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Q: What are public health responses to the risks of climate change?

Reduce exposures -Legislative policies -Alterations in built environment -Alterations in natural environment Prevent onset of adverse outcomes -Early warning systems -Surveillance and monitoring -Vector control programs -Public education and outreach Response / treatment -Medical training and awareness -Treatment -Emergency respons

42 important questions on Summary of everything

What is a Zoonose?

A disease that can be transmitted from animals to human

What are examples of diseases that become more active due to CC?

Vector borne diseases: Fever, malaria, dengue fever
Foodborne diseases: Salmonella
Waterborne diseases: Cholera, legionella

What are the differenct pathways a disease can transfer?

Direct: Physical contact with an affected person (human - human)
Indirect: No physical contact but you have contact with contaminated items (human/animal - vector - human/animal)

What are co-benefits of policies and strategies concerning CC

Example: Pollution is reduced because more people walk and take public transport instead of the car > Walking improves health by reducing chances of heart diseases, type 2 diabetes, some cancers and obesity related risks.

What are the health environmental alliances?

Leading European non-profit organization addressing how the environment affects health in the EU.
HEAL

How does the concept of health co-benefit helps to identify appropriate measures to mitigate climate change?

Market based programs: Carbon or energy taxes
Risk and vulnerability assessment: assessment of costs

What is a "health in all" policy?

An approach to public policies across all sectors that systematically take into account the health indicationhs of decisions seeks synergies and avoid harmful health impacts in order to improve population health and health equity.
(EU treaty obliges all EU Policies to adhere to the HiAP approach

What are the governance actions for Climate Change?

Evidence support
Setting goals and targets
Coordination
Advocacy
Monitoring and evaluation
Legal mandate and framework
Financial support
Implementation and management

What are public health responses to the risks of climate change?

Reduce exposures
-Legislative policies
-Alterations in built environment
-Alterations in natural environment
Prevent onset of adverse outcomes
-Early warning systems
-Surveillance and monitoring
-Vector control programs
-Public education and outreach
Response / treatment
-Medical training and awareness
-Treatment
-Emergency respons

What is a heat wave?

A period of time of unusually hot and humid weather with a discernible impact on human and natural systems

Which two kind of data do you have in GIS?

Geometry data: size, shape and identification of an object as well as coordinated (polygons, lines, points)
Attribute data: The object and contain additional information about the object (SES, population, disease counts, environmental exposures, etc.)

What is spatial epidemiology?

The description and analysis of geographic variations in disease with respect to demographic, environmental, behavioral, socio-economic, genetic and infectious risk factors

What kind of surveillance types can be distinguised?

3 types:
1. Disease surveillance: focus on infectious diseases
2. Public Health surveillance: Broad focus, incorporates infectious and chronic diseases but also other indicators such as GP visits and quality of life
3. Syndromic surveillance: Focus on unspecific datasources such as emergency calls, ambulance visits to detect potential public health threats as soon as possible

What is disease mapping?

The first step to visualize and explore spatial variations of risk

Which issues need to be addressed before creating a disease map?

Population at risk: determined by the respective disease
Modifiable area unit problem
Rate instability: may differ because of varying population densities
Cluster tests: more cases than expected
3 types of cluster tests:
1. Global: identifies, whether spatial autocorrelation exists
2. Local: Determines the location of areas with significant high or low rates (hot spots, low spots)
3. Focussed: Tests whether high rates are concentrated around a specific source e.g. cancer near neclear power plants
only cluster is statistically significant (if p<0.05)
Likelihood of cluster occurrence is less than 5%

What is the most important greenhouse gas?

Water vapor (66-85% of greenhouse effect)

What is the all hazards approach?

Concerns the arrangements for managing the large range of possible effects of risks and emergencies

What is a disaster risk reduction plan?

A document prepared by an authority, sector, organization or enterprise that sets out goals and specific objectives for reducing disaster risks together with related actions to accomplish these objectives

What are the core elements of disaster preparedness plan?

Collaborative mechanisms between institutions and a lead body to coordinate emergency responses
Early warning system
Provision of health care, social services, particularly vulnerable population groups
Infrastructure and equipment
Risk communication strategy
Inclusion of other sectors: land use, urban planning, energy and transport policies
Capacity building and training
Monitoring and evaluation

What do you need to assess and strengthen health system preparedness?

Improve:
Population health
Resilience
Adaptive capacity and adaptive baseline

Why is hospital resilience and safety important?

Safe hospitals programmes ensure that health facilities are safely built to withstand hazards, remaining operational in emergencies

What are the key considerations for multi-sectoral planning

Stakeholder analysis: all key stakeholders need to be involved in the planning process
Clear responsibilities: lead body, early warning, established responses, communication (who, what, when, how , with whom, where?)
All hazards approach: Relevance for various emergencies: large scale; complex; relatively rare; hard to predict
Evaluation

What are key elements of Adaptation?

Designing, implementing, monitoring, and evaluating

What are the key principal components of an early warning system?

Identification and forecasting of weather conditions
Link to prediction of possible health outcomes
Link to an effective and timely preparedness and response plan
Monitoring and ongoing evaluation of the system and its components (e.g. sentinel sites)

How is the development and utilization of climate information?

Data: Spatial and temporal coverage of critical weather variables
Methods: Simple correlation, trend analysis
Acceptability / credibility: Timely, relevant, compatible with existing decision-making protocols, accessible
Context: Early warning systems are not contingent on climate information alone

Examples for early warning systems in Europe

WMO
The European Flood Alert System (EFAS)
WHO heat decision support tool
National weather services

What have we learned from other early warning systems?

Early warning systems can save lives
Climate is only one of many determinants that can help in early warning systems
Early warnig of a crisis is no guarantee of prevention
Capacity and wilingness to respond is essential

Which adaptation measures can we implement to reduce health outcomes from floods?

Legislative policies: Improve land use planning
Decision support tools: Early warning systems and emergency response plans
Technology development

What do you have to take into account with a multi-sectoral flood preparedness and response plan?

Policies and legal statutes for interventions
Adequate land use and physical infrastructure
Insurance
Physical resilience of the built environment
Water supply and sanitation services
The promotion of individual and household preparedness
Capacity-building (enhancing the ability of individuals, organizations and institutions in developing countries and in countries with economies in transition to identify, plan and implement ways to mitigate and adapt to climate change) & training/drills
Rescue
Community engagement
Effective communication
Surveillance and monitoring
Evaluation

Name some measures to reduce the health impacts from climate risks and associated climate change

Strengthening public health systems
Building partnerships with multi-sectoral actors
Enhancing capacity of health systems
Protecting hospitals and other health infra-structure
Strengtening surveillance and control
Improving the use of early warning systems by the health sector
Building public health interventions at local level to increase community resilience

What are the key principles of health adaptations

Risk and vulnerability assessment
All-hazards approach
Multi-sectorial interventions
Long-term strategies
Continuous evaluation of effectiveness
Assessment of costs
Re-assessment of risks and vulnerabilities
(health adaptation measures can exacerbate health inequalities)

What are the Kyoto mechanisms?

Emission Trading
The Clean Development Mechanism
Joint Implementation

What are the commitments of the the Parma Declaration 2010?

Act on:

Health and environmental impacts of climate change and related policies
Health risks to children and other vulnerable groups posed by poor environmental, working and living conditions
Socioeconomic and gender inequalities in the human environment and health, amplified by the financial crisis
Burden of non-communicable disease through adequate policies in areas such as urban development, transport, food safety and nutrition, and living and working environments
Concerns raised by persistent, endocrine-disrupting and bio-accumulating harmful chemicals and (nano)particles, and by novel and emerging issues
Insufficient resources in parts of the WHO European Region

What are the objectives of the European Regional Framework for Action (2010)?

Ensure that all current and future mitigation and adaptation climate change measures, policies and strategies integrate health issues at all levels
Strengthen health, social and environmental systems and services to improve their capacity to prevent, prepare for, and cope with climate change
Raise awareness to encourage health mitigation and adaptation policies in all sectors
Increase the health and environment sectors' contribution to reducing greenhouse gas emissions
Share best practices, research, data, information, technology and tools at all levels on climate change, environment and health

What is health at all levels?

Health impact assassments
National adaptations plans with a focus on health
Enforce effective measures in reducing deaths and disease
Promote:
- Healthy, energy-efficient buildings and renewable energy
- Access to safe transport, encouraging physical activity and social contact
- Improved outdoor and indoor air quality
- Modification of carbon-intensive food choices and production practices

How can you raise awareness?

Develop special curricula
Train health and environment professionals
Promote and facilitate the development and implementation of communication strategies and advocacy campaigns
Involve children, young people and adults, in settings such as schools, hospitals and workplaces in promotional activities
Ensure public participation and access to information on climate change

What are the drivers for (re) emerging infectious diseases?

Globalisation
Increased frequency of travel
Secual risk behaviour
Environmental changes
Climate change
Drug resistance
Advance in food procession

Which components/factors have an impact on population health?

Demographic changes: Population growth, aging, etc.
Economic activity: Trade and capital mobility
Large-scale and systemic Environmental Impacts: Degradation of land and water, depletion of sources

What are examples of infectious diseases that can occur with climate change?

West Nile Fever
Schistosomiasis
Avian Flu
Middle East Respiratory Syndrome coronavirus (MERS-cov)
Lyme disease

Why is PM dangerous?

When the PM-rate is high, more people die, as shown in the 2003 heatwave

What are the determinants of vulnerable groups?

Demographic and socioeconomic variables
- Age, poverty, education, living alone, and race/ethnicity
Land cover
- Green space in a community
Health conditions
- Diabetes, cardiovascular diseases, renal disease, nervous disorders, emphysema, epilepsy, cerebrovascular disease, pulmonary conditions, and metal health conditions.
Air conditioning

What kind of diseases can rise because of climate change?

Vector-borne disease (arthropod species: ticks, triatomine bugs, sandflies, and blackflies) (arthropod: Cold-blooded, sensitive to climatic factors)
- Mosquito-borne disease
+ West Nile Fever
+ Dengue
+ Chikungunya
+ Malaria
- Sandfly-borne diseases
+ Leishmaniasis
- Tick-borne diseases
+ Tick-borne encephalitis (TBE)
+ Lyme borreliosis
+ Crimean-Congo haemorrhagic fever (CCHF)
Rodent-borne diseases
+ Plague
+ Hantavirus infections
Water-borne diseases
- Recreational water use
+ Gastroenteritis
+ Respiratory infections
+ Vibrio spp bacteria (Baltic and north sea) (Cause severe sepsis)
- Drinking water
+ Virbio cholerae (Cholera)
Airborne diseases
+ Respiratory syncytial virus (RSV)
+ Legionella
Food-borne diseases
+ Campylobacteriosis (gastrointestinal bacterial disease)
+ Salmonella

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Environmental determinants: Climate change and public health

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