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institutional limits (for example inadequate capacity of water management agencies). More generally, in addition, strategic limitation may have been selfimposed by lack of ambition in scope, exemplified in the past by the European Commission’s climate change adaptation strategy that paid little attention to public health (Appendix 3). This is now beginning to change: the European Commission’s forward look on strategy emphasises the need to reinforce links between climate adaptation and public health, for example to improve cross-sectoral cooperation on risk assessment and surveillance, and to increase awareness and capacity of the health sector, including at local level, to address current and emerging climate-related health risks. In developing better resilience, more can be done to integrate health into the SSPs (section 3.14) and other scenario planning, capturing both relatively predictable changes (e.g. demographics) and critical uncertainties (e.g. migration flows). Comparison of scenarios may be particularly helpful in revealing scientific opportunities and challenges. That is, what should be the research agenda to help understand and influence the trajectories? As described in section 3.14, adaptation of health care systems will need to vary according to SSPs. Although, for example, early warning systems, hospital preparedness and training are needed in all SSPs, their effectiveness may vary in more unequal societies with greater poverty. There will also be relevant implications for health in the adaptation plans progressed by other sectors, for example agriculture and construction. The Working Group identified some general points to set the overall context for mitigation and adaptation, before exemplifying specific case studies in the following sections. •

It is important to build social capital and resilience in systems and infrastructure, especially where there may be cases of market failure, and to reduce stress and other mental health consequences of climate change (Majeed and Lee 2017). Identification and comparison of mitigation and adaptation policy options requires good scientific data, and monitoring of interventions requires good baseline data. Much of the current debate on strategies is based on principles and (cost) effectiveness modelling rather than empirical evidence’ although there is some information, for example on strategies for ecosystem protection against climate disasters (Royal Society 2014). Improving the practical value of novel approaches, for example early warning or other alert and information systems for air quality39, infectious

disease threats, food insecurity, pollen forecasts, heatwaves and other extreme weather events (Bittner et al. 2014; Boekmann and Rohn 2014), requires co-design of systems with the community involved. •

In mitigation objectives, it is important to reduce climate risk to a much lower level as a basis for subsequent establishment of the most cost-effective adaptation measures. Several policy instruments are available for mitigation such as carbon taxes, and a range of options for negative emission technologies several of which are under investigation. It is not within the scope of the present EASAC project to ascertain what more can and should be done to promote negative carbon balances, but we emphasise the point that negative emissions technologies and mitigation technologies have significant potential in supporting human health. Taking account of health impact assessment is a key part of the work on comparing the different technologies’ in evaluating carbon pricing reform and in assessing other key EU initiatives, such as for the circular economy and bioeconomy.

The need to avoid unintended consequences of adaptation or mitigation strategies (see section 4.7). Downstream health impacts of proposals for climate engineering through negative emission technologies are still mainly unevaluated but there are concerns (Carlson and Trisas 2018). For example, replacing food crops by bioenergy crops has implications for food and nutrition security, and ocean fertilisation for carbon capture would trigger massive phytoplankton blooms, driving zooplankton blooms, and the potential for cholera outbreaks.

4.3  Mitigation and co-benefits Research indicates that the main policies proposed to mitigate climate change can also lead to localised improvements in the health of those populations undertaking the mitigation. These health co-benefits are additional to the global health benefits that will flow from mitigation and could help to offset the costs of tackling climate change (IAMP 2010). There are multiple potential benefits for air quality and climate (Haines et al., 2009; Smith et al., 2014) (see also discussion in section 3.8.1). Working Group discussion noted that some air pollution control measures such as the reduction of sulfur dioxide emissions can adversely affect climate by affecting radiative transfer in the atmosphere and increasing penetration of sunshine to ground level. However, there are also many air pollution

39  For example, air quality alerts specifically benefit asthmatics and there is potential for increasing public health protection by using personalised alert systems (Ho et al. 2018).

34  |  June 2019  |  Climate change and health


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...