalence of tick-borne infections in Denmark it has been shown that the emerging pathogen A. phagocytophilum is widely distributed and that a marked shift has occurred in the distribution of TBE-complex virus in Denmark. This finding supports studies that predict alterations in distribution due to climatic changes (2).

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).

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).

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 - Denmark

An extension of public prevention and treatment programmes and monitoring systems may be relevant in connection with more heat waves, altered infectious disease patterns, increasing occurrence of allergies and accidents and any increased occurrence of skin cancer in the future climate (7).

Adaptation strategies - General - Heatwaves

The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (8) 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 (9). 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 (10).

The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (11). 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 (12).

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 (13). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (14).

More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (15).

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 (16). 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 (17).

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 Denmark.

1. Danish Government (2008) 
2. Skarphédinsson et al. (2005)
3. Kunst et al. (1991); Lerchl (1998); Carson et al. (2006), in: EEA, JRC and WHO (2008)
4. Carson et al. (2006), in: EEA, JRC and WHO (2008)
5. Semenza and Menne (2009)
6. Hajat et al. (2003)
7. Danish Ministry of Climate and Energy (2010)
8. IPCC (2012)
9. Health Canada (2010), in: IPCC (2012)
10. WHO (2007), in: IPCC (2012)
11. Bartzokas et al. (2010), in: IPCC (2012)
12. McCormick (2010b), in: IPCC (2012)
13. Luber and McGeehin (2008), in: IPCC (2012)
14. Semenza et al. (2008)), in: IPCC (2012)
15. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
16. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
17. Akbari et al. (2001), in: IPCC (2012)