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Learn the foundations of climate science and human health Global Climate Change and Human Health examines the environmental crisis from a public health and clinical health perspective, giving students and clinicians the information they need to prepare for the future of health care. Edited by George Luber, associate director for climate change at the Centers for Disease Control and Prevention, and Jay Lemery, associate professor at the University of Colorado School of Medicine and section chief of Wilderness and Environmental Medicine in the Department of Emergency Medicine, and including chapters written by luminaries in the field, this landmark book provides a comprehensive introduction to climate change and health. Students will learn about climate changes direct effect on health, including extreme weather events, altered and degraded ecosystems, and threats to human security and welfare. Discussions on mitigation and adaptation strategies, including disease surveillance, communications, and greening health care, as well as a primer on the core concepts of climate change science are presented. Each chapter has a specific section on the clinical correlations of the impact of climate change on health. Informative illustrations depict increasing aeroallergens, shifting vector habitats, emergent risks, and more. Visual teaching materials broken down by chapter (including PowerPoint lecture slides) are available for instructors. This book shows how human health will be --and already has been -- affected and how health care practitioners need to start preparing. * Understand the science behind climate change and climate variability * Learn how the availability of food and clean water will affect public health * Consider the diseases that will surge as vector populations swell * Discover mitigation strategies targeted toward the health care community * Understanding how climate change affects human rights and how international institutions are responding Increased temperatures bring algal blooms that threaten clean water. Degraded air quality brings allergies, asthma, and respiratory diseases. Ground pollutants lower the nutritional value of food crops. It's clear that climate change is very much a public health concern, and Global Climate Change and Human Health helps those preparing to be on the front lines of health care.
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Cover
Title Page
Copyright
Dedication
Introduction
Acknowledgments
The Editors
The Contributors
Part 1: Our Changing Planet: Emergent Risks for Human Health
Chapter 1: Primer on Climate Science
Scientific Consensus
Weather, Climate Variability, Climate Change, and Scientific Theory
Energy Balance
Evidence of a Changing Climate
Climate Models
Projected Future Climate Changes
Conclusion
Chapter 2: Extreme Weather Events: The Role of Public Health in Disaster Risk Reduction as a Means for Climate Change Adaptation
Disasters Caused by Extreme Weather Events
Scope of the Problem
Public Health Impact of Extreme Weather Disasters
Managing the Public Health Risk of Extreme Weather Disasters
Conclusion
Chapter 3: Extreme and Changing Meteorological Conditions on the Human Health Condition
Social, Environmental, and Individual Factors within Well-Known Climate-Related Health Risks
Case Study
Conclusion
Part 2: The Health Consequences of Climate Change
Chapter 4: Changes in Hydrology and Its Impacts on Waterborne Disease
Changes in Hydrology due to Climate Change
Waterborne Pathogens
Other Infectious Diseases
Adaptation Strategies
Conclusion
Chapter 5: Ozone, Oppressive Air Masses, and Degraded Air Quality
Climate Change and Air Quality
Air Pollution–Vulnerable Populations
Future Projections of Climate Change's Effects on Air Pollution
Mitigation: Health Benefits of Reducing Carbon Pollution and Associated Co-Pollutant Air Pollution
Adaptation: Climate Health Preparedness and Reducing Air Pollution Vulnerability
Conclusion
Chapter 6: Effects of Climate Change on Noninfectious Waterborne Threats
Harmful Algal Blooms
Climate Change and Harmful Algal Blooms
Conclusion
Chapter 7: Climate Change, Carbon Dioxide, and Public Health: The Plant Biology Perspective
Direct Consequences
Indirect Consequences
Uncertainties and Research Priorities
Conclusion
Chapter 8: Climate and Its Impacts on Vector-Borne and Zoonotic Diseases
Malaria
The Recent Expansion of Dengue
The Sudden Emergence of West Nile Virus–Associated Illnesses
Lyme Disease in the United States
Rabies in Wild Carnivores and Bats
Conclusion
Chapter 9: Addressing the Challenges of Climate Change to Food Security, Safety, and Nutrition
Climate Change and Food Security: Impacts on Availability, Stability, Access, and Food Utilization
Climate Change Impacts on Food Stability and Access
Climate Change and Food Safety
Agriculture Impacts on Climate Change
Biofuel Production Challenges for Food Security and Nutrition
Climate Change and Undernutrition
Nutrition-Sensitive Climate Change Adaptation
Nutrition-Sensitive Climate Change Mitigation
Implications of Dietary Patterns to Climate and Nutrition
Cobenefits of Sustainable Food Production, Sustainable Food Consumption, and Food Waste Reduction
Policy Coherence and Good Governance for Climate Change and Nutrition
Conclusion
Chapter 10: Climate Change and Population Mental Health
Mechanisms
A Disproportionate Burden
Conclusion
Part 3: The Public Health Approach to Climate Change
Chapter 11: Improving the Surveillance of Climate-Sensitive Diseases
Environmental Monitoring
Health Surveillance for Climate Risks
Risk Mapping Approaches
Pollens and Allergies
Decision Making from Surveillance Information
Effectiveness of Prevention and Adaptation Measures
Identification and Ranking of Hazardous Situations
Communication
Future Improvements to Be Promoted
Conclusion
Chapter 12: Climate and Health Vulnerability Assessments: A Practical Approach
What Health Issues Should a Vulnerability and Adaptation Assessment Cover?
What Other Nonclimate Factors Should Be Considered?
Vulnerability and Adaptation Assessment
Understanding Future Impacts on Health
Identifying and Prioritizing Health Adaptation Measures
Integration, Implementation, and Iteration
Conclusion
Chapter 13: Climate Change Health Impact Projections: Looking into the Future
A Conceptual Overview of Climate Change Health Impact Projections
Merging Data Streams in the Climate Change Health Impact Model
Frontiers in Climate Change Health Impact Projection
Conclusion
Chapter 14: Community-Based Sentinel Surveillance as an Innovative Tool to Measure the Health Effects of Climate Change in Remote Alaska
The Public Health Context: Sentinel Surveillance and Community-Based Research in Public Health
Climate and Health in the Far North
What We Did and Why
Findings, Reporting Back to the Community, and Adaptation Plans
Conclusion
Chapter 15: Protecting Environmental Justice Communities from the Detrimental Impacts of Climate Change
Climate Resiliency and Environmental Justice
Heat Waves, Environmental Justice, and Climate Change
Extreme Weather Events and Environmental Justice
Indigenous Rights and Climate Change
Summary and Recommendations
Conclusion
Chapter 16: Climate Change Communication
Public Understanding of Climate Change and Principles of Climate Change Communication
Communicating the Impacts of Climate Change
Communicating Climate Change through a Focus on Health
Conclusion
Part 4: Taking Action: Adaptation, Mitigation, and Governance
Chapter 17: International Perspective on Climate Change Adaptation
Historical Perspective
Framework for Adaptation
Assessing Adaptation Needs and Options
National Adaptation Programmes of Action and National Adaptation Plans
Adaptation Options
Conclusion
Chapter 18: Health Cobenefits of Climate Mitigation Strategies
Climate Change Impacts, Mitigation Strategies, and Cobenefits
Conclusion
Chapter 19: Mitigation: International Institutions and Global Governance
The Climate Threat for Human Health
Climate Change Governance
UNFCCC and Health
Beyond the UNFCCC Process
Public Health Governance
Clinical Correlations
Disaster Relief/Migration: UN Office for the Coordination of Humanitarian Affairs
Way Forward
Conclusion
Chapter 20: Climate Change and the Right to Health
What Is the Right to Health?
Climate Change and Its Impact on the Right to Health
Human Rights–Based Approaches to Climate Change
Conclusion
Index
End User License Agreement
Table 1.1
Table 2.1
Table 2.2
Table 2.3
Table 2.4
Table 2.5
Table 2.6
Table 2.7
Table 2.8
Table 2.9
Table 2.10
Table 2.11
Table 3.1
Table 4.1
Table 6.1
Table 7.1
Table 9.1
Table 9.2
Table 16.1
Table 17.1
Table 18.1
Figure I.1
Figure 1.1
Figure 1.2
Figure 1.3
Figure 1.4
Figure 1.5
Figure 1.6
Figure 2.1
Figure 2.2
Figure 3.1
Figure 3.2
Figure 4.1
Figure 4.2
Figure 4.3
Figure 4.4
Figure 4.5
Figure 4.6
Figure 4.7
Figure 5.1
Figure 7.1
Figure 7.2
Figure 8.1
Figure 8.2
Figure 9.1
Figure 9.2
Figure 10.1
Figure 11.1
Figure 11.2
Figure 12.1
Figure 12.2
Figure 13.1
Figure 14.1
Figure 14.2
Figure 16.1
Figure 17.1
Figure 19.1
Figure 19.2
Cover
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George Luber
Jay Lemery
Cover Design: Wiley
Cover Images: Grandmother and Child ©Andrew Penner / iStockphoto; Flood ©Constance Knox / iStockphoto; Fire ©Scott Vickers / iStockphoto; Desert ©Yuriy_Kulik / iStockphoto; Hurricane ©Chieh Cheng / iStockphoto; Foggy Background ©Simone Becchetti / iStockphoto
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Library of Congress Cataloging-in-Publication Data
Luber, George, editor.
Global climate change and human health : from science to practice / George Luber, Jay Lemery.
pages cm
Includes index.
ISBN 978-1-118-50557-1 (pbk.) – ISBN 978-1-118-60358-1 (epub) – ISBN 978-1-118-50557-1 (pbk.)
1. Climatic changes—Health aspects. 2. Global warming—Health aspects. 3. Environmental health. I. Lemery, Jay, editor. II. Title.
RA793.L83 2015
615.9'02—dc23
2015018120
I have many people to thank for the privilege and opportunity to spend my days working on such an important issue. This book is dedicated to all of those who have shared their wisdom, offered mentorship, gave opportunity, and provided support, especially my mother, Maureen Ward; my mentors: Elois Ann and Brent Berlin, Carol Rubin, and Mike McGeehin; and of course, to my wife, Holly, and our sons, Lucas, Gustav, and Axel, for all of their support and love.
George Luber
* * *
To the educators of the Glens Falls, New York School District—may you continue to inspire; and of course, to my girls, Maeve and Zada, and my loving wife, Taryn.
Jay Lemery
Throughout history, the sky has served as a metaphor for the vast, wide open, and endless horizons. The notion that humans could in some way alter this vast expanse would have been unimaginable. It was not until our explorations into space in the 1960s that this notion began to be challenged. The first astronauts to leave the Earth reported that the atmosphere looked like a “thin blue line” in contrast to the enormous mass of the planet. Their eyes were not deceived; the atmosphere that envelops the Earth is thin—so thin that if the Earth were shrunk down to the size of a desktop globe, one would need only a sheet of plastic wrap to approximate the thickness of the atmosphere. The atmosphere is a mere sixty miles thick, compared with the eight-thousand-mile diameter of the Earth.
Following the publication of the first images from Earth's orbit, the widely held notion that the atmosphere is too vast to alter in any meaningful way was begun to be challenged by direct observational evidence. Meticulous measurements by Charles Keeling at the National Oceanic and Atmospheric Administration's (NOAA) Mauna Loa Observatory, beginning in 1956 and uninterrupted to date, have provided clear documentation of the year-on-year rise in global atmospheric carbon dioxide (CO2) levels, providing crucial observational evidence that the chemistry of the atmosphere is changing (figure I.1).
Figure I.1 Atmospheric Carbon Dioxide at Mauna Loa
Scripps Institution of Oceanography (scrippsco2.ucsd.edu/).
This change is substantial. At the start of the Industrial Revolution, it has been estimated that the globally averaged concentration of CO2 in our atmosphere was around 280 parts per million (ppm). By 1956 it was close to 320 ppm, and in the intervening fifty years, this level has risen to over 400 ppm, principally as a result of the burning of fossil fuels and land use and land cover changes.
Among its many properties, the atmosphere serves to help keep the surface of the Earth warm enough to sustain life. This is possible through the greenhouse effect in which the atmosphere allows solar radiation to pass through, generally unchanged, and trapping some of the outgoing infrared radiation that is emitted from the Earth's surface. The balance between incoming and outgoing energy is critical to maintaining some type of energy/temperature equilibrium at the Earth's surface. When this energy balance is altered, through an increase in inputs (solar energy) into the system or changes in Earth's atmospheric composition that alter how much of this incoming energy is captured (either naturally by volcanic emissions, or human activities such as the burning of fossil fuels or through land cover changes), changes in the Earth's surface temperature, and in turn its climate become evident.
Documenting and assessing the evidence for these potential changes in the Earth's climate system is the job of the Intergovernmental Panel on Climate Change (IPCC), a selected volunteer group of experts in the numerous disciplines and sectors with a perspective on climate change. One of the IPCC's main purpose is to undertake a periodic assessment every seven years to review and summarize the strength of the evidence around climate change, including the physical science basis and evidence, impacts in numerous sectors (e.g., agriculture, water, energy, public health), and regional impacts.
The Fourth Assessment Report of the IPCC was a landmark document and worthy of receiving the Nobel Peace Prize, not least for stating unequivocally that the Earth's climate is changing and that humans are principally responsible (IPCC 2007). This, and subsequent IPCC reports (IPCC 2012, 2013), have strengthened the evidence base on human-induced climate change. These reports have not only highlighted the complexities and magnitude of the climate change problem, but they have provided a solid evidence and rationale for action on a number of fronts. What they have concluded is that the global effects of climate change are already apparent from numerous observations of the destabilization of natural systems. These impacts include the melting and degradation of continental ice caps and glaciers, the warming and acidification of oceans, rising sea levels, an increase in frost-free days, and, not least, increases in extreme weather events such as heat waves, heavy rainfall events, drought, high storm surge, and tropical cyclones.
We can also expect substantial regional differences in the type and magnitude of these impacts. Some regions will become wetter, some dryer, and some will see no change. Consider this: the Third US National Climate Assessment reported that Grand Junction, Colorado, has warmed 3.2°F over the past century, while parts of southern Alabama actually cooled, dropping 0.6°F in the same time period (Melillo et al. 2014).
At an increasing rate, evidence is accumulating that the health threats of climate change are already affecting communities across the globe. From the direct effects of weather extremes on morbidity and mortality to the potential for profound changes in disease ecology and geography brought about by state shifts in the Earth's system, climate change will be the defining issue for public health in this century (Chan 2008).
Climate change poses to threaten health in a variety of ways. Most of the health threats of climate change that have been identified are not new ones; injury and death from heat waves and extreme weather events; reduced air quality from ozone, aeroallergens, and wildfire smoke; and from illnesses transmitted by food, water, and disease carriers such as mosquitoes and ticks. These health threats have always been with us, taking advantage of weaknesses and vulnerabilities in certain parts of our communities, particularly the young, old, the sick, economically disadvantaged, and culturally marginalized (Luber et al. 2014). For these groups, climate change represents yet another, perhaps more powerful, threat to their health and well-being.
Climate change will also threaten the critical systems and infrastructure we rely on to keep us safe and healthy: communication and transportation during emergencies, food and water systems during drought, the energy grid during prolonged heat waves. As the magnitude and frequency of extreme weather events increase, the resilience of these systems will be tested, and vulnerabilities will become more exposed. It is in this sense that climate change will serve as “risk multiplier” by amplifying both the exposures that bring about health risks and highlighting the vulnerabilities to these exposures as well.
In developing a global picture of the health impacts of climate change, it is important to acknowledge that these health impacts will differ substantially by location and pathway of exposure. These differences can be thought of as a function of the attributes of the population that confer vulnerability (the old and young, the prevalence of comorbidities, socioeconomic status), attributes of place that mediate exposure (floodplain, coastal zone, urban heat island), as well as the adaptive capacity of public health and associated infrastructure that helps maintain access to clean food and water and public health preparedness decisions that have been made in advance.
The picture is complicated, to say the least. Disentangling all of these interactions is a difficult task, requiring the expertise and perspectives of many disciplines. The purpose of this book is to bring together, in a single volume, these various perspectives—theoretical, methodological, and disciplinary—that should be brought to bear on such a critical challenge. In order to educate and empower the next generation of students and scientists to address this challenge, the four parts of this book span a science-to-practice continuum that promotes an evidence-based approach to public health practice and decision making.
Part 1, “Our Changing Planet: Emergent Risks for Human Health,” begins with an overview primer on climate science, with attention to relevant concepts for public health. The next two chapters summarize the various climate-related meteorological hazards and exposures that will increasingly become emergent risks for human health.
Part 2, “The Health Consequences of Climate Change,” focuses more closely on specific exposure pathways that will be altered with climate change and reviews the evidence base for the various health impacts of climate change, including waterborne disease, respiratory impacts from ozone, emissions, aeroallergens, harmful algal blooms, vector-borne and zoonotic disease, nutritional impacts, and mental health.
In Part 3, “The Public Health Approach to Climate Change,” the focus turns to a discussion of the practice dimension of this book. It details the various public health strategies and approaches that are already being developed to prepare for climate change. The authors cover a wide variety of practical and methodological approaches to climate change and health assessments including public health surveillance for climate change, conducting vulnerability assessments, and modeling future health impacts. The part concludes with three chapters that describe important concepts to consider from a public health perspective: adopting a community-based approach, environmental justice as a critical dimension of risk, and the importance of communication approaches as agents of change.
Part 4, “Taking Action: Adaptation, Mitigation, and Governance,” turns to an action-oriented perspective, outlining the various efforts and strategies that have been developed so far to tackle the enormous challenge of climate change. Emissions trajectories tell us that some warming is unavoidable and we must adapt. The how and why of such an endeavor is presented in the first chapter in this part before turning attention to tackling the root cause of the climate change crisis: increased emissions. This discussion focuses on a strategy to promote these mitigation efforts by seizing on the dual benefits, for both health and emissions, of certain strategies. Underpinning both adaptation and mitigation efforts is the governance structure that allows, or prevents, this from happening, and the various institutional and governance requirements for this to indeed happen are discussed. And the last chapter explores issues of climate justice and the likelihood that the most vulnerable among us will bear the heaviest burdens of climate change.
We have included pedagogical elements to facilitate both learning and instruction. Key terms and a comprehensive glossary introduce and reinforce the lexicon of this field. Key concepts and discussion questions will keep the learner oriented to the big picture messages throughout the chapters. To facilitate educators, we have provided visual presentation materials (PowerPoint) to complement each lecture. And finally, because this book topic straddles both public health and clinical medicine, we have provided “Clinical Correlates” sections in each chapter to facilitate understanding and discussion of the health impacts that will face individual care providers.
We consider this last point to be a significant differentiator for our book—that this text will be relevant for both MPH and MD/DO students. So much of the intransigence of policymakers worldwide is due to a lack of clear risk assessment of the insidious and often abstract threat of climate change. And when one compounds this with the fact that cutting-edge science by its very nature is uncertain, tough decisions related to climate or energy policy are easily undercut by a fear of commitment to any particular course of action, leaving inertia as the best rational choice.
This is where you come in as a science educator. Those of us in public health and clinical medicine are ideal interlocutors, society's go-betweens in translating abstract medical science into plans for healthy living. Research in social science supports that risks identified in terms of human life, such as “your mother's risk of cancer” or “your child's risk of asthma,” are much more effective fulcrums for change than abstract concepts. This is our hope for the book: to empower you with the knowledge to explain science in terms of health risks that can be readily understood and to be part of a movement to elevate public discourse to a more accurate assessment of risks and benefits. This is how meaningful change can occur and how we may have a chance to bequeath to our children a planet with a safe environment and stable climate.
An instructor's supplement is available at www.wiley.com/go/luber. Additional materials such as videos, podcasts, and readings can be found at www.josseybasspublichealth.com. Comments about this book are invited and can be sent to [email protected].
Chan, M. 2008. “The Impact of Climate Change on Human Health.” April 7.
IPCC. 2007.
Climate Change 2007: The Physical Science Basis. Contribution of Working Group I to the Fourth Assessment Report of the
Intergovernmental
Panel on Climate Change
, edited by S. Solomon,, D. Qin, M. Manning, Z. Chen, M. Marquis, K.B. Averyt, M. Tignor, and H. L. Miller. Cambridge: Cambridge University Press.
IPCC. 2012.
Managing the Risks of Extreme Events and Disasters to Advance
Climate
Change Adaptation. A Special Report of Working Groups I and II of the Intergovernmental Panel on Climate Change
, edited by C. B. Field, V. Barros, T. F. Stocker, D. Qin, D. J. Dokken, K. L. Ebi, M. D. Mastrandrea, et al. Cambridge: Cambridge University Press.
IPCC. 2013.
Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change
, edited by T. F. Stocker, D. Qin, G.-K. Plattner, M. Tignor, S. K. Allen, J. Boschung, A. Nauels, et al. Cambridge: Cambridge University Press.
Luber, G., K. Knowlton, J. Balbus, H. Frumkin, M. Hayden, J. Hess, M. McGeehin, et al. 2014. “Human Health.”
Climate Change Impacts in the United States: The Third National Climate Assessment
, edited by J. M. Melillo, T. Richmond, and G. W. Yohe,, 220-256. Washington DC U.S. Global Change Research Program.
Melillo, J. M., T. Richmond, and G. W. Yohe, eds. 2014.
Climate Change Impacts in the United States: The Third National Climate Assessment
. Washington DC U.S. Global Change Research Program.
We thank the “Clinical Correlates” editor, Cecilia Sorenson, MD; and editorial assistants Amanda Bond, Marisa Burton, Danika Evans, Sabrina Geer, DVM, Katharine Joy, and Amita Kulkarni. We also thank the Educational Materials editor, Carolyn Meyer, MD; and educational assistants Gavriel Roda and Rachel VanderWel. We are also indebted to proposal reviewers Kristie L. Ebi, Paul S. Auerbach, and Damon Chaky who provided valuable feedback on the original book proposal. Edward Avol, Qinghua Sun, Justin Remais, and Ivan Ramirez provided thoughtful and constructive comments on the complete draft manuscript.
George Luber is a Medical Anthropologist and Chief of the Climate and Health Program at the National Center for Environmental Health, Centers for Disease Control and Prevention (CDC). Since receiving his PhD in Medical Anthropology from the University of Georgia and joining CDC in 2002, he has served as an Epidemic Intelligence Service (EIS) officer and senior health scientist.
In addition to managing the Climate and Health Program at CDC, Luber is a cochair of the Climate Change and Human Health Workgroup at the US Global Change Research Program, a member of the American Anthropological Association's Presidential Task Force on Climate Change, a convening lead author for the Third US National Climate Assessment, and a lead author for the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. In 2015, Luber was profiled on the Weather Channel's Climate 25. He is also adjunct professor in the Departments of Environmental Health, Anthropology, and Environmental Science at Emory University.
The findings and conclusions in this report are my own and do not necessarily represent the views of the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry.
* * *
Jay Lemery is an Associate Professor of Emergency Medicine at the University of Colorado School of Medicine and is Chief of the Section of Wilderness and Environmental Medicine. He is the immediate past-President of the Wilderness Medical Society and is currently the EMS medical director for the US Antarctic Program. Lemery serves as a consultant for the Climate and Health Program at the Centers for Disease Control and Prevention and sits on the Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine. He is a fellow of the American College of Emergency Physicians and a past term member of the Council on Foreign Relations. From 2005 to 2012, he was the director of Cornell Wilderness Medicine and a member of the Global Health Steering Committee at the Weill Cornell Medical College.
Lemery was an Echols Scholar at the University of Virginia and received his MD from the Geisel School of Medicine at Dartmouth. From 2003 to 2004, he was chief resident in emergency medicine at NYU and Bellevue Hospitals. He also holds academic appointments at the Weill Cornell Medical College and the Harvard School of Public Health (FXB Center), where he is a contributing editor for its journal Health and Human Rights and was guest editor for the June 2014 edition on climate justice. He is affiliate faculty of the Colorado School of Public Health.
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Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!