Vulnerabilities Montenegro

Heat stress

Heat waves combined with urban heat islands (11) can result in large death tolls with the elderly, the unwell, the socially isolated, and outdoor workers (12) being especially vulnerable. Heat waves thus pose a future challenge for major cities (13).

Montenegro can expect a further increase in temperature, especially in the summer months, which will negatively affect the health condition of high-risk groups, while on the other side a temperature increase during the winter will lead to lower morbidity and mortality, particularly for chronic patients (5).

Over longer timescales, it is also possible for some degree of physiological acclimatization to occur. The countries with the highest rates of “excess” winter mortality in Europe are Portugal and Spain, while excess winter mortality is lowest in the Scandinavian countries, although their winters are much colder. Scandinavians are well adapted (acclimatized) to cold temperatures, while housing standards in southern and Western Europe may play a strong part in mortality seasonality (7).

Water, food and air quality

An increase in average monthly temperature, especially for the summer, will cause a higher frequency of diseases that are transmitted by food and water, such as salmonellosis, toxicoinfections and diarrhea (5).

Increasing temperatures in spring will prolongue spring vegetation, and thus also the allergy-caused respiratory diseases: seasonal allergic rhinitis and allergic asthma caused by pollen from trees, grasses and weeds, especially in case of children (5).

Temperature can influence transmission of salmonella infections, and has been estimated to be associated with about 35 % of all cases (including in the Netherlands, England, Poland, Switzerland and Spain) (6). In general, cases of salmonella increase by around 5–10 % for each degree increase in weekly temperatures, above a threshold of around 5 °C.

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).

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 (9,10). 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 (9).

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 - Montenegro

A change in behaviour and awareness building of the population about the impact of climate on health and how to reduce the impact of future climate change must be encouraged. Necessary primary measures of adaptation for the purpose of prevention, preparedness and action to prevent, mitigate and adapt to climate change include (5):

• permanent surveillance and control of health safety of drinking water;
• maintaining and improving water and sewer infrastructure, with special emphasis on the coastal part;
• air monitoring;
• quality control and improvement of the food chain; production and implementation of national action plans for food;
• strengthening of surveillance and control of communicable diseases;
• strengthening of the already existing public health measures of disease control and health protection, especially for high-risk groups;
• development and implementation of legal regulations concerning the environment and health;
• strengthening of regional and international cooperation to manage the risks carried by climate change;
• reform and strengthening of the public health sector for the coming climate change, its early organization and professional training in extreme situations, and especially well organized emergency medical services;
• preparation of national action plans, strategies for the prevention of effects of climate change on human health, their mitigation, adaptation to new conditions, especially for extreme heat;
• establishing a national system for early warning of impending disasters; inter-sectoral collaboration, research, pilot projects and studies on the influence of meteorological parameters on health, which will help finding the correlation between climate change and health.

Planned and proactive adaptation can reduce climate impacts in different ways. It may reduce population exposure to climatic stimuli (e.g., through urban planning and design); it may reduce population sensitivity (e.g., through vaccination programs); it may modify the non-climate risk factors (e.g., control of disease vectors); or it may reduce the direct impact of the disease (e.g., through early notification and treatment) (8).

Adaptation strategies - General - Heatwaves

The outcomes from the two European heat waves of 2003 and 2006 have been summarized by the IPCC (14) 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 (15). 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 (16).

The European Network of Meteorological Services has created Meteoalarm as a way to coordinate warnings and to differentiate them across regions (17). 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 (18).

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 (19). Some evidence has even shown that top-down educational messages do not result in appropriate resultant actions (20).

More generally, research shows that communication about heat preparedness centered on engaging with communities results in increased awareness compared with top-down messages (21).

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 (22). 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 (23).

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 Montenegro.

1. WHO (2005), in: Behrens et al. (2010)
2. Randalph (2004)
3. Semenza and Menne (2009)
4. Hajat et al. (2003)
5. Ministry for Spatial Planning and Environment of the Republic of Montenegro (2010)
6. Kovats et al. (2004), in:  Callaway et al. (2010)
7. Healy (2003), in:  Callaway et al. (2010)
8. Callaway et al. (2010)
9. Lindgren et al. (2006), in: Tamer et al. (2008)
10. EUCALB (2008), in: Tamer et al. (2008)
11. Basara et al. (2010); Tan et al. (2010), in: IPCC (2012)
12. Maloney and Forbes (2011), in: IPCC (2012)
13. Endlicher et al. (2008); Bacciniet al. (2011), both in: IPCC (2012)
14. IPCC (2012)
15. Health Canada (2010), in: IPCC (2012)
16. WHO (2007), in: IPCC (2012)
17. Bartzokas et al. (2010), in: IPCC (2012)
18. McCormick (2010b), in: IPCC (2012)
19. Luber and McGeehin (2008), in: IPCC (2012)
20. Semenza et al. (2008)), in: IPCC (2012)
21. Smoyer-Tomic and Rainham (2001), in: IPCC (2012)
22. Yip et al. (2008); Silva et al. (2010), both in: IPCC (2012)
23. Akbari et al. (2001), in: IPCC (2012)