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Elsa Casimiro,^1,2 Jose Calheiros,^1,3,4 Filipe Duarte Santos,^1,2,5 and Sari Kovats⁶

¹Scenarios, Impacts and Adaptation Measures (SIAM) Project, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal; ²Instituto Dom Luiz, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal; ³Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal; ⁴Departamento de Engenharia Química, Faculdade da Universidade do Porto, Porto, Portugal; ⁵Departamento de Fisica, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal; ⁶Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom

Abstract
In this study we investigated the potential impact of climate change in Portugal on heat-related mortality, air pollution–related health effects, and selected vectorborne diseases. The assessment used climate scenarios from two regional climate models for a range of future time periods. The annual heat-related death rates in Lisbon may increase from between 5.4 and 6 per 100,000 in 1980–1998 to between 8.5 and 12.1 by the 2020s and to a maximum of 29.5 by the 2050s, if no adaptations occur. The projected warmer and more variable weather may result in better dispersion of nitrogen dioxide levels in winter, whereas the higher temperatures may reduce air quality during the warmer months by increasing tropospheric ozone levels. We estimated the future risk of zoonoses using ecologic scenarios to describe future changes in vectors and parasites. Malaria and schistosomiasis, which are currently not endemic in Portugal, are more sensitive to the introduction of infected vectors than to temperature changes. Higher temperatures may increase the transmission risk of zoonoses that are currently endemic to Portugal, such as leishmaniasis, Lyme disease, and Mediterranean spotted fever. Key words: climate change, disease, health impact assessment, Portugal. Environ Health Perspect 114:1950–1956 (2006) . doi:10.1289/ehp.8431 available via http://dx.doi.org/ [Online 11 July 2006]

Address correspondence to E. Casimiro, SIAM Project, Faculdade de Ciências da Universidade de Lisboa, Observatório Astronómico de Lisboa, Edifício Leste, Tapada da Ajuda, 1349-018 Lisbon, Portugal. Telephone: 351 21 361 6748. Fax: 351 21 894 6011. E-mail: emvmcasimiro@sapo.pt

We thank K. Ebi for helpful comments on previous drafts. We are also grateful to S. Dessai and M.A. Valente for their valuable contributions to this project.

This project phase was funded by the Fundação Calouste Gulbenkian and by the Fundação para a Ciência e a Tecnologia (FCT) (PRAXIS/C/MGS/11048/98) . E.C. thanks FCT for the funding of contracts SFRH/BGGT/15277/2004 and POCI/CLI/56269/2004.

The authors declare they have no competing financial interests.

Received 17 June 2005 ; accepted 26 January 2006.