Protecting health from climate change in southeast Europe, central Asia and the Russian north Dr Bettina Menne, Programme Manager, Climate change, sustainable development & green health services WHO Regional Office for Europe

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Vulnerability Index (WB, 2011)

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; To promote population health within a changing climate

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Core activities for all countries Impact vulnerability and adaptive capacity assessment Health adaptation strategy/action plan Communications and awareness rising Education and training Country KAZXXX KGZXXXX TJKxXXX UZBXXXXX Specific adaptation measures 1.Emergency preparedness 2.Water safety plans and sanitation 3.Infectious disease prevention 4.Energy efficiency and renewable energy for hospitals 5.Air quality monitoring 6.Heat health action plans 7.Assessment of nutrition and food security 8.Dust storm and respiratory disease reduction 9.Strengthened public health services

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Support from WHO Euro provided Vision The nature of the problem Identify interventi ons Prioritize Develop a plan Evaluate and share learning Vulnerability assessment tool Vulnerability Risk assessment mapping (VRAM) Hospital safety index Heat health action plan Public health emergency management (PHEM) IHR Health damage and adaptation costs tool Health protection strategies tool Energy efficiency assessments tool Small scale water plans Air quality standards PAL Menne and Nurse, 2012, forthcoming

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; The Countries: Challenges and Achievements

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Kyrgyzstan

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Health severely affected Deaths and injuries from natural disasters are increasing; Increased projections for cardio-vascular diseases - by 10,5% by 2100; life years lost for man from climate change are higher than for women Increased projections for intestinal infections among children under one - by 18,2% by 2100 The areas of high potential risk for malaria will increase Spread and increase of tick borne infections projected

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Health protection is possible Programme of the health sector of the Kyrgyz Republic on Climate Change Adaptation for Health Adaptation working group: 18 members from MoH and 11 members from government agencies; 24 meetings were hold in 2009 – priorities were recognized in the Program Order of Minister of Health 531 as of 31, October 2011 for Funds necessary: 8,411, USD Funds available: 5,429, USD

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; How does climate change affect you? 1400 Village Health Committees covering people i.e.70% of the countrys population took part in the communication campaign 57 seminars with participation of 1151 representatives of Rural Health Committees and 1029 primary health workers were carried out

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Installing solar panels in 5 hospitals Solar energy technology transferred within 5 health care facilities (solar collectors, solar panels) Assessment of effectiveness of use of alternative energy source carried out Managers of health facilities increased awareness of alternative energy sources and technologies Video broadcast nationally Two methodical guides on use renewable energy sources / efficient technologies in health sector

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Uzbekistan

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; to reduce the burden of respiratory diseases, through early warning and early case detection and management; Monthly means of PM10 and PM2.5 WHO AQ Guidelines annual mean PM10 PM2.5 most of the daily PM 10 concentrations exceeded 50 μg/m, but mostly less than 75 μg/m 3 (monthly average about 70 μg/m 3 ); the general ratio PM 2.5 /PM 10 was about 0.4 in Tashkent (short period – more data available) two dust storm events in Nukus winter in Tashkent, clearly showing the effects of combustion with high PM 2.5. Two stations in Tashkent and Nukus equipped with samplers for PM10 and PM2.5 dust particle monitoring. Staff trained

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; to reduce the burden of respiratory diseases, through early warning and early case detection and management 307 medical doctors and 23 district coordinators have been trained on PAL 26 specialists from hospitals have been trained on the operation of respiratory equipment 90% of first – level health facilities have at least one doctor trained on PAL Health care facilities provided with basic equipment to implement PAL

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Early Warning System on dust storm developed

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Kazakhstan

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; North (Akmolinsk, Kostanay, North- Kazakhstan, Pavlodar regions) I East (East-Kazakhstan region) II West Mangystau, Atyrau, West-Kazakhstan, Aktyubinsk regions) III Central (Karagandy region) IV South (Kyzylorda, South- Kazakhstan, Zhambyl, Almaty regions) V 1. Less vulnerable to CC 2.Cold 3.Fires 4.Transboundary rivers (Irtysh) 5. Precipitations amount increase 6.Abnormal temperatures 7.Lack of foodstuffs 8.Migration 1.Floods and mudflows 2.Air quality (industrial enterprises, test site) 3.Lack of water 4.Unfavorable weather conditions 5.Heat (fires and droughts) 1.Heat >40C- drought, Wind load 2.water quality and amount, including drinking water, 3.Atmospheric air quality 4.Fire threat 5.Decrease of agricultural land areas 6. Development of oils and gas resources 7. Change of sea and the Ural River level 1.Extreme events 2.Lack of water including drinking water 3.Drought and fires 4.Air quality (industries, mines) 5. Lack of foodstuffs 6.Aggravation of sanitary and epidemiological conditions 7.Migration of population 8.Social conflicts (closing of mines, marginal groups) 1.In the south-east area: High air temperature (in summer it is over 50 С) Droughts, dust storms, salinity, fire threat) 2.Lack of water (irrigation, drinking water) 3.Lack of food 4.Aggravation of air quality 5. Migration of population Vulnerability by Region

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Health impacts An increase of ambient temperature by 1°C is associated with: increase of deaths from cerebrovascular diseases from 1.2% to 2.7%. (Women more at risk) Increase of daily deaths from external causes (accidents, homicides). a 5.3% increase in the number of cases of salmonella. Increased risk of changes in distribution of some climate sensitive infectious diseases (plague, CCHF, malaria, tick borne diseases..) Many health care facilities at risk (99 mapped) from extremes, and many hospitals show big gaps in capacity of managing risks

An example on setting priorities

Recommendations World Health Organization Organization 1.Creating mechanisms for interagency coordination to protect public health in a changing climate and environment 2.Creating an environmentally-friendly healthcare system and providing resilience 3.To strengthen the human and scientific potential of the healthcare system of the Republic of Kazakhstan 4.Raising awareness and environmental literacy among the public and healthcare workers 5.Strengthening the system of epidemiological monitoring and surveillance for climate-dependent infections 6.Inclusion of the issues of climate change into the list of priority scientific research, as well as to ones, funded by the Science Foundation 7.Identification of the major health indicators to monitor impact of climate change on health routinely 22

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Tajikistan

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Priorities In general V&A provides basic information for the development of the adaptation measures and sustainability Particular vulnerable populations such as women and children V&A priorities In descending order: Water and sanitation Food security Reproductive Health Communicable diseases Cardiovascular and respiratory diseases

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; NCCHASAP Main activities 1.Improvement of legislative bases. 2.Interventions to reduce vulnerability and socio- economic damage. 3.Enhancement of adaptive capacity of the population 4.Institutional and capacity building. 5.Public awareness.

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Improve water security and safety for health care institutions 80 % of health facilities in country do not have adequate quantity of running water 2 pilot sites chosen for developing Water Safety Plans One hospital site having water safety plan, including repair and installation of safe water delivery system Training on water safety planning Workshop for facilitators team of 13 professionals from Ministry of Health, for Water Safety Plan in pilot villages Training of trainers for hospital plumbing National advocacy seminar for 40 decision makers and potential donors

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Focus groups in Rudaki

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Before introduction to WSP

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; After implementing Water Safety Plan

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Media, people and information

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Water awareness rising

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; The importance of this initiative The multiplier effect –From 1 to 4 The leapfrog effect –Innovation and technology The political effect –Health in the UNFCCC –In the WHA The economic benefits of adaptation –Disease averted; absenteeism avoided The environment benefits –GHG savings The health benefits

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Priorities for the EU – CAR cooperation Support to implement the health adaptation strategies/action plans Strengthen public health and health services, workforce development Infectious disease early identification, mapping, control, surveillance Develop early-warning systems and strengthen health sector engagement in emergency planning Particular focus on vulnerable regions/populations Mother and child health development Men Leap-frog developments: sustainable and green health services/systems Health in NAMAs and in general mitigation action

Almaty, EU-CAR meeting 14 September, 2012 Dr Bettina Menne; Thank You! Dr Bettina Menne Programme Manager Climate change, sustainable development & green health services WHO European Centre for Environment and Health