Monitoring the implementation of national climate action plans (NDCs) using the WHO CaRBonH tool

One crucial area of work of the WHO European Centre for Environment and Health has been the assessment of the health effects associated with the use of fossil fuels, both directly through the generation of local air pollution and indirectly by contributing to global environmental and climate change. The WHO European Centre for Environmental Health in Bonn has developed various decision support tools to calculate both the health burdens of local pollutants and the benefits of selected interventions. A key outcome has been the recent development of a simplified calculation tool, Carbon Reduction Benefits on Health (CaRBonH), capable of estimating the health, carbon and economic benefits of selected mitigation interventions. CaRBonH allows quantification of the physical and economic consequences on human health achieved through improvements in country-level air quality from domestic carbon reductions, specifically the policy mitigation actions and measures as reported in the NDCs submitted by the Conference of the Parties to the UNFCCC in support of the objectives as set out in Article 2 of the Convention. The work of improving and updating the CaRBonH tool, based on feedback from users, and the process of extending the geographical scope of the tool to account for countries outside the WHO EURO region, will be discussed in this session.

Indicators to monitor policy progress in health adaptation to climate change: do they really do the job?

There is a need for urgent adaptive action to protect human health against climate change. Overall assessments based on a selection of indicators suggest that we are unable to cope with current climate impacts on health and unprepared to respond to increased pressures on climate-sensitive exposures and outcomes.

The health sector has been addressing climate adaptation to health, through siloed approaches limited to the health system, which reduces their capacity and effectiveness. Successful strategies for addressing climate and environmental degradation challenges to health, and related issues such as environmental health, nutrition or equity, require integrated adaptation approaches among the health systems, social protection systems, water and sanitation systems, urban planning, environmental health and climate services among others. For example, integrated monitoring and surveillance (human-animal-environmental-ecosystems health) is critical for the early identification of emerging risks, diseases or trends, and for resource planning and evaluation of the adaptation and control strategies. In addition, when climate and health indicators are put to use for prevention, and eventually adaptation, they are also frequently used in isolation, disregarding interactions. For example, early warning systems for the prevention of climate-influenced impacts on health, such as Heat Health Action Plans, air pollution warnings or allergenic pollen information systems are usually activated individually commonly fail to address the synergies across various climate-related or climate-aggravated exposures. Since various of those exposures tend to occur concurrently (e.g. heat, anthropogenic air pollution from thermal inversions, and Saharan dust intrusions), failure to integrate them in prevention efforts could affect their effectiveness and reach. Thus, there is a need to carry out an integrative approach for the multiple effects that climate change has on population health.

A new integrative perspective on early warning systems for health in the context of climate change

Climate change causes or aggravates a wide range of exposures with multiple impacts on health, both direct and indirect. Early warning systems have been established to act on the risks posed by these exposures, permitting the timely activation of action plans to minimize health effects. These plans are usually activated individually. Although they show good results from the point of view of minimizing health impacts, such as in the case of high temperature plans, they commonly fail to address the synergies across various climate-related or climate-aggravated exposures. Since several of those exposures tend to occur concurrently, failure to integrate them in prevention efforts could affect their effectiveness and reach. Thus, there is a need to carry out an integrative approach for the multiple effects that climate change has on population health. This article presents a proposal for how these plans should be articulated. The proposed integrated plan would consist of four phases. The first phase, based on early warning systems, would be the activation of different existing individual plans related to the health effects that can be caused by certain circumstances and when possible corrective measures would be implemented. The second phase would attempt to quantify the health impact foreseen by the event in terms of the different health indicators selected. The third phase would be to activate measures to minimize the impact on health, via population alerts and advisories, and additional social and health services, based on the provisions in phase two. Phase four would be related to epidemiological surveillance that permits evaluation of the effects of activating the plan. We believe that this integrative approach should be extended to all of the public health interventions related to climate change.

Organizing the institutional Public Health response to heat under climate change: A scoping review

Background

Extreme heat events are a major health risk, and their intensity and frequency are expected to increase under climate change. Heat health action plans (HHAP) aim to prevent adverse health effects through measures such as warning systems or communication campaigns. This scoping review asked whether the peer-reviewed Public Health literature suggests evidence for good practice governance of HHAP.

Methods

Databases PubMed and Web of Science were searched using search string combinations of heat, policy, warning system, and related terms. Data was extracted into a pre-defined extraction table based on theory-driven variables related to responsibilities, processes of stakeholder involvement, evaluation and whether good practice advice was provided. Findings were narratively synthesized and gaps in the current knowledge evaluated from a normative standpoint.

Results

Searches resulted in 6681 hits. After title, abstract and full text screening, 20 articles were assessed, 11 from Europe and 9 from other regions. Findings on structure of governance revealed that the Ministry of Health or Ministry for the Environment leads the development of an adaptation plan or HHAP guidance, while locally Departments of Health most often lead coordination of actions. Interagency cooperation was reported as essential, while in the majority of included studies the public are perceived as recipients of advice and warnings rather than as active stakeholders. Tailoring national guidance to local contexts as well as raising awareness of the plan not only among the public but also among all levels of management was one suggested good practice.

Conclusions

Few articles explicitly examine the organization of HHAP and no conclusions about whether a specific approach is superior can be drawn from these studies. To adequately protect human health from extreme heat events, an assessment of whether current governance structures are able to provide effective heat health action could be useful.

Key messages

The peer-reviewed literature does not provide information on which type of HHAP governance is superior. In the absence of a gold standard, it should be assessed what stakeholders and discourses are absent from HHAP governance to ensure vulnerable groups are adequately addressed by HHAP.

Contamination of food and agro products in the Republic of Macedonia

The Republic of Macedonia has 662,000 ha of cultivated land with well-organised agricultural production. It is a well known producer of agricultural products. From 1991 to 1999, authorized laboratories conducted systematic control of about 6,500 food samples in 1991 to 36,000 by 1999 which included a whole range of hygienic quality parameters including microbiological and chemical. Microbiological contamination of food was reported to have caused disease outbreaks in 1,578 people in 1995, which dropped to 126 people in 1999. The decreasing trend of samples unfit for human consumption was observed for all food groups. As for the chemical parameters, an increasing trend of contaminated samples was noted only for additives, with peaks reaching 6.9% in 1998 and 4.9% in 1999 of the total number of analysed samples.