The World Health Organization estimates that 150,000 people die annually due to climate change related causes including in floods, droughts, and heat waves. It’s for this reason that the WHO chose to name World Health Day 2008 “Protecting our Health from Climate Change,” thus recognizing the fact that climate change will dramatically affect global health. World Health Day, celebrated on 7 April, involved some pretty splendid celebrations worldwide, including a straight-from-IGHIH rap for the Southeast Asian Regional Office of the WHO (see below for lyrics). Two days later - yesterday - the US celebrated with a presentation to Congress by Howard Frumkin, one of the directors for the Center for Disease Control, on the public health impacts of climate change. “CDC considers climate change a serious public health concern,” he said — but he still kept a lot under wraps.

Mr. Frumkin presented the fact that climate change will directly impact health in the United States, particularly the health of children and the elderly. He described the increase in droughts, heat waves, flooding, increased extreme weather events, and the spread of vectorborne diseases. Yet, in a move more worthy of Fossil Fool’s Day than World Health Day, he then did not comment on whether carbon dioxide, a leading greenhouse gas, was thus a public health threat. Instead, his cautious phrasing was: “To the science, there is strong evidence that carbon dioxide is a greenhouse gas… and there is strong evidence that climate change affects public health.” Thanks, Frumkin!

The issue is, if Frumkin, the CDC, or the WHO do declare that because of the “strong evidence” connecting the simple dots, they would force the EPA to recognize that carbon dioxide IS a danger to public health, which would thus mean that the US EPA would be required to regulate it, according to a Supreme Court decision last year. But the EPA is stalling, saying that such a regulation would have major implications across sectors. Yeah! Exactly! This week, a coalition of states, led by Massachusetts, have brought this issue back to the US Court of Appeals, demanding that the EPA publish its findings related to emissions, after their 2003 claim that there remained “substantial scientific uncertainty” regarding the impacts of greenhouse gases. There wasn’t uncertainty then; there isn’t now. And as James Milkey, head of the environmental protection division of the Massachusetts Attorney General’s office, said to NY Times reporters, “One year ago today, the court rejected E.P.A.’s claim that it lacks authority under existing law to regulate greenhouse gases. It has the duty to regulate, not just the authority.”

Frumkin was able to say more than CDC Director Julie Gerberding could when she presented before the Senate Environment and Public Works Committee last October. Her draft testimony was dramatically limited by the White House; it was cut from 14 pages to 4, and almost all of the specific references to potential health risks were removed. The entire section “Climate Change is a Public Concern” was deleted, along with specific numbers of the people who could be impacted by climate change.

So despite my cynicism towards Frumkin’s testimony, as it seems to be more than a little restrained in comparison to the WHO’s scientific findings, things are changing, as it is now all too clear that climate change will impact our health. Margaret Chan, Director of the World Health Organization has said that climate change will affect “the most fundamental determinants of health: air, water, food, shelter and freedom from disease.”

I was able to attend the event at Southeast Asian Regional Office of WHO on World Health Day — to perform a rap about climate change and health, no less — and heard the Regional Director speak about the threats to Southeast Asia, where the health impacts are and will be enormous. Like everything associated with climate change, the impacts will not be equitably distributed throughout the world, and the threats are particularly frightening in India, with its large coastline and coastal population, large reliance on rainfed agriculture, and enormous population without access to basic health services already.

The massive migrations and health impacts caused by increasing floods AND droughts seem almost like a horror movie, and the rising sea levels will change both physical and cultural geographies due to mass migrations of climate refugees. All of these will not only impact physical health, but also create enormous mental health impacts.

However, the intersection of climate change and world health is not only that climate change will lead to direct health impacts, but that climate changes will exacerbate existing health problems and put greater stress on public health networks. Malaria is an issue the global health community is struggling to address, killing almost 1 million people annually, and warming winters will allow more malarial mosquito vectors to survive the cold seasons. Malnutrition is a problem that has not been solved despite the promises of the green revolution, still causing more than 3.5 million deaths a year, and the stresses of changing climatic conditions will only make the fight to survive an even more difficult battle. Lack of access to clean drinking water leads to diarrhoeal diseases, and increases in both droughts and floods are likely to decrease availability of fresh water. Urban sewage systems in India cannot treat the waste of existing populations, and with growing populations, rising sea levels AND increased precipitation, these problems will also be exacerbated. The global health community, and the general public must be aware of the impacts of climate change on health and prepare for these changes by expanding existing public health networks.

Dr. Chan, Director General of the WHO, wrote

We need to put public health at the heart of the climate change agenda. This includes mobilizing governments and stakeholders to collaborate on strengthening surveillance and control of infectious diseases, safer use of diminishing water supplies, and health action in emergencies.

This intersection between climate and health is actually demonstrative of even bigger issues of integrating adaptation into sustainable development. As Dr. Chan said, water supplies are already threatened by so many other human impacts - including overuse and massive pollution - such that melting glaciers, desertification and changing precipitation patterns will only increase freshwater scarcity. The forced migration and conflicts over scarce water resources, as witnessed in Darfur as Lake Chad shrinks, will only become more severe with climate change.

On the plus side, many of the ways we address climate change can also improve health directly. Reducing fossil fuel combustion will reduce the particulates in the air and other non-GHG emissions. Even, dare I say it, walking or biking to work rather than driving improves cardiovascular health and reduces emissions. Furthermore, indoor air pollution (primarily from cooking with dung, fuelwood or coal) causes 1.6 million deaths a year. Addressing climate change by finding more efficient ways to cook in rural areas (biogas, solar cookers, or more efficient solid fuel stoves) can greatly reduce the health impacts directly (and indirectly via emissions). In 2002, the WHO estimates that more than 120,000 people died in India alone of diseases exacerbated by air pollution! Reducing fossil fuel combustion can help improve air quality and reduce emissions, helping health directly and indirectly.

The Southeast Asian Regional Office of the WHO celebrated World Health Day with a performance by the music club of The Energy & Resources Institute, Pratibimb. The founders of the WHO 60 years may not have anticipated that the institutional birthday would be celebrated by a rap about climate change, but the world is full of surprises. As the Regional Director of WHO said, 60 is the year to retire, but WHO is still young and is never retiring — they might not be quite young enough to really be ready for rap, but I’m including a few of my favorite lyrics below, and will attach the recorded song as soon as I can.

The truth of climate change is all too clear;
We feel the climate impacts, they’re already here.
We know these climate changes will impact our health,
Threaten food security, safety and wealth.
Monsoons and floods are getting even stronger
While seasons of drought are getting even longer
Floods mean more drowning, and droughts mean starvation
Adaptation and mitigation offer salvation.

Our health is at stake, there are actions we must take
Let’s make it our mission to stop our emissions.

Warming waters lead to rising seas
With oceans submerging communities.
This heat increases storm intensities
Meaning bigger disasters with more injuries.
Climatic changes forcing families to move;
Mental health impacts are easy to prove.
All these massive changes making climate refugees –
No government’s prepared for migrations like these.

Our health is at stake, there are actions we must take
Let’s make it our mission to stop our emissions.

Climate change is shifting eco-zones;
More malarial mosquitoes entering homes.
Warming winters help vectors spread disease,
Making life easier for ticks, rats and fleas.
On the poverty line, the fight for life is getting tougher;
Old and young, the poor will be the ones to suffer.
The largest emissions come from the wealthy,
But can we afford to keep the world healthy?

Our health is at stake, there are actions we must take
Let’s make it our mission to stop our emissions.

Addressing climate change also makes cleaner air;
Improved respiration everywhere.
We’ll protect our climate and our health when we conserve;
Save our children’s planet, as they deserve
Stopping climate change, our emissions and pollution,
You know that we’re all part of the solution.
So on World Health Day 2008
Let’s be the change we wish to create.

Our health is at stake, there are actions we must take
Let’s make it our mission to stop our emissions.