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?

gas emission reductions exclude health co-benefits.And health gains are not considered in the UNFCCCclean development mechanisms used to finance manytypes of low-carbon development. Taken together, thisleads to a bias against greener policy decisions, and amissed opportunity for health, for the environment,and for the economy.WHO believes this can change. Initial findings fromWHO's series of reviews on Health in the GreenEconomy cover the potential co-benefits to health of mitigation action in: agriculture, transport,household energy, residential construction and healthcare facilities.These reviews summarise current knowledge andidentify important opportunities for re-thinking,strengthening, or fine-tuning existing policies to both enhance health and reduce our global carbon footprint.But this is only a first step. Our aim is to make thestrategic, political and scientific case for placinggreater emphasis on the health dimension as a way toimprove, relevance, and effectiveness of climatepolicy. A new and strengthened health focus, webelieve, can revitalise public engagement, and lead tofuture climate policies that take the biggest step yettowards global health in human history. nABOUT THE AUTHORDr Maria P. Neira was appointed Director of theDepartment of Public Health and Environment at TheWorld Health Organization, Geneva, Switzerland inSeptember 2005. Prior to that, she was Vice-Minister of Health and President of the Spanish Food Safety Agency. She had previously held senior positions in WHO as Director of the Control, Prevention and Eradication Programme on Communicable Diseases and as Coordinator of the Global Task Force on Cholera Control.Dr Neira began her career as a field physician andmedical coordinator working with refugees in ElSalvador and Honduras and later as a public healthadviser in Mozambique and Rwanda.Dr Neira is a Spanish national, and a medical doctorby training. She specialised in Endocrinology and Metabolic Diseases and also obtained anInternational Diploma in Emergency Preparednessand Crisis Management.Among her many distinctions, Dr Neira has beenawarded the Médaille de l'Ordre national du Mérite bythe Government of France and is a member of theAcademy of Medicine, Asturias, Spain.Acharya J, Bajgain MS, SubediPS, "Scaling up biogasinNepal, what else is needed."Boiling Point, 50;2005.Campbell-Lendrum D,Molyneux D, et al."Ecosystems and vector bornedisease control", In:Ecosystems and human well-being: policy responses, Vol. 3.Findings of the ResponsesWorking Group, MillenniumEcosystem Assessment,London, 2005, pp.353 374.Cavill N, Kahlmeier S, RacioppiF, eds. Physical activity andhealth in Europe: evidence foraction. Copenhagen: WorldHealth Organization; 2006.Edwards P, Tsouros AD. Ahealthy city is an active city: aphysical activity planningguide. Copenhagen: WorldHealth Organization; 2008.Fuel for life: household energyand health. Geneva, WorldHealth Organization, 2006.Global health risks, mortalityand burden of diseaseattributable to selected majorrisks. Geneva, World HealthOrganization, 2009.Kahn Ribeiro S, Kobayashi S,Beuthe M, et al. "Transportand its infrastructure." In: Metz B, Davidson OR,Bosch PR, Dave R, Meyer LA,editors. Climate Change 2007:Mitigation Contribution ofWorking Group III to the Fourth Assessment Report ofthe Intergovernmental Panelon Climate Change.Cambridge University Press;2007.REFERENCESPhoto: UN Photo/Eskinder Debebe110HEALTH