Protecting health from climate change in southeast Europe, central Asia and the Russian north

1. Protecting health from climate change in southeast Europe,central Asia and the Russian north Dr Bettina Menne, Programme Manager, Climate change, sustainable development & green health services WHO Regional Office for Europe menneb@ecehbonn.euro.who.int

2. Vulnerability Index (WB, 2011)

3. To promote population health within a changing climate

4. Core activities for all countries • Impact vulnerability and adaptive capacity assessment • Health adaptation strategy/action plan • Communications and awareness rising • Education and training Specific adaptation measures Emergency preparedness Water safety plans and sanitation Infectious disease prevention Energy efficiency and renewable energy for hospitals Air quality monitoring Heat health action plans Assessment of nutrition and food security Dust storm and respiratory disease reduction Strengthened public health services

5. Support from WHO Euro provided • Vulnerability assessment tool • Vulnerability Risk assessment mapping (VRAM) • Hospital safety index • Heat health action plan • Public health emergency management (PHEM) • IHR • Health damage and adaptation costs tool • Health protection strategies tool • Energy efficiency assessments tool • Small scale water plans • Air quality standards • PAL Menne and Nurse, 2012, forthcoming

6. The Countries:Challenges and Achievements

7. Kyrgyzstan

8. Health severely affected • Deaths and injuries from natural disasters are increasing; • Increased projections for cardio-vascular diseases - by 10,5% by 2100; life years lost for man from climate change are higher than for women • Increased projections for intestinal infections among children under one - by 18,2% by 2100 • The areas of high potential risk for malaria will increase • Spread and increase of tick borne infections projected

9. Health protection is possible Programme of the health sector of the Kyrgyz Republic on Climate Change Adaptation for 2011-2015 • Health Adaptation working group: • 18 members from MoH and 11 members from government agencies; 24 meetings were hold in 2009 – 2011 • 11 priorities were recognized in the Program • Order of Minister of Health №531 as of 31,October 2011 for 2011-2015 • Funds necessary: 8,411,040.00 USD • Funds available: 5,429,345.00 USD

10. How does climate change affect you? • 1400 Village Health Committees covering 2.500.000 people i.e.70% of the country’s population took part in the communication campaign • 57 seminars with participation of 1151 representatives of Rural Health Committees and 1029 primary health workers were carried out

11. Installing solar panels in 5 hospitals • Solar energy technology transferred within 5 health care facilities (solar collectors, solar panels) • Assessment of effectiveness of use of alternative energy source carried out • Managers of health facilities increased awareness of alternative energy sources and technologies • Video broadcast nationally • Two methodical guides on use renewable energy sources / efficient technologies in health sector

12. Uzbekistan

13. to reduce the burden of respiratory diseases, through early warning and early case detection and management; • most of the daily PM10 concentrations exceeded 50 μg/m, but mostly less than 75 μg/m3 (monthly average about 70 μg/m3); • the general ratio PM2.5/PM10 was about 0.4 in Tashkent (short period – more data available) • two dust storm events in Nukus • winter in Tashkent, clearly showing the effects of combustion with high PM2.5. Monthly means of PM10 and PM2.5 Two stations in Tashkent and Nukus equipped with samplers for PM10 and PM2.5 dust particle monitoring. Staff trained PM10 WHO AQ Guidelines annual mean PM2.5

14. to reduce the burden of respiratory diseases, through early warning and early case detection and management • 307 medical doctors and 23 district coordinators have been trained on PAL • 26 specialists from hospitals have been trained on the operation of respiratory equipment • 90% of first – level health facilities have at least one doctor trained on PAL • Health care facilities provided with basic equipment to implement PAL

15. Early Warning System on dust storm developed

16. Kazakhstan

17. Vulnerability by Region

18. Health impacts • An increase of ambient temperature by 1°C is associated with: • increase of deaths from cerebrovascular diseases from 1.2% to 2.7%. (Women more at risk) • Increase of daily deaths from external causes (accidents, homicides). • a 5.3% increase in the number of cases of salmonella. • Increased risk of changes in distribution of some climate sensitive infectious diseases (plague, CCHF, malaria, tick borne diseases..) • Many health care facilities at risk (99 mapped) from extremes, and many hospitals show big gaps in capacity of managing risks

19. An example on setting priorities

22. World Health Organization Recommendations • Creating mechanisms for interagency coordination to protect public health in a changing climate and environment • Creating an environmentally-friendly healthcare system and providing resilience • To strengthen the human and scientific potential of the healthcare system of the Republic of Kazakhstan • Raising awareness and environmental literacy among the public and healthcare workers • Strengthening the system of epidemiological monitoring and surveillance for climate-dependent infections • Inclusion of the issues of climate change into the list of priority scientific research, as well as to ones, funded by the Science Foundation • Identification of the major health indicators to monitor impact of climate change on health routinely

23. Tajikistan

24. Priorities In general V&A priorities In descending order: Water and sanitation Food security Reproductive Health Communicable diseases Cardiovascular and respiratory diseases • V&A provides basic information for the development of the adaptation measures and sustainability • Particular vulnerable populations such as women and children

25. NCCHASAP 2012-2020 Main activities Improvement of legislative bases. Interventions to reduce vulnerability and socio-economic damage. Enhancement of adaptive capacity of the population Institutional and capacity building. Public awareness.

26. Improve water security and safety for health care institutions • 80 % of health facilities in country do not have adequate quantity of running water • 2 pilot sites chosen for developing Water Safety Plans • One hospital site having water safety plan, including repair and installation of safe water delivery system • Training on water safety planning • Workshop for facilitators team of 13 professionals from Ministry of Health, for Water Safety Plan in pilot villages • Training of trainers for hospital plumbing • National advocacy seminar for 40 decision makers and potential donors

27. Focus groups in Rudaki

28. Before introduction to WSP

29. After implementing Water Safety Plan

30. Media, people and information

31. Water awareness rising

32. The importance of this initiative • The multiplier effect • From 1 to 4 • The leapfrog effect • Innovation and technology • The political effect • Health in the UNFCCC • In the WHA • The economic benefits of adaptation • Disease averted; absenteeism avoided • The environment benefits • GHG savings • The health benefits

33. Priorities for the EU – CAR cooperation • Support to implement the health adaptation strategies/action plans • Strengthen public health and health services, workforce development • Infectious disease early identification, mapping, control, surveillance • Develop early-warning systems and strengthen health sector engagement in emergency planning • Particular focus on vulnerable regions/populations • Mother and child health development • Men • Leap-frog developments: sustainable and green health services/systems • Health in NAMA’s and in general mitigation action

34. Thank You! Dr Bettina MenneProgramme ManagerClimate change, sustainable development & green health services WHO European Centre for Environment and Healthmenneb@ecehbonn.euro.who.int +49 2288150422