and i want to thank the international research team that conducted the study and all of the funds including the national institute of environmental health sciences because you have called attention to the connection that we have sometimes been too slow to see. we know that depending on the coal power plants that spew greenhouse gases is bad for the planet. but it's also bad for our health since it increases prevalence of disease like asthma and cancer. ..

and we know that the cost in human livescan the even hizer in countries with the emerging economies that have fewer resources to improve air quality. for all of these reasons president obama and i understand that we cannot wait any longer to act. president obama has made it clear he is committed to passing comprehensive energy and climate legislation that will create millions of new jobs in secure clean energy sources that are made in america and work for america but in the meantime we are looking for ways that we can start reducing this threat right

now. last friday i saw some of you at the white house state briefing that i hosted with lisa jackson the administrator of our environmental protection agency. at that briefings we talked about many of the steps my department is taking in this area for funding research on the health costs of greenhouse gas emissions to investing in committees to help demaris fanta climate related disease, to slashing greenhouse gas emissions and are owned buildings. this is not an afterthought for my department. this is a key part of our broader health strategy. wore and more we understand that health is not something that happens justin doctors' offices. whether you are healthier not depends on what you eat and drink, what e bright, how you get around and where you live. a world that is heating up and powered by coal-fired plants that filled the sky with harmful greenhouse gas is going to have fewer healthy people then the world that runs on clean

renewable energy. that is why even if our plan that was not in jeopardy, even if the energy independence was not crucial toward national security and even if clean energy was not a huge economic opportunity, reducing greenhouse gas emissions would still be an urgent priority for us. it is a key to building a healthier country and a healthier world. we know that the kinds of changes we need to make won't be easy. there are a lot of entrenched industries that profit from the status quo and we have a lot to learn about the best ways to reduce these harmful effects especially when it comes to health. but we can't afford to delay action. this is not a distant and abstract problem. this is the jobs of tomorrow and the health of our children today. we need to get to work. thank you.

>> greetings from the world health organization in geneva. the effects of climate change are already being felt. evidence of the harm to human health continues to mount. climate change will aggravate health problems that are already huge. largely concentrated in the developing world and difficult to combat. no one can doubt this anymore. already, nearly 1 billion people live on the margins of survival. it does not take much to push them over the brink. water scarcity, storms, floods, droughts, population displacements and polluted air, all of these events have a well documented impact on health.

sadly, policymakers have been slow to realize that the real bottom line of climate change is its threat to human health. although the situation is improving, i have personally attended high level conferences on climate change, were held was treated as the peripheral issue. this must change. health concerns need to be at the center of the debate. the impact on human health is the most significant measure of the harm done by climate change. this reality should add to the urgency of negotiations taking place next month in copenhagen. policies for mitigating the impact of climate change must align with policies for protecting public health. the studies being launched today take this argument a step

further and the news is good. as the studies show, strategy's from tackling climate change can actually be beneficial for health if they are wisely chosen. in my view, what makes these studies so important is their contribution of new evidence and arguments that can guide the assessment of alternative strategies for mitigation. motivate wise choices in bring value added benefits. these studies make a strong case, a strong case for linking the climate and help agendas a wise choice of mitigation strategies brings substantial benefits. good choices, help address some of the biggest and fastest growing global health challenges like acute respiratory

infections, cardiovascular disease, obesity, cancer and diabetes. moreover, the health benefits are immediate and local, making them attractive for politicians and the public alike. the recommendations coming out of these studies are extremely reasonable and make good sense. they bring clarity to issues often fraught with confusion and disagreement, especially when questions of responsibility enter the debate. by selecting mitigation measures that bring benefits for health, policymakers sees an important social opportunity and ensure a broader return on their investment. i congratulate the authors of these studies, the institutions and agencies who supported them

andy land set for its record on publication of the findings. it is my sincere wish that the arguments set out in these studies will shaped discussions during the copenhagen conference. your efforts today are giving this work a more appropriate high level profile. thank you. [applause] >> those were three splendent presentations and it is now my enormous pleasure and privilege to introduce like an in person and the burnham who is the secretary of state for health and has had a very distinguished career and politics, so you actually know all of the issues about governments across colonization of all of the issues from different perspectives of brown climate

change and they think we are delighted you have agreed to address us all this afternoon so andy. >> thank you very much indeed for that kind introduction and it is great for me to be here with colleagues in london and also our friends in washington. well any health minister has to deal with the daily for the rest of health policy i am clear that there is no more important event or meeting that i will attend this year than this one, so i want to thank everybody here in london and washington for giving their time to be here today and i would also like to thank all of the organizations on both sides of the kurlantzick that have made it possible. i want to start by endorsing the words of secretary sebelius, margaret chan and ban ki-moon. this is a year for climate change when the world comes together in copenhagen in a

couple of weeks' time. it will be essential that we strike a deal that is equal to that challenge we face and which the speakers before me have outlined. climate change poses a huge threat to global prosperity, security and development but to many people it can seem abstract, remote, non-erred ginned evin. it is when we think of the impact on people's health, the tarrow cost of inaction becomes clear. this human-caused of climate change has had relatively little attention so we are shining a light upon it today and i too congratulate the lancet on this timely report. temperature changes of just a few decrees can have huge consequences for health. the 2003 heatwave here in britain led to over 2,000 excess deaths and average temperatures that year were just 2 degrees

higher than normal. although we can't attribute individually thence to climate change we can expect extreme weather like we are seeing in cumbria at the moment to increase and global warming. the u.k. climate projections suggested temperatures increase by 2 degrees the-- could see around 25% more rainfall in my home region, the northwest in the temperatures increase by 4 degrees pekid see rum 35% more. the health implications of heatwaves aren't clear and indeed being felt now and i know that they were put out in some detail this morning. as is often the case it is the ports and those responsible-- least responsible who are likely to suffer first and suffer most. the havard some mali is about 100 times more likely to die as a result of climate change than

the average american despite admitting roughly 16,000 timon's less carbon. lincoln yet colleagues in the ministry of health have told us malaria is moving up land. the disease is being found in areas previously too cold for mosquitoes to bright and living. concerns disease could spread in unpredictable ways and in haiti environmental degradation that come together with terrible consequences. almost 90% of children are chronically infected with parasites from the dirty water and they have no choice but to drink. as you well know and i am sure this is true in the u.s., politicians are fond of quoting statistics. they sometimes trip up the tongue without giving thought to the meaning but if nothing else i would ask any fellow health minister around the world to bring the following statistics i am about to quote to the

attention of their president or prime minister in advance of copenhagen and they are of these. by 2080 climate change could mean an extra 600 million people worldwide are infected by malnutrition and an extra 400 million people can be exposed to malaria and an extra 1.8 billion people could be living without enough water. this could be the human face of climate change if we fail to act, human suffering of an unimaginable scale but we will act as prime minister gordon brown has made clear and that is why the united kingdom is pushing so hard for an ambitious global deal at copenhagen, a deal that works not just for us but also for the world's poorest people. together health ministers and professionals across the globe must work to highlight a clear and present danger to global warming poses to the health of our communities and we must work

to design effective climate change policies that bring real benefits for health. many of the steps we need to take to tackle climate change will help us lead long career in healthier lives as secretary sebelius said. changes to transport could reduce air pollution and encourage physical activity at big increase in walking and cycling would reduce pollution and improve health and are changed for live campaign is making a big difference in getting people more active. more than 370,000 families have already signed up. better housing insulation could reduce illness in the winter in keep people cool in the summer and in poor countries clean energy could reduce the weeds of a potentially significant impact to people's health. in the u.k. the climate change that means everyone has a role to play putting carbon emissions under our carbon budget. hospitals will have to reduce

this d.o.t. they use just like every other sector. we need to be part of the solution in today want to hault call on the health community to set an example and to demand the action we need to prevent climate change from endangering people's health and well-being of around the world. this week i've written to my fellow health ministers in 69 countries of around of all to tell them about this new research we are launching. i want to encourage them to work with me through the world health organization, the e.u. and bilaterally to ensure health is at the heart of our fight against climate change. the chance to reduce the spread of infectious diseases safeguard supplies of food and clean water to create a healthier environment is the price of the global deal and a price we have to win. the future of global health depends upon it. thanks very much for listening this afternoon and thank you for being here and let's all go out and play our part in making it

happen. thank you. [applause] >> thank you very much secretary of state. the messages we are hearing today are absolutely crucial and of course what we have no guts to do is act on them and i think we have agreed to answer a couple of questions from the audience. let's start with andy to is the author of the work we are hearing today. [laughter] >> thank you very much secretary of state. that was a very good talk but building on your experience with government departments how can we achieve thinking across the government on this issue? we heard from secretary of state sebelius that there are a number of-- resistance to the policies were proposing. how do you think we can help to overcome some of that resistance?

>> it is a very important question, andy and i think we have gone some way to achieving what you want but have we gone far enough? no, i am sure there is much more we can do. not having government pulling in the different direction and identifying the things we can do where we achieved a change for life is an interesting idea here, where it is a campaign the departments of health has launched to tackle obesity and encourage people to lead healthier lifestyles but clearly it has huge environmental benefits and the potential to help people reduce their carbon footprint. if we make a real appreciable impact on physical activity, for instance then we can as a country make a major, delivering our commitments. britain is somewhere in the relegation places of the world

league table of physical activity. for me there is no reason for that and it does not cost any public money to lift britain from its current place closer to the levels of physical activity in the netherlands, germany and scandinavia so that for me it's an area where the interest of my department like absolutely foursquare with the interest of the department. there is no differentiation here. there is no conflict in incentives and it is starting to line and all of its weight around the same objectives where they can make the transport system flow more quickly, we can get people healthier and encourage people to reduce their carbon. the government has got to get a bit more focused on how it is doing. we just launched a cycle to work scheme but we all came together and it is when the combined power of the government departments, the three together you can begin to make significant change in lead to

some behavior change but it does need that concerted action. ki-taek-- we have not done enough but clearly it is now. >> a lot of hands went up. >> thank you very much. thank you for that. it is clear from everything we have heard that we need to put climate change, health of the center of the climate change negotiations. looking at the european union position paper for copenhagen which is a 13 page document health appears only once as the single word on page 6. i wonder if he could comment on this and i wonder if he could tell us what the new york you will happen if there is no international agreement in copenhagen? >> thank you very much. that began by saying there is no aidid, doer really mean that? i thought of all the meetings i would be having in the next couple of days but in fact i do

and i think that is part of the problem here and perhaps health, politics and ministers around the world are absorbing on their own domestic problems but we don't lift their heads enough to look at the bigger picture, the big challenge that is coming, the devastating effects for public health and around the world if we don't act. i think inevitably, that then as manifestant, if health ministers are making this a priority than it does not reflect in the documents that come out, so both governments and multilateral organizations. i think this is an area where we can begin to connect climate change with the very real concerns of the public, i think we have done fantastic work in this country in raising awareness of poverty in africa, but actually these are the same

issues, these are poverty will be deepened and intensified if we don't take action on climate change. perhaps it is about refreshing our message, making it more impactful when we speak to the public and they think it does, when you talk about the examples that i did, when you talk about hallet can have a theory human face, the suffering in a very real time i think it begins to remove it from the abstracted into the direct and the human and that is probably what we need to do more. i am acknowledging this needs to be on our agenda more often. i have had many bilateral meetings climate change is the noise on the agenda? notice knop rashid bequest of course should be. >> can you say to you wire? >> i am an individual concerned about health and climate change. i was just wondering whether you were going to cope in hagan.

we heard earlier it would be good at health ministers attended or if you weren't what you were planning to do and noted to rally health? i know you said he wrote letters but what was then the letters? will you do something prior to the event and what can you do more than to suggest to the president of health is an important issue? >> i've not planning to go at the moment. those daily troubles of the nhs probably are keeping me from making the trip, but i shouldn't it-- that shouldn't diminish what i can do in advance of the summit. i fully appreciate writing a letter is not enough. perhaps i can get on the phone to people and i know kathleen sebelius. i know other health ministers around the world. i think it is important to start to get their voice in this debate and that is what is so important about today. if we can get that boys up in

the debate around the world i think we can start to make people listen who perhaps were not listening before and i certainly razaf to play my part in doing that, so i would always be open to suggestions about how you think i could do more. i think what i can also do is make the nhs and exemplar in this regard. is it doing enough to promote to physical activity for its staff, for promoting sustainable life styles and making the connection with health? i am not sure it is actually so i'm going to look at my own backyard. at the same time take those examples and speak with confidence on the world stage though i will happily receive suggestions for what i should do more, but let's get this on the agenda of health organizations and health ministers around the

world because being frank i don't think it is high enough on their agenda at the moment. >> one of the wonderful things was the passion from almost everyone from the audience. at different stages of their career and health professions and in recognition when we talk to physicians that one of the important roles for a physician as actually to look at public health and to be a powerful advocate so i think there lots of voices behind you. neleen help izzy you are in the health service and indeed in a rather arcane point that in spite of the slightly misleading article in the times this morning you have reaffirmed the fact that the nhs is-- so we wish you well and all of your health service and thank you. [laughter] thank you very much indeed for coming. [applause]

okay, so that was a really terrific session and i think the challenge now is we are hearing the right things from our political leaders but what we of course has to do is to turn the rhetoric into action and they think that is something that we have to hold our political masses to account and make sure the words become actions. is now my pleasure to hand over to the editor of the lancet and did i hear the concern that-- >> yes, of course. >> anyone can read them anywhere in the world on the web and that of course is very important. this is very much a part of a ship. it has been a global partnership and the participants of the projects have come from many different parts of the globe. and, it is also been a partnership of founders, transatlantic partnership and we are delighted to have been able to fund it and congratulate

everyone involved on the pace with which the of worked because the funding agreement was in fact only a year ago and the gear is quite a short time to produce a document, which although thin it is extremely weighty in its contents. and of course the researchers did work very hard to complete the work in time for copenhagen. i am now going to hand over to-- who is going to share the results of the task force finding and then leave the challenging prospect to the transatlantic roundtable. >> thanks very much. [applause] i just, i do want to say thanks to mark and-- because they have been fantastic supporters of this initiative to iraq and not just in finding the money to support this work but throughout

the process, working with this array of collaboratives which is no mean feat. think of the egos involved in these groups. it is fantastic. they have done a wonderful job and shepherding them all in this moment today so mark thank you for your personal commitment. we have had an orderly morning of presentations with a little bit of passion sprinkled over that discussion that now is going to get exciting. this is where the action is. it is 12 days to go before copenhagen and we are all know very aware that copenhagen is not as was said just a matter of a few weeks ago the last chance. it is actually the beginning, at the beginning of a very important process of mobilizing people of brown the science and round action. the science of climate change which we are going to hear about over the next 45 minutes or so has been pivotal in shaping policy and shaping politics and

we cannot get away from the political context of this debate. indeed when you look at some of the tensions that have taken place, even in the very recent weeks, that intersection between science, policy and politics is very very important threats to take seriously. only in the past week the debate there brown science and climate change has taken a sinister turn with false and suspiciously allegations about manipulation of data being vigorously rebutted but occupying an important part of our media discussion in the run-up to copenhagen. we should be very concerned as a scientific community about the way this has been released, manipulated and taken up so much of the oxygen of discussion of round climate change and for me one important purpose of this meeting is to counter that kind of ridiculous the version of

public debate. but also we see this issue has become a party political, the front page of the news takers-- newspapers talking about one party making a commitment more than the others to wishes around carbon reduction. the next election next year were likely to see the politics of carbon assume an increasing importance. we are certainly seeing that in the united states as well. at the same time we faced a very difficult moment in gathering public opinion behind this agenda, especially at the moment of global financial crisis. it is not whether we as scientists can persuade politicians to act. it is whether the public can lead politicians to make these difficult decisions so our audience has to be the public, the wider community to get their support behind this agenda and

to lead us into making what some say, tough unpalatable decisions. one thing we have to do is work much better to integrate climate change with other aspects of the health agenda. i think one of the issues for us is we have drawn a boundary around climate change and we integrated into bubba-- broader global health issues and it is time for these agendas to merge, to speak to one another. we are not just climate change advocates. we are help that the kids around a range of issues. we still have sadly even amongst our own health community a huge amount of persuading to do and he writes speak directly to our american colleagues. fira and i have the honor of hosting the international committee of "national journal" editors earlier this year with colleagues, i shall not name them, leading american journals

and we invited queue montgomery duest bannack passion advocate of climate change to come and speak to us all about white our journals should be covering climate change. there was a general cripple of agreement in the audience when he spoke, except from several leading american journals who felt that the climate change the agenda cutting across so many sectors of society was not an issue for health or medical journal to take up. this is a mistake and my colleagues in america, i look-ins' btu and say act now to change that in your journals. if you don't, who else will? [applause] we also see the experts give conflicting advice. is this an issue for transnational corporations and industries to deal with? or is it a matter of our individual personal behavior,

switching lights off, cycling to work, putting solar panels on our houses? there is confusing it buys out there and one of the purposes of this report is to try and look at the evidence, to give better advised to the public, to policymakers about what should be done. it has been a remarkable collaboration but it has been a remarkable collaboration because we have had a fantastic liter mac and i want to cite two groups. first of all the international climate and health council. many of these representatives here today, which is now an international organization for any health professionals to bear on this issue. my colleague and others have been pivotal in making this work. your money, so please dip into your pockets and write checks and support it. but also, and also very importantly the school of hygiene and tropical medicine

has been a fantastic leader in this and you were now going to hear from the leader of the leader, professor andy kaine civil take you to the findings of this report and allow you to interrogate him about its interpretation. andy, where are you? come up. [applause] >> thank you richard four-year exuberance introduction. it is involved the collaboration of 55 scientists in nine different countries. we have heard it is in full support from consortium agencies and i am grateful to all of them for making resources available particularly to-- for doing such a wonderful job of coordinating this to this time urgent program

of work. what do we do? the scope of our program covered four main sectors and the focus of it was not on the health impact of climate change about which you heard quite a lot this morning but much more on the health aspects of greenhouse gas litigation strategies. we chose these four sectors for the reasons they were both responsible for a large amount of greenhouse gas emissions but also because they bear strongly on the health the populations in high and low income countries. so we focused on these four sectors, household energy, food and agriculture and electricity generation. in addition there was one additional paper and my colleague kirk smith in washington was very much the leader of that paper which focused on the health effects of short-lived greenhouse polluters. much of the focus has been understandably on carbon dioxide, but increasingly we are

recognizing short-lived pollutants and i will talk more about those in just a moment are also very important as drivers of climate change and have important implications for public health. so what were the comparisons were made? for to the sectors, household energy, food and agriculture we did an experiment using a 2010 population with and without intervention to radically reduce greenhouse gas emissions in those two sectors and in the house will then energy we had a difference in our errors with regard to india and the u.k.. for two of the sectors we use 2010 population again that we used exposures to rai from 2030 projections comparing business as usual without trying to check greenhouse gas emissions in any way because letting the world economy rip versus substantial reductions and these are the sectors of transport and generation calculi to changes in the burden of disease and premature death and we will

focus particularly but not entirely on premature deaths because they are easy for-- we use methods adapted from w.h.o. methodology the comparative risk assessment approach. just to give you a flavor of the cuts we are talking about the u.k. committee on climate change has indicated the u.k. and industrialized countries need to reduce their emissions from 1990 levels, it being 100%, to an 80% cut by 2050, which by 2030 the kind of time scale in which we were doing our future projections means about 50% cut in greenhouse gas emissions for a rich country. overall of course the whole world will need to be broadened and by 2050 the climate change committee has agents adjusted to global initiatives will need to be cut by 50% of all countries will need to participate although some of the lowest emission countries may need to increase their emissions

moderately. wii the pathways from the emission reduction strategy to help and we took a number of case studies to illustrate the health effects in the 2010 population under these different future scenarios in high and low income places. the first one is household energy. this lied shows you the challenges on my-- on my left the lady with the cookstove, the energy inefficient cookstove and many no what strikes you when you going to the dwelling is the extraordinary level of indoor pollution, and many fall to the levels were exposed to and that is due to the products of incomplete production, often by almaz dung and would crop. you see the problem we are confronted with in the u.k., an old obsolete in efficient housing stock and the thermal energy shows you with the heat is being lost from that house.

fairly typical in the u.k.. the question then is what would be the health benefits from a program extensive program of modernization to improve the insulation and improve air flow in houses such as the ones we have here in the u.k.. turning first to u.k. household energy, looked at changes to insulation, ventilation control using heat recovery systems, fuel source and temperature setting. we looked at the impact of these in a 2010 population with and without interbraid urgence and we looked at the number of exposures particularly particles but also radon gas and the number of other exposures and remain outcomes were cardiovascular disease, lung cancer and cold related deaths. what we found in essence was compared with 1990 we could save 55 megatons of co2, a million tons of co2 through these various improvements, combined

improvements in the u.k. housing stock and we can save or obvert over 5,000 premature deaths from a range of different forces so large greenhouse gas reductions and worthwhile savings in terms of premature deaths of furtive. when we look to helsel banerjee in india this was a program of 120 million stoves introduced over a ten year period which we believe is a feasible program. the chinese managed to execute that this the-- successfully. the exposure to combustion products and the main outcomes were acute respiratory infections particularly in children, heart disease and chronic lung disease which is a major problem particularly in women in many low income countries. this is a comparison of the traditional and modern still, the traditional stove on the left and on the right a gasifier

stowe with a small electric lower. the battery can be recharged with the cell phone charger and this can result in 15 times less black carbon and other particles, ten times less ozone and five times less carbon monoxide than a traditional stokes ali radical improvement in indoor air quality could be achieved with today's technology. what is immediately apparent here because we know black carbon is an important greenhouse pollutant we can achieve climate change benefits and health benefits for the ghosts of the health benefits would be very substantial, avoided by 2020. we would be avoiding 20% of the test from the two major health categories from ischemia heart disease and in total perhaps over 2 million deaths could be avoided over the decade between 2010 and 2020 by the implementation of this improved cook still program at a cost of

around $50 per household the five years. thurso these reductions in black carbon, methane could amount to the equivalent of between half of 1 billion tons of co2 equivalence of the decade so it would be worthwhile reduction in greenhouse gases. the binnun to urban transport we left it to case studies one in london and one in delhi and three aspects of the health impacts, air pollution, impact on the rural traffic and injuries and the impact on activity, reducing the health burdens due to-- this shows you by way of illustration the london travel patterns we use. on the left, the brad column is the baseline pattern of travel showing a preponderance of-- amounting to 100 killam meters per person per week. the blue column is a lower

carbon driving scenario where we have similar patterns to today but less polluting cars using technology available now and increased active travel. this presupposes an increase in walking and cycling which is illustrated in this slide showing increasing cycling and walking. what would be the health benefits from these different scenarios? this shows you could change and burdens of the seas from the increased active travel to lower carbon driving in the commination helme what straights to immediately is the major benefits from the increase active travel so it is by improving increasing walking and cycling you get major health benefits. there are some benefits and reduced air pollution but they are not as large as the benefits from decreasing travel and obviously the commination is the best of all and the combination brings the greatest reduction of

greenhouse gas emissions. when we look at disease categories we see some of the major burdens of disease, ischemic heart disease are reduced by 20%. ists cerebrovascular disease, reductions in dementia and some reductions in some kinds of cancer and i want to emphasize that this exercise was done on the basis of the best available evidence from systematic reviews linking activity patterns with changes indices burdens. you will see there is a modest increase in road traffic crashes that did result in an increase in premature deaths in this particular scenario and we can come back to that in the discussion but the important point to make here is first of all this burden can be ameliorated by policies that separate walkers and settlers from road traffic and secondly in any of them the benefits accruing from these kinds of strategies to improve active

transport, the benefits will far outweigh any adverse consequences. when we look at delhi a broadly similar pattern results negative impact due to different assumptions which we can discuss on the panel discussion but it shows you the range of health impacts being positively impacted including in this case diabetes as well. in those cities with different transport patterns and different levels of air pollution you get the same thought broad picture of benefits, somewhat higher in delhi then in london. but still a reassuring pattern that in both locations to get substantial health benefits as well as substantial reductions in greenhouse gas emissions from these strategies. electricity generation adopted three broad regence the e.u. india and china and compared

2030 business as usual let the economy rip strategy with the global mitigation target, radical reductions in greenhouse gas emissions more than 50% by 2030 including some elements of carbon trading so there could be some limited trading of carbon per met, samming more renewables particularly in the case of india and china although e.u. has a high level of renewables built into energy protection levels. some increase tschinkel with carbon capture in storage but last call otherwise because it causes a major impact on health from particulate. the benefits the gatt are due to particulate air pollution. there may be other benefits that were not captured by this exercise. what was found? the reductions in emissions of carbon dioxide from 2030, in this case using a full trade

approach but there's also another approach which we can get into in the panel discussion in this gives you the reductions in millions of tons. you see in the case of china dramatic reductions from 5 billion tons down to just over a billion tons. substantial reductions the e.u. and india compared with business as usual so worthwhile reductions in co2 emissions and when we come to help we see about 90,000 premature death of avoided in 2030. india nearly 60,000 china under 10,000 in the e use of various assumptions you can make to change these somewhat but the picture is fairly clear that he will get bigger benefits in those economies where there are currently high levels of air pollution and less so somewhat but still worthwhile and economies were their vote in pollution. when i look at the cost of mitigation in u.s. dollars per

ton of co2 in the e.u. there is somewhat-- in china somewhat less and india lower still but what is important about this slide is the red box underneath that shows you that, the positive benefits to health costing those using the same methodology al-azdi edu uses and showing how in the case of india in particular it the benefits pretty well offset the cost and offset them in china and to an extent in do you-maggie use so some of the benefits already begin to offset some of the cost of implementing mitigation strategies. finally the fourth sector, the food and agriculture sector, food and agriculture is the source of ten to 12% of global greenhouse gas emissions and probably more than that when you factor in changes in land use deforestation in many countries

which is a significant contributor to global emissions so overall between 20 and 30% and the total commissions set to rise by 50% by 2030 because of burgeoning global population increase but also because of economic growth and demand for animal products. 80% of the total emissions of rice from places involved in livestock production so inevitably one has to focus particularly in that area at you want to achieve substantial reductions in greenhouse gas emissions. this slide illustrates the pathways to help them greenhouse gas emissions from the food and agriculture sector. the emissions provide partly from methane, but also from co2 emissions, fossil fuel and the food system and also the use of fertilizer as well contributes to the greenhouse gas emissions.

the helfgott comes this group modeled were particularly cardiovascular disease. there were other cancers that might be reduced by reducing animal produce that this particular focused on cardiovascular disease. to meet a u.k. target of 50% reduction by 2030 which is the reductions the u.k. and climate change committee is proposing are needed if the food and agriculture sector contributes its fair share, then we need agricultural technological improvements. they are necessary but not sufficient to meet the target according to the evidence we were presented and that implies there for that there needs to be an overall decrease in livestock production and if you assume that decrees and livestock production results and an assumption in animal products then you can modeled the impacts on health.

said the case studies we did were u.k. and we also use the city of sol palo in brazil partly because sol palo is an emerging economy with increasing demand for animal products and also because we are aware in brazil some of the greenhouse gas emissions contribute to deforestation where land is being deforested to grow livestock. as i say we assume 30% reduction in livestock production results in decrees consumption and estimated their relationship between animal source saturated fat and the scheme card disease. there will be substantial benefit of 15% reduction in disease burden of ischemia heart disease so that would translate in the u.k. to 18,000 premature deaths subverted so quite a substantial reduction in premature deaths in the u.k. as a result of these reductions of animal products consumption.

the fifth paper ticket slightly different look at the problem and it looks specifically at short-lived greenhouse aleutians. much of the focuses binnun-- in long live greenhouse guess but there are many others and many of them are short-lived. we looked at three major pollutants, black urban which is important because not only is the the greenhouse pollutant, also when it lands on the glacier in the himalayas it accelerates the melting of glaciers but also because people are exposed to lead in the in dire-- endure environment has important implications for human health. autozone a major pollutant formed through a complex series of pathways and it includes the first public studies of the long-term health effects of black carbon using data from 66 u.s. cities for a period of 18 years. the conclusion is black carbon is damaging to help. it may be more so than an

differentiated particles commonly used in air pollution studies but certainly what they are not it is more damaging is certainly damaging to health and adds to the evidence that ozone poses mortality independently from other pollutants of the control of black carbon would reduce climate change and benefit population health and because they are short-lived some of them last only for a few days, reductions in emissions would immediately benefit climate unlike the case of co2. sulfates, the situation is somewhat different. epidemiological studies are more damaging to health and undifferentiated particles and that same contrast is evidence. therefore the control of sulfates must continue worldwide because that control provide significant benefits for health, but sulfates are cooling the atmosphere. they reduce warming so as we

reduce sulfates we need to reduce greenhouse gas emissions even more in order to compensate for the losing of the cooling effect in the atmosphere. as a footnote some of you would have read in the press there are various proposals to undertake geoengineering schemes were the inject aerosols' in the atmosphere to cool the atmosphere using for example sulfate aerosols and the conclusion of the paper was there was insufficient evidence about the health effects of these geoengineering schemes and they need to be carefully evaluated before they proceed. what are the action points from this program, this multifaceted program of four? first of all policymakers should take into account health care benefits and harms were the occur when considering different options to reduce greenhouse gas emissions. we believe we can attain both health and development goals as well as substantially and

radically reducing greenhouse gases across the range of sectors. research bonders should tackle climate change yemeni to break out of the mono disciplinary ghetto of research and really try to work together across a range of different research disciplines and sectors. health policymakers to encourage behavioral changes. the dichotomy between individual lead policy change was posted the beginning and i think it is clear we need both. we do need policymakers to act in the same time individuals need to change their behavior but they need to be supported by policymakers and ordered to do so. health professionals should abdicate and educate to achieve benefits for health climate based on the best researched evidence. including would say the u.n. framework mention six to protect the environment economic development and human health. and the health gains associated with climate change mitigation

policies has say, is you have kurd receive farc too little attention. they must be featured in discussions at the forthcoming climate change discussion in copenhagen. with thought i will leave you and i am sure there will be questions and i invite my colleagues who contributed so much to the series to join me to respond to questions. thank you all very much. [applause] >> thank you very much indeed. we are going to conduct this to wade discussion. we are going to start with washington and it does say on my briefings it might even have a visual. yes, there you are. fantastic. now, we'll see very clearly and we are going to handed over to you to make maybe an opening

comments or opening question to andy or a member of our panel. i don't know if you can see our american colleagues-- can you see our panel? i have to wait for seconds. sfius. >> fantastic. so, over to you. and america would you like to make an opening comment or statement? >> verse, for professor haines, if you go through all the papers it is obviously very modeled after certain cities. is there a way of extrapolating all the numbers that you have to get a more global percentage or number of premature death or an estimate because this is all very piecemeal. give us a sense more but you are looking at and i will ask a

second question too. for dr. horton, after your speech, you made this sound like it is an advocacy position in he came out this whole issue from an advocate point of view. do you feel ethically it dismisses the signs or diminishes the signs it you know what you are going to abdicate beforehand before you do the research? thank you. >> andy. >> first of all can i say that we did not start out looking only for benefits. we looked across the range of sectors to look at dfx in general. would they be benefits to health than in fact we did find in some areas like urban land transport we did find the potential for increased road injuries, so it is important to state from the outset that we have looked back and try to draw together the best available scientific evidence to inform this analysis. you also left about whether we

can generalize the cities around the world and if we had more time and resources to divert this further we would like to develop these models for grange of cities around the world. i think we can be confident for many cities where there is very little active transport, perhaps i levels of berrick kip pollution we could get single benefits in different kinds of cities so for example the north american cities where the use of active transport modalities, walking and cycling is less, one might expect to see even larger benefits as a result of increased walking and cycling then we have seen in our modeling exercises. in some low-income cities where high levels of air pollution also having cleaner forms of transport, more walking and cycling again lead to quite substantial reductions in public health effects. perhaps to put it all in context the local police across the world there are 1.9 million

deaths a year related to inactivity, of that 800,000 deaths a year related to the outdoor air pollution and 1.6 million deaths a year due to an indoor air pollution so the upper limit of what could potentially be impacted on and i think my colleagues might want it added that. >> just a couple of comments. one is on the issue of piecemeal as electricity generation steadying. the figures of the edu, india and china was not peace milan the other is some of our estimates of the kinds of coe benefits are not at the upper end of the range in the studies. they are really quite modest. >> on the question about advocacy, the purpose of health research i assume was to improve health, and so if i published a study about a new medicine that might have dramatic impacts on

for example reducing the burden of cardiovascular disease of would be an obligation on myself and colleagues in the health professions to make sure that that work was implemented in some way. i didn't see any difference between the kind of work we publish in the traditional clinical sector and the work you have heard presented this morning for you. this work demonstrates the set of factions can deliver a high impact in terms of health benefits to the population, and it seems an obligation on all of us who were part of the health community to work as hard as we possibly can to make sure that those findings are widely disseminated, widely accessible and implemented to the maximum possible degree. ..

that it's easy to use active travel and if not then what recommendations he would make for example if we had andy berman as to how we could support that kind of shift. >> okay. this gets to the heart of implementation. james, do you want to have a go of that act of transport?

>> that isn't wrong for those kind of market strategies and they can succeed in terms of behavior. we did look at here quite far reaching changes in travel packages, and i think it is probably unlikely social markets and would be sufficient to achieve that in itself. we did not do a detailed policy analysis. we did what if this happened what are the health benefits, but clearly if you are talking about large increases in walking cycle then you need to talk about policies, prioritizing pedestrians and cyclists over those so that walking or cycling can become the most direct most convenient and most pleasant option for the majority. >> perhaps i can add here while we are waiting that i think one of the issues we need to deal with is the perception of danger

and unless we can address the perception of danger angst waters and cyclist it is going to get difficult to get people on their cars out of fact transport so we need to develop policies which will separate walkers and cyclists on the one hand from vehicles on the other and that is perhaps one of the most important things that can be done. let me go back to washington and also invite any other panelists who are in washington if they would like to make comments on the questions you hear or with the panel says. is that roger staring their? >> yes it is, richard, and we woke up to your incantations though over coffee. so nice to hear you. i have a question for andy haines. specifically andy i.t. what you've done is bring us around a common theme which we buy into and agree to. my question is for the ministers in the developing world, the ministers of health who have many competing demands of hiv, child mortality, how do we

structure the climate change agenda so that we can include this in the portfolio of programs without taking away from those issues that are so immediate which are life-and-death. >> thank you very much. that is what is so important about this coburn of the agenda. it gives the opportunity to tackle today's health problems and tomorrow's health problems in the same strategy so the kind of strategies that will reduce exposure to indoor air pollutants for women and children in low-income countries will also help prevent climate change, and therefore reduce the risk of global warming. i also think that increasingly ministers and other health professionals and low-income countries are recognizing the impact climate change is having on the society. i just come back a couple weeks ago from ugonda which there was a ugandan organized conference on climate change.

and one of the big issues concerning them was the movement of malaria to higher altitude so already they are dealing with these kind of problems in the day to day professional life, and it was very clear that the drive, the concern was coming from within ugonda. it wasn't being brought by externals experts sweating increasingly is becoming integrated into a public health agenda at the country level. >> let's see if roger wants to come back on that. >> o.k. let's go to this audience please. yes, please. >> i would like to follow on the issue of transport. social marketing is probably a small impact in terms of the instruments we need to apply to make change particularly important as regulation of the streets and so on if you are a pedestrian or cyclist for second-class citizen and it is not a matter of perception if you go by foot or cycle you run

ten to 20 times the risk of death and injury per kilometre travel so this is the perception of reality. it is not just a fiction of the imagination. >> james, did you want to comment on that? when we had a press conference at lunchtime a colleague who i don't know if he's still here from a cycling magazines i think made the comment that actually the more people that cycle there will be a safety number of sect, and so by sheer volume of cyclists i guess this has a protective mechanism and leedy scales up their the weight of their importance. >> to come back on that i first went to beijing in 1990 and the rivers of bicycles they were totally dominant in the year 2000 cars are door and so i think we need to go to cities like germany where 30% of the trips are done by cyclists and

pedestrians because they have the proper infrastructure, regulations and policing. >> james, would you like to make -- >> when we looked at the modeling we were looking at two different affects and basically reducing the number of motor vehicles on the road, reduces the kinetic energy, reduces the danger of the pedestrians and cyclists face, so big part of making the walking and cycling save is to reduce the number of motive. now as there were a lot more pedestrians and cyclists we found in london to increase without the combined effect that would decrease in the injuries. i would say tackling this kinetic energy that is on the streets that is the source of the danger in terms of the number of the motor vehicles but also importantly we didn't look at this tackling the speed can make a big difference to the safety of pedestrians and cyclists face, and i think as -- there is uncertainty about safety and numbers but as more

people to walk and cycle i think they will be increasing pressure for the policies to make walking and cycling safe. they have to go hand-in-hand. >> let me go back to washington. >> [inaudible] >> i just published a paper showing the direct link between the longitudinal development of obesity and traffic density around the homes of children, and clearly we need to ensure that place is with sensitive populations like children, schools and residential neighborhoods do not have fast traffic moving through them and there are numerous measures that can be implemented to koln traffic within residential neighborhoods and to ensure that it is diverted away from sensitive areas such as schools. but they often meet with opposition from unlikely sources like fire chiefs who are concerned about emergency

response times and others commuting through neighborhoods and want to save that two or three minutes off the drive by affording the lights on the main streets. so this is a public health issue that we know how to deal with it. piquancy the reductions and accidents dropped by -- there are reductions of to 75% with the introduction of speed humps and traffic circles in residential areas. so the evidence is very clear that we can get these benefits. it's now a matter of pushing the agenda forward and ensuring that the sensitive areas do not have fast-moving traffic. and when we look at some of the most successful cities in the world, like amsterdam, there is a speed humps on every block. there is a raised intersection on every block, and no one drives from residential neighborhoods unless they lived there. and that is a goal that we should be trying to achieve if we want to have sustainable transportation patterns and get people out of their cars and walking.

>> very good. thank you. let me come now to ian robertson london. >> there is a question directly principally to the founder of which perhaps mark walport congealed on behalf of them. it's the minister was here earlier and twice he said his big contribution to the win-win between health and climate was the change for life program which is the website for goodness sake and website and they will send you some toys and puzzles and it's done in collaboration with the food industry and you can go into the supermarket and play games. it is of the planet. i know why he didn't stay because if i had a chance to ask this question -- [laughter] sorted is very clear to me that the kind of political class's even though they say they have it haven't got it at all. when the wheels fell off the

economy the first thing gordon brown did is gave payouts to the car industry and incentive scheme to scrap your car and get a new one. it is complete nonsense. so the question. [laughter] the question is it is clear actually we have worked hard disseminating these results up words, and nothing much is happening. we have to do exactly what you said, and actually share these results with the people. i think the welcome, and everybody that has funded this has done a tremendous job, but it is only one-tenth donner. we have to communicate these results to the massive population where there is a huge movement for community road safety. and if we can share them to win when we know about will it become some way to sort of meeting our responsibility. >> very good. this is a question that you have to -- >> broadly i agree. it is about affecting public

engagement and what we are increasingly hearing is the politicians do pretty much get it. but actually is the general public that we need to engage with. we've got to do it right and there was some criticism of your polemic approach, richard, if i may say so and i think actually we have got to present a clear and we are actually persuasive rather than try to beat each other up because i think if we try to beat each other up that won't work. [laughter] and the question of course is can the worker trust and similar organizations helped. yes, we can, but only up to a point. and i think that we have to be effective and persuasive. >> anybody on the panel one to come back to this? please don't forget food, electricity, household energy. we are talking a lot about transport but any comments from the panel? go on, paul. >> sorry. the source of -- the source of

changes that we are the injuring her, they are quite tough challenges, quite -- and i think no solutions are going to be particularly easy. and the you change things and it isn't going to be by persuading any single group alone or any single measure. it's going to be a range of measures come into structural, legal changes, campaigns, all sorts of things will be necessary. but i think the recognition of what the degree of changes and pace of change and the fact that some of the pathways that we have pursued are attractive, they can help improve health and probably environment owls well, all of those things need to be made very widely known as by every single route we can possibly become. i agree with the principle the more we can persuade the general public everyone to understand the positive messages and the sorts of things which need to be achieved and could benefit us

the better it isn't a simple thing. it is a persistent message, widely distributed to bring about change in our politicians, to bring about some very major policy initiatives. >> let me go back to washington. >> steve kirk with the climate change report. and i correct in the preceding that the health benefits at least in the developed world mostly come from bucko benefits such as increased exercise, reduce air pollution, reduced consumption of high-fat foods and things like that? and lice from the direct reduction or less from the direct effects from climate affects from production of greenhouse gas emissions. and number two, the polls in the united states show that the

public here increasingly uses climate change as a back burner issue and is the focus on health motivated by that type of public attitude of least in the united states >> let's go to alan if you want to pick up the first point about food and then maybe to andy on the wide public policy question. >> i think there is a lot to be said here, and its -- you know, i think how many people really know what we are eating and with the carbon cost of what we are eating is. that is a good question. do you know that the last report in this country on the national survey of dalia trey taken said that adult health 81-kilo per week. what is the cost of a diet of that nature? what is the cost of the environment?

individuals, people in the street have the right to know this sort of information and have the right to use it to make decisions. what we are seeing in this report and what we are seeing in the papers is if you provide information to allow people to make informed decisions they might make choices based on climate. and those choices will have benefits of health and we have shown clearly that reduction for example in the consumption of saturated fat in the u.k. would prevent 18,000 deaths from heart disease in the u.k. premature death, so that's 3% of total deaths in this country would result from the policy that would reduce the consumption of saturated fat. that policy would also have benefits to the climate. who knows about that? who knows about the cost? in sweden the information on the carvin cost of food is printed on the side of the package along side the amount of calories and the amount of salt. that information which should make available.

there is a lot of -- there is a lot that is unknown, kept in the silos. we should be going out and telling people about it, and as we have heard from ian roberts that is the sort of thing we should be sharing this information as lightly as possible making sure people can make informed choices. >> andy, very quickly. we have only a couple of minutes before i have to hand over to david. >> the only benefits we did not include the benefits of rising from the reduction in the severity of climate change itself. we focused very much on the kuhl benefits on the direct effects of the greenhouse gas mitigation technologies themselves. obviously, or policies. obviously there would be additional benefits as a result of reducing the impact of climate change itself and hopefully averting dangerous climate change which comes -- which brings with it a whole range of issues such as rising sea levels to catastrophic effect and so on and so on. so, these are essentially the near-term more direct the more local benefits that occurred and the other important thing is

that they occur both in negative and low-income countries. so it is a kind of women's situation if you like. that we can get these near-term benefits to the health, promote development and reduce climate change. >> okay. just make one final comment. >> [inaudible] first my compliments to the team that put the report together and it obviously increases the need and the benefits of rapid and substantial change. my question comes back again to what we now do because despite at least ten years of active debate and discussion on these issues since kyoto we have both population, media and political inertia. in april of this year the public pool in the country showed only 3% of people believe anything at all to do with environment had any relevance to their lives at all in terms of their voting. the national newspaper ran a headline stories about the debate in the climate change and with 12 years after the kyoto deal we still 12 years morning

matt looks like we have installed process in copenhagen in only next month. so what is it that we now duplex i appreciate we are saying we need political action and economic action and individual action but we fail to achieve those so i would like some practical solutions from the panel, please. >> i think that tease this up for the next session because i don't think we will be able to answer that now but what i would like to invite all of you to thank the panel and give them a round of applause. [applause] >> we will be discussing how tackling climate change by decreasing greenhouse gases benefits health, just what you've heard in the other preceding discussions and panel. you will remember that by a more efficient transport, walking and cycling, we can have a positive impact on things such as obesity and to dementia.

by household energy being more efficient we can decrease respiratory infections. by cutting down on meat consumption in high consuming countries we can have an impact on the scheme because can eckert disease, cardiovascular disease, and finally by electricity generation it is with renewable energy we can decrease air pollution. so, just as a summary of what went on previously been and now i would like to just turn to our panel members in washington and there are three panel members in washington. dr. john andrews, deputy director of paho. is there a way i can see from my screen? dr. john andrews, dr. retek cole will from the university of maryland and former director of u.s. national science foundation and dr. roger glass the director of the fogarty international

center. john? >> thank you, david. it's an honor to be here on behalf of the pan american health organization particularly director, dr. rosis who couldn't make it today. let me start by acknowledging in the past there's been several studies the demonstrated the greenhouse gas but addition measures can reduce debt from their evolution and they would be much of the final cost things to the findings presented earlier in this conference new research also shows a much wider range of additional health benefits. litigation policies related to household energy electricity generation, food and agriculture and transport could all bring potential health gains and these could include a significant reduction in some of the largest global health burdens of disease that we are currently challenged and facing such as respiratory infections, cancer and cardiovascular disease.

health benefits with the implementation of litigation policies are achievable essentially everywhere in the world. not only in the developed countries but the countries we are working with in the communities of poverty that we are working with in our countries particularly in the region of the americas where the pan-american health organization is the regional office where who serves. many of the studies cited today are conducted outside of the region. but the results are the most relevant for us. for example, replacing the inefficient and polluting cooking stoves of the types we often see in countries and communities of central america and south america will bring reductions in the respiratory disease in children, cardiovascular disease and women while reducing the harmful effects of black carvin. climate change, urban health, world development and food

security or all broad topics, but actually quite intertwined determinants of public health and health equity. in implementing active public transport in urban centers has championed by bogot and new york city can bring important cuts in the party of respiratory disease while also reducing greenhouse emissions. these benefits are immediate and local, and therefore should be particularly relevant for policymakers and the public. and this is one of the roles where the pan american health organization can play a vital part. however, the stark reality is at the moment these most cost-effective mitigating measures are neglected and often misunderstood by the public. the example of the interrelationship of food, agriculture, obesity and chronic disease highlights this point.

with the data presented today, i think we have the opportunity to push three critical action points for policy implementation. at the national level is important to prioritize those mitigation measures that will have the greatest impact on health and are the most cost-effective. failure to select the most health enhancing and cost effective interventions will be tremendous missed opportunity for countries and will clearly reduce the return on any investment in measures for greenhouse gas mitigation. at the international level partners should also prioritize mitigating measures that will increase the likelihood of resource mobilization and advocacy in the context of sustainable development. at all levels it's important that the measures contributing to a greater health benefits be given greater weight

particularly in areas such as transport, energy and the construction environment. the question was asked by roger what can health ministers do with the life-threatening conditions they face on a day-to-day basis? they can bring the evidence, they can bring it into a multi sectoral arena and promote the necessary actions with very little cost on their part. but they can take the leadership role so that health is in that decision making tree for policy implementation at all levels. to support this policy, w.h.o. has published several documents and pipelines in the workshops over the last two decades including four regional and subregional workshops addressing the fact climate health and public health. in may of 2008 passed the

resolution that would rapidly implement actions to protect public health from climate change. during the celebration of world health day last year in 2008, w.h.o. jones the scene of protecting health from climate change. in consultation with member states as part of the commitment activities, paho prepared a regional plan of action, to protect people's health from climate change. this plan of action was presented to the directing council, which is a yearly meeting of every minister of health in every country of the region of the americas and it was well received and is now being implemented to the extent that we now in the initial phases have pilot studies in planting the guide lines from a document called for our ability and adoption assessment, and they are being elaborated in these five countries i mentioned that our pilot studies.

once the pilot studies are finished in the near future the results will be published and disseminated and will be sure the decision makers tall levels receive the lessons learned. at this point i would also like to promote another activity that paho could be giving in the region of america where we experienced some of the greatest health disparities in the world. but marginal population where the slightest tip can produce the most significant will benefits from health. and i think that this role can be clearly a cross section approach grounded in scientific oversight with a good technical review. we are monitoring and evaluation of interventions as a key component to the plan of action. russia will not just in health but the multispectral approach mentioned. that brings and the donor's blood donors that are not just

giving money but are a part of the technical cooperative team at all levels. and bringing in the major stakeholders. the plan of action should have the most cost-effective study strategies. the regional approach addresses the issue whereas secretary sebelius says it doesn't matter who is at a meeting of the gas wherever in the region or wherever in the world. it affects all of us. sweet crosses borders. it crosses boundaries in a regional approach i think it will be highly beneficial. it will require advocacy tall levels particularly health professionals where they can play a role as they have in the past with other preventive measures in latin america and caribbean and we often refer to the area this issue of culture of prevention is something where we can continue to take advantage of and promote particularly if the communication message clearly highlights what's cost-effective and what is, what works.

with that i would like to thank the organizers. paho will continue to be actively involved. we are pulling a global forum on health the urbanization in the next few days and we will be also participating in other global the activities such as next year in 2010 world health day that will promote urbanization and health. thank you very much. [applause] >> i would like to address several points that were made, that may appear to be tangentially but really to the point. first, i do think the ordinary citizen is well aware that climate change is occurring.

scientists at the smithsonian have published papers showing flowers are blooming two weeks earlier. washington, d.c.. and bird watchers have already recorded that eagles on the potomac or fledging two weeks earlier of the past compared to fight for ten years ago. so there is this personal understanding involvement that the doctor spoke of in his presentation. i would also emphasize that infectious diseases have a very demonstrated seasonality, and there is an increasing abundance of evidence showing that malaria are shunning extended seasonality and moving further north and south in the case of

what american countries. in a study that we carried out with our colleagues in england we showed a very dramatic seasonality for a water-borne disease with a distinct spurring occurrence increase in that water-borne disease. and the introduction today, the remark was made that dirty water has led to 90% of the children in a country where water sanitation is lacking being subjected and infected with parasites. i would like to point out that water-borne diseases are directly a result of increase in a result of climate change. studies that have been done over the last ten or 15 years have shown the direct relationship of

the warming of the surface in the coastal waters and river waters and the monitoring by satellite of chlorophyll concentration in these water temperatures. it has allowed a prediction of the intensity of cholera epidemics and bangladesh and calcutta, in fact to the point where a few millimeters increases in rainfall in calcutta will lead to a 33% increase in the number of the cholera cases. similarly a small percentage of increase in the quarter fell concentrations resulted in a predictable 6% or 7% increase in the cholera cases, and this is because of the direct relationship of the cholera bacteria with plankton in the

water. now this is an important observation because another follow-through from that is that simple filtration, very simple filtration in bangladesh, and africa where it has allowed the reduction in cholera by 50%. so i was struck by the stove scenario for india. it just by improving the cookstoves and making these available have a very significant effect on air quality and reduction in her respiratory infection and respiratory disease and also

other her chronic diseases. so i think that the science based symbol solutions that can be implemented lightly in countries like africa and india, bangladesh but also have a counterpart as was pointed out in the studies in the developed countries by improving indoor air quality, improving the control of temperature and heat this then is a very powerful message for the individuals in these countries and for the individuals in the u.s.. i would emphasize we now have powerful tools. we have the tools of molecular biology that allow us to track pathogens. we have the tools of remote sensors and satellites that allow loss to do now casts and

eventually forecasts of infectious diseases and that with one of the factors of climate change namely sea level rise and flooding and having just returned from london and reading about the thousand year flood that has occurred in the english northwest coast is clear that the affect of climate change hour directly impacted on the individual's and populations the flooding itself is one factor but the water-borne diseases that are carried by the flood is particularly in those areas of the world like bangladesh and india where the central distribution of safe drinking water and sanitation, sanitary controls are not available that by implementing simple solutions we think we can

address these affects public health effects. so i would like to close my comments by saying that indeed emphasizing the very real public health effects that occur with climate change and of the mitigation steps that can be taken with respect to public health are very real and very i think important to the individual so i think that the messages that are provided in the lancet series of articles, if they can be translated to the simple language of the ordinary citizen can be extremely powerful, persuasive and i think allow messages than to be sent from the people to i think it

was referred to the political class and therefore address the climate change in a very real way can be undertaken roger? >> thank you very much. i really congratulate the team that put together this landmark issue of the land set because it demonstrates the value of bringing research, academic research, health research to a topic that is critical to all of us today. so i congratulate all of the participants and richard, for you to publish this and andy to lead the initiative. on behalf of dr. collins, the director of nih, i want to state a few comments that led you know about our engagement in this issue and really congratulate dr. howard and linda birnbaum,

the director of the niehs for moving this along. we feel at niehs we have to take science where the problems are, and this initiative on climate change actually allows us to take our research efforts and focus our research at the link between global public health and the global issue of climate change. it brings them together in ways that are unique and have value for the research agenda in the future. and i should say that at nih under the leadership of our global health working group, george rosenthal and chris who are here, we are actually looking at our portfolio to see how best to move the research agenda on our side to address the issues that have been raised in this issue of lancet but the investigators so we hope that that will be a very productive

way to take what has been a global call to action and begin to address and fingar granularity issues of both the basic science of climate change related to health as well as the problems in individual countries as we look around the world so we've really welcome this opportunity of the lancet series of the research presented and the call to action in copenhagen on climate change to link a global agenda on energy and climate change with the health agenda that is critical to a small. this is clearly an area and a time of global health for all. we see this throughout the world and president obama as mentioned with global health and in the pillars of am i each's new research director and agenda so there is a lot we can do in this area. we are looking for opportunities where our research and our research with our collaborators

overseas can really address these issues are clearly. i welcome you and congratulate you and we will be part of the research agenda as it moves forward. thank you so much. [applause] >> i plight thank the three panelists in washington for their interventions and i would now like to turn to the panel here in london. the head of the science the burden of energy and climate change, dr. maria, the director of the public health and firemen department at niehs dee dee to w.h.o. and the director of the nhs sustainability unit. >> thank you. i thought i was very important that the department of energy and climate change was here at this important event because as

many of you know the dickerman of energy and climate change [inaudible] it is leading the u.k. negotiations at copenhagen and hours have stayed, and milled and has been planning an important role in galvanizing the international will, the political will to get into a deal at copenhagen. a mitigation action is the key challenge, it's the big challenge. what we need to do is peak in greenhouse gas emissions soon, certainly before 2020 and reduce emissions by 50% by 2015 globally, and we have heard that in terms of developed countries, the u.k. the yet recommended 8% reduction in a greenhouse gas emissions. and that is a huge challenge. domestically what we have done the last year is produced below

carbon transition plan which sets out a detailed strategy to 2020. and that meets the e.u. target of the 20% reduction across the e.u.. internationally we have published a document to copenhagen which sets out what we want to achieve at copenhagen in particular the 2-degree target to keep global temperature rise from to below the 2 degrees. so those documents, the work we have been doing our around setting targets about emissions of greenhouse gas emissions in particular, but what we have sometimes missed is it is about reducing impact and the way impacts have often been characterized in terms of floods, in terms of food

shortages and as agriculture production is affected but at the end of the day i was very much impressed by what margaret had to say because it is about at the end of the data human health because food shortages lead to health impacts. flooding and leads to health impacts. a lot of the kind of physical changes that will happen on the global scale if we took no action would directly lead to health impact, and that is a message that to some extent has not been at the forefront as it should be. i think maybe because if you think about it, the agenda has been driven largely by physical science etc. have said what is the problem in terms of emission targets and various things.

what also needs to happen is okay, that's one characterization. why is that important, and taking that next step to say the reason why it's important is because it has these profound effects on public health and we've got to get that message back to the forefront because it once was there in the u.s. ec initial documentation and it somehow has been sidelined. i felt the papers were extremely useful. i mentioned the low carbon trans world plant. i have to say no where in that document does it say there are health benefits to these particularly strategies but looking at some of the papers that have been produced clearly some would have significant

health benefits and it is worth while reflecting on what we are doing at the moment when we are looking at mitigation strategies and costing them all out of the costs are about reducing damages from climate change but also costs of taking the mitigation actions. but i haven't seen the analysis of the mitigation action impact on human health. now, that figure that was shown with india i thought was very instructive. you can offset most of the litigation costs from the health benefits, therefore i think this series of papers has come out very critical time and will inform and go back and explain with the implications of these

papers to say they ought to be -- someone said this earlier on in the kind of decision tree in policy-making we ought to be taking these into account in deciding a policy option, as a for instance if you look at transport there are a number of different policy options that we are investigating, personal transport in terms of electric vehicles, public transport etc. now these will have different health impacts, and it seems to me following this work, this very groundbreaking work we ought to be looking specifically at the health impacts of these policy measures, so finally i welcome this and i think it serves as a reminder that impacts at the end of the day mean health impacts. thank you. [applause] maria?

>> thank you. it is a pleasure to hear from the people representing the ministry of energy that you recognize health as part of your agenda. this is a wonderful day. i have to -- i have to wonder what my -- [inaudible] and what she said of a video message this morning. in a few days, a couple of weeks who will be in copenhagen and we will even have a slight event that we want to become the age event of the copenhagen that means the health event because probably will be very little or minor presentation of the health sector in copenhagen at least as part of the official delegations. i know that many of you will be joining in copenhagen on your capacity of your associations or groups but as a part of the

delegation there will be probably one of two ministers of health representing us but the good news is we have the ministers from the energy sector who will be having the role in the health minister as well if i understand correctly. [laughter] great. [laughter] we said that from the undersecretary this morning as well as it is a fantastic opportunity you know, what will be the message is that it will be taken to public tv copenhagen. one there is a human face behind all of this agenda. don't forget this is about our economy, about our environment, it is about our planet, and it is about polar bears but as well for the cubans and health of the people so what we will be deciding in copenhagen and after copenhagen is something we have an enormous impact on the health of our people. so, a lot of passion is needed and i sure that we can all move

in that direction. the second message we have taken is that there are benefits, there are health benefits that can be obtained from these climate change agendas for fighting climate change and for investing in good mitigation, good and wise mitigation strategies and i think the report is extraordinarily important because if we want people to become the linkages between health and environment we need these messages. if we want people to change the way they consume, the way they commute, the way they use their private car or the way they eat meat or not we need to have a very positive arguments, and i think the report that has been produced today would be very positive message we can use to make sure not only health professionals are convinced, not only energy people are

convinced, not only transport people are convinced, but the general population. that they will reach the general population than the climate change agenda will move along probably even without our support. debate people will understand when you fight climate change your health and benefit or not they will put a lot pressure on politicians, on our health ministers as well and on everybody to make sure that there is some critical taken. don't forget as health professionals climate change means for us an opportunity to revitalize primary prevention because environmental health is about primary prevention. it is again about investing safe water and as retek was singing, and roger before, it is investing on better surveillance system and a primary public health interventions that for

many years we have been advocating that need to be done. now in terms of funds there is a role for the health community here, a critical one. the moment adaptation -- because they cannot come from the poverty pocket or the poverty money that is already coming from the different development agencies, the data to the money will come for adaptation we need to make sure the health sector from the developing countries are well-positioned in order to be able to start to receive those adaptation thumbs, and i think this answers a little bit, roger, your question before, what are the messages we can give to the developing countries which are already dealing with so many priorities. we need to help them to attain new funds to deal with adaptation. and now, we have another major role as the health community we can lead by example.

you know we need to reduce our carbon footprint, and we have a reputation and credibility be can use for that but we need as well to stimulate and inspire the health sector. as you know the health sector is one of the most important employers in the world and certainly one of those that are contributing to generate greenhouse gases. so maybe we can contribute as well to reduce the carbon footprint of the health sector and that can be part of our contribution to that. but i think today is a fantastic day and maybe we have by now the type of motivator we all need in order to push a little bit on a very strong way of the climate change, and i hope in copenhagen if we are not obtaining something than the health sector will take over and we will leave and make sure that health is

well recognized and that everybody understands the benefits we can obtain from that. thank you very much. [applause] >> thank you, maria. david? >> i would like to say a few final comments from the point of view of health services and health systems i'm going to focus my comments briefly about communication and actually put a few things right that i think we've heard today which are not right. the first thing is we have heard politicians understand the system. if you think they understand this issue, if you think that is true you are wrong. politicians are not going to lead us through. politicians are not paid to lead us through this. politicians are paid to follow. this is a democracy. it is the people need to tell the politicians. politicians will not do this on their own ends the importance of communication. secondly if you think the public understands, if you think the public gets it you are equally wrong. everyone of us in this room

there are 10,000 people out there who don't care about this so i want to implore you all to stop coming to these conferences and turnaround and go and speak ten times to 100 people who don't think that this is important. your time will be far better spent. [laughter] [applause] third come if you think that health professionals get this you are wrong. health professionals do not get this. health professionals say to me every day i spent my whole day saving patience. you want me to save the planet as well? there is an important halo effect here that we somehow as health professionals have a spiritual or professional offset when we don't need to do anything because we are already the good people. that is absolutely not true. do not underestimate the advocacy power of health professionals. it is absolutely profound. you get this the nhs has the

largest work force in the world facing the largest health challenge we have ever faced. so, can the nhs do something? of course it can do something want this heard now, i want is recorded that this really important set of research papers we have heard is focused on five period -- kuhl benefits at the global and population level but there is a third sort of benefit and that is that the system level. and when you need to understand actually our colleagues in the united states have done this very well quite unwittingly of course that the estimate for fiscal reasons supplies come surprise. some of the health care systems in the united states or some of the most for for ackley

integrated, low carbon health systems in the world and everything that is good for the low carbon systems [inaudible] of moving secondary into primary care. removing primary-care into self care. there are profoundly well scenarios which are very positive. it isn't taking the off of the ball in the health services. there is a fantastically positive message here which we must get at that comes back to communication. and ultimately you heard in the previous session we must measure these things unless we measure it this will become tiresome rhetoric and that is the duty

you see today. every person in this room has the duty to read this and internal voice and communicate in words of one syllable and decimal to those people who matter. it is absolutely essential. the responsibility is yours. the pattern is being passed over from this international research consortium and every one of you listening to a recording of this session. that you need to go -- you have a duty of care to make a good story be known. finally i would start by seeking the high quality communication is essential. and positive communication is essential as well. martin luther king did not say i have a nightmare. [laughter] so we have got some profoundly good stories to tell that profoundly important there is research absolutely necessary but is not sufficient and it needs to be well communicated. the world will be changed by good data and to your responsibility and my responsibility to do it is

happening on our watch and it is our legacy. thank you. [applause] >> thank you very much, david. i would like to thank the panel in washington and the panel here in london for their contributions. it has been quite a steady journey to where we are today. from early, tim, thinking about the messages that could be used to looking in the letter to find the association's two today a series which is clearly explaining the issues and the benefits from action at this point. we heard from john the benefits are achievable in countries with paho and that's reassuring and the cost effective studies must be done and prioritization must be made. we heard from retek that the

seasons are changing at least in the u.s. and we know in other countries as well. and infectious diseases are impacted by these changes. and we heard from roger the value of bringing health research close to where the problems are and making sure that research is done. at nih and fogarty will certainly play an important role in that. here we heard the leadership the u.k. has shown both nationally and internationally in these issues. in fact we remember it was the u.k. that brought this to the world health assembly for example in geneva and we were sure it got on the agenda despite hostility for many other countries. we also heard the importance of the public health message being at the forefront and maria made a comment that it's wonderful to hear that from the department of energy. maria talked about the upcoming event that will be held in

copenhagen. maybe you can tell a little bit more about that. and the importance of putting a human face behind the agenda. and i wouldn't attempt to summarize what david said because each one of his messages was so very important and the most important being that high quality of communication at all levels. no one understands the issues clearly. we must be sure we get our message right so that everybody understands the issues. so i think it has been a very interesting and important exchange of information that gives us as public health workers and others the chance now to move ahead in a very positive and more rapid direction and we have moved in the past. ..

we that would be most likely cost effective but what's really have to be studied. in the area of immunization we

have in the region and a project that is enhancing national capacity to make evidence-based decisions for new vaccines and that project as the potential to be expanded into all the other priority issues. we are creating a network of centers of excellence that do economic studies that are now working very hard but they are working in isolation so one of the rules of regional office has to bring these scientists together and begin to tackle some of these issues as well, i think that will be an important area of work but that is my initial response. thy think coupled with all of this is no one size will fit also the local involvement with, a local technical cooperation duplicated at the regional and global level will be very important to use local data to determine what needs to be done. i am very intrigued by the discussion on the stoves. i think it is relevant for many

communities in central and south america and what technology would be most cost-effective and by country? >> david very good questions. as they set up here i am thinking about the indoor air pollution which links very close to the acute respiratory disease agenda that as long time been a part of child health programs. i am sitting next to read that the spend a lifetime working on water pollution and water issues and waterborne diseases and other long-term research agenda that we see in the future. i heard the presentation on the value with of dealing with research than india when the impact climate change research could have on human health. it seems like we have the global agenda but we have to look-- act locally. how do we do that? critical is that we are talking

about long-term agendas and that means people, training people to do the research, to get involved with the advocacy and to actually developed a data loak aleve which will entice can convince local policymakers to make the right decisions this so we have a long way to go when this issue of the lancet in the research that is an outline is only the beginning to where we go from here. i think the path before it is clear and there are lots of issues we have to address their research and training of researchers in the developing world to extend the mandate we have here. one. >> i think that and it is really critical to take this extraordinarily important set of papers which are all written understandably in scientific

terms. it has to be translated into simple language that is understood by the late people. you have to be understood by the citizens, the ordinary citizens of europe, england, united states as well as the countries of asia and so forth by the translation is critical. otherwise there is no message. also we need to translate the changes that we are recording in infectious diseases. in the u.s., lime disease has spread across the u.s., the piracy reps periodically. in africa malaria and in india it scourges but it is changing. the distribution is expanding. we need to translate this in terms of, and i agree very much with david, it is not in terms of i have a nightmare but let us understand what is happening and

then respond. we need a simple solution at the same time we have the complex tools to do the measurements, the monitoring to develop perhaps along with weather forecast, health forecasts in terms of the public to understand. the simple solution are the-- solution the improvement of the cookstove, providing simple filtration for the complicated devices for which there are no repairs or no parts that can be replaced but just simple solutions. i think are critical in need to be disseminated and made available throughout the developing world but translated perhaps in a more complicated opportunity in the developed world. it comes down to really translation and communication and all that we are putting

together and that we are understanding. these are actually critical, otherwise copenhagen will not respond. [applause] >> thank you for your interventions. let me come back to you with one more question and that question is where do we get the money to move this agenda forward and how do we get there? maybe you would just think on that date that and come back to us. we will come back to you but i would like to turn to the u.k. and ask them a question about communication which seems to be at the forefront of what has been here in london. that question is, how do we make sure that the messages are getting out? i know tomorrow morning and this afternoon people will be monitoring the wires, monitoring

the pressmark is the of this has accomplished just a little bit more in moving the message out to the public but how do we really take a hold of this and get it out to the health community, to the health workers in the energy community? how do we do that? we have heard maria say a few things about possibly things going on in copenhagen but how do we get that message out its morrow the message has not been taken by the press what our next steps. i would like to start with nasriye. >> communication is absolutely the key. we heard early on from richard, talking about the uva incident, where the message about climate change has been undermined as it were by some individuals who

have taken unscrupulous actions and misinterpreted what is there. and that has a potential to damage the ability to reach the agreements that we need to do to take rapid action. now, in this area as i was saying, we need to reintroduce the reason, the main reason why we are taking this dramatic path because what we are saying is that the world his guts to radically change and it has to change rapidly as well. but why, why do we have to do it? year and one of the duties of about this set of papers and i accept that it is-- is that it gives case studies and it gives

thaxton did give some numbers, and you can put, you can point to it and say look here is a body of evidence that you can translate into a language that people understand that etc but it is a corpus of the evidence that can be used in a very effective way. now, it can be used, so it will be used effectively and i certainly will be doing it because i think you are right, not everybody understands. a lot of people say yes we do when they really don't come as though it is translating this to the internal workings of the policy process, which is long enough and gary, baillieu did. that is where it will-- as well as communicating to the public

because it you communicate that message it is a completely abstract idea in say more than 50 years' time. it is about your health and your children's health, about your health and your children's health nobody much more effective message to get across. >> thank you for kumar rio. >> thank you david. if we want to communicate we need to change certain things. one is that our message is too general. it is about the planet is you were saying, in about the next generation and saving the environment. i think we need to be pragmatic in communicating this about your health then it is about now and we can go as far as saying your asthma is mildly related to climate change in environmental issues so make sure people understand. second, we need something positive to communicate. we need to make sure that people

will have a dream. we go outside with an idea to change. this morning people were talking about civil disobedience. i think is maybe too much because her final note to helmke-- but positive resolution yes. it is time for a positive revolution in this can be a very positive revolution that will help us to revitalize this primary prevention concept that the health community and then said if you will allow me to say that, many years ago and for reasons we now forget about. we need to give action to people. we cannot just communicate and say this is a disaster, the climate change will change your help. weed to say, maybe by not voting when any more the government that is now in charge and doing the wrong things and vote for somebody else but i think the system needs to be empowered.

second we need to empower our own health community. they have not understood and i am sure if you give them many of them the opportunity to discuss with all the sectors other than health or the ministry of the economy the message that will pass to the ministry of the economy is i need more money to build more hospitals so we need to empower the ministries of health in order for them to have arguments that the day they will be invited to the ministry of energy, and say i have something to say and those are my arguments. the literature has produced the key message for health professionals. if you are meeting with other sectors those are the messages you can pass and say those are the reasons why i want to influence your own sector. then i think there are many movements outside do we need to work with and give them this ability because doctors and health professionals, they--

there is the green movement for health initiated that is quite powerful. we need to give them the opportunity to show up and we need to be the health of the kids as we used to be in the past. it is time for a positive revolution, or alignment for some people because it might be an alignment for people if we dream of helping climate change. thank you. >> briefly i think the great problem with communication is the illusion that is being a chief. the and i think one of the principles of communication is it is happening to human behavior and there are probably three things that affect human behavior. if you can understand what motivates people to act and work backwards from there then you might be on to it winner but seriously a think probably i am not a communication experts but one of the most important about

communication and seek to understand the for you seek to be interested so that means going out and listening to people, what they feel, why they behave in the way they do because there will be a quasirushnell reason ba'hi did so listen first before you make a great mistake of six salting, shouting, getting angry entin stilling guilt because that will do will play into the worst possible scenario. if you read jared diamond's book about why societies collapse, and that is exactly what we are facing, a sizable collapse in previous collapses is that we do this no langle. we know we are doing this. that is the great tragedy of that, so it is very important we get out there and we understand people and we understand organizations and understand systems so we can help people and take people and a very positive long journey to

possible survival. that is what it is all about because if we don't we will find in the words of jared diamond that we will use techniques that were very successful in the past which are going to be very unsuccessful in the future and i would just give you one example. one of the morphed important coping mechanisms of human beings for u.n. for me is that all important power put human behavior called denial. it is fantastically useful. it is one of our most fantastic coping mechanisms. we would not get to the day if we were not black melts in being able to deny. the problem is that behavior that god is down from the trees in the past loculus in the future so for goodness sakes don't try to communicate with people in any way at all that well in any way make them want to deny what this and it is easy to make people tonight. one of the issues around

copenhagen is that we are going to get climate change fatigue from the press so continue to refreshed and renewed and rearticulate the ways in which we sell positive messages. what i would do it is that someone invited me to communicate with them i would say you should take action. it is good for your wallet, it is fun and it will be good for your children. >> cow. >> thank very much david. with a question for you of the london-based panel is, certainly over the past two months there have been no difficulty in getting the press to focus on the influence of. are there any lessons from this, the way the press is focused on influenza to how we could better convey the message of climate change to the press and get the same headlines for climate change issues and health? so back to washington. what i would like to do is ask the washington panel to give an answer or several answers to the

question on where the money will come from or where it could come from and then i would like to open its to the audience in washington for two or three questions from some of the audience in washington. panel first on where the money might come from more could come from? >> i want to preface my response by saying that this is a very complex set of interactions that is going to require a very complex strategy and it meant my response is clear and concise in short. i think it is going to require a short-term strategy as well as the long term strategy. a lot of times we try to fix things in the short run and forget about the need and importance of having a long-term vision and strategy, so it is a combination of country level work where you were building country level political

commitment, that culture of prevention using science to drive the agenda and a lot of the success we have had in immunization in america has been on the minister's embracing this culture of prevention and expanding their own fiscal space. so when you talk about resource mobilization and you talk about polio eradication 90% of those resources came from the government so there's an opportunity there where they can begin to prioritize cost-effective interventions that are relatively low in terms of their country budgets. that would be short term as long as well-- as well as long-term if it is coupled with things like expanding space legislative actions that would lead to good governance. i will end by saying that really one critical factor leading to success in resource mobilization i believe is being able to tell

a story. you have to tell a success story, so in doing that you have to have a groundswell of activities that clearly demonstrate success and i think those country level experiences where you can share between countries is one way to do that and i think that will be much of our work from the perspective of the americas and sharing those experiences, what works and then bringing those key people, this key stakeholders together to monitor and implement what would be a regional plan of action. bat i believe will attract additional resources that are catalytic to what governments, despite the fiscal crisis, can do themselves. >> david you don't give us easy questions but i do want to take you back about ten years and think about the global health agenda. when you go back ten years we didn't have bill gates

involvement, we did not have pepfar, we did not have the global fund for hiv, tb and malaria. we did not have the global alliance for vaccines. we did not have bono, we didn't have nelson mandela, we didn't have jimmy carter. over ten years the global health agenda has become a major agenda for countries around the world than we see our lives are intertwined in real insubstantial ways. what made the case for global health? you know as physicians we think it was held. we think it was humanitarian gestures but really what moved the case was the linkage to security, the linkage that helped diplomacy, the linkage to development, the linkage to competitive ambitions in business. the linkage to science, so i think this is a way that the

global health agenda has moved and i see this thing happening with the climate change agenda. you know the value of this lancet piece has to do i would say with the word coe benefit that with by introducing a cookstove we may have a more effective way to burn fuel or to heat food but we are also having a co-benefits of health. when i take my bicycle to work in the morning i am having the benefit for my own health but also having a benefit for the environment. of these things are intricately linked and lacy part of the agenda as laid out in the lancet issue and is the climate change agenda and health moves forward is the ability to link the health benefits to these other energy activities that will come into the future. so we need a major movement. communication will be key to finding the messages, but if you think where we were ten years

ago with global health and how far we have, think it is a positive message for getting people engaged in providing a new stimulus, recognizing we are aldington there is nothing that links us better than the climate and the global climate. so we have something to gain by working together. >> let me take another perspective. i think one of the most interesting findings of the lancet papers is the message that everyone participates. it actually is doable with individual participation and individual action. let me give you an example. human behavior is a very powerful motivation stimulation. studies we did in rural bangladesh villages some years ago funded by the national institutes of health and nursing institute, this simple filtration reintroduced was

grounded in laboratory studies, science-based in the ms knowledge of the waterborne disease in in this case it was cholera. caller of vexed 100,000 to 200,000 people every year, mainly children under the age of five so what we did was work with the women in the villages and explain to them that by filtering their water, simple filtration. every morning when they collect the water their children would timulus.likely toick. five years later there is still victory and no one is there to keep telling them to do so. an addition, the people if they are surrounded, if you are surrounded by people who filter you are less likely to come down with cholera so by engaging each of the individuals, you in the fact are bringing billions of dollars to the table in tiny

amounts per person's efforts. so i think the message clearly is that this is a global effort with at the individual level and each person does count. each person does make a difference. that message i think is absolutely critical. >> thank you rita and thank you to the panel in washington. i would like to open it up to the panel in washington but i would like if he would introduce yourself first and be very brief in your question and one of the panel members in washington or in london will take the opportunity to reply. so, over to washington. are there any questions or comments? >> married barber with rti, international and i would like to ask you well to reflect again on copenhagen. it is coming up very quickly.

is not going to have a whole lot of time to hone a communication message. hill is going to champion this in copenhagen? how will it be championed? any thoughts? >> i would like to ask maria and-- marie neira to answer the question. >> who is ready to champion and i would like to think that what you were saying to you were referring to w.h.o.. [laughter] w.h.o. will try to championed these. as i mentioned we will have a side event to which you are all invited, with we will have ministers and authorities from different countries that we hope they will be able to champion

these and to go back to their country and help us on this agenda. of course our major work will be in the corridors. decided that will be an opportunity but we will try to convince everybody about the positive messages and how this can be a fantastic opportunity to revitalize public health. i think health has to be presented as part of the solution and if we do so i think we will be doing something on the championing. who will be there? we are trying the best we can to influence people in the ministry of health, so we worked very much with them, but we want to empower them, giving them the messages that they can pass to all of their sectors when they discuss with them. we would like to empower the

health community and health professionals telling them there is something fantastic they can achieve by conspiring to join this movement and were preparing messages for the general public, something called the did you know? did you know when you take the-- the bus instead of a private care, you were-- so there many messages, many people here and given the opportunity to create a platform that will collect all of these movements contributing to greening the health sector and moving to a green for help. >> there are also many grassroots, grassroots level initiatives as well. is mike in the room by any chance? do you want to say a word? >> mic. >> there was a great question

about where does the money come from and it is a clear championship message that we should begin to deliver and i did not actually hear any reference to the u.s. secretary. the other thing is, this whole point about money. this set of papers profoundly alters the political defense ability of the internalizing the externalities'. we are talking about taxing fossil fuel use. at the end of the day one way or the other as a major, major plank of policy. no one has mentioned the word tax. we might mention the word train but that is fine. six let's be honest, the defense began offer about why we need to tax. health professionals did not stand back when it came to the need, why should we stand back when it comes to the need for taxing fossil fuel? [applause] >> thank you.

i have one more question in washington and i would like to turn back to washington. tankless mic for that intervention. washington? >> u.s.-the council for science in the environment. i want to ask more in terms of the question about black carbon or to use this specific term four-letter word, said and that is that it really exemplifies the interconnectedness of the problems that recent research by nobel laureate with molino and his colleague have identified that suds may be one of the real factors it is leading to the melting of i.c.e. especially in the glaciers were 25% of the world is dependent on glacial water four, glacial milk for their water so it seems like this is a, it could be the critical factor in slowing

global warming, improving health both from a respiratory and water perspective so my question is what would it really take to launch this effort of around the world where people are still dependent on wood for cooking to do these advance stoves into really very quickly change people's lives and changed the trajectory of climate change? >> thanks very much. and of these i wonder if you could give us a perspective on that? >> it seems on the face of it a no-brainer of looking at the results that have come up in previous studies about black carbon and cooking stoves in india. and there are understand programs to roll out these new stoves in india. in respect to black carbon and climate change, certainly there

is new evidence about the impact of black carbon on the melting of glaciers and i.c.e. sheets, so there is beginning to be quite a compelling case to do something about it. malcomite in terms of whether as a result of this evidence, it will sway governments, that is to be seen. as you may know india takes a particular view about who is responsible for climate change and who should take action. the studies that we have done in the u.k. lucky nick global impacts show early action benefits india more than most-- countries so they have got a pretty strong incentive to take

action, including reducing black carbon from the use of these particular cooking stoves. >> thank you nafees. i would like to turn to the london panel and come back to the question of lessons that might have been learned from the influence the communications as to how climate change and health can capture the headlines. maybe i will star with david. >> one of the things they think is very interesting about health professionals is that we tend to be crisis junkies. we have luff problems that are tangible, identifiable and soluble in a meaningful space of time so that is why we love er. the problem with climate change is it is a slow burn emergency. that means it is happening slow enough so that tomorrows business and fast enough that it will kill us.

that is a combination said you are absolutely right david, of we have to watch climate change as a crisis because that is what health professionals do well. we don't do planning well. planning is for somebody else. that is not what we are wired to do. somehow we have to articulated as an emergency that need action now but that is not easy at all and we really have to think of some clever ways to do that. by going down the planning route i don't think that is going to get there and in communicating this issue, the different ways in which things are turned on. some people are turned on by the mark-- moral and ethical case and some people are turned on by the financial kasem that is fine. some people are obsessed by the low whatever dishence the importance of politicians and interestingly some organizations are cronon by the reputational

cases, so i think my earlier elusion to listening is to find out what it is in the people you are trying to help change what it is that changes them and press on that button because that is most likely to work. >> how do we press the button? >> i was hoping you would this gave me because this is a difficult question. it is always a mystery for me what excites the media and what not. it took us 20 years to convince anybody in the world that debaca was the major public health problem and was killing people and it took us a few minutes to excite the community about h1n1. i don't know what is the answer but i will go back again to the fact that you get something to the community saying this is the problem but this is how you can respond to the problem. otherwise we will generate that paralysis and people will be

verified but paralyzed at the same time. the approach of the emergency my work for the first phase but i'm wondering whether for such aid medium and long term climate change and help will be something useful. probably we need to go on different-- today in transferrer, tomorrow on household energy and after tomorrow energy efficiency and linking ourselves on the very opportunistic way to the energy agenda is, to the housing agendas, to the new buildings agendas and the mitigation policy making sure that health is always part of the debate and therefore we keep immediate attention. i am concerned as well. i think we have a couple of years or maybe less than that and the journalists will move to the next crisis. unless weed catalog ourselves as no crisis but still exciting we might get out of the--

>> the agri that influence is a press story because there is a threat of vincent that. it is not a good news stories so to kind of say that the climate change should be like is a slow burn story. it should be more on the inside pages or the front pages, the kinds of things that get on front pages of not the kind of thing which we want the system to respond to. i think that point, all kind of systems respond to and for the next 20 years you don't want to be on the front pages. you want people to internalize it so it is a different kind of communication strategy which i accept we have not worked out yet and we need to. >> thanks very much. i would like to now turn to the london audience for one or two questions and then we will ask

the panel in washington to give the answer to these questions. no time. okay, there is no time to ask questions in london i have been told so we will have to end now. i would just end by trying to summarize what i understand from the exchanges which have gone on today and that is very simple in maybe three different ways of expressing it. first is the of linney to continue to expand the evidence-based can translate this evidence days into communications, effective communications. the second is we then need to use these communications to increase engagement of governments, of the global development community, of the public, of communities, health workers. we need to engage everyone in these activities and finally by engaging in need to increase the demand that there will be changes in the climate change

agenda that will benefit health. so i would like to thank you all for participating in this panel and thank the welcome in london school for having supported us. [applause] >> good afternoon everyone. i am the chairman of the welcome trust. i am 62 years of age. i have children and i have grandchildren and i've come to this conference extraordinarily excited by what the d5 scientists have achieved in just one year. let's start with the issue of the opening session this afternoon when we had both political leadership and leadership of our largest global institutions. one about the importance to act urgently on climate change and

one in terms of the importance of the health issues within the agenda. if you wind the clock back just 12 months he would not that had that group of individuals representing both national governments and global institutions with the same degree of consistency or the passion in their messages. we heard about the need of climate change within the world. we heard about 1 billion people being on the brink and in fact this 1 billion people have the least tolerance to a minor change within their sustainable society. the people who have delivered the lowest co2 emissions over the last century. we have heard about health being a peripheral issue. just one word in the policy document from the european commission and we listened to it and the berman talking about frankly i have got to do-- more to do in my backyard. the interesting thing about

global climate change is it is not only the backyard but the globaling yard we have to deal with and i believe we are seeing tremendous progress in this ability to look both globally at global consensus and then local accountability. so i would like to come back. i think it is remarkable that the d5 scientists in one year should come out with the paper, with a striking, very striking headline because most people have not seen climate change so far. we have heard about ways of reshaping the macroeconomics policies of the industrial world. we have never had a health care dividend. so i would like to thank the international climate health council and the london school of hygiene and all of those involved with this extraordinary effort. i would like to complement the scroop on setting an agenda which has robust consistency in terms of steadying energy,

transport, electrical generation and food and agriculture. i would like to think of them for the initiative of publishing so appropriately just before the copenhagen meeting with such clarity both in the lancet journal and the-- i would like to point that although we have the world science represented both in washington and the united kingdom i heard not a single challenge to the findings here. our discussions have been much more about the communications of the findings and that is a very good sign in terms of the acceptance of the rigor of the science in the simple messages which i think most people can understand travel and cleaner air we can do much to reduce the great health care burdens of the world in terms of reducing respiratory and cardiovascular disease and that pandemic of obesity which is striking it every nation both developed and

undeveloped. so as we look forward, we have heard comments about how we make this agenda realistic and 80% reduction in greenhouse gases by 2015 is the u.k. objective. we are on a long journey. copenhagen is not the end zilaitis the start. it is the start of the partnership between science, industry and politics and a partnership where we explain to the electric in the world and find a mechanism for delivering greater political accountability. we need to continue to explore whether the key factors of the health research agenda of that will allow us to make the recommendations for what is the therapeutic investments we have to make in terms of the health care outcomes of global climate change. how arby going to medicaid and adapt to make sure that we have a healthy society around the

world, one where health care is affordable and one where we understand how we can both medicaid and adapt to the impact of climate change. we have talked a lot about communications this afternoon. there is not just communications to get-- if we are to meet the challenge of global warming and behavioral sciences and how we go about this modification of behavior within society is yet another key task another of the great steps we have to take. and i do believe the world of science thinks the focus of what it sees as a key performance indicator that allows us to believe as we go through a year on year that we are actually progressing with the logical policies that delivering a sustainable world which embraced key outcomes and also embraced the concept of lifecycle

accounting for carbon because many politicians have seemed to have ignored the most basic concepts that allow was to make the right decisions for the globe. so, we have talked a lot today about advocacy. i was absolutely pleased with the rigor of the science arguments in the last document. i felt that i had heard today from global scientific and health care professionals who make their case. that it buys has informed us. wendell have to insured informs the public debate and political debate and the public policy and political accountability. finally as we go forward, we have heard about the silos and the silos are in every aspect of our lives. we need to make sure we continue to encourage geographical and cross discipline partnership to find the right solutions for the many functional skills that exist in the world. we need to find a way that we

realize this is truly a one world, one health challenge where one medicine is appropriate. we need global consensus, regional plans accountability. quickly we need to find a way of ensuring that we moved the resources to the developing nations and find the mechanism of ensuring we not only deliver the local global health agenda but we deliver the health agenda to the global citizens and that is the best way for us to sustain nationally global civil society. without extending the benefits we can see coming from the help-- we are not going to stop the forces of migration and the destabilizing impact that will have on civil society. once again i think an extraordinary step for 55 people, well coordinated. i would like to say to washington you are continuing with your rigorous debate this afternoon. i hope you feel you will have a

happier things giving toasting the climate dividend as you enjoy your turkey. now i am going to handed over to dr. linda birnbaum director of the environmental health sciences for her closing comments from washington. [applause] >> thank you sir. as he no so often in the past the reality of climate change has been and i should say continues to be questioned by many people. it would be hard to overestimate the difficulty that we as scientists have faced in trying to help our citizens and their governments to understand the true urgency of the problems. up until this point most of the message has been doom and gloom. does it is with a bit of irony that i've read the phase in the

lancet executive summary that says that the news is not all that. in fact, the research findings presented here today give us compelling evidence that there is every reason to be encouraged what this research shows is that we can now credibly argue that the mitigation of climate change, while undoubtedly improving the health of our planet, will also simultaneously and in some cases immediately, greatly improve the health of people around the world. at my institution, the national institutes of environmental health sciences we are keenly aware of the serious consequences of air pollution for health. particularly for the most vulnerable among us, children, the elderly, the poor. in fact, we spend a large portion of our budget,

approximately $100 million last year or more than 20% of our total budget on research into the health effects of air pollution including support for the work of kirk smith and michael jerrett you were here as authors of the lancet articles as well as their co-author, catherine tony. that is why it is so gratifying for us to support along with all the other funders the groundbreaking research we have heard reported today. the findings clearly show that solutions to some of the worst air pollution problems will also benefit human health in the near term as well as the long term. i think it is important to note the finding that savings in health care costs would offset the cost of climate mitigation. key to the lancet article are the quantifying dfcs and as the

mets, and i think it is important for us to realize these qualifications aren't really conservative because not all of the health benefits are being quantified. the estimates run cardiovascular disease, lung disease, a few whether things but very little talk about the lifelong impairments in your development and health of children who are exposed as children to air pollution as well as other issues. i would really like to join certification casville four thanking our steady authors for bringing their critical insight in expertise to bear on these studies into a acknowledge the work of the task force on climate change mitigation and public health for its efforts in helping to conceptualize and read you this research. i also want to thank all of our partners in the united kingdom

for supporting these efforts in particular the welcome trust and the london school of hygiene and tropical medicine and of course we thank the lancet for their efforts to ensure that this critically important definitive research finds wide dissemination. finally, i would like to thank the u.n. foundation for co-sponsoring this event and the many staff on both sides of the pond you helped to make this joint discussion possible. at this point in his time to conclude our satellite link, so we will bid our u.k. collaborators a good day, say thank you and once again i would like to say i personally look forward to seeing you all in copenhagen. thank you very much. [applause]

>> now a news conference from the national institute of environmental health sciences. we just heard about their recent report on the positive help the effects of reducing greenhouse gas emissions. this briefing is about an hour. >> okay guys i think we have a seven minute stretch. and a baseball game it does not take very long so let's get back. before we begin the question and answer session we are really privileged to have today my colleague dr. howard koh who is the assistant secretary for health and human services and dr. koh was going to share his remarks. he has been kind enough to work us into his incredibly busy schedule and will have to leave shortly after his remarks for

another critical engagement so following his remarks he has agreed to take one or two questions before he has to go. before joining the department of health and human services dr. koh was most recently the heart beebe fineberg professor of the practice of public health, this is the dean for public health practice and the director of public health practice at the harvard school of public health. at harvard he served as the principal investigator of multiple research grants related to community health participation and participatory research, a cancer prevention, health disparities, tobacco control and emergency preparedness. at harvard he served as director of the center for public health preparedness and from 1997 to 2003 he served as commissioner of public health for the commonwealth of massachusetts. dr. koh is an elected member of the institute of medicine and previously served as chair of

the board of scientific counselors for cdc's coordinating office for terrorism prepared as an emergency response. dr. koh has received numerous awards and honors including the distinguished service award from the american cancer society. dr. koh it is a pleasure to have you with us today. [applause] >> thank you so much dr. birnbaum for that very kind introduction and thank you for your outstanding leadership in public health. it is a joy to be here at a historic conference into celebrate the release of such land farc science. we have really had an extraordinary morning today where we started with some remarks by global leaders and then we heard some very pivotal research findings from an international team of scientists who collaborated on this

project, the first major international study of its kind to investigate the public health and pecks of different strategies to reduce greenhouse gas emissions. i had the great privilege of being here for the entire symposium and the messages i heard today resonated with me from a number of view points. first i am a former professor and researcher and i deeply respect the rigor of the science presented today and published in the lancet. secondly i am a former state health commissioner and i know the impact of this research on states and local communities. and third i am a physician who has cared for patience for over 30 years and we know fundamentally these results will impact on the lives of all the patients that we care for around the world. as the new assistant secretary for health five fad the great privilege of coordinating and integrating scientific expertise

within the department on this issue and so in that capacity this been a great pleasure to work with dr. birnbaum, dr. crist poitier and i want to thank him for his leadership for coordinating with dr. roger glass in many outstanding scientists within the health and human services. at sessions like this we remind ourselves that our goal in public health is to help all people reached what is known as "the highest attainable standard of health." a phrase from the world health organization and w.h.o.. the w.h.o. defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity and "and we think about this basic goals and definitions when we hear extraordinary science like we have today. as the assistant secretary i also have a great honor of

overseeing a national health planning process called healthy people and there is a wonderful line in that document that they read to you now. the health of the individual is almost inseparable from the health of the greater community." so all the things we have heard today, the science, the comments of the minification, dissemination, an advocacy relate to the fact that the health of individual is almost inseparable from the health of the greater community and in short we are all interdependent and all interconnected. every person around the planet is affected by the research that we are hearing about today, because these issues affect every aspect of every life. it affects the air we breathe, the food we eat, the vehicles in which we ride, the energy we

use, the places in which we live, the help we enjoy in the lives we lead. and we can also each individually make a contribution in terms of promoting the power of prevention with respect to greenhouse gas emissions and climate change, so this is an issue for us individually and collectively. as the assistant secretary i am very pleased as you have heard from secretary sebelius earlier, to send a message that the obama administration has made wellness, public health and prevention a high priority. there has already been investments through recovery act funds to promote clean energy efforts and wellness and prevention. there are renewed effort to send a message of health and all policies so that health issues are not of health and human

services thug drought all of the agencies and federal government, and we have had accelerated momentum with respect to the specific issues of climate change in greenhouse gas emissions. just last friday there was a white house stakeholders meeting giant lease sponsored by the department health and human services and the informant a protection agency were both secretary sebelius and administrator jackson spoke. the theme was clean energy reform in public health and their workshops devoted to clean energy choices, safer and healthier transportation efforts and better designed resilience communities. so we are seeing a great energy and literally in many definitions of that term and great momentum with respect to promoting global health as we have seen today. going forward with this new