Download Climate Change, Influencing the Health of Urban Populations

ICCG Think Tank Map: a worldwide observatory on climate think tanks
Climate Change, Influencing the
Health of Urban Populations
Sabrina Dekker, ICCG
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
Climate Change, Influencing the Health of Urban
Populations
Sabrina Dekker (ICCG)
Abstract
Cities are facing the impacts of climate change and consequently faced with the demand to
address it. However, policy has typically focused on the economic and social impacts of climate
change. Recently, there has been a call for healthy cities as means to address climate change in
urban environments. Thus this paper looks at the impacts of climate change on human health in
urban environment. Then discusses how cities can address human health and climate change
through the social determinants of health and the WHO’s Healthy Cities Guidelines.
1
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
Introduction
Planning for healthy environments is not a novel concept. Throughout the history of urban planning
there have been movements to make urban environments healthy and improve the quality of life
experienced by citizens. From the sanitation/hygiene movement to the city beautiful movement,
the garden city and now the healthy city, city planning has gone full circle1. A key shift in this
transition has been the movement from planning as a means to mitigating public health issue, to a
focus on the physical environment and the economic growth of the city, and now back to public
health. The healthy cities movement began in the 1980s however, recently the movement
experienced a resurgence, and cities are creating health city plans2. The driver of this has been
climate change with its adverse impacts on urban environments in the forms of: extreme weather
events, flooding, extreme temperatures, air pollution and poor air quality; all of which impact
human health and well-being. Thus, what are the impacts of climate change on the health of urban
populations and how can cities address them? To answer these questions it is important to firstly
understand what health challenges are prevalent in urban environments, then how climate
change impacts them. Then analyse how cities can approach the challenges with existing tools,
namely the social determinants and the WHO Healthy City Guidelines, to develop effective policies
and plans.
Urban Health and Climate Change
“Cities face health challenges from climate change that are similar in some respects to their
hinterlands but in other respects are unique because of greater population density and
diversity, complexity of the built environment and dependence on technological systems
for survival. Urban residents are more insulated from the natural environment, which leads
to a lack of understanding about human effects of environmental systems and negative
feedbacks from degraded environments to human health” - Harlan and Ruddell, 2011
Urban environments by their nature present unique health challenges. A city’s physical structure
plays a role in the health outcomes of residents by influencing and shaping the way they work, live
and play3. Cities provide services to their residents in the forms of housing, water and sanitation,
food, energy, transportation, social services and employment, all of which play a role in their
livelihoods and health4. Notably the provision of health services is not listed or rather classified
under social services; yet historically, public health was a key driver in planning, until economic
development built on the physical and technical achievements of cities became central to a city’s
competitiveness5. Health plays a vital role in the growth and success of a city. Cities are
dependent upon its citizens, who need good health to maintain the economic and social
competitiveness of a city and vice versa, and climate change is threatening health6. Climate
change research has primarily focused on the economic costs to cities, and to some extent the
social costs, but not the health costs to cities stemming from climate change7. This could be for
several reasons namely the research linking health to climate change is scientific, and little has
been done in relation to health economics8. Regardless, it is necessary to understand how climate
change impacts health in cities.
Hall, 1996; Botkin and Beveridge, 2008; Berger 2013; Fleischman and Barondess, 2004; Kenzer, 1999
WHO, 2000; Barton, Mitcham and Tsourou, 2003; Ritsatakis, 2012
3 Stephenson, et al., 2013; Blas, et al, 2008; Marmot, 2005; AIA, 2013; Barton, 2009
4 Marmot, 2005; Blas, et al., 2008
5 Kenzer, 1999
6 WHO, 2013; Berger, 2013; Barton, 2009; Younger, et al. 2008
7 Tol, 2009; Forde and Raine, 2008;
8 Hallegatte and Corfee-Morlot, 2011; Campbell-Lendrum and Corvalan, 2007; WHO, 2012
1
2
2
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
What are the health threats for urban populations and what factors of the urban environment that
lend themselves to the perpetuation of ill health? There are broadly three categories of health
challenges that face cities: communicable diseases, non-communicable diseases and medical
conditions9. Communicable diseases are those which are transferred from human-to-human, and
non-communicable diseases are those that are vector borne. Medical conditions include diseases
that are neither vector borne or transferred by human-to-human contact, such as respiratory and
cardiovascular diseases, cancer, injury and mental health. Below is a table derived from research
conducted by the WHO on health and climate change, highlighted are the diseases likely to be
found in cities and who’s prevalence may increase due to climate change. The research
conducted by the WHO runs the risk of stating that all diseases related to climate change. It is
important to emphasize the work of the WHO is global. Not all cities will experience a rise in these
diseases in relation to climate change, geographical location of cities will determine what diseases
will affect populations. Further, more research needs to be done to understand the causal
pathways linking health and climate change10. The objective is to educate cities on how climate
change will impact the health of citizens; such that they can plan to mitigate negative health
outcomes.
Table 1. Health Challenges and their climate factors11.
Allergies
Normal Geographical
Range
Global
Vectors/Mode of
Transfer
N/A
Asthma
Global
N/A
Cancer (need to identify
types)
Global
N/A
Radiation, pollutants
Cardiovascular disease
Global
N/A
Various mechanisms, air quality, air
pollution
Global
N/A
Air quality, air pollution
Global
Global
Global
Global
N/A
N/A
N/A
N/A
Various mechanisms, food shortages
Extreme heat and heat waves
Extreme cold, snow storms, ice storms.
various mechanisms
Global
N/A
Various mechanisms
Global
Global
Global
Global
N/A
N/A
N/A
N/A
Malaria
Tropical and semitropical world (106
countries approx.)
Mosquitoes
Dengue
Cities in tropical and
sub-tropical areas,
because of abundant
breeding sites and high
density of human
populations for
transmission
Mosquitoes
HIV
Global
STD
Leishmaniasis
Four continents and
considered to be
endemic in 88 countries,
72 of which are
developing countries:
Female sandflies
Drought, water shortages,
Various mechanisms
Various mechanisms
Various mechanisms
Rainfall (breeding sites for mosquitoes),
humidity (survival), and temperature
(development of parasite); cyclones and
the breaking of a drought in a region
Climate coupled with high density
populations perpetuate its spread; heavy
rainfall can lead to standing water;
drought encourages people to store
water around the home. Warm
temperatures optimize mosquito and
virus development.
Complex, increased population, sexual
violence, sanitation of health facilities
Environmental changes, such as
deforestation, building of dams, new
irrigation schemes and urbanization, and
the accompanying migration of nonimmune people to endemic areas.
Disease/Health Outcome
Chronic Obstructive
Pulmonary Diseases
(COPD)
Diabetes
Heat Exhaustion/stroke
Hypothermia
Injury
Mental Health/Illness
(depression, anxiety, etc)
Malnutrition
Morbidity/Mortality
Obesity
Physical disability
Climate Change Factors/Influences
Air pollution, air quality
Air pollution, air quality, related to wild
fires, heat, humidity, volcanic eruptions,
emissions
Campbell-Lendrum and Corvalan, 2007; WHO, 2010; WHO, 2012; McMichael et al, 2010
Hosking and Campbell-Lendrum, 2012
11 WHO, 2010; WHO, 2012
9
10
3
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
Chagas Disease
Japanese Encephalitis
West Nile Virus and other
encephalitides
Guanarito, Junin, and
Machupo Viruses
(Arenaviruses)
Hantavirus
Rabies
Latin America.
Increasingly detected in
the United States of
America, Canada,
many European and
some Western Pacific
countries.
Asia, from the islands of
the Western Pacific to
the Pakistani border,
and from Korea to
Papua New Guinea.
Presence in Muslim
countries is negligible.
Africa, Europe, the
Middle East, North
America and West Asia
South America
Blood-sucking
triatomine bug
Population migration, consequently
migration stemming from climate change
can contribute to spread of disease
Mosquitoes belonging
to the Culex
tritaeniorhynchus and
Culex vishnui groups,
Rainfall, stagnant water for breeding
sites,
Mosquitoes
Rainfall, population movement, rising
temperatures
Transferred to humans
via rodents
Various factors
Rodents
Animals
Poor sanitation, various other modes
Poor sanitation, various other modes
Fresh water snails
Rising temperature and increased rainfall
Animal waste
Poor sanitation, various other modes
Extreme weather events (hurricanes,
earthquakes, typhoons), increased
precipitation and flooding
Extreme weather events (hurricanes,
earthquakes, typhoons), increased
precipitation and flooding
Correlation to transmission with an
increase in dust levels, and reduced
humidity; working hypothesis is that dry,
hot and dusty air irritates respiratory
mucosa encouraging an invasion of the
bacteria. Extreme heat
Leptospirosis
Global
Global
Tropical and sub-tropical
areas
Global
Cholera
Global
Contaminated water
and food
Cryptosporidiosis
Global
Contaminated water
Meningitis
Global with burden on
sub-saharan Africa,
Dry air
Schistosomiasis
Coccidioidomycosis
Onchocerciasis
Southwestern United
States, and parts of
Mexico and Central and
South America
West and Central Africa,
but it is also prevalent in
Yemen and six countries
in Latin America
Rift Valley Fever
Africa, Saudi Arabia,
and Yemen
Nipah/Hendra Viruses
Australia, Bangladesh,
Cambodia, China, India,
Indonesia, Madagascar,
Malaysia, Papua New
Guinea, Thailand and
Timor-Leste, and Africa
Air borne, fungal spores
transmitted through the
bites of infected
blackflies of Simulium
species,
Infects human when
they consume the
blood or organs of
infected animals,
Transmitted to animals
via mosquitoes
Fruit bats of the
Pteropodidae family
Dry air, drought, contributing to increases
in dust,
Rising temperatures, especially in bodies
of water
Above average rainfall, allowing for the
breeding of mosquitoes
Poor sanitation, reduced water quality
Given the above information it would appear that cities do not have the means to address the
human health impacts of climate change. However, research on the health impacts of extreme
temperatures12, extreme weather events13 and air pollution14 have focused on the health
Baccini et al, 2008; Dear et al 2005; Corburn, 2009; Harlan and Ruddell, 2011; Kim et al, 2012; Basagna, et al. 2011; Hajat et
al 2010; Madrigano, et al (2013)
12
4
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
consequences in urban centers; thus, the recommendations stemming from the research state that
cities are in the best position to respond15. Moreover, cites are responding by implementing policies
focused on greening the city via green infrastructure and transportation policies centered on
public transit and cycling, to mitigate climate change. Changing the nature of the built
environment is not the only means by which cities can mitigate the health impacts of climate
change. The social determinants of health (SDH) have gained prevalence in the dialogue on
human health and climate change, primarily as a point from which to develop policy16. The SDH
highlight how health is a result of the environments that people inhabit, and their interactions with it.
Climate change impacts the human environment, therefore, the SDH can also provide insights into
the means by which cities can address the health impacts of climate change17.
Cities and the Social Determinants of Health
“Health is associated with social determinants—nowhere more so than in cities” – Rydin et
al, 2012
It is evident from research that living conditions play a significant role in human health outcomes.
For example, poor housing, overcrowding, and poor sanitation contribute to the spread of
diseases, risk of physical injury and death. The previous ICCG Reflection looked at the SDH and their
relationship to climate change and human health, the discussion was broad. Here the focus is on
cities and the potential for the SDH to serve as a link between climate change policy and public
health policy in cities.
In cities, the SDHs exert an incredible amount of influence on the health of human beings18. The
SDH that contribute to human health and well-being, in urban environments are19: economic
opportunity, wealth/poverty, housing, violence and crime, green space, and physical
infrastructure20. As, economic opportunity and wealth/poverty were discussed in the previous
reflection, this paper looks at the remaining SDH. Briefly, the challenge with both is that they hinder
access to opportunities to improve quality of life via purchasing power; forcing the prioritization of
income expenditure. Thereby compounding the ability of families and individuals to access an
essential SDH, such as housing.
Access to stable housing plays a role in health outcomes by reducing vulnerability to numerous
health risks associated with living outside or precarious housing. The solution to this is often high
density affordable social housing. However, overcrowded conditions in social housing (and slums)
have adverse effects on human health such as contributing to the quick spread of disease21.
Overcrowded conditions are also associated with poor facilities in terms of clean water, adequate
sanitation and energy supply, which contribute to negative health outcomes22. Even, when
housing is not overcrowded, but there is no access to clean water, and/or a reliable energy supply
there are health challenges23. Studies related to extreme temperatures have highlighted the
vulnerability of the elderly living in poor housing conditions where pipes are frozen during the winter,
or electricity is cut off during heat waves; these factors have contributed to high mortality rates in
this population24. Another factor related to housing, is safety, this refers not just to the physical
structure and the maintenance of housing, but the location and social cohesion. Location
Zanobetti et al, 2013; Epstein, 2002
Anlitias, et al, 2014; Harlan and Ruddell, 2011
15 Anlitais, et al, 2014; Campbell-Lendrum and Corvalan, 2007; Barton 2009
16 Galvao, et al, 2009; Blas, et al, 2008; Ritasatkis, 2012; Berger 2013
17 Galvao, et al, 2009; Forde and Raine, 2008; Marmot, 2008
18 Rydin, 2009; WHO 2013; Rydin, 2012; Rydin et al 2012
19 Rydin, 2009; WHO 2013; Rydin, 2012; Rydin et al 2012
20 Mikkonen and Raphael, 2010; WHO 2013; Blas et al., 2008
21 Barton, 2009; Younger, et al., 2008; Berger, 2013
22 Stephenson, et al., 2013; Grady and Goldblatt, 2012
23McMichael, et al., 2010; Corvalan et al, 2006; Stephenson, et al., 2013
24 Younger, et al, 2008; Kovats and Akhtar, 2008
13
14
5
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
contributes to perceptions of safety which is related to social cohesion. A lack of social cohesion in
poor communities is often attributed to perceptions of safety and the fear of violence and crime25.
Social housing is often found in neighbourhoods of high crime, which perpetuates fear and forces
people to stay inside26. Collectively and separately, all of the afore mentioned determinants have
negative consequences for health, mentally and physically. In turn, impacting the ability of
individuals to access basic necessities to improve their livelihoods, such as stable employment27.
By contrast, scientific evidence shows that green spaces and parks, are associated with:
improvements in physical and mental health, maintenance of good health and prevention of ill
health in urban environments28. Central to green spaces improving health are access and use,
which are related to physical planning and safety. In order for health to be improved or be
maintained individuals must have access to green spaces29. Parks need to be planned such that
people can easily access them. Many cities incorporate the goal of “access to a park or green
spaces within a 5 to 10 minute walk”, an important an attribute but it does not stand alone30. The
desire to use green spaces must also be present. “Use” is complicated by individual behavior and
attitudes towards physical activity, and perceptions of safety31. People will not use parks if they
hold the belief that they could be victimized in a park. How parks and green spaces are planned
determine their use and value to human health, which is linked to the overall physical planning of a
city32.
The physical layout of a city plays a role in shaping the health of its citizens, especially infrastructure
which includes: transportation, sanitation and water, and energy33. Transportation is vital in
creating healthy urban environments; planners are tasked with balancing the need to transport
goods in and out of the city, with the movement of people within, and in and out of the city34.
Roads are the primary means of doing this. However, as motorized vehicles are the primary
contributor of greenhouse gases, there is a need to reduce the demand for motorized transport.
The response has been transportation plans focused on increasing public transportation use,
promoting cycling, and improving walkability35. Inadvertently improving the physical health of
residents by encouraging active transport and mitigating the risk of injury and death from traffic
accidents36. Improving the ability of people and goods to move has benefits for health. Yet, there
are issues of access and use. The primary users of public transportation, and other alternative
modes of transportation (walking and cycling), prior to the call for increasing their use, has been
the urban poor37. Income and employment play heavily in this outcome, the need to have a job
sees the urban poor willing to take employment that is far from their homes and at varying hours38.
Consequently they are forced to take multiple modes of transportation, which may involve using a
significant portion of their income. This is a simple causal relationship between transportation,
income, and the health of the urban poor. In reality the relationship can be far more complex. The
primary challenge is access in the form of affordability. Secondary to this is safety (as with parks)
people need to know that public transportation, and cycle paths are safe39.
Sanitation and water systems are essential services provided by cities or regional government
depending on location. In urban areas, the assumption is often made that everyone has access to
reliable sanitation and water systems and there are no health risks40. This is a false assumption as
Barnett, 2001; Grady and Goldblatt, 2012; Berger 2013
Stephenson, et al., 2013; Grady and Goldblatt, 2012; Berger, 2013
27 WHO, 2013; Rydin et al, 2012; Stephenson, et al, 2013
28 Wolf, 2003; Kovats and Akthar, 2008; Corvalan, et al.2006; Charron, 2012
29 Wolf, 2003
30 Corburn, 2009; Tzoulas, et al., 2007
31 WHO, 2012; Rydin, 2012, Barton, 2009
32 Tzoulas, et al., 2007; Rydin, et al., 2012
33 Berger, 2013
34 Rydin, et al, 2012; Berger, 2013
35 Barton, 2009; Tzoulas, et al 2007
36 Barton, 2009; Berger, 2013; Younger, et al, 2008
37 Rydin, et al, 2012
38 Rydin et al, 2012; Stephenson, et al., 2013; Grady and Goldblatt, 2012; Berger, 2013
39 Berger, 2013
40 Younger et al, 2008; Barton, 2009; WHO 2013; Berger, 2013
25
26
6
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
the urban poor often experience living conditions where access to proper sanitation and safe
drinking water is not possible. Consequently the health of the urban poor is compromised and
increasing their risk of contracting water borne diseases, which in turn impede on their ability to
work, and so forth. Energy is another service provided by cities that plays a role in health; as it is
essential for daily activities41. Without energy individuals and families are at risk of dying from
exposure to cold or heat, injury from attempting to use alternative means of heating, and
numerous other health risks.
Overall, the physical infrastructure provided by cities and urban regions is a significant determinant
of health. Moreover, each of the SDH are connected to each other via diverse causal pathways.
Adding the impacts of climate change into this equation only amplifies the challenge of
maintaining and improving human health in urban environments. Thus the question becomes how
can cities integrate health into their existing plans (or in some cases use health as a starting point
for developing a plan), such that cities become resilient to climate change and prevent poor
health outcomes?
WHO Guidelines for Healthy Cities
The WHO’s guidelines for healthy cities are built as a generic approach based on the experience
gleaned from the implementation of healthy city programmes across the WHO’s various regions.
The key reasons for this are the recognition of variations in: health, political structure, level of
urbanization, leadership, and capacity. Given this the guidelines begin with a three phase
approach, acknowledging the broad spectrum of development that cities fall within. The phases
are as follows42:
1. Awareness raising and establishment of an intersectoral initial task force for a Healthy Cities
project and ends with gaining strong commitment and support of the local government.
2. Works to develop organizational structure, working mechanisms, city health profile, plan of
action and capacity for the project.
3. Implementation of the established plan of action and continued development of
sustainable mechanisms to ensure promotion of health in the city.
Phases 2 and 3 revolve around the development of an action plan, the puts into motion the city’s
efforts to improve its population’s health. The recommendation for the contents of an action plan
by the WHO are:
•
•
•
•
•
•
•
•
41
42
Characteristics of the city: topography and climate, history, culture and heritage,
administration, and demographics
Vision of the city
Health and environmental situation of the city: population health, lifestyles and preventive
activities, health care services, welfare services, environmental health services, living
environment, environmental quality, urban infrastructure, natural environment, land-use and
urban planning, local economy, education, income and family living expenses, community
activities, legislation and regulations.
Priority health problems
Planning goals and targets
Actions and activities to resolve priority health problems, including elemental healthy
settings activities: schools, work places, market places.
Roles of Individual groups in implementing above actions/activities
Resources required and available for implementing the actions/activities
Campbell-Lendrum & Corvalan, 2007; Corvalan, et al. 2006; Rydin, et al, 2012
WHO, 2000; Berger 2013; Barton 2009; Kenzer, 1999
7
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
•
Implementation and monitoring/evaluation mechanisms: coordination and communication
mechanisms for implementation, indicators for monitoring and evaluation of progress,
mechanisms for evaluation and reporting systems.
The WHO guidelines are not a panacea, as there are limitations. Not every city has the capacity to
conduct and finance research into the health status of their populations, much less conduct
comprehensive environmental assessments. However, it is a starting point that provides direction
and guidance for cities as they plan for the impacts of climate change on human health. As the
WHO highlights, intergovernmental, intersectoral and engagement with a range of stakeholders will
be vital in enabling cities to develop plans that incorporate the scientific evidence and connect it
to the economic and social policies that have dominated urban planning. As such, research
needs to be conducted into the health economics of climate change; this will not be without
challenges, particularly related to the valuation of human life43. In general, more research is
necessary to fully understand how climate change will impact human health, especially beyond
heat related mortality, and air pollution. Increased knowledge on the causal pathways that link
climate change and human health will only serve to strengthen policy in the future. Regardless,
cities should not wait, action needs to build on and innovate current climate change policies to
incorporate health
Conclusion: Action and Research
Cities are not stagnant environments, they are in constant flux, they do not pause; nor does climate
change. While it will be challenging for many cities to incorporate health into plans on the
mitigation of climate change, especially under the guidelines of the WHO44. The unknown costs of
not developing policies far outweighs costs of incorporating health now. More importantly the
scientific evidence, as it currently stands, suggests that impacts of climate change are undeniable.
Thus, focusing on the physical environment and climate change is not enough, human health
needs to be placed at the core of climate change plans45. This paper has shown how the physical
environment plays a role in health, but there are other compounding factors highlighted by the
SDH, that shape health. As such, policy can use the SDH as a tool, and the WHO Health City
Guidelines, as guides for policy development. They can also highlight where more research is
needed, namely the economic costs, such that the case for health focused climate policy is
strengthened
The health of endangered species in natural environments have long be toted as a reason for
climate change mitigation; it is only logical that human health be at the fore climate change
mitigation in urban environments.
References
Anlitias, A., et al. (2014). “Effects of Heat Waves on Mortality: Effect Modification and Confounding
by Air Pollutants”. Epidemiology 25(1):15-22.
Baccini, M. et al (2008). “Heat Effects on Mortality in 15 European Cities”. Epidemiology 19(5):711719.
Barton, H. (2009). “Land use planning and health and well-being”. Land Use Policy 265: S115-S123.
Harpham, 2008; Proust et al, 2012; Kenzer, 1999; Barton, 2009
WHO, 2000
45 Forde and Raine, 2008; Barton 2009; Hosking and Campbell-Lendrum, 2012; Corburn, 2009; Harpham 2008
43
44
8
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
Barton, H., Mitcham, C., and Tsourou, C., eds (2003). “Healthy urban Planning in practice:
experience of European cities” Report of the WHO city Action Group on healthy Urban Planning.
WHO
Basagna, X., et al. (2011). “Heat Waves and Cause specific Mortality at all Ages” Epidemiology
22(6):765-772.
Berger, A.M., ed (2013). “Report: Health and Urban Planning” MIT.
Blas, E., et al. (2008). “Addressing social determinant of health inequities: what can the state and
civil society do?” The Lancet 372:1684-1689.
Botkin, D.B., and Beveridge, C.E., (1997). “Cities as environments”. Urban Ecosystems 1 pp 3-19.
Campbell-Lendrum, D., and Corvalan, C., (2007). “Climate Change and Developing-Country Cities:
Implications For Environmental Health and Equity.” Journal of Urban Health: Bulletin of the New York
Academy of Medicine 84(1):i109-i117
Corburn, J. (2009). “Cities, Climate Change and Urban Heat Island Mitigation: Localising Global
Environmental Science”. Urban Studies 46(2):413-427
Corvalan, C., Hales, S., and McMichael, A. (2006). “Ecosystems and Human Well-Being: Health
synthesis: a report of the Millennium Ecosystem Assessment”. WHO
Dear, K. et al, (2005). “Effects of Temperature and Ozone on Daily Mortality During the August 2003
Heat Wave in France.” Archives of Environmental & Occupational Health 60(4):205-212
Epstein, P.R., (2002) “Climate Change and Infectious Disease: Stormy Weather Ahead?”
Epidemiology, 13(4):373-375.
Fleischman, A.R., and Barondess, J.A. (2004). “Urban Health: A Look Out Our Windows”. Academic
Medicine 79(12):1130-1132
Forde, I., and Raine, R., (2008). “Placing the individual within a social determinants approach to
health inequity”. The Lancet. 372:1694-1696.
Galvao, L.A.C., et al. (2009). “climate change and social determinants of health: two interlinked
agendas”. Global Health Promotion. Supp 16:81-84.
Grady, M., and Goldblatt, P. eds (2012). “Addressing the social determinants of health: the urban
dimension and the role of local government”. WHO.
Hall, P. (1996). Cities of Tomorrow. Blackwell Publishers Massachusetts, USA.
Hallegatte, S., and Corfee-Morlot, J. (2011). “Understanding climate change impacts, vulnerability
and adaptation at city scale: an introduction”. Climatic Change 104:1-12.
Harpham, T. (2008). “Urban health in developing countries: what do we know and where do we
go?” Health and Place 15:107-116
Hosking, J., and Campbell-Lendrum, D., (2012). "How Well Does Climate Change and Human
Health Research Match the Demands of Policy Makers? A Scoping Review” Environmental Health
Perspectives 120(8): 1076-1082
9
Climate Change, Influencing the Health of Urban Populations
ICCG Reflection No. 20/March 2014
Kim, Y.K, Kim, S., Cheong, H.K., Ahn, B., and Choi, K., (2012) “Effects of Heat Wave on Body
Temperature an Blood Pressure in the Poor and Elderly”. Environmental Health and Toxicology 27
Kovats, S., and Akthar, R. (2008). “Climate, climate change and human health in Asian cities”.
Environment and Urbanization 20:165-175.
Madrigano, J., et al. (2013) “Temperature, Myocardial Infarction, and Mortality: Effect Modification
by Individual- and Area-level Characteristics”. Epidemiology 24(4):439-446.
Marmot, M. (2005). "Social determinants of health inequalities". The Lancet 365:1099-1104
McMichael, A.J, et al. (2010) “Chapter 20: Global Climate Change” Comparative Quantification of
Health Risks. WHO
Mikkonen, J., and Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto :
York University School of Health Policy and Management.
Ritsatakis, A. (2012) “Healthy cities tackle the social determinants of inequities in health: a
framework for action”. WHO. regional office for Europe.
Rydin, Y. (2012). “ Healthy cities and planning”. The Planning Review 83(4): xiii:xviii
Rydin, Y., et al (2012). “Shaping cities for health: complexity and the planning of urban
environments in the 21st century”. The Lancet 379:2079-2108.
Stephenson, J., Crane, S.F., Levey, C., and Maslin, M. (2013). “Population, development, and
climate change: links and effects on human health.” the Lancet 382:1665=1673
Tol, R.J.S. (2009). “The Economic Effects of Climate Change”. Journal of Economic Perspectives
23(2) pp. 29-51.
Tzoulas, K. et. al., (2007). “Promoting ecosystem and human health in urban areas using Green
Infrastructure: A lit Review”. Landscape and Urban Planning 81:167-178.
WHO (2000). Regional Guidelines for Developing a Healthy Cities Project. WHO Regional Office for
the Western Pacific.
WHO (2008). Our Cities,Our Health, Our Future: A synopsis of the Report of the Knowledge Network
on Urban Settings to the WHO Commision on Social Determinants of Health. WHO Centre for Health
Development, hub of the Knowledge Network on Urban Settings
WHO (2012). The Atlas of Health and Climate. World Health Organization
WHO (2013). Our cities, our health, our future: Report to the WHO Commission on Social
Determinants of Health from the Knowledge Network on Urban Settings Acting on social
determinants for health equity in urban settings.
Wolf, K.L. (2003) “Ergonomics of the City: Green Infrastructure and Social Benefits”. Engineering
Green.
Younger, M., Morrow-Almeida, H.R., Vindigni, S.M., and Dannenber, A.L., (2008). “The Built
Environment, Climate change, and Health: Opportunities for Co-Benefits”. American Journal of
Preventive Medicine 35(5): 517-526
10