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REVIEW ARTICLE
Climate change and health in Iran: a narrative review
Arefeh Mousavi
1
&Ali Ardalan
1
&Amirhossein Takian
2,3,4
&Abbas Ostadtaghizadeh
1
&Kazem Naddafi
5
&
Alireza Massah Bavani
6
Received: 2 August 2019 /Accepted: 24 February 2020
#Springer Nature Switzerland AG 2020
Abstract
Background The consequences of climate change are highly impeding the achievement of Sustainable Development Goals
(SDGs) anywhere, especially in low and middle-income countries. While climate change scales up, its health-related risks
increase, which in turn leads to cause new challenges for public health. As a second largest country of the Eastern
Mediterranean Region of World Health Organization, Iran is highly vulnerable to the effects of climate change.
Purpose This study seeks the notion of health risks and challenges of climate change in Iran and provide potential evidence-
based remedies to prevent and diminish such destructive effects.
Methods A comprehensive literature in various computerized databases was conducted, and numerous published original
research and review articles about climate change status and evidences of adverse health consequences of climate change in
Iran were reviewed.
Results The evidence suggests that the expected health challenges related to climate change in Iran are: rising temperatures;
frequent extreme weather events; reduction of air quality; food-borne, water-borne, and vector-borne diseases; mental health and
well-being consequences; and the increasing trend of natural disasters and deaths associated with climatological hazards.
Conclusions By considering the growing burden of diseases associated with climate variability in Iran as well as the interdisci-
plinary nature of climate change and health issues, an integrated, multi-sectoral, and comprehensive approach for identification,
prioritization, and implementation of adaptation options is required by Ministry of Health and Medical Education as a custodian
of public health in order to enhance the resiliency and adaption against adverse health effects of climate change.
Keywords Climate change .Waterborne diseases .Vector-borne diseases .Communicable diseases .Non-communicable
diseases .Food safety .Food security
Background
Global warming is a consequence of the civilizations’devel-
opment in all over the world. Since the industrial revolution in
the nineteenth century, human activities have increased the
carbon dioxide levels, up to now, the most abundant green-
house gas emissions are in the atmosphere. The industrial
revolution was a turning point in the interaction between
*Ali Ardalan
aardalan@tums.ac.ir
*Amirhossein Takian
takian@tums.ac.ir
Arefeh Mousavi
a-mousavi@razi.tums.ac.ir
Abbas Ostadtaghizadeh
ostadtaghizadeh@gmail.com
Kazem Naddafi
knadafi@tums.ac.ir
Alireza Massah Bavani
armassah@ut.ac.ir
1
Department of Disaster and Emergency Health, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
2
Department of Global Health & Public Policy, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
3
Department Management and Health Economics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
4
Health Equity Research Center (HERC), Tehran University of
Medical Sciences, Tehran, Iran
5
Department of Environmental Health Engineering, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
6
Department of Irrigation and Drainage Engineering, College of
Abureyhan, University of Tehran, Tehran, Iran
Journal of Environmental Health Science and Engineering
https://doi.org/10.1007/s40201-020-00462-3
human and the environment,which has brought a set of effects
on environment as well [1]. According to the definition of the
United Nations’Framework Convention on Climate
Change)UNFCCC), climate change (CC) is ‘the change that
can be attributed directly or indirectly to human activity that
alters the composition of the global atmosphere and which is
in addition to natural climate variability observed over
comparabletime periods’[2]. Therefore, climate change
might influence the development of human beings via fossil
fuels burning, deforestation, desertification, and other activi-
ties that increase the concentration ofgreenhouse gases in the
atmosphere [2]. Climate change and its consequences are se-
rious concerns for humanity that can impede the pathway
towards Sustainable Development Goals (SDG) in all settings,
particularly within low and middle-income countries [3].
Climate change is called ‘the biggest global health threat of
the twenty-first century’[4]. Through various mechanisms and
paths, CC can adversely affect the key requirements of life, i.e.
water, food, agriculture, and health. Worse still, any influence
on other criteria could also affect health consequently. For
instance, by altering the pattern of diseases, especially in
low-income and more vulnerable countries, CC is threatening
the health of millions of people [4,5]. Although all people are
vulnerable to climate change and its consequences, some
groups, i.e. elderly, people with disability, people with past
medical history or in poverty, children, and women are more
vulnerable to the burden of many climate-sensitive diseases
[6]. Four paths have been identified in this regard.
First, CC may lead to inadequate water resources and lack
of sanitary. Water availability would presumably reduce in
areas where consuming water is supplied by melting ice from
the mountain ranges [4]. Heavier rainfall would probably in-
crease the risk of floods and subsequent death tolls. Greater
precipitations with higher temperatures will make sanitary
water supplies harder and costlier, which would surge the risk
of infectious diseases such as diarrhea, typhoid, cholera, ma-
laria, and dengue fever ultimately [7]. Sea level rise threatens
the life of people who live in coastal areas, through harming
the industries and river floodplains, and adverse effects on
their physical and mental health.
The second path is the health effects caused by temperature
rise [4]. In other words, higher temperature increases the risk
of mortalities associated with cardiovascular and heat-related
diseases [6]. For example, in 2003, a heat wave caused up to
70,000 premature deaths across Europe due to cardiovascular
and respiratory diseases [8].
The third path is pertinent to the impact of climate change
on agriculture and food supplies. Higher temperature would
ultimately lead to the decrease of efficiency in desirable crops.
Also, reducing food productions in dry and tropical regions
increase the number of people exposed to famine and hunger,
which would ultimately force the population to displace and
migrate to other regions that could also create conflicts on
scarce resources [4]. It may also have adverse effects on food
security and creates malnutrition, especially in children.
As the fourth path, climate change may contribute to ex-
treme weather events (e.g., drought, storms, and floods) as
well as heat waves to occur more violently and more frequent-
ly. From 1960 to 2007, the number of affected people by
droughts, floods, storms, and extreme temperatures has
mounted up about ten times globally [7].
First of all, this study has introduced the status of climate
change and some related indexes in Iran. Then it has investi-
gated the various aspects of health issues associated with
changing in climate variables such as temperature and rainfall
in Iran’s territory. Consequently, it has provided a comprehen-
sive vision on the issue. In the following, this article has fo-
cused on the organizational and managerial structure of cli-
mate change health aspects for better understanding of
existing challenges. These challenges would reveal more as-
pects for future studies on climate change and health field.
Climate change status in Iran
Located in West Asia and being 17th largest country in the
world [9], Iran is an upper-middle-income economy [10], with
over 80 million population in 2017 [11] . Population growth
rate 1.1% in 2017 [12], population under five 8.8%, and pop-
ulation aged 65 or older 4.9% in 2015 accordingly [13]. Also,
the Human Development Index (HDI) was 68 in 2014
[14]. Other indicators are shown in Table 1.
More than 80% of Iran is in the arid and semi-arid regions.
Almost 11.2% of the country’slandisagricultural,whilefor-
ests, rangeland, deserts, and industrial/residential areas ac-
count for 8.7%, 52.1%, 19.7%, and 7.3% of the area, respec-
tively. Enjoying its unique geographic location, Iran has a
variety of climates with different types of terrestrial and ma-
rine species. However, the country has encountered rainfall
decrease, drought, water scarcity, urban and industrial pollu-
tions, desertification, soil erosion, and loss of biodiversity
during recent past few years [15]. The average annual rainfall
was about 240 mm in Iran [16], which is less than one-third of
Table 1 Some health indicators, demographic and economic estimates
in Iranian population estimated in 2013
Health indicators, demographic and economic estimates
Population living in urban areas (2013) 72.3%
Life expectancy at birth (2013) 74 years
Under-5 mortality per 1000 live births (2013) 17
GDP per capita (current US$, 2013) 6631 USD
Total expenditure on health as % of GDP (2013) 6.7%
Reference [13]
J Environ Health Sci Engineer
the world average precipitation [17]. The range of tempera-
tures is −20 to +50 degrees Celsius in Iran [15,17].
Climate change has been associated with some economic
and social consequences, i.e. an increase in the urban migra-
tion due to drought, reduced agricultural production, and dev-
astating environmental damage [15]. Proportion of people liv-
ing in urban areas reached 72.3% in 2013, which was about
four times higher than it was in 2007 [13].
It is estimated that temperature will rise around 4.5 degrees
Celsius in most parts of Iran by 2100’s[18], which will be
more intense in the central and the southern areas due to their
sensitivity to climate change [19]. Under a high emissions
scenario, the mean annual temperature is projected to increase
by about 6.2 degrees Celsius on average from 1990 to 2100 in
Iran. If global emissions decrease rapidly, the temperature rise
will be limited to about 1.7 degrees Celsius. It is projected that
the number of heat spell days will be approximately 215 days
on average in 2100, while it was ten days in 1990. This will be
limited to about 50 days on average if global emissions de-
crease rapidly [13].
Iran is the eighth carbon dioxide emitter after China, the
United States of America, the European Union, India, the
Russian Federation, Japan, and Canada, and was the fifth con-
sumer of natural gas in the world (5.5% share in natural gas
consumption) in 2015 [20]. Iran’s total emission of carbon
dioxide was 630 million tones and about 8.0 metric tons per
capita in 2015 [20].
Iran’s performance regarding Climate Change Performance
Index (CCPI) was 59 in 2018 [21], which is not promising.
While the country is home to 1.07% of world’s population
[22], it has produced 1.72% of the world’s carbon dioxide
emissions [23], 34% of which associated with the energy sec-
tor. Iran’s transport sector had the highest methane emissions
among other sectors in 2010 [16].
The 21thConference on parties (COP21) in 2015 empha-
sized on countries’acceptance to reduce carbon dioxide emis-
sions, where signatory countries agreed to modify their indus-
trial and economic development processes to reduce green-
house gases globally, aiming to limit the global range temper-
ature to a maximum of 2 degrees Celsius. It was also agreed
that high-income countries will donate 100 billion US dollars
to reduce greenhouse gas emissions in low and middle-
income countries through applying new and clean energy by
2030 [24]. During COP21, Iran announced that it would vol-
untarily try to reduce its greenhouse gas emissions by 4%until
2020 to reach 12%, subject to meaningful lift of unfair inter-
national sanctions and obtaining required funds [25].
IPCC classification on health effects of climate change
Intergovernmental Panel on Climate Change (IPCC) declared
in successive reports that climate change contributes to the
global burden of diseases and premature deaths [5]and
classified two main categories for the health impacts of cli-
mate change. First, direct mortalities due to climate-sensitive
natural disasters such as floods, heat waves, hurricanes,
droughts, and landscape fires. Second, the indirect effects that
are divided into two sub-categories: non-communicable dis-
eases (NCD), infectious diseases, food and water contamina-
tion, plus changes in the life cycle of vector-borne diseases on
one hand and social consequences like migration, food and
water insecurity, conflicts, and mental stress on the other hand
[26]. (See Table 2).
Overview of the pattern of diseases in Iran
West Asia, where Iran is located in, is strongly influenced by
the health impacts of climate change [28]. Overall, NCDs are
responsible for 82% of all deaths in 2018 [29], while the
burden of communicable diseases was 9.7% in 2012 [30].
As a result of improved health standards, the estab-
lishment of national surveillance systems over the past
two decades, urbanization, and changing lifestyle, the
pattern of diseases has transformed from infectious to-
wards non-communicable diseases, mainly cardiovascu-
lar diseases, cancers, and road traffic injuries (RTI) [31].
It is estimated that 79,200 deaths per year are the re-
sults of environmental factors with the proportion of
disability-adjusted life years (DALY) of 19.0% in
World Health Organization (WHO) report 2009 on en-
vironmental burden of disease. Also, 9100 deaths per
year have been estimated as potential outcomes of out-
door air pollution in that year [32]. It is obvious that air
pollution and other chemical pollutions have been in-
creasingly behind the rising burden of NCDs in Iran
[30], while malaria, leishmaniasis, Crimean-Congo
haemorrhagic fever (CCHF), diarrhea, and cholera have
been the most significant infectious diseases associated
with climate change in Iran during recent decades [33].
Methods
We used the narrative review method for data collection.
This narrative review is based on material derived from a
comprehensive literature search conducted using various
computerized databases (i.e. the PubMed, Web of
Science, EMBASE, Cochrane Library, Scopus, Science
Direct, and Google Scholar). The narrative review cov-
ered articles that have been published before 31
December 2017. There was no limitation with the date
of studies, but the type of articles was only restricted to
original research and review articles. Also, the study lan-
guage was only English. The eight keywords were select-
ed after consulting with experts. The experts were in-
volved in climate change and health fields. In addition,
J Environ Health Sci Engineer
MeSHtermsinPubMedwereused.Theresearchstrategy
was determined for searching the database as follows:
1. ((Climate Change) AND Health) AND Iran
2. ((Climate Change) AND Waterborne Disease*) AND Iran
3. ((Climate Change) AND Vector-Borne Disease*) AND
Iran
4. ((Climate Change) AND Natural Disaster*) AND Iran
5. ((Climate Change) AND Non-Communicable Disease*)
AND Iran
6. ((Climate Change) AND Communicable Disease*) AND
Iran
7. ((Climate Change) AND Food Security) AND Iran
8. ((Climate Change) AND Food Safety) AND Iran
Inclusion and exclusion criteria
There was an attempt to identify authentic articles writ-
ten in English that were published in English peer-
reviewed journals. These articles had to been focused
on evidence of adverse health effects of climate change
in Iran directly. Moreover, they had to explain the in-
fluences of climate variables on sensitive diseases to
climate change, the number of hospital admission, num-
ber of illness cases, the death toll in climatological di-
sasters, quality and sanitation of water. The documents
withoutfulltextorthosewhichtheirfulltextswerenot
available were excluded. Figure 1shows the PRISMA
flow diagram for the selection process of articles for
this review.
Data extraction and analysis
The researchers performed the screening of the titles and ab-
stracts according to the inclusion and exclusion criteria. Then
the full texts of the relevant articles were reviewed. Abstracts
and articles were selected for review if they come across our
research goal. Also, the references of selected articles were
studied and other relatedarticles were followed. Those articles
which were not in line with the goals and objectives were
excluded.
Also, in order to extract the current challenges and
remedies of the Iranian health system for controlling
and adapting to the adverse health consequences of cli-
mate change, an expert panel was held with 11 health
experts that have been educated in climate change field
from the Tehran University of Medical Sciences and the
Ministry of Health.
Results
The full text of 68 articles from 278 original research and
review articles published by the end of 2017 was reviewed.
Selected articles have been published between 2003and 2017.
Table 2 Adverse health impacts of climate change
Effects Categories Example Climatic factors
Direct Climate-sensitive natural
disasters
Floods, heat waves, hurricanes, droughts, and landscape fires - Rainfall increased in some areas
- Precipitation reduction in other areas
Indirect Non-communicable
diseases (NCD)
Cardiovascular diseases - Temperature increase
- Increased concentrations of pollutants
and allergens
Respiratory diseases
Cancers
Diseases related to the heat wave
Food-borne diseases Food safety (Diseases such as Diarrhea, intestinal infections) - Precipitation increase
- Temperature increase
- Change in relative humidity
Water-borne diseases Diarrhea, Cholera, Typhoid, Intestinal infections - Precipitation increase
- Temperature increase
- Change in relative humidity
Vector-borne diseases Malaria, Leishmaniasis, Dengue fever - Changes in maximum and minimum
temperatures, climatic and seasonal
patterns
- Changes in precipitation pattern
- Changes in relative humidity
Stresses on social processes Food insecurity (Malnutrition, Hunger, Famine, Population
displacement, Migration, and Conflict over limited resources)
- Temperature increase
- Reduction of rainfall, increase in
precipitation, and impact on
agricultural crops
The table was designated by the authors: According to the classification of IPCC [5,26,27]
J Environ Health Sci Engineer
As mentioned above, public health in the Islamic Republic of
Iran is highly affected by extreme weather events and numer-
ous natural disasters due to diverse climates and climate
change. Therefore, the results of this study are presented be-
low in five main groups based on the available evidence in
Iran.
Sensitive diseases and injuries to climate change
in Iran
Non-communicable diseases
Overall climate change has had an effect on people that have
been exposed to heat stresses due to the global warming in
Tehran [ 34]. A recent study on indirect health effects of cli-
mate change revealed a strong and positive association be-
tween cardiovascular mortality and maximum temperature,
plus a negative and weak but significant association between
minimum temperature and mortality [35]. It is expectable that
increases and decreases in ambient temperature and the num-
ber of hot days in the next decades could intensify cardiovas-
cular disease mortality, especially in vulnerable groups in Iran
[35–37]. Some regression and linear correlation models also
show that temperature reduction is associated with a rise in
respiratory and cardiovascular mortality [35,37].
Tehran, the capital city of Iran is one of the top ten polluted
megacities in the world [17,38]. About 4000–5000 of Tehran
inhabitants die due to the air pollution every year [39]. One
study showed that 14% of days throughout the year of 2004
were polluted in Tehran, and 26% of Chronic Obstructive
Pulmonary Diseases (COPD) were recorded during those days
[38]. Another study showed that air pollution with dust parti-
cles and SO2 contributed to death toll rises as a result of
respiratory diseases in Iran [37,40]. Regression models in
an ecological study indicated that short-term exposure to an
ambient concentration of air pollutants such as PM10 and CO,
during cold weather, could increase hospital admissions and
mortality risk due to CVDs [41–44]. Also, exposure to a high
daily mean concentration of SO2, CO, PM10, and NO2 have
been related to chronic obstructive pulmonary diseases
(COPDs), hospitalizations due to respiratory diseases, and
number of patients visiting the emergency departments, espe-
cially among the elderly groups [45,46]. As well as the total
mortality caused by trauma (injuries such as traffic accidents,
falls, drowning and heat exhaustion) has been increased in the
warm season. It has been attributed to the raising activity or
traveling in the warm season [47,48]. Finally, as one of the
five common cancers in Iran [49], various types of skin cancer
have been associated with climate change and environmental
factors such as ultraviolet radiation [50].
Records identified through
database searching (N= 278)
Additional records identified
through articles references
(N= 24)
Total records
(N= 302)
Duplicates records removed
(N= 18)
Records screened
(N= 284)
Records excluded by title
review (N= 172)
Abstract assessed
(N= 112)
Records included by abstract
review (N= 11)
Full-text articles assessed for
eligibility (N= 101)
Full text articles excluded by
criteria (N= 33)
Full text articles included for
data extraction (N= 68)
Fig. 1 Flow diagram of the search
and selection of articles
J Environ Health Sci Engineer
Vector-borne diseases
Among various vector-borne diseases, malaria and leishman-
iasis, are common health problems in the Eastern
Mediterranean Region (EMR) of WHO that are related to
climate change [51,52]. These diseases follow seasonal pat-
terns of incidence in Iran [53]; their epidemiology and trans-
mission could be predicted by meteorological variables [54].
The climatic parameters such as maximum and minimum tem-
peratures, humidity, and rainfall rate [51,55,56] are the most
effective factors on the life cycle of plasmodium and their
transmitters (anopheles mosquitoes) [51]. Population move-
ment [55] and the previous number of malaria cases are other
predisposing factors [57]. Although Iran is currently in the
pre-elimination phase of malaria control based on the WHO
classification, [52,58] three provinces in south-east Iran have
a tropical climate and are still endemic zone for malaria, con-
taining 95% of all of the nation’s malaria cases [52,59,60],
especially among children [61]. The program of malaria con-
trol has become more difficult because of proximity with en-
demic countries such as Iraq, Afghanistan, and Pakistan as
well [62–64]. More acute cases of malaria have been regis-
tered during the hot seasons in Iran. One-degree Celsius in-
crease in the maximum temperature has increased the inci-
dence of malaria by 15% and 19% during the same and sub-
sequent months [52].
Two forms of leishmaniasis Cutaneous [65–67]and
Visceral are more common in Iran [33]. Although in some
studies [68,69] average temperature did not play important
role in the number of reported leishmaniasis Cutaneous (CL)
cases in Iran, various studies approved that changes in climate
variablea including higher maximum temperature, lower rain-
fall and lower relative humidity are trigger factors in geo-
graphic distribution of leishmaniasis, especially in central
Iran [33,70–73]. In addition, Crimean-Congo haemorrhagic
fever (CCHF) that is endemic in south-east, central, south,
north-east, and north Iran [33], follows a seasonal pattern
[74], and the number of its reported cases in warmer and
low rainfall seasons are normally higher than other seasons
in Iran [75]. Maximum temperature, accumulated rainfalls,
and maximum relative humidity have been significantly cor-
related with the monthly incidence of CCHF in Iran [74].
Water-borne diseases
Climate change brings new challenges to control infectious
diseases, including water-borne diseases that are highly sensi-
tive to climate conditions, especially temperature and rainfall
[6]. For instance, Cholera that usually spreads through con-
taminated food and water [76], is still endemic in Iran [77],
especially in the south-eastern districts with subtropical and
tropical climate condition [77].Thenumberofregisteredchol-
era cases in Iran’s health surveillance system has been
significantly correlated with climatic factors such as higher
temperature, heavy rainfall, and flood [33,78–80], and hu-
midity in particular [78]. One study showed that rainfall above
294 mm in the rainy seasons, the high temperature above 49.6
degrees Celsius in hot seasons, humidity around 50%, and
moderate temperature of under 25 degrees Celsius were major
factors related to the cholera epidemic in the country [81].
Furthermore, the incidence of diarrhea depends on climatic
factors. Temperature and sea-level rise can influence the fre-
quency and duration of diarrhea outbreaks [82]. For instance,
Shigella has been considered as an essential agent of diarrhea
among 2–5-year-old Iranian children, while a seasonal pattern
of diarrhea was reported mostly in Iran’swarmermonths[83].
Other consequences of climate change that contribute to high
incidence of diarrhea include limited accessible drinking wa-
ter, warm weather, and extreme environmental pollution [84].
Also, the microbial quality of drinking water in terms of cre-
ating dysentery and typhoid diseases is important in hot sea-
sons [85]. With the remaining constant of other factors that
influence the incidence of typhoid fever, It has been projected
that YLDs (Years Lived with Disability) will be increased by
increasing temperature [86].
Food safety and security
Food security is among the greatest challenges of the twenty-
firstcentury. The influence of climate changeon crop yield has
been proved [87]. Sea level and temperature rising increase
the frequency and intensity of extreme weather events, which
may bring adverse effects to farming [88]. Several regions are
prone to drought in Iran, which will get worse in years to come
[89]. Hence, strong measures need to be taken to prevent the
effects of climate change on food security, especially for vul-
nerable groups, such as children under the age of five [30].
Whose life cycle of Shigella, Salmonella, and Escherichia coli
relies on the climatic variables. These have been the most
prevalent causes of food-borne diseases in Iran [90,91]. A
significant association was reported between the incidence
of shigellosis and monthly temperature, humidity, and atmo-
spheric dust in Iran [92], where the incidence rate of shigello-
sis showed peaks every summer, especially during August
[92]. Finally, the epidemiological analysis of food-borne dis-
eases indicated that the number of outbreaks was the highest
during warm months, especially in August with 17.8% of total
outbreaks [91]. For Instance, brucellosis and fascioliasis prev-
alence peaks were associated with accumulated summer rain-
fall [93,94].
Climate-sensitive natural hazards
Iran is the sixth exposed nation to natural disasters and among
top ten countries whose people are affected by natural disas-
ters. One hundred and three natural disasters happened
J Environ Health Sci Engineer
between 1900 and 2012 in Iran, with the total of 155,878
deaths [95]. Iran’s natural disasters risk class has been estimat-
ed as 8 out of 10 [96], and the trend of its natural disasters has
been increasing in recent years [97]. Climatological disasters,
i.e. flood, flash flood, drought, landslides, forest fire, heat
wave, windstorm, and tropical cyclone have been considered
as the most intensive and frequent climate-sensitive natural
hazards in Iran [96,98]. Golestan flash floods (2000–2005)
and Gonu cyclone (2007) have been the deadliest climatolog-
ical disasters of the last two decades in the country [99].
A comprehensive recent study to provide a natural disaster
profile of Iran showed that out of all natural hazards, 72, 95.3,
14 and 45% of the occurrence, affected population, number of
fatalities, and number of damaged buildings respectively were
due to hydro-climatological hazards, and the trend was in-
creasing over 1997–2010. Further, the flood has had the
highest rate of occurrence with 96.9% and drought possesses
the most rate of the affected people with 91.7% in total hydro-
climatological disasters in Iran in the past four decades [100].
As a consequence of drought, dust storms have been com-
mon in arid and semi-arid regions, particularly in the Middle
East [101], where the adverse health effects have been a major
concern [102]. Of the 31, 18 provinces in Iran have experi-
enced wind erosion [89]. Factors, such as persistent drought,
high evaporation, high wind erosion, reduced rainfall, and
lower relative humidity have exacerbated the generation of
dust storms in Iran [89]. Worse still, due to anthropogenic
impacts on the environment and the imposed war on Iran
during 1980–1988, there are still traces of nuclear, chemical,
microbial,and heavy metals contaminants in some areas of the
country, which will enrich dust storms by sources of air pol-
lutants [89], and will make dust particles more dangerous for
people’shealth[103,104].
The management structure of health and climate
change in Iran
In the Islamic Republic of Iran, there are three organizations
responsible for health impacts of climate change, including:
Ministry of Health and Medical Education (MoHME),
Department of Environment (DoE), and Institute for
Environmental Research (IER). (See fig. 2).
Iran’s health system lead by the Ministry of Health and
Medical Education plays a vital role in responding and miti-
gating the health effects of climate change. At present,
MoHME of the Islamic Republic of Iran is a member of the
Regional Committee of WHO and committed to the World
Health Assembly resolution on May 2008 for protecting direct
and indirect health effects of climate change. Given the essen-
tial role of the health system in partnership with other involved
sectors, the effective diplomatic reaction by this section would
create a extensive approach for adaptation and mitigation of
adverse health effects of climate change. The aim of this
approach is eventually protecting the planet while promoting
the health and well-being of its inhabitants. In this regard,
MoHME began a National Adaptation Strategies and Plan of
Action project (NASPA) to investigate the impact of climate
change on human health. Several working groups, including
experts, policy makers and planners in different fields of pub-
lic health gathered to deliver their adaptation programs.
The working groups have focused on six main topics, in-
cluding water resources, infectious diseases, occupational
health, non-communicable diseases, nutrition, and food secu-
rity and health management in natural disasters. As a result,
National Adaptation Strategies and Plan of Action project
(NASPA), was submitted to the relevant organizations in
2014. The main goal of NASPA was to identify related health
risks and to suggest emergency programs for reducing inju-
ries. In total, 85 operational projects have been extracted from
NASPA. In addition to this project, concerning climate change
and health, MoHME also launched other projects listed
below:
&Establishment of a National Working Group on Health
and Climate Change under the leadership of Center for
Environmental and Occupational Health and in collabora-
tion with Institute for Environmental Research at Tehran
University of Medical Sciences
&Establishment of the Department of Climate Change and
Health in the Institute for Environmental Research at
Tehran University of Medical Sciences
&Implementation of six projects on health system vulnera-
bility assessment against climate change (in collaboration
with the World Health Organization and the Institute for
Environmental Research) in the field of water-borne
Organizations
responsible for
health impacts of
climate change
MoHME
(EOHC)
DoE IE
R
Fig. 2 Organizations responsible for health impacts of climate change in
Iran
J Environ Health Sci Engineer
diseases, vector-borne diseases, occupational health, nu-
trition, non-communicable diseases, and extreme events
&Participation in the drafting of a chapter on health and
climate change in Iran National Communication to
UNFCCC
&Taking part in WHO Conference on Health and Climate
Change in Geneva, Switzerland in 2014 with the
Department of Environment of Islamic Republic of Iran
Environmental and Occupational Health Center (EOHC) at
the deputy of the Ministry of Health and Medical Education
(MoHME) is responsible for policy making and providing
public health strategies and adaptation programs related to
climate change. ClimateChange committee has been designed
under the supervision of EOHC and has had a close collabo-
ration with the Institute for Environmental Research (IER).
EOHC has proposed preventive and curative approaches in
order to perform its duties. This center tries to establish the
leadership, guidance and supervision roles with external links
in other sectors involved in health, for example, water and
agriculture as well. It also needs to strengthen its technical
and financial expertise also academic and executive research
activities in order to be able to succeed.
On the other angle, at the Department of Environment
(DoE), there are offices for legislation and health system mon-
itoring. The duties of these offices include evaluating the per-
formance of organizations related to weather and climate
change, water and soil, environmental pollution and environ-
mental impacts.
It should be noted that the provisions related to climate
change in this organization have been minor. Consequently,
fewer assessments have been done in this field. However, in
the field of public health, provisions related to the human
environment encompass broad dimensions which could be
considered for the health effect of climate change.
In addition to the mentioned authorities, the Institute for
Environmental Research (IER) at Tehran University of
Medical Sciences has comprised to promote an academic level
of the health system in the environment field, so some educa-
tional and research measures have been done in the national
and international levels.
One of the most important of these measures is setting up
adepartment on Climate Change and Health, which has been
doing activities such as health system vulnerability assessment
against climate change in partnership with the World Health
Organization; provision of the textbook of health and climate
change; investigation of health effects of water shortage in
partnership with WHO; active membership in WHO climate
change regional network; running workshops on climate
change adaption in partnership with Oxford University in
Hong Kong; partnership in the study on the estimation of the
number of pre-hospital emergency bases in Tehran for dealing
with the effects of air pollution and climate change; and
partnership in the study on the cardiovascular effects of heat
waves inthe Rashtcity.
Beyond that, one of the mechanisms for inter-sectoral col-
laboration is Secretariat of Supreme Council for Health and
Food Security that has been in interaction with 12 ministries
and government agencies at the National and province levels.
This high-ranking entity provides a context for an integrated
approach to health, food and public policies with direct and
indirect impacts on public health.
Some challenges and limitations from the perspective
of health and climate change in Iran
Despite the above-mentioned issues, there are still challenges
to raise the level of social vulnerability to climate change in
Iran. In spite of the importance of climate change and health
issue, this subject is not a priority in the health system in our
country. It needs notifications in policy making level and se-
nior management of the health system. According to the peo-
ple in charge and experts’opinions that have been given by
discussion group meetings, the most important challenges of
Iran’s health system in dealing with the adverse effects of
climate change include:
1) Lack of awareness of policy-makers and health officials
towards adverse consequences of climate change
2) Lack of proper collaboration between related organiza-
tions to managing health impacts of climate change (nex-
us approach)
3) Poor stewardship and leadership roles of the health sys-
tem in policy-making and management of issues related
to climate change in the country
4) Lack of technical, organizational, financial and human
resources capacities in order to manage these effects
5) Inadequate high-quality research, documentation, train-
ing, planning, and implementation of operational pro-
grams regarding risk management, reduction of vulnera-
bility and response to the adverse health effects of climate
change
6) Lack of budget for the development of climate change
and health programs
7) Weak role of health systems in the process of regional and
international negotiations on climate change
Conclusion
Considering the full range of problems, the burden of climate-
sensitive diseases in Iran, and the growth of acute and chronic
diseases and health problems in relation to climate change, the
need for national planning to adapt and reduce health prob-
lematic effects caused by climate change is more than ever.
J Environ Health Sci Engineer
Reliable policy-making is needed to develop effective plans.
Therefore, the Ministry of Health and Medical Education has
not only the preventive and therapeutic approach, but should
have a comprehensive and wide-ranging approach, leadership,
guidance and observing other health - related sectors such as
agriculture and water.
In short, strategies and measures to adapt and reduce the
effects of climate change in different levels of society can be
beneficial. Knowledge of risks associated with climate
change; integration of health services, climate and environ-
ment; provision of long-term climate models to estimate the
burden of disease; developing response plans and early warn-
ing systems; and finally, the development of risk assessment
models can significantly reduce the risk of climate-sensitive-
diseases, especially among vulnerable populations.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
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