The World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health, a responsibility that it fulfils in part through its publications programmes. Through its publications, the Organization seeks to support national health strategies and address the most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. 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WHO Library Cataloguing in Publication Data Climate change and stratospheric ozone depletion : early effects on our health in Europe / edited by Sari Kovats...[et al.] (WHO regional publications. European series ; No. 88) 1.Climate 2.Environmental health 3.Greenhouse effect 4.Heat – adverse effects 5.Ozone 6.Ultraviolet rays – adverse effects 6.Forecasting 7.Communicable diseases 8.Europe I.Kovats, Sari II.Series ISBN 92-890-1355-9 (NLM Classification: WB 700) ISBN 978-92-890-1355-0 ISSN 0378-2255 Text editing: David Breuer Cover illustration: Paola Chartroux World Health Organization Regional Office for Europe Copenhagen Climate change and stratospheric ozone depletion Early effects on our health in Europe Edited by Sari Kovats, Bettina Menne, Anthony McMichael, Roberto Bertollini and Colin Soskolne WHO Regional Publications, European Series, No. 88 ISBN 92-890-1355-9 ISBN 978-92-890-1355-0 ISSN 0378-2255 The Regional Office for Europe of the World Health Organization wel- comes requests for permission to reproduce or translate its publications, in part or in full. 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PRINTED IN DENMARK Contents Page Foreword ...................................................................................................... vii Preface .......................................................................................................... ix Executive summary ..................................................................................... xi Introduction ................................................................................................... 1 Initiatives on climate change and human health ..................................... 3 1. Climate change in Europe ...................................................................... 7 Climate in Europe ..................................................................................... 7 Observed changes in climate .................................................................... 9 Projections of future climate change ...................................................... 13 Rise in sea level ....................................................................................... 14 Impact of climate change on water resources ......................................... 15 Stratospheric ozone depletion ................................................................ 17 2. Effects on health of climate change in Europe ................................... 21 Thermal stress .......................................................................................... 24 Climate change and urban air pollution ................................................. 28 Aeroallergens ........................................................................................... 29 Extreme weather ...................................................................................... 30 Foodborne diseases.................................................................................. 33 Water-related diseases ............................................................................. 34 Vector-borne diseases .............................................................................. 36 Rodent-borne diseases............................................................................. 49 Pest species .............................................................................................. 50 Effects on food supply............................................................................. 50 3. Health effects of stratospheric ozone depletion .................................. 53 Skin cancer .............................................................................................. 53 Damage to the eye ................................................................................... 56 The immune system ................................................................................. 56 4. Early effects of climate change on human health ............................... 59 5. Action to reduce the health effects of climate change ......................... 63 Mitigation to reduce or prevent climate change .................................... 63 Secondary health benefits of mitigation policies .................................. 66 Adaptation strategies to reduce the potential effects on health of climate change in Europe ............................................... 67 Monitoring and surveillance .................................................................. 68 Intersectoral issues................................................................................... 77 Research and policy ................................................................................ 77 6. Conclusions ............................................................................................ 79 References .................................................................................................... 81 Annex 1. Policy document prepared for the Third Ministerial Conference on Environment and Health, London, 16–18 June 1999.......................................................................... 97 Annex 2. Members of the Working Group on the Early Human Health Effects of Climate Change and Stratospheric Ozone Depletion in Europe ....................................................... 115 Foreword Many people in Europe are concerned about the impacts of climate change and stratospheric ozone depletion on human health. A warm- ing trend and stratospheric ozone depletion have been observed in Europe over the last four decades. The European Environment and Health Committee identified the need to assess these topics in 1997, as part of the lead-up to the Third Ministerial Conference on Envi- ronment and Health, held in London in June 1999. This review is the result. It is based on the deliberations of technical experts at two meetings in 1998, a review of current available science on the health effects of climate change and stratospheric ozone depletion within the European Region, and further technical input since the Confer- ence. Understanding what effects environmental changes could have on the health of the European population was the principal driving force behind the review. It clearly points out that there is still sub-