Strengthening resilience to address climate change and chronic diseases: evidence from small states

Abstract Background Climate & environmental change are disproportionally impacting small states, given higher costs per capita associated with coping with the immediate risks of environmental & climatic events. Climate change has been identified as a serious public health threat. This is especially true for heatwaves in the Mediterranean Basin, with poor air quality worsening the health impacts during periods of extreme heat, often affecting already high levels of chronic diseases. Promoting climate change adaptation measures is crucial to address the negative socio-economic impacts brought by heatwaves, & its interactions with poor air quality. While awareness about the link between poor air quality & heat-waves is gaining momentum, there is still a gap in policy responses, especially in small states. This research assesses the level of preparedness of the European Union, with a focus on adaptation to heat-waves since the extreme European heat-wave of 2003. A case study on Malta is also presented, aiming at discovering what measures the island is adopting to tackle the problems arising from the interaction between poor air quality & heatwaves. Methods A systematic literature review is conducted, investigating the links between heat-waves & air pollution post 2003, followed by a qualitative content analysis to assess the preparedness of climate change adaptation measures in this regard. Results and conclusions The findings of this research show that the link between heat waves & poor air quality has not been sufficiently acknowledged by academia, with evident gaps in applied small states research. Also, a closer look at key adaptation policies & measures in Malta finds that heat waves & poor air quality are hardly been linked, leaving much scope to introduce policy & economic instruments to tackle both public health risks to address growing chronic diseases, & not to compromise current & future socioeconomic wellbeing.


Background:
City design can have major health and environmental implications. The overall layout of cities influences air quality, as urban sprawl can encourage the use of motorised vehicles and decrease active travelling. Furthermore, lack of trees has a negative impact on particulate matter levels and contributes to the urban heat island effect. There is a growing interest for creating an urban environment conducive of healthier lifestyles.

Methods:
The analysis uses the five OECD criteria to assess best practices in public health -Effectiveness, Efficiency, Equity, Evidencebase, and Extent of coverage -to carry out a systematic assessment of selected candidate best practices to improve the public health potential of cities. The impact of scaling up these interventions within and across countries is evaluated by using the OECD SPHeP-NCD microsimulation model.

Results:
Interventions such as Superblocks in Barcelona, which reshapes the city layout to make them more people centric and less vehicles reliant, or Cycle Superhighways from Denmark, which develops cycling networks, have a the potential to avoid a significant number of chronic diseases by promoting an active lifestyle and decreasing transportrelated pollution. Such interventions can also decrease healthcare expenditure and, if well designed, health disparities. Discussion: While many urban design interventions are a good investment for countries and, in general, there is good support, a number of implementation hurdles exist. First, extent of coverage is still relatively limited across European countries. Second, changes take time to be implemented and some of the health impact materializes in the longer-term. Third, the implementation of such interventions is generally competence of other authorities, other than the health authorities. Building strong multistakeholder approaches and making a strong case for such investments can promote change.

Background:
Climate & environmental change are disproportionally impacting small states, given higher costs per capita associated with coping with the immediate risks of environmental & climatic events. Climate change has been identified as a serious public health threat. This is especially true for heatwaves in the Mediterranean Basin, with poor air quality worsening the health impacts during periods of extreme heat, often affecting already high levels of chronic diseases. Promoting climate change adaptation measures is crucial to address the negative socio-economic impacts brought by heatwaves, & its interactions with poor air quality. While awareness about the link between poor air quality & heat-waves is gaining momentum, there is still a gap in policy responses, especially in small states. This research assesses the level of preparedness of the European Union, with a focus on adaptation to heat-waves since the extreme European heat-wave of 2003. A case study on Malta is also presented, aiming at discovering what measures the island is adopting to tackle the problems arising from the interaction between poor air quality & heatwaves.

Methods:
A systematic literature review is conducted, investigating the links between heat-waves & air pollution post 2003, followed by a qualitative content analysis to assess the preparedness of climate change adaptation measures in this regard.

Results and conclusions:
The findings of this research show that the link between heat waves & poor air quality has not been sufficiently acknowledged by academia, with evident gaps in applied small states research. Climate change is arguably the greatest threat to population health worldwide. Urgent action is needed to mitigate and adapt to the impacts. National public health institutes (NPHIs) are key actors in preventing illness and improving the health and wellbeing of their populations. They therefore have a crucial role to play in addressing climate change and making it central to their agendas. They can contribute to a better understanding of how climate change affects health, translate this knowledge into policy advice, and identify health co-iii92 European Journal of Public Health, Volume 32 Supplement 3, 2022