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pollutants in Europe, and as much as 60 to 70 percent in developing countries. WHO estimates thatreducing the level of one of the main components of airpollution (PM10) from 150 ?g /m3 - an order ofconcentration found in many large low- and middle-income cities -to 75 ?g /m3 would reduce short-termmortality from air pollution by 5 per cent, with largergains over longer time periods (WHO, 2006).Similar opportunities are available in the householdenergy sector in developing countries. ChronicObstructive Pulmonary Disease resulting from relianceupon energy-intensive and inefficient biomass andcoal stoves in developing countries causes over 1million premature deaths each year. A significantproportion of ischaemic heart disease and lung canceris also due to such stove use. These burdens falloverwhelmingly on women. Cleaner and greener biomass and biogas stovetechnologies now becoming available can prevent suchdeaths. Cleaner stoves also can very significantlyreduce environmentally-triggered childhoodpneumonia, one of the biggest killers of under-fives. Indeveloped countries greener and cleaner homeheating, insulation and ventilation can help controlallergies, asthma and other common respiratory NCDsas well as cardio-vascular disease associated with bothheat and cold extremes. All of these interventionsdeserve support as much by the health sector as by theenvironment sector.MANAGING THE TRANSITION TO AGREEN AND HEALTHY ECONOMYIn the long run, green growth, and the transition to amore sustainable and equitable economy, are key topopulation health. For at least the next few decades,however, we also need to protect people from theimpacts of the environmental degradation - to whichwe are already committed.Again, we are not doing as well as we should. Forexample, there is now clear evidence that climatechange is already worsening a range of health risks.This includes impacts on air (extreme air temperaturesand higher levels of some air pollutants), water(reduced quantity and quality of freshwater), food(reductions in rain fed agriculture), shelter (destructionfrom weather extremes), and freedom from disease(improved conditions for transmission of vector-borneand water-borne disease). These impacts areconcentrated on the poorest populations, and affectsome of the largest disease burdens, includingmalnutrition, diarrhea, and vector-borne diseases suchas malaria. WHO conservatively estimates that theclimate change that has occurred since the 1970salready causes over 140,000 excess deaths each year.To date, however, the international response is weak.While WHO, UNFCCC and the World Bank estimatethat climate change will result in an increase ofbetween US$2-12 billion in annual health costs by2020, current international support for healthadaptation to climate change is about 0.5 per cent ofthis figure. The Governments of the most vulnerablecountries have now clearly identified the criticalcomponents of health systems that need to bestrengthened to protect from climate change. As wemove towards a green economy, we also need to ensurethat we protect populations from the consequences ofpast pollution. SEEING THE BIGGER PICTUREIn the last few years, international attention hasfocused on global crises in climate, food security,energy prices, and finance. Each of these is a hugechallenge, including for health. However, addressing046HEALTHPhoto:" "INVESTMENT INPUBLIC TRANSIT,WALKING AND CYCLING SYSTEMS,ARE STRONGLY ASSOCIATED WITHIMPROVED HEALTHAND REDUCEDCARDIOVASCULARDISEASE AND OBESITY

HEALTH047them presents opportunities to promote changes indevelopment, production and consumption patternsand preferences that support health and sustainability.There is mounting evidence that green economicactivity can have many clear and quantifiable globalhealth benefits, reducing the burden of disease overalland particularly among the poorest and the mostvulnerable, as well as more genuine long-term securityfor jobs, livelihoods and economies - in developed aswell as developing countries. This is what green growthreally means. nFully referenced version of this article can be found at theWHO site at THE AUTHORDr Maria P. Neira was appointed Director of theDepartment of Public Health and Environment atThe World Health Organization, Geneva, Switzerlandin September 2005. Prior to that, she was Vice-Minister of Health and President of the Spanish FoodSafety Agency. She had previously held seniorpositions in WHO as Director of the Control,Prevention and Eradication Programme onCommunicable Diseases and as Coordinator of theGlobal Task Force on Cholera Control. Dr Neira beganher career as a field physician and medicalcoordinator working with refugees in El Salvador andHonduras and later as a public health adviser inMozambique and Rwanda. Dr Neira is a Spanishnational, and a medical doctor by training. Shespecialised in Endocrinology and Metabolic Diseasesand also obtained an International Diploma inEmergency Preparedness and Crisis Management.Among her many distinctions, Dr Neira has beenawarded the Médaille de l'Ordre national du Mériteby the Government of France and is a member of theAcademy of Medicine, Asturias, Spain.