12.4.11 Human health
Countries in Europe currently experience mortality due to heat and cold (Beniston, 2002; Ballester et al., 2003; Crawford et al., 2003; Keatinge and Donaldson, 2004). Heat-related deaths are apparent at relatively moderate temperatures (Huynen et al., 2001; Hajat et al., 2002; Keatinge, 2003; Hassi 2005; Páldy et al., 2005), but severe impacts occur during heatwaves (Kosatsky, 2005; Pirard et al. 2005; Kovats and Jendritzky, 2006; WHO, 2006; see also Section 12.6.1). Over the next century, heatwaves are very likely to become more common and severe (Meehl and Tebaldi, 2004). Heat-related deaths are likely to increase, even after assuming acclimatisation (Casimiro and Calheiros, 2002; Department of Health, 2002). Cold mortality is a problem in mid-latitudes (Keatinge et al., 2000; Nafstad et al., 2001; Mercer, 2003; Hassi, 2005) but is likely to decline with milder winters (Department of Health, 2002; Dessai, 2003). Major determinants of winter mortality include respiratory infections and poor quality housing (Aylin et al., 2001; Wilkinson et al., 2001, 2004; Mitchell et al., 2002; Izmerov et al., 2004; Díaz et al., 2005). Climate change is likely to increase the risk of mortality and injury from wind storms, flash floods and coastal flooding (Kirch et al., 2005). The elderly, disabled, children, women, ethnic minorities and those on low incomes are more vulnerable and need special consideration (Enarson and Fordham, 2001; Tapsell and Tunstall, 2001; Hajat et al., 2003; WHO, 2004, 2005; Penning-Rowsell et al., 2005; Ebi, 2006).
Changes in tick distribution consistent with climate warming have been reported in several European locations, although evidence is not conclusive (Kovats et al., 2001; Lindgren and Gustafson, 2001; Department of Health, 2002; Bröker and Gniel, 2003; Hunter, 2003; Butenco and Larichev, 2004; Korenberg, 2004; Kuhn et al., 2004). The effect of climate variability on tick-borne encephalitis (TBE) or Lyme disease incidence is still unclear (Randolph, 2002; Beran et al., 2004; Izmerov et al., 2004; Daniel et al., 2006; Lindgren and Jaenson, 2006; Rogers and Randolph, 2006). Future changes in tick-host habitats and human-tick contacts may be more important for disease transmission than changes in climate (Randolph, 2004). Visceral leishmaniasis is present in the Mediterranean region and climate change may expand the range of the disease northwards (Department of Health, 2002; Molyneux, 2003; Korenberg, 2004; Kuhn et al., 2004; Lindgren and Naucke, 2006). The re-emergence of endemic malaria in Europe due to climate change is very unlikely (Reiter, 2000, 2001; Semenov et al., 2002; Yasukevich, 2003; Kuhn et al., 2004; Reiter et al., 2004; Sutherst, 2004; van Lieshout et al., 2004). The maintenance of the current malaria situation is projected up to 2025 in Russia (Yasyukevich, 2004). An increased risk of localised outbreaks is possible due to climate change, but only if suitable vectors are present in sufficient numbers (Casimiro and Calheiros, 2002; Department of Health 2002). Increases in malaria outside Europe may affect the risk of imported cases. Diseases associated with rodents are known to be sensitive to climate variability, but no assessments on the impacts of climate change have been published for Europe.
Climate change is also likely to affect water quality and quantity in Europe, and hence the risk of contamination of public and private water supplies (Miettinen et al., 2001; Hunter, 2003; Elpiner, 2004; Kovats and Tirado, 2006). Higher temperatures have implications for food safety, as transmission of salmonellosis is temperature sensitive (Kovats et al, 2004; Opopol and Nicolenco, 2004; van Pelt et al. 2004). Both extreme rainfall and droughts can increase the total microbial loads in freshwater and have implications for disease outbreaks and water quality monitoring (Howe et al., 2002; Kistemann et al., 2002; Opopol et al. 2003; Knight et al., 2004; Schijven and de Roda Husman, 2005).
Important climate change effects on air quality are likely in Europe (Casimiro and Calheiros, 2002; Sanderson et al., 2003; Langner et al., 2005; Stevenson et al., 2006). Climate change may increase summer episodes of photochemical smog due to increased temperatures, and decreased episodes of poor air quality associated with winter stagnation (Hennessy, 2002; Revich and Shaposhnikov, 2004; Stedman, 2004; Kislitsin et al., 2005), but model results are inconsistent. Stratospheric ozone depletion and warmer summers influence human exposure to ultra-violet radiation and therefore increase the risk of skin cancer (Inter-Agency Commission, 2002; van der Leun and de Gruijl, 2002; de Gruijl et al., 2003; Diffey, 2004). Pollen phenology is changing in response to observed climate change, especially in central Europe, and at a wide range of elevations (Emberlin et al., 2002; Bortenschlager and Bortenschlager, 2005). Earlier onset and extension of the allergenic pollen seasons are likely to affect some allergenic diseases (van Vliet et al., 2002; Verlato et al., 2002; Huynen and Menne, 2003; Beggs, 2004; Weiland et al., 2004).