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The links between rapid population growth and concerns regarding climate change have received little attention. Some commentators have argued that slowing population growth is necessary to reduce further rises in carbon emissions. Others have objected that this would give rise to dehumanizing "population control" programmes in developing countries. Yet the perspective of the developing countries that will be worst affected by climate change has been almost completely ignored by the scientific literature. This deficit is addressed by this paper, which analyses the first 40 National Adaptation Programmes of Action reports submitted by governments of least-developed countries to the Global Environment Facility for funding. Of these documents, 93% identified at least one of three ways in which demographic trends interact with the effects of climate change: (i) faster degradation of the sources of natural resources; (ii) increased demand for scarce resources; and (iii) heightened human vulnerability to extreme weather events. These findings suggest that voluntary access to family planning services should be made more available to poor communities in least-developed countries. We stress the distinction between this approach, which prioritizes the welfare of poor communities affected by climate change, and the argument that population growth should be slowed to limit increases in global carbon emissions. The paper concludes by calling for increased support for rights-based family planning services, including those integrated with HIV/AIDS services, as an important complementary measure to climate change adaptation programmes in developing countries. Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. .ةلاقلما هذهل لماكلا صنلا ةياهن في ةصلاخلا هذهل ةيبرعلا ةمجترلا

Climate change and population, taken individually, are among the most contentious issues in public policy; bringing the two issues together is a recipe for controversy. The paper by Bryant et al. (852–857) in this issue1 points towards a more constructive approach to addressing these linked concerns. For all of its complexities, the basic challenge of climate-change policy is the apparent conflict between the drive to maximize short-term individual or national gains (increasing per capita GDP through use of cheap fossil fuel energy) and the need for long-term protection of shared benefits (reducing climate change and minimizing global damage to natural and human systems). Closely tied to this is the issue of fairness. Those populations that have contributed least to past emissions of greenhouse gases are most vulnerable to the impacts of climate change, including on population health.2,3 The governments of developing countries are therefore reluctant to commit to limits on greenhouse gas emissions to help solve a problem that has, so far, been created elsewhere. For their part, the governments of richer countries generally acknowledge their responsibility to take a lead in combating climate change, but hesitate in implementing policies that they consider may harm short-term economic growth and hamper their competitiveness against rapidly developing economies. Some aspects of this debate find analogies in discussion of population policy. Again, there is a potential tension between the immediate rights of individuals (to control their own fertility) and a longer-term, population-level concern (that rapid population growth could potentially overstretch natural and socioeconomic resources, hamper development and lay conditions for conflict). These two issues are also closely linked, but discussing them together has often generated more heat than light. Although the major driver of greenhouse gas emissions remains the consumption patterns of richer populations, human population is also a fundamental determinant of this trend. However, even stating the fairly obvious fact that an individual’s number of children makes a major contribution to their “legacy” of greenhouse gas emissions4 has sparked outraged reaction in some quarters. Population growth is also fastest in developing countries, leading to suggestions that this should be the starting point to reduce climate change. In response, developing countries point out that per capita emissions of children born in poor countries are, and are likely to remain, much lower than those in richer countries, and claim that they are being stigmatized for “profligate reproductive behaviour” as a negotiating position over greenhouse gas commitments.5 Can these issues be discussed constructively? The best approach is probably to choose the least controversial entry point – identifying where human rights, health, environmental and equity objectives converge, rather than conflict. This can be framed around the fact that, in developing countries, approximately 200 million women express an unmet need for family planning services.6 Meeting this need is supported by the following arguments. First, control over reproduction is an individual right, supported through the landmark Programme of Action of the 1994 International Conference on Population and Development. Improved access to reproductive health services is also a Millennium Development Goal. Second, it provides major public health benefits; systematic reviews across multiple countries show that increasing birth spacing from less than 18 to more than 36 months correlates with a two-thirds drop in childhood mortality.7 Third, reducing local overpopulation decreases vulnerability to near-term environmental and other stresses. Fourth, over the long-term, it relieves climate change and other pressures on the global environment.8 Other studies have already identified improved access to reproductive health services as one of several “win-win” interventions that can both improve individual well-being and reduce climate change.9–11 The paper by Bryant et al., however, is the first to provide strong support for the third point – showing that the majority of the least-developed countries cite population pressure as an important determinant of their vulnerability to climate change. The fact that the affected countries themselves identify this as a local priority avoids the conflict that comes from framing population regulation as a way of reducing global greenhouse gas emissions. When developing this case, the order of the arguments is critically important. Individual rights come first, with the population health, local and global environmental benefits as welcome and important co-benefits. In contrast, using the need to reduce climate change as a justification for curbing the fertility of individual women at best provokes controversy and, at worst, provides a mandate to suppress individual freedoms. This new paper is an important contribution in its own right. It is also a reminder that, although the case for family planning services should be self-evident, it needs to be carefully constructed and sensitively handled. ■

Anthropogenic climate change appears to be increasing the frequency, duration and intensity of extreme weather events. Such events have already had substantial impacts on socioeconomic development and population health. Climate change's most profound impacts are likely to be on food, health systems and water. This paper explores how climate change will affect food, human health and water in China. Projections indicate that the overall effects of climate change, land conversion and reduced water availability could reduce Chinese food production substantially - although uncertainty is inevitable in such projections. Climate change will probably have substantial impacts on water resources - e.g. changes in rainfall patterns and increases in the frequencies of droughts and floods in some areas of China. Such impacts would undoubtedly threaten population health and well-being in many communities. In the short-term, population health in China is likely to be adversely affected by increases in air temperatures and pollution. In the medium to long term, however, the indirect impacts of climate change - e.g. changes in the availability of food, shelter and water, decreased mental health and well-being and changes in the distribution and seasonality of infectious diseases - are likely to grow in importance. The potentially catastrophic consequences of climate change can only be avoided if all countries work together towards a substantial reduction in the emission of so-called greenhouse gases and a substantial increase in the global population's resilience to the risks of climate variability and change.Le changement climatique anthropique est à l'origine d'une augmentation de la fréquence, de la durée et de l'intensité de phénomènes météorologiques extrêmes. Ces phénomènes ont déjà eu des conséquences notables sur le développement socioéconomique et la santé des populations. Les effets les plus marqués du changement climatique se manifesteront certainement au niveau de l'alimentation, des systèmes sanitaires et de l'eau. Cet article examine la manière dont le changement climatique affectera l'alimentation, la santé humaine et l'eau en Chine. Selon les prévisions, les effets globaux du changement climatique, la conversion des terres et la diminution de l'eau disponible pourraient considérablement réduire la production alimentaire chinoise, bien que de telles prévisions comportent inévitablement un certain degré d'incertitude. Le changement climatique aura probablement des conséquences importantes sur les ressources en eau, avec par exemple des modifications des régimes de précipitations ou encore des sécheresses et des inondations plus fréquentes dans certaines régions de Chine. Ces effets mettront indubitablement en péril la santé et le bien-être de nombreuses communautés. À court terme, la santé des populations en Chine devrait se trouver affectée par l'augmentation des températures de l'air et de la pollution. Sur le moyen et le long terme, cependant, ce sont les effets indirects du changement climatique (par ex., changements au niveau de la disponibilité des denrées alimentaires, de l'eau et des lieux de résidence, dégradation de la santé mentale et du bien-être des personnes, changements dans la répartition et la saisonnalité des maladies infectieuses) qui devraient prendre de l'importance. Les conséquences potentiellement catastrophiques du changement climatique ne peuvent être évitées que si tous les pays œuvrent ensemble en vue de réduire sensiblement les émissions de gaz à effet de serre et d'augmenter la résilience de la population mondiale face aux risques de variabilité et de changement climatiques.Parece que el cambio climático antropogénico está aumentando la frecuencia, duración e intensidad de fenómenos meteorológicos extremos. Tales fenómenos ya han afectado enormemente el desarrollo socioeconómico y la salud pública. Los efectos más profundos del cambio climático tienen posibilidades de afectar a la alimentación, los sistemas sanitarios y el agua. En este artículo se explora cómo influirá el cambio climático en la alimentación, la salud pública y el agua en China. Las previsiones indican que los efectos generales del cambio climático, la conversión del suelo y la menor disponibilidad de agua podrían reducir la producción de alimentación en China de forma sustancial, a pesar de que la incertidumbre es inevitable en dichas previsiones. Es probable que el cambio climático afecte de manera importante a los recursos de agua, por ejemplo, cambios en los patrones de las precipitaciones y aumentos de la frecuencia de las sequías y las inundaciones en algunas zonas de China. Sin duda, tales impactos amenazarán la salud pública y el bienestar de muchas comunidades. A corto plazo, la salud pública china se verá perjudicada por los aumentos de la temperatura del aire y la contaminación. Sin embargo, de medio a largo plazo, es probable que aumente la importancia de los efectos indirectos del cambio climático, como los cambios de la disponibilidad de alimentos, refugio y agua, una reducción del bienestar y la salud mental y cambios en la propagación y estacionalidad de enfermedades infecciosas. Las posibles consecuencias catastróficas del cambio climático pueden evitarse únicamente si todos los países trabajan juntos para reducir en gran medida la emisión de los conocidos gases de efecto invernadero y para aumentar la resistencia de la población mundial ante los riesgos de la variabilidad y el cambio climáticos.يبدو أن التغير المناخي الناجم عن تأثيرات بشرية يؤدي إلى زيادة وتيرة حدوث الظواهر الجوية الشديدة ومدة سريانها وشدتها. وكان لمثل هذه الظواهر تأثيرات كبيرة بالفعل على التنمية الاجتماعية والاقتصادية وعلى صحة السكان. من المرجح أن تقع التأثيرات الأشد خطورة لتغير المناخ على الطعام والأنظمة الصحية والمياه. تساهم هذه المقالة البحثية في استكشاف تأثير تغير المناخ على الطعام وصحة الإنسان والمياه في الصين. تشير التوقعات إلى أن التأثيرات الإجمالية لتغير المناخ، وتبوير الأراضي الزراعية، ونقص توفير المياه يمكن أن تقلل من إنتاج الصين للغذاء بشكل كبير – بالرغم من أن مثل هذه التوقعات تحتمل قدرًا من عدم التيقن وهو أمر حتمي. من المحتمل أن يكون لتغير المناخ تأثيرات كبيرة على الموارد المائية - فعلى سبيل المثال التغيرات في أنماط هطول الأمطار وزيادة حدوث موجات الجفاف والفيضانات في بعض مناطق الصين. ومما لا شك فيه أن مثل هذه التأثيرات سوف تؤدي إلى تهديد صحة السكان وعافيتهم في العديد من المجتمعات. من المرجح أن تتأثر صحة السكان في الصين بشدة على المدى القصير بسبب الزيادة في درجات الحرارة ومعدلات التلوث. إلا أن التأثيرات غير المباشرة لتغير المناخ على المدى المتوسط إلى البعيد – على سبيل المثال التغيرات في معدل توفير الطعام والمأوى والمياه، وانخفاض مستوى الصحة العقلية والعافية، وتغير معدلات انتشار الأمراض المعدية وحدوثها بحسب الفصول – من المرجح أن تزيد أهميتها. لا يمكن تفادي العواقب الكارثية المحتملة لتغير المناخ إلا إذا تعاونت جميع البلدان وعملت معًا بهدف خفض معدلات انبعاث ما يسمى الغازات المسببة للاحتباس الحراري بنسبة كبيرة وزيادة قدرة سكان العالم على مواجهة مخاطر تقلب المناخ وتغيره.由人类活动引起的气候变化导致极端天气事件的频率、持续时间和严重程度正逐渐增加。 这类事件已经对社会经济发展和人口健康产生了重大影响。 气候变化最具冲击力的影响可能是在食物、卫生系统和水源方面。 本文探究气候变化将如何影响中国的食物、人类健康和水源。 据预测，气候变化、土地流失和可用水资源减少的总体影响可能会导致中国食物产量大幅度下降——虽然此类预测中存在一定不可避免的不确定性。 气候变化可能会对水资源产生重大影响——例如，中国部分地区降水方式发生变化以及干旱与洪涝频率增加。 毫无疑问，此类影响将威胁许多社区的人口健康和幸福感。 短期来看，气温上升和污染加剧可能会对中国人口健康产生不利影响。 但从中长期来看，气候变化间接影响因素——例如可用食物、住所和水资源的变化、心理健康和幸福感的下降、传染疾病的分布和季节性的变化——可能会越来越重要。 只有各国协力合作，从本质上降低温室气体的排放，并提高全球人口对气候多样性和气候变化的适用能力，才能避免气候变化带来的潜在灾难性后果。.Антропогенные климатические изменения, по-видимому, способствуют увеличению частоты возникновения, продолжительности и интенсивности экстремальных погодных явлений. Такие явления уже оказали значительное влияние на социально-экономическое развитие и здоровье населения. Наиболее серьезные последствия климатических изменений, вероятно, затронут продукты питания, системы здравоохранения и воду. В данной статье изучается влияние изменения климата на продукты питания, здоровье человека и воду в Китае. Согласно результатам прогнозирования, общие последствия изменения климата, освоения земель и уменьшения доступности воды могут привести к значительному сокращению производства продуктов питания в Китае, хотя прогнозы всегда несут в себе долю неопределенности. Изменение климата, вероятно, значительно повлияет на водные ресурсы, например на режим выпадения осадков и на увеличение частоты засух и наводнений в некоторых областях Китая. Такие последствия, несомненно, поставят под угрозу здоровье и благосостояние населения во многих сообществах. В краткосрочной перспективе здоровье населения в Китае, скорее всего, подвергнется негативному воздействию повышенных температур и загрязнения воздуха. При этом в средне- и долгосрочной перспективе вероятен рост значимости косвенных последствий климатических изменений, т. е. изменения доступности продуктов питания, жилья и воды, ухудшение психического здоровья и благосостояния и изменения распределения и сезонности инфекционных заболеваний. Чтобы избежать потенциально катастрофических последствий изменения климата, все страны должны объединить свои усилия по значительному уменьшению выброса так называемых парниковых газов и значительному увеличению устойчивости мирового населения к рискам, связанным с нестабильностью и изменением климата.

Tropical storms, such as cyclones, hurricanes and typhoons, present major threats to coastal communities. Around two million people worldwide have died and millions have been injured over the past two centuries as a result of tropical storms. Bangladesh is especially vulnerable to tropical cyclones, with around 718 000 deaths from them in the past 50 years. However, cyclone-related mortality in Bangladesh has declined by more than 100-fold over the past 40 years, from 500 000 deaths in 1970 to 4234 in 2007. The main factors responsible for these reduced fatalities and injuries are improved defensive measures, including early warning systems, cyclone shelters, evacuation plans, coastal embankments, reforestation schemes and increased awareness and communication. Although warning systems have been improved, evacuation before a cyclone remains a challenge, with major problems caused by illiteracy, lack of awareness and poor communication. Despite the potential risks of climate change and tropical storms, little empirical knowledge exists on how to develop effective strategies to reduce or mitigate the effects of cyclones. This paper summarizes the most recent data and outlines the strategy adopted in Bangladesh. It offers guidance on how similar strategies can be adopted by other countries vulnerable to tropical storms. Further research is needed to enable countries to limit the risks that cyclones present to public health., Bulletin of the World Health Organization, 90(2), pp.150-156; 2012

In the 132nd session of the Executive Board of the World Health Organization (WHO), held in January of this year, the phrase “health diplomacy” was mentioned time and time again. Indeed, the Director-General used it in her opening remarks: “Health diplomacy works.”1 In two papers published in this Bulletin in 2007, we underscored the importance of global health diplomacy, particularly the need to build capacity in this domain within WHO and in WHO’s Member States, in line with changes in the global environment.2,3 During the years that have since transpired, it has become amply clear that health diplomacy is not a transient fashion. In fact, the Global Health Programme 2012, launched by The Graduate Institute in Geneva to promote research and knowledge translation and diffusion, represents a turning point in global health diplomacy training. This training takes the form of face-to-face as well as online courses for diplomats, health attaches and staff of international organizations. WHO staff at headquarters, regional offices and country offices take part in the programme, and China, Hungary, Indonesia and Turkey are now co-hosting courses with the Institute or WHO.4 Four elements have contributed to the ascent of global health diplomacy. First, foreign affairs ministries are becoming more involved in health because of its relevance for soft power, security policy, trade agreements and environmental and development policy. Countries need to address trans-border challenges that can undermine global stability, such as pandemics and climate change.5 Health touches on matters of national and economic interest; it embodies the tensions between national sovereignty and global collective action. New skills are needed to negotiate global regimes. Some countries have addressed this by seeking greater coherence “at home” between foreign policy and health policy through national global health strategies that bring together different ministries concerned with domestic and global issues so they can speak with one voice in the global arena.6 Second, the venues of health diplomacy are expanding; many new actors outside WHO have become (health) diplomats.7 “Global health diplomacy” refers to both a system of organization and to communication and negotiation processes that shape the global policy environment in the sphere of health and its determinants. Health is part of summit diplomacy in the United Nations and of club and head-of-state diplomacy involving countries such as the group of eight (G8), the group of twenty (G20) and BRICS (Brazil, the Russian Federation, India, China and South Africa). The European Union (EU) has adopted the European Council’s conclusions on the EU’s role in global health in 2010 and the Organisation of Islamic Cooperation has recently established a unit for health issues. Global issue diplomacy continues in connection with human immunodeficiency virus infection, children’s health and non-communicable diseases – and it is particularly in this area that nongovernmental organizations, foundations and companies have become health diplomats. The ministries of health now play a dual role: to promote the country’s health and to advance the health of the global community. Third, globalization, new donor–recipient relationships, new types of health alliances and the rise of cooperation between low- and middle-income countries have heightened the need for health diplomacy.8,9 More long-term negotiation processes for both binding and non-binding agreements are taking place. One example is the WHO Pandemic Influenza Preparedness Framework. Approved by the World Health Assembly in 2010, it is a milestone in global health governance.10 The 2011 United Nations (UN) High-Level Meeting on Non-Communicable Diseases adopted the Political Declaration on the Prevention and Control of Non-communicable Diseases. The Protocol to Eliminate Illicit Trade in Tobacco Products was adopted by the parties to the WHO Framework Convention on Tobacco Control in 2012. New challenges are in the wings: negotiating ways to implement the recommendations of the Consultative Expert Working Group on Research and Development; finalizing decisions on the WHO reform process; embedding health within a UN Framework Convention on Climate Change and, of course, establishing health goals in the post-2015 development agenda. Fourth, we need competent health diplomats more than ever. Fly-in, fly-out negotiations for health no longer suffice.11 The many health negotiations taking place in different venues involve interactions at many levels of governance and a new interface between domestic and foreign policy. Representatives of countries and other interested actors are continuously engaged in negotiations in hubs such as Geneva, New York, Brussels and Addis Ababa, and health attaches play an important role, but not many countries can dedicate substantial resources to these negotiation processes. At the recent session of WHO’s Executive Board, Member States underlined the importance of good preparation at the national and, increasingly, at the regional level. Global health diplomacy, if well conducted, results in improved global health, greater equity, better relations and trust between states and a strengthened commitment on the part of stakeholders to work together to improve health nationally and globally. We hope that there will be increasing willingness to support countries seeking to strengthen their capacity not only in the governance of health systems, but also in global health diplomacy.