A new integrative perspective on early warning systems for health in the context of climate change.

Climate change causes or aggravates a wide range of exposures with multiple impacts on health, both direct and indirect. Early warning systems have been established to act on the risks posed by these exposures, permitting the timely activation of action plans to minimize health effects. These plans are usually activated individually. Although they show good results from the point of view of minimizing health impacts, such as in the case of high temperature plans, they commonly fail to address the synergies across various climate-related or climate-aggravated exposures. Since several of those exposures tend to occur concurrently, failure to integrate them in prevention efforts could affect their effectiveness and reach. Thus, there is a need to carry out an integrative approach for the multiple effects that climate change has on population health. This article presents a proposal for how these plans should be articulated. The proposed integrated plan would consist of four phases. The first phase, based on early warning systems, would be the activation of different existing individual plans related to the health effects that can be caused by certain circumstances and when possible corrective measures would be implemented. The second phase would attempt to quantify the health impact foreseen by the event in terms of the different health indicators selected. The third phase would be to activate measures to minimize the impact on health, via population alerts and advisories, and additional social and health services, based on the provisions in phase two. Phase four would be related to epidemiological surveillance that permits evaluation of the effects of activating the plan. We believe that this integrative approach should be extended to all of the public health interventions related to climate change.

Contamination of food and agro products in the Republic of Macedonia.

The Republic of Macedonia has 662,000 ha of cultivated land with well-organised agricultural production. It is a well known producer of agricultural products. From 1991 to 1999, authorized laboratories conducted systematic control of about 6,500 food samples in 1991 to 36,000 by 1999 which included a whole range of hygienic quality parameters including microbiological and chemical. Microbiological contamination of food was reported to have caused disease outbreaks in 1,578 people in 1995, which dropped to 126 people in 1999. The decreasing trend of samples unfit for human consumption was observed for all food groups. As for the chemical parameters, an increasing trend of contaminated samples was noted only for additives, with peaks reaching 6.9% in 1998 and 4.9% in 1999 of the total number of analysed samples.