Climate Change and Developing-Country Cities: Implications For Environmental Health and EquityAbstractINTRODUCTIONURBAN HEALTH VULNERABILITIES TO GLOBAL CLIMATE CHANGEHeat WavesFloods and StormsCommunicable DiseasesAir PollutionIMPROVING URBAN HEALTH WHILE PROTECTING THE GLOBAL CLIMATEDISCUSSIONCONCLUSIONSReferencesJournal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 84, No. 1doi:10.1007/s11524-007-9170-x* 2007 The New York Academy of MedicineClimate Change and Developing-Country Cities:Implications For Environmental Health and EquityDiarmid Campbell-Lendrum and Carlos Corvala´ nABSTRACT Climate change is an emerging threat to global public health. It is alsohighly inequitable, as the greatest risks are to the poorest populations, who havecontributed least to greenhouse gas (GHG) emissions. The rapid economic develop-ment 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 healthvulnerabilities of urban populations in developing countries and highlight the range oflarge 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 healthand cutting GHG emissions most obviously through policies related to transportsystems, urban planning, building regulations and household energy supply. Theseinfluence some of the largest current global health burdens, including approximately800,000 annual deaths from ambient urban air pollution, 1.2 million from road-trafficaccidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor airpollution. GHG emissions and health protection in developing-country cities are likelyto become increasingly prominent in policy development. There is a need for a moreactive input from the health sector to ensure that development and health policiescontribute to a preventive approach to local and global environmental sustainability,urban population health, and health equity.KEYWORDS Climate change, Cities, Energy, Equity, Health, Transport.Abbreviations: IPCC – Intergovernmental Panel on Climate Change; GHG – green-house gas; WHO – World Health OrganizationINTRODUCTIONWhoever wishes to investigate medicine properly, should proceed thus: inthe first place to consider the seasons of the year, and what effects eachof them produces for they are not at all alike, but differ much fromthemselves in regard to their changes. Then the winds, the hot and thecold, especially such as are common to all countries, and then such as arepeculiar to each locality. In the same manner, when one comes into a cityCampbell-Lendrum and Corvala´n are with the Department of Public Health and Environment, WorldHealth Organization, Geneva 27, Switzerland.Correspondence: Diarmid Campbell-Lendrum, Department of Public Health and Environment, WorldHealth Organization, 20, Avenue Appia, 1211, Geneva 27, Switzerland. (E-mail: [email protected])i109to which he is a stranger, he ought to consider its situation, how it lies asto the winds and the rising of the sun; for its influence is not the samewhether it lies to the north or the south, to the rising or to the settingsun.—Hippocrates (BAirs, waters, and places.^ Approx. 350BC)Emissions of the greenhouse gases (GHGs) which cause climate change arecurrently determined mainly by consumption patterns in cities of the developedworld. The most recent completed report of the Intergovernmental Panel onClimate Change (IPCC)1reported that in 1990, buildings were responsible forapproximately 20% of global emissions. Transport was estimated to contribute to13% of GHG emissions, with the total contribution expected to more than doubleby 2020. In addition to the direct effects on the environment, the increasingrequirements of urban populations also cause Bdisplaced^ effects on ecosystemservices in other locations. For example, the agriculture sector increasinglyproduces and transports food and fiber for urban populations in rich countries.Agricultural production and waste contributed 18% of GHG emissions in 1990,with total emissions estimated to increase by about 50% by 2020,1and can degradeland and water resources.2The forthcoming fourth assessment report of the IPCC,due for publication throughout 2007, is expected to confirm the broad pattern andapproximate magnitude of these trends and their climatic impacts.Currently, populations of low- and middle-income countries have a much lowerimpact on the global environment. Per capita emissions of GHGs in the USA, forexample, are over seven times higher than in China and 19 times higher than inAfrica.3This underscores the urgency of actions to reduce GHG emissions in alldeveloped countries. However, while the impact of each individual citizen indeveloping countries will remain lower than in developed country counterparts forthe foreseeable future, these populations are simultaneously urbanizing, growing,and increasing consumption rates. In the clearest example, China is poised toovertake the USA as the largest single emitter of carbon dioxide before 2010.3Decisions made in developing-country cities in the next few decades will thereforebe among the most important determinants of new and future local and globalenvironmental stresses.4These trends have two major implications for public health. First, they requirea reconsideration of policies to protect health from climate-related threats in citiesof the developing world.5Secondly, there is likely to be an increasing attention paidto policies that can reduce GHG emissions, many of which also have major directhealth consequences. Decision makers would therefore benefit from assessmentsthat can assist them to select development policies that can bring synergies oroptimize trade-offs between protecting the local and global environment while alsobringing health gains.2URBAN HEALTH VULNERABILITIES TO GLOBALCLIMATE CHANGEThe IPCC has assessed that the global mean temperature is likely to rise by 1.4–5.8-C between 1990 and 2100 with associated changes in the hydrological cycle.These will cause a range of health impacts.6A World Health Organization (WHO)quantitative
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