s concerns mount over the long-term risks of climate change to the planet'shealth, there is a wave of interest in"green" economic development amongUN and multi-lateral aid agencies, nationalgovernments and industry. But can "green" economicinitiatives also yield more immediate public health benefits? Early findings emerging from a new series of globalreviews by WHO of climate change mitigation policiesin key economic sectors say "yes", health can be awinner in greener development strategies.Well-designed initiatives that curb greenhouse gasemissions in energy, residential construction,transport, and agricultural systems can not onlyenhance global public health, but also improve healthamong poor populations and save scarce healthresources -in a relatively short time frame. Better understanding of the multiple "win-win" health and climate benefits that could be obtained from mitigation could help build support for existing and future climate change agreements,such as the one being negotiated in the talks in Cancún.Embracing "health-enhancing" low-carbon strategiescan allow policy-makers to demonstrate positive healthand wealth-generating results within a period of years -while averting devastating long-term impacts to the planet. The general public can potentially be motivated toadopt more sustainable lifestyles when there is betterunderstanding of how such measures also improvepersonal health and well-being in tangible ways.THE HEALTH COST OF GREY, THESAVINGS OF 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 (2 millionannually) are due to leaky and inefficient householdenergy systems that burn biomass fuels and coal, and upon which 3 billion people still rely for fuel (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 instove emissions could also reduce the climate impactsof black carbon (USAID/RDMA, 2010; Ramanathanand Carmichael, 2008). The burden of disease from urban outdoor air pollution(1.2 million deaths annually) and traffic injury (1.3million deaths annually) could similarly be addressedby policies that promote more compact urbandevelopment around public transport corridors as wellas "active" transport by walking and cycling. An evergrowing body of literature indicates that activetransport to work, school and shopping can alsoaddress obesity-related diseases caused by physicalinactivity (3.2 million deaths annually) (Aytur, et al,2008; WHO, 2006; WHO, 2008). Recent modeling of cities in developed and developingcountries indicated that the potential is huge. A majorGREEN ECONOMIC DEVELOPMENT CAN BEGOOD FOR HEALTH078HEALTHADR MARIA NEIRA, DIRECTOR OF THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, WORLD HEALTH ORGANISATION (WHO)Right:Dr Maria Neira,Director, Department ofPublic Health andEnvironment, WHO,Geneva
HEALTH079study published last year in The Lancet, carried outwith WHO participation, modelled effects on health inLondon and Delhi from low-emission vehicles andpolicies to increase "active travel" and reduce cartravel. A combination of active travel and lower-emission motor vehicles was projected to reduce thenumber of years of life lost from ischaemic heartdisease by 10-19 per cent in London and 11-25 percent in Delhi (Woodcock et al, 2009). In many cases,the health and health care cost savings resulting from climate change mitigation actions can also covermuch of the cost of the interventions (Metz B, et aleds., 2007). FINE-TUNING MITIGATION POLICIES TOCONSIDER HEALTH Significantly, some mitigation policies may be betterthan others, in health terms. For instance, mitigationpolicies to encourage lower-emission vehicles canindeed help combat air pollution. But some expertscontend that improved public transport, walking andcycling systems could potentially do much more - byattacking air pollution, obesity and traffic injury in an integrated and cost-effective way (Wright andFulton, 2005; Kahn Ribeiro et al, 2007; Woodcock etal, 2009). Sometimes, tradeoffs also need to be considered. For instance, improving the insulation quality of homes in developed countries offers one very major climate change mitigation opportunity,according to the reviews of the IntergovernmentalPanel on Climate Change. Better insulation can also help protect against extreme heat and cold waves that become more frequent with climatechange. However, in health terms, adequate provisionfor ventilation must also be assured to keep down levels of indoor air pollution from dust and mould and chemicals that otherwise might build up inclosed spaces. This is why more careful health assessment andanalysis of mitigation policies is required in order toexplore what combination of climate change mitigationpolicies can yield the most optimal health benefits inany given economic sector. Relative costs and benefitsalso need to be examined by diverse economies and regions. LEADING BY DOING Mitigation policies can and should also be appliedin the health sector itself to obtain better use of health system resources. Currently, hundreds ofthousands of health clinics in Africa, Asia and 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. In developing world cities, where power outages are often common, expanded hospital access torenewable energy sources and on-site co-generation of heat and electricity could potentially provide health facilities with more efficient, reliable andindependent sources of energy for emergencies.Building energy efficiencies into construction and the use of medical devices can help hospitals, large or small, and in developing or developed countries,better rationalise resources. 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 thegrass roots, health facilities are launching energy?