Education And Debate

Climate change and health: implications for research, monitoring, and policy

BMJ 1997; 315 doi: (Published 04 October 1997) Cite this as: BMJ 1997;315:870
  1. Andrew Haines (, professor of primary health carea,
  2. Anthony J McMichael, professor of epidemiologyb
  1. a Joint Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine and University College London Medical School, London NW3 2PF
  2. b Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  1. Correspondence to: Professor Haines
  • Accepted 13 June 1997


The potential effects of climate change on human health are summarised in the previous article.1 These are wide ranging and pose considerable challenges to both researchers and policy makers.2 The complexity of these environmental processes and their impact on health necessitates a multidisciplinary approach.

In environmental health there is a close relation between epidemiological research and those monitoring activities which seek evidence of changes in the environmental or health status of populations. A distinction is usually made between monitoring and surveillance, the latter being the continuing standardised recording of the occurrence of disease. In the context of climate change and health, however, both monitoring and surveillance are needed to (a) identify important changes in disease incidence, health risk indicators, or health status; (b) determine whether these changes are likely to be the result of local, regional, or global environmental changes; (c) to help develop countermeasures and assess their effectiveness; and (d) to develop hypotheses about the potential health effects of climate change. Monitoring should also help in the detection of unexpected events.3

The research challenge

Since there is uncertainty about the profile and rate of future climate change it is necessary to estimate effects on health in relation to specified probable climate scenarios. This process differs in several important ways from the more familiar empirical procedure of quantitative risk assessment.4 The latter is usually conducted in relation to some existing index of environmental exposure for which there is prior empirical evidence of direct (usually toxicological) health risks across an exposure range which includes the index exposure.

The three main approaches to health risk assessment based on scenarios are extrapolation based on specific (historical) analogue situations for some aspects of climate change; formal integrated mathematical modelling; and generalised assessments drawing on expert judgment of the range of health consequences (physical, …

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