The reduction of population vulnerability is, in general, the most cost-effective strategy to deal with the health impacts of climate change. In the lowest-income countries, where impacts are likely to be greatest, strengthening the public health infrastructure should be a priority. There has been a widespread decline in public health training, facilities, and programmes over the past decade (McCally et al., 1998).

Equally important, the health of communities will be improved by social-economic development that promotes income redistribution and the reduction in health inequalities. Impoverished populations are at greater risk of adverse health outcomes (such as those due to exposure to infectious agents, vulnerability to thermal extremes, and marginal nutritional status) because they have fewer choices. For populations whose health status is already compromised, the consequences of climate change will often be a critical further stress upon health.

Population health vulnerability would also be reduced by taking specific steps to lessen the health impacts of climate change. Examples include improved urban and housing design, vaccination programmes, upgraded wastewater and refuse disposal systems, and public education and early-warning programmes. Improved understanding by the public and policymakers of the potential health impacts of climate change is a prerequisite to reducing the impacts. This can be achieved by:

• Encouragement of research institutions to pursue long-term, multidisciplinary research.
• Dissemination and public discussion of research results and risk assessments.
• Monitoring of, and quantification of, any early health outcomes.

With respect to the mitigation of climate change, awareness of potential health impacts should be a central consideration in the public discourse. The social incentives for GHG mitigation would be further enhanced by market mechanisms, particularly pricing, that take account of human health costs.

With respect to the capacity of populations to adapt to climate change, public policies to reduce socio-economic and physical-environmental vulnerability are necessary. Health sector institutions and processes, however, are not able to deal effectively with health problems on their own. The task is multi-sectoral. A structured approach for cross-sectoral strategies and international cooperation is therefore required, entailing explicit reference to environmental health impact assessment of all policies. Low-income countries are unable to afford many of the basic health protection measures without international assistance. Overall, intergovernmental agreements are needed for national policy making and funding, and for coordinated research and monitoring to reduce the health impacts of climate change.

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