ealth can be a winner in greenerdevelopment strategies, say early findingsemerging from a new series of globalreviews by WHO of climate changemitigation policies in key economic sectors.Well-designed initiatives that curb greenhouse gasemissions in energy, residential construction,transport, and agricultural systems can improve healthamong both rich and poor populations, and save scarcehealth resources. Critically, these benefits accruequickly, and locally, allowing policy-makers todemonstrate how they are improving the lives of theirown constituents in a few years, as well as avertingdevastating long-term impacts to the planet.THE HEALTH COST OF GREY, THESAVINGS OF THE GREENOverall, WHO estimates that nearly one-quarter of the global disease burden is attributable toenvironmental pollution and degradation, which couldbe readily addressed by available technologies invarious economic sectors (WHO, 2009). For instance,most deaths from indoor air pollution (two millionannually) are due to inefficient and pollutinghousehold energy systems that burn biomass fuels andcoal, and upon which three billion people still rely forfuel (WHO, 2009).However, much of this burden of disease couldpotentially be reduced or eliminated through improvedaccess to cleaner-burning cookstoves or fuels nowbecoming available in developing countries (WilkinsonP et al, 2009; WHO 2006). Concurrent reductions in stove emissions could also reduce the climateimpacts of black carbon (USAID/RDMA, 2010;Ramanathan and Carmichael, 2008).FINE-TUNING MITIGATION POLICIES TOCONSIDER HEALTH Significantly, some mitigation policies may be better than others, in health terms. For instance,mitigation policies to encourage lower-emissionvehicles can indeed help combat air pollution. But theevidence suggests that improved public transport,walking and cycling systems could potentially do muchmore - by attacking air pollution, obesity and trafficinjury in an integrated and cost-effective way (Wrightand Fulton, 2005; Kahn Ribeiro et al, 2007;Woodcock et al, 2009).Sometimes, tradeoffs also need to be considered.Better insulation can reduce energy bills and protecthealth, both against cold temperatures and theheatwaves that are expected to become more frequentwith climate change. However, adequate provision for ventilation must also be assured to keep downlevels of indoor air pollution from dust and mould and chemicals that otherwise might build up in closed spaces.This is why health assessment of mitigation policies isrequired, in order to identify the combination ofpolicies that can yield the largest health benefits in anygiven economic sector, or location.LEADING BY DOINGMitigation policies can and should also be applied inthe health sector itself to obtain better use of healthsystem resources. Currently, the health care sector inHEALTH AND GREEN ECONOMIC DEVELOPMENT108HEALTHHDR MARIA NEIRA, DIRECTOR, DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, WORLD HEALTH ORGANIZATIONRight:Dr Maria NeiraOver page:A hospital in Mongolia
HEALTH109rich countries is highly energy intensive, whilehundreds of thousands of health clinics in Africa, Asiaand Latin America have no power at all. If such clinicscould be supplied with renewable electricity for basicneeds from solar panels, the quality of health carecould potentially be improved, at little long term costto the planet.Recognising these realities, the health sector is already"leading" with its own "greening" initiatives. Hospitalsin a number of Chinese cities recently launchedprogrammes to promote "green and safe" hospitals -that can function better in emergencies. From theUK's National Health Service to small NGOs at thegrassroots, health facilities are launching energy auditsand examining how carbon efficiencies can benefitboth the planet and health."ADAPTIVE" MITIGATIONInitiatives for "green and safe" hospitals recognise thatmany measures that "mitigate" against future climatechange can also be integrated with measures thatimprove adaptation to the impacts of climate changealready being felt. Other such "adaptive mitigation"measures could include:Integrated vector management, which combinesenvironmental management with wise use ofchemicals, can help combat climate change-inducedchanges in vector borne disease transmission, whilealso reducing long-term environmental impact ofchemicals (van den Berg et al, 2007; Campbell-Lendrum, et al, 2005).Greener urban development could improve homesitting and construction to better protect from heatwaves, flooding and mudslides that may be caused byclimate change - while also improving access to publictransport, walking and cycling, to mitigate againstfuture climate change.VALUING HEALTH IN THE CLIMATECHANGE DEBATE The original United Nations Framework Convention onClimate Change (UN, 1992) notes "adverse effects ofclimate change on the economy, public health and thequality of the environment" as the three critical sets ofimpacts that the international climate effort isdesigned to avoid. The Intergovernmental Panel onClimate Change notes that the immediate healthbenefits of reduced air pollution could pay for much ofthe cost of greenhouse gas mitigation measures.Despite this, only approximately one per cent of theinternational funding on climate change currently goesto protect health. Almost all of the economic modelsthat attempt to guide decision-making on greenhouse?