Vulnerabilities

Heat stress

The impact of the extremely hot summer of 2003 in Western Europe on heat-related mortality has been studied well; the impact of the hot summer of 2007, which concentrated more significantly in south-eastern Europe, has not received as much attention. This year was one of the warmest in the history of instrumental observations in Greece, Romania and Moldova; in the latter, practically all temperature records were broken in winter, spring and especially in summer. The monthly temperatures in 2007 exceeded the baseline climate (1961–1990) by 2.5–4.0σ, and the summer temperature by 5σ (16). On the whole, in May to September six heat waves and two individual heat days, with a total duration of 47 days, were observed. The enumerated heat events caused 146 excess deaths in Chisinau, the capital of Moldova, or about 77% of the total number in the warm period of 2007. It was estimated that about 17–25% of the total excess deaths refer to a frail subset of the population who would have died shortly thereafter anyway. It was concluded that excess human mortality was higher due to relative high temperatures during the night than during the day (16).

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 (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).

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).

Malnutrition

This vulnerability may appear as a confluence of two factors: first, an important share of the rural population is dependent on smallholder subsistence agriculture and, second, the agriculture sector seems to be poised to suff er a significant impact from climate change. In the absence of adaptation policies, severe climate events, such as droughts, floods and hails may ruin crops, leaving small farmers with no food and no income, meaning that rural children will face serious nutrition risks. It is worthwhile mentioning that already in the recent years, approximately 37% to 40% of children have been suffering from iodine deficiencies, poor nutrition and anaemia (5).

Adaptation strategies - Moldova

Measures such as improved health care, better building design and insulation, and the installation of early warning systems, improved emergency preparedness and disaster relief, and a host of other preventative strategies will help alleviate the health risks and impact of climate change, particularly those associated with extreme weather events. These could be included in a National Adaptation Strategy for the Health Sector or as amendments to the existing sector strategy. The following list of practical measures and policy recommendations has been advised (5):

• An early warning system with regards to extreme weather events, such as heat, and water quality trends posing serious health risks should be introduced. Specifically, for managing negative effects of heat-waves authorities should develop capacities for implementing globally renowned approaches, such as model heat watch systems;
• Extending further medical insurance to fill the gaps in the coverage of the poor and the rural population;
• Implementing sanitation and water treatment projects in order to ensure large rural communities and important social institutions have quality water access;
• Organisation of information campaigns for targeted vulnerable groups of the population;
• During the hot period of the year, provide public transport, work places, hospital areas, institutions for disabled people with air coolers, ventilation systems and medical kits;
• Provide family doctors and ambulances with diagnostic equipment and medical aid kits in case of serious climatic events;
• Examine patients for hypertension illness and other disorders of the circulatory system, intestinal infections and diseases which depend on climate conditions;
• Improve sanitary management in order to improve human health, especially that of pregnant women; coordinate actions between family doctors and specialised consultants;
• Improve preventive treatments for people sensitive to climate conditions in order to diminish the negative impact of extreme climate conditions;
• Develop an aeroallergen monitoring system (currently there is a total absence of data and effort in this area) and asthma surveillance;
• Introduce air quality regulations and ensure the proper implementation of relevant guidance (such as WHO guidance) in this area of concern;
• Develop broad public dialogue involving general public, civil society, and international community emphasising that climate change requires a simultaneous change in behaviour of millions. Focus on promoting healthy lifestyle though such public health campaigns.
• Specific attention should be paid to the health care system, improve its work by building capacity through professional training for medical workers on climate change impacts, new possible diseases, complication of already known diseases, etc.;
• Changes should be made to the system of health data collection from doctors, which currently is paper based and time consuming;
• In order to keep track of health development in the country an electronic system of data collection from doctors should be developed;
• There should be provisions made for extreme weather events, including a regulation for extreme weather cases, by the common efforts of medical and municipal authorities that would provide for climate change related health emergency prevention measures;
• A public information and awareness campaign should be prepared and implemented on a continuous basis, in order to prepare and inform the population on the possible health impacts of climate change and also provide adaptation measures to reduce possible negative results.

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. Urban greening can also reduce temperatures, protecting local populations and reducing energy demands (15).

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 Moldova.

1. WHO (2005), in: Behrens et al. (2010)
2. Randalph (2004)
3. Semenza and Menne (2009)
4. Hajat et al. (2003)
5. UNDP (2009)
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. Corobov et al. (2013)