Health Aspects of Climate Change in Cities with Mediterranean Climate, and Local Adaptation Plans
1.1. Mediterranean Climate Type Regions and Their Vulnerability to Climate Change
1.2. Climate Change Impacts on Health in Mediterranean Cities
- Extreme high air temperatures contribute directly to deaths from cardiovascular and respiratory disease, particularly among elderly people and those with chronic diseases. The impacts are worsened by the “urban heat island” effect, which results from greater heat retention of buildings and paved surfaces in urban areas.
- Direct physical injuries and deaths from extreme weather events such as intense rainfall, winds and floods. Extreme events may also damage homes, create dangerous transport conditions and disrupt the supply of medical and health services.
- Increasingly variable rainfall patterns (drought, floods) affect the supply of fresh water. A lack of safe water can compromise hygiene and increase the risk of water-borne diseases.
- Worsening air quality related to changes in temperature and precipitation resulting in the formation of smog may cause respiratory illnesses. High temperatures also raise the levels of ozone and other pollutants in the air that exacerbate cardiovascular and respiratory diseases. Pollen and other aeroallergen levels are also higher in extreme heat conditions.
- Illnesses and deaths occur from the spreading and expanded range of vector-borne infectious diseases.
- Food-borne diseases resulting from bacterial growth in foods exposed to higher temperatures.
1.3. The Importance of Adaptation Policy at the City Level
- Temperature extremes
- Wind, storms, and floods
- Fresh water supply and quality
- Air quality and aeroallergens
- Vector-borne diseases
- Protection of urban biodiversity and functioning ecosystems
- Risks to vulnerable populations
- Education and raising awareness.
3. Results and Discussion
3.1. Rising Temperatures: Heat Waves, Heat Stress, Heat Island Effect
3.2. Heavy Rainfall and Flooding
3.3. Fresh Water Supply and Quality
3.4. Air Quality
3.5. Water-Borne Diseases, Food-Borne Diseases, Vector-Borne Diseases
3.6. Loss of Biodiversity, Functioning Ecosystems
3.7. Risks to Vulnerable Populations
3.8. Awareness Raising and Education
- Assessment of health risks: conduct risk assessments in order to identify the main threats to urban public health in a Mediterranean climate, and to maintain up-to-date data on risks and vulnerabilities, transparent to the citizens.
- Extreme events management: prepare comprehensive plans for extreme events, including early-warning systems. These plans should be cross-sectoral with a focus on vulnerable populations.
- Long-term adaptation: go beyond short-term preparedness for extreme events, and prepare for the longer-term changing climate over a 20 to 50-year span, although this is a challenge due to much shorter political time frames. Specifically:
- Strategic urban planning: based on risk assessments—building regulations, land-use planning, revising master plans.
- Micro-climate: long-term adaptation for a hotter climate is a special opportunity for Med-cities, which can contribute to the wellbeing of the urban population throughout the hot Mediterranean climate. Cities should increase the amount of shaded public spaces, using trees both with wide canopies and other shading elements. The shaded areas should include public squares, playgrounds, bus stops, pavements on main streets and rest areas in parks .
- Social resilience: strengthen communities and improve social networks.
- Physical resilience: adapt water infrastructure for floods and drought, improve buildings, e.g., encourage homeowners to reduce risks of extreme weather.
- Risk communication: raise awareness of the expected health risks, and promote opportunities for better understanding of adaptation health benefits (and co-benefits) among the general public, politicians, professionals in the municipality and city health system, local civil society organizations in the public sector, and schools.
- Collaborative governance: design adaptation policies collaboratively across the different municipality departments, between the municipality and the public, local civil society organizations and local businesses, and across levels of government: local, national and international.
- Multi-level, global network governance: to deal with health risks as a result of climate change, collaboration and coordination could be carried out not only at the county and/or state levels, but also with other cities dealing with similar challenges. An initial step toward collaboration between Med-cities has been taken recently with the establishment of the “Mediterranean City Climate Change Consortium (MC-4)”  that aims to coordinate efforts across political borders and disciplines to bring more resources and knowledge to building solutions for cities in the five Mediterranean-climate regions.
- Health systems: build capacity and resilience in local public health agencies for short-term and long-term adaptation. The U.S. CDC developed a framework for Building Resilience against Climate Effects (BRACE) to facilitate the process in public health agencies .
- Ecosystems and natural buffers: protect these resources to reduce the impact of climate change, including mitigation of floods and storms.
- Vector-, water- and food-borne diseases: improve surveillance and control of climate-sensitive diseases.
- Research: conduct local research to improve assessments of health risks, identification of locally-appropriate adaptation measures and evaluation of the implementation and outcomes of health-related climate action plans.
Conflicts of Interest
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|Variable||Adelaide||Barcelona||Cape Town||Los Angeles||Santiago|
|Temperature (°C) and precipitation (mm) in January and July ||Jan: max 29.2 °C; min 17.1 °C; 19.7 mm |
Jul: max 15.3 °C; min 7.5 °C; 76.9 mm
|Jan: max 13.4 °C; min 4.4 °C; 41 mm |
Jul: max 27.5 °C; min 18.6 °C; 20 mm
|Jan: max 26.1 °C; min 15.7 °C; 15 mm |
Jul: max 17.5 °C; min 7.0 °C; 82 mm
|Jan: max 20.1 °C; min 8.8 °C; 79.2 mm |
Jul: max 28.4 °C; min 17.6 °C; 0.3 mm
|Jan: max 29.7 °C; min 13 °C; 0.4 mm |
Jul: max 14.9 °C; min 3.9 °C; 86.6 mm
|Population size [40,41,42,43,44]||21,618 (in 2012) and 1,225,235 in Greater Adelaide (2012)||1,602,386 (in 2014)||3,740,026 (in 2011)||3,928,864 (in 2014)||358,000 (in 2015)|
|Socio-economic status [45,46,47,48,49,50,51]||11.2% unemployed |
11.5% below poverty line
|10.2% unemployed, |
28.1% at risk of poverty or exclusion
|23.9% unemployed, |
No household income: 13.7%
Less than 9600Rand (~$670): 6.7%
|8.0% unemployed, |
22% below poverty level
|6.0% unemployed (national data), |
14.4% below poverty line (national data)
|Population distribution [42,45,52,53]||0–14: 17.7% |
65+: 15.4% (in Greater Adelaide)
|0–14: 12.6% |
|0–14: 19% |
|0–14: 20.7% |
60+: 13.4% (in Greater Santiago)
|World Bank economic rating of country (#/193 countries), 2014 ||12||14||33||1||42|
|Human Develop. Index (HDI) rating of country (#/187 countries), 2014 ||2||27||118||5||41|
|GDP of country ($), 2014 ||1.454 trillion||1.404 trillion||349.8 billion||17.42 trillion||258.1 billion|
|Environ. Performance Index (EPI) of country (#), 2014 ||3||7||72||33||29|
|Green space/number of trees per sq. km. [58,59,60,61,62]||Park Lands = 9.3 km2||6.82 m2 green space/inhabitant in urban area |
11.02 km2 urban green space
|Over 50 km2 of accessible open space. 2.89 km2 district parks; 17.81 km2 community parks; 1.14 km2 biodiversity areas; 12.15 km2 greenbelts; 19.96 km2 road verges||Park space = 10% of city area||Green areas in Santiago Commune: 1.41–2.93 km2|
|Mediterranean-Climate City||Adelaide, Australia||Barcelona, Spain||Cape Town, South Africa||Los Angeles, United States||Santiago, Chile|
|Risk Vulnerability assessments [63,64,65,66,67,68,69,70,71,72,73]||Adaptation Strategies [74,75]||Adaptation Strategies [66,76,77,78]||Adaptation Strategies [36,67,68,79,80]||Adaptation Strategies [70,71,81,82,83]||Adaptation Strategies [72,73]|
|Rising Temperatures: Heat Waves, Heat Stress, Heat Island Effect |
Identified as a local risk by all 5 cities
|Heatwave management: Emergency management procedures; formalize extreme heat strategies. |
Urban design: Water sensitive urban design; increase vegetation in capital works projects. Urban Design strategies and approaches incorporating urban heat island mitigation measures (network of greenways, tree-lined streets, open spaces).
|Heatwave management: Emergency program for extreme events; provide adaptation measures to protect exposed workers from increasing climate conditions (especially heat-related health risks). |
Early warning systems.
Urban design: Include adaptation criteria (to heat island effect risks) in drafting new urban development plans; reform existing ones.
Convert fleet of buses to hybrid/electrical as measure to combat heat island effect.
|Heatwave management: Increase awareness of how to manage heat-related stress and other climate-related illnesses: Design and implement “Heat-Health” action plans, including plans in respect of emergency medical services. |
Nation-wide climate change and atmosphere monitoring systems/networks: Climate Change Response Monitoring and Evaluation System.
|Heatwave management: Public Health agency to issue heat alerts, guidance to schools, ensure appropriate resources (i.e., cooling centers) available to public. |
Establish, improve and maintain mechanisms for robust rapid surveillance of environmental conditions, climate-related illness, vulnerabilities, protective factors and adaptive capacities.
Urban design: Million Trees Initiative to increase tree canopy throughout the city.
|Heatwave management: Monitoring system WebGIS, Adapt monitoring systems and emergency plans by including any climate change related health effects in risk management practices. |
Urban design: Green standards in new development projects; protection of ventilation corridors. More green spaces to reduce heat island effect.
|Heavy Rainfall and Flooding |
Identified as a local risk by all 5 cities
|Infrastructure: Design public spaces to assist in adapting to climate change;|
incorporation of green infrastructure into the renewal of the City.
Adaptation measures and protection from predicted sea level rise in Development Plans.
Protect existing infrastructure (stormwater discharge management).
|Flood management: Risk mapping, prevention plan, emergency plan, action plan for flood zones. |
Implementation of monitoring systems and systematic data input.
|Flood management: Climate Adaptation Plan of Action (CAPA): sea-level rise risk assessment and economic modeling; Coastal Protection Zone By-law; stormwater management responses to more intense rainfall, sea-level rise and storm surges. |
Nation-wide climate change and atmosphere monitoring systems/networks: Climate Change Response Monitoring and Evaluation System.
|Emergency management: Develop comprehensive plans to prepare for climate change impacts, i.e., increased drought, wildfires, sea level rise, and public health impacts. |
Climate forecasting, sea level rise; vulnerability and risk assessments.
|Flood management: Monitoring system WebGIS. |
Adapt monitoring systems and emergency plans by including any climate change related health effects in risk management practices.
Infrastructure: Revitalizing existing water flow networks (river irrigation channels); permeable pavements. More green spaces to reduce flooding exposure.
|Fresh water supply and quality |
Identified as a local risk by all 5 cities
|Water Quality: Continue implementation of Biodiversity and Water Quality Action Plan.||Water management: Drought control. Update inventory of wells, recover wells and aquifers dismissed as resource for irrigation and gardening water, better treatment/use of wastewater; improve water use efficiency.||Water management: Reduce water demand, adopt an integrated water management approach, conduct long-term monitoring of selected hydro-meteorological parameters.||Water management: Water conservation and recycling, reduced water consumption, implement water and wastewater integrated resources plan, including capture and reuse of stormwater. |
Maintain and upgrade water accessibility information.
|Water management: Reduce agricultural water demands through efficient irrigation technologies—sustainable water balance between availability and demand, reduce exploitation of groundwater resources, increase environmental flows.|
|Air Quality |
Identified as a local risk by Barcelona, Cape Town and Los Angeles assessments
|Reduce emissions: Promote use of biofuels; reduce GHG emissions and suspended particle matter.|
Urban design: Establish spaces free of motorized vehicles; create a more equitable city.
|Reduce emissions: A key strategy to reduce the brown haze. |
Reduce ambient PM, ozone, and sulphur dioxide concentrations by legislative and other measures.
Nation-wide climate change and atmosphere monitoring systems/networks: Climate Change Response Monitoring and Evaluation System.
|Reduce emissions: Lower impact of carbon intensity of transportation sector (directly related to smog and toxic air pollutants).||Urban design: More green spaces to improve air quality.|
|Water-Borne Disease, Food-Borne Disease, Vector-Borne Disease |
Identified as a local risk by Barcelona, Cape Town, Los Angeles and Santiago assessments
|Surveillance programs and control programs for vector-borne diseases.||Improved climate-sensitive disease surveillance and control, safe water and improved sanitation. |
Increased support for public health facilities in dealing with diarrhoea and dehydration; improved sanitation in informal settlements.
Improve the bio-safety of the current malaria control strategy; strengthen the awareness program on malaria and cholera outbreaks.
|Develop existing environmental contaminant biomonitoring. |
Track data on environmental conditions and associated diseases related to climate change.
|Create and develop capacities to address the potential introduction of yellow fever, dengue fever, malaria and vectors such as aedes and anopheles mosquitoes.|
|Loss of Biodiversity, Functioning Ecosystems |
None of the cities identified this as a risk
|Environmental management: Maintenance of vegetation health, protection of biodiversity; continued implementation of Biodiversity and Water Quality Action Plan.||Environmental management: Develop strategy for metropolitan green spaces and urban biodiversity. Gradual adaptation of vegetation with species adapted to climatic conditions (low water consumption, more fire resistant). Protect/conserve coastal system biodiversity to maintain healthy ecosystem functions (i.e., seagrass beds that act as a carbon sink, help reduce the erosion effect of coastal dynamics, and stabilize beaches). |
Map vulnerability of biodiversity, consolidate ecological monitoring networks.
|Environmental management: Protection, management and rehabilitation of functioning ecosystems. Mapping and identification of the functioning ecosystems that must be protected and managed. |
Monitoring climate change impacts.
|Environmental management: Protection of urban biodiversity (trees, gardens). Revitalizing existing water flow networks (river irrigation channels) and their ecosystem functions.|
|Overarching concept: Risks to Vulnerable Populations||Strategic plan: Adelaide City Council Emergency Plan 2012–2016 completed. Strategy covers extreme weather events (including heat waves and flooding).|
Adelaide Central Bus station established as refuge for the community during extreme heat conditions. Continued coordination with Street to Home service providers to monitor and assist rough sleepers during extreme heat events.
|Assessment of the effects of climate change on health and mapping of vulnerable areas under different climate scenarios.||Urban design and infrastructure: Improve management and eventual elimination of informal settlements, electrification and improved public transport in urban areas to reduce local pollution levels and improve the quality of life of the poor, and reduce their vulnerability to extreme climate events.||Urban design: Create a more equitable distribution of open space, greenery, and recreational opportunities. |
Develop preparedness and response plans to identify vulnerable populations in Los Angeles County.
|Urban design: Halt decline of existing green spaces and increase new ones in urbanization projects and vulnerable zones; create more urban green spaces with public participation, increase public access and use of green spaces. |
Identify vulnerable areas or those with the greatest health risks due to different factors; consider the affected population.
|Overarching policy mechanism: Awareness raising and education||Build community knowledge, capacity and resilience in adapting to climate change; communication and awareness campaigns (research, stakeholder forums).||Increase knowledge and awareness of climate change and effects among municipal agents and wider public. |
Public participation campaigns on climate change and health.
|The Climate Smart Cape Town Campaign promotes climate change literacy and awareness among residents and decision-makers. |
The Cape Town Climate Change Coalition includes businesses, NGOs, academia, and provincial and local government.
“Communication, Education and Public Awareness project (CEPA).
Develop public awareness campaigns on health risks of high temperatures and appropriate responses.
|Improve the public’s capacity to respond to an emergency. |
Develop an educational campaign to increase public awareness of the health impacts of climate change, and educate staff.
|Education/awareness campaign for greater public; educate/train public officials responsible for urban planning in climate change and its impacts. |
Strengthen the capabilities of health personnel to address prevention and care of adverse effects caused by climate change. Interact with other sectors in order to identify effects of climate change on the health of the population.
© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
Paz, S.; Negev, M.; Clermont, A.; Green, M.S. Health Aspects of Climate Change in Cities with Mediterranean Climate, and Local Adaptation Plans. Int. J. Environ. Res. Public Health 2016, 13, 438. https://doi.org/10.3390/ijerph13040438
Paz S, Negev M, Clermont A, Green MS. Health Aspects of Climate Change in Cities with Mediterranean Climate, and Local Adaptation Plans. International Journal of Environmental Research and Public Health. 2016; 13(4):438. https://doi.org/10.3390/ijerph13040438Chicago/Turabian Style
Paz, Shlomit, Maya Negev, Alexandra Clermont, and Manfred S. Green. 2016. "Health Aspects of Climate Change in Cities with Mediterranean Climate, and Local Adaptation Plans" International Journal of Environmental Research and Public Health 13, no. 4: 438. https://doi.org/10.3390/ijerph13040438