Vladimir Kendrovski

This publication has been developed within the WHO/german Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU) project on protecting health from climate change in Europe, coordinated by Dr Bettina Menne and Dr Joanna Nurse, WHO Regional Office for Europe. We are grateful for the financial support of the Federal Republic of germany. We are grateful for the technical support in the implementation of the project: “Protecting health from climate change – a seven - country initiative” in the Republic of Macedonia provided by the Climate Change and Health Committee of the Ministry of Health

Climate change is a phenomenon that we became aware of in the last couple of decades. Exceptional changes in the external environment have had an adverse effect on many bio-systems on our planet and also on human health. Such changes contribute substantially to climate change while inadvertently contributing to respiratory and other illnesses. Many of the scientists around the world think that one of the main reasons for climate change lies in the massive consumption of energy obtained from fossil fuels, in the pursuit of greater technological development. However, while manufacturing installations are the biggest energy consumers, health-care facilities are definitely near the top of the consumption hierarchy. The provision of health care with all of its challenges requires a massive amount of energy in terms of: • Thermal energy (heating, cooling, drying, sterilization) • Electrical energy (lighting, medical appliances). The primary goal of this manual is to raise the awareness and ...

The National Heat Health Action Plan has been developed to implement adaptation measures and prevent health consequences of extreme heat within the National Strategy for adaptation of health sector due to climate change. Its goal is to decrease morbidity connected with heat waves through issuing heat and health warnings, to encourage the planning in the relevant sectors and to practically adopt the syntagma of health in all policies, to raise the public’s and health workers’ awareness, as well as to mobilize the resources for managing the heat effects.

According to the Census from 2002, there were 53.879 Roma living in Macedonia, representing 2,66% of the total population. Since the introduction of political pluralism in Macedonia in 1991, Roma established their own political parties and more than 40 Roma NGOs in Macedonia, which are active in the fields of human rights, culture, education, environmental issues and infrastructure projects. There are a number of periodicals printed in Roma, as well as several television and radio stations. Roma are especially burdened by transition problems. Social and economic status places them in the category of the poorest citizens and the most marginalised group in Macedonia. Poor health status in Roma is associated with poverty, the specific culture and lifestyle, low level of immunization, low level of education, especially health education, poor nutrition, continuous stress and lack of proper sanitation. The consequences of that are higher morbidity and mortality, especially infant mortalit...

The Republic of Macedonia has 662,000 ha of cultivated land with well-organised agricultural production. It is a well known producer of agricultural products. From 1991 to 1999, authorized laboratories conducted systematic control of about 6,500 food samples in 1991 to 36,000 by 1999 which included a whole range of hygienic quality parameters including microbiological and chemical. Microbiological contamination of food was reported to have caused disease outbreaks in 1,578 people in 1995, which dropped to 126 people in 1999. The decreasing trend of samples unfit for human consumption was observed for all food groups. As for the chemical parameters, an increasing trend of contaminated samples was noted only for additives, with peaks reaching 6.9% in 1998 and 4.9% in 1999 of the total number of analysed samples.

Western Balkan countries (WBCs) have a long-standing culinary tradition. The promotion of traditional foods may be a tool for coping with modernisation trends in such transition economies. This paper explores consumer preferences toward food in this region, focusing on a traditional fresh cow cheese locally called 'Mladi Sir'. This product was quoted in all the preliminary focus groups as a common traditional product present in the six WBCs studied: Bosnia-Herzegovina, Croatia, Macedonia, Montenegro, Serbia and Slovenia. After a literature review investigating the concept of traditional food in WBCs and the implementation of focus groups, a survey including a conjoint analysis on preferences for fresh cow cheese was carried out in 2011 to collect data from 1200 respondents. Four clusters of consumers were identified: one focused more on the local origin; one oriented more toward the scale of production (on-farm and small dairy); the third favouring low prices and the fourth preferring high prices and industrial products. Policy makers and the supply chain could take these differences in consumer preferences regarding traditional food products into account in order to develop specific strategies.

Higher temperatures have been associated with higher salmonellosis notifications worldwide. The objective of this paper is to assess the seasonal pattern of Salmonella cases among humans. The relationship between ambient maximum temperature and reports of confirmed cases of Salmonella in the Republic of Macedonia and Skopje during the summer months (i.e. June, July, August and September) beginning in 1998 through 2008 was investigated. The monthly number of reported Salmonella cases and ambient maximum temperatures for Skopje were related to the national number of cases and temperatures recorded during the same timeframe using regression statistical analyses. The Poisson regression model was adapted for the analysis of the data. While a decreasing tendency was registered at the national level, the analysis for Skopje showed an increasing tendency for registration of new salmonella cases. Reported incidents of salmonellosis, were positively associated (P<0.05) with temperature dur...

Projected climatic changes for the former Yugoslav Republic of Macedonia for the period 2025-2100 will be most intense in the warmest period of the year with more frequent and more intense heat-waves, droughts and flood events compared with the period 1961-1990. The country has examined their vulnerabilities to climate change and many public health impacts have been projected. A variety of qualitative and quantitative methodologies were used in the assessment: literature reviews, interviews, focus groups, time series and regression analysis, damage and adaptation cost estimation, and scenario-based assessment. Policies and interventions to minimize the risks and development of long-term adaptation strategies have been explored. The generation of a robust evidence base and the development of stakeholder engagement have been used to support the development of an adaptation strategy and to promote adaptive capacity by improving the resilience of public health systems to climate change....

This study assesses the relationship between daily numbers of deaths and variations in ambient temperature within the city of Skopje, R. Macedonia. The daily number of deaths from all causes, during the period 1996-2000, as well as those deaths from cardiovascular diseases, occurring within the city of Skopje were related to the average daily temperature on the same day using Multiple Regression statistical analyses. Temperature was measured within the regression model as two complementary variables: 'Warm' and 'Cold'. Excess winter mortality was calculated as winter deaths (deaths occurring in December to March) minus the average of non-winter deaths (April to July of the current year and August to November of the previous year). In this study the average daily total of deaths was 7% and 13% greater in the cold when compared to the whole period and warm period respectively. The same relationship was noticed for deaths caused by cardiovascular diseases. The Regressio...

This Program has three major elements: 1.  Identifying the primary threats to human and ecosystem health within the watershed. 2.  Involving the people most likely to be concerned or most able to take action to solve the problems. 3.  Taking corrective actions in a comprehensive, integrated manner once solutions are determined.

EHRA is an essential element in environmental management and an important condition in precise priority setting to the necessary actions for environmental sanitation. The level of risk can be described qualitatively or quantitatively. The module is describing principles of EHRA studies, especially their designing and implementation phase.