Tag: Planetary Health

Climate change is deemed “the biggest global health threat of the 21st century”. (1) Global warming is now unequivocal; global average temperatures have risen by 0.85°C between 1880 and 2012. (2) Global mean temperature is projected to increase by about 1.6 to 2.6°C above the preindustrial period by the 2050s, depending on the scenario used.2 Using median values, projected temperature increases for Europe and America are between 2 and 4°C for the 2050s (relative to present-day climate). (2) Higher increases are projected over much of Asia and Australia. (3) Heat waves, defined as extended periods of extreme high temperature, are regarded as one of the primary weather-associated threats to human life. (4) As increased frequency, intensity, and duration of heat wave events occurred associated with global warming, impact of heat wave on health has drawn more and more attention worldwide. (5-7) It is well-established the relationship between extreme high temperatures and human morbidity and mortality. (8)

There is also now strong evidence that such heat-related mortality is rising as a result of climate change impacts across a range of localities. (9) For instance, the excess mortality during the extremely hot summer of 2003 in Europe and the 2010 Russia heat wave, resulted in more than 70,000 and 11,000 deaths, respectively. (10,11) Much of the excess mortality from heat waves is related to cardiovascular, cerebrovascular, and respiratory disease and is concentrated in some populations groups. These groups include women, young children and older people, people with existing health problems or disabilities, and poor and marginalised communities. They are particularly vulnerable to the health effects of climate change, whether because of existing socioeconomic inequalities, cultural norms or intrinsic physiological factors.

Other risks were associated with rising temperatures and changes in precipitation pattern. For example, the modification of viable distribution of disease vectors such as mosquitoes carrying dengue or malaria. Temperature affect the range and reproductive rates of malarial mosquitoes and also affect the lifecycle of the parasitic protozoa responsible for malaria, possibly increasing the incidence of a disease that causes 660 000 deaths per year. (12) There are equally complex relationships and important climate-related risks associated with dengue fever, cholera and food safety. (13-15)

Moreover, a heat wave can be a big threat in urban area because of the “urban heat island (UHI) effect”. The UHI effect results in the temperatures being somewhat higher in cities than in suburban and rural areas, primarily because of the abundance of heat-retaining surfaces such as concrete and black asphalt, that exacerbate the negative heat effect on residents compared with reflective, transpiring, shading, and air-flow-promoting vegetation-covered surfaces. (16,17)

The events occurred in Europe and Russia and those which occurred in Australia, 2012/2013 and 2016/2017; North America, 2012; India and Pakistan, 2015 and Europe 2015 have led to the implementation of specific policies to reduce heat-related mortality such as the National Heat Wave Plan in France, (18) and the Heatwave Plan for England. (19) Evidence suggests that effective adaptation measures would reduce the death rates associated with these heat waves. Adaptation measures also include increasing green infrastructures and urban green spaces, improving the design of social care facilities, schools, other public spaces, and public transport to be more climate-responsive. Adaptation options within health care include training of health-care workers and integrated heatwave early warning systems (HEWS). (20)

A communication and public education strategy is an essential part of the warning system, public health messages should be disseminated to all age and vulnerable groups to increase awareness of symptoms of heat-related illness.

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References

1. Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change. The Lancet. 2009; 373(9676): 1693–1733.
2. IPCC, 2013a: Summary for Policymakers In: Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change Change [Stocker TF, Qin D, Plattner GK, Tignor M, Allen SK, Boschung J, Nauels A, Xia Y, Bex V, Midgley PM (eds.)]. Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA, pp. 1–30.
3. Bassil K, Cole D. Effectiveness of public health interventions in reducing morbidity and mortality during heat episodes: A structured review. Int J Environ Res Pub Health. 2010; 7: 991–1001.
4. Luber G, McGeehin M. Climate change and extreme heat events. Am. J. Prev. Med. 2008; 35: 429–435.
5. Wang C, Chen R, Kuang X, Duan X, Kan H. Temperature and daily mortality in Suzhou, China: a time series analysis. Sci Total Environ. 2014; 466–467.
6. Gronlund C, Zanobetti A, Schwartz J, Wellenius G, O’Neill MS. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992–2006. Environ Health Perspect. 2014; 122: 1187–1192.
7. Gao J, Sun Y, Liu Q, Zhou M, Lu Y, Li L. Impact of extreme high temperature on mortality and regional level definition of heat wave: a multi-city study in China. Sci Total Environ. 2015; 505: 535–544.
8. Forsberg, B. Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment. BMJ Open. 2013; 3: e001842.
9. Smith K, Woodward A, Campell-Lendrum D. Human health—impacts adaptation and co-benefits. Climate change 2014: impacts, adaptation, and vulnerability Working Group II contribution to the IPCC 5th Assessment Report. Cambridge University Press, Cambridge, UK and New York, NY, USA; 2014.
10. Robine J, Cheung S, Roy S, Oyen H, Herrmann F. Report on excess mortality in Europe during summer 2003. EU Community Action Programme for Public Health. Grant Agreement 2005114. 2007.
11. Agence France-Press. Russian heat wave caused 11,000 deaths in Moscow: Official. 2010. Press release. 2010.
12. WHO. World malaria report. World Health Organization, Geneva; 2012.
13. Bhatt S, Gething P, Brady O. The global distribution and burden of dengue. Nature. 2013; 496: 504-507.
14. Sutherst R. Global change and human vulnerability to vector-borne diseases. Clin Microbiol Rev. 2004; 17: 136-173.
15. WHO. World Meteorological Organisation. Atlas of health and climate. World Health Organization, Geneva; 2012.
16. Roth M. Review of urban climate research in (sub) tropical regions. Int J Climatol. 2007;27:1859–1873.
17. Gabriel K, Endlicher W. Urban and rural mortality rates during heat waves in berlin and Brandenburg. Germany Environ Pollut. 2011;159(8–9):2044–2050.
18. Pascal M, Le Tertre A, Saoudi A. Quantification of the heat wave effect on mortality in nine French cities during summer 2006. PLoS Curr. 2012: 4:RRN1307.
19. Public Health England. 2015. Heatwave Plan for England. Protecting health and reducing harm from severe heat and heatwaves. Public Health England, London, UK.
20. Ghasem S, FitzGerald G, Aitken P, Verrall K, Tong S. Are heat warning systems effective? Environmental Health. 2013: 12-27.

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Ana Pinto de Oliveira
Public Health Resident
Arnaldo Sampaio Public Health Unit, Lavradio, Portugal

Catarina Oliveira
Public Health Specialist
Arnaldo Sampaio Public Health Unit, Lavradio, Portugal

The access to safe drinking water is essential to health and a basic human right, as well as a structural part of an effective policy for health protection. (1)

Since 1958, aiming primarily to protect public health, the WHO has published several editions of a document, currently called WHO Guidelines for drinking-water quality, which has been regularly updated through rolling revision. This document establishes the principles and guidelines that are the base for the national programs of the United Nations members. (1)

The model for regulating water quality in Portugal has been progressively consolidated through regular legislation revisions that reflect scientific and technical progress. The consequences have been globally positive and are evidenced in a favourable evolution of the indicator on “safe water”, which builds on the fulfilment of sampling frequency and the observance of parametric values (e.g. microbiological and chemical). Figure 1 shows the evolution of the quality level of drinking water; nowadays 99% of water is guaranteed to be controlled and of good quality (in 1993 this indicator was at a mere 50%). (2) (3) (4)

This excellence level is supported by strictly monitoring the stakeholders in this process, among them health authorities that may be integrated in Public Health Units (PHU). (3)

The Activity Plan of the ACeS Alto Ave PHU includes a program of sanitary surveillance for drinking water systems with public distribution. These systems undergo annual characterization as a way to promote risk analysis and management for health. I have recently followed my unit’s environmental health technician on his visits to the drinking water systems in the Fafe area.

These visits started at a Water Treatment Station, where water undergoes a complex treatment process after catchment and is then sent to several reservoirs in the area, which then distribute the water to consumers. Besides verifying the maintenance, hygiene and safety parameters, the process also identifies the treatment types for water (e.g. pre-oxidation, decantation and filtration).

We have then visited all the storage reservoirs in the area where special care is given to the inner lining of tanks/cells, vent protection and latest sanitation date.

Some locations, due to their position and/or demographic rate, benefit from local water capture (e.g. water holes, water springs or wellheads). These Dispersed Systems have their own device for water purification with sodium hypochlorite and sometimes pH correction with caustic soda.

These visits allow us to promote the conservation and maintenance of several infrastructures of the public water supply systems by the appropriate authorities. But they also allow Public Health physicians (as Health Authorities) to intervene in a stricter and more appropriate way in the case of potential infringements of the chemical or microbiological parameters reported. It may therefore be necessary to establish measures to minimize health hazards to the population. (2)

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References

1. World Health Organization. Guidelines for drinking-water quality: four edition incorporating first addendum. Geneva, 2017.
2. República Portuguesa. Diário da República, 1.ª série-N.º 164-27 de Agosto de 2007. Decreto-Lei n.º 306/2007. 2007.
3. Entidade Reguladora dos Serviços de Águas e Resíduos (ERSAR). Relatório anual dos serviços de águas e resíduos em Portugal – 2017. 2017. Vols. Volume 2 – Controlo da qualidade da água para consumo humano.
4. República Portuguesa. Diário da República, 1.ª série-N.º 235-7 de dezembro de 2017. Decreto-Lei n.º 152/2017. 2017.

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José Miguel Fernandes
Public Health Resident, Public Health Unit ACeS Alto Ave – Fafe
Portugal