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Mediterranean Climate Change Impacts

Elena Xoplaki Justus-Liebig University of Giessen, Germany

• The Mediterranean basin • Climate change
– Mean and extremes

• Health issues in the Mediterranean basin • Adaptation strategies • Conclusions

The Greater Mediterranean Region

It is influenced by subtropical processes, mid-latitude dynamics …
Source: ESA, 2010

High population density (~60 persons/km2), vulnerability, exposure to climate change….a “hot spot”
Xoplaki, 2002 Giorgi, 2006

What we know about the Mediterranean

Liguria Es Trenc Carthage




Do we know?

Pindos Rome Formentor


Do we know?

Vulnerability in the Mediterranean

Hydrologic cycle – Rainy season
Water resources & water quality Agriculture & environment Economics & social development & behaviour

Temperature extremes – Heat waves
Air pollution, health Tourism

Vulnerability in the Mediterranean
Deforestation, afforestation, desertification Land degradation Food production, food security Livelihood Civil security, migration Political conflicts Energy demand, energy generation, solar, wind Public health

The Mediterranean Climate Summer temperature


Station data °C Toreti 2010

Mediterranean Climate Change Summer temperature 1951-2006


Station data °C/decade Toreti 2010

Mediterranean summer Tmax & Tmin

-0.12°C/decade -0.19°C/decade

+0.67°C/decade +0.61°C/decade

-0.27°C/decade -0.30°C/decade

+0.48°C/decade +0.43°C/decade

Kuglitsch 2010

The Mediterranean Climate Winter precipitation

Station data



Toreti 2010

Mediterranean Climate Change Winter precipitation, 1951-2005


Station data

Toreti 2010

Extreme events in the Mediterranean

Extreme precipitation

Probability of occurrence of extreme events. Estimated tendency

sign increase

sign decrease

no significance

Toreti 2010

Dry days (< 1 mm), October – March

Differences of dry days occurrences

sign increase

sign decrease

no significance

Heat waves trends
HWI95: +1.33 ± 0.06°C/decade
56% stations significant

HWL95: +0.85 ± 0.02 days/decade
37% stations significant

HWN95: +0.17 ± 0.01/decade
47% stations significant
Kuglitsch et al. 2010

Heat waves trends

Heat waves “hot spots”?
Western Balkans Western Turkey Black Sea Coast

Kuglitsch et al. 2010

Eastern Mediterranean heatwaves

from The International Disaster Database; Kuglitsch, 2010

Apparent temperature > 105°F/40.7°C

Changes are strongest over humid and warm regions (coasts and river basins)
Fischer and Schär 2010

Health risk and population density

Fischer and Schär (2010)

Source IIASA

Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health*: food, air, water.

Margaret Chan, Director General, WHO

* Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (Preamble to the Constitution of the World Health Organization, 1946)

Climate change can affect human health
Adapted from Confalonieri et al. 2007
Sustainable development and mitigation Environmental conditions Socio-economic conditions

Heat/cold waves Heat stress Cardiovascular failure Respiratory diseases Air pollution Respiratory and cardiovascular diseases Vector- and rodent borne disease Malaria Encephalitis Hantavirus West-Nile Fever Lyme disease Water- and food borne diseases Cryptosporidiosis Campylobacter Leptospiriosis Toxic infections (mycotoxins) Seasonality in gastro-intestinal diseases Water stress Skin and eye diseases Infectious diseases Food supply Malnutrition Refugees/Migration

Climate change Long term changes in climate Inter-annual climate variability Short-term climate variability Extreme events

Direct exposures (extreme events) Indirect exposures (through changes in vector ecology, food yields, ect.) Social & economic disruption Health systems Prevention and adaptation

Exposure-response Max apparent TT – daily mortality April – September
Rome Bari








Tel Aviv

Analitis et al. 2012

J-shaped relationship highest increase in temperate cities
Rome Bari








Tel Aviv

Analitis et al. 2012

Increase in total natural deaths by age group in heat waves days
80 60 40 % increase 20 0 -20 -40

Total causes: 14% Cardiovascular: 22% Respiratory: 32%


Bari Istanbul

all ages
Valencia Palermo TelAviv Rome Lisbon Tunis

Analitis et al. 2012

Heat waves effect on total mortality
Heatwave effect on TM, all ages
50 40 30 % increase 20 10 0 -10 No poll.
Barcelona Athens


TelAviv Rome Valencia Palermo Lisbon Tunis

Analitis et al. 2012

Temperature & air pollution effects
• Synergistic effect of higher PM10 concentrations and higher temperatures • More pronounced for the elderly and cardiovascular causes; not entirely consistent in all cities • Synergistic effect of O3 with temperature only for total mortality, elderly • No synergistic effect between NO2 and temperature • Heat waves effects larger during days with higher PM10 concentrations; however NOT statistically significant • Overestimation of apparent temperature and heat waves without adjustment for PM10
Wolf et al. 2012

Climate sensitive infectious diseases The burden of disease

Population density

Cultural and economic separation between high income countries (northern shore) and mid-income countries (N. Africa, Middle East)

Burden of infectious diseases

Total population (x1000)

All causes death rate (per 100000)
WHO 2004 - GBD

Burden of infectious diseases

Infectious and parasitic diseases death rate (per 100000)

Infectious and parasitic diseases (without climate related) (per 100000)
WHO 2004 - GBD

Burden of infectious diseases

Infectious vs. all causes death rate (%)

Infectious (climate) vs. all causes death rate (%)
WHO 2004 - GBD

Causes for observed emergent infectious diseases
a) the infection was present but unrecognized or unrecorded b) the pathogens existed in the past but in a less virulent form c) environment and behavioral changes provide new conditions in which the disease may flourish d) a new epidemic arise from the introduction of a virulent organism into a non-immune population
Hagget (1994)

Epidemiological factors: economical security
• Capability of individuals & government to overcome difficulties connected with infectious diseases • Security correlated with economic welfare and investment on health • Clear differences between EU-countries and the others

Epidemiological factors: land and water use
Changes in the Mediterranean – anthropogenic biomes • colonization of new environments in order to expand food production • abandonment of farmland reverting to woodland • alteration of the local water regimes due to water control and irrigation • disease implications of the growing urban population and the abandonment of rural areas alterations in the survival of pathogens and in the interaction between hosts and vectors

Agricultural and forest land cover and land cover change

Croplands %

Pastures and rangelands % Forests

Variation of cultivated area 1962-2003 Forest area change 1990-2005

Remaining forest Original extent

FAO 2007

Water resources, water use

FAO 2007

Water use – water availability

EEA 2012

Water resource exploitation 2025


Epidemiological factors: mobility of hosts and vectors
• enhancement of spatial mobility for human hosts, vectors and micro-organisms • bird migratory routes • displacement of human populations as a result of war, natural disasters • merchant shipping • travel • human migration

Main bird migration routes

Migration routes

Maritime trade Europe – Asia routes of one company

Mobility, air travel

Grublerand Nakicenovic 1991

Relevant climatesensitive infectious diseases for the Mediterranean Basin

Assessing health effects Adaptation strategies
• Assessments of climate change and health impact vulnerability and adaptation provide essential information about the risks to health, their differential distribution between groups and places, future projected risks and help to set priorities for adaptation and financing.

Mediterranean countries with UNCFFF communications
Albania Croatia France Greece Italy Malta Montenegro Spain Algeria Egypt Israel Lebanon Morocco Tunisia Turkey

UNFCCC communication (link)

Specific health concerns outlined
only general health concerns mentioned, not specified heatwaves, foodborne disease, respiratory allergies, malaria, tick borne meningoencephalitis, mainly heat, separate assessment published forest fires and floods, as well as air pollution aggravated in cases of extreme heat waves all possible risks are listed all possible risks are listed and in part assessed all possible risks are listed and partly assessed only general health concerns mentioned, not specified only general health concerns mentioned, not specified Schistosomiasis, Malaria, Lymphatic Filariasis, Rift Valley Fever, emerging: Tuberculosis, Avian Influenza, water-borne and food-borne diseases only general health concerns mentioned, not specified only general health concerns mentioned, not specified only general health concerns mentioned, not specified health not mentioned only very general health concerns mentioned, not specified

Mapping climate change vulnerabilities to infectious diseases

Would specific vector-borne diseases be affected by climate change? Semenza et al. 2011

Mapping climate change vulnerabilities to infectious diseases

Semenza et al. 2011

Adaptation strategies
• Training for assessing health risks of climate change • Enabling national public health experts to coordinate the development of a climate change and health strategy, emphasizing the health sector role in adaptation and mitigation • Sustainable adaptation:
– Strengthen monitoring and disease surveillance – Strengthen public health systems in responding to climate change – Promote the development of a green economy and health cobenefits of mitigation and adaptation

• climate change-related exposures and health impacts are likely to increase in the Mediterranean
– high temperatures, heat waves and air quality – changes to the distribution and patterns of climate sensitive infectious diseases – health risks related to water availability and quality, droughts, food and nutrition can trigger migration and conflict. The full scale of the health security risks need to be further understood – additional efforts need to be put into data collection, surveillance, homogenized definitions and partnerships across disease networks

• Adaptation strategies:

–strengthen health, social and environmental systems and services to improve their capacity to prevent, prepare for, and cope with climate change –ensure that all current and future mitigation and adaptation climate change measures, policies and strategies integrate health issues at all levels –raise awareness to encourage health promoting mitigation and sustainable 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 and to identify research gaps (WHO Regional Office for Europe, 2010).

Healthy cities – Key messages
• Cities are complex systems, so urban health outcomes are dependent on many interactions • The so-called urban advantage—whereby urban populations are, on average, at an advantage compared with rural populations in terms of health outcomes—has to be actively promoted and maintained • Inequalities in health outcomes should be recognised at the urban scale • A linear or cyclical planning approach is insufficient in conditions of complexity • Urban planning for health needs should focus on experimentation through projects • Dialogue between stakeholders is needed, enabling them to assess and critically analyse their working practices and learn how to change their patterns of decision making
Rybin et al. The Lancet 2012

Thank you very much for your attention!