Making Administrative Systems Adaptive to Emerging Climate Change-Related Health Effects: Case of Estonia
Abstract
:1. Introduction
1.1. Climate Change Adaptation of Health Systems
1.2. Factors Influencing Adaptation of Policy Programmes, Monitoring Systems, and Response Measures
2. Methods
3. Results
3.1. Adapting Health Systems to Climate Change
3.1.1. Planning Responses to Climate Change-Related Health Risks
3.1.2. Gathering Information and Monitoring the Situation
3.1.3. Protective Measures and Responses
3.2. Explanations for the Current Situation with Respect to Health Adaptation
3.2.1. The Inner Functioning of the State Apparatus Influences the Adaptation Activities
3.2.2. Adaptation Activities Influenced by the External Pressure Factors of the State Apparatus
3.2.3. International Pressures
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
- Expert on social work (4 March 2015)
- Local government official (10 March 2015)
- Tartu City Government official (17 March 2015)
- Environmental health scientist (20 April 2015)
- Official from the ministry of the Interior (29 April 2015)
- Climate expert (29 April 2015)
- Environmental health specialist, Ministry of Social Affairs (4 May 2015)
- Official from the Estonian Environmental Research Centre (4 May 2015)
- Family physician (member of the managing board, Association of Family Physicians) (7 May 2015)
- Health Board official (7 May 2015)
- Public health specialist (8 May 2015)
- Official from the Ministry of the Environment (21 May 2015)
- Representative of a hospital (member of managing board) (4 June 2015)
- City medical officer (12 June 2015)
- Representative of volunteer rescue service providers (16 June 2015)
- Representative of Rescue Board (Lääne päästekeskus) (18 June 2015)
- Official from the Health System Development Department, Ministry of Social Affairs (19 June 2015)
- Chief specialist from the Environmental Health Research Centre, Health Board (27 May 2015)
- Official from the Health Board’s medical bureau (25 May 2015)
- Official from Pärnu City Government (26 August 2015)
- Official from Government Office (27 August 2015)
Appendix B
- What do you think about the climate change and its health effects?
- ○
- Health risks in the world/Estonia
- ○
- Future trends
- How would you assess health systems functioning to cope with CC effects on health?
- ○
- Sufficiency of regulations, programmes
- ○
- Monitoring and information gathering (prognoses, risk analyses)
- ○
- Protective responses, prevention
- What could be the key drivers/impediments on (a) tailoring programmes, measures, and (b) their implementation for CC health adaptation, (c) gathering information? Assess the role of ...
- ○
- yourself as an expert; public salience, NGOs, private companies, scientific groups, international organisations
- ○
- state officials, their competences and resources, regulatory style (and size), architecture (dispersion of responsibilities).
Appendix C
1 | Personal Exposure | No Exposure | Extreme Exposure | ||||
Please rate on a scale of 1–5 your exposure to extreme weather events | 1 | 2 | 3 | 4 | 5 | ||
2 | Personal worry | No exposure | Extreme exposure | ||||
In general, how worried are you about the health risks posed to you and your family by your residential environment? | 1 | 2 | 3 | 4 | 5 | ||
3 | Belief in need for measures | No exposure | Extreme exposure | ||||
Measures against climate change related risks are urgently needed | 1 | 2 | 3 | 4 | 5 | ||
4 | Belief in institutional efficiency | No exposure | Extreme exposure | ||||
I trust that the authorities will take care of the healthfulness of my living environment | 1 | 2 | 3 | 4 | 5 |
Appendix D
Low Demand, n (%) | High Demand, n (%) | Chi2 | p Value | |
---|---|---|---|---|
Gender | 3.11 | 0.08 | ||
Male | 320 (72.7) | 120 (27.3) | ||
Female | 377 (67.6) | 301 (32.4) | ||
Age | 2.47 | 0.29 | ||
Age, 20–34 | 110 (67.9) | 52 (32.1) | ||
Age, 35–54 | 211 (69.2) | 94 (30.8) | ||
Age, 55–75 | 109 (62.3) | 66 (37.7) | ||
Education | 0.03 | 0.98 | ||
primary | 23 (65.7) | 12 (34.3) | ||
secondary | 262 (67.2) | 128 (32.8) | ||
higher | 143 (66.8) | 71 (33.2) | ||
Home language | 13.86 | 0.00 | ||
Estonian | 496 (73.6) | 178 (26.4) | ||
Russian or other | 201 (62.0) | 123 (38.0) | ||
Place of residence | 9.93 | 0.00 | ||
Urban | 473 (66.9) | 234 (33.1) | ||
Rural | 224 (77) | 67 (23) | ||
Self-rated health status | 8.69 | 0.12 | ||
Very good | 52 (71.2) | 21 (28.8) | ||
Good | 299 (72.7) | 112 (27.3) | ||
Average | 277 (67.6) | 133 (32.4) | ||
Bad | 59 (69.4) | 26 (30.6) | ||
Very bad | 6 (75.0) | 2 (25.0) |
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Key Institutions | Policies and Programmes | Monitoring and Information-Gathering | Responses and Protective Measures | Addressing Climate Change? |
---|---|---|---|---|
Ministry of Social Affairs, Health Board, National Institute for Health Development | National Health Plan 2020 | Health Board: monitoring and prevention of infectious diseases, vector transmitted diseases, including cyanotoxins in bathing water | Health Board: Information on web on prevention of infectious diseases, vector transmitted diseases. | No |
Ministry of Environment, Weather Service | Environmental Strategy 2030 | Weather Service [53,54,55]: European forecast model HIRLAM, Weather Alert System Meteoalarm, Baltic Sea forecast models HIROMB; UV radiation; pollen content for allergens | Weather Service: forecasts and warnings on web: Estonian Weather Service, Air Quality Management System [56]. | Included in environment monitoring |
Ministry of Interior | Emergency Act [57], Internal Security Development Plan 2015–2020 | Rescue Board in collaboration with Health Board conducts risk analysis for emergency situations including floods, extensive forest fires, extremely cold and warm weather | Emergency plans for large-scale forest or landscape fires; storms and floods in densely populated areas; epidemics. Instructions on behaviour during emergencies on Crisis web | Included in rescue capacity |
Base Model | Sig. | Exp(B) |
---|---|---|
Gender, man (ref woman) | 0.79 | 0.96 (0.68–1.34) |
Age, 20–34 (ref 55–75) | 0.19 | 0.73 (0.46–1.17) |
Age, 35–54 (ref 55–75) | 0.10 | 0.71 (0.48–1.06) |
Education, primary (ref higher) | 0.84 | 1.08 (0.50–2.33) |
Education, secondary (ref higher) | 0.57 | 0.90 (0.62–1.30) |
Home language, Estonian (ref Russian or other) | 0.01 | 0.61 (0.43–0.86) |
Self-rated health status | 0.71 | 0.96 (0.79–1.18) |
Social and psychological factors * | ||
Belief in state institutions taking care of the healthfulness of living environment | 0.52 | 0.94 (0.79–1.18) |
Worry about health effects from environment on personal and family health | ||
Low (ref high worry) | 0.01 | 0.57 (0.37–0.88) |
Medium (ref high worry) | 0.01 | 0.58 (0.38–0.88) |
Exposure to extreme weather events | 0.01 | 1.24 (1.06–1.45) |
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Orru, K.; Tillmann, M.; Ebi, K.L.; Orru, H. Making Administrative Systems Adaptive to Emerging Climate Change-Related Health Effects: Case of Estonia. Atmosphere 2018, 9, 221. https://doi.org/10.3390/atmos9060221
Orru K, Tillmann M, Ebi KL, Orru H. Making Administrative Systems Adaptive to Emerging Climate Change-Related Health Effects: Case of Estonia. Atmosphere. 2018; 9(6):221. https://doi.org/10.3390/atmos9060221
Chicago/Turabian StyleOrru, Kati, Mari Tillmann, Kristie L. Ebi, and Hans Orru. 2018. "Making Administrative Systems Adaptive to Emerging Climate Change-Related Health Effects: Case of Estonia" Atmosphere 9, no. 6: 221. https://doi.org/10.3390/atmos9060221