Public health services in urban settings and climate change.

Some experiences from Barcelona

Joan R Villalbí, MD, MPH

March 15th, 2016

Time goes by...

Kyoto protocol, 1997. EU signatory, ratification by MS (Spain 2002, official in 2005).– EU policy 2008: emissions, energy, emissions

trading system... – Spain: CC and clean energy strategy, 2006.– Catalonia: first report in 2005. – BCN: strategy & plans building on previous efforts.

• Energy, CC and air quality 2011-20• Urban green and biodiversity 2020• Urban mobility 2013-18• Air quality improvement 2015-18• Resilience and CC adaptation (expected in 2016)

What are the main issues CC poses for health in

Spain?

• Heat waves.• Water quality & availability.• Air quality.• Vector transmitted diseases.(according to expert assessments)

Extreme events: heat waves

The mortality rise in the summer of 2003 marked a turning point.

Planning for heat waves: warning systems

Part of the municipal emergency plans since 2004. Warning

activates actions for PHC and social services.

And then what happens? Partly a black box.

Daily monitoring of funeral services in town.

Tracking vulnerability: mapping data by neighborhoods

% elderly living alone & available family income

Air, water and placesAir pollution caused mainly by traffic. • Action plans for the area.• Climate change impacts:

– Less rainy days – Nox - ozone– Wildfires

Water quality:• Periodic droughts, and getting worse.• Precipitations. So far similar rainfall, but less days of

precipitation.• Limited sources of drinking water.• Major infrastructure improvements in 2008-09.

Levels of major air pollutants as percentages of air quality standards. Barcelona, 2001-14.

-50

-25

0

25

50

75

1002001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

PM10 PM2.5 NO2

Source: official monitors in the city, as collected by the Public Health Agency. Levels are the average of mean annual levels provided by all valid monitors for the year. PM2.5 began to be collected in 2005.

Standards are current standards for EU, except for PM2.5 where the EU 2020 standard has been applied (NO2 40 μg/m3; PM10 40 μg/m3, PM2.5 25 μg/m3).

European air qualitystandards (%)

Average THMs in drinking water from the Llobregat basin (B zone). Barcelona, 1979-2013.

Source: 1979-81 results are from CSIC studies, 1998 from a study in the Public Health Agency as the lab methods for THMs were being piloted, from 2003 on values are the official control values reported by the

Public Health Agency.

0

50

100

150

200

1979 1980 1981 1998 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Before new ED limits After new ED limits

Vector control: mosquitoes

• Warming means more warm days and more reproductive cycles: longer period of activity and larger population.

• Beyond the nuisance caused by mosquitoes, the presence of Aedes albopictus poses risks of arbovirus transmission.

• Globalization and climate change may bring new vectors.

• Need to work further on:– Vector surveillance. – Reduce risk of arbovirus transmission.

Reported malaria cases, by year and place of residence. Barcelona, 1993-2013.

0

20

40

60

80

100

120

140

160

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Reported cases City residents

What remains to be done? Some ideas...

PH services:• Reinforce operational links with Emergency Plans.• Review and evaluate current heat wave plans. • Draft specific information system, with emphasis in mapping

vulnerable populations (link with emphasis in inequalities and in community programs).

With others:• Explore and pilot changes in ornamental fountains and street

drains.• Predictive models for vectors and arbovirus transmission.• Promote pilot changes in urban design to mitigate heat island

effects and evaluate pilot areas.