Valuation and perception of the costs of climate change on health.

BACKGROUND AND AIMS: Climate change affects our societies and lives through our economies, our livelihoods, and our health. Economic losses of climate change are estimated at $23 trillion, largely through externalities due to premature mortality, healthcare expenditure, and health-related work losses. Even if there are established methods to quantify the health economic burden, there is limited information on how people perceive this information. The current study aimed to examine different health cost evaluation methods and observe perceptions of stakeholders in the climate change context. METHOD: The participatory research approach of the World Café with 41 participants was applied to explore four topics associated with valuing the costs of climate change. The data were analyzed following an inductive approach. RESULTS: Despite the willingness-to-pay approach being widely applied, many experts see actual healthcare costs as a more explicit indicator of costs; however, this approach might underestimate actual costs. Participants experienced difficulties accepting and understanding cost estimates that indicated very high externalities as a percentage of gross domestic product. The cost-effectiveness of mitigation and adaptation measures was also challenged by a concern that while the costs of such measures are incurred now, the benefits do not come to fruition until later, for example, when building bike lanes or dams. CONCLUSIONS: Policies should favor environmentally friendly activities such as making cycling more convenient in cities with the health benefits presented in monetary terms, while limiting car driving. Moreover, the public might better understand the costs of climate change via tools that map how solutions influence different sectors and outlining the costs in evaluating the benefits for health and the environment.

Linking climate change adaptation and public health: perspectives of Norwegian policymakers.

AIMS: To explore the perspectives of selected Norwegian climate and health policymakers working at national and municipality level regarding how health is accounted for in climate change adaptation plans. METHODS: Semi-structured digital interviews were conducted with representatives from eight municipalities participating in a national network for climate change adaptation, one political unit and five national public administrations working in climate, health, environment, preparedness, and civil protection. RESULTS: Municipalities coordinate the development of climate change adaptation plans with support from key national actors. Although municipalities were experienced in preparing for extreme climate events and securing infrastructure, limited consideration was given to health in the climate change adaptation work. Such integration was hindered by lack of resources and knowledge regarding what to do, and lack of collaboration between municipality sectors. To connect climate change adaptation and health better, the representatives suggested providing evidence-based information regarding health impacts of climate change, developing concrete tools including warning systems, and implementing regional, national, and international projects to map the impact of climate change and raise capacity. The representatives called for more stringent national guidelines for the integration of health in climate change adaptation, and pinpointed that lessons learnt from the COVID-19 pandemic will enable municipalities to be better prepared and more adaptable in the future. CONCLUSIONS: Governmental authorities should provide more concrete guidance regarding the integration of health in climate change adaptation plans. Public health authorities have a central role to play in supporting such endeavours.

Implementation of climate adaptation in the public health sector in Europe: qualitative thematic analysis.

BACKGROUND: Adaptation, to reduce the health impacts of climate change, is driven by political action, public support and events (extreme weather). National adaptation policies or strategies are limited in addressing human health risks and implementation of adaptation in the public health community is not well understood. AIM: To identify key issues in climate change adaptation implementation for public health in Europe. METHODS: Key informant interviews with decision-makers in international, national and local city governments in 19 European countries. Participants were recruited if a senior decision-maker working in public health, environmental health or climate adaptation. INTERVIEWS ADDRESSED: Barriers and levers for adaptation, policy alignment, networks and evidence needs. RESULTS: Thirty-two interviews were completed between June and October 2021 with 4 international, 5 national and 23 city/local government stakeholders. Respondents reported inadequate resources (funding, training and personnel) for health-adaptation implementation and the marginal role of health in adaptation policy. A clear mandate to act was key for implementation and resource allocation. Limited cross-departmental collaboration and poor understanding of the role of public health in climate policy were barriers to implementation. CONCLUSIONS: Across Europe, progress is varied in implementation of climate adaptation in public health planning. Providing appropriate resources, training, knowledge mobilization and supporting cross-departmental collaboration and multi-level governance will facilitate adaptation to protect human health.

Mapping food surveillance chains through different sectors.

European countries are investing in strengthening disease surveillance from a One Health (OH) perspective. During the MATRIX project, in the context of the One Health European Joint Programme, existing surveillance chains across the sectors of animal health, food safety, and public health have been investigated through questionnaires. Provided information has then been selected to be displayed in a single slide using an implemented mapping template. Two real-life scenarios are presented as case studies: the surveillance activities in place in France for Salmonella in the pork meat food chain, and in Norway for Listeria monocytogenes in the dairy food chain. The results collected through the questionnaires and the lessons learnt during the mapping process are reported, to share the advantages and drawbacks of the methodology. Moreover, the presented template could be adjusted and applied to different contexts. Mapping the components of existing disease surveillance systems is a fundamental step in understanding the relationships between its components, and subsequently facilitating their collaboration and integration under a OH approach.

Heavy weather events, water quality and gastroenteritis in Norway.

Climate change will lead to more extreme weather events in Europe. In Norway, little is known about how this will affect drinking water quality and population's health due to waterborne diseases. The aim of our work was to generate new knowledge on the effect of extreme weather conditions and climate change on drinking water and waterborne disease. In this respect we studied the relationship between temperature, precipitation and runoff events, raw and treated water quality, and gastroenteritis consultations in Norway in 2006-2014 to anticipate the risk with changing climate conditions. The main findings are positive associations between extreme weather events and raw water quality, but only few with treated drinking water. Increase in maximum temperature was associated with an increase in risk of disease among all ages and 15-64 years olds for the whole year. Heavy rain and high runoff were associated with a decrease in risk of gastroenteritis for different age groups and time periods throughout the year. No evidence was found that increase in precipitation and runoff trigger increased gastroenteritis outbreaks. Large waterworks in Norway currently seem to manage extreme weather events in preventing waterborne disease. However, with more extreme weather in the future, this may change. Therefore, modelling future climate scenarios is necessary to assess the need for improved water treatment capacity in a future climate.

The implementation of European Union (EU) rules on cross-border care: moving towards convergence?

This article studies the implementation of the European Union (EU)'s Patients' Rights Directive in Germany and Norway. The objective of the Directive was to allow EU member states to have a say in the regulatory work, ensure predictability and uniformity in the application of EU rules on cross-border care, and enhance a move towards EU harmonisation in this area. So far, the implementation processes in Norway and Germany have mixed results regarding the likelihood of achieving uniformity and harmonisation. Although the Directive has had convergent effects on certain areas of cross-border care, such as setting up National Contact Points and providing patients with the basic right to treatment abroad, implementation also shows divergent patterns. In both countries, adapting to EU rules has strengthened patients' rights to choose freely among health-service providers in a wider European health-service market. However, due to legal discretion and country-specific institutions within which the new rules are applied, divergent patterns prevail.