by Acad. Anatoly GRIGORYEV, RAS Vice-President, supervisor of studies of the RAS Institute of Biomedical Problems; Alexander MAKOSKO, Dr. Sc. (Tech.), Head of the Laboratory of Atmospheric Transfer Simulation, A. Obukhov Institute of Physics of Atmosphere, RAS; Anna MATESHEVA, Cand. Sc. (Tech.), research assistant of the same Institute

A stable trend to increase the incidence and extreme intensity of environmental factor manifestations, negatively affecting humans, has been observed over the last 15 years. Among these factors are weather abnormalities, helio-and geomagnetic perturbations, extreme hydrometeorological phenomena. Atmospheric pollution augments the effects of these factors. As a result, the population sickness rate and mortality increase, and the demographic situation is deteriorating. The level of mass medical care in the Russian Federation often fails to meet the requirements associated with emerging threats, which leads to appreciable economic losses. That is why the studies, which we call geomedical, are so important today, as they promote improvement of disease prevention, rehabilitation treatment, and rehabilitation of appropriate population groups in the country.

The human organism is well adapted to the environment. However, the ability to withstand fluctuations of its parameters is individual. It is determined by age, sex, health state, training state, professional activities, etc. It has been found long ago that the weather tells on the general state of individuals and groups of people and is linked with spreading of some diseases. Up to 35-45 percent of even healthy people are weather-sensitive.

Changes in the mean daily air temperature, humidity, fluctuations of atmospheric pressure, precipitation level, and wind velocity negatively influence the health of people liable to cardiovascular and respiratory diseases. In particular, exacerbations of essential hypertension, coronary disease, arrhythmia, asthma, etc. become acute. The records of urgent hospitalization of patients with myocardial infarction and stroke indicate that in case of 24-h temperature changes per every 1 °C, the incidence of the former rises by 1.9 percent and of the latter by 4.9 percent.

Under conditions of high solar and geomagnetic activity the human organism develops untoward reactions, such as, disorders in the cardiovascular, endocrine, nervous systems, and blood system. Exposure to heliogeomagnetic factors leads to adaptation stress, accompanied by purely individual reactions of the vascular tone, changes in arterial pressure, increase of blood clotting, and heart rhythm disorders. This results in increased incidence of hypertonic crises, acute cerebrovascular disorders, myocardial infarctions, and sudden death cases. According to some data, magnetic storms promote, among other things, an increase in the incidence of myocardial infarctions by 31 percent and of apoplexy by 23 percent. In addition, the development of the above exacerbations can be forestalling, immediate, or delayed.

Studies of the complex effects of geomagnetic activity and weather conditions on health have shown that the meteorological factors are interrelated, while the geomagnetic activity is a factor not depending on weather conditions.

Extremely high and low temperatures, long periods of heat and cold lead to an appreciable increase in the incidence of exacerbations of and mortality from cardiovascular and respiratory diseases and diabetes. Thus, intense heat of August 2003 was responsible for up to 44,000 deaths in Europe. The Russian data are distressing too. In Moscow, the most significant thermal waves, when cases of urgent hospitalization and mortality reached extremely high levels, were recorded in the summer of 2001, 2002, and 2010. The consequences of lasting cold weather can be illustrated by the situation of January-February 2006, when abnormally low temperatures, persisting in Moscow during

Arterial pressure rise in a patient with coronary artery disease after the beginning of a magnetic storm based on 24-h monitoring. (Data of T. Breys, Institute of Cosmic Studies, RAS).

26 days, caused high mortality of elderly people. According to the results of studies carried out in a number of Russian cities, the incidence of cardiovascular catastrophes increases significantly during temperature waves, when extremely high or extremely low temperatures persist during a long period, in comparison with the periods of mean seasonal values.

Let's discuss other negative effects of weather deviations. Lasting heat creates favorable conditions for an increase in the incidence of infectious diseases transmitted by insects, such as malaria, hemorrhagic fevers, tick-borne encephalitis. The incidence of mental disease exacerbations increases under conditions of high temperatures, for example, the number of suicide cases. In addition, it has been found that heat and high air humidity provoke about 1,000 extra cases of delirium tremens annually in Moscow, more than 10,000 in Russia as a whole.

The extreme hydrometeorological phenomena, such as hurricanes, squalls, floods, droughts, etc., and their consequences are particularly hazardous for the population health. They cause serious physical damage to numerous people and tremendous economic losses.

Ecological factors are no less important for human comfort than geophysical factors. For example, the admixtures present in atmospheric air stimulate the platelet aggregation and blood clotting, thus promoting the development of coronary artery disease. High atmospheric pollution under unfavorable weather conditions or during the periods of blocking processes in the atmosphere augments negative effects of weather on human health. The assessment of risks of population sickness rate caused by technogenic pollution of atmosphere, carried out in more than 30 cities of Russia over the last 15 years, revealed high level of danger for health in many of these cities. Long-term predictions with consideration for probable trends of climate changes suggest that this danger may increase.

The aftereffects of extreme atmospheric conditions were particularly evident in the summer of 2010, when lasting heat and a drastic deterioration of the air environment quality led to tremendous human and economic losses. The significant increase of the toxic chemicals concentrations in the air was caused by not only combustion products from numerous forests and peat bogs, but also by the unfavorable weather conditions, promoting accumulation of pollutants in the surface layer of the atmosphere. As a result, the high mortality rate of the population of Russia in July-August of 2010 reached about 58,000 cases (according to tentative estimations)--much higher than the annual mortality rate from car accidents.

The results obtained by the present time indicate that, as we have mentioned above, cardiovascular patients are particularly sensitive to environmental conditions, as one of the priority factors determining adaptation of the organism. The respiratory organs, nervous and endocrine systems are also highly sensitive. However, at

present the scientists more and more often assume that there is a relationship between many human diseases and negative environmental effects. This is so primarily for immune system disorders and tumors: in such cases it is not easy to detect the relationship between the health state and unfavorable environmental effects. Hence, the sensitivity of human organs and systems to geophysical and ecological factors deserve special attention and detailed studies.

By the way, today the problem of environmental effects on health has acquired a new content and has become vital due to changes in the global climate* and its regional manifestations. More and more days with anomalously high and/or low temperatures are recorded, and the incidence of extreme hydrometeorological phenomena increases. On the other hand, the areas of arid lands increase, volumes of satisfactory potable water reduce, etc. This involves changes in the incidence and specific features of diseases transmitted with water (as a result of poor quality of water supply and sanitation).

We should admit that the expert evaluations of probable climatic shifts are ambiguous.* A part of scientists speak about the beginning of global cooling. However, several years ago the concept of global warming predominated and its probable variants were discussed. For example, according to these hypotheses, warming in the Northern Hemisphere was associated with the increasing incidence of anomalous weather (at least, locally). The probability of such phenomena as storms, typhoons, hurricanes will increase, the number of days with high temperature (as a rule, associated with a higher atmospheric pollution) will increase as well.

The aftereffects of global warming for health are different for residents of various regions of our country-urban and rural residents of different age groups. The significant rise of atmospheric temperature and a lesser incidence of rain in the south of European Russia and Ural in summer can lead to an increase of agricultural lands liable to droughts and hence, to foodstuff shortage. Shortage of potable water and water for everyday needs, soil salination, land devastation and loss of dust, invasion of insects are fraught with greater health hazards for the population of these territories.

* See: O. Sorokhtin, "Global Warming and Its Causes: Real and Imagined", Science in Russia, No. 2, 2010; O. Sirotenko, V. Romanenkov, "Biosphere Climate and Evolution: Russia of the 20th-21st Centuries", Science in Russia, No. 6, 2007.--Ed.

* See: Yu. Izrael, "Threat of Climatic Catastrophe?", Science in Russia, No. 4, 2004.--Ed.

Mean 24-h air temperature in Moscow, concentration of smoke particles larger than 10 µm in size, and mortality rate higher than the mean level in July-August 2010. Data of A. Ginsburg, (A. Obukhov Institute of Physics of the Atmosphere, RAS).

Some scientists expect a significant rise of atmospheric and frozen soil temperatures in the Russian North. This can lead to a significant deterioration of reliability of bases of buildings and technical constructions, to a significant increase of susceptibility of indigenous population to heretofore unknown diseases, characteristic of regions with warmer climate.

In order to minimize the negative effects on health, we should organize now early warning of the population about the onset of hot weather periods, extreme natural phenomena and improve the epidemiological control system. It is essential to carry out consistent accumulation of medical, meteorological, ecological, and socio-economic information at local, regional, and national levels. Comprehensive measures for adaptation of man to aftereffects of climate change should be developed.

Such measures are being discussed in the world since the end of the 1980s. EU countries do their best to prevent negative effects of climatic changes. For example, plans of actions for protection of the population health during periods of extreme heat have been prepared in the majority of these countries. It seems that adaptation programs should be created in Russia as well, primarily in megalopolises, southern and Arctic cities, with consideration for shifts in the climate that have already taken place and are expected. It is a priority, as the extremely hot summer of 2010 in Russia demonstrated an obvious failure of the state and municipal administrations in their attempts to prevent and alleviate the negative effects of the extreme weather conditions and their ecological and medical consequences.

The analysis of studies in this sphere in the Russian Federation has shown that despite the theoretical and practical importance of the problem, it is still far from being solved. Starting from 2002 scientists of the Russian Academy of Sciences in collaboration with specialists of the Russian Academy of Medical Sciences and Ministry of Health and Social Development of the Russian Federation have been studying interrelations between weather conditions, changes in the climate, environmental pollution and the population health within the framework of the Program of the Presidium of the Russian Academy of Sciences "Basic Sciences for Medicine".

During this period the scientists of A. Obukhov Institute of Physics of the Atmosphere and Lomonosov Moscow State University carried out an assessment of the impact of anthropogenic activities on the air quality in the Moscow megalopolis basin, monitoring of the state of aerosol and gas pollution of the atmosphere in the south-western part of Moscow, and an analysis of weather and synoptic processes on the basis of specially created forecasts of the Hydrometeocenter of the Russian Federation.

Due to the creation of a universal system for medical forecasts of weather for the Caucasian Mineral Waters, dependence of cardiovascular patients on weather reduced significantly in the region by means of preventive measures. The quality of spa and rehabilitation treatment has improved. There have been created bases for medical weather forecast for the Moscow Region. Specialists from the RAS Institute of Physics of the Atmosphere, Russian Cardiological Research Center, RAS Hydrometeocenter, Pyatigorsk Research Institute of SPA Treatment, RAS Central Clinical Hospital, RAS Institute of Economic Prognoses have worked out bases for scientifically-based methods of evaluation of the effects of climatic and weather factors on cardiovascular patients, people suffering from rheumatic fever, migraine, and other health disorders. The vast scope of data on cosmic weather effects at the level of reactions of groups of people, in the form of an increase in the incidence of myocardial infarction and cases of sudden death, development of hypertensive crises has been accumulated and analyzed at the Institute of Cosmic Studies of the Russian Academy of Sciences. The studies have proved that biological systems of all levels of organization-from cellular to population--are sensitive to space weather factors.

Studies carried out at Vernadsky Institute of Geochemistry and Analytical Chemistry of the Russian Academy of Sciences have shown that high concentrations of heavy metals in soil waters, formed due to air transmission of these elements at the global level, along with food and air, play the leading role in exogenous intoxication of man.

The relationship between mesodiencephalic modulation (exposure of the brain to low frequency pulsed currents) and the quality of life of patients with chronic heart failure was studied at the Central Clinical Hospital of the Russian Academy of Sciences. The relationship between air temperature fluctuations, atmospheric pressure, geomagnetic field changes, and the state of patients with essential hypertension was confirmed. As a result, the use of this method in mixed therapy effectively prevented exacerbations of these diseases.

The specialists at the RAS Central Clinical Hospital carried out also measurements of short-period pressure changes on a microbarograph of the Institute of Physics of Atmosphere. The dependence of patients' state on weather conditions was analyzed and confirmed.

Scientists at the RAS Institute of Economic Prognoses demonstrated that long periods of anom-

alously high and low temperatures exert an essential influence on the mortality rate from cardiovascular and respiratory diseases.

As a whole, recent studies carried out at a number of RAS institutes revealed some regularities of dynamics of parameters of the environment and medical indicators, established cause-and-effect relations between the processes in the biosphere and human sickness rate, formulated fundamentals of systemic medico-ecological monitoring.

Intense studies of the influence of environmental factors on human health led to the creation in 2009 of the Meteopathology Department at Central Clinical Hospital No. 1 of OAO RZhD (Russian Railways). A similar department is planned at the RAS Central Clinical Hospital (Moscow).

Besides, it is intended in the near future to create "Environment and Health" Internet site by scientists of the Institute of Physics of the Atmosphere. The site will present assessments of risks and prognoses of negative environmental effects on human health, as well as references and necessary information for specialists that will enable them to take timely measures for preventing or alleviating meteopathic reactions and pathological disorders in risk groups.

Due to these and other studies of the Russian scientists it became possible to assess summary effects of the natural and anthropogenic factors on the development of the extreme hydrometeorological and ecological conditions and the danger they may represent for human health. On the other hand, there are still no adequate models and methods for proper registration of the effects of such conditions on our health. The data of medical, hydrometeorological, and particularly ecological monitoring for validation of influence models of geophysical and ecological factors on the health of man and the population as a whole, created in Russia and foreign countries, are obviously insufficient.

However, the geomedical studies are not confined to studies of unfavorable effects of the environment on human health and evaluation of their risks. As the consequences of weather fluctuations, climatic shifts, and environmental pollution effects cause great economic losses and reduce the quality of life of the population, it is very important to analyze socio-economic aspects of this problem (evaluation and prognoses of economic risks, analysis of the consequences and recommendations to alleviate them, including insurance problems). With this aim in view, the fundamentals of socio-economic adaptation to atmospheric pollution aftereffects have been developed at the Russian Academy of Sciences; they are aimed at reduction of losses from ecology-caused diseases and improvement of the population's quality of life.

Today the studies of the problem should be integrated within the framework of a universal trend "Geomedicine". The work should be coordinated by the Interdisciplinary Academic Council, consisting of leading specialists in the relevant spheres of knowledge. In addition, changes of the climate we are now witnessing enhance the significance of the work. That is why the studies carried out at the Russian Academy of Sciences are now implemented at a higher--state-level. Thus, on the initiative of Academician Yevgeny Chazov, a State Program has been developed and is now discussed. It is to alleviate the complex negative effects of environmental factors on the population health and to help adapt to these factors under conditions of the changing climate. This Program is to be realized by the Ministry of Health and Social Development, the Russian Academy of Sciences and the Russian Academy of Medical Sciences in collaboration with Rosgidromet, Rosstat, and Lomonosov Moscow State University.

The results and conclusions will probably involve respective amendments in the legislation, correction of the standards of ecological and medical services, social security, sanitary, hygienic, and technical requirements to conditions of residential territories, different production areas, and infrastructure objects.

In conclusion we should state that more and more money is annually spent on medicine in the developed countries for realization of plans directed to reduce sickness and mortality rates caused by the negative environmental effects, increasing under conditions of the changing climate. Hence, accelerated development of basic and applied geomedical studies in Russia is essential for the construction of an effective system for alleviation of and adaptation to the changing environmental conditions.