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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

believe, can revitalise climate change processes and lead to future climate change agreements thattake the biggest step yet towards global health inhuman history. nABOUT THE AUTHORDr Maria P. Neira was appointed Director of theDepartment of Public Health and Environment at the World Health Organisation, Geneva, Switzerlandin September 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 andMetabolic 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, Subedi PS,"Scaling up biogas in Nepal, what else isneeded." Boiling Point, 50;2005. Atkinson J , Chartier Y , Pessoa-SilvaC , Jensen P , Li Y and Seto WH ,eds. Natural Ventilation for InfectionControl in Health-Care Settings, WorldHealth Organization, 2009. Aytur SA, Rodriguez DA, Evenson KR,Catellier DJ. "Urban containmentpolicies and physical activity: A time-series analysis of metropolitan areas,1990-2002." American Journal ofPreventive Medicine. 2008; 34: 320-332.Campbell-Lendrum D, Molyneux D, et al."Ecosystems and vector borne diseasecontrol", In: Ecosystems and humanwell-being: policy responses, Vol. 3.Findings of the Responses WorkingGroup, Millennium EcosystemAssessment, London, 2005, pp.353-374.Cavill N, Kahlmeier S, Racioppi F, eds.Physical activity and health in Europe:evidence for action. Copenhagen: WorldHealth Organization; 2006.Edwards P, Tsouros AD. A healthy city isan active city: a physical activityplanning guide. Copenhagen: WorldHealth Organization; 2008. Fuel for life: household energy andhealth. Geneva, World HealthOrganization, 2006.Global health risks, mortality andburden of disease attributable toselected major risks. Geneva, WorldHealth Organization, 2009. Kahn Ribeiro S, Kobayashi S, Beuthe M,et al. "Transport and its infrastructure."In: Metz B, Davidson OR, Bosch PR,Dave R, Meyer LA, editors. ClimateChange 2007: Mitigation Contribution ofWorking Group III to the FourthAssessment Report of theIntergovernmental Panel on ClimateChange. Cambridge University Press;2007.Kroeger et al, Black carbon emissions inAsia: sources, impacts and abatementopportunities, report prepared for theUS Agency for InternationalDevelopment's Regional DevelopmentMission for Asia (USAID/RDMA),Bangkok, Thailand, April 2010.Metz B, Davidson OR, Bosch PR, DaveR, Meyer LA (eds). Contribution ofWorking Group III to the FourthAssessment Report of theIntergovernmental Panel on ClimateChange, Cambridge University Press, 2007.Pruss-Ustun A, et al, Preventing diseasethrough healthy environments, towardsan estimate of the environmentalburdenof disease (2004 update of globalstatistics. Annex 2 tables). Geneva,WorldHealth Organization, 2009.Pruss-Ustun A, et al, Safer water, betterhealth - Costs, benefits andsustainability of interventions to protectand promote health. Geneva, WorldHealth Organization, 2008.Ramanathan V, Carmichael G. Globaland regional climate changes due toblack carbon. Nature Geoscience.2008; 1:221-227.Remais J, Chen L, Seto, E. Leveragingrural energy investment for parasiticdisease control: shistosome ovainactivation and energy co-benefits ofanaerobic digestors in rural China. PLoSONE, March 2009; 4:3: e4856.Van den Ber, H. Reducing vector-bornedisease by empowering farmers inintegrated vector management. Bulletinof the World Health Organization, Vol.85;7 (2007), pp. 561-566.Wilkinson P, et al., "Public healthbenefits of strategies to reducegreenhouse gas emissions, householdenergy." The Lancet, 374 (9705):1917-1929.Woodcock J, Edwards P, Tonne C, et al."Public health benefits of strategies toreduce greenhouse-gas emissions:urban land transport." The Lancet.2009 Dec 5;374(9705):1930-43.Wright L, Fulton L. "Climate ChangeMitigation and Transport in DevelopingNations." Transport Reviews. 2005;25(6):691-717.REFERENCESHEALTH081