10.3.4. Climatic changes and extreme weather conditions
Acronyms
10.3.4.1.
Introduction
Floods, extreme temperature, droughts and wildfires
cause thousands of deaths and billions of euro of economic loss each year in
the WHO European Region. Between 1990 and 2006, the Emergency Events Data Base
(EM-DAT, 
http://www.emdat.be), a global
disaster database managed by the Centre for Research on the Epidemiology of
Disasters – a WHO collaborating centre – recorded 323 events, causing 76.250
deaths in the 25 European Union countries26, affecting over 12 million
people, with an estimated economic damage of more than 78.000 Million Euro.
This chapter presents first of all an information source and then provides an
overview on different extreme events and the impacts these have (Table
10.3.4.1). Finally, it highlights the need to develop more effective control
and policy tools.
Table 10.3.4.1. Global trends in extreme weather
events
|
|
|
Phenomenon and trend
|
Projections for the
21st century
|
Benefits or risks to human health
|
|
Over most land areas, warmer and fewer cold days and
nights, warmer and more frequent hot days and nights
|
Virtually certain
|
Reduced mortality from decreased cold exposure
|
|
Increase in frequency of warm spells/heat-waves over
most land areas
|
Very likely
|
Increased risk of heat-related mortality, especially for
the elderly, chronically ill, very young and socially isolated
|
|
Increase in frequency of heavy precipitation events over
most areas
|
Very likely
|
Increased risk of deaths, injuries, infectious,
respiratory and skin diseases, and mental health problems
|
|
Increase in drought areas
|
Likely
|
Increased risk of food and water shortages, malnutrition
and water- and foodborne diseases
|
|
Increased incidence of extreme high sea levels
(excluding tsunamis)
|
Likely
|
Increased risk of deaths and injuries from drowning and
of negative migration-related health effects
|
|
Source: adapted from Climate change 2007 (IPCC, 2007a).
|
10.3.4.2. Data sources
In response to the need for better data on disaster
occurrence, a number of databases have been established around the world, with
different criteria, formats and purpose. These databases, while individually
useful, have been generally limited in scope and have not been compatible with
other existing databases. Inconsistencies, data gaps and ambiguity of
terminology make comparisons and use of the different data sets difficult. This
had let to a fair amount of confusion in the perception and evaluation of a
disaster situation and poses a severe obstacle for planning and fund raising.
Since 1988 the WHO Collaborating Centre for Research on
the Epidemiology of Disasters (CRED) operates an Emergency Events Database
(EM-DAT). EM-DAT was created with the support of the WHO and the Belgian
Government with the main objective to serve the purposes of humanitarian action
at national and international levels. It is an initiative aimed to rationalise
decision making for disaster preparedness, as well as providing an objective
base for vulnerability assessment and priority setting. For example, it allows
on to decide whether floods in a given country are more significant in terms of
its human impact than earthquakes or whether a country is more vulnerable than
another for computing resources is. EM-DAT contains core data on the occurrence
and effects of over 12.800 mass disasters in the world from 1900 to present.
The database is compiled from various sources, including UN agencies,
non-governmental organisations, insurance companies, research institutes and
press agencies.
Establishing a central database on all disaster events
occurring in the world is an effort, which requires first of all, the data
items to be included in the register. To be workable, these definitions have to
be kept simple and concrete to allow easy collection of these data by field
assessment teams. Standard procedures for the collection and reporting of these
data also have to be worked out between all participants to this effort. In
order to remain a manageable enterprise, the scope of this central database has
to be limited only to essential data and agency specific information may be
maintained as supplement to this core database. For a disaster to be entered
into the database at least one of the following criteria must be fulfilled: 10
or more people reported killed, 100 people reported affected, declaration of a
state of emergency or call for international assistance (EM-DAT, 2007).
10.3.4.3. Data
description and analysis
Climatic changes
There is growing evidence that climate change and
variability is now affecting health. Heat-waves and cold-waves, floods,
droughts, fires and intense rainfall: in recent years, European countries have
been experiencing increases in the severity and frequency of extreme weather
events. These events are putting many people at risk. Children, the elderly and
the poor are the most vulnerable.
European Ministers acknowledged already in 1999 at the
Third WHO Ministerial Conference on Environment and Health the relationship
between human-induced changes in the global environment and a range of severe
health risk which are threatening economic development as well as social and
political stability.
The Intergovernmental Panel on Climate Change has provided
evidence that most of the changes observed today result from rising greenhouse
gases emissions over the last 50 years. However, the effects of measures that
countries have begun to put into place will take a long time to appear. This
stresses the need for immediate action. Identifying potential risks early
enough and responding in a timely fashion will protect the public health.
Climate change is becoming a reality with increases in
surface temperature, sea level and heat waves, and with a shrinkage of the
Arctic sea ice (Solomon, 2007; ICC, 2007a). In Europe, climate change has
caused an increase in the frequency and intensity of heat-waves – which alone
in summer 2003 killed more than 50000 people (Menne, 2005; Menne & Ebi,
2006). The 2005 European Commission’s Communication "Winning the Battle
against Global Climate Change" outlined the challenges ahead for
tackling global climate change. The European Council and Parliament have both
confirmed the objective to limit average global temperature increase to a
maximum of 2°C compared to pre-industrial levels. The European Council
expressed the need to further explore strategies that can deliver the necessary
emission reductions and requested the European Commission to deepen its
analysis. A new Communication is being prepared to respond to this request
(European Commission, 2007).
The EU is projected to reach its Kyoto targets.
Projections of existing policies for the EU15, show that greenhouse gas (GHG)
emissions will only be 0.6% below base-year levels in 2010, well above the
collective reduction target of 8% for 2008-2012. Additional measures can reduce
the gap by more than half and the Kyoto mechanisms and the removal through
sinks will deliver the remaining effort. This underlines the importance of the
implementation of all existing and additional measures. A second phase of the
European Climate Change Programme (ECCP) started in October 2005. The European
Commission has since come forward with a proposal to include aviation in the EU
emissions trading scheme (EU ETS) and will put forward a communication on
emissions from cars, a proposal on carbon capture and geological storage (CCS)
and a Green Paper on adaptation during 2007. The review of the EU-ETS has started
and the 7th Framework Programme for research (2007-2013) increased the budget
for environment, energy and transport to around € 8 bn.
New research confirms that the climate is actually
changing and there are indications that these changes have accelerated. The 10
warmest years on record occurred after 1990. Today's atmospheric methane and CO2
levels are unmatched during the last 650000 years. Acceleration in sea-level
rise has been observed. A large share of the ecosystem services will be
adversely impacted such as reduced glacier cover and increased ocean
acidification, with potentially dramatic impacts on the environment.
Uncertainty about the impacts of climate change is reduced. Critical
temperature levels that risk to trigger large scale disruptions are well within
the range of projections for this century, confirming the need to limit
temperature increase to 2°C. Recent studies point to an increasing risk of
exceeding the 2°C objective with GHG concentrations levels beyond 450 parts per
million volume CO2 equivalent (ppmv CO2 eq.).
The climate change adaptation strategies for human health
(CCAHSh), funded by the EC-DG Research and concluded in 2005, investigated the
epidemiology of several climate-related diseases, providing advice on how
health systems could be prepared to deal with them. EUROHeat, funded by the
EC-DG SANCO and currently underway, aims at producing guidelines on
heat-related disease and advice on how to improve public health responses to
heat-waves. EUROHeath pays special attention to the ageing population, children
and workers who are particularly exposed or vulnerable to heat.
Scientific methodologies and data gaps still do not allow
for a complete analysis of the costs of inaction. The on-going PESETA study,
coordinated by the Joint Research Centre will fill some of the knowledge gaps
for the EU. Preliminary results indicate that grain crop productivity is
projected to decrease in Southern Europe and increase in Northern Europe. Health
effects include increased summer heat related mortality and morbidity
(illness). The reverse is the case for winter. Preliminary results indicate
that without acclimatisation the increase in heat related deaths by the end of
the century could be larger than the reduction in cold related deaths. Damages
due to sea-level rise in the EU are very significant if no adaptation
occurs. Adaptation reduces costs in the medium term up to 50% and in the long
run by more than 70%. The results show the benefits of timely adaptation using
measures like dike construction and beach nourishment. However, costs will
remain considerable. Extreme weather events such as major floods are projected
to increase. Preliminary results for two river catchments draw consistent
conclusions. Estimated total damages of a 100-year flood are projected to
increase with up to 40% for the Upper Danube and up to 14% for the Meuse
catchment. Preliminary results also indicate that the zone with excellent
conditions for beach tourism currently located around the Mediterranean, will
shift towards the North, but conditions in spring and autumn in the
Mediterranean will improve. The extent of the impacts will depend on the level
of adaptation by tourists to these changes in weather conditions.
Climate actions to reduce emissions and reverse deforestation,
once agreed upon and implemented, would also have substantial benefits on other
policy domains such as air quality, energy security, employment and soil
fertility.
Extreme weather events
Table 10.3.4.2 gives an overview of events recorded in
European Union countries. Extreme temperature events, specifically the
heat-waves affecting Western Europe, accounted for most of the deaths, whereas
floods, although much more frequent, caused relatively fewer deaths. The
following sections give more details on specific events: on extreme temperature
events as the event having caused most deaths, on flooding and storms as the
most frequent events and on droughts as the extreme event having affected most
people.
Table 10.3.4.2.
Deaths and damage from extreme weather events in 25 European Union countries, 1990–2006
Only accidents with 10 or more killed and/or 100 or more
affected are included in the figure. Accidents include the following
categories:
1) industrial accidents: technological accidents of an
industrial nature or involving industrial buildings (such as factories),
including chemical spills or leaks, explosions, radiation and gas leaks,
poisoning, fires and other technological accidents involving industrial sites;
2) transport accidents: technological transport accidents
involving mechanized modes of transport, including accidents involving
aeroplanes, helicopters, airships and balloons, accidents involving sailing
boats, ferries, cruise ships, other boats, accidents involving trains and
accidents involving motor vehicles on roads and tracks; and
3) miscellaneous accidents: technological accidents of a
non-industrial or transport nature, including explosions, collapses, fires and
other miscellaneous accidents involving domestic/non-industrial sites.
Extreme temperatures are periods of very low (cold
spells) or high (heatwaves) temperatures. Heatwaves are associated to significant short-term
increases in mortality. High temperatures contribute to about 1-2% of annual
mortality in older age groups in Europe , although large uncertainty remains in
quantifying this burden in terms of lost years of life. The sensitivity of a
population to extreme temperature changes over decadal time-scales . A main reference point is the unexpected
heat-wave that hit parts of Europe in 2003, resulting in an unprecedented death
toll of more than 70 000 excess deaths. For populations in the EU,
mortality has been estimated to increase 1–4% for each degree increase of
temperature above a cut-off point. During heat-waves, deaths increase from a range of causes.
Other harmful exposures were also caused or exacerbated by
extreme weather, e.g. outdoor air pollutants (tropospheric ozone and
particulate matter) and pollution from forest fires. Further to the severe
health impacts, the heatwave caused also economic damages. France and Italy
claimed 4 400 Million US $ damage each, Germany 1650 Million US $ and Spain 880
Million US $ economic damage.
Some crucial lessons have been learned from the 2003
experience about who was affected and what were the risk factors. These risk
factors should help Member States in the European Region to adopt measures to
prevent similar health effects in the future and mitigate the effects of
high-temperature. Risk factors refer to age, specific causes of death and
pre-existing illness as well as to medication and the place of residence.
For example, people older than 70 years of age were
affected most severely. Given the ageing populations in many European
countries, this is of particular concern. In France, deaths among people aged
75 or more increased by 70%, in United Kingdom by 22% (with a 59% excess in the London area), in Portugal by 47% and in
Italy by 21%, amounting to 92% of all deaths. Females were particularly
affected. In France, female mortality was 15–20% higher in all age groups, in
Italy 32–33% and in Portugal more than twice . Elderly people are most at risk
because ageing impairs the body’s physiological capacity to regulate its own temperature
(thermoregulation). Children, people with chronic diseases and those confined
to bed, need particular care during extremely hot weather conditions.
With regard to cause of death, the burden of
heat-wave mortality falls across a wide range of causes. Heat stroke, although
widely underreported, was fatal in 10–50% of all cases and may lead to nervous
system disorders in 20–30% of people. Deaths have been further attributed to
cardiovascular and respiratory diseases. People with chronic debilitating
diseases are more at risk. These include cardiovascular diseases, respiratory
insufficiency, mental and nervous system disorders, blood and metabolic or
endocrine gland disorders, diabetes and malnutrition. In particular, people
confined to bed need to be carefully followed up.
Many types of medication can directly affect the central
and peripheral mechanisms of thermoregulation and/or increase cardiac output
and thereby heat elimination. Heat exposure can increase medication toxicity
and/or decrease its efficacy. Health professionals need to give careful advice
to people taking medication. Age-associated factors such as social isolation
are very important, as are the often lower socioeconomic status of elderly
people and the social and health care aspects of their lives. The highest
excess mortality was registered among vulnerable, low-income people (+18% in Rome) and in groups with lower educational levels (+43% in Turin) . Nursing homes in
Northern Italy and retirement homes in France reported a larger than expected
excess death rate.
Figure 10.3.4.1.
The distribution of excess mortality during heatwave 2003 in 25 European Union
countries
Vulnerability in urban and rural areas
is different; heat island effects in all large urban environments can account
for a temperature increase of up to 4.6°C during summer in Athens or 8°C in London . The Urban heat island effect increases existing health risks in urban areas
and excess mortality in France ranging from +4% in Lille to +142% in Paris
suggests that heat gain by city buildings or traffic patterns may influence
mortality . Exceptionally, mortality cases were reported more in rural villages
than in provincial capitals in Spain . The position and location of buildings,
indoor temperature, exposure to a high concentration of ozone and particulate
matter and heat-waves with higher intensity and duration increased the risk of
dying during a heat wave.
The opposite extreme event to heat waves are cold-spells.
Cold-related mortality in European populations has declined since the 1950s . Cold days, cold nights
and frost days have become rarer, but explain only a small part of this
reduction in winter mortality; as improved home heating, better general health
and improved prevention and treatment of winter infections have played a more
significant role . In general, population sensitivity to cold weather is
greater in temperate countries with mild winters, as populations are less
well-adapted to cold . However, cold spells continue to be a problem in
Northern latitudes, where very low temperatures can be reached in a few hours
and extend over long periods. Accidental cold exposure occurs mainly outdoors,
among socially deprived people (alcoholics, the homeless), workers, and the
elderly in temperate and cold climates . Living in cold environments in polar
regions is associated with a range of chronic conditions in the non-indigenous
population as well as with acute risk from frostbite and hypothermia . In
countries with populations well adapted to cold conditions, cold-waves can still
cause substantial increases in mortality if electricity or heating systems
fail.
Flooding is the most frequent natural disaster in European
Union countries, with important effects on human health (Figure 10.3.4.2). The
total economic damage in the past sixteen years amounts to 51 861 Million US $
from floods and 16 598 Million US $ from storms. In the following, the emphasis
is on flooding as the far more frequent event. Most studies divide the health
aspects of floods into direct effects caused by the floodwaters (such as
drowning or injuries) and indirect effects caused by other flood effects (such
as waterborne, vector-borne and rodent-borne diseases), acute or chronic
effects of exposure to chemical pollutants released into floodwaters or food
shortage. Consequently, the health impacts of flooding range from death and
injuries (sprains/strains, lacerations, "other injuries" as well as
abrasions and contusions) to water related and water-borne diseases and
illness, vector-borne diseases, rodent-borne disease to serious mental health
impacts as analysed by Ahern et al (xxxx).
From the current published literature as reviewed by Ahern
et al , we can deduce that major health effects of floods include traumatic
injuries, waterborne and vector-borne diseases, rodent-borne diseases such as
leptospirosis, snake bites (as snakes tend to seek shelter in houses to escape
from flooding), sewage and waste contamination of the drinking-water supply,
post-traumatic stress disorders and poisoning caused by toxic substances.
Health effects are further aggravated by multiple stresses. Although there is
little evidence about the role of extreme rainfall on waterborne disease
outbreaks, extreme rainfall and runoff events may increase the total microbial
loads in watercourses and in drinking-water reservoirs . Notable outbreaks of
cryptosporidiosis have been associated to heavy rainfall . Flooding may lead to
the contamination of water systems with dangerous chemicals from storage,
plants or pesticides. Published data and evidence are lacking on a clear
cause–effect relationship between chemical contamination and the pattern of
morbidity and mortality following flooding events .
Figure
10.3.4.2. Frequency of floods and windstorms
with numbers of related deaths in the European Region, 1990–2006
Exposure to flooding reportedly results in long-term
problems including increased rates of anxiety and depression stemming from the
experience itself, troubles brought about by geographic displacement, damage to
the home or loss of family possessions and stress in dealing with builders and
other repair people in the aftermath. The persistence of flood-related health
effects is directly related to flood intensity. Studies in both high- and
low-income countries indicate that the mental-health aspects of flood-related
effects have been inadequately investigated . A systematic review of
post-traumatic stress disorders in high-income countries demonstrated a small
but significant effect of this disorder in relation to disasters . Elderly and
disabled people, children, women, ethnic minorities and people with low incomes
are more vulnerable and need special attention during the response and recovery
periods . Hospitals, ambulances, retirement homes, schools and kindergartens in
flood-prone areas are at especially at risk, with evacuation of patients and
vulnerable groups representing a further risk.
A recent example of impacts of flooding has been outlined
taking as example the flooding occurred in Bulgaria in 2005. The case of
Bulgaria shows that floods threaten the security of populations through their
direct and indirect impact on health and on economic stability as well as by
increasing vulnerability in terms of the ability of communities and individuals
to cope and recover . In summer 2005, torrential rains and flooding in Bulgaria
affected 2 million people, claiming 20 lives and leaving an estimated 10 000
people homeless. Damage to the economy was estimated to be about US$ 624
million, with massive destruction of farmland and vital infrastructures. The
regions of Targovishte, Rousse, Velico Tarnovo, Stara Zagora, Haskovo,
Pazardzik, Shoumen and Bourgas were most severely affected. A state of emergency
was declared in the flood-affected areas. The State Agency for Civil Protection
conducted immediate assessments and urgent search and rescue activities
together with the Ministry of Health and other government stakeholders. An
international response was also launched to deliver emergency supplies such as
clean water, blankets and food and provide technical support to the government.
The WHO conducted a rapid health assessment in the flooded
areas to identify environmental health threats and address the public health
needs of the population. In particular, the assessment investigated the
following areas: water, sanitation and hygiene, vector control, epidemiological
surveillance and basic health care, chemical hazards in the flooded areas, food
and public awareness. A communicable disease surveillance system was in place
and vaccinations continued without interruption. Health facilities were largely
unaffected by the floods and no shortage of drugs or vaccines was reported. The
provision of basic health care was uninterrupted. Although no major outbreaks
had been reported, contamination of water supplies and food sources posed a
potential threat to health, livelihoods and security.
Cultivated land that normally provided basic food for
families was flooded and contaminated by septic pits. The resulting economic
losses affected a wider population than those directly affected by the floods,
leaving people in a difficult situation, especially vulnerable groups. Although
water supply was not disrupted, the wells in private homes were largely
contaminated by sewage water. The local authorities warned people about the
risk of possible water contamination and advised them to use only mineral
water, adding an additional burden on the already limited income of rural
families. The mass media reported on deaths by drowning as a result of the
flooding, and lightning killed one man as he tried to rescue his livestock.
The WHO assessment also reported a high level of distress
among the community, particularly elderly people. Research from previous floods
indicates that, aside from the experience of being flooded, many mental health
problems, such as increased incidence of anxiety and depression, stem from the
troubles brought about by geographical displacement, damage to the home or loss
of familiar possessions. Lack of insurance is also likely to make recovery
difficult. Some previous studies suggest an increase in suicide after a flood,
although there was no evidence of this in Bulgaria. Although the immediate health
effects of the floods in Bulgaria were addressed through public health measures
such as disease surveillance, water analysis and treatment, health education
and information to the public, the more enduring health effects in terms of
mental health and of reduced access to health care by vulnerable groups may not
have been sufficiently addressed .
Droughts and wildfires
Drought is defined as a period of below average
precipitation that adversely affects gross primary productivity and causes
water scarcity. It affected 6 million people in the European Union during the
period from 1995 to 2006. The most important impact of drought is on
agriculture and soil quality rather than human health directly. Extended
droughts make soil more vulnerable to erosion and desertification. Food
production may also be affected as demonstrated by the heat wave occurred in
2003 which was associated with annual precipitation deficits up to 300 mm. Drought contributed heavily to the estimated 30% reduction in gross primary production of
terrestrial ecosystems in Europe . This reduced agricultural production and
increased production costs, led to an estimated damage of more than 11 billion
euro.
The effects of droughts on human health comprise
malnutrition (protein–energy malnutrition and/or micronutrient deficiencies),
respiratory diseases and waterborne diseases in developing countries. In
Europe, particularly in Southern Europe and in the European islands, droughts
represent a risk to human health in summer time through water scarcity.
Droughts can affect drinking-water supply and compromise water quality. Drought
in Europe has also consequences for wastewater re-use and might present a
significant risk when regulations are not updated. Low water levels in rivers
can increase the loads of contaminants in water supplies. The incidence of
viral hepatitis A and shigellosis dysentery increased during the 2004 droughts
in Bulgaria. The loss of livelihoods resulting from droughts is also a major
trigger for population movements and mass displacement.
Further to this, drought can lead to forest and bush
fires. Fires cause burns, damage from smoke inhalation and other injuries.
Since 1990, 228 people have died from wildfires in the European Region, and the
devastation caused affected almost 300 000 people. Large fires are also
accompanied by an increased number of patients seeking emergency services .
Toxic gaseous and particulate air pollutants are released into the atmosphere,
which can significantly contribute to acute and chronic illnesses of the
respiratory system, particularly in children, including pneumonia, upper
respiratory diseases, asthma and chronic obstructive pulmonary diseases .
Pollutants from forest fires can affect air quality for thousands of kilometres
.
10.3.4.4. Control
tools and policies
For what concerns the existing legislation, only some
aspects can be briefly mentioned in this chapter. With regard to heat, the
French parliamentary inquiry concluded that the health impact was ‘unforeseen’,
surveillance for heat wave deaths was inadequate, and the limited public-health
response was due to a lack of experts, limited strength of public-health
agencies, and poor exchange of information between public organisations . In
response to this, in 2004, the French authorities implemented local and
national action plans that included heat health-warning systems, health and
environmental surveillance, re-evaluation of care for the elderly, and
structural improvements to residential institutions (such as adding a cool
room) . Across Europe, many other governments (local and national) have
implemented heat plans to prevent adverse health outcomes .
With regard to flooding, we can state that the situation
in European Union countries fortunately reflects the effectiveness of present
structural and non structural measures. Thus, mortality rates are very low, and
mainly arise from drowning and heart attacks. For what concerns the other
health impacts of flooding, the vulnerability of communities is closely related
to the level of public awareness of health-related flood hazards, economic
conditions, structural and non-structural mitigation measures in place
including the maintenance of river banks and canalization systems and the
institutional response capacity and recovery planning. Therefore, disaster
preparedness and strategies for reducing risks need to be emphasized more
strongly before a flood occurs. This requires an intersectoral approach and can
include: legislating to relocate structures away from flood-prone areas, proper
land use, planning and maintenance of riverways, improved early warning and
flood forecasting and insurance policies. It also implies international
cooperation in terms of land and river use and flood forecasting. A WHO (cCASHh) survey with ministries of health
throughout Europe found that although all the respondent countries had
emergency intervention plans, no governments had strategies to prevent
long-lasting health impacts from flooding or offered financial incentives for
citizens to increase their ability to resist them.
10.3.4.5. Future
developments
Since the observed higher frequency of heatwaves is likely
to have occurred due to human influence on the climate system , the excess
deaths of the 2003 heat-wave in Europe are likely to be linked to climate
change. Extreme temperatures in the form of heat-waves are increasingly
frequent weather events that are likely to become even more common in the
future.
Also the risk of drought is likely to increase,
particularly in Southern and central Europe. Warmer, drier conditions will
eventually lead to more frequent and prolonged droughts with increased risks of
forest and bush fires, particularly in the Mediterranean region.
At the same time, the European Region should address the
issue of flooding through coordinated planning, action and cooperation in
response, due to expected increased risk of flooding under future climate
change
10.3.4.6.
References
Solomon, 2007
ICC, 2007a
Menne, 2005
Menne B, Ebi KL (Eds.)(2006): Climate change and
adpatation strategies for human health. WHO. Steinkopff Verlag, Darmstadt.
European Commission, 2007
Ahern et al (xxxx)
WHO (cCASHh) survey. Information available
at the WHO page:
http://www.euro.who.int/globalchange/assessment/20070403_1
