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Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilities of urban populations in developing countries and highlight the range of large direct health effects of energy policies that are concentrated in urban areas. Common vulnerability factors include coastal location, exposure to the urban heat-island effect, high levels of outdoor and indoor air pollution, high population density, and poor sanitation. There are clear opportunities for simultaneously improving health and cutting GHG emissions most obviously through policies related to transport systems, urban planning, building regulations and household energy supply. These influence some of the largest current global health burdens, including approximately 800,000 annual deaths from ambient urban air pollution, 1.2 million from road-traffic accidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor air pollution. GHG emissions and health protection in developing-country cities are likely to become increasingly prominent in policy development. There is a need for a more active input from the health sector to ensure that development and health policies contribute to a preventive approach to local and global environmental sustainability, urban population health, and health equity.
This report synthesizes the findings from the Millennium Ecosystem Assessment (MA) global and sub-global assessments of how ecosystem changes do or could affect human health and well-being. Over the past 50 years humans have changed natural ecosystems more rapidly and extensively than any comparable period in human history. The findings provide the strongest evidence so far of the ways in which pressures on ecosystems have resulted in the loss of vital ecosystem services which purify and replenish water soil and air resources essential to health and also keep many diseases in check. Loss of these ecosystem services in turn affect patterns of communicable and non-communicable disease distribution and transmission. In the future, still-increasing pressures on ecosystems could impact public health in a variety of ways that are unpredictable and potentially severe. Human exploitation of ecosystem services has indeed contributed to substantial net gains in well-being and development across much of the planet. Still not all regions and groups of people have benefited from this process and many have been harmed. Moreover the full costs associated with these gains are only now becoming apparent. Approximately 60% of the ecosystem services examined, from regulation of air quality to purification of water, are being degraded or used unsustainably. The Millennium Ecosystem Assessment has worked to assess the consequences of ecosystem change for human well-being and establish the scientific basis for actions needed to enhance the conservation and sustainable use of those systems so that they can continue to supply the services that underpin all aspects of human life. The assessment exercise has involved more than 1 300 experts worldwide and started in 2001.