Effectiveness, Degree of Implementation and Obstacles of Adaptation:

Further Impacts

We also enquired about further possible impacts of climate change on the health sector. Respondents listed diseases associated with disease vectors, algal toxins, the import of new diseases through worldwide ecological changes, the long-term exacerbation of ozone and smog related problems, and health impacts of skin and eyes due to changes in solar radiation.

particularly from health departments and ministries from the following seven federal states: Hamburg, Berlin, Mecklenburg-Western Pomerania, Thuringia, Hesse, Saarland, and Baden-Württemberg. The following results of the survey must be seen as preliminary assessment of the measures that are suitable to adapt the German health sector to climate change, since only one expert per federal state was approached and the return of the questionnaires from the federal states was scarce.

In the survey, different dimensions of the adaptation measures were evaluated; the effectiveness of the measures to mitigate the potential impacts and capitalize on potential opportunities of climate change introduced in section 4.5.5 (see Tab. 4-5), and the present degree of implementation of the adaptation measures (see Fig. 4.5-4).

Heat Waves: Education, Warning Systems, Emergency Planning, Insulation and Cooling of Buildings

Nearly all respondents saw education and improved warning systems as an effective measure to adapt to heat waves (see Tab. 4-5). Only half of the respondents thought that improved emergency planning would be effective, and surprisingly few saw improved insulation and cooling of buildings for specific groups of people (elderly and infirm) as an effective measure.

Tab. 4-5: Rating of the degree of effectiveness of adaptation measures to mitigate risks and capitalize on opportunities of climate change in the health sector. The number of respondents that rated a particular measure of mitigation resp. exploitation as effective is shown. Sample size: 6 questionnaires from the federal states Berlin, Hamburg, Thuringia, Hesse, Baden-Württemberg, and Mecklenburg-Western Pomerania.

Measures

Fewer problems with frost (frostbite, deaths

through cold)

Increased problems with heat

(circulation problems, impacts

on brain vessels and the respiratory

system, death through heat)

Deaths and injuries through extreme events (storm, flood)

Distribution of ticks

distribution of Anopheles-mosquitoes

(malaria)

Diseases caused by problems with

water quality (surface water and drinking

water)

Heat waves

Education 1 5 1 5 4 1

Improved warning systems - 4 1 2 3 1

Improved emergency planning - 2 1 - - 3

Improved insulation and cooling of buildings for specific groups

of people 1 2 - - -

-Extreme events

Education 1 1 3 2 2 2

Improved warning systems 1 1 4 - - 2

Improved emergency planning - 1 4 - 1 2

Vector-borne diseases

Education - - - 5 3 1

Improved warning systems - - - 2 3

-Campaigns of vaccination - - - 1 1

-Measures integrating several risks

Insurance against damages

through climate change - 1 1 - - 1

Creation of reserve funds for future adaptation measures and damage reparation payments

- - 1 - - 1

Impacts

Fig. 4.5-4: Assessment of the degree of implementation of measures that are suitable to adapt to climate change in the health sector. Sample size: 7 questionnaires from the federal states Hamburg, Berlin, Mecklenburg-Western Pomerania, Thuringia, Hesse, Saarland, and Baden-Württemberg. The n-values give the number of questionnaires each box-plot is based on. For further explanation of the graphic illustration see Fig. 4.5-3.

not discussed

currently consideredplanned

partially implemented implemented

Degree of implementation

Creation of reserve funds Insurance against damages Vector-borne diseases: Campaigns of vaccination Vector-borne diseases: Improved warning systems Vector-borne diseases: Education Extreme events: Improved emergency planning Extreme events: Improved warning systems

Extreme events: Education Heat waves: Improved insulation and cooling of buildings for specific groups of people Heat waves: Improved emergency planning

Heat waves: Improved warning systems Heat waves: Education

n=1 n=4

n=4 n=5 n=7

n=6 n=7 n=7

n=7

n=6 n=5

n=1

Respondents rated the degree of implementation for adaptation measures to heat waves overall as lower than that for adaptation measures to extreme events (e.g.

floods) and vector-borne diseases (see Fig. 4.5-4). There are large differences between federal states, particularly with regard to education, warning systems, and emergency planning. Highest degrees of implementation (already “implemented”) are reported from Hesse and Thuringia for education, from Hesse for improved warning systems, and from Baden-Württemberg for improved emergency planning. Most respondents name the experiences during the heat summer of 2003 as the reason for implementing these measures, as well as the initiative of a consortium of the higher state authorities on health, which was put into place upon suggestion of the DWD.

Only the expert from Hamburg named climate change as an additional reason, but exclusively for the implementation of education regarding heat waves.

The lowest degree of implementation of measures that are suitable to adapt to heat waves is found for the insulation and cooling of buildings for specific groups of people.

In all federal states, this measure is either “not discussed” or “currently considered”.

Only the expert from Thuringia reported this measure as already “partially implemented”. As reasons for this the respondent named modernisation and energy saving plans, but not the intention to adapt to heat waves.

About half of the respondents saw organisational hurdles as obstacles for the implementation of the four measures to adapt to heat waves. For the implementation of education, warning systems, and emergency planning, one or two respondents named financial hurdles, while nearly all respondents saw financial hurdles for the improved insulation and cooling of buildings. As an additional obstacle, respondents reported that the precaution against heat waves was not yet an issue within political and public awareness outside of Southern Germany, which was particularly impacted by the 2003 heat wave. With regard to these obstacles, respondents rated the education about heat waves and improved warning systems on average as “slightly complicated”, improved emergency planning as “complicated”, and the insulation and cooling of buildings for specific groups of people even as “very complicated”.

Extreme Events: Education, Warning Systems and Emergency Planning

Most respondents thought of specific education, warning systems and emergency planning as effective to avoid injuries and fatalities through extreme events (see Tab.

4-5). Education and improved warning systems were on average across federal states rated as already “partially implemented”, while improved emergency planning was on average described as “planned” (Fig. 4.5-4). However, this is based on ratings from only four and five federal states, respectively. Nevertheless, the differences in the responses from these few states were extraordinarily high: the ratings ranges across the whole spectrum from “not discussed” to “implemented”. The highest degree of implementation for all preventive measures against extreme events was reported from Hamburg, and regarding warning systems also from Berlin.

The main reasons that were given for the implementation of these measures were flood experiences and flood protection. None of the respondents named climate change as an additional reason for implementation of these measures. Only one expert responded about obstacles to implement the preventive measures²¹. This respondent named mainly organisational obstacles for all three measures. Only two experts rated the complexity of the measures, and responded “slightly complicated” to

“complicated”.

21 The targeted experts from health departments and ministries usually do not have access to the background knowledge necessary to evaluate concrete obstacles of implementation, since the implementation of measures against extreme events falls under the responsibility of the Ministry of the Interior.

Vector-Borne Diseases: Education, Warning Systems, and Campaigns of Vaccination

In all federal states, education of the public is seen as the most effective means to prevent a further spreading of ticks in the context of climate change (see Tab. 4-5).

Most respondents thought of education and improved warning systems as effective to prevent the potential increased spread of malaria. Only one respondent thought of campaigns of vaccination as an effective measure to mitigate these two risks.

Respondents rated the education about vector-borne diseases and the related warning systems as on average already “partially implemented”, and the respective vaccinations as “planned” – but there were marked differences between federal states (see Fig. 4.5-4). In Berlin, Thuringia and Hesse, education on risks through vector-borne diseases was rated as already “implemented”. In Hamburg, the highest degree of implementation is reported for warning systems, in Thuringia for vaccinations. The following reasons were listed for implementing these three measures: prevention, legally compulsory registration in accordance with the law on protection against infections, and observations of tick-borne encephalitis and lyme disease. The respondent from Hamburg stressed the increased risk of Hamburg as a seaport to import mosquitoes, rodents and flees. According to respondents, climate change did not play a role in implementing the adaptation measures.

Respondents did hardly report on obstacles and complexity of the measures. A few respondents named financial and organisational hurdles, as well as lacking knowledge (lacking information about incidence and prevalence). The implementation of education and warning systems was rated on average as “slightly complicated”, the implementation of campaigns of vaccination as “complicated”.

Measures against water-borne diseases

Respondents thought of improved warning systems and emergency planning as effective measures to prevent diseases related to possibly enhanced problems with water quality due to climate change. Two out of six respondents further thought of education as effective (see Tab. 4-5). To avoid excessive length of the surveys, we did not ask about degree of implementation, obstacles and complexity of these measures.

Measures integrating several risks: Insurances and Reserve Funds

Only one respondent thought of insurance against damages through climate change and creation of reserve funds for future adaptation measures and damage reparation payments as effective to respond to potential impacts of climate change (see Tab. 4-5). Although we asked about the general effectiveness of these measures, representatives of health departments and ministries seem to have related this inquiry only to their specific administration. Therefore, the impression of limited effectiveness of insurance and financial reserve instruments seems justified, since these administrations mainly deal with the prevention of disease and death, rather than the financial impacts. It is further understandable that only one respondent reported on the degree of implementation of these measures in his federal state, and rated them as “not discussed” in his administration (see Fig. 4.5-4). The degree of implementation of insurance and reserve measures is much higher on citizen level, regarding citizens’

life insurances, occupational disablement insurances, accident insurances, health insurances and financial reserves in case of illness.

Further Measures

Moreover, experts were asked for further measures in the health sector that may be suitable to prevent risks of climate change or capitalize on opportunities in their federal states. Respondents listed the following measures: reduction in urban heat islands through climate-suitable urban planning, climate–suitable architecture (design of buildings), education about solar radiation and skin diseases, research on changes in flora and fauna through spreading of toxic or allergenic species, as well as disease vectors, and long-term monitoring of health effects.

Adaptation to Climate Change in Health Departments and Ministries

Only three respondents from the health departments and ministries of federal states reported that there is a debate about the adaptation to climate change within their administration. In these three federal states – Hesse, Baden-Württemberg and Hamburg – there are practical programmes for the adaptation to climate change, which mainly relate to the implementation of warning systems. Hesse also collaborates with the project InKlim (integrated Climate Protection Program, InKlim 2012), and Hamburg collaborates with the Department of Hazard Protection. Asked about the current relevance of climate adaptation in their administration in relation to other topics, two respondents replied “important” (Baden-Württemberg and Berlin), one replied “slightly important”, and three replied “unimportant”. In none of the administrations the topic was rated as “very important”. In the health departments and ministries, adaptation to climate change impacts currently seems to play a varying role, which is never very large and mostly focused on the risk of heat waves.

Adaptation in the Health Sector: Summary and Conclusions

Many respondents thought of education (and also improved warning systems) as broadly effective regarding adaptation to the potential impacts of climate change²². Many experts list several effective adaptation strategies for each potential impact of climate change. Moreover, these measures do not seem to be very complicated. There may have been few responses on the complexity of the implementation of adaptation measures, but many were rated as only “slightly complicated”.

Such measures are, however, not yet fully implemented in the surveyed federal states.

This is particularly the case concerning preventive measures against heat waves, and within this category particularly regarding insulation and cooling of buildings for specific groups of people. Even if few respondents regard this measure as effective, it is still highly necessary: Elderly and infirm people need suitable rooms where they can stay after a heat wave warning has been issued. Most respondents rate education and warning systems as effective.

The health sector shows the highest variability in the degree of implementation of adaptation measures, relative to the other climate-sensitive sectors. For nearly all measures, at least one federal state reports “full implementation”. At the same time, nearly all measures are also “not discussed” in at least one federal state. Therefore we strongly recommend transfer of knowledge between federal states on sufficient means and ways to implement adaptation measures.

It is doubtful whether the currently available and planned measures within the German health sector will suffice to adequately respond to anticipated climate change impacts.

According to respondents, climate change nearly never among the reasons to implement adaptation measures. A debate about adaptation to climate change is currently taking place only in few federal states (mainly concerning the implementation of heat warning systems). Many unanswered questions in the surveys are further evidence that climate change has rarely been discussed in the health sector. We therefore conclude that the impacts of climate change were not (or only very slightly) considered in present planning, and that the health sector is not yet adapted to climate change n many federal states. Consequently it is time to act.

Adaptation needs to be seen as long-term process; due to the inherent uncertainty in concrete future impacts of climate change, alterations in adaptation strategies will become necessary as our scientific knowledge base improves continuously.

Damaging events in the past are often listed as reasons for implementing measures that are also suitable to adapt to climate change. Federal states that have already been hit in the past by heat waves, extreme events or increased occurrence of

22 We cannot draw conclusions on the measures integrating several risks, such as insurances and the creation of financial reserves, since there were only very few responses regarding these measures.

borne diseases, report distinctly higher degrees of implementation of adaptation measures, than federal states that so far have hardly been impacted. The pattern to implement preventive measures only when a particular risk has already caused damages can also be observed in other climate-sensitive sectors (e.g. agriculture).

However, the health sector is concerned with risks of losses of human lives, losses that cannot be compensated after the event, as opposed to losses in the agricultural or forestry sectors. Therefore, in the health sector it is particularly important to move from reactive to proactive planning of adaptation measures, and to take into account scenarios of climate change in addition to climate trends of the past. When climate changes, past trends are poor indicators of future events.

The German health sector is not yet adapted to climate change. However, adaptation should well be possible in future, since effective adaptation measures are available for the various potential impacts of climate change. These are mainly education and warning systems, which also do not seem to be particularly complicated to implement.

Im Dokument Climate Change (Seite 132-139)