- Email: [email protected]
World Health Assembly 2008: climate change and health
Comment
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Lawn JE, Cousens SN, Wilczynska K. Estimating the causes of four million neonatal deaths in the year 2000: statistical annex—the world health report 2005. Geneva: World Health Organization, 2005. Stoll BJ. The global impact of neonatal infection. Clin Perinatol 1997; 24: 1–21. The WHO Young Infant Study Group. Clinical prediction of serious bacterial infections in young infants in developing countries. Pedatr Infect Dis J 1999; 18: S4–S7. Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet 2008; 371: 135–42.
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Baqui AH, El-Arifeen S, Darmstadt GL, et al. Effect of community-based newborn-care intervention package implemented through two servicedelivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet 2008; 371: 1936–44. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999; 354: 1955–61. WHO. Management of the sick newborn: report of a technical working group. Ankara, 5–8 June 1995. http://www.popline.org/docs/1459/ 122806.html (accessed April 16, 2008).
World Health Assembly 2008: climate change and health Two months ago on World Health Day 2008, the Director-General of WHO, Margaret Chan, wrote that the past year has marked a turning point in the debate on climate change. “The scientific evidence continues to mount,” she wrote, “The climate is changing, the effects are already being felt, and human activities are a principal cause.”1 This month the international health sector has itself reached a turning point in its own engagement with this great global issue. The 61st World Health Assembly in Geneva on May 19–24,2 that mandated WHO to engage more actively in the international multi-agency effort to respond to global climate change, and underscored the urgency of adapting health systems to deal with the health risks of climate change—risks that will increase in future, particularly in vulnerable geographic regions and in poorly resourced populations. Weather-sensitive disease events give a clear preview of the health impacts of climate change.3–5 For example, major heatwaves have exacted heavy tolls of extra deaths in many countries this decade.4 Short-term increases in temperature in African highland areas of eastern and southern Africa have resulted in malaria transmission in populations without previous exposure and immunity.4,5 Flooding related to El Niño in eastern Africa has caused, via an increase in breeding sites for mosquito vectors and a closer proximity of cattle and human beings, major outbreaks of Rift Valley fever.6 Temporary increases in air pollutants, during especially hot spells, have caused exacerbations of serious respiratory disease.4 The debate on the resolution in the World Health Assembly referred to many of these glimpses into the future, as national delegations highlighted the health risks likely to predominate in their geographic region. Indeed, the debate was remarkable in the extraordinarily www.thelancet.com Vol 371 June 7, 2008
large number of countries that spoke in its support. Several such interventions were on behalf of entire regions, such as the sub-Saharan African countries and the small island states. Further, compared with just several years ago, there was manifestly a heightened level of awareness of the issues and the risks to human health, and of the need for action. Finally, the resolution makes explicit that the response of the health sector will need to be undertaken in wide collaboration with many other sectors of government and social action. The debate made it clear that there can be no illusion that global climate change is a simple environmental health problem amenable to a sector-based technical solution.7 The health sector, in general, has been slow to perceive the enormous significance of global climate change, as a threat to Earth’s life-support systems, including the provision of water, food, clean air, and stable ecosystems—and, therefore, to human wellbeing, health, and survival. Most of the early policy debate focused on threats such as those related to economic activity, livelihoods, tourism, physical infrastructure and wildlife. This slowness has mirrored that of society at large. We are only just now recognising the full measure of the threat posed by a change in the world’s climate. That growing recognition was underscored by the frequent reference, in the Assembly debate, to how climate change jeopardises the achievement of the Millennium Development Goals, especially those that relate directly to health outcomes: infectious diseases, hunger and undernutrition, and child and maternal mortality. This recognition signifies that there is emerging, at last, a clearer recognition that Millennium Development Goal 7, the achievement of environmental sustainability, is intimately bound up with the achievement of the other human-centred goals. 1895
Comment
Panos Pictures
The printed journal includes an image merely for illustration
Aftermath of cyclone Nargis, Burma
In her opening address to the Assembly, Chan described climate change as one of “three global crises looming on the horizon”, each posing threats to our public health security.8 Already apparent this year, she said, is the crisis of regional food shortages and soaring food prices, a threat to the very foundation of child development and lifelong health—ie, adequate nutrition. For climate change, which threatens the world with more droughts, floods, and tropical storms, she stressed that the increased risks of various diseases and greater demands for humanitarian assistance require reinforcement of health systems to deal with the additional disease burden that will occur. For both these global crises—food and climate—Chan indicated that the poor are at greatest risk. The third crisis, pandemic influenza, lurks menacingly in the future and, in the Director-General’s words, “we would be very unwise to let down our guard or slacken our preparedness measures”. The Assembly’s resolution lays out a five-point agenda of research and action. First, fuller documentation of the risks to health and of differences in vulnerability between and within populations. Second, development of healthprotection strategies. Third, identification of the health co-benefits of actions taken to reduce greenhousegas emissions or, in other sectors, to adapt to climate change. Fourth, development of decision-support tools and systems to predict the impact of climate change for member states. And fifth, estimation of the financial costs of actions and inactions in relation to health. The resolution then calls on WHO to assist the international community to understand the nature 1896
and extent of the risks to health of climate change on the basis of evidence gleaned from its research agenda, so that this information can be taken into account in formulating international responses to climate change, both mitigation and adaption. It mandates WHO to engage with other international agencies in responding to climate change, including participating actively within the UN Framework Convention on Climate Change.9 The passage of this resolution by the World Health Assembly signifies recognition that the health sector has a central role to play in ensuring our public-health security and providing the evidence that will contribute to the pursuit of the restoration of Earth’s natural climatic conditions. The health sector will be the source of much crucial information and understanding about the human consequences of climate change. That fuller understanding, in turn, should help ensure that governments everywhere have a fuller understanding of the risks posed by climate change—and therefore less excuse for delayed or inadequate action. In the words of the Director-General on World Health Day this year: “Consideration of the health impact of climate change can help political leaders move with appropriate urgency.”1 *Anthony J McMichael, Maria Neira, David L Heymann Australian National University, Canberra, ACT 0200, Australia (AJM); and WHO, Geneva, Switzerland (MN, DLH) [email protected] We declare that we have no conflict of interest. 1
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WHO. The impact of climate change on human health. April 7, 2008. http://www.who.int/mediacentre/news/statements/2008/s05/en/index. html (accessed May 30, 2008). 61st World Health Assembly, Geneva, May 19–24 2008. http://www.who.int/ mediacentre/events/2008/wha61/en/index.html (accessed May 30, 2008). McMichael AJ, Woodruff R, Hales S. Climate change and human health: present and future risks. Lancet 2006; 367: 859–69. Confalonieri U, Menne B, Akhtar R, et al. Human health. In: Parry ML, Canziani OF, Palutikof JP, van der Linden PJ, Hanson CE, eds, Climate change 2007: impacts, adaptation and vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate change. 2007. http://www.ipcc-wg2.org (accessed May 30, 2008). McMichael AJ, Woodruff RE. Climate change and infectious diseases. In: Mayer KH, Pizer HF, eds. The social ecology of infectious diseases. New York, NY: Academic Press, 2008: 378–407. Woods CW, Karpati AM, Grein T, et al. An outbreak of Rift Valley fever in northeastern Kenya, 1997–98. Emerg Infect Dis 2002; 8: 138–44. WHO Media Centre. 61st World Health Assembly. Notes from day 4: Thursday, 22 May 2008. http://www.who.int/mediacentre/events/2008/ wha61/journal4/en/index.html (accessed May 30, 2008). Chan M. Address to the 61st World Health Assembly. May 19, 2008. http://www.who.int/dg/speeches/2008/20080519/en/index.html (accessed May 30, 2008). UN. UN Framework Convention on Climate Change. UN Conference on Environment and Development (UNCED), Rio de Janeiro, 1992. http:// unfccc.int/resource/docs/convkp/conveng.pdf (accessed May 30, 2008).
www.thelancet.com Vol 371 June 7, 2008
5
6 7
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Lawn JE, Cousens SN, Wilczynska K. Estimating the causes of four million neonatal deaths in the year 2000: statistical annex—the world health report 2005. Geneva: World Health Organization, 2005. Stoll BJ. The global impact of neonatal infection. Clin Perinatol 1997; 24: 1–21. The WHO Young Infant Study Group. Clinical prediction of serious bacterial infections in young infants in developing countries. Pedatr Infect Dis J 1999; 18: S4–S7. Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet 2008; 371: 135–42.
9
10
11
Baqui AH, El-Arifeen S, Darmstadt GL, et al. Effect of community-based newborn-care intervention package implemented through two servicedelivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet 2008; 371: 1936–44. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999; 354: 1955–61. WHO. Management of the sick newborn: report of a technical working group. Ankara, 5–8 June 1995. http://www.popline.org/docs/1459/ 122806.html (accessed April 16, 2008).
World Health Assembly 2008: climate change and health Two months ago on World Health Day 2008, the Director-General of WHO, Margaret Chan, wrote that the past year has marked a turning point in the debate on climate change. “The scientific evidence continues to mount,” she wrote, “The climate is changing, the effects are already being felt, and human activities are a principal cause.”1 This month the international health sector has itself reached a turning point in its own engagement with this great global issue. The 61st World Health Assembly in Geneva on May 19–24,2 that mandated WHO to engage more actively in the international multi-agency effort to respond to global climate change, and underscored the urgency of adapting health systems to deal with the health risks of climate change—risks that will increase in future, particularly in vulnerable geographic regions and in poorly resourced populations. Weather-sensitive disease events give a clear preview of the health impacts of climate change.3–5 For example, major heatwaves have exacted heavy tolls of extra deaths in many countries this decade.4 Short-term increases in temperature in African highland areas of eastern and southern Africa have resulted in malaria transmission in populations without previous exposure and immunity.4,5 Flooding related to El Niño in eastern Africa has caused, via an increase in breeding sites for mosquito vectors and a closer proximity of cattle and human beings, major outbreaks of Rift Valley fever.6 Temporary increases in air pollutants, during especially hot spells, have caused exacerbations of serious respiratory disease.4 The debate on the resolution in the World Health Assembly referred to many of these glimpses into the future, as national delegations highlighted the health risks likely to predominate in their geographic region. Indeed, the debate was remarkable in the extraordinarily www.thelancet.com Vol 371 June 7, 2008
large number of countries that spoke in its support. Several such interventions were on behalf of entire regions, such as the sub-Saharan African countries and the small island states. Further, compared with just several years ago, there was manifestly a heightened level of awareness of the issues and the risks to human health, and of the need for action. Finally, the resolution makes explicit that the response of the health sector will need to be undertaken in wide collaboration with many other sectors of government and social action. The debate made it clear that there can be no illusion that global climate change is a simple environmental health problem amenable to a sector-based technical solution.7 The health sector, in general, has been slow to perceive the enormous significance of global climate change, as a threat to Earth’s life-support systems, including the provision of water, food, clean air, and stable ecosystems—and, therefore, to human wellbeing, health, and survival. Most of the early policy debate focused on threats such as those related to economic activity, livelihoods, tourism, physical infrastructure and wildlife. This slowness has mirrored that of society at large. We are only just now recognising the full measure of the threat posed by a change in the world’s climate. That growing recognition was underscored by the frequent reference, in the Assembly debate, to how climate change jeopardises the achievement of the Millennium Development Goals, especially those that relate directly to health outcomes: infectious diseases, hunger and undernutrition, and child and maternal mortality. This recognition signifies that there is emerging, at last, a clearer recognition that Millennium Development Goal 7, the achievement of environmental sustainability, is intimately bound up with the achievement of the other human-centred goals. 1895
Comment
Panos Pictures
The printed journal includes an image merely for illustration
Aftermath of cyclone Nargis, Burma
In her opening address to the Assembly, Chan described climate change as one of “three global crises looming on the horizon”, each posing threats to our public health security.8 Already apparent this year, she said, is the crisis of regional food shortages and soaring food prices, a threat to the very foundation of child development and lifelong health—ie, adequate nutrition. For climate change, which threatens the world with more droughts, floods, and tropical storms, she stressed that the increased risks of various diseases and greater demands for humanitarian assistance require reinforcement of health systems to deal with the additional disease burden that will occur. For both these global crises—food and climate—Chan indicated that the poor are at greatest risk. The third crisis, pandemic influenza, lurks menacingly in the future and, in the Director-General’s words, “we would be very unwise to let down our guard or slacken our preparedness measures”. The Assembly’s resolution lays out a five-point agenda of research and action. First, fuller documentation of the risks to health and of differences in vulnerability between and within populations. Second, development of healthprotection strategies. Third, identification of the health co-benefits of actions taken to reduce greenhousegas emissions or, in other sectors, to adapt to climate change. Fourth, development of decision-support tools and systems to predict the impact of climate change for member states. And fifth, estimation of the financial costs of actions and inactions in relation to health. The resolution then calls on WHO to assist the international community to understand the nature 1896
and extent of the risks to health of climate change on the basis of evidence gleaned from its research agenda, so that this information can be taken into account in formulating international responses to climate change, both mitigation and adaption. It mandates WHO to engage with other international agencies in responding to climate change, including participating actively within the UN Framework Convention on Climate Change.9 The passage of this resolution by the World Health Assembly signifies recognition that the health sector has a central role to play in ensuring our public-health security and providing the evidence that will contribute to the pursuit of the restoration of Earth’s natural climatic conditions. The health sector will be the source of much crucial information and understanding about the human consequences of climate change. That fuller understanding, in turn, should help ensure that governments everywhere have a fuller understanding of the risks posed by climate change—and therefore less excuse for delayed or inadequate action. In the words of the Director-General on World Health Day this year: “Consideration of the health impact of climate change can help political leaders move with appropriate urgency.”1 *Anthony J McMichael, Maria Neira, David L Heymann Australian National University, Canberra, ACT 0200, Australia (AJM); and WHO, Geneva, Switzerland (MN, DLH) [email protected] We declare that we have no conflict of interest. 1
2 3 4
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6 7
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WHO. The impact of climate change on human health. April 7, 2008. http://www.who.int/mediacentre/news/statements/2008/s05/en/index. html (accessed May 30, 2008). 61st World Health Assembly, Geneva, May 19–24 2008. http://www.who.int/ mediacentre/events/2008/wha61/en/index.html (accessed May 30, 2008). McMichael AJ, Woodruff R, Hales S. Climate change and human health: present and future risks. Lancet 2006; 367: 859–69. Confalonieri U, Menne B, Akhtar R, et al. Human health. In: Parry ML, Canziani OF, Palutikof JP, van der Linden PJ, Hanson CE, eds, Climate change 2007: impacts, adaptation and vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate change. 2007. http://www.ipcc-wg2.org (accessed May 30, 2008). McMichael AJ, Woodruff RE. Climate change and infectious diseases. In: Mayer KH, Pizer HF, eds. The social ecology of infectious diseases. New York, NY: Academic Press, 2008: 378–407. Woods CW, Karpati AM, Grein T, et al. An outbreak of Rift Valley fever in northeastern Kenya, 1997–98. Emerg Infect Dis 2002; 8: 138–44. WHO Media Centre. 61st World Health Assembly. Notes from day 4: Thursday, 22 May 2008. http://www.who.int/mediacentre/events/2008/ wha61/journal4/en/index.html (accessed May 30, 2008). Chan M. Address to the 61st World Health Assembly. May 19, 2008. http://www.who.int/dg/speeches/2008/20080519/en/index.html (accessed May 30, 2008). UN. UN Framework Convention on Climate Change. UN Conference on Environment and Development (UNCED), Rio de Janeiro, 1992. http:// unfccc.int/resource/docs/convkp/conveng.pdf (accessed May 30, 2008).
www.thelancet.com Vol 371 June 7, 2008