Download HEALTH,Climate change _UNFCCC submissionMSVK, RM (1)

Note: This submission is based on the findings of a national health vulnerability, impact and
adaptation assessment of climate change ((h)VIA) carried out in the Republic of Macedonia as
part of a WHO/BMU seven countries initiative named Protecting health from climate change,
implemented in the period 2009 – 2013.
1. Name/s of institution(s) and any collaborating partner(s)
Ministry of Health in cooperation with the following partners:
 Ministry for Environment and Physical Planning
 Institute for Public Health
 Institute for Occupational Health, WHO Collaborative Centre
 Health house Skopje – Emergency Medical Services
 Public Health Centre – Skopje
 City of Skopje
 Crisis Management Centre
 Directorate for Protection and Rescue
 Red Cross
2. Country/Countries of focus
The Republic of Macedonia covers a geographical area of 25 713km2,, with a population of
around 2.06 million and an average population density of 80.1/km2. 17.3% of the population are
aged between 0-14, and 11.8% aged 65 and over. The rate of natural population increase has
dropped from 3.6 ‰ in 2001 to 1.6 ‰ in 2011 (SSO 2012). Life expectancy is 69.9 years for
males and 74.4 years for females, with circulatory diseases (59.2%), neoplasms (18.2%), and
endocrine, nutritional and metabolic diseases (3.9%) being the leading causes of mortality.
In recent years, Macedonia has recognized that climate change is a significant threat to
population health (UN 2012). It was the country most affected by climate related events in
Europe in 2007, with a rate of 488 affected people per 1000 inhabitants. During July 2007, daily
temperatures reached 43°С and caused more than 200 fires destroying over 2000 hectares of
forests, and almost 1000 excess deaths (compared to the averages for 1994–2008). As the
evidence continues to mount for the direct and indirect consequences of anthropogenic climate
change, the need for development of adaptation measures, policies and strategies to improve
resilience to climate change and its impacts has become an increasingly recognised challenge.
According to climate change scenarios the average increase in temperature in the Republic of
Macedonia could reach 3.8 °C in 2100, and the average decrease in precipitation could be up to
-13% compared with 1970–1990 averages. A likely consequence of this would be more frequent
and more intense heat-waves, droughts and flood events. A significant increase in the burden of
climate-sensitive diseases could be expected in this south Mediterranean country, such as heatrelated mortality and illness, re-emergence of vector-borne disease, diarrhoeal disease, injuries
from extreme events, and respiratory diseases is also expected.
3. Research, analyses, tools, methods or approaches (that have been used or
developed), etc.
3.1 Health vulnerability and impact assessment ((h)VIA)
The (h)VIA used the methods developed by WHO in 2003, 2005 and adjourned in 2012.
(Campbell-Lendrum et al. 2003; Kovats et al. 2005; WHO 2012). A national framework was
established to oversee activities: this included a national multisectoral steering committee and a
technical working group, which defined the scope, the methods, the peer review process, and
the process of defining priorities. The project team carried out a baseline scoping exercise to
identify readily available information and data on the climate associated health exposures and
risks to population health (Kendrovski and Spasenovska in press)..
The (h)VIA utilised a range of qualitative and quantitative methodologies, reflecting data and
information availability, and the nature of the challenge under review (WHO 2003) (Tables 2 and
3). Additional data was collected through case studies, stakeholder interviews and focus group
discussions with representatives of the sectors responsible for climate change adaptation and
mitigation. Where specific vulnerabilities had been identified for further investigation, in-depth
analyses were performed to improve understanding of the scope and scale of the exposures
and risks. This included investigation of the influence of heatwaves on mortality, the risks
associated with salmonellosis, the presence of the vector Aedesalbopictus and the onset of
pollen and aeroallergens in the city of Skopje.
Analysis of the data was carried out through time series and regression analysis for selected
health outcomes, scenario based impact assessment and a damage and adaptation cost
estimation was carried out for heat-waves. An overview of the assessment process and data
sources utilised is given in table 2. (table 2)
3.2 Health adaptation Strategy development process
A three-day workshop1 was held in 2009 to identify general priorities and provide strategic
direction for the development of a climate change health adaptation strategy, using the public
health approach designed by WHO Euro. (figure 1) Key factors considered at the workshop
included a) the size and the nature of the problem related to each of the priorities, b) effective
interventions, c) the goal and objectives of the strategy for each of the priorities, d) involvement
of institutions and responsibilities, e) indicators, f) financial implications. Following the workshop,
three multi-sectoral working groups, with specific responsibilities for assigned priority areas,
were created to take forward development of the plan, with an overall co-ordinator appointed to
oversee progress. The criteria utilised to inform detailed development of the strategy included
the approximate costs of proposed interventions, benefits to health and other sectors from
1
Participants were representatives from the Ministry of Health, Public Health Institute, Ministry of Environment and Physical Planning,
Hydrometeorology institute, Crisis management centre, Direction for protection and Rescue, Emergency medical services, Public health centres,
Institute for occupational Medicine, World Health Organisation, Red Cross and other NGOs.
intervening, feasibility to implement within existing services or systems, potential harm from any
intervention, and potential barriers or obstacles and opportunities for implementation. The
strategy was informed by comments received at the workshop, and then sent to selected local
experts for peer review and revision.
4. Key results (including both quantitative and qualitative evidence)
4.1 Results from the (h)VIA
The (h)VIA process identified a number of specific climate sensitive conditions and diseases
where adaptation is required. The results are summarized in table 3. (table 3). The impacts of
climate change on health are already manifesting in the Republic of Macedonia. Major heatwaves, floods and droughts have led to deaths and human suffering, social disruption and a
substantial burden to health systems (WHO 2008). Over 1000 excess deaths in the heat-wave
during the summer of 2007 (WHO 2011), and around 10% excess winter mortality have been
observed in the country and in the Region (Healy 2003; Kendrovski 2006), together with
changes in the spatial distribution of some infectious disease vectors and in pollen seasonality
(Confalonieri 2006l; Kendrovski et al. 2012; KaradzinskaBislimovska et al. 2012).
The direct health effects of heat-waves could be a significant problem, especially in the context
of increased urbanization, with more than 60% of the population already living in the cities.
Increased mortality during heat-waves is likely, particularly for people with chronic diseases, and
cardiovascular and respiratory diseases. (Kendrovski et al, 2010)
Food safety is compromised by higher temperatures, with several studies confirming and
quantifying the effects of high temperatures on common forms of food poisoning, demonstrating
an approximately linear increase in salmonella reported cases with each degree increase in
weekly or monthly temperature (5-10% higher salmonellosis notifications for each degree
increase in weekly temperature for ambient temperatures above 5°C). (Kovats et al, 2004;
Kendrovski et al. 2012).
4.2 Climate change health adaptation strategy
The (h)VIA showed that a number of current measures, policies and strategies needed to be revised or strengthened to respond to current and projected levels of risks from climate change. (
Kendrovski et al. 2009)
On the basis of the (h)VIA, the Climate Change Health Adaptation Strategy and Action Plan was
developed and endorsed by the Government in February 2011 with the following priority
domains of action:
raising awareness of climate change and the effect on health;
identifying, registering and monitoring risks connected with climate change and their
influence on people’s health; and
improving the health system in its promotion and prevention activities.
The general goal of the Strategy is to plan climate change adaptation measures for the health
system in order to prevent and/or overcome both existing and future risks and to respond
promptly to the risks and problems for people’s health and well-being that are expected as a
result of climate change in the Republic of Macedonia. (Figure1 and table 4)
Key areas addressed by the National Health Adaptation Strategy include: adapting the health
care infrastructure (hospitals, nursing homes) to be more resilient to the effects of heat, fires
and floods; development of local “Hospital”' plans for coping with disasters; and increasing
awareness of how people can adapt to changes in climate. These can be summarised as the
need for greater emphasis to be placed on climate change and its impacts; the need for
governments to focus on this problem; and the identification of measures individuals can take to
mitigate the effects of climate change on their health.
5. Good practices and lessons learned (as appropriate)
The process followed in the the Republic of Macedonia provides a case study of practical on the
ground action, built on a robust vulnerability assessment, delineating the areas where human
health vulnerability to climate change were likely to occur. By defining areas of increased risk
and exposure, the country was able to provide a firm foundation for health officials, planners
and decision makers to develop and focus adaptation strategies, highlighting the relationships
between climate change, specific environmental, cultural, social and geographical factors and
human health outcomes.
The evidence collected through the (h)VIA process visibly demonstrated that climate change is
likely to have both direct and indirect impacts on the health of its population. It highlighted and
underlined the key lesson that these impacts are happening now, and that they do not come in
isolation, but exist alongside and potentially exacerbate existing challenges to the health, social,
environmental and economic systems. For example, about 10% of the population still lacks
access to clean and safe water, be it for drinking or for meeting their basic needs. Droughts,
poor irrigation, and the damage that flooding will make to existing sewage systems will
exacerbate this. In addition, there are year-on-year growing trends for certain groups of
communicable diseases, especially those associated with contaminated food and water
(salmonellas, alimentary toxic infections, shigelloses). Changes to the distribution of vectors, the
destruction of their habitats, pest control and the density of hosts are also likely to result in reemergence and increased prevalence of vector-borne diseases. Recently, some vector-borne
diseases sensitive to climate change (e.g., Lyme disease, malaria) have been reported in
neighboring countries and other infections have occurred in the country (e.g., West Nile fever).
Addressing this scale of challenge is not impossible, but it does underline the need for effective
partnership working and intersectoral engagement. Challenges on this scale do not just have a
health impact, but more broadly affect the economic and social stability of countries. This is a
shared agenda, not a health services agenda. Continuous epidemiological surveillance and
advanced early warning systems need to be supported by robust intersectoral communication
and a shared vision and support for effective action.
The (h)VIA provided a firm baseline for building cross sectoral adaptive capacity. It identifies key
risks and exposures, and recommends proactive steps which can be taken to engage people
and communities in the development of resilience and capacity to prepare for changing climate
conditions and extreme weather events. By identifying areas where vulnerability is particularly
high – threats that exhibit distinct climate sensitivity – it provides a good example of the ways in
which (h)VIA processes can help clarify where efforts to increase adaptive capacity should be
focused, and ensure that efforts to address climate change are appropriately incorporated into
broader health, social, environmental and economic policies and strategies. For example, poor
communities, without access to good health protection and support from the social sector, are
more susceptible to the unpleasant health effects that arise from the climate and other changes
in the living environment. Efforts to improve resilience to climate change can therefore impact
on both the health and social determinants agendas, and have broader economic impact.
However, ensuring this evidence and commitment to action is translated into practical on the
ground action remains a fundamental concern.
Supporting and encouraging cross sectoral engagement has increased levels of understanding
of the challenges climate change poses to health and wellbeing and population health. Taking
this forward to ensure that future developments, and ongoing selection and development of
policy options to further improve the capacity and capability of the health system to promote and
protect health, and improve its resilience to climate change risks to people’s health within the
country is essential. Management of the threats identified by the (h)VIA is likely to require
innovative strategies acknowledging that the systems protecting public health have limited
resources and are dynamic, incompletely understood, and subject to multiple stakeholders.
Institutional learning at multiple levels has been key to increasing adaptive capacity, and
adaptive management. The development of a National Strategy for adaptation of the health
sector due to climate change has been identified as a high priority and, along with an increased
focus on learning, modeling, and adaptive management, this will help increase the resilience of
local public health systems. By building an integrated, efficient and effective approach for
prevention, early warning, managing and overcoming the climate change consequences as a
result of heat waves, floods, increased air – pollution, UV radiation, communicable diseases, the
Republic of Macedonia is making significant strides towards developing adaptive capacity to
improve climate resilience. However, developing effective adaptations to distinctly climatesensitive health threats presents a host of management challenges, including uncertainty in
climate projections and future socioeconomic conditions.
attached an invitation to an expert briefing on the causes of the floods and recent flood-risk
assessments that will take place on Monday, 22 August 2016, at 14.00-15.30, It is a framework
for managing future climate risk and offers the potential of reducing future economic,
environmental and social costs, particular in the health sector in the country. To reach this point,
more new knowledge is required on climate impacts, particularly on regional impacts as well as
on the economic costs of action/inaction.
5. Tables and figures
Table 1.Specific objectives and methods of the Project in the Republic of Macedonia
Objective
Methods used
To assess the health impacts and vulnerability
to climate change
Qualitative and quantitative epidemiological methods






Literature reviews
Interviews
Focus group
Action research
Time series and regression analysis
Scenario based assessment
To develop a national health adaptation strategy
 Damage and adaptation cost estimation for heat
Public health approach





Stakeholder engagement plan
Defining a vision
Defining priorities
Defining actions
Developing a strategy and implementation plan
Source: adapted from WHO, 2009 to reflect Republic of Macedonia’s approach
Table 2 . Vulnerability and impact assessment Approach
Climate
sensitive
diseases
and
conditions
Assessment
method
Data and information sources
Details
literature reviews
Ministry of Environment and Physical
Planning
Internet literature research (Google scholars) by
keywords (Floods, R. Macedonia, Health,
Climate change) on December 2010
Assessed
Floods
Interviews
Center for Crises management
Focus group and
action research
Protection and Rescue Directorate
Stakeholders Interviews by specially designed
Questionnaire ( 6 persons, app. 20 min)
- Stakeholders Focus Group discussion on
perception on climate change, floods, droughts,
wildfires and health, as well as action in place
and needs (12 persons, app. 1 hour)
Droughts
literature reviews
Ministry of Environment and Physical
Planning
Interviews
Internet literature research (Google scholars) by
keywords (Droughts, R. Macedonia, Health,
Climate change) on December 2010
Center for Crises management
Wildfires
Focus group and
action research
Protection and Rescue Directorate
literature reviews
Center for Crises management
Interviews
Protection and Rescue Directorate
Focus group and
action research
Air pollution
Focus group
Internet literature research (Google scholars) by
keywords (Wildfires, R. Macedonia, Health,
Climate change) on December 2010
Stakeholders Interviews by specially designed
Questionnaire ( 4 persons, app. 20 min)
Ministry of Environment and Physical
Planning
literature reviews
on – line research
Stakeholders Interviews by specially designed
Questionnaire ( 4 persons, app. 20 min)
Institute for Public Health of R.
Macedonia
Internet literature research (Google scholars) by
keywords (Air pollution, R. Macedonia, Health,
Climate change) on December 2010
Stakeholders Interviews by specially designed
Questionnaire ( 8 persons, app. 20 min)
Center for Public Health in Skopje
- Stakeholders Focus Group discussion on
perception on climate change, air pollution and
health, as well as action in place and needs (8
persons, app. 1 hour)
UV radiation
literature reviews, on
– line research
Available literature , Internet resources
Internet literature research (Google scholars) by
keywords (UV radiation, R. Macedonia, Health,
Climate change) on December 2010
Temperature
related
mortality in
Skopje
Time series analysis
and poisson
regression analysis
Excess winter
mortality
methodology
Scenario based
assessment
Damage and
adaptation costs
Meteorological data (National Hydro
meteorological Office)
Temperature heat related mortality investigated
using Seasonal Index for mortality (1994-2007)
Air pollution data (Ministry of
Environment and Physical Planning)
Time series analyses of daily mortality data
(1996-2000 and 2007) using poison regression
models to study air temperature dependence of
daily number of deaths in Skopje. Logistical
regression and odds ratio to explore excess
mortality rates (95% threshold) (PM10 (μg/m3)
and ozone (μg/m3) included in model)
Daily counts of deaths (State
Statistical Office)
Premature deaths were valued using
the value of a statistical life;
productivity using the average daily
GDP per capita multiplied by the
average number of days of illness;
health care using the health care
charges of the health insurance fund
and the average uses of outpatient
services (per case) and average rate
of inpatient admission (per case
seeking treatment).
Based on the national heat-health
action plan, which is in process of
being implemented, the annual
recurrent and the one-off investment
costs were estimated.
Associations between average air temperature
and morality and maximum temperature and
heatwaves.
Global Circulation Models based on SRES A2
and B2 and local climate change projections
were used to describe the relationship between
large-scale climate variability across south-east
Europe and local-climate variability, with scaling
to other marker SRES emission scenarios (A1T,
A1b, A1Fl, B1) using the pattern scaling method
(Bergant 2006) daily average monthly deaths as
a function with daily average monthly
temperature for Skopje for the period 19962000 using climatic average scenario for 20262030 period (Kendrovski 2005).
Models:
The burden of disease attributable to climate
change was calculated as:
Attributable burden = (estimated burden of
disease under climate change scenario) –
(estimated burden of disease under a baseline
climate, such as that in to 2000).
PB=FB-CB
CB months (0C) = MTmonths (2001…2008) MTmonths (1991…2000)
PB-Predicted burden as estimation of difference
between future burden and attributable current
burden; FB-Future burden of the monthly mean
temperature due to Climate change estimated
by scenario , CB- Current burden as attributable
fraction of the monthly mean temperature due
to Climate change, MT- Monthly mean
temperature.
Conventional economic methods were used to
value premature death, health-related
productive time losses, and health care costs.
An Excel-based calculation methodology was
devised based on common economic methods
for estimating the costs of illness. Premature
deaths were valued using the value of a
statistical life; productivity using the average
daily GDP per capita multiplied by the average
number of days of illness; health care using the
health care charges of the health insurance
fund and the average uses of outpatient
services (per case) and average rate of
inpatient admission (per case seeking
treatment).
Salmonella
poisoning
distribution
in 5
Macedonian
towns
Time series and
poisson regression
analysis
Meteorological data (National Hydro
meteorological Office)
Seasonal Index for Salmonella poisoning
Poisson regression
Weekly counts of human Salmonella
confirmed cases (Institute for Public
Health of R.Macedonia)
Scenario based
assessment
Estimation of the monthly average Salmonella
human cases (Seasonal Index) as a function
with average monthly temperature for Skopje
for the period 1985-2000. Investigation of
relationships between ambient temperature in
Skopje and salmonella cases between 1998
and 2008 and projection of future burdens, by
forecasting the
future burden due to climate change in the
period ranging 2025-2050 and 2075-2100 for
the central region of Macedonia where the city
of Skopje belong. The scenario from the
Second
National communication on climate change was
used. The changes of future burden of mean
monthly air temperature
(°C) by seasons were projected using predicted
burden as attributive fraction by estimation of
difference between future and currant burden
for Skopje in 21st Century.
Global Circulation Models based on SRES A2
and B2 and local climate change projections
were used to describe the relationship between
large-scale climate variability across south-east
Europe and local-climate variability, with scaling
to other marker SRES emission scenarios (A1T,
A1b, A1Fl, B1) using the pattern scaling method
(Bergant 2006)
Pollen
distribution
projections
Regression analyses
Quantifying the
onset of flowering,
maximum and end
of the length of
seasons for each of
pollen
Quantifying the
current and
projected future
burdens of weather
temperature
Meteorological data (National Hydro
meteorological Office)
9 pollen weekly distribution (Betula,
Cupressaceae, Quercus, Fraxinus,
Platanus, Urticcaceae, Plantago,
Chenopodiaceae, Poaceae) (Institute
for Occupational Health of R.
Macedonia)
Evaluated the correlation between the
oncentration of pollen grains in the
atmosphere of Skopje and maximum
temperature, during the vegetation period of
1996, 2003, 2007 and 2009 as a current
burden in context of climate change.
9 representatives of each phytoallergen
group (trees, grasses, weeds) were selected.
The concentration of pollen grains was
monitored by a Lanzoni volumetric pollen
trap. The correlation between the
concentration of pollen grains in the
atmosphere and selected meteorological
variable from weekly monitoring was studied
with the help of linear regression and
correlation coefficients
Table 3 .Results from (h) VIA
Table 3: Results from (h)VIA
Climate sensitive
diseases and
conditions
IMPACT: Current and projected
Floods
Catastrophic floods in 1916, 1935, 1962,
1979, 1995 and 2004 resulted in serious
damage to residential areas and
infrastructure as well as to the water
supply and sewage systems.
RESPONSE: Proposed
adaptive or measures for the
National health adaptation
strategy
Other relevant plans
Establish an integrated,
efficient and effective approach
for prevention, early warning,
management and overcoming
of the effects of climate change
connected to floods and fires.
Municipality action plans
Flood risk plans
Projections indicate flooding will seriously
affect about 4050 households (temporary
loss of 275 700 sq.m residential area) in
the Skopje valley and about 1750
households (temporary loss of 124 500
sq.m residential area) in the Pelagonia
valley within the next 100 years.
Droughts
As a result of severe droughts (1985-1997)
and other climate changes (higher
temperatures and frequent late spring
frosts), over 3700 ha of fruit orchards
became parched, and the fruit growing
area decreased from 23 900 ha in 1985 to
16 500 ha in 1997. The weather conditions
in 2007 led to one of the most extreme
droughts since meteorological records
began in the country.
Effective operational strategies
to improve irrigation required.
Droughts are expected to increase in
number and severity, resulting in loss of
agricultural land, with both nutritional and
economic consequences.
Temperature
related mortality in
Skopje
The most striking anomaly was in 2007 in
Skopje, when July temperatures were 3.4
oC above the average monthly
temperature, and deaths were 16.5%
higher, than the average of the period
1994-20082.
Under heat-wave conditions, an increase
of temperature of 1°C above the heat cutpoint (30.8°C) leads to an increase in
mortality of 4.8%. (Kendrovski et al. 2010)
Develop and implement a heat
health action plan
Cold Health Action Plan
draft
Overcome the climate change
health consequences
connected with air pollution
and cold weather during winter
by establishing control and
preventive measures
According to projected scenarios for
mortality trends in the country and in
Skopje for the period after 2035, an
increase in average monthly temperatures
of only 1ºC compared to the period 1996–
2000 will significantly influence the
distribution of total mortality expressed as
a monthly average. This increase in the
monthly mortality rate would be higher in
the months of April, May and June (4–
11%) and on average 10% higher
compared to the period April, May and
2Direct
Heat Health Action Plan
endorsed since 2010
effects of rising temperatures on mortality in the Republic of Macedonia.Chapter 2.
June 1995–2004. (Kendrovski and
Spasenovska in press)
Economic analysis of the costs of adaptive
action was also performed. This found that
the total heat wave costs were
approximately twice those of climate
change-attributed costs, at approximately
170 million MKD per year, or € 2.6 million.
The adaptation costs were estimated at 3
million annually plus 90 million MKD
investment. Assuming that investments are
expected to last 10 years (which is
conservative), this resulted in an
annualized investment cost of 9 million
MKD, and a total annualized cost of 12
million MKD. Compared with the total
damage costs in recent years (except
2007) of around 170 million MKD per year,
this suggested that the adaptation costs
would be relatively small. However, there
was insufficient evidence to determine the
proportion of climate change-attributed
diseases cases and deaths which could be
averted from these adaptation measures.
(Kendrovski and Spasenovska in press)
Salmonella
poisoning
distribution in 5
Macedonian
towns
Investigated the relationship between
environmental temperature and reported
salmonella infections among the
population in five cities (Skopje,
Kumanovo, Bitola, Strumica and Veles).
The detected threshold weekly
temperature for the cities varies from 17°C
to 18.3°C for the period 1998–2008. All
cities in this study show seasonal patterns
of salmonella infections, with a peak in the
summer months after the peak
temperatures.
Overcome the climate change
health consequences
connected with air pollution
and cold weather during winter
by establishing effective
control and preventive
measures, including:
Projected impact? Higher ambient
temperatures have been associated with
higher salmonellosis notifications for each
degree increase in weekly temperature.
For Skopje, an increase in the weekly
temperature of 1°C above detected
threshold of 17.9°C was associated with a
2.8% increase in salmonellosis cases.
- Continuous monitoring of
meteorological conditions in
order to predict the stable
weather conducive to
accumulation and nondispersal of polluting
substances.
- Continuous monitoring and
reporting on the type and
concentration of the polluting
substances in the ambient air
for the protection of people’s
health.
- Develop an early warning
system for the air quality and
weather conditions.
- Strengthen the system for
recording incidence of
respiratory diseases during
increased levels of ambient air
pollution.
- Implement legislation for
managing the quality of the
ambient air.
- Perform gradient
measurements and explore
temperature inversions and
inversive fogs in the Skopje
valley.
Pollen distribution
projections
Generally, distribution of pollens increases
during three main periods and will also
have the potential to increase the risk of
allergy: early spring (March), with
Cupressaceae, Fraxinus and Poaceae;
spring (April–June), characterized by
Platanus, Betula and Quercus pollens; and
summer (July–August), characterized by
Urticaceae, Plantago and Chenopodiaceae
pollens, which are the main cause of
allergies during these month. The beta
coefficient (b = -0.23) for the total weekly
pollen count of Cupressaceae as a
function of the weekly maximum
temperature in Skopje for all years was
statistically significant for p = 0.02, i.e.
p<0.05. (Kendrovski et al. 2012)
Projected impact: Pollen distribution
associated with higher temperatures
projected to increase allergic diseases
distribution. The prevalence of sensitivity to
standard pollen allergens in Skopje
showed an increase from 16.9% in 1996 to
19.8% in 2009/2010.
(KaradzinskaBislimovska et al. 2012)
Airpollution
Air pollution may confound the effects of
high and low temperature morbidity and so
daily ambient levels of PM10 (μg/m3) and
ozone (μg/m3) should be investigated in
this manner (Kochubovski and Kendrovski
2012)
Establish an integrated,
efficient and effective approach
for prevention, early warning,
management and overcoming
of the effects of climate change
as a result of increased UV
radiation through:
- Establishing a system for
monitoring the UV index and
associated health risks.
- Monitor the incidence and
prevalence of those diseases
where exposure to ultraviolet
radiation has or can have an
additional influence on the
patient’s condition.
-Prevention and promotion to
raise awareness of the harmful
effects of UV radiationamong
the public, the media,
employees and employers.
- Epidemiological surveillance,
reporting, monitoring and
analysis of communicable
diseases that are transmitted
by vectors.
- Education of the general
public on the benefits and
necessity of disinfection and
extermination of rats and
insects.
- Undertake preventive
disinfection and pest control
(extermination of rats and
insects) in educational, social
and health institutions.
Uv radiation
In the Republic of Macedonia, the average
total numbers of newly registered patients
with melanoma were 77 (48 for males and
29 for females) for the period 2002–2006.
A skin cancer was the cause of death in 40
males and 21 females in 2002; 44 males
and 25 females in 2003; 23 males and 21
females in 2004; 34 males and 25 females
in 2006; and 32 males and 16 females in
2007.
Projected: rising incidence of melanoma
associated with UV radiation
Aedesalbopictus
The analyses of the collected material and
the literature data (referring to the
representatives of the family Culicidae in
Macedonia), showed the existence of 51
species from Culicidae family on the
territory of R. Macedonia (Fig.9). These
species belong to 16 subgenuses, 8
genuses, 6 tribuses and 2 subfamilies.
During the field investigations, in total 7
mosquito species were registered:
Anopheles (Anopheles) maculipennis,
Ochlerotatus (Ochlerotatus) hungaricus,
Ochlerotatus (Finlayia) geniculatus,
Culex (Culex) mimeticus, Culex (Culex)
tritaeniorhynchus, Culex (Neoculex)
martinii andOrthopodomyiapulchripalpis.
Existance of AedesAlbopictus was not
registered. (Stevkov et al. 2011)
Table 4. Results of the process of development national adaptation health strategy
Key process
steps
Vision
Problem identification
Effective interventions
Identified
Priorities and strategy
Results
Reduce the burden of disease, injury, invalidity, suffering and morbidity due to climate change
Increased air temperature, reduction of rainfalls in all seasons except winter, frequent and more severe
periods of drought and heavy rainfall, heat waves, floods, occurence of new communicable diseases,
early onset of pollen, air - pollution.
Adaptation is required to reduce the current vulnerability from climate change, which is already a reality,
and further adaptation will be needed in order to respond to the health risks that are foreseen to happen
during the next decades
General interventions identified: (1) coordinated approach and functional cooperation between the
sectors and the relevant institutions; (2) building capacity for promotion, prevention and timely response
to climate change risks;, (3) raising climate change awareness and the effect on health; (4)
communication; (5) health system preparedness planning; (6) identification, registering and monitoring of
risks connected with climate change and their influence on people’s health.
Specific interventions identified: establishment of an integrated, efficient and effective approach for
prevention, early warning, management and overcoming of health effects from extreme heat, cold, floods
(heat health action plan, plan for cold weather etc), infectious disease surveillance and response (specific
guideline on climate change and communicable diseases);
The National Climate Change Health Adaptation Strategy of the Republic of Macedonia envisages
objectives and activities that will be carried out by the health sector in cooperation with the other relevant
sectors in the country
- Provide a coordinated approach and functional cooperation between the sectors and the relevant
institutions in terms of effective and efficient use of the available resources;
- Raise public awareness about climate change and its effect on health;
Action Plan
Evaluation
- Establish an integrated, efficient and effective approach for prevention, early warning, management and
overcoming of the effects of climate change due to heat-waves.
- Overcome the climate change health consequences connected with air pollution and cold weather
during winter, by establishing control and preventive measures.
- Establish an integrated, efficient and effective approach for prevention, early warning, management and
overcoming of the effects of climate change as a result of increased UV radiation.
- Control and prevention of allergic diseases caused by pollen in the context of climate change.
- Establish an integrated, efficient and effective approach for prevention, early warning, managing and
overcoming of the effects of climate change connected to floods and fires.
- Protection from climate-change-related communicable diseases.
An Action Plan has been developed to provide clear and specific guidelines in the process of
implementation of the adaptation strategy. It consists of clear defined actions, measures, timeframe,
responsible institutions and monitoring and evaluation indicators.
The country determined national structures and resources for surveillance, alert and response to
climate–change-related diseases and developed and implemented national action plans that meet the
demands for key capacities. The strengthening of the national preparedness, surveillance and response
capacities are essential for a long-term reduction of public health threats in the country, as well as
preventing their spreading internationally.
The implementation of the Health Sector Adaptation Strategy for climate change will be monitored and
evaluated regularly in accordance with the indicators specified in the Action Plan for implementation of
the Strategy. The Ministry of Health and the other institutions in authority will monitor the flow and
dynamics of the implementation of the activities and will suggest any necessary changes for achieving
the defined goals.
In carrying out the activities set out in the Strategy, regular evaluation will be conducted on an annual
basis, by the responsible person from the Ministry of Health, through reports prepared by the relevant
ministries and institutions, according to their jurisdiction.
When necessary, additional surveillance will be undertaken in order to respond to potential risks for the
appearance of new diseases due to climate change (e.g. chikungunya, which is transmitted via the Tiger
mosquito and which up till now has not been recorded in the Republic of Macedonia).
6. Relevant hyperlinks, including to information
http://toplotnibranovi.mk/en/
Kendrovski V, Spasenovska M, Menne B. (2014). The Public Health Impacts of Climate Change in the
Republic of Macedonia.Int. J. Environ. Res. Public Health 2014, 11(6), 5975-5988;
doi:10.3390/ijerph110605975 available at:http://www.mdpi.com/1660-4601/11/6/5975/htm
Kendrovski, V.; Spasenovska, M. The Effects on Health of Climate Change in the Republic of Macedonia,
Ministry of Health: Skopje, The Republic of Macedonia. 2011, pp. 31–76. Available at:
http://toplotnibranovi.mk/en/downloads/4_Publication_5_Vulnerability_assessment.pdf
Kendrovski, V.; Karadzovski, Z.; Spasenovska, M. Ambient maximum temperature as a function of
Salmonella food poisoning cases in the Republic of Macedonia. North Am. J. Med. Sci. 2011, 3, 264–267.
Stefkov, G.; Hristovski, S.; Prelik, D.; GjorgjievskaCvetkovska, A.; Mitev, T. Study on Presence of
AedesAlbopictus in the Republic of Macedonia; Ministry of Health: Skopje, Macedonia, 2011; pp. 1–20.
Kendrovski, V.; Milkovska, S.; BislimovskaKaradzinska, J.; Minov, J.; Spasenovska, M.; Hristovska
Kisman, M. The impacts of maximum temperature and climate change to current and future pollen
distribution in Skopje, Republic of Macedonia. Taf. Prev. Med. Bull. 2012, 11, 35–40.
KaradzinskaBislimovska, J.; Minov, J.; Kendrovski, V.; Milkovska, S.; Stoleski, S.; Mijakoski, D.
Prevalence of the respiratory allergies among adult population in the city of Skopje in relation to climatic
change and change in pollen micro flora. JEP 2012, 2, 1364–1372.
7.Contact details for further information
Dr. Jovanka Kostovska,
State Councelor,
Ministry of Health
[email protected]
+38975392873
Dr. Teodora O. Grncarovska,
State Councelor
Ministry of Environment and Physical Planning
[email protected]
UNFCCC Focal Point
+38976446911