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Monday, March 1, 2010

Climate change and health

Key facts

•Climate change affects the fundamental requirements for health – clean air, safe drinking water, sufficient food and secure shelter.
•The global warming that has occurred since the 1970s was causing over 140 000 excess deaths annually by the year 2004.
•Many of the major killers such as diarrhoeal diseases, malnutrition, malaria and dengue are highly climate-sensitive and are expected to worsen as the climate changes.
•Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond.
•Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved health.

Climate change

Over the last 50 years, human activities – particularly the burning of fossil fuels – have released sufficient quantities of carbon dioxide and other greenhouse gases to trap additional heat in the lower atmosphere and affect the global climate.


In the last 100 years, the world has warmed by approximately 0.75oC. Over the last 25 years, the rate of global warming has accelerated, at over 0.18oC per decade1.
Sea levels are rising, glaciers are melting and precipitation patterns are changing. Extreme weather events are becoming more intense and frequent.

What is the impact of climate change on health?

Although global warming may bring some localized benefits, such as fewer winter deaths in temperate climates and increased food production in certain areas, the overall health effects of a changing climate are likely to be overwhelmingly negative. Climate change affects the fundamental requirements for health – clean air, safe drinking water, sufficient food and secure shelter.

Extreme heat

Extreme high air temperatures contribute directly to deaths from cardiovascular and respiratory disease, particularly among elderly people. In the heat wave of summer 2003 in Europe for example, more than 70 000 excess deaths were recorded2.
High temperatures also raise the levels of ozone and other pollutants in the air that exacerbate cardiovascular and respiratory disease. Urban air pollution causes about 1.2 million deaths every year.
Pollen and other aeroallergen levels are also higher in extreme heat. These can trigger asthma, which affects around 300 million people. Ongoing temperature increases are expected to increase this burden.

Measuring the health effects

-Measuring the health effects from climate change can only be very approximate. Nevertheless, a WHO assessment, taking into account only a subset of the possible health impacts, concluded that the modest warming that has occurred since the 1970s was already causing over 140 000 excess deaths annually by the year 2004.

Who is at risk?
All populations will be affected by climate change, but some are more vulnerable than others. People living in small island developing states and other coastal regions, megacities, and mountainous and polar regions are particularly vulnerable.


Children – in particular, children living in poor countries – are among the most vulnerable to the resulting health risks and will be exposed longer to the health consequences. The health effects are also expected to be more severe for elderly people and people with infirmities or pre-existing medical conditions.
Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond.

WHO response

Many policies and individual choices have the potential to reduce greenhouse gas emissions and produce major health co-benefits. For example, promoting the safe use of public transportation and active movement – such as cycling or walking as alternatives to using private vehicles – could reduce carbon dioxide emissions and improve health.


In 2009, the World Health Assembly endorsed a new WHO workplan on climate change and health. This includes:
•Advocacy: to raise awareness that climate change is a fundamental threat to human health.


•Partnerships: to coordinate with partner agencies within the UN system, and ensure that health is properly represented in the climate change agenda.


•Science and evidence: to coordinate reviews of the scientific evidence on the links between climate change and health, and develop a global research agenda.


•Health system strengthening: to assist countries to assess their health vulnerabilities and build capacity to reduce health vulnerability to climate change.

Bottled drinking water

"Water, water everywhere, but not a drop to drink" from the Rhyme of the Ancient Mariner is perhaps a fitting description of the attitude of many consumers living in urban areas today who are increasingly looking toward bottled water as a means of meeting some or all of their daily requirements. As fresh water supplies are further stretched to meet the demands of industry, agriculture and an ever-expanding population, the shortage of safe and accessible drinking-water will become a major challenge in many parts of the world. In the wake of several major outbreaks involving food and water, there is a growing concern for the safety and quality of drinking-water. While bottled water is widely available in both industrialised and developing countries, it may represent a significant cost to the consumer. Consumers may have various reasons for purchasing bottled drinking-water, such as taste, convenience or fashion, but for many consumers, safety and potential health benefits are important considerations. Since such considerations are often not founded on facts, these will be specifically addressed here.

The safety of bottled drinking water

While the term bottled water is widely used, the term packaged water is perhaps more accurate. Water sold in countries for consumption can come in cans, laminated boxes and even plastic bags. However, bottled water is most commonly sold in glass or disposable plastic bottles. Bottled water also comes in various sizes from single servings to large carbouys holding up to 80 litres. Depending on the climate, physical activity and culture, the drinking-water needs for individuals vary, but for high consumers it is estimated to be about two litres per day for a 60 kg person and one litre per day for a 10 kg child.

Drinking-water may be contaminated by a range of chemical, microbial and physical hazards that could pose risks to health if they are present at high levels. Examples of chemical hazards include lead, arsenic and benzene. Microbial hazards, include bacteria, viruses and parasites, such as Vibrio cholerae, hepatitis A virus, and Crytosporidium parvum, respectively. Physical hazards include glass chips and metal fragments. Because of the large number of possible hazards in drinking-water, the development of standards for drinking-water requires significant resources and expertise, which many countries are unable to afford. Fortunately, guidance is available at the international level.

The World Health Organization (WHO) publishes Guidelines for Drinking-water Quality which many countries use as the basis to establish their own national standards. The Guidelines represent a scientific assessment of the risks to health from biological and chemical constituents of drinking-water and of the effectiveness of associated control measures. WHO recommends that social, economic and environmental factors be taken into account through a risk-benefit approach when adapting the Guideline values to national standards. As the WHO Guidelines for Drinking-water Quality are meant to be the scientific point of departure for standards development, including bottled water, actual standards will sometimes vary from the Guidelines. It should also be noted that water used for making edible ice should be subject to the same drinking-water standard and include specific sanitary requirements for equipment for making and storing ice. For water in carbouys, similar sanitary requirements for dispensing devices need to be observed.

In applying the WHO Guidelines to bottled waters, certain factors may be more readily controlled than in piped distribution systems and stricter standards may, therefore, be preferred in order to reduce overall population exposure. This has, for example, been argued for the case of lead. Similarly, when flexibility exists regarding the source of the water, stricter standards for certain naturally-occurring substances of health concern, such as arsenic and fluoride, may be more readily achieved than in piped distribution systems.

Contrary to this, some substances may prove more difficult to manage in bottled than tap water. This is generally because bottled water is stored for longer periods and at higher temperatures than water distributed in piped distribution systems. Control of materials used in containers and closures for bottled waters is, therefore, of special concern. In addition, some micro-organisms, which are normally of little or no public health significance, may grow to higher levels in bottled waters. This growth appears to occur less frequently in gasified water and in water bottled in glass containers compared to still water and water bottled in plastic containers. However, the public health significance of this remains little understood, especially for vulnerable individuals, such as infants and children, pregnant women, immuno-compromised individuals and the elderly. In regard to infants, as bottled water is not sterile, it should be disinfected - for example, by boiling for one minute - prior to its use in the preparation of infant formula.

There have also been reports of fraud in which ordinary tap water has been added to used mineral water bottles and sold as the original article. Consumers may not be able to detect this by taste alone and, if concern is warranted, should examine the closures of bottled waters carefully before purchase and insist on seeing bottles opened in their presence in restaurants and other food and beverage service establishments.

The potential health benefits of bottled drinking water

In European and certain other countries, many consumers believe that natural mineral waters have medicinal properties or offer other health benefits. Such waters are typically of high mineral content and, in some cases, significantly above the concentrations normally accepted in drinking-water. Such waters have a long tradition of use and are often accepted on the basis that they are considered foods rather than drinking-water per se. Although certain mineral waters may be useful in providing essential micro-nutrients, such as calcium, WHO is unaware of any convincing evidence to support the beneficial effects of consuming such mineral waters. As a consequence, WHO Guidelines for Drinking-water Quality do not make recommendations regarding minimum concentrations of essential compounds.

On the other hand, in some countries, bottled waters with very low mineral content, such as distilled or demineralised waters, may be offered for sale. While a large number of people have traditionally consumed rainwater which is similarly low in minerals without apparent adverse health effects, WHO has no scientific information on the benefits or hazards of regularly consuming these types of bottled waters.

International standards for bottled drinking water
The intergovernmental body for the development of internationally recognized standards for food is the Codex Alimentarius Commission (CAC). WHO, one of the co-sponsors of the CAC, has advocated the use of the Guidelines for Drinking-water Quality as the basis for derivation of standards for all bottled waters.

The CAC has developed a Codex Standard for Natural Mineral Waters and an associated code of practice. The Codex Standard describes the product and its labelling, compositional and quality factors, including limits for certain chemicals, hygiene, packaging and labelling. The Codex Code of Practice for Collecting, Processing and Marketing of Natural Mineral Waters provides guidance to the industry on a range of good manufacturing practices matters. While CAC standards and recommendations are not strictly mandatory, Codex health and safety requirements are recognized by the World Trade Organization as representing the international consensus for consumer protection and any deviation from Codex recommendations may require a scientifically-based justification.

This Commission is currently developing a draft of a Codex Standard for Bottled/Packaged Waters to cover drinking-water other than natural mineral waters. Under the existing Codex Standard and Code of Practice, natural mineral waters must conform to strict requirements concerning, for example, their direct collection and bottling without further treatment from a natural source, such as a spring or well. In comparison, the draft Codex Standard for Bottled/Packaged Waters has been proposed to include waters from other sources, in addition to springs and wells, and treatment to improve their safety and quality. The distinctions between these standards are especially relevant in regions where natural mineral waters have a long cultural history. Within the CAC, the Codex Committee for Natural Mineral Waters, which is hosted by Switzerland, is responsible for the development of draft Codex Standards and Codes of Practice in consultation with other relevant Codex Committees, notably the Codex Committees on Food Additives and Contaminants and Food Hygiene. Parties interested in participating in this work of Codex should contact the National Codex Contact Point in their country.

It should be noted that neither the CAC nor WHO offer certification of any bottled or mineral water products. In this regard, WHO does not permit its name or emblem to be used in connection with any commercial purposes. While many countries have national standards for bottled waters and some have national certification schemes, no universally accepted international certification scheme now exists. Persons seeking information on bottled water certification should approach the national authorities in the country concerned.

tHe PoWeR oF SmiLe...

Even a smile or a kind word is considered charity..


Giving charity is such an important part of Islam that even the Arabic word tasaddaqa (to give charity) comes from the root sadaqa meaning to speak the truth, to be sincere. Sadaqah (voluntary charity) is different from zakah, the compulsory alms that are collected every year.


A Muslim shows his sincerity of faith and attains piety by being generous:


[Ye will not attain unto piety until ye spend of that which ye love. And whatsoever ye spend, Allah is aware thereof.] (Aal `Imran 3:92)
There are dozens of verses in the Quran in which Allah (God) tells Muslims to give in charity. Sometimes this charity is in expiation for a wrongdoing, and other times it is an acknowledgment that everything one "owns" is in fact a trust from Allah, and that anything spent in the way of Allah will be paid back in full and multiplied on the Day of Judgment. In fact, the Quran in places calls this spending "a beautiful loan."


Muslims are enjoined to give charity without reproach to the recipient. It is also better for them to give secretly rather than openly, so that their intention is entirely to gain the pleasure of Allah and not to gain the admiration of people.


[A kind word with forgiveness is better than alms giving followed by injury. Allah is Absolute, Clement. O ye who believe! Render not vain your alms giving by reproach and injury, like him who spendeth his wealth only to be seen of men and believeth not in Allah and the Last Day….] (Al-Baqarah 2:263 – 264)


It is easy to give money as charity when one is wealthy, but the best charity is given when one fears poverty, for one must then sincerely trust in Allah's reward.


When the Prophet Muhammad was asked which charity is best, he replied,


"That you should give charity (in a state when you are) healthy, closefisted, haunted by the fear of poverty and hoping to become rich (charity in such a state of health and mind is the best). And you must not defer (charity to such a length) that you are about to die and would be saying: This is for so and so, and this is for so and so. Lo, it has already come into (the possession of so and so)." (Muslim)


Even the money that a person spends on his family counts as charity if his intention is for Allah. The Prophet (peace and blessings be upon him) said, "When a Muslim spends on his family seeking reward for it from Allah, it counts for him as charity." ( Muslim)


There is reward in good deeds done with no expectation of remuneration in this life


And a woman may give charity of her husband’s earnings. Aishah, the wife of the Prophet reported that he said,


"When a woman gives in charity some of the food in her house, without causing any damage, there is reward for her for whatever she has given, and a reward for her husband for what he earned. The same applies to the trustee. In no respect does the one diminish the reward of the other." (Muslim)


In fact, Prophet Muhammad told his followers that sadaqah (voluntary charity) is incumbent upon them every single day. But this sadaqah can take many forms:


"There is a (compulsory) sadaqah (charity) to be given for every joint of the human body (as a sign of gratitude to Allah) everyday the sun rises. To judge justly between two persons is regarded as sadaqah; and to help a man concerning his riding animal, by helping him to mount it or by lifting his luggage on to it, is also regarded as sadaqah; and (saying) a good word is also sadaqah; and every step taken on one's way to offer the compulsory prayer (in the mosque) is also sadaqah; and to remove a harmful thing from the way is also sadaqah." (Al-Bukhari)


Thus, even those who have little or no extra money can give charity. For them, there is still reward in good deeds done for the pleasure of Allah with no expectation of remuneration in this life. Elsewhere, the Prophet told even more ways that Muslims can give charity.


The Prophet said, "Giving charity is obligatory upon each Muslim." It was asked, "What do you say of him who does not find (the means) to do so?" He said, "Let him do manual work, thus doing benefit to himself and give charity." It was asked, "What about one who does not have (the means) to do so?" He said, "Then let him assist the needy, the aggrieved." It was asked, "What do you say of one who cannot even do this?" He said, "Then he should enjoin what is reputable or what is good." He asked, "What if he cannot do that?" He (the Prophet) said, "He should then abstain from evil, for verily that is charity on his behalf." (Muslim)


Muslims are also encouraged to establish an ongoing charity whose rewards they will continue to reap after their deaths. This can be knowledge that is passed on in a book or other form, fruit trees from which the poor may eat, or an endowment.


Thus sadaqah, in whatever form, should be a part of the Muslim's daily life. Such charity strengthens the Muslim’s piety, turns his intentions to his Creator, and spreads wealth and goodwill among the community.