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?
partners and stakeholders, is a key aim of WHO'sclimate change adaptation and mitigation efforts. Such efforts can help strengthen the globalcommunity's capacity to protect health from climatechange and thus reap more immediate and widerbenefits from strong mitigation polices. GETTING HEALTH ON THE CLIMATECHANGE AGENDA To date, health issues have been marginal in theclimate talks -even though "adverse effects of climatechange on the economy, public health and the qualityof the environment" were noted in the first UnitedNations Framework Convention on Climate Change asthe three critical arenas of global climate-relatedcommitment (UN,1992).Less than 2 per cent of the international funding onclimate change adaptation goes to protect health, andthere has been no systematic quantification ofpotential health opportunities and funding in thecontext of IPCC mitigation reviews. Out of the 323 sideevents at the COP15 conference in 2009 inCopenhagen, only one focused on health.The very significant health gains and cost savings thatcan be realised through climate change mitigationpolicies are not typically considered in economicmodels that aim to guide decision-making ongreenhouse gas emission reduction. This, in fact, can lead to incomplete evidence and a bias againstmore sustainable and greener decisions! Finally,quantifiable health gains are not typically consideredin the context of UNFCCC clean developmentmechanisms used to finance many types of low-carbon development. WHO believes this can change. Initial findings fromWHO's series of reviews on Health in the GreenEconomyto be presented at the Cancun conferencecover the potential co-benefits to health of mitigationaction in: agriculture, transport, household energy,residential construction and health care facilities. These reviews will summarise current knowledge andevidence of the health impacts of climate changemitigation strategies in different sectors and identifyopportunities for fine-tuning and strengtheningexisting policies to both enhance health and reduceour global carbon footprint. But this is only a first steptowards ongoing, global and systematic reviews of theevidence on climate change mitigation and health.Our aim is to make the strategic, political and scientificcase for placing greater emphasis on the healthdimension at COP16 as a way to improve publicengagement, relevance, and effectiveness of climatepolicy. A new and strengthened health focus, weaudits and examining how carbon efficiencies canbenefit both 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).Improved home and hospital design to facilitatenatural ventilation can improve air flows for betterinfection control and heat wave resilience whilereducing reliance on air-conditioning (Atkinson et al, 2009). Greener urban development could improve home sitingand construction to better protect from heat waves,flooding and mudslides that may be caused by climatechange - while also improving access to publictransport, walking and cycling, to mitigate againstfuture climate change. "KNOCK-ON" BENEFITS Greening initiatives in one sector also can have otherindirect "knock-on" health benefits in other areas. For instance, new programmes in China and Nepal todevelop household biogas installations for homecooking not only provide people with a more efficientand less-polluting source of home energy, butencourage the building of latrines to provide the fuelsource (Remais, 2009; Acharya, 2005).That is of considerable importance in light of the fact that some 2.6 billion people worldwide had no access to a hygienic toilet or safe latrine in 2008 (WHO/UNICEF, 2010). Improved sanitation is a critical means of reducing deaths (1.9 millionpeople annually) from unsafe water and sanitation(WHO, 2009). Despite their enormous potential, the health impactsof climate change mitigation are not measuredsystematically enough today. But it is possible todevelop that knowledge with more health sectorresearch and involvement overall. Reviewing andconsolidating such evidence, together with our" "INITIATIVES FOR 'GREEN ANDSAFE' HOSPITALSRECOGNISE THAT MANY OF THE CARBON-EFFICIENT MEASURES THAT'MITIGATE' AGAINSTFUTURE CLIMATECHANGE CAN ALSO BE INTEGRATED WITHMEASURES THATIMPROVE ADAPTATION TOTHE IMPACTS OF CLIMATECHANGE ALREADYBEING FELT 080HEALTH