diseases there is still considerable controversy about the degree to which climate change has been responsible for changes in the incidence and distribution of disease. This is due to the potential contribution of other factors, such as changing land-use patterns, human behavior, and methodological issues including the use and analysis of appropriate climate data.”

Haines also reviews several efforts to date to estimate the future impact of climate change on infectious diseases, which—although individually problematic—support his overall conclusion that “it is likely that the disease burden as a result of climate change will [increase] substantially over time and will be particularly concentrated in the poorer populations.” Thus, his proposed strategies to address the negative health effects of climate change focus on the poor: first, by improving their access to basic public health services (clean water, sanitation, immunization); second, by providing them with cleaner fuels, which offer both immediate health benefits and long-term protection for the atmosphere. “Infectious diseases are one of a number of categories of health outcomes that are likely to be affected adversely by climate change,” Haines concludes. “Public health policies should take into account the need to adapt to a changing climate, as well as the potential for near-term benefits to health from a range of policies to mitigate climate change.”

Haines’s paper is followed by two reprinted pieces, authored (in the first case) and coedited by Epstein (in the second), that illustrate the breadth of biological responses to climate change. The first manuscript is an essay, originally published in the New England Journal of Medicine in October 2005—weeks after Hurricane Katrina devastated the Gulf Coast—that focuses on the wide-ranging health effects of extreme weather. The second, an excerpt from the report Climate Change Futures: Health, Ecological and Economic Dimensions (Center for Health and the Global Environment, 2005), introduces a “multidimensional assessment” incorporating trend analysis, case studies, and scenarios that focus on health, ecological, and economic impacts of climate change. This project, undertaken in collaboration by the Center for Health and the Global Environment at Harvard Medical School, the United Nations Development Programme, and Swiss Re, a global reinsurance company, was designed to assess threats posed by climate change to the institution of insurance, a “time-tested method for adapting to change.” Such threats go far beyond immediate property damage, and indeed even health consequences, to the social and political stability of regions affected by climate disasters (see also Chapter 4).

In his workshop presentation, Epstein emphasized the methodologies that make such threat assessments possible. He identified three phenomena that underlie climate- and weather-related changes in disease distribution:

  1. Since 1950, nighttime and winter warming have occurred twice as fast as overall global warming.

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