the american council o n
science a n d health presents

a position paper of the
american council o n science a n d health

special report

 global climate change and human health
a position paper of the arnerican council on science and health

by Sidney Shindell, M.D., LL.B., and Jack Raso, M.S., R.D.

Prqect Cuurdimtur
Simona Kwon, M.P.H.
Art Dzkectur
Larry Anderson

PreszZenf
Elizabeth M. Whelan, Sc.D., M.P.H.
October 1997

AMERICAN COUNCIL ON SCIENCE A N D HEALTH
1995 Broadway, 2nd Floor
New York, NY 10023-5860
Tel. (212) 362-7044

URL: http://www.acsh.org

Fax

(212) 362-4919

E-mail: acsh@acsh.org

Individual copies of this report are available at a cost of $3.85. Reduced prices for 10 or more copies are
available upon request.

ACSH accepts unrestricted grants on the condition that it is solely responsible for the conduct of its research and the
dissemination of its work to the public. The organization does not perform proprietary research, nor does it accept
support from individual corporations for specific research projects. All contributions to ACSH-a publicly funded
organization under Section 501 (c)(3) of the Internal Revenue Code-are tax deductible.

 THE AMERICAN COUNCIL ON SCIENCE AND HEALTH (ACSH)
APPRECIATES THE CONTRIBUTIONS OF THE REVIEWERS NAMED BELOW.

Sallie Baliunas, Ph.D.

Charles F. Kegley, Ph.D.

Harvad-Smithsonian Center for Astrophysics

Kent State University

Norman

E. Borlaug, Ph.D.

Cindy F. Kleiman,

M.P.H.

Exas A &A4 University

Sisters of charity Healthcare System

Gale A. Buchanan, Ph.D.

Manfred Kroger, Ph.D.

The University of Georgia
Earl

J. Laurence Kulp, Ph.D.

L. Butz, Ph.D.

University of Washington

Purdue University
Donald G. Cochran, Ph.D.

Virginia Polytechnic Institute and state university
Ernst

The Pennsylvania State University

M. Davis, Ph.D.

Center for Health Promotion
and Disease Prevention
Detroit, Michigan

Karl Maramorosch, Ph.D.

Rutgers University

W. Moeller, Ph.D.
Harvard University
Dade

A. Alan Moghissi. Ph.D.
Institute for Regulatory Science
Alexandria, Virginia

R. DeGregori, Ph.D.
University of Houston

Thomas

R. Dunn, Ph.D.
Averill Park, New h r k

Albert

Thomas

G. Moore, Ph.D.
Hoover Institution

James

G. Nickel
Lyons La vey Nickel Swift, Inc.

Michael Fox, Ph.D.
Thomas T. Poleman, Ph.D.

Richland, Washington

CorneII University
William Paul Glezen,

M.D.

Baylor College of Medicine
Norman

G. Gratz, D.Sc.

S. Fred Singer, Ph.D.
Science and Environmental Policy Project
Fairfax, Virginia

w o r d Health organization
Fredrick J. Stare, M.D., Ph.D.
Ruth Kava, Ph.D., R.D.

Harvard school of Public Health

ACSH
Fredric Murry Steinberg,

Decatur, Georgia

M.D.

 Table of Contents
Position Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
A . What Is Climate Change? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
B . The Potential Human Factor in Climate Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
C . ACSH's Approach to the Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
D . Health Policy Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
E . Minor Hypothetical Health Outcomes of Projected Global Climate Change . . . . . . .10
Heat-Related Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
Psychosocial Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IO
Undernourishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
F. Major Hypothetical Health Outcomes of Projected Global Climate Change . . . . . . .11
Vector-borne Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
Injury due to Extreme Weather Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Waterborne Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
I1. Current Causes of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
A . The Global Burden of Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
B. Future Trends in Disease Independent of Global Climate Change . . . . . . . . . . . . . . .14
C . Special Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
New and "Emerging" Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
I11. Approaches to Dealing with Projected Global Climate Change . . . . . . . . . . . . . . . . . . .16
A . Mitigation Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
B . The Cost of Mitigation Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
C . Adaptational Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1V.Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20

List of Tables
Abbreviations Used in This Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Table 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
Table 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
Table3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

List of Figures
Figure
Figure
Figure
Figure
Figure

1................................
2 ................................
3................................
4 ................................
5 ................................

. . . . . . . . 10
. . . . . . . . 12
. . . . . . . . 13
. . . . . . . . 14
. . . . . . . . 16

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

Abbreviations Used in This Report
ACSH . . . . . . . . . . .American Council on Science and Health
C . . . . . . . . . . . . . .Celsius

CC&HH . . . . . . . . .Climate Change and Human Health
FCCC . . . . . . . . . . .United Nations Framework Convention on Climate Change
GBDS . . . . . . . . . . .Global Burden of Disease Study
GHG . . . . . . . . . . . .greenhouse gas
IPCC . . . . . . . . . . .Intergovernmental Panel on Climate Change
WHO . . . . . . . . . . .World Health Organization
WHR . . . . . . . . . . . World Health Report

Position Statement

T

he following statements summarize the position of
the American Council on Science and Health
(ACSH) on dealing with the potential health
effects of projected climate change.
Nearly all of the potential adverse health effects of
projected climate change are significant, real-life
problems that have long persisted under stable climatic conditions. Bolstering efforts to eliminate or
alleviate such problems would both decrease the
current incidence of premature death and facilitate
dealing with the health risks of any climate change
that might occur.
Policies that weaken economies tend to weaken
public health programs. Thus, it is likely that
implementation of such policies would (a) increase
the risk of premature death and (b) exacerbate any
adverse health effects of future climate change.
Infectious diseases have always been a major cause of
premature death for humans. In 14th-century Europe, for
example, successive epidemics of bubonic plague depopulated 200,000 towns and killed 25 million peop1e.l Over
subsequent centuries life expectancy in Europe gradually
increased as scientific, technological, agricultural, and
industrial revolutions improved food supplies. housing,
and public sanitation and made clean clothing more
affordable. By the early 19th century, advances in chemistry, microbiology, epidemiology, and medicine had vastly improved understanding of the nature of diseases.
European life expectancy continued to increase steadily,

largely because of smallpox immunization and improvements in supplies of food and water. Organic chemistry
and other biological sciences set the stage for the creation
of new pharmaceuticals for treatment of infectious diseases.
In the United States, where most infectious diseases
have been largely controlled, life expectancy has increased
from 46 years in 1900 to 76 years in 1996. All of the
numerous causes of this increase in life expectancy derive
from science, technology, and industry. Those causes
include water processing, immunization, antibiotic therapy, the use of pesticides to control disease-spreading
organisms, and improvements in the availability, safety,
and essential-nutrient content of foods.
In developing countries, increases in life expectancy
in recent years have also been substantial. Between 1960
and the early 199os, life expectancy in developing nations
increased from 46 years to 64 years. Nevertheless, infectious and parasitic diseases continue to constitute the
main cause of premature death (i.e.. death at any age
below 65) in developing nations.
the 52 million people who died worldwide in 1996, about 30 million died
prematurely. About half the premature deaths were due to
preventable infectious diseases. such as malaria and many
intestinal illnesses. Many infectious diseases are spread by
insects, mites, and ticks.
There is good reason to expect further improvement
in the control of vectors-the insects and other organisms
that transmit sources of disease. According to The Global
Burden o f Disease study (1996)-a worldwide public health
survey compiled by the World Health Organization
(WHO), the Harvard School of Public Health, and the
World Bank-poverty is a frequent reason that people die
from vector-borne diseases. It has been estimated that in
1995 malaria killed as many as 2.7 million people world-

of

5

 6

GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

wide and newly afflicted as many as 500 million.2 But the
authors of The Global Burden of Disease Study projected that
malaria, the 11th most common cause of death in 1990,
would be the 29th most common cause in the year 2020.
Recently, concern has been raised that future climate
change due to human actions will complicate the control
of malaria and other infectious diseases. According to
Climate change and Human Heal& (CC&Hfl--the
1996 report by a Task Group of the World Health
Organization, the World Meteorological Organization,
and the United Nations Environment Programme-if
warming of the Earth’s surface occurs, the incidence of
infectious diseases may increase. CC&HHstates that such
warming could increase the range of the organisms that
transmit the sources of these diseases. For example, the
CC&HHTask Group estimated that global warming may
increase the annual number of new malaria cases by 50
million by the year 2100.
The Task Group also suggested that global climate
change may cause additional deaths by increasing the incidence of extreme weather events (e.g., severe storms, heat
waves, and droughts) and by raising the sea level. The
effects of climate change could be direct, as in drowning
due to a flood, or indirect, as in starvation due to crop failure. Because future climate change could increase health
risks, the Task Group recommended stringently limiting
human-induced emissions of carbon dioxide, methane,
and other greenhouse (heat-trapping) gases termed
“minor.*’4
From the standpoint of public health, stringently
limiting such emissions at present would not be prudent.
Fossil-fuel combustion, the main source of humaninduced greenhouse-gas emissions, is vital to high-yield
agriculture and other practices that are fundamental to the
well-being of the human population. A significant shortterm decline in such actions could have adverse health
repercussions.
What, then, is the optimal policy for dealing with
the hypothetical adverse health effects of projected
human-induced global climate change? Having reviewed
the pertinent literature, the American Council on Science
and Health has reached the following conclusions. These
are based on the working assumption that the predictions
of the Intergovernmental Panel on Climate Change concerning the magnitude of human-induced global climate
change and its adverse effects on weather and human
health are correct.
The global burden of disease is formidable. wellunderstood public health measures could significanlly decrease the current incidence of premature

death. But resources for applying these measures are
currently inadequate. Thus, work toward increasing
these resources is prudent regardless of the prospect
of climate change.
Measures to adapt economies, healthcare systems,
and living conditions to existing and foreseeable
challenges to human health (for example, infectious
diseases, undernourishment, and weather disasters)
should be the focus of any policy concerning climate change and human health.
The optimal approach to dealing with prospect of
climate change would (a) include improvement of
health infrastructures (especially in developing
countries) and (b) exclude any measures that would
impair economies and limit public health resources.
Dealing with current and future public health problems should include increased investment:
in improving drinking water and sanitation in
developing countries;
in cost-effective control of organisms that spread
disease, especially in developing countries;
in improving food production and distribution in
developing countries;
in systems of emergency responses to extreme
weather events;
in the economic and health infrastructures of developing countries to increase access to medical services;
in development of additional vaccines and antibiotics against infectious diseases;
in research concerning energy technologies that
entail low greenhouse-gas emissions; and
in research concerning the potential health effects
of projected climate change.

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

Executive Summary

A

ccording to some forecasters, adverse impacts on
the health of the human population may result
from anthropogenic (human-induced) climate
change-specifically, rises in the average temperature of
the Earth’s surface due to human actions that increase
atmospheric concentrations of carbon dioxide and other
greenhouse (heat-trapping) gases.
Computer simulations of the Earth’s climate project
that, if atmospheric concentrations of greenhouse gases
increase as predicted, the average global temperature will
increase by 1 to 3.5 degrees Celsius
by the year 2100.
Simulations based on this estimate project changes in environmental conditions that may be detrimental to human
health, including increases in:

(c)

7

foreseeable-challenges to human health. Such a strategy
would focus on preventing adverse health effects of ongoing
natural climate change without impeding the global economic system. Regardless of whether human-induced climate change will occur, we need policies for coping with
infectious diseases and severe weather impacts of natural
origin. Implementation of policies for dealing with presentday climatic impacts adverse to human health would facilitate coping in the future with any adverse health impacts of
human-induced climate change.
According to most computer simulations, global climate change would develop slowly. Timely, vigorous, wellfinanced medical-research and public health efforts
against major real-life health problems should provide
tools that would be effective against most of the potential
adverse 2 1st century health effects of projected climate
change.

exposure to infectious diseases,
the incidence of extreme weather events (e.g., heat
waves), and
coastal flooding due to sea level rise.

In this report the American Council on Science and
Health (ACSH) reviews recent assertions concerning the
potential adverse health effects of projected humaninduced global climate change. Sourcebooks included
Climate change and Human Health, The Global Burden of
Disease study (1996),5 the World Health Report 1996,6and
the word Health Report 1997.7 It was not ACSH’s intention to evaluate the hypothesis that such climate change
will occur. O u r guiding questions were:

I. Introduction

A

ccording to recent controversial studies, future
global climate change due to human actions
would have an adverse impact on human population health. Some researchers have theorized that global
climate change-projected
from possible atmospheric
increases in greenhouse gases (GHGs) such as carbon
dioxide-would increase human mortality by increasing:
the incidence of vector-borne diseases (for example,
malaria, yellow fever, and dengue, which are caused
by mosquito-transmitted parasites);
the incidence of flooding;

How might global climate change affect the health
of the human population?
How should policymakers respond to the prospect
of climate-change-related health effects?
Current proposals for dealing with projected climate
change focus on mitigating (lessening) predicted humaninduced global warming through severe compulsory limiting of developed countries’ greenhouse-gas emissions.
Implementation of lhese proposals would significantly
weaken the global economic system. The optimal approach
to dealing with the prospect of adverse climatechange-related health effects would be largely adaptationat
its primary goal would be to suit economies, healthcare systems. and living conditions to lasting-Le., existing and

the incidence of droughts; and
heat and relative humidity.
The poor, the elderly, the ill. and children would be
particularly susceptible to events whose incidence future
global climate change may increase.

A. What Is C l i m a t e Change?
Below are definitions of some of the more important
terms used in this paper.

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

8

weather: The short-term state of the
atmosphere in a locality. The values of
atmospheric parameters-such
as temperature, relative humidity, and precipitation-can
change significantly within
a day.
climate: The average weather in a relatively large area over years.
climate change: A change in atmospheric
parameters (e.g., average yearly temperature) over a moderately long period (e&,
decades) that is either regional (e.g., New
England, North America, southern
hemisphere) or global.
global warming: An increase in the average surface temperature of the Earth.
Climate change has long impacted life on Earth and
will continue to do so. Natural (non-human-induced) climate change can be rapid, geologically speaking. Global
climatic upheavals-as when the average global temperature falls by 5 to 8 degrees and great masses of ice move
over land-can occur within one millennium. Ice ages are
periods of widespread coverage of land by glaciers. The
last ice age ended approximately 12,000 years ago. For the
last 10,000 years Earth’s climate has been relatively warm;
this warm climate has contributed to cultural development and to the growth and geographic expansion of the
human population. But the historical record shows that
even during this epoch, modest variations in climate have
sometimes had severe consequences, especially at the
edges of climatic zones.8 Climate change is therefore an
important policy consideration.

c

B.

T h e Potential H u m a n Factor
in C l i m a t e C h a n g e

Concern has arisen that certain human actions may
adversely affect the health of the human population
through effects on both the Earth’s mean climate and its
variability.
Key to the industrial development that began in the
late 18th century has been the large-scale burning of fossil fuels, such as coal, gas, and oil. The considerable
increase in energy production led to an historic increase in
human productivily; to the development of high-speed
transportation, communication, and computation; to
major advances in agriculture; and to the development of

science-oriented medicine. Industrialization and technological progress resulted in an alleviation of human suffering and an increase in human life expectancy.
But the large-scale burning of fossil fuels has also
increased the atmospheric concentrations of carbon dioxide and other greenhouse gases. Gases termed “greenhouse” are those that tend to prevent the transference of
heat from the atmosphere to outer space. Recent projections from computer climate simulations by the United
Nations Intergovernmental Panel o n Climate Change
(IPCC) suggest that, at current rates of GHG emissions,
the Earth’s average surface temperature will increase by 1
to 3.5 degrees by the year 2100.9 Projections from some
climate simulations also suggest that regional climate
changes will cause events deleterious to humans.
The potential health impacts of projected humaninduced climate change are the focus of Climate change
and Human Health ( c c & H H ,the 1996 report by a Task
Group of the World Health Organization, the World
Meteorological Organization, and the United Nations
Environment Programme.

c

C. ACSH’s Approach to the Issue
According to CC&Hff climate change would most
seriously affect human population health: (1) by causing
shifts in ecological systems that could increase the incidence of vector-borne infectious diseases; (2) by increasing
the incidence of extreme weather events (e.g., heat waves);
and (3) by raising the sea level.1°
Accurate descriptions of existing health problems are
essential for sound health-policy development. In 1995
infectious diseases killed 17 million people, 1 1 million of
whom were children. The potential impact of projected
climate change on the spread of infectious diseases is a
major theme in cc&HH O u r approach to the climate
change-human health issue was to compare the healthrelated predictions of CC&HHwith the content of three
other major documents: The Global Burden of Disease
study (GBDS), the world Health Report 1996, and the

world Health Report 1997.
The GBDS is the result of a cooperative effort by the
World Health Organization (WHO), the Harvard School
of Public Health, and the World Bank. The book features:
(a) a review of health statistics that pertain to the period
of 1950 to 1990 approximately, and (b) forecasts of global rates of death, disease, and disability to the year 2020.
Global climate change was not a consideration in these
forecasts.
The World HeaIth Report ( WHR) is an annual that
describes the actions of the WHO. The 1996 and 1997

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

9

Table 1. Sources of Information on World Health Used in the Preparation of this Report
Title

Period Covered

Comment on
Infectious Disease

Primary Focus

Climate Change
and Human Health

1800-1996
(real data)
1996-2100
(projected threat analysis)

The spread of
infectious diseases
will increase by
2100 because

hypothetical future health
problems due to projected
climate change

of climate change.
The Global Burden

ofDisease Study

1950- 1990
(real data)
1990-2020
(projected data)

are on the decline.

worldwide human health status
(no mention of climate change)

Infectious diseases

World Health Report 1996

1995

“Fatal complacency
is now costing
millions of lives.”

worldwide human health status
(passing mention
of climate change)

WorldHealth Report 1997

1996

Health providers should
address the “double burden”
of infectious disease and

worldwide human health status
(passing mention of the WHO’S
support of the work of the
International Panel
on Climate Change)

chronic illness.

editions were used in preparing this ACSH special report.
Table 1 briefly describes the aforementioned four
books.
The chief assumption underlying the following
analysis is that global climate change will occur as projected by the IPCC (the CC&”Task
Group made this
assumption). Mortality was the only health parameter
used in the analysis. Nearly all governments require
reporting of mortality. Other parameters of health-disability, for example-were not considered.

D. Health Policy Implications
By cosponsoring the publication of CC&”.
the
WHO has suggested that it will consider human-induced
climate change in its development of future global health
policy. Regarding climate change and health, c C & H . ( p .
6) states: “It is anticipated that most of the impacts would
be adverse.” To support this statement, the CC&HHTask
Group reviewed how “natural climate fluctuations” have
affected human population health during the industrial
age (approximately 1800 to the present).
Adverse weather is local, short-term, and largely
unpredictable. Extreme weather events cause considerable
human suffering, and in some areas systems for coping

with weather disasters are inadequate. Efforts should be
made to improve responses to adverse weather and its consequences. If the focus of policy decisions changes from
coping with weather calamities to limiting GHG emissions, a misallocation of resources would occur that could
have an adverse impact on human population health. If, as
the IPCC has suggested, decades will pass before hypothetical human-induced global climate change has significant consequences, the opportunity exists to develop technology that would ameliorate or even cost-effectively
avoid most of the projected health consequences.
The cost of decreasing human-induced emissions of
G H G s could significantly weaken the global economic
system.l 1*12*13Severe limiting of GHG emissions seems
unnecessary at present: If hypothetical human-induced
global climate change occurs as projected-i.e.,
slowly
and moderately-there is time to develop affordable mitigative technology before future global climate change has
a significant impact on human population health. l 4
In any case, focusing on the broader issue of natural
climate change is desirable because such change has
occurred repeatedly for millennia and its recurrence is
inevitable.

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

10

E. Minor Hypothetical Health Outcomes of
Projected Global Climate Change
Some of the hypothetical outcomes of global climate
change indicated in Figure 1 are much more serious than
others. One serious hypothetical outcome is an increase in
the incidence of malaria and other vector-borne infectious
diseases-a subject addressed in Section F (page 11).Two
questions can help distinguish major from minor hypothetical outcomes of global climate change: (1) How
many human deaths would the mediating process (e.g..
sea level rise) cause? (2) How strong is the link between
projected global climate change and the mediating process
and outcome?

Heat-Related Deaths

A globally averaged warming of 1 to 3.5 degrees C by
the year 2100 probably would not affect the incidence of
heat-related death. The worldwide number of deaths in
1995 due to heat waves (successive days with temperatures
above 90 degrees Fahrenheit) probably constituted a very
small fraction of the total number of 1995 deaths.15 An
increase in mortality during a heat wave is usually followed by a decrease,16 because the people most susceptible to heat waves are those for whom death from other
causes is likely within several weeks of the heat wave.17
Furthermore, it is possible that a decrease in cold-related
deaths would offset a long-term increase in heatwave-related deaths.18 In any case, according to 1996
occur in winter and at high latitudes.

Figure 1

Psychosocial Problems
Climate change might impair
economies, infrastructures, and
resource supplies and thus might
displace populations. But how
such problems would affect
human health would depend
largely on the pre-impact economic and sociopolitical status
of the affected community and
of adjacent areas. In any case,
political factors (e.g., war) would
probably be much more important than climate change as a
cause of psychosocial problems.

Ir

Respiratory Disorders

h

Adapted From McMichaei et ai. Climate ChanRc and Human Health. 1996.

The link between projected climate change and respiratory disorders is perhaps the weakest of
the
climate-change-outcome
links: (1) Although tuberculosis
and influenza will probably be
important infectious diseases in
the 21st century, neither has
been linked to global climate
change. (2) Even if future global
climate change does affect lungcancer factors in the 21st century. smoking would continue to
be the principal cause of lung
cancer. (3) Acute respiratory illness, which kills millions of chil-

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

dren each year in developing countries, is primarily related to unsanitary living conditions (especially overcrowding) and lack of medical services.

Undernourishment
There is no scientific consensus on how projected climate change might affect global agricultural productivity.
That climate change would increase productivity is plausible. First, elevated atmospheric carbon dioxide increases
plant growth. Second, projections suggest (a) that highlatitude regions in the northern hemisphere would benefit agriculturally from global warming (though not evenly) because of longer growing periods; and (b) that the
agricultural effect of global warming on most other
regions would be sma11.19~20
In any case, undernourishment will continue to be a
major health problem in the 21st century, because the predominant cause of undernourishment is not underproduction, but poverty-related maldistribution of food (as a
result of political upheaval, for example). Today. about
700 million people do not have enough food for a healthy,
productive life.21 Furthermore, the United Nations has
projected that the worldwide human population will have
increased from the 5.3 billion of 1990 to over 11 billion
by the end of the 21st century, and that nearly all of this
growth will occur in countries currently underdeveloped.22

E Major Hypothetical Health Outcomes of
Projected Global Climate Change

Some of the hypothetical adverse health effects of
projected climate change that cc&HH covers are wellknown public health problems that will require attention
regardless of whether significant human-induced climate
change occurs:

ktor-borne Diseases
According to cc&",
climate change would cause
shifts in ecological systems that could increase the incidence of vector-borne infectious diseases. Such diseases
(malaria and dengue fever, for example) are real-life major
health problems. Efforts to control the mosquitoes, ticks,
flies, and rodents that transmit diseases to humans are
integral to public health. Intensification of vector-control
efforts would be extremely beneficial regardless of the
prospect of global climate change.

11

Injury due to Extreme Weather Events
According to cc&HH, climate change would
increase the incidence of extreme weather events (e.g.,
heat waves). Extreme weather events can kill both directly
and indirectly. Weather forecasting, preparation for emergencies, and speedy evacuation can prevent, for example,
drowning in floods. But major disasters due to "natural
climate fluctuations" (in CC&",
the primary meaning
of this expression seems to be "abnormally bad weather")
continue to occur. For example, in November 1970 a
typhoon-driven tidal wave from the Bay of Bengal in East
Pakistan (now Bangladesh) killed nearly 750,000 peo~ l e . Bangladesh
~3
remains vulnerable to a disaster of this
magnitude.

Waterborne Diseases
The mixing of sewage and drinking water that occurs
during floods and severe storms is a recurrent problem
that may worsen if storms occur more frequently.
Diarrheal disease, which is directly linked to unclean
drinking water, is a major killer of children. Bottled water
is unaffordable in most developing countries. T h e availability of clean tap water would facilitate the control not
only of many waterborne diseases, but also of many foodborne diseases.
According to a study of population sustainabilityZ4:
Nearly half the human population suffers from diseases related to insufficient or contaminated water.
Virtually all such people live in developing countries, and the majority of sufferers in developing
countries are poor.
Two billion people are at risk of waterborne and
foodborne diarrheal diseases.
Waterborne and foodborne diarrheal diseases kill
nearly four million children each year.
Schistosomal (worm) eggs infect some 200 million
people per year through human contact with water
that contains the eggs.
Ten million people per year contract dracunculiasis
through drinking water that contains the parasitic
worm Dracunculus medinensis.
Millions of people per year contract diseases transmitted by insects whose larvae live in water. More
than 250 million people per year thus contract
malaria; 90 million, filariasis (e.g., elephantiasis) ;

 12

GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

EME
FSE
CHN
LAC
OAI
MEC
IND
SSA

Established Market Economies
Formerly Socialist Economies of Europe
China
Latin America & Carribean
Other Asian & Islands
Middle Eastern Crescent
India
Sub-Saharan Africa

Group I

communicable. maternal. perinatal &
nutritional conditions
Group I1 non-communicable diseases
Group I11 injuries

Source: Murray and Lopez.
The Global Burden of Disease Study. 1996.

11. Current Causes of Death

30 to 60 million, dengue fever; and 18 million, river
blindness (onchocerciasis).
Water chlorination and improvement in sanitation
could greatly improve drinking water in developing countries.

A. The Global Burden of Disease

T

he fact lists published as accompaniments to the
WHR are summaries of worldwide human health
status. According to “Fifty facts from the World
Health Report 1997,” the world population increased by
80 million during 1996, reaching 5.8 billion by midyear.
the more than 52 million deaths worldwide in 1996,
over 17 million were due to preventable infectious and

of

 GLOBAL CLIMATE C H A N G E A N D H U M A N 'HEALTH

parasitic diseases. Infectious
and parasitic diseases accounted for 43 percent of the 40 million deaths in developing
countries, where 11 million
children died before the age of
five.
The 1996 edition of the
WHR states: "Malaria is
endemic in 91 countries, with
about 40% of the world's population at risk. . . . u p to 500
million cases occur every year,
90% of them in Africa, and
there are up to 2.7 million
deaths annually. '' According t o
the Malaria
Foundation,
malaria kills more people each
year than have died from
AIDS in the last 15 years.
Most of the victims are children. The parasites that cause
malaria-a
disease for which
no
vaccine
exists-have
become more resistant to antimalarial
d r u g ~ . ~
Global
~
warming in the 21st century
could increase the geographical range of malaria-transmitting mosquitoes.26 T h a t a
globally averaged warming of
3 degrees by the year 2100
could increase the annual
number of malaria cases by
50-80 million has been
h y p o t h e s i ~ e d . But
~ ~ timely,
vigorous, well-financed public
health efforts against the disease would prevent such an
increase.
Optimal allocation of
resources is critical. Should we
invest now in efforts to
decrease atmospheric GHG
concentrations i n the hope of
limiting the future incidence of
malaria? Or should we invest
in efforts to control the mosquito population, prevent
malarial infection, and eliminate the disease?

m WE

+e
A C"

6 MK:

c

6
1999

zm

lCII0

wm

t(w

EME
FSE
CHN
LAC
OAI
MEC
IND
SSA

Established Market Economies
Formerly Socialist Economies of
Europe
China
Latin America & Carribean
Other Asian & Islands
Middle Eastern Crescent
India
Sub-Saharan Africa

Group 1

communicable, maternal, perinatal &
nutritional conditions
Group I1 non-communicable diseases
Group Ill injuries

Source: Murray and Lopez. The Global Burden of Disease Study 1996.

13

 14

GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

organisms due t o increasing
international air travel, trade,
and tourism
changes in global food
trade, including the shipment of livestock; new
modes of food production, storage, and marketing; and altered food
preferences

I Jleo

“The effects of climate
change may [emphasis
added] allow some diseases to spread to new
geographical areas. Microbes continue to evolve
and adapt to their environment, adding antimicrobial resistance to their
evolutionary pathways.”

Source: Murray and Lopez. The Global Burden ofDisease study 1996.

The Executive Summary of the 1996 edition of the
WHRenumerates “obstacles” to fighting disease:
poverty-related exposure to infectious diseases and
lack of regular access to essential drugs
overcrowding and unhygienic living conditions due
to continuing global population growth and rapid
urbanization
migration and mass population displacement due
to wars, civil turmoil, or natural disasters
collapse of, o r inability to establish, adequate health
systems
rapid intercontinental transport of pathogenic

Clearly. dealing with the first
six obstacles-real-world problems-outweighs
dealing with
the last “obstacle,” which is an
eventuality.
Furthermore,
progress against the real-world
obstacles would increase the
likelihood of dealing effectively
with the hypothetical obstacle.

B. Future Trends in Disease Independent of
Global Climate Change

C C & H . the GBDS?and the WHR have different
slants on the same diseases. CC&HH suggests that some
diseases, particularly the vector-borne and waterborne diseases of developing countries, will become more prevalent
and spread to developed countries.
The GBD.5, whose health projections do not factor
prospective global climate change, is more optimistic about
certain infectious diseases, particularly those that kill large
numbers of children. It underscores the importance of economic vitality to health by comparing eight World Bank
regions in terms of their disease statistics. Such comparison
shows a correlation between extremes of wealth and poverty and extremes of health and sickness. Wealth tends to
bring health and longevity; poverty tends to bring infec-

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

Table

2. Trends

in Group

I11 [Injury] Deaths

(in Thousands)

Year

1990

2000

2010

2020

AI1 Injuries

5,084

6,099

7,157

8,381

Unintentional Injuries
(thousands)
1. Road traffic accidents
2. Poisonings
3. Falls
4. Fires
5. Drowning
6. Other unintentional

3,233

3,812

4,380

5.053

999
242
292
265
504
932

1,391
265
347
298
497
1,013

1,837
278
388
325
475
1,076

2.338
293
439
354
469
1,160

Intentional Injuries
(thousands)
1. Self-inflicted injuries
2. Violence
3. War

1.851

2.287

2,778

3,328

786
563
502

929
702
656

1,080
864
834

1,229
1,052
1,047

world Population
(miIIions)

5,267

6,160

7,000

7,844

56.116

60,828

68.337

world Total Deaths
50,467
(thousands)
6.4
% LlnintentionaI
% IntentionaI
3.7
% Group III /Injury/ Deaths 10.0

6.7
4.0
11.0

7.2
4.6
12.0

Source: Murray and Lopez. The Global Burden o f Disease study 1996.

.

tious disease, high infant and childhood mortality, and
short life spans.
The GBDS classifies causes of death as: Group Icommunicable diseases and maternal, perinatal, and nutritional conditions; Group 11-noncommunicable diseases;
and Group 111-injuries. The greatest opportunity for
improving the human population health lies in preventing
Group 1 problems. These are more viewable as diseases of
poverty than are noncommunicable diseases or injuries.
Noncommunicable diseases are, to some degree, diseases
of old age.
Figure 2 (page 12) presents by age group, sex, and
region the probability of death due to each of the three
disease-injury groups.28 Group 1 diseases predominate in
childhood (ages 0 to 15) and are most prevalent in developing countries. Per capita gross product is inversely related to childhood mortality. The ratio of noncommunica-

7.4
4.9
12.0

15

ble-disease deaths to Group 1
deaths is a rough indication of
the health status of a regional
population: the higher the proportion of noncommunicable
diseases, the better the health.
Figure 3 (page 13) shows expected trends in the ratio of noncommunicable to Group 1 diseases in
the eight World Bank regions to
the year 2020.
A comparison between the major
causes of death in 1990 and
expected causes in 2020 is also
instructive. Figure 4 (from the
GBDS; page 13) shows the following trends.
Heart attack and stroke
will continue t o be the
world’s top killers.
The relative importance of
infectious diseases, except
tuberculosis and HIV disease, will decrease.
The relative importance of
diseases of old age will
increase.
The relative importance of
war, violence, and selfinflicted
injury
will
increase.

C. Special Issues
New and ‘Emerging”Diseases
Global climate change might (a) cause mutations or
biological events that would accelerate the genesis of
microorganisms (i.e., contribute to an increase in their
diversity), and (b) affect the incidence of rare diseases.
But how such events would affect humankind is unforeseeable. The overall result might be harmful, negligible,
or even beneficial.
Injuries
The CC&HHTask Group has suggested that global
climate change would increase the incidence of extreme

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

16

Natural disasters are direct
causes of only a small percentage (probably less
than one percent) of
Group I11 deaths. Group
111 deaths occur predominantly in people aged 15
to 60. T h e incidence of
such deaths in children
under 6 years old is greatest in the least developed
countries.
Developed
countries have emergency
response systems that
limit considerably the
incidence of deaths related to natural disasters.

Figure 5

111.
Approaches to
Dealing with
Projected
Global Climate
Change
A. Mitigation
Measures

weather events. Although extreme weather events can have
a long-term impact on public health infrastructures,
injuries are usually considered the direct causes of weather-related death. According to the GBDS (see Table 2,
page 15):
The percentage of Group 111 deaths will increase by
only two percent between 1990 and 2020.
Drowning incidence will decrease between the present and 2020.
Deaths due to road-traffic accidents, self-inflicted
injuries, violence, and war are on the rise.

T

he centerpiece of
the 1992 United
Nations Framework Convention o n
Climate Change (FCCC) was the goal of stabilizing
“greenhouse gas concentrations in the atmosphere at a
level that would prevent dangerous anthropogenic
(human-induced) interference with the climate system.”
But the FCCC did not specify such a level. Moreover,
while attempting to return GHG emissions to 1990 levels
is obligatory for some FCCC signatory nations, mostmore than 130 countries-have no such obligation.
Carbon dioxide has received more attention than
other GHGs for two reasons: (1) most of the humaninduced increases in atmospheric concentrations of
GHGs are due to increases in carbon-dioxide concentration; and (2) the other GHGs’ energy input to the atmosphere can be expressed in carbon-dioxide equivalents.
Measures to decrease human contributions to atmos-

Source: Murray and Lopez. The GIobal Burden of Disease study 1996.

 Table 3. Adaptational Responses
Population-Level Public
Policy Measures

Reduction of heat-related
mortaliy and morbidity

Insulate buildings and apply other design features that reduce heat load.
Plant trees within cities, and select materials with high albedo for roads, parking lots and roofs
to decrease urban “heat island” effect.
Establish new weather watch/warning systems that focus on health-related adverse conditions,
such as oppressive air masses.
Create public education campaigns regarding precautions to take during heat waves and establish
weather watch/warning systems.
Implement work schedules for outdoor workers that avoid peak daytime temperatures.

Reduction of transmission
of vector-borne diseases

Assess the vector-borne disease implications of development projects and policies that could
increase vector-borne disease transmission, and where possible implement environmentally sound
measures to prevent or mitigate such increases.
Improve use of climate forecasts in order to stockpile vaccines, pesticides, and other control tools
more efficiently, and prepare measures for control of any expected disease outbreaks.
Undertake public education to encourage elimination of human-made vector breeding sites (e.g.,
small water containers).
Install mosquito and fly screens in buildings in endemic areas.
Promote the judicious use of pesticides and biological control methods.
Undertake education campaigns to sensitize healthcare workers in geographically vulnerable areas.
Expand the coverage of existing vaccination programs aimed at the elimination of diseases such as
yellow fever, which are likely to increase in incidence after climate change.

.
.

Reduction of agricultural
stresses

Reduce monoclonal farming, to reduce dependence on chemicals for pest control.
Promote land reforms that favor environmentally sound land use.
Develop climate-adjusted plant species through genetic engineering.

Reduction of impacts of
extreme weather events
and sea level rise

Maintain and strengthen emergency management and disaster preparedness programs, including
local public health service capacity to conduct rapid health needs assessments and to make
psychological support interventions.
Implement engineering measures such as strengthening of seawalls and ensure strict adherence to
building regulations and standards in hurricane-prone areas.
Adopt land-use planning to minimize erosion, flash-flooding, poor siting of residential areas, and
deforestation.

~~~~~

Reduction of General
Population Vulnerability

Reduce poverty and socioeconomic inequalities.
Maintain biodiversity.
Protect cultural resources.
Carry out effective monitoring of the environment, biological indicators, and human health.

Personal Adaptive Measures

Education to demonstrate

the need (particularly among the chronically ill and the elderly) to increase hydration and mineral
intake levels during extremely hot weather
the need to reduce skin cancer risk by avoiding sun exposure, wearing protective clothing and sun
glasses, and-particularly among children and adolescents-using sunscreen
the need to use m o s q u i t o nets impregnated w i t h pyrethroid compounds or a p p l i
cation of insect repellents to reduce malaria transmission (particularly among
babies. children and pregnant women)
Derived from

CC&HH.

 18

GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

pheric GHGs fall into a response category called “mitigation.” Some mitigation measures listed in CC&HHcould
have serious side effects.

B. The Cost of Mitigation

Measures

The FCCC calls for stabilization of atmospheric concentrations of GHGs, not stabilization of emissions.
Substantial decreases in emission rates would be necessary
to stabilize atmospheric concentrations: perhaps a 60-percent decrease in GHG emissions worldwide. Such a
decrease would cause considerable-perhaps
intolerable-disruption of the global economic system.
Even lesser emission decreases could cause significant
damage. Economists Alan S. Manne and R. S. Richels
estimated that if the U.S. returns GHG emissions to 1990
levels by the year 2000 and then decreases them by an
additional 20 percent by 2020, the annual Gross
Domestic Product (GDP) loss would be nearly 1.8 percent-well over 100 billion dollars in today’s economy.29
Yet an emissions decrease of this magnitude by developed
countries only would prevent about 0.1 degree
of
warming30 According to the Economic Policy Institute,
implementation of the least restrictive current proposalwhich calls for returning U.S. GHG emissions to 1990
levels by 2010-could result in a loss of 1.5-2.6 million
new jobs and a GDP decrease of $17 trillion from 2005
to 2015.31
The FCCC divides signatory nations into two
groups: developed countries and developing countries.
According to the FCCC, developed countries must bear
the burden of mitigation efforts so that the economies of
developing countries are not hampered. Figure 5 (page
16) illustrates the futility of this concept as an approach to
decreasing total carbon-dioxide emissions. Increased fuel
consumption in China alone could neutralize any decrease
in GHG emissions achieved in developed countries.
Mitigation measures may be unnecessary (whether
increases in GHG emissions would cause significant global climate change is uncertain) and may be ineffective in
decreasing total GHG emissions. Furthermore, mitigation
measures may disrupt the economies of developed
nations, may impoverish developing nations, and may
hamper international-aid and public health programs.

c

C. Adaptational

Measures

Measures to suit human actions to current and foreseeable problems may be termed “adaptational.” The goal
of adaptational measures is to prevent or control real-life
problems rather than hypothetical future problems.
Throughout human history, societies have adapted to

environments by modifying their behavior-for example,
by planting crops whose growth the different climate
favored. Several adaptational measures are paramount
today and will continue to be important regardless of
whether global climate change occurs:
emergency-response and international-relief
programs;
programs to control disease-spreading insects;
adequate sewage treatment and the provision
of potable water;
the provision of adequate nourishment; and
the provision of basic medical services, especially
pre- and perinatal care and immunization.
Table 3 (page 17) lists other proposed adaptational
measures, most of which are sound.
The GBDSpredicts that by 2020 the incidence of
infectious diseases will have decreased dramatically in
many developing countries. And the IPCC estimates that
by that year the maximal global warming will be a few
tenths of a degree
Thus, a prudent approach to future
global climate change would be to fight infectious diseases
and improve sanitation and nutrition; to try to resolve the
many uncertainties about global climate change; and to
implement stringent mitigation measures if and when the
need for them becomes clear.

c.

IV. Conclusion
The health risks from projected human-induced
global climate change discussed in Climate change and
ffuman Health (Cc&“) have been compared with current and foreseeable health problems discussed in three
other documents: The Global Burden of Disease study and
the 1996 and 1997 editions of the world Health Report.
Most assertions of adverse health effects of projected
human-induced climate change rest on computer simulations.
One should consider the uncertainty of the hypothetical health outcomes of projected human-induced climate change in light of the 922,000 deaths in India in
1990 from preventable diarrheal disease. This is not to say
that the possibility of human-induced climate change is
an unimportant consideration in policymaking. But if

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

global climate change occurs as gradually as the
Intergovernmental Panel o n Climate Change has predicted, policymakers can safely take several decades to plan a
response, and scientists will have enough time to develop
cost-effective anti-climate-change strategies.
Implementation of current proposals for mitigation
measures-measures
to stabilize the concentration of
greenhouse gases in the atmosphere-would be both costly and ineffective.
Adaptational measures-measures to suit economies,
healthcare systems, and living conditions to real-life,
imminent, and foreseeable challenges to human health
(for example, infectious diseases and weather disasters)should be the central component of any policy whose
theme is the potential health impact of global climate
change. Implementation of adaptational measures would
improve human population health regardless of whether
global climate change occurs. Such measures include:

19

improvement in emergency responses to extreme
weather events, with coordinated international
efforts as required;
intensive cost-effective control of arthropod vectors,
especially in developing countries, to decrease mortality from infectious diseases;
improvement in drinking water and sanitation in
developing areas;
continued investment in climate change research;
continued investment in medical research, particularly in the area of infectious diseases;
continued investment in research concerning energy technologies that entail low greenhouse-gas
emissions: and
continued improvement in the economic and
health infrastructures of developing countries.
Implementation of all of the aforementioned measures is imperative now, regardless of the prospect of
human-induced climate change.

 GLOBAL CLIMATE CHANGE A N D HUMAN HEALTH

20

References

11. See Shanahan J. The unions vs. environmentalists.
ADTIIssue BriefNo. 148. April 8, 1997. Charles

1.

MoelIer DW. Environmental Health. Cambridge,
MA: Harvard University Press, 1997:196-197.

2.

World Health Organization. Executive Summary

world Health Report 1996: Fighting Disease,
Fostering Development. Geneva, Switzerland: World
Health Organization, 1996:6.

3.

AJ, Haines A, SIoof R, Kovats S (eds.).
Climate change and Human Health: An Assessment
pmpared by a Task Group on behalf of the World
Health organization, the world Meteorological
Organization and the united Nations En vironment
Programme. Geneva, Switzerland: WHO Document
McMichael

WHOlEHGl96.7; 1996.
4.

Water vapor is the only greenhouse gas termed
“major’’;it accounts for about 90 percent of the
greenhouse effect.

5.

Murray

CJL, Lopez AD. The Global Burden o f
Disease study, Global Burden of Disease and Injury
Series. Boston, MA: Harvard University Press;

World Health Organization. w o r d Health Report

1996: Fighting Disease, Fostering De velopment.
Geneva, Switzerland: World Health Organization,

1996.
7.

World Health Organization. world Health Report

1997. Conquering Suffering, Enriching Humanity.
Geneva, Switzerland: World Health Organization,

1997.

8.
9.

Lamb HH. Climate History and the Modern world.
New York, NY:Methuen and Company; 1985:387.

IPCC 1996, Climate Change 1995, The science of
Climate Change. Contribution of Working Group I
to the Second Assessment Report of the
Intergovernmental Panel on Climate Change.
Houghton J. et al. (eds.). Cambridge. UK:
Cambridge University Press; 1996.

10. Regarding the hypothesis that human actions

12. See Manne AS. Global Carbon Dioxide ReductionsDomestic and International Consequences. Special
Report. American Council for Capital Formation
Center for Policy Research. Washington DC, April
1995. According to the Center: (a) Under proposed
measures, the U.S. would agree to stabilize its carbon-dioxide emissions between 1990 and 2000,
decrease them to 80 percent of this level by 2010,
and stabilize them thereafter. (b) Accomplishing
this would result in a Gross Domestic Product
decrease of 1 percent annually by the year 2000
and a GDP decrease of nearly 2.5 percent annually
after 2020.

13. see Organized labor breaking ranks with adminis-

1996.
6.

River Associates, an econometric modeling firm,
has estimated that the Clinton administration’s plan
to restrict U.S. GHG emissions would cause (a) an
unemployment increase of 0.25 percent and (b) a
Gross Domestic Product decrease of 3.3 percent.
Based on current economic output, implementation
of the plan would cost $260 billion annually and
the average American household would be poorer
by nearly $2,700 a year.

will

cause significant global climate change, see, e.g..
Lindzen R. Ann. Rev Fluid Mechanics. 1994; 26:353.

tration on climate change treaty. EPA Watch. March
14, 1997:6-7. The Executive Council of the AFLCIO states that proposed measures “will create a
powerful incentive for transnational corporations to
export, jobs, capital, and pollution.” “Carbon taxes
or equivalent carbon emission trading programs,
will raise significantly electricity and other energy
prices to consumers. These taxes are highly regressive and will be most harmful to citizens who live
on fixed incomes or work at poverty-level wages.”

14. Wigley TML, Richels R, Edmonds JA. Economic
and environmental choices in the stabilization of
atmospheric
concentrations. Nature. 1996;

co2

379:240-243.
15. CC&HH Ta ble 3.5 :57.
16. Haines A. The possible effects of climate change on
human health. In: Chivian E. McCalIy M, H u H,
Haines A (eds.). Critical Condition: Human Health
and the Environment. Cambridge, MA: The MIT
Press: 1993.

 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

21

17. CC&HH52.

Presented at the National Forum o n Global
Climate Change, Columbus, Ohio, September 7,

18. McMichael AJ, Beers MY. Climate change and

1995.

human population health: Global and South
Australian perspectives. Transactions of the Royal

Society of S. Aust. 1994; 118:91-98.

19. Leemans R, Solomon AM. Modelling the potential
change in yield and distribution of the earth’s crops
under a warmed climate. Climate Research; 1993;

3:79-96.
20. Rosenzweig C. et al. Climate change and world
food supply. oxford: University of Oxford
Environmental Change Unit (ECU Research
Report No. 3); 1993.

I? World Food Zends and Future
Food Security. Washington, DC: International Food
Policy Research Institute (Food Policy Report
Series); 1994.

2 1. Pinstrup-Anderson

22. United Nations. Long-range world population prqiections: two centuries of population growth 1950-21 50.
New York: United Nations; 1992.

23. Lamb HH.Climate History and the Modern World.
New York, NY: Methuen and Company; 1985:305.
24. Cohen JE. How Many People Can the Earth
Support?New York, NY: W.W. Norton &
Company; 1995:532.

25. Shell ER. Resurgence of a deadly disease. Atlantic
Monthly. August 1997 :4 5.
26. Patz JA, Epstein PR, Burke TA, Balbus JM. Global
climate change and emerging infectious diseases.
JAMA. 1996; 275(3):217-223.

27. Martens WJM, Rothman JJ. Niessen LW. Climate
change and vector-borne diseases: A global modelling perspective. Global Environmental Change.
1995; 5(3):195-209.

28. Murray CJL, Lopez AD. Mortality by cause for
eight regions of the world: Global Burden of
Disease Study. The Lancet. 1997; 349:1269-1276.

29. Manne A, Richels R. The Berlin Mandate: the costs
of meeting post-2000 targets and timetables.

30. Bolin B. IPCC Report to the Fifth Session of the
SBSTA and Sixth Session of the AGBM.
February-March 1997.
3 1. Allen v. Leading scientists call for global warming
treaty. InfoBeat (Reuters), September 30, 1997.

 )I

A C S H

t

x

t

c

I~I

~V

s~

~

A

F

F

Elizabeth M. Whelan, Sc.D., M.P.H.
President
A C S H

Chairman

"

of the h a r d , ACSH
Institute for Regulatory Science
Zxm A&M University

Taiwo K. Danmola. C I A .
ArthwAndemn LLP
F. J. Francis. Ph.D.

D I R E C T O R S

D. Pmten

Stephen S. Stemberg, M.D.

Jerald L. Hill, Esq.

R.T. Ravenholt. M.D., M.P.H.

Lorraine Thelian

Population Health Imperatives

Ketchum Public Relations

Roger P. Maickel. Ph.D.

F&ck

Purdue University

Harvard School
of Public Health

Elizabeth M. Whelan. Sc.D., M.P.H.
P'ident,
ACSH
Robert J. White, M.D.. Ph.D.
Care Western Reserve University

Henry 1. Miller. M.D.

,

Fust co.

Memorial s/oan-KetteringCancer Center

J. Stare, M.D.. Ph.D.

Fredric M. Steinberg, M.D.
Mainstreet Health Care Inc.

Hoover Institution

Albert G. Nickel

Uniwm'tyof Mamchusetts

F

9
U

M.D.

Hill & hociates

Norman E. Borlaug. Ph.D.

O

Coming Clinical Laboratories

Raymond Gambino,

A. Alan Moehissi. Ph.D

H O A R V

Lpns Lavey Nickel Swifi, h c .

A C S H

Julie A. Albrecht, Ph.D.
U of Nebraska. Lincoln
Rosl n B. Alfin-Slater, Ph.D.
UdA
Thomas S. Allems, M.D., M.P.H.
Enviromed Health Servim Inc.

B O A R D

O F

S C I L N I I F I C

C. Jelleff Cam, Ph.D.
Columbia, MD
Robert G. Cassens. Ph.D.
Universiq of Wisconsin

James J. Cerda. M.D.
Universityof Florida

Dale J. Chodos. M.D.
American Institute of Nutrition (EASE@ Kalamazm. MI
Emil William Ch n, M.D.
John B. Allred. Ph.D.
Manhattan Ey,
Thmat Hospital
Ohio state University
Walter L. Clark. Ph.D.
Philip R. Alper, M.D.
chapman university
U of CaIihrnia. San Fmncisco
Dean 0. Cliver, Ph.D.
Dennis T. Avery
Richard G. Allison, Ph.D.

g&

A N V

P O L I C Y

A V V I S O H S

John. E. Dodes, D.D.S.

K. H. Ginzel. M.D.

National Council Against Health Fraud

University of Arizona

John Doull, Ph.D., M.D.

William Paul Glezen, M.D.

Universityof Kansas
Therun W. Downes, Ph.D.
Michigan state university
Adam Drewnowski. Ph.D.
Universityof Michigan

Michael A. Dubick. Ph.D.
U S Arm Institute of
surgical i m m h
Edward R. Duffie Jr.. M.D.
Savannah, GA

Bayor College of Medicine

Ja Alexander Gold. M.D., J.D.,
XPH.
Medical College of Wisconsin

Roger E. Gold. Ph.D.
Exas A&M University
Timothy N. Gorski, M.D.
Arlington, TX

Ronald E. Gob. M.D., Ph.D.
National MedicaJ Advisoy &vim

Michael Gough. Ph.D.

Robert S. Baratz. D.D.S., Ph.D.,
M.D.

E M. Clydesdale, Ph.D.

Boston University school
of Medicine

Donald G. Cochran, Ph.D.

James R. Dunn, Ph.D.
Averill Park, NY
Robert L. DuPont. M.D.
DuPont hwiates, PA.
Henry A. Dymsza. Ph.D.

Viiginia Polflechnic Institute & state
University

Universityof Rhode Island

Harvard Center for Risk AnaIFs

Michael W. Fasley, D.D.S., M.P.H.

James Ian Gray, Ph.D.

Hudson htitute

Universityof California,
Davis

University of Marrachusettc

Stephen Barrett, M.D.
Allentown, PA
Walter S. Barrows Sr., P1i.D.
Carpinteria. CA
Thomas G. Baumgartner. M.Ed..
Pharm.D.
university of Florida. Gainesville

Blaine L. Blad. Ph.D.

W. Ronnie Coffman. Ph.D.
Cornel/ Uriiversity

Bernard L. Cohen. D.Sc.
Universityof Pittrburgh

Neville Cohan, M.D.. Ph.D.

Cat0 Institute

Henry G. Grabowski, Ph.D.
Duke University

John D. Graham. Ph.D.

State Universityof New hrk

Michigan state University

Michael PI Ekton, M.D.

William W. Greaves. M.D., M.S.P.H.

Rapid City Regional Hospital

Medical College of Wisconsin

James E. Enstrum. Ph.D., M.P.H.

Saul Green. Ph.D.
Zol Consultants. Inc.
Richard A. Greenberg, Ph.D.
Himdale. IL
Gordon W. Gribble. Ph.D.

UCLA

Univenityof Nebraska

St. Lukei Rmevelt
Hospital Center

Hinrich L. Bohn. Ph.D.

Gerald E Combs, Jr., Ph.D.

Univenity of Arizona
Ben Wilsman Botch. Ph.D.
Rhodes Co&e

Cornell University

Teny D. Etherton, Ph.D.
Pennqivania State University

Michael D. Corbett, Ph.D.

Sidney A. Ewing, Ph.D.. D.V.M.

William Grierson, Ph.D.

Oklahoma state univenity

J. E Borzelleca, Ph.D.

Eliot

University of Florida
Lester Grinspoon, M.D.
Harvard Medical schoo/

Eppey Institute for Cancer Research

Corday, M.D.

Medical College of Eiginia

Cedars-SinaiMedical Center

Michael K. Botts. Esq.
Presmtt, WI
Michael B. Bracken, Ph.D., M.P.H.

Roger A. Coulombe. Ph.D.
Utah State University

H. Russell Cross, Ph.D.

ya/e University

Exas A&M University

George A. Bray, M.D.

Charles R. Curtis, Ph.D.

Pennington Biomedical ReseaKh Center

Ohio State Univeixity

Allan

Brett, M.D.

Ilene

R. Danse, M.D.

University of South Carolina

Eriviromed Health Servies

Christine M. Bruhn. Ph.D.

Ernst M. Davis, Ph.D.

Center for Consumer Reseairh

U of Trxas at Houston

Gale A. Buchanan, Ph.D.

Harry G. Day, Sc.D.

E.
D.V.M., Ph.D.
P
arvard school of Public Health
n

hex.

Daniel E Farkas. Ph.D.
Oregon State Uniwrsity

Richard S. Fawcett. Ph.D.
H d e j IA
John B. Fen er. M.D.

2

Phoenix,
Owen R. Fennema, Ph.D.
Universityof Wisconsin

Madelon Lubin Finkel, Ph.D.
Corndl Univenity

Jack C. Fisher, M.D.

University of Georgia

Indiana Univenity

U of Calibrnia, San Diego
Kenneth D. Fisher, Ph.D.
Commirrion on D i e t q Supplement

Edward E. Bums, Ph.D.

Jerome J. DeCosse, M.D.

Labels

N. Y Hospital-Cornell
Medical Center

Exas A&M University

Francis F. Busta, Ph.D.
Univenityof Minnesota

Thomas

Ogbourne Butler, Ph.D.
College Station, TX
Earl L. Butz. Ph.D.

Robert

Piirduc

R. DeGregori. Ph.D.

Uhivenity of Houston

M. Devlin. Ph.D.

Univenity of Massachusetts

Seymour Diamond, M.D.

Un,versity

William G. Cahan. M.D.

L)i;l,iiondHeadache Clinic

Memorial Sloari-Ketrwing
Cancer Center

Donald C. Dickson. M.S.

Elwood E Caldwell. Ph.D.. M.B.A

John Diebold
nie Uirfn)ldInstitute for Public policy

University of Minnrsota

Barbara N. Canipai

ne,

Ph D

Aiiieikan Collegr of &ort.r

Zerle L. Carrnter. Ph.D.
Trxas A&M

niveiJity System

Gilbert. AZ
StlIdIPS
Ralph E
Huurtoii.

Dittman. M.D.. M.PH

TX

Leonard T. Flynn,
Morganville. NJ

Ph.D., M.B.A.

Emory University
leman.

Helen A. Guthrie, Ph.D.
Pennqlvania State University

Philip S. Guzelian. M.D.
university of Colorado
Alfred

E. H a p Ph.D.

University of isconsin

Robert D. Havener
.%hang, CA
Virgil W. Ha s Ph D
university o/kntuiky.

Dwight B. Heath, Ph.D.
Brown Univenity

Norman D. Heidelbaugh. V.M.D..
M.P.H., S.M., Ph.D.
Exas A&M University

William H. Foege, M.D., M.P.H.
Ralph W. Fo

Dartmouth College

Zane R. Helsel. Ph.D.
Rugers Univenity

D.V.M.

L. M. Henderson, Ph.D.

Upper Black Eddy. PA

Univeniry of Minnesota

E.M. Foster, Ph.D.

Victor

Universityof Wi'onsin

Bmnx VrtemnsAffairs Medical Cenitei

Glenn Froning. Ph.D.

John

U of Nebraska, Lincoln

Arthur

Furst. Ph.D.. Sc.D.

Herbert. M.D., J.D.

Higginson. M.D., ER.C.P.

Savannah. GA

Richard M. Hoar, Ph.D.

Uriiveixity of San FranciJco

Wilhainistown. MA

Charles 0.Gallina. Ph.D.

John H. Holbrook. M.D.

Ill/nois Dept. of Nuclear Sakty

university of Utah

LaNelle E. Geddes, Ph.D.. R.N.
Piiidue University

 A C S H

B O A R D

O

t

S C l E N r l F l C

A N D

I ' O L I C Y

A V V I S O H S

Edward S. Horton. M.D.

Henry G. Manne. J.S.D.
&w Mason University
Karl Maramomh. Ph.D.

Jdin Diabetes Center

Rutgen University

Corm11 University

Colorado State University

Joseph H. Hotchkiss. Ph.D.

Judith A. Marlett. Ph.D., R.D.

Charles Polk, Ph.D.
Universityof Rhcde bland
Gary l? Posner. M.D.
Tamp, FL
John J. Powers, Ph.D.

M p n Solber Ph.D.

Robert M. Hollingworth. Ph.D.
Michigan State University

Corm11 Univenity

University of Wimmin, Madison

Susanne L. Huttner. Ph.D.
IY of California. Berkeley
Lucien R. Jacobs, M.D.
UCLA Srhczdof Medicine
Rudolph J. Jaeger, Ph.D.

James R. Marshall, Ph.D.
Arizona Cancer Center

James D. McKean, D.V.M.. J.D.
Iowa State Uiwnity
John J. McKetta. Ph.D.
Univenity of Texac.
Amtin

Envimnmental Medicine. lnc.
G. Richard Jansen. Ph.D.
Colorado state Univenity

Donald J. McNamara, Ph.D.

William T. Jarvis, Ph.D.

Patrick J. Michaels, Ph.D.

Loma Linda University
Edward S. Josephson, Ph.D.
Uniwm'tyof Rhode Island

Universjrv of Kginia

Michael Kamrin. Ph.D.

&Nutrition Center

Thomas H. Milby, M.D.. M.P.H.
Walnut creek, CA
Joseph M. Miller. M.D., M.P.H.

Michigan State Lhivenity

University of New HampshiR

John B. Kaneene,

WilliamJ.Miller,p h , ~ .

Ph.D.

D.V.M., M.P.H..

Michigan State Univenity
Philip G. Keeney, Ph.D.
Pennsylvania State University

John G.Keller. Ph.D.
Olnej MD
George R. Kerr, M.D.
University of Teas
George A. Ke orth 11. Ph.D.

University of &@a

Mary Frances Picciano. Ph.D.
Pennsylvania State Univem'ty

Thomas T Poleman. Ph.D.

Uniwm'ty of &@a

Robert A. Squire, D.V.M.. Ph.D.
Johm Hopkinr Unin?nity

Daniel J. Raiten. Ph.D.
FASEB
Russel J. Reiter. Ph.D.. D.Med.
Universiyof E x a
John H. Renner, M.D.

James H. Steele, D.V.M.. M.P.H.
Univeniyof Teas
Robert D. Steele. Ph.D.

Consumer Health Information Rsearrh
lmtitute

Rita Ricardo-Campbell, Ph.D.

Pennsylvania State Univenity

Mark A. Roberts, M.D., Ph.D.

Grace P. Monaco, J.D.
Medical Can?M p t . Corp.

Medical Collqe of Wisconrin

William 0.Robertson, M.D.
Universityof Mington

Brian E. Mondell. M.D.

J. D. Robinson, M.D.

John c. Kirsfhman. Ph.D.
Emmaus. PA
Ronald E. Kleinman, M.D.

Baltimo~Headache Imtitute
Eric W. Mood. LL.D.. M.P.H.
Yale Univem'ty

&p Washington University
David B. Roll, Ph.D.
Univenity of Utah

John €? Morgan, M.D.
City University of New hrk
John W. Morgan, Dr.P.H.

Dale R. R o m s . Ph.D.
Steven T. Rosen, M.D.

Mamchussettc Genera/ Hospital
K a t F M. Kola,sa. Ph.D.. R.D.
East amhna Univenity

Loma Linda Uniwsity

Northwtem University Medical school

W. K. C. Morgan, M.D.

Kenneth J. Rothman. Dr.P.H.

Univenity Hmpital, Ontario

Newton Lower Falls, MA

Stephen J. Moss. D.D.S., M.S.
David B. Kriser Dental Center
Ian C. M u m . Ph.D.
CanE x , hc.
Kevin B. Murphy

Stanley Rothman, Ph.D.

Pmgm and &om

Foundation

Michael Kirsch, M.D.
Highland Heigho, OH

Herman F. Kraybill, Ph.D.
Olne): MD
David Kritchevsky, Ph.D.
7he wistar Institute. Philadelphia

Manfred Kro er, Ph.D.

Merrill Lynch, Piem, Fermer & smith

univenity ofdiraska
Leonard T. Sperry, M.D., Ph.D.
Medical College of Wimndn

Universiyof British Columbia
Kenneth M. Prager. M.D.
Columbia Pmbyterian Medical center

Dade W. Moeller, Ph.D.
Harvad School of Public Health

cook collqe, ktgen Uniwnity

Roy E Spaldin Ph.D.

William D. Powrie. Ph.D.

Hoover Imtitution
Barbara K. Rimer, Dr.P.H.
Duke UNm'tyMedid &ter

John A. Miher. Ph.D.

Robert B. Sklaroff. M.D.
E/km Pa&, PA
Gary C. Smith. Ph.D.

Michigan state University

Smith College
Edward C. A. Runge. Ph.D.
Exas A&M University

Stephen H. Safe. D.Phil.
Exas A&M Univenity
Paul D. Saltman. Ph.D.

Ronald T. Stanko, M.D.
University of Pimblrbwgh

Pennsylvania State University

Judith S. Stem, Sc.D.
,yniWm.tyof califomia, ~~~h

C. Joseph Stetler, Fkq.
Bethesda, MD
Martha Barnes Stone, Ph.D.
Colorado State Univenity

Glenn Swogger Jr., M.D.
Epeka, KS
Sita R. Tatini. Ph.D.
University ofM i m t a
Mark C. Taylor, M.D.
Physicim for a Smoke-Free Canada

Steve L. Taylor. Ph.D.
University of Nebraska

Murray M. Tuckerman. Ph.D.
Winchendon Springs, MA
Joe B. Tye. M.S.. M.B.A.
Varro E. Tyler, Ph.D., Sc.D.
Purdue Univem'ty

Robert l? Upchurch, Ph.D.
University of Arizona

Mark J. Utell. M.D.
U of Rochester Medicd h t e r
Shashi B. Verma. Ph.D.
U of Nebmka, Linmh
Willard J. Visek. Ph.D.. M.D.

Pennylvania &ate Univenig
J. Laurence Kulp. Ph.D.
Federal Wa): WA

Philip E. Nelson. Ph.D.
Purdue Univem'ty

LI. of California.San Diego

University of IuinoiF

CarolynJ.Lacke P h D R D

Malden C. Nesheim, Ph.D.

Wallace I. Sampson, M.D.
stanhod U school

W. E Wardowski. Ph.D.

of Medicine

Miles Weinberger, M.D.

Harold H. Sandstead. M.D.
Universityof Teas Medical Bmnch
Herbert l? k t t . Ph.D.
Samta. FL
Lowell D. Satterlee. Ph.D.

University of Iowa Hmpitah
and Clinim

~orth
Carolina dite UGenity'

Cornell University

J. Clayburn LaForce. Ph.D.
UCLA
Lawrence E. Lamb
Santa Barbam. CA
Lillian Langseth, Dr.P.H.
Lyda Amxiate, hlisades, NY
Larry Laudan. Ph.D.

John S. Neuberger, Dr.P.H.
University of Kanm
Gordon W. Newell. Ph.D.
Palo Alto, CA
James L. Oblin er. Ph.D.
North Camlina state Univenity

Richard Oksas. M.l?H.. Pharm.D.
National Autonomous Univenity of Mexico Medicationmomation
srvice
Brian C. Lentle, M.D.
J. E. Oldfield. Ph.D.
kncouwr General Haspita/
Oregon State University
Floy Lilley, J.D.
Stanley T. Omaye. Ph.D.
Univenityof ex as^ Austin
University of Nevada
Bernard J. Lika. Ph.D.
Jane M. Orient, M.D.
Purdue University
Tuuon. AZ
James A. Lowell, Ph.D.
Pima Community Co1lese
M. Alice Ottoboni. Ph.D.
Sparks, N V
Frank C. Lu. M.D.
Miami, FL
Loren Pankratz. Ph.D.
Oregon Health Scienm University
William M. Lunch. Ph.D.
Oiegon Stare Univenity
Michael W. Pariza, Ph.D.
Daryl Lund. Ph.D.
Univenity of Wisconsin
Corne// University
Albert M. Pearson, Ph.D.
Harold Lyons, Ph.D.
Oqon State University
Rhodes College
Timothy Dukes Phillips, Ph.D.
Exas A&M University
Howard D. Maccabee. Ph.D.. M.D.
Radiation Onco/ogy Center

OMahoma State Uniwrsity

Marvin
J. Schissel. D.D.S.
Wdhaven, NY
Barbara Schneeman, Ph.D.
Unim'tyof Cali/onia. Davis
Edgar J. Schoen, M.D.
Kaiser Permanente Medical Center

Patrick J. Shea, Ph.D.

University of Florida

Scott T. Weiss. M.D.
Harvard Medical School

Steven D. Wexner. M.D.
Cleveland Clinic, FL
Joel
E. White, M.D.
Radiation Onmlogy Gnter
Carol Whitlock, Ph.D.. R.D.
Rochster h t . of T~hnology

Christopher F. Wilkinson, Ph.D.
T~hnology
Services Gmup, hc.
Carl K. Winter, Ph.D.

Univem'tyof Nebraska. Lincoln

University of California,Davis

Sidney Shindell, M.D.. LL.B.

James J. Worman, Ph.D.

Medica/ Co//ge of Wismmin

Rochester Imtitute of T~hnology

Sarah Short. Ph.D.. Ed.D.. R.D.

James Harvey Young, Ph.D.

Syracux University
A. J. Siedler, Ph.D.
Univenig of Minois

Panayiotis Michael Zavos, Ph.D.

Jutian L. Simon, Ph.D.

Ekhard

univenjty of Maryland

University of Iowa

EmoIy Univem'g

Univenip of Kentucky

S. Fred S i n p , Ph.D.
Science & v~mnmental
Policy Pmject

The opinions expreued in ACSH publicariuns do nor necessarily reprererir rhe views of all ACSH Directom and Advimm
ACSH Dtrrcrors and Advisas ierve wirlioor coinpensarion.

E. Ziegler, M.D.