Extreme climate change is likely to have acute effects on human health, including both physical and psychological damage due to extreme conditions like drought, floods, fires, and heat/cold waves. Moderate climate change is also expected to impact patterns of morbidity and mortality. For example, climate change may lead to changes in the patterns of chronic illnesses such as cardiovascular disease, respiratory disease, and even cancer. Increases in ground-level ozone (O3), caused by high temperatures, can increase risk for asthma in children. Even moderate climate change is likely to alter the seasonality of infectious diseases (viral, bacterial, and parasitic), particularly those transmitted among human beings (for example: diarrhea, mumps, measles, and rubella). Climate change is also expected to impact incidence of diseases transmitted by vectors such as insects (for example, West Nile virus, malaria and cutaneous leishmaniasis) and rodents (for example, plague, typhus, and leptospirosis), as well as pesticide use for vector control. The prevalence of illnesses related to poor sanitation – such as foodborne disease – is also likely to be affected by climate change.
Contribution to the Global Effort against Global Warming Emission of greenhouse gases and industrial and transportation pollutants are the main causes of global warming and climate change. Since Israel was not a party to the first annex of the UN Framework Convention on Climate Change, it did not commit to reducing greenhouse gas emissions between 2008 and 2012. However, pursuant to a government decision, a national plan for energy efficiency entered into effect in 2010. The plan set an efficiency target of 20% for 2020 (reduction of energy costs and more efficient use of energy). The Clean Air Law, which entered into effect in 2011, along with "green" taxation for vehicles (which provides higher tax benefits for vehicles that pollute less) are also expected to contribute to a reduction not only in air pollution, but to greenhouse gas emissions as well.
Preparation and Adaptation for Climate Change
In June 2009, a committee of directors-general was formed that was authorized to formulate recommendations for a national action plan to prepare and adapt for climate change. One of the components of the plan was to draft guidelines for relevant government ministries so as to equip them with tools required for minimizing damage resulting from changing climatic conditions. The Israeli Climate Change Information Center (ICCIC) was established in March 2011 by the Ministry of Environmental Protection (MoEP) at the University of Haifa. The ICCIC published three reports in 2012–2013.
The Israel Defense Force (IDF) Home Front Command is responsible for taking care of the general population in the event of natural disasters, including extreme climate events (for example earthquakes and flooding). The Emergency Department at the Ministry of Health (MoH) provides organizational and logistical infrastructure related to the healthcare system during emergency situations, including natural disasters. Today, there is no entity in Israel responsible for climate events that are not defined as extreme events. There is, for example, no specific legislation focusing on preparation for climate change associated with global warming.
Data on Climate Change in Israel and the Health Effects of Climate Change
Since the 1960s, higher temperatures have been recorded in the Middle East, with an increase in the frequency, intensity, and duration of heat waves. At the same time, there has been a decline in the general amount of rainfall, as well as a change in the pattern of rain distribution during the rainy season. In recent decades there has been a steep rise in the number and scope of forest fires in the Middle East. During extreme climate events in January and December 2013 new records were set for rainfall and water flow. The data indicate that gradual and extreme climate events are already occurring in Israel. While the connection between acute climate events and public health is clear, the link between gradual change in climatic conditions and human health is more difficult to prove.
Since the climate in Israel is relatively susceptible to severe heat waves, the effects of heat waves on mortality in Israel need to be examined. A study published in 2014, based on data collected between 2000 and 2005 reported an increase of about 3.7% in mortality in Tel Aviv from cardiovascular and respiratory diseases for every increase of one unit in the thermal discomfort index (a combination of temperature and relative humidity) above the defined threshold value.
This study found that even a single day in which the heat burden exceeded this threshold is sufficient to cause an increase in mortality rate. This study did not examine implications of climate change on morbidity rates that did not culminate in death. Another study conducted in Israel reports a 1.47% increase in the number of visits to hospital emergency departments with each increase of 1 °C in ambient temperature during heat waves.
Research conducted several years ago in Israel found that an increase in temperature is a positive predictive factor for size of the mosquito population. The rise in the number of mosquitoes, a vector for West Nile fever and other diseases, was found to be a risk factor for disease transmission. Similarly, another study conducted in Israel found a connection between the rise in water temperature in fishponds generated by heat waves and an increase in morbidity caused by Vibrio vulnificus bacteria.
A study conducted in collaboration with the MoH and published in 2013 described an association between the number of reported cases of West Nile fever, which is transmitted by mosquitoes, and environmental temperature. This study, examining the impact of various climate factors on the outbreak of West Nile fever in Europe in 2010, found that morbidity in northern Europe increased about two to four weeks after the rise in temperature. In Israel and countries located in southern Europe there is a shorter time-lag between increase in temperature and onset of illness. These data indicate that while in northern Europe a rise in temperature is a predictive indicator for taking preventive action, in Israel the time-lag is liable to be either too short or too late for effective warning.
There has been an increase in morbidity from Campylobacter bacteria in recent years in Israel. Campylobacter is pathogenic for human beings, causing a range of malignant symptoms in the digestive system. A study examining the impact of external temperature on reported morbidity in Israel between the years 1999–2010 found that high temperatures throughout the year are linked to greater morbidity from Campylobacter. With regard to the general population, an increase in temperature of 1 °C under the threshold temperature of 25 °C raises the rate of morbidity from Campylobacter by 3.8%, while an increase of 1 °C above this threshold temperature raises the rate of morbidity from Campylobacter by 15.4%. The study also found that different age groups have different thermal sensitivity thresholds to morbidity from Campylobacter, and concluded that this finding is relevant to health impacts of global warming.
The MoH collects data on the incidence of morbidity from various factors, including morbidity from malaria, West Nile fever and cutaneous leishmaniasis, in weekly epidemiological reports available on the Ministry’s website. These reports provide data on morbidity based on continuous monitoring of the population in Israel. These data are likely to indicate trends in the incidence of disease following gradual or extreme change in climate conditions.
In 2014, researchers from the MoH reported that after decades of small, intermittent outbreaks, nearly 1,400 cases of West Nile fever were reported in Israel between 2000 and 2012. Marked increases in the reported human cases coincided with the identification of new viral genotypes in the mosquito population (Figure 1).
Figure 1: West Nile Fever in Israel, 2000-2012
Research on Climate Change and Health Effects in Israel
- Researchers from the University of Haifa, Ben-Gurion University, Tel Aviv University and Bar-Ilan University found that a rise in ambient temperature increased the risk of heart defects among infants born in the Tel Aviv area during the years 2000–2006.
- A joint study by researchers from Tel Aviv University, the Hebrew University of Jerusalem and Sheba Medical Center (Heller Institute) is currently assessing the impact of climate on traffic accidents in Israel.
- The MoH Public Health Laboratories and Tel Aviv University’s School of Public Health are jointly studying climatic fluctuations in Israel and their connection to the incidence of foodborne zoonotic diseases (salmonella and campylobacter) during the years 1995–2010. Within the framework of the study researchers will forecast possible effects of climate change on morbidity due to these food contaminants in the year 2030.
- The MoH publishes an annual report on the incidence of West Nile fever. Part of the long-term monitoring conducted in this epidemiological study includes information on the geographic distribution of suspected and verified cases of morbidity from the fever.
- The MoH is using the monitoring system of zoonotic diseases and the reporting system of the Israel Meteorological Service in order to study associations between change in temperature as an index of climate change and the incidence of cutaneous leishmaniasis. Thus far, the study focused on three regions in Israel that are considered to have high potential for contagion and found that an increase in the number of new cases occurs about 12 weeks (on average) after a high increase in temperature. The study will later focus on the impact of absolute humidity on the incidence of morbidity.
Progress and Challenges
- Based on reports submitted by the ICCIC, Israel has yet to develop a national plan for coping with climate change.
- Within the framework of the committee of directors-general, draft guidelines have been developed for the MoH to cope with climate change. These guidelines include recommendations for strengthening collaboration between the Meteorological Service and the MoH. Such collaboration would enable the health system to have more advance warning of extreme climate events and thus minimize the public health impact to the extent possible. Similarly, collaboration is needed to track patterns of diseases and morbidity that are likely to be affected by gradual climate change. The central challenge in monitoring the health effects of climate change in Israel is the lack of a nationwide up-to-date electronic database containing indices of exposure and health outcomes from hospitals and Health Maintenance Organizations.
- In recent years, there has been an increase in the number of cases of leishmaniasis in various places in Israel. The Leishmania parasite causes severe skin disease that is characterized by ulcers and infections. In 2012, in light of the rise in the number of cases, the government decided on a national plan for reducing Leishmania. The plan is funded by the MoEP and the MoH.
This chapter and all other chapters in the report was written by a team of scientists and professionals from the Ministry of Health, in collaboration with Environment and Health Fund.
(1) Agay-Shay K., Friger M., Linn S., Peled A., Amitai Y., Peretz C. (2013). Ambient temperature and congenital heart defects. Human Reproduction, 28(8), 2289-2297.
(2) Anis E., Grotto I., Mendelson E., Bin H., Orshan L., Gandacu D., Warshavsky B., Shinar E., Slater P.E., Lev B. (2014). West Nile fever in Israel: The reemergence of an endemic disease. Journal of Infection, 68(2), 170-175.
(3) GLOBE International (2013). The Globe climate legislation study: Review of climate change legislation in 33 countries, 3rd addition.
http://www.globeinternational.org/images/climate-study/3rd_GLOBE_Report.pdf (retrieved July 2014).
(4) Green M.S., Pri-Or N.G., Capeluto G., Epstein Y., Paz S. (2013). Climate change and health in Israel: Adaptation policies for extreme weather events. Israel Journal of Health Policy Research, 2(1), 23.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707789/pdf/2045-4015-2-23.pdf (retrieved July 2014).
(5) Israel Ministry of Environmental Protection (updated April 2014). Israeli Climate Change Information Center, Files for download: Report No. 1; Report No. 2; Report No 3 (Hebrew).
http://www.sviva.gov.il/subjectsEnv/ClimateChange/AdaptationKnowledgeCenter/Pages/CCKnowledgeCenter.aspx (retrieved July 2014).
(6) Israel Ministry of Health. Dangers of the cold weather for the elderly.
http://www.health.gov.il/English/Topics/SeniorHealth/HealthPromo/Pages/coldness.aspx (retrieved July 2014).
(7) Israel Ministry of Health. Recommendations for dealing with hot weather in old age.
http://www.health.gov.il/English/Topics/SeniorHealth/HealthPromo/Pages/HotWeather.aspa (retrieved July 2014).
(8) Israel Ministry of Health. Weekly epidemiological reports archive (Hebrew).
http://www.health.gov.il/UnitsOffice/HD/PH/epidemiology/Pages/epidemiology_report.aspa (retrieved July 2014).
(9) Israel Ministry of Health (2013). West Nile fever: Report of illness, prevalence of virus-carrying mosquitoes (Hebrew).
http://www.health.gov.il/Subjects/disease/WNF/Pages/StatusReport2013.aspx (retrieved July 2014).
(10) Karakis I., Gandcu D., Baharad A., Shafir H., Anis E., Grotto I., and Alpert P. (August 2013). Cutaneous Leishmaniasis in Israel and correlation over time with average ambient temperature. Abstracts of the 2013 Conference of the International Society of Environmental Epidemiology (ISEE), The International Society of Exposure Science (ISES), and the International Society of Indoor Air Quality and Climate (ISIAQ), Basel, Swiss.
http://ehp.niehs.nih.gov/ehbasel13/p-1-12-09/ (retrieved July 2014).
(11) National Institute of Environmental Health Sciences. Climate Change and Human Health.
http://www.niehs.nih.gov/research/programs/geh/climatechange/ (retrieved July 2014).
(12) OECD (2011). Climate change and air quality. OECD Environmental performance reviews: Israel 2011.
http://www.keepeek.com/Digital-Asset-Management/oecd/environment/oecd-environmental-performancereviews-israel-2011/climate-change-and-air-quality_9789264117563-10-en#page1 (retrieved July 2014).
(13) Paz, S. et al. (2013). Permissive summer temperatures of the 2010 European West Nile Fever Upsurge. PLOS One, 8(2), e56398.
(14) Peretz C., Buggeri A., Baccini M., Alpert P. (2012). The effect of heat stress on daily mortality in Tel Aviv, Israel. National Security and Human Health Implications of Climate Change, NATO Science for Peace and Security Series C: Environmental Security, 241-251.
(15) Society for the Protection of Nature in Israel, Israel Ministry of Environmental Protection and Israel Nature and Parks Authority (2013). Developing a sustainable interface for mosquito control and protection of the biological diversity in bodies of water in Israel, policy recommendations (Hebrew). http://www.teva.org.il/_Uploads/dbsAttachedFiles/Mimshak_yatushim.pdf (retrieved July 2014).