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

Highlights

• Exposures caused or aggravated by climate change tend to happen concurrently.

• However, preventive plans on such exposures are usually activated individually.

• Failure to integrate prevention efforts could affect their effectiveness and reach.

• A template for indicator-based plans integration is proposed in this article.

Abstract

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.

Introduction

Both the drivers of climate change, as well as its impacts, severely affect health at a global level. Fossil fuel burning (a major driver of climate change) crucially contributes to the 7 million annual deaths from outdoor and indoor air pollution, whereas climate-related risks and exposures are bound to threat many aspects of the societies we live in, severely affecting health (WHO, 2018).

The causality between some climate-influenced direct exposures and health outcomes is well-established and understood, such as the impact of heat waves on mortality (Carmona et al., 2016; Martinez et al., 2019; Linares et al., 2020) and -with more heterogeneity-also on population morbidity (Cheng et al., 2019; Díaz et al., 2017). Others, such as the impact of heat waves on car accidents, work-related accidents, and mental health or violence are still to be fully explained. Mental health disorders, for example, seem to be influenced by climate change mainly in relation to the loss of homes or uninsured economic losses due to extreme weather events, droughts or the rise in sea level but in the practice this issue is largely unexplored (Watts et al., 2018).

Changes in vector borne diseases and their geographic redistribution (Ebi et al., 2018; Linares et al., 2020) are another of the risks of climate change on human health whose influence will be exacerbated in Europe (Cramer et al., 2018), as will food-borne and water-borne, expected to increase in coming years as a consequence of the increase in global temperature (Kovats et al., 2004; Ciscar et al., 2014).

Indirectly, climate change also affects the concentrations of air pollution present in large cities, reducing ventilation and pollutant dispersion or through the elimination of processes of troposphere-stratosphere exchange of ozone (Linares et al., 2020). It influences the increase in forest fires with a clear impact on the health of citizens (Linares et al., 2018), and increases concentrations of tropospheric ozone as a consequence of the temperature increase. Mineral dust advection can also be affected by atmospheric dynamics, especially in Europe, where in recent years an increase has been detected in PM10 concentrations in the Eastern Mediterranean as a consequence of dust storms (Krasnov et al., 2016). These desert dust intrusions have a clear effect on, not only through the increase in PM10 concentrations, but also through the increase in other pollutants (Moreira et al., 2020; Pandolfi et al., 2014).