Despite rapid economic growth over the past few decades, inequalities in income have generally increased both within and between countries, in association with an increasingly market-driven global economy. Between 1960 and 1993, the difference between average per capita incomes in industrialised and in developing countries tripled (UNDP, 1996). Inequalities in health have also increased because, although the health of most populations has improved over the past half-century, these gains have not been shared equally. International reviews indicate that present trends in population growth, consumption, and economic inequality are likely to lead to ecologically unsustainable patterns of development that would undermine the basic prerequisites for good health (UNDP, 1996, 1998; UNEP, 1999).
There is a large and growing population that suffers the double burden of poverty and disease (WHO, 1995). This population, especially in developing countries and countries with economies in transition (CEIT), is also increasingly having a double disease burden, with the highest incidence of both infectious endemic diseases (tuberculosis, dengue, cholera, etc.) and the degenerative diseases typical of urban-industrial societies. The "technology" exists to prevent or control most of the world's biggest killers, because they are linked to factors such as inadequate: food supply, mosquito control, safe water, secure shelter, access to education and healthcare (WHO, 1992). The barriers that exist to improved public health are to a large extent the same social and political barriers to the elimination of poverty.
Assessment of the potential for adaptation is dependent on both knowledge of potential impacts and on the vulnerability. Vulnerability is a function of the extent to which a health outcome is sensitive to climate change, and on the capacity of the population to adapt to new climate conditions (Parry and Carter, 1998). Thus, technologies that strengthen adaptive capacity are technologies that reduce vulnerability and vice versa.
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