Greater emphasis must now be given to helping countries where there is a particular need to improve vulnerability assessment, to identify climate change health risks, and to define needs and resources for mitigation and adaptation programmes. The strengthening of intersectoral efforts at the international level (for example, between the health, meteorology, agriculture, and fisheries sectors) could be a longer-term goal. WHO collaborates with other UN agencies on a number of monitoring programmes, such as GEMS (Global Environmental Monitoring System) that provides monitoring and assessment of air and water quality. International monitoring programmes could be extended to include exposures to the direct and indirect health hazards associated with climate change and sea level rise (McMichael et al., 1996; WHO/MRC/UNEP, 1998). Linkages between health-related early warning systems that are already in existence, such as Global Information and Early Warning System (GIEWS) and ProMED, will need to be strengthened.
Research requires the availability of quality data. Many international agencies have a responsibility to collect and disseminate data; e.g., WHO supports a major international database focused on the incidence of infectious diseases worldwide. They also have a responsibility to ensure that financial considerations concerning access to data do not impede research (Colwell and Patz, 1998). International agencies could support the formation of a central clearinghouse for data on climate-health linkages in order to facilitate the gathering of data for research, especially for developing countries and particularly for data generated by global monitoring systems.
Food security in some countries may be worsened by climate change while it may be improved in others (IPCC, 1996 WGII [Chapter 13]). In the former countries, personal, community and national level adaptation options are likely to be severely limited. The most effective strategies for adaptation would entail changes in the international mechanisms of agriculture, trade and finance. Global organisations such as the World Trade Organisation may be best placed to implement the required changes of policy - provided there is the political will to address the issue seriously.
In recent decades, there has been a shift of economic power away from national governments to various private and public organisations (e.g., multi-national corporations, the World Trade Organization, and regional free trade associations) which are not explicitly accountable for, nor concerned by, the social, health and environmental effects of their actions. The "globalisation" and liberalisation of international systems of trade and finance has facilitated the exploitation of poorly protected environmental resources in the short term (McMichael, 1995). Although responsibility for population health remains primarily national, there is need for new mechanisms for international collective action in favour of forms of social and economic development that are compatible with sustained good health (Jamison et al., 1998; McMichael et al., 1999).
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