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Box 4.1  National portfolios of action encompass the following 1. 2. 3. 4. 5.

Improving indoor and outdoor air quality for all. Ensuring universal, equitable, sustainable access to safe drinking water, sanitation and hygiene for all. Minimising adverse effects of chemicals on human health and the environment. Preventing and eliminating adverse effects related to waste management and contaminated sites. Strengthening adaptive capacity and resilience to climate change-induced health risks and supporting measures to mitigate climate change and achieve health co-benefits in line with the Paris Agreement. 6. Supporting efforts of European cities and regions to become healthier, more inclusive, safer, resilient and sustainable. 7. Building the environmental sustainability of health systems and reducing their environmental impact.

human health, identifying opportunities for health cobenefits from climate mitigation actions and tracking national policy responses. Worldwide, there are about 40 of these country assessments, including in the EU, France, Germany, Italy and the UK (see also Watts et al. 2018a)38. Analysis of patterns of adaptation planning in different parts of the EU (at city as well as country level (Aguiar et al. 2018)) found that priorities reflected the main local vulnerabilities, for example for flood protection and water management or for urban planning. The main barriers to adaptation were insufficient resources, capacity, political commitment and uncertainty. At first sight, the health sector is well integrated into some countries’ nationally determined contribution plans addressing mitigation and adaptation opportunities and challenges. However, concrete actions are often missing and links with SDGs are weak (Dickin and Dzebo 2018). It would be highly valuable for specific actions relating to health to be strengthened in the next iteration of the national plans. The perception of weaknesses in health linkages is reinforced by a systematic review of published information on countries in the OECD (Organisation for Economic Co-operation and Development), which notes that there are differing views on what responsibilities and obligations are expressed by national governments regarding climate change and health (Austin et al. 2016). These OECD findings suggest that national goals in health are focusing relatively narrowly on infectious disease and heat-related risks posed by climate change, typically emphasising issues for capacity building and information-based initiatives. Further efforts were recommended for cross-sectoral collaboration, vertical coordination and national health adaptation planning, accompanied by evaluation to define what health adaptation looks like in practice so that lessons of good practice can be shared between countries and used to inform policy. The OECD analysis reaffirms a broader point about highlighting the relative importance of non-communicable diseases among the effects of climate change: interest has been previously expressed by various bodies, including EASAC, in extending the






Figure 4.1  Adaptation limits.

remit of ECDC beyond infectious disease to cover noncommunicable diseases. 4.2  Approaches to adaptation and mitigation Adaptation has its limits, and various dimensions – exogenous and endogenous (Figure 4.1). Physical limits (e.g. low-lying islands or other territories), behavioural limits (e.g. populations living in vulnerable areas), technological limits (e.g. nature of flood defences) and financial limits (e.g. deciding who pays and cost–benefit considerations) may all contribute to the constraints to achieving effective adaptation. The contribution of different limits to the overall constraints on adaptation will vary according to the context. For example, a national case study on public water supply in adapting to climate change (Arnell and Delaney 2006) illustrated physical limits (drying up of rivers), economic limits (affordability), socio-political limits (construction of water storage reservoirs may not be acceptable because of effects on the environment) and

38  Although not specific to health, all current EU national policies and measures on climate change are tracked by the EEA: see their Briefing No 7/2018 ‘Tracking climate policies in European Union countries’, on


Climate change and health  |  June 2019  |  33

The imperative of climate action to protect human health in Europe  

Opportunities for adaptation to reduce the impacts and for mitigation to capitalise on the benefits of decarbonisation. The pace and extent...

The imperative of climate action to protect human health in Europe  

Opportunities for adaptation to reduce the impacts and for mitigation to capitalise on the benefits of decarbonisation. The pace and extent...