BMJ  2005;331:1283-1284 (3 December), doi:10.1136/bmj.38684.496354.DE (published 29 November 2005)

Editorial

Health and climate change: a call for action

The health sector has to become proactive, not reactive

Climate change—the subject of this week's United Nations summit in Montreal—is already affecting human health in Europe, and countries are not prepared. It is now five years since the Intergovernmental Panel on Climate Change concluded that there is new and stronger evidence that most of the global warming that has occurred over the past 50 years is attributable to human activities and that climate change could affect human health.¹ Even before that, in 1999, ministers of health and environment from the World Health Organization European Region acknowledged that "human-induced changes in the global climate system and in stratospheric ozone pose a range of severe health risks and potentially threaten economic development and social and political stability."

Several countries have started the essential action of reducing greenhouse gas emissions. As long as these measures are not altering the ongoing changes in the climate there is a need to understand how people and systems can effectively adapt to new climate patterns and potential threats, and to determine what should be done now to avoid the impact on human health that may result.² In response, the WHO Regional Office for Europe has coordinated a project to assess both the health impacts of climate change and the required measures and policies that it demands.²

Climate change and variability are affecting health in a variety of ways. The heatwave in August 2003 caused over 35 000 excess deaths in Europe.³ Cases of salmonellosis rise by 5-10% for each 1°C increase in weekly temperature when the ambient temperature is at least 5°C.⁴ Floods have hit European countries in recent years, causing deaths, injuries, and diseases, and their frequency is expected to increase.⁵ Lyme borreliosis and tickborne encephalitis have spread into higher latitudes (as seen in Sweden)⁶ and altitudes (such as in the Czech Republic)^{7 8} in recent decades and have become more common. The average length of the growing season of plants with allergenic pollen and other elements causing allergic sensitivity in Europe has increased by 10-11 days over the past 30 years.⁹

We are in a time of uncertainty. Human health will continue to be affected directly and indirectly by climate change, and health systems will need to act to prevent and manage the impacts on populations. At the same time, health services will face various other complicating challenges such as rising costs of health care and an ageing society, making effective preventive strategies even more necessary.

What should the health sector do? It needs to shift from a reactive to a proactive attitude, and to learn from other sectors about anticipating risks. Most countries and cities have barely made a start on this, but a few have developed warning systems for imminent heatwaves and floods. Although effective measures to reduce mortality related to heatwaves are still under debate, some countries have tried a combination of health system preparedness, information for citizens, assistance to elderly and sick people, and long term urban and housing planning. For the city of Rome, for instance, the societal costs in the absence of planned adaptation to heatwaves would be in the order of 281m for the year 2020 (at 2004 rates).¹⁰

The health sector can further contribute by reviewing and strengthening existing activities for disease control and health protection. Examples include achieving and maintaining the highest standards of control and surveillance along the food chain⁵ and of vaccination for tickborne encephalitis in high risk areas.⁶

If the health system is to exercise its stewardship it will have to learn to collaborate with climatologists and planners in land use and urban design, and to prepare communities and cities against the growing health risks of climate change.² It will have to work with other sectors in, for example, health impact assessments of structural and non-structural measures for flood prevention and with the energy, transport, industry, and agriculture sectors to advocate "healthy" measures to mitigate the impacts of climate change. Moreover, the health sector will have to inform the public and keep them aware of how to avoid risks of foodborne diseases, allergic disorders, and some vector and rodent-borne diseases. For this, it is essential to collect information systematically on the potential impacts of global changes and on cost effective strategies to reduce them.

In addition, lessons learnt in different countries, regions, and sectors that have applied early warning systems or changes in land use must be shared so that prevention strategies can be modified, new ones put in place, and measures and standards raised.^{11 12}

Political will and support for public health approaches are a prerequisite for reducing any health risks and instability resulting from climate change. Identifying ways to reduce the causal factors of climate change (mitigation) and to help populations and systems deal with the risks and threats posed by climate change (adaptation) could lead to a greater sense of security and control and result in improved population health. The health sector has to be at the heart of this.

(bme{at}ecr.euro.who.int)
WHO Regional Office for Europe, European Centre for Environment and Health, Via F. Crispi, 00187, Rome, Italy

WHO Regional Office for Europe, European Centre for Environment and Health, Via F. Crispi, 00187, Rome, Italy

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This article was posted on bmj.com on 29 November 2005: http://bmj.com/cgi/doi/10.1136/bmj.38684.496354.DE

Competing interests: BM is coeditor of Climate Change and Adaptation Strategies for Human Health, which forms part of the climate change and adaptation strategies for human health (cCASHh) project.

References

1. Intergovernmental Panel on Climate Change (IPCC). Climate change 2001. Impacts, adaptations and vulnerability. Contribution of Working Group II to the third assessment report of the Intergovernmental Panel on Climate Change. New York: Cambridge University Press, 2001.
2. Menne B, Ebi K. Climate change and adaptation strategies for human health. Darmstadt: Steinkopff Verlag, 2006.
3. Kovats RS, Wolf T, Menne B. Heatwave of August 2003 in Europe: provisional estimates of the impact on mortality. Eurosurveillance Weekly 2004;8(11). www.eurosurveillance.org/ew/2004/040311.asp#7 (accessed 23 Nov 2005).
4. Hajat S, Ebi KL, Kovats S, Menne B, Edwards S, Haines A. The human health consequences of flooding in Europe and the implications for public health: a review of the evidence. Applied Environmental Science and Public Health 2003;1(1): 13-21.
5. Kovats RS, Edwards SJ, Hajat S, Armstrong BG, Ebi KL, Menne B. The effect of temperature on food poisoning: a time-series analysis of salmonellosis in ten European countries. Epidemiol Infect 2004;132: 443-53.[Medline]
6. Lindgren E, Gustafson R. Tick-borne encephalitis in Sweden and climate change. Lancet 2001;358: 16-8.[CrossRef][ISI][Medline]
7. Daniel M, Danielova V, Kriz B, Jirsa A, Nozicka J. Shift of the tick Ixodes ricinus and tick-borne encephalitis to higher altitudes in central Europe. Eur J Clin Microbiol Infect Dis 2003;22: 327-8.[Medline]
8. Daniel M, Danielova V, Kriz B, Kott I. An attempt to elucidate the increased incidence of tick-borne encephalitis and its spread to higher altitudes in the Czech Republic. Int J Med Microbiol 2004;293(suppl 37): 55-62.
9. Menzel A. Trends in phenological phases in Europe between 1951 and 1996. Int J Biometeorol 2000;44: 76-81.[CrossRef][ISI][Medline]
10. Alberini A, Chiabai A. Urban environmental health and sensitive populations: how much are the Italians willing to pay to reduce their risks? Milan: Fondazione Eni Enrico Mattei, 2005. (FEEM working paper 105.)
11. Yohe G, Ebi K. Approaching adaptation: parallels and contrasts between the climate and health communities. In: Ebi K, Smith J, Burton I, eds. Integration of public health with adaptation to climate change: lessons learned and new directions. London: Taylor and Francis, 2005: 18-43.
12. Ebi K, Smith J, Burton I, eds. Integration of public health with adaptation to climate change. Lessons learned and new directions. London: Taylor and Francis, 2005.

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