Health Experts’ voice for Healthier Choice – a call for Zero Air Pollution in the Western Balkans

Abstract In 2019, the European Environment Agency has shown that the fine particulate matter PM2.5 caused more than 25 000 premature deaths in six Western Balkans countries alone, namely Albania 4 000, Bosnia and Herzegovina 5 900, Kosovo* 2 800, Montenegro 900, North Macedonia 3 400 and Serbia 11 400. In the same year, more than 2 200 lives were lost due to nitrogen dioxide (NO2) and ozone (O3) pollution. Air pollution and climate change are major health problems in the region. Health experts in the Western Balkans region have joined forces to highlight the importance of air quality actions and achieving zero air pollution as a prevention intervention for public health. We brought together a call for the Western Balkans policy-makers to invite them to commit to full alignment of all national air quality standards with the World Health Organization guidelines, to establish regional intersectoral cooperation to accelerate the moving to zero pollution, to including health authorities, public health institutes, and medical societies, patient representative and all health care experts and providers; to end direct or indirect public subsidies of polluting processes, especially fossil fuel activities such as coal power plants; to finalise the process of the ratification of the Convention on Long-range Transboundary Air Pollution and its protocols; to support modelling to establish economy-wide emission reduction commitments for the five main pollutants; to develop and implement Air Quality Strategies; to increase the uptake of Best Available Technologies (BAT) in accordance with the Industrial Emissions Directive; to establish an adequate air quality monitoring system, and to including through accreditation of air quality monitoring networks. Public health experts from the WB, united in the regional call, highlight the urgent need for improvements in air quality in the region together with a zero air pollution objective and a timeline to reach it.

The EU Green Deal is the framework to achieve carbon neutrality by 2050, and decarbonisation and sustainability in the main economic sectors.This includes a revised greenhouse gas reductions goal of at least 55% for 2030, as well as commitments on zero pollution, healthier agricultural production, sustainable mobility and energy.Moreover, as part of the EU Green Deal, the European Commission has established a Just Transition Mechanism (JTM), to ensure that the transition towards a climate-neutral economy happens in a fair way, leaving no one behind.The aim is to mobilise at least E100 billion over the period 2021-2027 for carbon-intensive industries.But health costs of pollution are absent in Just Transition considerations.The Green Deal includes all the right ''buzz words'' and commitments for a healthy planet for healthy people.However, policy-makers also need to walk the talk when it comes to adopting the right laws and measures.
The science and the acceleration of the climate change, environmental and health crises show us that we need to step up.HEAL believes a zero pollution-and health-based approach can be the overarching principle to deliver on these ambitions.The war in Ukraine as the latest crisis has brought up once again the need for the swift, without any delay, phaseout of all fossil fuels.In Europe, the recently proposed RePower EU plan aims to set a pathway for increased renewables, energy savings and diversification well before 2030.However, with a holistic view of the problem under a health lens, it is clear that in this transition from fossil fuels inequalities and social considerations need to be placed central.Of particular importance is to not give space for false solutions such as replacing Russian imports with fuels from other authoritarian regimes or economies which will only continue to perpetuate Europe's energy dependence, or to build up infrastructure that will continue the pollution (gas and biomass included).
Air pollution is the main environmental driver associated with health.It is well documented that poor air quality is responsible for increased risk of mortality and morbidity.The social cost of mortality in 2015 was estimated in 3 trillion (OECD, 2016).The Western Balkans (WB) comprise Albania, Bosnia and Herzegovina, Kosovo Ã , North Macedonia, Montenegro and Serbia covering area of 218 750 km2 and a population of 19.9 million with total GDP of E94.2 billion (Banja et al., 2020).The WB was selected for this study because it is one of the air pollution hotspots in Europe where the levels of PM2.5, PM10, NO2 and O3 are frequently above the EU Air Quality Directive guidelines.This situation has been associated with a higher proportion of premature deaths attributable to air pollution exposure (4-19% of total deaths) in this region compared to EU member states (EEA, 2021).The health impacts including mortality and morbidity were estimated for particulate matter PM2.5, ozone (O3) and nitrogen dioxide (NO2) at country and city level on the basis of exposure in 2019 derived from monitoring stations and model estimations.Mortality impacts were parameterised using the number of premature deaths.Morbidity costs included: chronic bronchitis, hospital admissions due to respiratory diseases, hospital admissions due to cardiovascular diseases, bronchitis in children, asthma in children, reduced activity days and work lost days.The costs of mortality attributable to air pollution were estimated on the basis of non-market welfare based methods (WTP approach) while morbidity costs were estimated mainly with market based methods combining both direct and indirect costs.The 2019 health costs, both per capita and as share of the GDP, associated with air pollution in the WB were considerably higher than those in EU27.
In 2019, the European Environment Agency has shown that the fine particulate matter PM2.5 caused more than 25 000 premature deaths in six Western Balkans countries alone, namely Albania 4 000, Bosnia and Herzegovina 5 900, Kosovo Ã 2 800, Montenegro 900, North Macedonia 3 400 and Serbia 11 400.In the same year, more than 2 200 lives were lost due to nitrogen dioxide (NO2) and ozone (O3) pollution.Air pollution and climate change are major health problems in the region.Health experts in the Western Balkans region have joined forces to highlight the importance of air quality actions and achieving zero air pollution as a prevention intervention for public health.We brought together a call for the Western Balkans policy-makers to invite them to commit to full alignment of all national air quality standards with the World Health Organization guidelines, to establish regional intersectoral cooperation to accelerate the moving to zero pollution, to including health authorities, public health institutes, and medical societies, patient representative and all health care experts and providers; to end direct or indirect public subsidies of polluting processes, especially fossil fuel activities such as coal power plants; to finalise the process of the ratification of the Convention on Long-range Transboundary Air Pollution and its protocols; to support modelling to establish economy-wide emission reduction commitments for the five main pollutants; to develop and implement Air Quality Strategies; to increase the uptake of Best Available Technologies (BAT) in accordance with the Industrial Emissions Directive; to establish an adequate air quality monitoring system, and to including through accreditation of air quality monitoring networks.Public health experts from the WB, united in the regional call, highlight the urgent need for improvements in air quality in the region together with a zero air pollution objective and a timeline to reach it.
Abstract citation ID: ckac129.146How much global climate adaptation finance is targeting the health sector?

Tilly Alcayna
T Alcayna 1 , D O'Donnell 1 1 Red Cross Climate Centre, The Hague, Netherlands Contact: alcayna@climatecentre.orgClimate change seriously threatens health and wellbeing with projected health burdens estimated to cost USD 2-4 billion a year by 2030.Adaptation in the health sector is critical to keep pace with the ongoing consequences of the climate crisis and the impacts projected to occur in the next decade and beyond.Yet estimates by the WHO indicate that climate finance targeting the health sector to date is extremely low: less than 0.5% of multilateral climate adaptation funding has targeted the health sector.In this study, we trace and quantify the amount of adaptation financing targeting the health sector from both multilateral and bilateral sources using publicly available information on the OECD-DAC database and Climate Funds Update.We find that between 2009-2019 only 0.39% of multilateral and bilateral climate adaptation funding targeted health-related efforts specifically.Despite the relatively higher number of health-related projects in Sub-Saharan Africa compared to other regions, a smaller amount of funding is allocated per project compared to other regions.Regional variations in funding are concerning as the countries with the most vulnerability to the climate crisis coincide with regions getting the least amount of funding per project.There is a significant gap in globally financed adaptation efforts in the health sector.Swift and committed remediation is needed to minimise the spiralling risk of high negative health outcomes.

Key messages:
Between 2009-2019 only 0.39% of multilateral and bilateral climate adaptation funding targeted health-related efforts specifically.
The countries with the most vulnerability to the climate crisis coincide with regions getting the least amount of funding per health project.

3.F. Round table:
Better DiPH -To plan, implement, evaluate, and the future of digital public health interventions Abstract citation ID: ckac129.147 Organised by: Leibniz ScienceCampus Digital Public Health Bremen LSC (Germany), EUPHA-DH Chair persons: Laura Maass (Germany), Chen-Chia Pan (Germany) Contact: laura.maass@uni-bremen.de The potential of digital technology for improving the health of individuals, communities, and populations is unprecedented.Technological advancements empower individuals to engage in self-monitoring and self-management of their chronic conditions or health and well-being.There is an unparalleled opportunity to reform prevention, health promotion, and healthcare services with lower cost and better reach and accessibility.However, health technologies are often developed without supportive evidence or a user-centred design.This leads to a lack of long-term user engagement in digital public health interventions.Our workshop aims to facilitate a mutual understanding of the specific properties of digital public health tools by creating a space for discussing the various perspectives of such technologies.We want to start a conversation of essential steps for conceptualising, implementing, and evaluating needs-based and society-centred digital public health interventions to improve the acceptability and sustainability of such interventions in users.The workshop will address digital public health tools on different steps and describe the progression as an iterative approach to highlight where these aspects are linked.The first speaker will provide a theoryguided overview of digitalisation in health to create a shared understanding of the terminology for the workshop.This includes the differentiation between digital health and digital public health.The talk will highlight the importance of digital tools for surveillance, monitoring, healthcare, health promotion, and their significant meaning for society.Following this input, the other panellists will guide us through different aspects of digital public health tools: The second speaker will discuss the importance of society-centred designs based on users' needs rather than on technological advancements for interventions.Our third speaker will present a meta-framework of extended criteria for developing and evaluating digital technologies for public health.The fourth panellist will share Malta's COVID-19 contact tracing app as a case study.He will