1. James Creswick Bettina Menne Global Change and Health WHO Regional Office for Europe James Creswick Bettina Menne Global Change and Health WHO Regional Office for Europe Protecting health in Europe from climate change 3rd EIONET Workshop

2. Content WHO political mandate WHO Regional Office for Europe activities on climate change and health Current challenges Monitoring health effects over time

3. The rising profile of climate change and health at global level Climate change top priority of UN; UN Secretary General establishes coordination group including WHO; World Health Day "Protecting health from climate change" – April 2008; World Health Assembly Resolution on climate change and health - May 2008; World Health Assembly approves new WHO workplan on climate change and health – May 2009

4. Mandates from World Health Assembly and Executive Board Urges member states: Include health measures in adaptation plans Build technical, strategic and leadership capacity in the health sector Strengthen capacity for preparedness and response to natural disasters Promote active cross-sectoral engagement of the health sector Express commitment to meeting challenge of climate change, and guide planning and investments

5. Mandates from World Health Assembly and Executive Board Requests the WHO Director General to promote research and pilot projects in this area; to engage actively in the UNFCCC Nairobi Work Programme to consult Member States on the preparation of a workplan for scaling up WHO’s technical support.

6. WHO workplan on climate change and health (WHA 2009) Aim: to support health systems of all countries, but in particular those of low and middle income countries and small island states, to enhance capacity for assessing and monitoring the health vulnerability, risks and impacts due to climate change identify effective strategies and actions to protect human health and particularly the most vulnerable groups share knowledge and good practices on health system actions

8. In the European Union The White paper: Outlines the need to Increase the resilience of health and social policies calls upon exploring with the WHO and EU agencies ways of ensuring adequate surveillance and control of the impact of climate change on health, such as epidemiological surveillance, the control of communicable diseases and the effect of extreme events. In the accompanying staff working paper "Adapting to climate change: Towards a European framework for action Human, Animal and Plant Health Impacts of Climate Change", it calls upon –Cooperating with the WHO and within the WHO Framework for Action in the European Region and the WHA resolution on climate change and health complements the WHO actions within the territory of the EU.

9. Climate change in WHO Euro Region World Health Day 2008: “Protecting health in Europe from climate change” (7 April) 3rd Ministerial Conference on Environment & Health London, 1999 4th Ministerial Conference on Environment & Health (extreme events & energy), Budapest, 2004 Nobel Peace Prize to the IPCC World Health Day 2007: focus on health security

10. 5 TH Ministerial Conference health issues at all levels and sectors in all current and future climate change mitigation and adaptation measures strengthen health systems to improve their capacity to prepare for the health impacts of climate change; Strengthen research and develop and implement educational and public awareness programmes on climate change and health; promote active collaboration between and coordination of early warning and response systems for disease and emerging threats to vulnerable populations; aim to increase the health sector’s contribution to reducing greenhouse gas emissions and its leadership on energy- and resource-efficient management, in collaboration with the environment sector. to set up a European [information platform/clearing house], for systematic sharing of best practices, research, data, information, technology and tools at all levels. Regional framework for action Protecting health in an environment challenged by climate change and Ministerial Declaration:

11. Heat-wave increases are a most certain consequence of climate change Mortality increases between 1% and 4% for each degree of temperature increase (KOVATS 2006) HOW TO REDUCE HEALTH EFFECTS Implement heat-health action plans by  ensuring health systems’ preparedness and ability to respond  reducing community exposure to heat  providing timely weather-related health alerts and advice to citizens  86,000 extra deaths estimated per year with a global mean temperature increase of 3°C in 2071-2100 in the EU (PESETA 2008).  Over 70,000 extra deaths reported in Europe in summer 2003 (ROBINE 2008). Number of daily mortality in Paris and min-max temperatures 25 June-19 August 2003. Paris Funeral Services (2003)

12. Health effects of air pollution and heat Age group Low* PM 10 % increase (95% CI) High** PM 10 % increase (95% CI) All ages + 11.1 (6.3, 16.0)12.6 (8.7, 16.8) 0-64 yrs7.6 (2.3, 13.2)7.7 (4.3, 11.2) 65-74 yrs8.8 (3.6, 14.3)9.3 (4.8, 14.0) 75-84 yrs + 11.2 (4.2, 18.6)13.6 (8.6, 18.9) 85+ yrs + 12.6 (5.5, 20.1)19.4 (8.1, 31.9) *: at the 25 th percentile of the city-specific distribution of ozone **: at the 75 th percentile of the city-specific distribution of ozone +: significant interaction at P<0.05 Percent increase in the total daily number of deaths in days with a heat-wave and a “low” or “high” level of PM10 (random effects models) EuroHEAT technical summary, 2009

14. Public health action Recommendations for the public during heat-waves Vulnerable population groups Recommendations for general practitioners Some recommendations for retirement and care home managers Adverse effects of drugs during hot weather Considerations for medical professionals regarding drinking recommendations during hot weather and heat-waves Key principles of heat risk communication Mild and moderate heat illnesses and their management Management of life-threatening heatstroke Reducing indoor temperatures during hot weather

15. Seasonal forecasting http://www.euroheat-project.org/dwd/index.php

16. Assistance to countries: core capacity development Collaborative mechanisms between institutions and a lead body to coordinate emergency responses; Accurate and timely meteorological forecasts; Reduction of exposure to heat; Particular care for vulnerable populations; Provision of health care, social services and infrastructure; Risk communication mechanisms; Urban planning, energy and transport policies; Monitoring and evaluation. Key early warning indicators; Prevention and risk reduction measures; Case examples

18. Health security assessments DG SANCO co-funded project in 2007/2008 http://www.euro.who.int/Document/E92121.pdf ENP: Armenia, Azerbaijan, Moldova (country reports online) Strengthen health systems to manage crises Tool for health security assessment –Checklist for health systems’ preparedness planning (including infrastructure, safer hospitals, …) –Health crisis management and health-risk reduction; early warning and surveillance –Multi-hazard approach and multi-sectoral coordination mechanisms

20. Protecting health from climate change in Southeast Europe, Central Asia & Northern Russian Uzbekistan: Dust storms Droughts Aral sea environmentally degradated Food production decrease Tajikistan: GLOFs, floods, landslides Droughts, aridity of soil; food production decrease Kyrgyzstan: GLOFS, floods, landslides droughts Kazakhstan: Increase in aridity of soil; heat-waves; extreme precipitation; Former Yugoslav Republic of Macedonia: Increased risk from heat-waves Albania: Heat-waves frequency Effects of air quality in summer Reduced hydrological resources Russian Federation: Permafrost melting Environmental degradation WHO Regional Office for Europe German Ministry for Environment (BMU)

21. Project Activities Developing health adaptation strategies: Capacity will be developed to enable participating countries to assess the health risks from climate change, with a particular focus on vulnerable groups, emerging risks, the capacity of health systems to take action now; and to target national or sub-national health adaptation strategies. Increasing surveillance and early disease detection: National and sub-national capacity in early identification of potential infectious disease risks from climate change, improved systems for outbreak alert and response and stronger capacity to implement the revised International Health Regulations, will be developed. Strengthen early warning, make hospitals safe and prepare for extreme weather events: Early warning mechanisms for heat-waves and other extreme weather events will be developed and heat-health action implemented. Emergency medical services will be strengthened, and guidance for disaster-proofed health care infrastructure provided. Implementing the European Food and Nutrition action plan: a pilot survey on the risks for nutrition within the WHO Food and Nutrition Action Plan for Europe will be carried out. Improving air quality, early identification of respiratory diseases: Air quality monitoring and action to reduce air pollution will be strengthened. Dust early warning systems will be connected to the early identification of respiratory diseases. Energy efficient health services: Energy efficiency in health services will be assessed to help saving government expenditure and to contribute to adapt to heat and cold. Access to renewable energy will be provided to increase resilience of health services, particularly in isolated areas. Information sharing: Information sharing will be ensured through a web-based information platform.

22. Scope of Indicators Most important public health problems: - a widespread significance both at national and multinational levels; - magnitude and severity of ill-health The climate change-health indicators should enable a balanced & comprehensive picture of the most important public health problems related to climate change across the Region The following health-relevant aspects of climate change were selected: (a) acute climatic events: floods, heat waves; (b) ambient air quality including air-borne pollen/ allergen; (c) infectious diseases: vector-borne, food-borne and water.

23. Overview of indicators (1 of 2) Air quality & respiratory health 1Population exposure to Ozone 2Respiratory mortality (COPD, pneumonia) Air-borne pollen/ allergens 3Air-borne pollen/ allergen exposure: flowering 4Air-borne pollen exposure: intensity x duration 5Population exposure to ragweed 6Respiratory morbidity Acute climatic events and health 7Flood-related mortality 7aPolicy action to counteract health effects of flood 8Excess heat-related mortality: short-term 9Excess heat-related mortality: long-term 10Policy action to counteract heat-related health effects

24. Overview of indicators (2 of 2) Infectious diseases 10Lyme disease 11Salmonellosis: human cases 12Cryptosporidiosis and water-borne outbreaks Policy action indicator 13Cross-cutting integrating 5 components in one index; or 5 separate indicators (like 7a and 9a) Surveillance systems for the above infectious diseases/ groups is in urgent need for improvement across the EURO Current surveillance systems are passive (based on notification), lack sensitivity and have considerable under-reporting

25. Further information & contacts James Creswick – jcr@ecr.euro.who.intjcr@ecr.euro.who.int Bettina Menne – bme@ecr.euro.who.intbme@ecr.euro.who.int Website: www.euro.who.int/globalchangewww.euro.who.int/globalchange Address: WHO Regional Office for Europe European Centre for Environment and Health Via Francesco Crispi 10, I-00186 Rome, Italy