Version classiqueVersion mobile
OpenEdition Books

The Mediterranean region under climate change

 | 
Jean-Paul Moatti
, 
Stéphane Thiébault

Part 2. Vulnerability and impacts

Sub-chapter 2.5.3. Final remarks and recommendations for the future

Jean-François Guégan, Robert Barouki et Isabella Annesi-Maesano

Texte intégral

Main remarks and recommendations

1Further original research is absolutely indispensable, notably in the Mediterranean basin to assess climatic changes and their related health impacts (Hosking and Campbell-Lendrum 2012). Accomplishing this requires the establishment of a pan-Mediterranean research coordinating institution (Trans-Mediterranean CDCs) with ties to international funding organizations, stakeholders in the region and abroad, and established international and national scientific communities. The research groups involved in climate change and its impacts should be the promoters of this trans-regional programme that aims to train researchers to conduct longitudinal studies, in data acquisition and comparative analysis, and should guide research toward priority topics like observational studies, transdisciplinarity, analytical and epidemiological studies, and statistical analysis on spatio-temporal series of disease cases. They are few or no studies addressing important topics such as water supplies and waterborne diseases, food and malnutrition, and the health risks of extreme events other than the effects of heat (Hosking and Campbell-Lendrum 2012). In the same vein as that proposed by Negev et al. (2015), epidemiological data on major infectious diseases morbidity and mortality should be collected systematically, and consolidated with environmental, socio-economic, demographic and ecological data. Environmental management of infectious diseases like vector-borne diseases, which can require the elimination of breeding sites for mosquitoes through the use of insecticides, should be discussed regionally and weighed against pesticide toxicity through structured-decision making. Relevant examples could be adopted by other countries in the region. Ideally, health system preparedness for climate change-sensitive diseases should be evaluated regularly, specifically when environmental signals like the El Niňo phenomenon occur.

2In the Mediterranean region where climate change may add to existing problems (drought, water scarcity, traffic, etc.), non-communicable diseases (NCDs) are strongly challenged by changes in the climate via both direct and indirect pathways (Cecchi et al. 2010). Climate change, and its driver greenhouse gas emissions, affect NCDs through: 1) an increased number of cardiorespiratory deaths and acute morbidity due to heatwaves; 2) increased frequency of cardiorespiratory events due to higher concentrations of ground level ozone; 3) changes in the frequency of NCDs due to transboundary long-range air pollution by particulate matter (e.g. related to fires and aerosols); 4) increased incidence of skin cancers due to excessive sun exposure of the skin; and 5) altered spatial and temporal distribution of allergens that increases the risk of allergic diseases. These pathways will not only affect patients with existing NCDs by causing their aggravation but may also influence the incidence and hence the prevalence of NCDs. People who are very young, old, poor, or who live in vulnerable areas are more fragile (McMichael et al. 2006). However, it is not easy to evaluate the impact of climate change and related factors on the prevalence, the severity and the incidence of NCDs. Research on the adverse impacts of climate change on NCDs should have the following goals: 1) Improve our understanding of the climate system and its drivers; 2) Improve our understanding of climate impacts and vulnerability; 3) Increase our understanding of adaptation pathways and their putative health costs; 4) Identify the mitigation options that reduce the risk of longer-term climate change; 5) Improve decision support and integrated assessment; 6) Link environmental, socioeconomic and health datasets through an exposomic approach that will provide new insights into the potential associations between climate change and human health and wellbeing.

3These goals have to be based on cross-cutting research capacities: 1) Integrate medicine, toxicology, natural and social science, engineering, and other disciplinary approaches; 2) Ensure availability of observations, monitoring, and infrastructure for critical data collection and analysis; 3) Build capacity for climate assessment through education, training, and workforce development; 4) Enhance the development and use of scenarios; and 5) Promote international research and collaboration. These capacities are achievable in the Mediterranean region where important resources and competences exist.

4Regarding training, researchers, medical doctors and public health epidemiologists should be trained to climate change risks and to long-term understanding of processes at work in human health outcomes, and not solely to short-term, molecular-based approaches. Public education and communication is essential and should be strengthened in the Mediterranean region with public involvement in prevention of outbreaks and in combating infectious disease foci like breeding sites for mosquitoes (Negev et al. 2015). Evaluation and assessment of the implementation of adaptation plans to climate change and health should be conducted according to structured-decision making and sustainable practices, and the French example of climate change and health assessment (Guégan and Pocher 2010) is a start in this direction. The Mediterranean should benefit from adopting an ecosystemic approach, the so-called OneHealth-EcoHealth concepts, to reach the sustainable development goals, and at least numbers 3 (good health and human well-being) and 13 (climate action). Health and well-being in the Mediterranean, whatever the borders and the sub-regions should be the unifying theme that enables crystallization of a trans-national initiative such as the Mediterranean Union. We also would like to stress the assets of the Mediterranean region with regard to health outcomes. Indeed, the Mediterranean diet displays a number of health benefits compared to other diets and it should be preserved at least to partially offset some of the detrimental effects that climate change may have. As previously mentioned another asset in the Mediterranean region is the wide range of skills and facilities that already exist. An integrative public health approach with investments in regional public health infrastructures should be applied here.

Bibliographie

References

Ahn K., 2014
The role of air pollutants in atopic dermatitis. Journal of Allergy & Clinical Immunology, 134(5): 993-999.

Analitis A., Katsouyanni K., Biggeri A., Baccini M., Forsberg B., Bisanti L., Kirchmayer U., Ballester F., Cadum E., Goodman P.G., Hojs A., Sunyer J., Tiittanen P., Michelozzi P., 2008
Effects of cold weather on mortality: results from 15 European cities within the PHEWE project. American Journal of Epidemiology, 168: 1397-1408.

Ayres J.G., Forsberg B., Annesi-Maesano I., Dey R., Ebi K.L., Helms P.J., Medina-Ramón M., Windt M., Forastiere F., 2009
Environment and Health Committee of the European Respiratory Society. Climate change and respiratory disease: European Respiratory Society position statement. European Respiratory Journal, 34(2): 295-302.

Baccini M., Kosatsky T., Analitis A., Anderson H.R., D’Ovidio M., Menne B., Michelozzi P., Biggeri A.; Phewe Collaborative Group, 2011
Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios. Journal of Epidemiology & Community Health, 65: 64-70.

Baldacci S., Maio S., Cerrai S., Sarno G., Baïz N., Simoni M., Annesi-Maesano I., Viegi G., 2015
HEALS Study. Allergy and asthma: Effects of the exposure to particulate matter and biological allergens. Respiratory Medicine, 109(9): 1089-1104.

Basagaña X., Jacquemin B., Karanasiou A., Ostro B., Querol X., Agis D., Alessandrini E., Alguacil J., Artiñano B., Catrambone M., de la Rosa J.D., Díaz J., Faustini A., Ferrari S., Forastiere F., Katsouyanni K., Linares C., Perrino C., Ranzi A., Ricciardelli I., Samoli E., Zauli-Sajani S., Sunyer J., Stafoggia M., MED-PARTICLES Study group, 2015
Short-term effects of particulate matter constituents on daily hospitalizations and mortality in five South-European cities: results from the MED-PARTICLES project. Environmental International, 75: 151-158. doi:10.1016/j.envint.2014.11.011.

Bates P.A., Depaquit J., Galati E.A.B., Kamhawi S., Maroli M., Mcfowell M.A., Picado A., Ready P.D., Salomón O.D., Daniel O., Shaw J.J., Traub-Csekö Y.M., Warburd A., 2015
Recent advances in phlebotomine sand fly research related to leishmaniasis control. Parasites & Vectors, 20158: 131. DOI: 10.1186/s13071-015-0712-x

Casimiro E., Calheiros J., Santos F.D., Kovats S., 2006
National assessment of human health effects of climate change in Portugal: approach and key findings. Environmental Health Perspectives, 114: 1950-1956.

Cecchi L., D’Amato G., Ayres J.G., Galan C., Forastiere F., Forsberg B., Gerritsen J., Nunes C., Behrendt H., Akdis C., Dahl R., Annesi-Maesano I. (2010)
Projections of the effects of climate change on allergic asthma: the contribution of aerobiology. Allergy, 65(9):1073-1081.

Chevalier V., Tran A., Durand B., 2014
Predictive modeling of West Nile virus transmission risk in the Mediterranean Basin: how far from landing? International Journal of Environmental Research and Public Health, 11: 67-90. doi: 10.3390/ijerph110100067.

Conte A., Candeloro L., Ippoliti C., Monaco F., De Massis F., Bruno R., Di Sabbatino D., Danzetta M.L. et al. (2015)
Spatio-Temporal Identification of Areas Suitable for West Nile Disease in the Mediterranean Basin and Central Europe. PLoS One, 10(12): e0146024. doi: 10.1371/journal.pone.0146024

Corvalan C., Hales S., McMichael A.T., 2005
Ecosystems and human well-being: health synthesis. A report of the Millenium Ecosystem Assessment. World Health Organization, Geneva, Switzerland.

Costello A., Abbas M., Allen A., Ball S., Bell S., Bellamy R. et al., 2009
Managing the health effects of climate change. Lancet and university College London Institute for Global Health Commission. Lancet, 373: 1693-1733.

Davídkovová H., Plavcová E., Kynčl J., Kyselý J., 2014
Impacts of hot and cold spells differ for acute and chronic ischaemic heart diseases. BMC Public Health, 14: 480. DOI: 10.1186/1471-2458-14-480

D’Amato G., Cecchi L., Bonini S., Nunes C., Annesi-Maesano I., Behrendt H., Liccardi G., Popov T., van Cauwenberge P., 2007
Allergenic pollen and pollen allergy in Europe. Allergy, 62(9): 976-990.

D’Amato G., Vitale C., D’Amato M., Cecchi L., Liccardi G., Molino A., Vatrella A., Sanduzzi A., Maesano C., Annesi-Maesano I., 2016
Thunderstorm related asthma: what happens and why. Clinical and Experimental Allergy, 46: 390-396.

D’Amato G., Holgate S.T., Pawankar R., Ledford D.K., Cecchi L., Al-Ahmad M., Al-Enezi F., Al-Muhsen S., Ansotegui I., Baena-Cagnani C.E., Baker D.J., Bayram H., Bergmann K.C., Boulet L.P., Buters J.T., D’Amato M., Dorsano S., Douwes J., Finlay S.E., Garrasi D., Gómez M., Haahtela T., Halwani R., Hassani Y., Mahboub B., Marks G., Michelozzi P., Montagni M., Nunes C., Oh J.J., Popov T.A., Portnoy J., Ridolo E., Rosário N., Rottem M., Sánchez-Orges M., Sibanda E., Sienra-Monge J.J., Vitale C., Annesi-Maesano I., 2015
Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organization Journal, 8 (1): 25. doi: 10.1186/s40413-015-0073-0.

de Donato F.K., Leone M., Noce D., Davoli M., Michelozzi P., 2013
The impact of the February 2012 cold spell on health in Italy using surveillance data. PLoS One, 8 (4): e61720.

Di Sabatino D., Bruno R., Sauro F., Danzetta M.L., Cito F., Iannetti S., Narcisi V., De Massis F., Calistri P., 2014
Epidemiology of West Nile Disease in Europe and in the Mediterranean Basin from 2009 to 2013. Biomed Research International, 907852. doi: 10.1155/2014/907852

Eddabra R., Moussaoui W., Prévost G., Delalande F., Van Dorsselaer A., Meunier O., Scheftel J.-M., Mimouni R., 2011
Occurrence of Vibrio cholerae non-O1 in three wastewater treatment plants in Agadir (Morocco). World Journal of Microbiology and Biotechnology, 27: 1099-1108.

Esteves K., Hervio-heath D., Mosser T., Rodier C., Tournoud M.-G., Jumas-Bilak E., Colwell R. R;, Monfort P.,2015
Rapid Proliferation of Vibrio parahaemolyticus, Vibrio vulnifucus and Vibrio cholera during Fresjhwater Flash Floods in French Mediterranean Coastal Lagoons. Applied and Environmental Microbiology, 81: 7600-7609.

Faustini A., Alessandrini E.R., Pey J., Perez N., Samoli E., Querol X., Cadum E., Perrino C., Ostro B., Ranzi A., Sunyer J., Stafoggia M., Forastiere F.; MED-PARTICLES study group, 2015
Short-term effects of particulate matter on mortality during forest fires in Southern Europe: results of the MED-PARTICLES Project. Occupational and Environmental Medicine, 72(5):323-329.

Flahault A., Schütte S., Guégan J.-F., Pascal M., Barouki R., 2015
Health can help saving negotiation on climate change. Lancet, 385: 49-50.

Giorgi F., Lionello P., 2008
Climate change projections for the Mediterranean region. Global Planetary Change, 63: 90-104.

Guégan J.-F. Pochet A. (EDS), 2010
Plan national d’adaptation au changement climatique - Partie Santé - Rapport de Groupe Interministériel et parlementaire. Expertise collégiale. La Documentation française, Paris, France.

Guégan J.-F., Simard F., 2015
Changements environnementaux et maladies infectieuses: mieux coordonner la surveillance. Actualité et dossier en santé publique, 93: 23-28.

Guernier V., Hochberg M.E., Guégan J.-F., 2004
Ecology drives the worldwide distribution of human diseases. PLoS Biology, 2: 740-746.

Habib R.R., 2011
Climate Change and Health research in the Eastern Mediterranean region (EMR). Research and Policy Memo #10. Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Lebanon.

Habib R.R., Zein K.E., Ghanawi J., 2010
Climate change and health research in the Eastern Mediterranean Region. EcoHealth, 7: 156-175.

Hosking J., Campbell-Lendrum D., 2012
How Well Does Climate Change and Human Health Research Match the Demands of Policymakers? A Scoping Review. Environmental Health Perspectives, 120: 1076-1082.

Iñiguez C., Schifano P., Asta F., Michelozzi P., Vicedo-Cabrera A., Ballester F., 2016
Temperature in summer and children’s hospitalizations in two Mediterranean cities, Environmental Research, 150: 236-244. doi: 10.1016/j.envres.2016.06.007.

Khader Y.S., Abdelrahman M., Abdo N., Al-sharif M., Elbetieha A., Bakir H., Alemam R., 2015
Climate change and health in the Eastern Mediterranean countries: a systematic review. Reviews on Environmental Health, 30: 163-181.

Kuglitsch F.G., Toreti A., Xoplaki E., Della-Marta P.M., Zerefos C.S., Türkeş M., Luterbacher J., 2010
Heat wave changes in the eastern Mediterranean since 1960. Geophysical Research Letters, 37: L04802. doi: 10.1029/2009GL041841

Lucas R.M., Norval M., Neale R.E., Young A.R., de Gruijl F.R., Takizawa Y., Van der Leun J.C., 2015
The consequences for human health of stratospheric ozone depletion in association with other environmental factors. Photochemical & Photobiological Sciences, 14(1): 53-87.

Mallone S., Stafoggia M., Faustini A., Gobbi G.P., Marconi A., Forastiere F., 2011
Saharan dust and associations between particulate matter and daily mortality in Roma, Italy. Environmental Health Perspectives, 119(10): 1409-1414. doi: 10.12989/ehp.1003026.

Mcmichael A.J., Woodruff R.E., Hales S., 2006
Climate change and human health: present and future risks. Lancet, 367 (9513): 859-869.

Messeri A., Morabito M., Messeri G., Brandani G., Petralli M., Natali F., Grifoni D., Crisci A., Gensini G., Orlandini S., 2015
Weather-Related Flood and Landslide Damage: A Risk Index for Italian Regions. PLoS One, 10(12): e0144468. doi:10.1371/journal.pone.0144468

Michelozzi P., Accetta G., De Sario M., D’Ippoliti D., Marino C., Baccini M., Biggeri A., Anderson H.R., Katsouyanni K., Ballester F., Bisanti L., Cadum E., Forsberg B., Forastiere F., Goodman P.G., Hojs A., Kirchmayer U., Medina S., Paldy A., Schindler C., Sunyer J., Perucci C. A.; Phewe Collaborative Group, 2009
High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. American Journal of Respiratory Critical Care, 179: 383-389. doi: 10.1164/rccm.200802-217OC

Morris A., Gozlan R.E., Hassani H., Andreou D., Couppié P., Guégan J.-F., 2014
Complex temporal climate signals drive the emergence of human water-borne disease. Nature Emerging Microbes & Infections, 3: e56.

Navarra A., Tubiana L. (EDS), 2013
Regional Assessment of Climate Change in the Mediterranean. Vol. 2. Agriculture, Forests and Ecosystem Services and People. Springer Ltd., Heidelberg, Germany, 402 pages.

Negev M., Paz S., Clermont A., Groag Pri-Or N., Shalom U., Yeger T., Green M.S., 2015
Impacts of Climate Change on vector Borne Diseases in the Mediterranean basin-Implications for Preparedness and Adaptation Policy. International Journal of Environmental research and Public Health, 12: 6745-6770.

Odolini S., Gautret P., and Parola P., 2012
Epidemiology of Imported Malaria in the Mediterranean Region. Mediterranean Journal of Hematology and Infectious Diseases, 4: e2012031.

Ostro B., Tobias A., Karanasiou A., Samoli E., Querol X., Rodopoulou S., Basagaña X., Eleftheriadis K., Diapouli E., Vratolis S., Jacquemin B., Katsouyanni K., Sunyer J., Forastiere F., Stafoggia M.; MED-PARTICLES Study Group., 2015
The risks of acute exposure to black carbon in Southern Europe: results from the MED-PARTICLES project. Occupational and Environmental Medicine, 72(2):123-129. doi: 10.1136/oemed-2014-102184.

Oudin Åström D., Schifano P, Asta F., Lallo A., Michelozzi P., Rocklöv J., Forsberg B., 2015
The effect of heat waves on mortality in susceptible groups: a cohort study of a mediterranean and a northern European City. Environmental Health, 14: 30.

Rezza G., 2016
Dengue and other aedes-borne viruses: a threat to Europe? Euro Surveillance, 21: pii=302.38.

Rezza G., Nicoletti L., Angelini R., Romi R., Finarelli A.C., Panning M., Cordioli P., Fortuna C., Boros S., Magurano F., Silvi G., Angelini P., Dottori M., Ciufolini M.G.,Majori G.C., Cassone A.; CHIKV study group, 2007
Infection with chikungunya virus in Italy: an outbreak in a temperate area. Lancet, 370: 1840-1846.

Roche B., Léger L., L’Ambert G., Lacour G., Foussadier R., Besnard G., Barré-cardi H., Simard F., Fontenille D., 2015a
The Spread of Aedes albopictus in Metropolitan France: Contribution of Environmental Drivers and Human Activities and Predictions for a Near Future. PLoS One, 10(5): e0125600. doi: 10.1371/journal.pone.0125600

Roche B., Morand S., Elguero E., Balenghien T., Guégan J.-F., Gaidet N., 2015B
Does host receptivity or host exposure drives dynamics of infectious diseases? The case of West Nile Virus in wild birds. Infection, Genetics and Evolution, 33: 11-19. DOI: 10.1016/j.meegid.2015.04.011

Rodó X., Pascual M., Fuchs G.,
Faruque S.G., 2002 ENSO and cholera: A nonstationary link related to climate change? Proceedings of the National Academy of Sciences U. S. A., 99: 12901–12906.

Rodríguez-Arias M.A., Chlif S., Wolf T., Rodó X., Ben Salah A., Menne B., 2008
A Literature Review on Climate-Sensitive Infectious Diseases in the Mediterranean Region. Technical Report · January 2008. GOCE 036961 CIRCE. DOI: 10.13140/RG.2.1.3203.4726

Roiz D., Ruiz S., Soriguer R., Figuerola J., 2014
Climatic effects on mosquito abundance in Mediterranean wetlands. Parasites & Vectors, 7: 333.

Roiz D., Boussès P., Simard F., Paupy C., Fontenille D., 2015
Autochthonous Chikungunya Transmission and Extreme Climate Events in Southern France. PLoS Neglected Tropical Diseases, 9(6): e0003854. doi:10.1371/journal.pntd.0003854

Samoli E., Stafoggia M., Rodopoulou S., Ostro B., Alessandrini E., Basagaña X., Díaz J., Faustini A., Gandini M., Karanasiou A., Kelessis A.G., Le Tertre A., Linares C., Ranzi A., Scarinzi C., Katsouyanni K., Forastiere F., 2014
MED-PARTICLES Study group. Which specific causes of death are associated with short term exposure to fine and coarse particles in Southern Europe? Results from the MED-PARTICLES project. Environment International, 67: 54-61. doi: 10.1016/j.envint.2014.02.013.

Sainz-Elipe S., Latorre J.M., Escosa R., Masià M., Fuentes M.V., Mas-Coma S., Bargues M.D., 2010
Malaria resurgence risk in southern Europe: climate assessment in an historically endemic area of rice fields at the Mediterranean shore of Spain. Malaria Journal, 9: 21.

Schaffner F., Mathis A., 2014
Dengue and dengue vectors in the WHO European region: past, present, and scenarios for the future. Lancet Infectious Diseases, 14: 1271-1280.

Senderovich Y., Izhaki I., Halpern M., 2010
Fish as reservoirs and vectors of Vibrio cholerae. PLoS One, 5: e8607.

Succo T., Leparc-Goffart I., Ferré J., Roiz D., Broche B., Maquart M. et al., 2016
Autochtonous dengue outbreak in Nîmes, South of France, July to September 2015. Euro surveillance, 21: 30240.

Suk J.E., Semenza J.C., 2011
Future Infectious Disease Threats to Europe. American Journal of Public Health, 101: 2068-2079.

Vezzuli L., Previati M., Pruzzo C., Marchese A., Bourne D.G., Cerrano C., 2010
Vibrio infections triggering mass mortality events in a warming Mediterranean sea. Environmental Microbiology, 12: 2007-2019.

Vezzulli L., Brettar I., Pezzati E., Reied P.C., Colwell R.R., Höfle M.G., Pruzzo C., 2012
Long-term effects of ocean warming on the prokaryotic community: evidence from the vibrios. The ISME Journal, 6: 21-30.

Vittecoq M., Thomas F., Jourdain E., Moutou F., Renaud F., Gauthier-Clerc M., 2013
Risks of Emerging Infectious Diseases: Evolving Threats in a Changing area, The Mediterranean basin. Transboundary and Emerging Diseases, 61: 17-27.

WHO, 2016
WHO|Cholera. Available at: http://www.who.int/topics/cholera/en/ (access June 20, 2016).

Wild C.P., 2005.
Complementing the genome with an “exposome”: The outstanding challenge of environmental exposure measurement in molecular epidemiology. Cancer Epidemiology, Biomarkers & Prevention, 14: 1847-1850.

Youssouf H., Liousse C., Roblou L., Assamoi E.M., Salonen R.O., Maesano C., Banerjee S., Annesi-Maesano I., 2014
Non-accidental health impacts of wildfire smoke. International Journal of Environmental Research and Public Health, 11(11): 11772-804. doi: 10.3390/ijerph111111772.

Zhao F., Elkelish A., Durner J., Lindermayr C., Winkler J.B., Ruёff F., Behrendt H., Traidl-Hoffmann C., Holzinger A., Kofler W., Braun P., von Toerne C., Hauck S.M., Ernst D., Frank U., 2016
Common ragweed (Ambrosia artemisiifolia L.): allergenicity and molecular characterization of pollen after plant exposure to elevated NO2. Plant, Cell & Environment, 39(1): 147-164.

Ziska L.H., Beggs P.J., 2012
Anthropogenic climate change and allergen exposure: The role of plant biology. Journal of Allergy and Clinical Immunology, 129(1): 27-32.

Auteurs

INSERM, UPD, UMR Toxicology, Pharmacology and Cell Signaling, France
UMR-S 1124 «Pharmacologie, Toxicologie et Signalisation cellulaire» INSERM-Université Paris Descartes, Paris, France.
robert.barouki@univ-paris5.fr

© IRD Éditions, 2016

Conditions d’utilisation : http://www.openedition.org/6540

Lire

Freemium

open access

Offert par L’éditeur de ce site