Located in southeastern Europe, Bulgaria’s topography consists of hills and mountains (around 60%) and forests (around 34%) (1). Classified as an upper-middle income country, Bulgaria’s economy predominantly depends on the private sector, which accounts for more than 80% of the national GDP; scientific and technological research are at the top of the budgetary expenditure (2). Bulgaria’s overall population has decreased, but the urban population is increasing, while the rural population is decreasing (1).
Bulgaria’s climate is temperate continental with an influence from the subtropical climate of the Mediterranean. High altitude areas receive the most precipitation. Bulgaria has experienced a rise in temperatures; changing precipitation patterns (including drought and flood events); less snow cover; and severe storms. Climate-related health risks include atypical infectious diseases, such as malaria; ambient air pollution; and heat stress (affecting outdoor workers in particular) (1,3).
There have been many extreme weather events in Bulgaria in recent years, with injuries, deaths and material losses; for example, flash floods (in January 2021 and June 2014), droughts, tornadoes and storms. Indeed, the number of extreme weather events has risen by 30% in Bulgaria in the period 1991–2007, compared with the period 1961–1990, and is estimated to have risen by 50% in 2020. By 2050, the number of extreme weather events in Bulgaria could triple (data provided by the Ministry of Health).
Bulgaria, as a member of the European Union (EU), is committed to the European Nationally Determined Contribution (NDC), which seeks to mitigate at least 55% of its greenhouse gas emissions by 2030 compared with the 1990 levels (4). Bulgaria’s National Adaptation Strategy identifies health adaptation options, such as education and awareness programmes, and assessing health vulnerability at the national and local level (3).
Country-specific projections are outlined up to the year 2100 for climate hazards under a ‘business as usual’ (BAU) high emissions scenario compared to projections under a ‘two-degree’ scenario with rapidly decreasing global emissions (see Figures 1–5).
The climate model projections given below present climate hazards under a high emissions scenario, Representative Concentration Pathway 8.5 (RCP8.5 – in orange) and a low emissions scenario (RCP2.6 – in green).a The text describes the projected changes averaged across about 20 global climate models (thick line). The figuresb also show each model individually as well as the 90% model range (shaded) as a measure of uncertainty and the annual and smoothed observed record (in blue).c In the following text the present-day baseline refers to the 30-year average for 1981–2010 and the end-of-century refers to the 30-year average for 2071–2100.
Modelling uncertainties associated with the relatively coarse spatial scale of the models compared with that of geographically small countries are not explicitly represented. There are also issues associated with the availability and representativeness of observed data for some locations.
Under a high emissions scenario, the mean annual temperature is projected to rise by about 4.8°C on average by the end-of-century (i.e. 2071–2100 compared with 1981–2010). If emissions decrease rapidly, the temperature rise is limited to about 1.5°C.
Total annual precipitation is projected to decrease by about 15% on average under a high emissions scenario, although the uncertainty range is large (-33% to +2%). If emissions decrease rapidly, there is little projected change on average with an uncertainty range of -6% to +8%.
The percentage of hot daysd is projected to increase substantially from about 15% of all days on average in 1981–2010 (10% in 1961–1990). Under a high emissions scenario, about 60% of days on average are defined as ‘hot’ by the end-of-century. If emissions decrease rapidly, about 30% of days on average are ‘hot’. Similar increases are seen in hot nightsd (not shown).
Under a high emissions scenario, the proportion of total annual rainfall from very wet dayse (about 15% for 1981–2010) could increase by the end-of-century (to about 25% on average with an uncertainty range of about 15% to 30%), with little change if emissions decrease rapidly. These projected changes are accompanied by a decrease in total annual rainfall under a high emissions scenario (see Figure 2).
The Standardized Precipitation Index (SPI) is a widely used drought index which expresses rainfall deficits/excesses over timescales ranging from 1 to 36 months (here 12 months, i.e. SPI12). It shows how at the same time extremely dry and extremely wet conditions, relative to the average local conditions, change in frequency and/or intensity.
SPI is unitless but can be used to categorize different severities of drought (wet): above +2.0 extremely wet; +2.0 to +1.5 severely wet; +1.5 to +1.0 moderately wet; +1.0 to +0.5 slightly wet; +0.5 to -0.5 near normal conditions; -0.5 to -1.0 slight drought; -1.0 to -1.5 moderate drought; -1.5 to -2.0 severe drought; below -2.0 extreme drought.
Under a high emissions scenario, SPI12 values are projected to decrease from about 0 to -0.6 on average by the end-of-century (2071–2100) indicating an increase in the frequency and/or intensity of dry episodes and drought events. If emissions decrease rapidly, there is little change although year-to-year variability remains large.
The health risks of heat stress include heat-related illnesses such as dehydration, rash, cramps, heatstroke, heat exhaustion and death.
Under a high emissions scenario (RCP8.5), additional attributable deaths per warm season are projected to rise to 3463 in 2071–2099. A reduction in emissions (RCP4.5) could reduce attributable deaths per warm season in 2071–2099 to 1742 (6).
Food safety and security problems can lead to malnutrition, micronutrient deficiencies, other noncommunicable diseases (NCDs), foodborne diseases and mortality. Increasing temperatures can also lead to increases in foodborne illnesses through spoiled food from refrigeration failure in transport/storage or changes in patterns of salmonella growth. Around half of Bulgaria’s land is used for agricultural purposes, which contributes around 5% to the country’s GDP. Agricultural production has already been affected by climate change in Bulgaria, with extreme weather events (including droughts and floods) and overall rising temperatures posing significant challenges (9).
Physical injury and drowning are direct health risks from extreme weather events associated with climate change. Indirectly, the impact of climate change on water quality and quantity can lead to waterborne diseases (such as diarrhoeal disease) and noncommunicable diseases. Increasing extreme weather events and changing precipitation patterns are likely to increase water security issues for Bulgaria. There is a particular need to update infrastructure and implement integrated water resource management and integrated risk management of floods and droughts, to ensure future sustainability of water resources under increased climatic variability (11).
There is a potential risk of re-establishment of local malaria transmission in Bulgaria, which is determined by receptivity and vulnerability. Currently, vulnerability is identified as moderate and is determined by the number of imported malaria cases from endemic countries. However, vulnerability is dependent upon a number of factors, including migration, economic, social and cultural factors, which could change in the future. Therefore, the vulnerability of Bulgaria to malaria transmission must be continually monitored (12).
All of the top ten most populated cities in Bulgaria for which air pollution data were available had annual mean PM2.5g levels that were above the WHO guideline value of 5 μg/m3 (see Figure 9) (13).
Ambient air pollution can have direct and sometimes severe consequences for health.
Fine particles, which penetrate deep into the respiratory tract, subsequently increase mortality from respiratory infections, lung cancer and cardiovascular disease.
Health co-benefits of mitigation in NDCs
Health adaptation in NDCs
Implementation for health in NDCs
Total 2018 emissions
57,815.6 kt CO2 equivalent (16)
NDC target
At least a 55% reduction in greenhouse gas emissions by 2030 compared with the 1990 levels (4)
The following section measures progress in the health sector in responding to climate threats based on country reported data collected in the 2021 WHO Health and Climate Change Country Survey.
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has a national health and climate change strategy or plan been developed ? | YES | ||
| Are the health co-benefits of climate change mitigation action considered in the strategy/plan? | NO | ||
| Level of implementation of the strategy/plan? | N/A | ||
| Portion of estimated costs to implement the strategy/plan covered in the health budget | N/A | ||
| Are health adaptation priorities identified in the strategy/plan? | YES |
Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy?
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Transportation | Unknown | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Electricity generation | Unknown | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Household energy | Unknown | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Agriculture | Unknown | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Social services | Unknown | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Water, Sanitation & Waste-water management | Unknown |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has an assessment of health vulnerability and impacts of climate change been conducted at a national level? | YES | ||
| → Level of influence of the assessment findings on policy prioritization to address the health risks of climate change | Unknown | ||
| → Level of influence of the assessment findings on human and financial resource allocation to address the health risks of climate change | Unknown |
| Climate-sensitive diseases and health outcomes | qid | Health surveillance system is in place (a) | Health surveillance system includes meteorological information (b) |
|---|---|---|---|
| Thermal stress (e.g. heat waves) | 22111 | NO | NO |
| Vector-borne diseases | 22121 | YES | NO |
| Foodborne diseases | 22131 | NO | NO |
| Waterborne diseases | 22141 | YES | NO |
| Nutrition (e.g. malnutrition associated with extreme-climatic events) | 22151 | NO | |
| Injuries (e.g. physical injuries or drowning in extreme weather events) | 22161 | NO | NO |
| Mental health and well-being | 22171 | YES | NO |
| Airborne and respiratory diseases | 22181 | YES |
| Climate hazard | qid | Health early warning system (HEWS) in place? | Health sector response plan in place? | Health sector response plan includes meteorological information? |
|---|---|---|---|---|
| Heat waves | 23111 | NO | NO | NO |
| Storms (e.g. hurricanes, monsoons, typhoons) | 23131 | NO | NO | NO |
| Flooding | 23141 | NO | NO | NO |
| Drought | 23161 | NO | NO | NO |
| Air quality (e.g. particulate matter, ozone levels) | 23171 | NO | NO | NO |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is there a national curriculum developed to train health personnel on the health impacts of climate change? | NO | ||
| Does your human resource capacity as measured through the International Health Regulations Monitoring Framework (IHR) adequately consider the human resource requirements to respond to climate-related events? | NO |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has there been a national assessment of the climate resilience of health infrastructure and technology? | NO | ||
| Have measures been taken to increase the climate resilience of health infrastructure and technology? | NO | ||
| Is there a national initiative/programme in place to promote the use of low-carbon, energy-efficient, sustainable technologies in the health sector? | NO |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is your government currently accessing international funds to support climate change and health work? |
Greatest challenges faced in accessing international climate funds
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Greatest challenges faced in accessing international climate funds | Lack of information on the opportunities | ||
| Greatest challenges faced in accessing international climate funds | Lack of country eligibility | ||
| Greatest challenges faced in accessing international climate funds | Lack of connection by health actors to climate change processes | ||
| Greatest challenges faced in accessing international climate funds | Lack of capacity to prepare country proposals | ||
| Greatest challenges faced in accessing international climate funds | Lack of success in submitted applications | ||
| Greatest challenges faced in accessing international climate funds | None (no challenges/challenges were minimal) | ||
| Greatest challenges faced in accessing international climate funds | Not applicable | ||
| Greatest challenges faced in accessing international climate funds | Other (please specify) |
There are no multisectoral agreements in place on climate change and health. Enhance collaboration between health and health-determining sectors with agreements on climate change and health action (e.g. with transport, energy, water and sanitation, national meteorological and hydrological services sectors). Promote climate mitigation and adaptation policies that protect and promote health and strengthen health systems.
Meteorological information is not currently used to inform risk surveillance of climate-sensitive diseases. The use of climate/weather information can be integrated into health surveillance systems and used to predict outbreaks of climate-sensitive diseases (i.e. climate-informed health early warning systems) to help ensure a preventive approach to specific climate-sensitive health programmes.
Health co-benefits of mitigation are currently not included in Bulgaria’s Nationally Determined Contribution (NDC). Ensure that climate mitigation policies include the health risks posed by climate change, identify health adaptation priorities and measure and optimize the health co-benefits of climate mitigation action.
Measures can be taken to prevent the potentially devastating impacts of climate change on health care facilities and health service provision while decreasing the climate and environmental footprint of health care facilities. A commitment towards climate-resilient, environmentally
sustainable health care facilities can improve system stability, promote a healing environment and mitigate climate change impacts.
1. Seventh National Communication on Climate Change. United Nations Framework Convention on Climate Change. Republic of Bulgaria, SOFIA; 2018
2. Data: Bulgaria. World Bank Group; 2020
3. National Climate Change Adaptation Strategy and Action Plan. Republic of Bulgaria; 2019
4. Update of the Nationally Determined Contribution of the EU and its Member States. Submission by Germany and the European Commission on Behalf of the European Union and its Member States; 2020
5. Analysis and assessment of the vulnerability of Bulgarian economy sectors from climate change. Government of Bulgaria; 2014
6. Kendrovski V, Baccini M, Martinez GS, Wolf T, Paunovic E, Menne B. Quantifying projected heat mortality impacts under 21st-century warming conditions for selected European countries. Int J Environ Res Public Health. 2017;14(7):729. doi: 10.3390/ijerph14070729.
7. Romanello M, McGushin A, Di Napoli C, Drummond P, Hughes N, Jamart L et al. The 2021 report of the Lancet countdown on health and climate change: code red for a healthy future. Lancet. 2021;398(10311):1619–62. doi: 10.1016/S0140-6736(21)01787-6.
8. The Lancet. Explore our data (website). Lancet countdown: tracking progress on health and climate change
9. Climate Change Knowledge Portal: Bulgaria. World Bank Group; 2020
10. Aqueduct Flood Risk Data. World Resources Institute [website]. Aqueduct; 2020
11. Water Security in Bulgaria. World Bank Group; 2017
12. Kaftandjiev IK. Characteristics of imports and assessment of the possibility of malaria recovery in Bulgaria in the face of global climate change. PhD Thesis. National Center of Infectious and Parasitic Diseases, Sofia; 2019
13. Ambient Air Pollution Database WHO; 2018
14. Ambient air pollution – Deaths by country. Geneva: World Health Organization, Global Health Observatory data repository; 2016
15. Economic cost of the health impact of air pollution in Europe: clean air, health and wealth. WHO Regional Office for Europe, OECD; 2015. Copenhagen: WHO Regional Office for Europe
16. UNFCCC Greenhouse Gas Inventory: Bulgaria. UNFCCC; 2020
17. Climate and health country survey (part of the WHO UNFCCC Health and Climate Change Country Profile Project). Geneva: World Health Organization; 2021
18. International health regulations (2005) monitoring framework. State Party self-assessment annual reporting tool (e-SPAR). Geneva: World Health Organization; 2019
WHO/HEP/ECH/CCH/21.01.07
© World Health Organization and the United Nations Framework Convention on Climate Change, 2021
Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence.
All reasonable precautions have been taken by WHO and UNFCCC to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO and UNFCCC be liable for damages arising from its use.
Most estimates and projections provided in this document have been derived using standard categories and methods to enhance their cross-national comparability. As a result, they should not be regarded as the nationally endorsed statistics of Member States which may have been derived using alternative methodologies. Published official national statistics, if presented, are cited and included in the reference list.
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PUBLICATION
Без сожалений. Расширение масштабов деятельности по смягчению последствий изменения климата и адаптации к ним в целях охраны здоровья в Европейском регионе ВОЗ, второе издание. Основные тезисы Рабочей группы по изменению климата и его влиянию на здоровье
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2023
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2022
