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Background: The need to identify and try to prevent adverse health impacts of climate change has risen to the forefront of climate change policy debates and become a top priority of the public health community. Given the observed and projected changes in climate and weather patterns, their current and anticipated health impacts, and the significant degree of regulatory discussion underway in the U.S. government, it is reasonable to determine the extent of federal investment in research to understand, avoid, prepare for, and respond to the human health impacts of climate change in the United States.

Objective: In this commentary we summarize the health risks of climate change in the United States and examine the extent of federal funding devoted to understanding, avoiding, preparing for, and responding to the human health risks of climate change.

Discussion: Future climate change is projected to exacerbate various current health problems, including heat-related mortality, diarrheal diseases, and diseases associated with exposure to ozone and aeroallergens. Demographic trends and geophysical and socioeconomic factors could increase overall vulnerability. Despite these risks, extramural federal funding of climate change and health research is estimated to be < $3 million per year.

Conclusions: Given the real risks that climate change poses for U.S. populations, the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, and other agencies need to have robust intramural and extramural programs, with funding of > $200 million annually. Oversight of the size and priorities of these programs could be provided by a standing committee within the National Academy of Sciences.

Background: According to a wide variety of analyses and projections, the potential effects of global climate change on human health are large and diverse. The U.S. National Institutes of Health (NIH), through its basic, clinical, and population research portfolio of grants, has been increasing efforts to understand how the complex interrelationships among humans, ecosystems, climate, climate variability, and climate change affect domestic and global health.

Objectives: In this commentary we present a systematic review and categorization of the fiscal year (FY) 2008 NIH climate and health research portfolio.

Methods: A list of candidate climate and health projects funded from FY 2008 budget appropriations were identified and characterized based on their relevance to climate change and health and based on climate pathway, health impact, study type, and objective.

Results: This analysis identified seven FY 2008 projects focused on climate change, 85 climate-related projects, and 706 projects that focused on disease areas associated with climate change but did not study those associations. Of the nearly 53,000 awards that NIH made in 2008, approximately 0.17% focused on or were related to climate.

Conclusions: Given the nature and scale of the potential effects of climate change on human health and the degree of uncertainty that we have about these effects, we think that it is helpful for the NIH to engage in open discussions with science and policy communities about government-wide needs and opportunities in climate and health, and about how NIH’s strengths in human health research can contribute to understanding the health implications of global climate change. This internal review has been used to inform more recent initiatives by the NIH in climate and health.

Objective: Because the state of the atmosphere determines the development, transport, dispersion, and deposition of air pollutants, there is concern that climate change could affect morbidity and mortality associated with elevated concentrations of these gases and fine particles. We review how climate change could affect future concentrations of tropospheric ozone and particulate matter (PM), and what changing concentrations could mean for population health.

Data sources: We review studies projecting the impacts of climate change on air quality and studies projecting the impacts of these changes on morbidity and mortality.

Data synthesis: Climate change could affect local to regional air quality through changes in chemical reaction rates, boundary layer heights that affect vertical mixing of pollutants, and changes in synoptic airflow patterns that govern pollutant transport. Sources of uncertainty include the degree of future climate change, future emissions of air pollutants and their precursors, and how population vulnerability may change in the future. Given these uncertainties, projections suggest that climate change will increase concentrations of tropospheric ozone, at least in high-income countries when precursor emissions are held constant, which would increase morbidity and mortality. Few projections are available for low- and middle-income countries. The evidence is less robust for PM, primarily because few studies have been conducted.

Conclusions: Additional research is needed to better understand the possible impacts of climate change on air pollution–related health impacts. If improved models continue to project higher ozone concentrations with climate change, then reducing greenhouse gas emissions would enhance the health of current and future generations.

The health sector component of the first U.S. National Assessment, published in 2000, synthesized the anticipated health impacts of climate variability and change for five categories of health outcomes: impacts attributable to temperature, extreme weather events (e.g., storms and floods), air pollution, water- and food-borne diseases, and vector- and rodent-borne diseases. The Health Sector Assessment (HSA) concluded that climate variability and change are likely to increase morbidity and mortality risks for several climate-sensitive health outcomes, with the net impact uncertain. The objective of this study was to update the first HSA based on recent publications that address the potential impacts of climate variability and change in the United States for the five health outcome categories. The literature published since the first HSA supports the initial conclusions, with new data refining quantitative exposure–response relationships for several health end points, particularly for extreme heat events and air pollution. The United States continues to have a very high capacity to plan for and respond to climate change, although relatively little progress has been noted in the literature on implementing adaptive strategies and measures. Large knowledge gaps remain, resulting in a substantial need for additional research to improve our understanding of how weather and climate, both directly and indirectly, can influence human health. Filling these knowledge gaps will help better define the potential health impacts of climate change and identify specific public health adaptations to increase resilience.

The debate about whether global environmental change is real is now over; in its wake is the realization that it is happening more rapidly than predicted. These changes constitute a profound challenge to human health, both as a direct threat and as a promoter of other risks. We call on health care providers to inform themselves about these issues and to become agents of change in their communities. It is our responsibility as clinicians to educate patients and their communities on the connections between regressive policies, unsustainable behaviors, global environmental changes, and threats to health and security. We call on professional organizations to assist in educating their members about these issues, in helping clinicians practice behavior change with their patients, and in adding their voices to this issue in our statehouses and Congress. We call for the development of carbon- and other environmental-labeling of consumer products so individuals can make informed choices; we also call for the rapid implementation of policies that provide tangible economic incentives for choosing environmentally sustainable products and services. We urge the environmental health community to take up the challenge of developing a global environmental health index that will incorporate human health into available “planetary health” metrics and that can be used as a policy tool to evaluate the impact of interventions and document spatial and temporal shifts in the healthfulness of local areas. Finally, we urge our political, business, public health, and academic leaders to heed these environmental warnings and quickly develop regulatory and policy solutions so that the health of populations and the integrity of their environments will be ensured for future generations.

Background. The generation and management of solid waste pose potential adverse impacts on human health and the environment.

Objective. The present study examines the operational performance of municipal solid waste (MSW) disposal in the Wa Municipality, Ghana.

Methods. The study applied both qualitative and quantitative research methods and modelled the Wa Municipality's MSW disposal system using the municipal solid waste decision support tool (MSW DST). Acid gases (sulphur oxides and nitrogen oxides) and total particulate matter that have a direct impact on human health were set as the objective functions for modelling five MSW disposal scenarios. The modelled scenarios were: 1) landfill disposal only; 2) composting and landfill disposal; 3) composting, incineration, refuse derived fuels (RDF) and landfill disposal; 4) separation, composting, incineration, RDF and landfill disposal; and 5) separation, transfer, material recovery, composting, incineration, RDF and landfill disposal. The pollutants chosen as indicators for substance flow analysis included lead, cadmium, arsenic, mercury, copper, chromium, and zinc.

Results. Scenarios 4 and 5 produced the least engineering cost of 1 150 000 US $/year for the entire MSW disposal system, whereas scenario 2 produced the highest cost of 1 340 000 US $/year. Scenario 5 produced the least average health impacts of −5.812E-04 lbs/year, while scenario 2 generated the highest engineering cost and produced the highest average health impact of 9.358E-05 lbs/year. Scenarios 5 and 4, which included waste-to-energy conversion in the systems, produced the lowest average health impacts (−5.812E-04 lbs/year and −5.611E-04 lbs/year, respectively).

Conclusions. The adoption of an integrated solid waste management concept, including waste-to-energy technologies, will not only help to lessen MSW disposal hazards, but also to produce alternative sources of energy for Ghana and other developing countries.

Competing Interests. The authors declare no competing financial interests