Weather, Climate and Health

ISBN 92-63-10892-7

NOTE The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Meteorological Organization concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. CONTENTS

Page

FOREWORD 5

INTRODUCTION ...... 7

WEATHER AND CLIMATE INFLUENCES ON HUMAN HEALTH AND WELL-BEING 8 Humans are adapted to their local climate 9 Heatwaves ...... 10 Air pollution and weath;r ...... 12 Climate variability, El Nino/Southern Oscillation and epidemics ...... 13

GLOBAL CLIMATE CHANGE AND HUMAN HEALTH .. '...... 16 Stratospheric ozone depletion and human health ...... 18 Food and water supply...... 20 Climate change and vector-borne diseases 21

PLANNING AND OPERATING IN HARMONY WITH CLIMATE AND WEATHER .. 24 Biometeorology and bioclimatology 24 Building design and urban planning 26 Disaster mitigation ...... 28 Heat health watch warning systems 29 Food security, environment and sustainable development 32

CONCLUSION ...... 34

HOW TO FIND OUT MORE ...... 36 FOREWORD

Each year, World Meteorological Day is low-level ozone are often linked to asthma celebrated on 23 March to commemorate and other respiratory diseases, especially the coming into force of the Convention of in urban areas. The depletion of the the World Meteorological Organization protective ozone layer in the upper parts (WMO) in 1950. For each anniversary, of the atmosphere leads to greater expo WMO selects a theme which highlights the sure to harmful ultraviolet radiation from contribution of meteorology and opera the sun, resulting in increased cases of tional hydrology to an issue of importance skin cancer, especially among people to humanity. For the 1999 World of temperate latitudes, and the weakening Meteorological Day, WMO has chosen to of the immune system of humans and focus on the impact of weather and animals. climate on health with the theme Weather; Furthermore, extreme weather events, Climate and Health. This is particularly such as tropical cyclones and severe appropriate in the light of human suffering floods, cause loss of life and the destruction as a consequence of the many recent of property and often create favourable natural disasters around the world. conditions for the transmission of various Human beings have a great capacity diseases. In particular, such events destroy to adapt to varied climates and environ food supplies and contaminate freshwater, ments, but they are still vulnerable to causing malnutrition and the spread of marked changes in meteorological condi certain diseases such as diarrhoea and tions. Refugees, children and elderly cholera. Severe droughts have similar people are particularly sensitive. Illnesses socio-economic and health impacts that and deaths due to extreme heat or sudden develop more slowly and are generally cold temperatures are common. In some longer-lasting and more widespread. parts of the world, the onset of rainfall In addition, it is recognized that the often results in an outbreak of endemic predicted global warming and the result diseases such as malaria and cholera. The ing climate change are likely to affect the airborne transport of pollutants and pollen, health of human populations in the future. the incidence of acid rain and toxic For instance, a warmer world may cause a deposits that contaminate farmlands, spread of vector-borne diseases into some forests, water sources and fish stocks, all non-tropical parts of the world. A signifi depend on prevailing meteorological cant portion of the world's vegetation conditions. Smog and toxic gases including types would change, and some medicinal plants and animal species could become I wish to thank Dr Anthony Since our earfy extinct. Climate change would also have McMichael, Professor of Epidemiology at ancestors first an impact on the availability of freshwater, the London School of Hygiene and wa[R!a the 'Earth/ particularly for domestic and agricultural Tropical Medicine, for overseeing this the rhythms of use, and a rise in sea level would cause booklet and Sari Kovats for preparing the saltwater contamination of underground excellent manuscript. I hope that the infor nature/ or the water supplies. mation provided and the activities of annua[ march of WMO therefore places high priority on World Meteorological Day will serve to the seasons/ seea the enhancement of the capabilities of the draw the attention of governments, the time anaha17Jest/ national Meteorological and Hydrological public and the international, regional and Services (NMHSs) to adequately monitor national health authorities to the linkages cora anaheat/ aay and predict the weather and climate between climate, weather and health, and ana night/ have conditions which contribute to health t; the role of WMO and the NMHSs' in pe17Jaaea a[[ problems, and for the provision of timely contributing to a safer and healthier world aspects ofhuman advice to mitigate the impacts. for future generations. enaeavour. Settfements ana civi[izations have risen anafa[fen in concert with shifts in the patterns of (G.O.P. Obasi) the 'Earth/s Secretary-General cfimate. 7 INTRODUCTION

We have long been aware that weather Every species on the planet is biolog and climate affect health and well-being. ically adapted to its local climate, as part Two and a half thousand years ago, of its environment. This includes the human Hippocrates wrote about regional differ species. We, however, have the unique ences in climate and their relationship to ability to deliberately modify our environ states of health. Folklore everywhere is ment. Thus our behaviour, buildings and rich in wisdom and belief about the effect societies are also adapted to the local climate. A considerabLe vaLue of the seasons and weather fluctuations In recent years, there have been new from meteoroLogicaL upon human health. "Fevers" (which, over insights into climate variability and regularly observations is past centuries, have inclwded a multitude occurring phenomena that influence world the contribution of infections) vary seasonally; so do mood weather. The El Nifio event of 1997/98 made to the health and various psychological disorders; joint had a significant impact on weather across ofhumanity aches and pains flare up in the winter; and the globe. It brought drought, floods and (Bureau of Meteorology, heatwaves can kill, particularly the very rains, and U: triggered epidemics. Australia) young and the very old. The balance of evidence now The climate is a resource that suggests that there is a discernible human provides for the necessities of life. influence on the global climate. Significant Throughout the ages, human beings have changes in climate in the next hundred adapted to this resource by arranging years and beyond are projected. These shelter, food production, energy provision impending changes have focused new and lifestyles in harmony with climate and attention on the health consequences of environmental conditions in general. Our climate and weather. There are still many needs and productivity are linked in subtle uncertainties as to how each and every ways to the climate and the seasons. species will respond to climate change. 8 WEATHER AND CLIMATE INFLCIENCES ON HCIMAN HEALTH AND WELL-BEING [n popular terms, weather is what we the sick season because malnutrition experience on a day-to-day basis. Climate increases vulnerability to infection and means the "average weather" and its exposure to tropical diseases is greatest. longer-term variability over a particular Today, epidemiological research period or over a month, season, year or the study of the distribution and determi several years. nants of disease and injuries in We are most aware of the weather populations - is the principal scientific when it is hot or cold, or very wet or very discipline used to study how disease dry. [t is the extremes of weather that have relates to weather and climate. There is, the most devastating impacts on human however, a long history of attempts to health and well-being. Storms, tropical assess this relationship. [n Roman times, cyclones and floods kill many thousands for example, the architect Vitruvius Pollio of people every year. Non-catastrophic describes how, in selecting a site for a new weather can also have varied and signifi settlement, animals who had grazed there cant impacts on human health. For were sacrificed and their livers examined. example, weather affects the level of air [f the livers were greenish yellow in pollution in a city; rainfall can increase the colour, the area was considered healthy. local population of malaria mosquitoes. Nowadays, less colourful measures are The link between weather and disease used in epidemiology. is illustrated by the seasonality of many Epidemiologists have traditionally diseases. Until the early part of this viewed the influences of weather and century, summer diarrhoea was a major climate on health as part of the natural cause of childhood deaths in Europe. backdrop to life. Not only are natural Now, annual peaks in mortality due to climate variations not amenable to our bacterial diarrhoea are largely confined to control, but their relationships to health poorer countries. For some populations in can usually be studied only at the level tropical areas that rely on seasonal rains of whole communities or populations, for agriculture, their food supply and, whereas modern epidemiological research hence, nutritional status are highly has become focused on studying disease seasonal. The wet season is the "hungry risk factors at the level of the individual season" because the harvest has begun to (e.g. smoking, drinking, food, type of job). run out. The wet season is also considered Hence, there has been relatively little 9

incentive for epidemiologists to study the considerable. Physiological and behav effect of weather and climate on health. In ioural differences between cultures have recent years, however, the threat of global developed over many millennia as a climate change has led to an increased consequence of exposure to vastly differ interest in studying these relationships. ent climatic regimes. The Inuit who live near the Arctic circle can withstand Humans are adapted to intense cold through adaptations such as their local climate housing, clothing and diet. The eventual failure of a Norse settlement in Greenland Human beings, like all other species, are in the 14th century, established during the adapted to the climate in which they live. several warmer preceding centuries, is Unlike other species, hUn;lan populations, likely to have been due to poor behav over many thousands of years, have ioural adaptation to the changed strayed outside their original climatic environment and climate. That is, the zones, and are able to deploy culture and settlers continued with the subsistence technology to ensure adaptation to other practices ot their homeland that left them wise unfamiliar climates. much more vulnerable to climate variabil The capacity of humans to adapt to ity than their Inuit neighbours. In the 14th varied climates and environments is century, this vulnerability was further exacerbated by the cooling trend at the 45 onset of the Little Ice Age in Europe. 40 Most homes have an indoor tempera D 35 ture ranging between 17 C and 31 DC. Humans cannot comfortably live in ~ 30 temperatures outside this range. The On; 25 Comfortable .... I tolerance range of anyone individual is '0 '1 Too ~ 20 I usually less than this and tends to get .3 damp e .... "I narrower with age or infirmity. The ~ 15 Sun needed for comfort I E I A simple comfort Q) temperature of the surrounding air is the f- 10 diagram indicates in most significant factor for human comfort. a general way how 5 Comfort is also dependent on other Too cool wind and sunshine o factors such as humidity, wind, sunshine extend the ranges of (which delivers short-wave radiation) and conditions which are o 10 20 30 40 50 60 70 80 90 100 long-wave (infrared) radiation. Humidity comfortable Relative humidity (%) has a pronounced effect on our sensation 10 of temperature, especially when condi Heatwaves tions are hot; wind has a significant effect Outside the comfortable range of human on our well-being when conditions are tolerance, as temperatures increase, cold or very hot. thermal stress leads progressively to Humans respond physiologically to a greater discomfort, physiological stress, ill number of atmospheric conditions which health and even death. Heat can cause potentially stress the body, including solar several clinical syndromes. Heatstroke is radiation, atmospheric humidity and air the most serious and occurs when the pollution. Considerable research has been core body temperature exceeds 40.6°C; it devoted to the development and improve is usually fatal. Heat exhaustion can also ment of ways to measure human response occur after several days due to inadequate to weather. Although several approaches replacement of water and salts, but it is have dealt with the evaluation of winter not usually fatal. Daily mortality in discomfort, most "comfort" indices evalu In a typical year, relatively few people New York shOWing a ate the impact of heat stress on the individ die from heatstroke. However, it is now peak attributed to a ual and take into account temperature, becoming clear that hot weather can summer heatwaue humidity or a combination of the two. The increase the likelihood of dying from other in 1966 "temperature-humidity index" and various formulations of "apparent temperature" are 14 well-known examples. However, such 13 comfort indices do not take into account all 12 o mechanisms of heat exchange between an g 11 individual and his or her environment. Thus, g 10 heat exchange depends on air temperature, Qj 9 Q. humidity, wind velocity, short- and long ~ 8 ~ wave radiation, and an individual's meta .£ 7 bolic rate and clothing which provides ~ o 6 insulation. Through heat exchange, humans E 5 "0 must keep heat production and loss at an .~ 4 equilibrium in order to maintain the body "0 ~ 3 core temperature at around 37°C. Heat c ~ 2 budget models, which describe all mecha VI nisms of heat exchange, are therefore the o most sophisticated tools for the assessment o 10 20 30 40 50 60 70 80 90 100 11 0 120 130 and forecasting of human comfort. Days from May to August 11

were recorded. During various heatwaves in India during 1995 and 1998, it is esti mated that the number of excess deaths rose by several thousands. A record breaking heatwave during June 1998 in central Russia caused more than 100 deaths. Elderly people are the most vulnerable to the effects of thermal stress. Studies have shown that the excess mortality attributed to a heatwave is greatest in those aged over 65. It may be the presence of health problems, not age per se, which determines sensitivity to heat. Physio logical factors which increase vulnerability to heat stress include: chronic illness (e.g. cardiovascular disease, cerebrovascular disease); skin disorders that impair sweat Urban populations are causes. During heatwaves in the USA and ing; learning difficulties and dementia (that more vulnerable to in Europe, deaths from all causes are affect behaviour); and certain drugs which heatwaves due to shown to increase. This increase may be impair the ability to regulate body temper greater exposure to substantial. Death rates can rise to over ature (e.g. major tranquilizers, antidepres the "heat island" 50 per cent above normal baseline levels sants and alcohol). effect which means during unusually hot episodes. Some of We are beginning to understand why that the temperature these deaths are due to the hastening of populations in some cities are more in a city can be the time of death in susceptible (i.e. very vulnerable to heatwaves than populations several degrees ill) persons. However, many deaths would in others. Some populations show clear higher than in the not have occurred in the absence of the thresholds for increased daily mortality surrounding heatwave. when critical temperatures are exceeded countryside In large cities, the increase in mortality (e.g. Shanghai in contrast to Guangzhou (H. Fromm) during hot weather can be very significant, in China). However, not all urban popula numbering in the hundreds over a period tions show this threshold effect. of several days. Such was the case in Urban populations are typically more Chicago, USA, during a summer heatwave vulnerable than rural populations because in 1995, when over 500 excess deaths they experience higher temperatures - 12

16.------., the urban heat island effect. Further, indi viduals are more vulnerable to heat stress if they are in poorly designed housing, with no access to air conditioning or cooler buildings. These risk factors are more likely to be present in urban than rural areas. Persons are also more vulner able if they are already ill and isolated. However, with our accruing knowledge, we are able to take community-wide steps to reduce these deaths. Certain types of air mass are more hazardous to health than others in a given location. Using this knowledge, heat watch warning systems are now being used in some countries to o give local populations advance warning of England & Wales London England & Wales London heatwaves (see page 29). 1976 1995

Air pollution and weather The spread and concentration of these Excess daily mortality particles and gases are very dependent on in London, and in The air around us is full of particles and the prevailing weather conditions, air England and Wales, gases that may affect our health, such as currents, temperature variation, humidity during heatwaves in pollen, fungal spores and toxic emissions and precipitation. Large, slowly moving 1976 (15 days) and from burning fuels and waste materials in anticyclones may cover an area for 1995 (5 days). Excess vehicles, factories, offices and homes. The several days, or a week or more, and give mortality is age main air pollutants in our cities are ozone, rise to static conditions that readily allow adjusted and relative nitrogen dioxide, particulates, carbon particles and gases to accumulate. to the 31-day moving monoxide and sulphur dioxide. All have The incidence of asthma has been average for the same been shown to have significant adverse increasing in many countries in recent year affects on human health. decades but the reasons for this are not (A. McMichael and Weather and climate have a consider clear. Acute episodes or "attacks" of S. Kovats) able influence on the concentration of asthma, however, have been linked to the these particles and gases. The production presence in the air of certain dusts, pollen, of many allergens, particularly pollen, in particles from animal furs, ozone, other air the air depends on the season of the year. pollutants, or a mixture of some of these. 13

Thunderstorms have also been observed permitted soybean dust to be transported to trigger asthma attacks in the United directly into densely populated areas of Kingdom and in Australia. An outbreak of the city. Recent research has shown that asthma attack in London, UK, in June previously unexplained epidemics of 1994 was associated with a rapid drop in asthma that occurred in the 1950s and air temperature several hours before a 1960s in New Orleans, USA, were likely to storm, in combination with a high grass have been similarly caused by a combi pollen count. nation of soy dust from the harbour and In Barcelona, Spain, emergency prevailing winds. admissions for asthma rose from less than five to over 100 on certain days when Climate variability, El Nifioj soybeans were being .. loaded at the Southern Oscillation and harbour. However, this situation did not epidemics occur on all days when the loading took Enuironmental factors place but on those days when a prevailing El Nino is the term that is used to describe that directly affect wind from the direction of the harbour plus an extensive warming of the upper ocean human health a stable atmosphere with high pressure in the tropical eastern Pacific lasting three or more months. El Nino events are linked nneric with a change in atmospheric pressure aS' ,,0' heat between the western and central regions '3- of the Pacific Ocean (known as the

I Southern Oscillation), a shifting of the C ~ focus of tropical rainfall from the western o to the eastern Pacific Ocean, a weakening -j of the Pacific trade winds, and sea-level -< changes. Because the ocean and atmos pheric changes are so closely linked with each other, they are collectively known as El Nino/Southern Oscillation, or ENSO. ENSO is now recognized as a major driving force behind changes in the weather from year to year. For example, U\I droughts are more frequent during and immediately following El Nino in Brazil, Australia and in southern Africa. Rainfall 14 extremes associated with El Nino can west India, Sri Lanka, Venezuela and adversely affect human societies by trig Colombia. In some cases, the meteorolog gering food shortages, floods and ical factors that are behind these landslides. Indeed, the aggregate effect of relationships have yet to be determined. El Nino is so great that the global burden Thus, El Nino may provide important of natural disasters is greater in the year clues about the climate and environmental after the onset of El Nino, compared to the drivers of epidemics of mosquito-borne year before an El Nino. This relationship is disease. particularly strong for drought and related Rift Valley fever (RVF) is a viral food shortages. El Nino has even been disease that is transmitted by mosquitoes. Malaria mortality linked to world food crises because it It primarily affects livestock. In Kenya, and morbidity in affects many countries at the same time. olJ.tbreaks in the usually dry grasslands Venezuela haue The effect of El Nino along the are always associated with periods of increased by an western coast of South America is very heavy rain. It is thought that the local auerage of36.5% in strong, particularly in Peru. Nearly every mosquito vector lays its eggs in the dry years follOWing El Nino, whether weak or strong, has grassland depressions and that these eggs recognized El !'lino an impact on this region. Many health are already infected with the RVF virus. euents. This consequences were recorded after El relationship appears Nino-related flooding in 1983 in Peru, to be more strongly such as increases in the incidence of acute related to drought in diarrhoeaI and respiratory diseases. In the year preceding outbreaks than to addition, extreme weather also has a 2 significant impact on the public health ;:;- rainfall during '6 :0 infrastructure. Following the 1997/98 El (; epidemic years. E Nino, 10 per cent of the health facilities (; Relatiue changes in were damaged in Peru, in addition to &1.5 mortality (deaths ~ disruptions to the power and water (; 1910-1935) and E supplies and to the transport system. ClI morbidity (cases .'"> Recent studies have also shown that Qj'" 1975-1995), El Nino is linked to epidemics of certain "" calculated as cases in diseases. It affects the climate in many year n diuided by areas that experience epidemic malaria. cases in year n-1 Studies of the El Nino cycle in relation to (M. Bouma, London 0.5 L----'-_-'-_'----'-_"---_"-----'-_-'-~'--' historical outbreaks of malaria have o V) School of Hygiene and revealed a relationship in Pakistan, north- 0; '" Tropical Medicine) 15

Flooding in this habitat enables the mosquitoes to develop and appear in high enough densities to sustain transmission of the disease. The 1997/98 El Nino event caused very heavy rainfall in north eastern Kenya and southern Somalia from October 1997 to January 1998. The associated outbreak of RVF killed many cattle in the affected regions, and the epidemic spread to the local human popu lation. The World Health Organization (WHO) estimated a total of 200-250 deaths and 89 000 cases in southern Somalia and north-eastern Kenya. This may be the largest outbreak of Rift Valley fever, in both human and cattle, ever recorded.

Satellite image of Hurricane MUch in October 1998, caused by El Niflo, under the influence ofLa Nifla, which triggered massive flooding and landslides, killing over 11 000 and leaving millions homeless and at high risk ofdisease (ME~tl~o- Franee) 16 GLOBAL CLIMATE CHANGE AND HUMAN HEALTH

Human societies over the ages have 0.6°C in the past 100 years. An increase depleted natural resources and degraded of 1 to 3.5°C in the global temperature is their local environments. Populations have forecast for the next hundred years. This also modified their local climates by rate of change is faster than has occurred cutting down trees or building dams. In naturally since the end of the last ice age consequence, many of these local popula before human settlement began, around tions have been more vulnerable to 10 000 years ago. disease and ill health. Today, the aggre As the science of human-induced gate human impact has attained an climate change becomes clearer, the unprecedented global scale, which reflects importance of addressing its potential rapid increases in population size and in impacts increases. Initial concerns tended energy-intensive consumerism. The WMO/ to focus on material and ecological United Nations Environment Programme systems important to human society: (UNEP) Intergovernmental Panel on human settlements, coastal zones, agricul Climate Change (fPCC), in its Second ture, forests and fisheries. Recognition has Schematic ofpossible Assessment Report (1995), has concluded now grown that climate change is also changes in frequency that "the balance of evidence suggests a likely to affect the health of human popu distribution of discernible human influence on the global lations. Increasing our understanding of temperature. Dark climate". Fossil fuel burning and land use the linkages between climate, weather and blue areas mark 5 per changes, such as deforestation, may have health will help us to forecast the impacts. cent extremes of contributed to the observed increase of Whatever the immediate outcome of normal distribution; light blue areas

0.4 represent increase in number ofextreme events outside 0.3 unperturbed 5 per ~ :.c cent limits for an .2 0.2 e increase in mean 0.. only (left) and an 0.1 increase in variance only (right) (K. Maskell. UK Cold Warm Cold Warm Meteorological Office) 17

Mediating process Health outcomes Direct .. Altered rates of heat- and Exposure to thermal extremes ., cold-related illness and death Altered frequency and/or intensity ... Deaths, inJ"uries, psychological disorders; of other extreme weather events , TEMPERATURE ~ damage to public health infrastructure AND ======WEATHER Indirect CHANGES ~

Changes in geographic ranges and incidence of vector-borne diseases

Changed incidence of diarrhoeal and,other infectious diseases Malnutrition and hunger, and consequent impairment of child growth and development

Sea-level rise, with Increased risk of infectious population displacement and disease, psychological disorders damage to infrastructure

Levels and biological impacts Asthma and allergic disorders; of air pollution, including other acute and chronic pollens and spores respiratory disorders and deaths

Social, economic and Wide range of public health demographic dislocations due to consequences: mental health and Possible major types effects on economy, infrastructure nutritional impairment, of impact ofclimate and resource supply infectious diseases, civil strife change and stratospheric ozone Skin cancers, certain types of cataract depletion on '''' and immune system suppression; indirect STRATOSPHERIC OZONE DEPI,;ETION • human health , impacts via impaired productivity of (WHO/WMOjUNEP) a ricultural and a uatic s stems ------

agreements under the United Nations translate into changes in climate. It must Framework Convention on Climate then take account of the assessment, by Change, there is an expectation that the other scientific disciplines, of how those world is already committed to a significant climate changes would affect the world's amount of climate warming, along with biological and physical systems which then uncertain changes in climate variability. influence such things as mosquito habitat, The potential health effects of climate freshwater supplies and food yield. change include the easily foreseen health effects of changes in the intensity and Stratospheric ozone depletion frequency of extreme temperature events; and human health for instance, more heatwaves and fewer cold spells. In many temperate zones, the Stratospheric ozone depletion and green Prolonged exposure to effects of warmer winters could be benefi house gas accumulation both induce increased ultraviolet cial because, currently, more people die in changes in the global climate - the radiation may cause the winter than at other times of the year. "global commons". That is, although the a higher rate of The extent to which climate change gaseous emissions arise from diverse skin cancer will be associated with changes in the localized sources, in all continents, their (WWFjBIOS) frequency of other extreme weather events (e.g. storms, floods) at a local level is not known, but regional impacts are likely to be significant. Even a small shift in mean value can lead to a disproportion ate increase in the frequency of extreme values. Scientists contributing to the IPCC Second Assessment Report (1995) have forecast increases in both droughts and floods. Further, the risk of flooding in coastal areas will be increased due to sea level rise. Assessment of the potential health impacts of climate change is an unusually contingent exercise. It draws initially on the assessment by climatologists of when, where and to what extent the ongoing accumulation of greenhouse gases will 19

of stratospheric ozone may decline for another one to two decades and is not expected to return to its normal level until the second half of the next century. Increases in ground-level UVR are presumed to have occurred, particularly at higher latitudes. However, such trends are difficult to ascertain because wave length-specific UVR measurements have only recently begun. In addition, local factors such as clouds, aerosols and ozone pollution can absorb or reflect UVR before it reaches the ground. Many epidemiological studies have implicated solar radiation as a cause of skin cancer in fair-skinned humans. Thus, skin cancer rates are very likely to increase due to stratospheric ozone deple Climate change has environmental impact is of a diffuse global tion, and may already be doing so. The a direct impact on ized kind. Local emissions thus contribute Ozone Secretariat of the United Nations the availability of to an integrated global change that has Environment Programme estimates that water resources serious consequences for hlJman health. for a "European" population living at (L. Taylor) Stratospheric ozone shields the around latitude 45 degrees North there Earth's surface from incoming solar ultra will be an excess incidence in skin cancer, violet radiation (UVR) which is harmful to peaking at around a 5 per cent increase all animals and plants. Significant stratos during the 2070s. This corresponds to pheric ozone losses have occurred mainly an extra 100 cases of skin cancer per at middle and high latitudes due to human million population per year. The current activities. The emission of the ozone background rate of skin cancer is approx depleting substances, halocarbons, has now imately 2 000 cases of skin cancer per been restricted under the internationally million population per year. Changes over agreed Montreal Protocol on Substances time in human exposure to UVR are typi that Deplete the Ozone Layer and its cally more affected by changes in London (1990) and Copenhagen (1992) behaviour than by' changes in ambient Amendments. However, the concentration UVR levels. However, human-induced 20 stratospheric ozone depletion presents an potential global impacts of climate change additional burden on human health, in on water resources and food yield. addition to ongoing behavioural or lifestyle Although it is not yet possible to forecast changes. precisely how those impacts would affect Ultraviolet radiation is known to affect human health, these assessments are human health in other ways. UVR can important in identifying regional and local cause damage to the eye, such as snow vulnerability. blindness, and apparently causes certain Climate change is anticipated to have types of cataract. There is now good significant regional impacts on agricul evidence that UVR causes the immune tural yield. Populations at risk include system to be suppressed in humans and those of sub-Saharan Africa, south Asia, animals. The wider significance of this for east Asia and south-east Asia, and some patterns of disease (especially infectious P;"cific island nations. However, such disease) in populations, however, is difficult modelling assessments focus on average to assess. effects over space and time. Many impor tant factors affect food supply at,the local Food and water supply level and over short periods (drought and floods) and these will significantly Long-term changes in world climate increase vulnerability to climate change. would affect the foundations of public A further consideration is an increase in health: sufficient food and safe and the risk of damage by plant pests and adequate drinking water. pathogens that are also sensitive to All plant and animal species are climatic factors. sensitive to climate change. Therefore, Climate change will have an impact widespread and significant effects on agri on freshwater resources - both the avail culture and ecosystems are anticipated. ability of fresh water (for domestic, The scientists contributing to the IPCC agricultural or industrial consumption) Second Assessment Report (1995) have and water quality. The timing- and intensity forecast that one third to one half of the of rainfall is a major determinant of runoff, world's vegetation types will change. flooding, groundwater recharge and also Indeed, many plant and animal species soil erosion. Flooding can lead to the con unable to adapt fast enough to their chang tamination of water with human and ing environment will become extinct. animal waste and agricultural chemicals. Recent research using integrated Reduced water levels can concentrate assessment models has addressed the pollutants and pathogens in surface water. 21

Minimum therefore particularly sensitive to climate temperature Optimum and meteorological factors. Mosquitoes for mosquito temperature development for mosquitos also breed in standing water and, there fore, their population densities are often 8910 ...•1415 16171819 25 26 27 .40 related to rainfall events. Minimum temperature for The distributions of vector-borne parasite development diseases are restricted by the climatic P. vivax < P. falciparum tolerance limits of their vectors (see map on page 27). The distributions of vector Critical temperatures As well as affecting food supply, reduced borne diseases are also limited by for malaria water availability has health implications biological factors that limit the survival of transmission (degrees because it has been shown that in times of the infective agent in the vector species. Celsius); the water shortage cooking takes precedence The diagram above illustrates these minimum over hygiene. The contamination of drink temperature thresholds for malaria trans temperature for vivax ing water with waste and/or salt water mission. However, in many countries much development is less already occurs in many countries under has been done to eradicate or control than the minimum current climate conditions. Such problems vector-borne diseases. For example, the temperature for will be exacerbated with sea-level rise. quick detection and treatment of cases falciparum reduce the availability of the parasites, development, the two Climate change and vector-borne and appropriate spraying of insecticides main types ofmalaria diseases can control the local vector population. parasite Because climate can play a dominant (WHO/WMO/UNEP) Many important infectious diseases are role in determining the distribution and transmitted by an insect vector. For abundance of insect vectors, either example, species of mosquito transmit directly or indirectly through its effects on malaria, yellow fever and Rift Valley fever host plants and animals, climate change is (see page 14) and species of tsetse fly likely to have a significant effect on the transmit African trypanosomiasis or geographical range of many vector "sleeping sickness". Such vector-borne species, and potentially on the distribution diseases are a major burden of ill health of the diseases themselves. in developing countries, especially for Palaeoclimatic records of insects children. It is estimated that currently demonstrate that shifts in species distribu more than one million children die from tions have been associated largely with malaria each year. Insects such as temperature change in earlier millennia, mosquitoes are cold-blooded and are and that these shifts occurred more 22

Areas at risk of malaria transmission based on climatic factors: (left) potential risk areas under baseline climate scenario and (right) under climate scenario for 2050s (W.J.M. Martens, International Centre for Integrative Studies, The Netherlands)

~.,

. --:.._~~~ .:~ -l_

rapidly than shifts in the distribution of to drugs and pesticides. However, it is likely vegetation and higher animals. It is now that recent trends in average temperatures possible to map vectors using satellite have also begun to influence the pattern of In the aftermath of data to identify habitats that foster high malaria. Marked increases in the inci floods and rainstorms, survival rates for tsetse flies and dence and range of malaria were observed pools ofstagnant mosquitoes. Subsequent analysis using during an atypically hot and wet year in water provide the Geographical Information Systems, in Rwanda in 1987. Malaria may also have ideal environment for combination with population and other been moving to higher altitudes in the the proliferation of the data, can then establish the geographical Eastern African highlands in association mosquito vectors of patterns for human risk of infection. with local warming. Researchers are now infectious diseases Malaria is currently increasing in turning their attention to these possibilities. (WHOjlnstitut Pasteur) many countries where it had previously Malaria incidence, as has been well been eliminated or greatly reduced with documented in field research, is sensitive vector control measures. Much of this is to local changes in annual and seasonal due to human population increases, land temperature and precipitation. Laboratory use changes, the deterioration of public studies have shown that the time the health defences, and the rise of resistance malaria parasite takes to complete its life 23

Climatic capacity for malaria transmission

High.

Medium. LOWC]

No transmission C]

.~-

cycle in the mosquito (the extrinsic incu global climate models. The output from bation period) decreases with increasing one of these models is shown in the maps temperature, below a limiting maximum above and opposite. At present, these value (see diagram on page 21). This models are unable to address socio knowledge is now being applied to inves economic factors that restrict transmission tigate the impact that climate change in many temperate countries. Indeed, could have on the dynamics and trans climate-related increases in malaria inci mission of this disease. Integrated dence are most likely to occur primarily in mathematical models have been developed regions next to endemic areas, where to forecast future changes in malaria risk in disease transmission is currently limited by relation to climate change scenarios from temperature. 24 PLANNING AND OPERATING IN HARMONY WITH CLIMATE AND WEATHER

The science of weather prediction - and successful seasonal forecasts for many now climate prediction - is rapidly regions of the globe were made available advancing. The improvement in weather by NMHSs and received with some confi forecasts achieved over the last decade dence by the public and decision-makers. has saved millions of lives through warn Seasonal forecasting clearly has huge ings of tropical cyclones, floods and other potential to mitigate the impacts of severe weather events. Weather and weather-related disasters. Knowledge of climate forecasts and the use of historical general weather patterns a few months in climate data for planning have been a advance can be used in all stages of major boost to the efficiency of food handling disasters: awareness and educa production. This was shown by a recent tion, preparedness and prevention, and study that noted that while the prolonged disaster detection and prediction. It may drought induced by El Nino and other also become possible in the futupe to fore factors in Thailand and Indonesia had cast weather-related outbreaks of certain adversely affected production of fruits, vector-borne diseases. Climate forecasts vegetables and grains, it had also resulted could therefore be used to prepare health in an increase of between 2.5 and 6.7 per facilities, and to stockpile vaccines, pesti cent of the output of plantation crops, cides and other control tools. forestry and fisheries. Considerable progress towards Biometeorology and longer-range predictions is likely over the bioclimatology next few years, as a result of work being carried out under WMO Programmes, for The potential for meteorological and example the World Climate Programme. c1imatological forecasts to mitigate health New services based on medium-term or impacts and improve health services is seasonal predictions are likely to become not yet fully appreciated. established during the next decade. In Currently, meteorological services in particular, the ability to forecast ENSO many countries include the provision, events and related anomalous climate usually in cooperation with public health conditions will help mitigate many of the authorities, of regular measurements of associated health impacts. The El Nino of pollen count, dust, comfort indices, biocli 1997/98 may be the first event for which matic maps, UV and sunburn forecasts, --~---

and pollution warnings. Pollution warnings the air. The start of the grass pollen are issued in line with national air quality season in the United Kingdom can differ standards that in turn are derived from by about 32 days according to the weather epidemiological studies that quantify the in the spring and early summer. impact on health. Meteorological services are also used Daily pollen forecasts can be used to for the planning and design of industrial warn hay fever sufferers of adverse condi plants so as to avoid air pollution and Continued emissions tions so that they can take preventative harmful effects on the local population. ofcarbon and suLphur measures. A person suffering from hay The application of meteorological knowl dioxides acceLerate fever may be allergic to one or many edge is essential if tall chimneys are to be gLobaL warming and types of pollen. The pollen count can be designed to disperse industrial emissions generate acid rain measured, for example, Q.S the number of at high levels rather than to allow them to with harmfuL effects pollen grains per cubic metre of air accumulate to adversely affect people, on forests, agriculture sampled, averaged over 24 hours. The animals and vegetation at ground level. and groundwater pollen counts show when the various However, while tall chimneys help to resources seasons start and end as well as the day solve local' air-pollution problems, they (WHO/J. Mohr) to-day variation in the amount of pollen in facilitate the long-range transport of pollutants. This has been a major problem in Europe, where acid rain (caused by sulphur dioxide) from western European countries is said to have damaged remote pristine areas in Scandinavia. Likewise, northern USA emissions have damaged forests in south-east Canada. Bioclimatology is the study of the effects of climate on living systems. The mapping of bioclimatological para meters can be used to highlight geographical variations in weather elements that can affect human health and well-being. Examples of bioclimatic maps include: • the climatic types of a region such as cool/humid, optim\lm, hot/dry, etc.; ------

-33 Bioclimatic map for -30 Europe depicting -27 -24 heat Load intensity -21 conditions (in -18 -15 degrees CeLsius) -12 during the period -9 September-November -6 -3 (after G. Jendritzky, o Deutscher Wetterdienst) 3 6 9 12 15 18 21 24 27 30 33

• maps of heat load or cold stress, Building design and urban modelled as perceived temperature, on planning a variety of scales from local to global; One of the greatest specialities of humans, • isotherm maps indicating distribution the ability to modify the surrounding envi limits of disease vectors. ronment, is best expressed in the For example, the vector responsible technological mastery of clothing and for epidemics of dengue (or "break-bone architecture. It has allowed humans to fever") is the Aedes aegypti species of expand their range far beyond the tropics, mosquito. The current range of this into the deserts, the polar regions and mosquito is limited by cold weather, which even to the moon, as no other single kills both larvae and adults. In Australia, species has done. its distribution is restricted to areas with a Building design is particularly mean mid-winter temperature exceeding important for people living in cold and lOoC; in the United States of America, its warm humid climates. For cold regions, a current northern limit is 35°N latitude, high standard of insulation is of great corresponding to the 10°C winter importance so that reasonable comfort isotherm. inside is economically attainable. In warm 27

humid climates the need is primarily for outside air during the day. With such shading from the sun (e.g. by trees), measures the daily range of temperature The general coupled with ample ventilation, preferably indoors can be much lower than that distribution ofdengue from the wind. In extremely hot, dry prevailing outside. and/or dengue climates, shading from the sun is required, Bioclimatic mapping can help archi haemorrhagic fevel; by trees if feasible (or by other means if tects to plan optimal building designs. In ]975-]998 not). Construction materials should be addition, daily weather forecasting can (WHO) insulating to protect the interior from hot help achieve indoor comfort with 28 minimum energy consumption at all cyclone in Bangladesh in May 1994. Opposite: The times. Seasonal climate monitoring and About 200 people were killed compared Philadelphia heat predictions can help plan for the storage with over 130 000 deaths in a similar health watch/ and distribution of heating energy sources cyclone in 1991. This was achieved prin warning system in cold climates. A carefully designed cipally through improvements in warning building may change its responses to systems and evacuation. During the last seasonal changes in energy flow. Energy few years the accuracy and timeliness efficiency is an important way to reduce of warnings of severe weather have fuel consumption and, therefore, reduce improved as a result of a far better under Impact ofnatural future climate change. standing of how severe weather forms and disasters by region far better methods for monitoring and and by disaster type Disaster mitigation fQJ:ecasting the detail of weather systems. (Source: International Warnings of severe weather can also be Federation of Red Cross Extreme weather and climate events and used by the national health services of the and Red Crescent their impacts are often thought of as country concerned as they prepare to deal Societies, and Em-Dat, beyond our control. However, there is with the potential health hazard's caused Catholic University of much that can be done to mitigate by natural disasters. Louvain, Belgium) their impacts. Extreme events need not lead to a disaster. A disaster only occurs Burden of natural disasters by type (annual average 1972 to 1996) if emergency measures taken by a Number of Number of community fail to reduce significant deaths people affected losses so that the population is unable to Droughts and food shortages 73606 59253008 return to normality without substantial Floods 12696 65876497 landslides 793 137905 external assistance. High wind/storms 15960 11 722925 Weather systems respect no political Volcanic eruptions 1 017 94119 boundaries. The early sharing of informa Earthquakes 18715 1 653066 tion about threatening weather patterns Total 122787 138737520 has saved many lives and livelihoods. Burden of natural disasters by region (annual average 1987 to 1996)

Members of WMO routinely exchange Number of disasters Number ofpeople affected meteorological observations under the Africa 43 12731564 World Weather Watch (WWW) and use the Americas 73 3029403 Asia 107 185 798 713 shared global information to provide Europe 33 1 717626 national warnings on weather-related Oceania 16 2368316 disasters. The success of the World Total 271 38426780 Weather Watch is illustrated by the Source: IFRC World Disaster Report 1998. 29

Data input Human activities clearly both five variables every six hours contribute to extreme events and increase 24-hour and 48-hour forecasts vulnerability. Drought and desertification, .. for instance, may be the result of long 48-hour synoptic index periods of unusually dry weather condi category estimation tions, combined with non-sustainable land-use practices, including excessive Does day belong to forest clearance for crop production and offensive category? overgrazing by livestock. The impacts of extreme events are greatest on communi ties with few social and technical resources. The precise nature and extent of the impact of extreme weather also 24-hour synoptic index depends upon the anticipation of risk and category estimation on assumptions made about the level of .. protection 'that is needed, including Does day belong to medical provisions. These assumptions in offensive category? turn depend on knowledge concerning the frequency and intensity of extreme events - which are likely to be affected by global climate change.

Mortality predicted from Heat health watch warning offensive category algorithm systems

Is elevated mortality A global climate warming will increase the predicted? frequency of warm years, milder winters, hot summers and heatwaves. Heat stress No further action required Health "warning" is issued is an important issue facing both devel Maintain alert (three levels) oped and developing countries due to the increased number of persons living in Level 1: Level 2: Level 3: urban environments. In recent years, heat 1-4 excess 5-14 excess >14 excess waves in cities in the USA and India, deaths deaths deaths among other countries, have had major predicted ~redicted ~redicted impacts on their populations. However, 30

Natural disasters The average number of people killed by natural disasters each year is 123 000. This is only a small proportion of the average number of persons that are affected each year. That is, the number of people in need of shelter, 4.0. food or medial treatment is approximately 138 million 3.5. each year due to natural disasters. It is impossible to assess 3.0 the human suffering caused by these disasters. The global 2.5 human and financial cost of disasters has been increasing. However, loss of life in countries with good disaster 2.0. management facilities, based on warning and prepared , 1.5 ness, has fallen. ___~--= 1.0- In addition to the immediate and direct impact7, extreme events have many indirect impacts on human Smoke haze over Indonesia on 19 October 1997, caused by health. These include an increased risk of infectious forest fires, measured as aerosol density by the satellite-borne disease due to factors such as a breakdown in sanitation, lack of clean fresh water, and overcrowding among total ozone mapping spectrbmeter survivors. Damage to the local health care infrastructure is (National Aeronautics and Space Administration, USA) also very important. Damage to crops and loss of food supplies can also occur during extreme events. Floods There is a widespread belief that epidemics of infectious Massive damage to infrastructure in the aftermath ofa disease frequently follow disasters. Such an awareness may have arisen from the historical association of war, famine hurricane that hit Macon, Georgia, USA, in 1994 and social upheavals with epidemics of smallpox, plague (J. Crawford) and dysentery. Epidemiological evidence confirms that floods cause disease, in particular those diseases associated with the contamination of water with human and animal waste. For example, following flooding in several coun tries, the incidences of hepatitis A, typhoid fever, cholera and dysentery are known to have risen dramatically in the affected population. Many lesser-known infections can be exacerbated by natural disasters. For example, the disease leptospirosis is carried by rats and outbreaks often follow flooding which allows rat urine to come in contact with large numbers of people. 31

there is much that can be done to mitigate Forest and bush fires the health impacts of hot weather. There has been a long tradition of vegetation burning in south-east Heat health watch warning systems Asia and elsewhere to clear land for crops. However, the dry season can alert people to impending dangerous of 1997 was extremely dry, due in part to the influence of El Nino. weather. Such systems are operated in Local fires quickly became out of control. The smoke from these fires combination with public health education therefore enveloped a wide area. The smoke and haze caused disruption of air transport and drastically reduced the tourist trade. campaigns to promote behaviour to The effects on human health were widespread, with dramatic reduce heat stress. Public health agencies increases in hospital admissions for respiratory infections in Kuala also use the systems to guide their Lumpur and Sarawak, Malaysia. Wood smoke pollution has a very implementation of mitigation procedures high concentration of particulates that are known to cause acute during very hot weather. Such biometeo respiratory problems and also long-term effects on health. rological forecasting for hot weather Traditional slash and burn practices in northern Al'T\azonia, again is practised in several countries. In in the context of a prolonged drought linked to El Nino, caused the Germany, a service tailored to the needs largest forest fires ever reported in Brazil. Fires were set to clear the fields in early 1998, after almost six months with no rain. In two of the medical profession and the general months the fires spread to an area of 30 000 km2, killing about public has been in operation for 12 000 cattle. A 50 per cent increase in the incidence of respiratory some time. In the eastern USA, the diseases was reported. National Weather Service issues excessive Smoke from very large forest fires may be carried downwind for heat warnings based on a daytime heat 1 000 km or more and mix through a layer in the atmosphere 5 km index. or more thick. During the fires of 1997, NMHSs were required to A new watch/warning system for heat advise their governments on a daily basis. Satellite images and stress has been developed based on numerical weather prediction proved useful in determining the evolution of the fires and smoke, and thus assisted in the efforts to synoptic climatological methods. The extinguish the fires. WMO provided technical assistance and coordi Health Commissioner and local National nation, both for short-term evaluation of fires and the smoke Weather Service cooperate on issuing through wind and precipitation forecasts. WMO also helps in the health "alerts", "watches" and "warnings". longer-term through the dissemination of El Nino and related The system has been credited with saving seasonal climate forecasts. It contributed to the establishment of the lives in Philadelphia, especially during the Specialized Meteorological Centre in Singapore, providing services very hot summer of 1995. Existing for the Association of South-East Asian Nations. The Centre played a watch/warning systems in the USA are key role in the provision of advisories in relation to the fires. being evaluated and plans are being developed for implementation of similar warning systems for worldwide locations, such as Rome, Madrid and Shanghai, with WMO support. ------

Food security, environment and a composite measure of the burden of ill sustainable development health). The global burden of deficiencies in Food production should be environmentally water supply, sanitation and hygiene is esti friendly and, hence, sustainable. WMO mated to account for 5.3 per cent of deaths supports the provision of meteorological, and 6.8 per cent of total DALYs. Climate hydrological and related services to the variability and change can make food and farming community to help develop water supplies more uncertain or tenuous in sustainable and economically viable agri various regions, increasing the risk to cultural systems as well as improve health for hundreds of millions of vulnerable agricultural production and decrease pollu persons, particularly in sub-Saharan Africa. tion by agricultural chemicals or other Efforts are continuously being made agents that contribute to ill-health and by WMO to ensure that NMHSs have the the degradation of the environment. capacity to issue timely warnings and Application of meteorological and hydro provide guidance to decision-makers. In logical information can contribute particular, the WMO Climate Information significantly to the efficient use of scarce and Prediction Services (CLIPS) pmject aims water resources in semi-arid and drought to bridge the gaps between the provision of prone lands. Climate information is used mainly for planning purposes, while recent weather data and weather forecasts are used in current agricultural operations. For example, in the semi-arid tropics, the use of rainfall probabilities computed from long term daily rainfall data, in conjunction with potential evapotranspiration data, have contributed to more efficient use of the limited water available in the water storage Operational tanks for supplementary irrigation to crops. hydrological services Ensuring secure food supplies is a provided by the major problem in many countries. national Hydrological Malnutrition is a major factor in 11.7 per Services of WMO cent of deaths worldwide (Le. 5.8 million Members are essential deaths every year) and accounts for an to sustainable estimated 15.9 per cent of the global total food security of Disability-adjusted Life Years lost (DALYs, (WHO/P. Almasy) 33

historical climate information and near future predictions. CLIPS will foster interna tional cooperation to enable all countries to develop their climate services. CLIPS is committed to the long-term sustainability of human society. Drought Monitoring Centres in Nairobi, Kenya and Harare, Zimbabwe, were established in 1984 to provide Eastern and Southern African countries with timely warnings on the occurrence of drought and other adverse weather conditions. The African Centre of Meteorological Applications for Development (ACMAD), established with the support of WMO in Niamey, Niger, provides seasonal forecasts and climate outlooks which enable NMHSs to issue advance warnings of adverse weather conditions.

Drought can have devastating effects on human health, primarily through its impact on food production. Famines can kill very large numbers ofpeople. Shown above is a relief worker distributing oral therapy (used to treat diarrhoea) in a drought-stricken area ofBurkina Faso (L. de Toledo) ~------;

34 CONCLUSION

WMO promotes the application of climate global climate change and stratospheric and weather information and knowledge ozone depletion because of the possible to improve human health. This can only occurrence of irreversible changes in the be achieved through cooperation between world's environment and climate systems NMHSs, health professionals and other and because of the potentially serious decision-makers responsible for human nature of the health outcomes. health and welfare. Climate and weather Both existing and future environmen forecasts are of no value if they are not tal health problems share many of the acted upon. In addition, at the local or same underlying causes, relating to community level, information must be poverty, inequality, and socio-economic expressed in terms that complement local v;jues and practices. The global-scale Environment can knowledge and perceptions. processes of climate change and environ affect health at the The impacts of climate change and mental change and degradation will tend local, regional and variability on human health are becoming to exacerbate these various current health global levels more important on the environment and problems, such as local malnutrition, the (A. McMichael) health agenda. However, there are many information gaps that need to be filled by Indirect and local studies of the health impacts of Disruption of (somewhat) short-term variations in weather and Earth's natural delayed effects biogeochemical on human climate. In addition, health scientists systems population should engage climatologists, meteorolo health gists and scientists from other disciplines to undertake more collaborative research. The 1992 United Nations Conference on Environment and Development (UNCED) recognized in Agenda 21 that the unavoidable uncertainties attached to fore casting the potentially serious impacts of global environmental change do not justify a wait-and-see inaction. Rather, in such circumstances there is a strong case for prudent, precautionary action. This "Pre cautionary Principle" is directly relevant to 35

The Secretary-General of WMO, Professor G.O.P. Obasi (second from right), at the United Nations Conference on Environment and Development (Prendergast/UN)

range of vector-borne infections and the information can support the development rfJ-{uman beings are consequences of weather events in many of protective measures and improve the at the centre of countries. Climate change may also capacities of populations to adapt to both concerns for present new and unanticipated problems climate change and climate variability, for human health. Climate and weather and mitigate the impact on health. sustainabre aevewpment. 'Ifze!J are entitrea to a heafth!J ana proauctive fife in harnwn!J with nature.}}

Rio Declaration Principle 1. United Nations Conference on Environment and Development 36 HOW TO FIND OOT MORE The extent to which information related to • Proceedings of the WMO/WHO/UNEP climate and human health is available varies Symposium on Climate and Human greatly from country to country. Some Health, Leningrad, 1986, Volumes I and 11. NMHSs already have special sections • Intergovernmental Panel on Climate devoted exclusively to the subject and Change (lPCC). IPCC Second Assessment organized for the provision of advisory or Report. Climate Change 1995. consultancy services to the health and plan • Multi-author Review, 1993. Human ning authorities. In some cases, specialized Biometeorology, 14 papers published in biometeorological forecasts are also Experientia, Birkhaeuser, Basel, Volume provided for the general public. 49, Nos. 9 and 11. However, where such special services are • WHO, WMO, UNEP, 1996. Climate not available, those who seek further infor _ Change and Human Health: An mation and/or advice on matters related to Assessment prepared by a Task Group on' climate and human health should start by behalf of the World Health Organization, contacting their national Meteorological the World Meteorological Organization Service. As a minimum, NMHSs will be able and the United Nations Environm~nt to provide basic c1imatological information Programme. A.J. McMichael, A. Haines, as well as advice on how and where to get R. Slooff and S. Kovats (eds.), additional service. [WHO/EHG/96.7], WHO, Geneva. Within the United Nations family of • UNEP Ozone Secretariat, 1998. organizations, UNEP, WHO and WMO have Environmental Effects of Ozone a special responsibility for matters related to Depletion: 1988 Assessment. climate and human health. They have been • MRC/WHO/UNEP. First InterAgency actively involved in developing this sector, Climate Change and Human Health and over the years a number of interna Monitoring Workshop: Identifying tional meetings and symposia have been Research Priorities. London, 4-5 held. December 1997. Workshop Report, Proceedings from these events as well as R.S. Kovats. Medical Research Council, some relevant publications are listed below: London.