Climate Change, Human Health, and Sustainable Development
The medical model understands the body as a machine, emphasizes treating specific diseases, does not accommodate mental or social problems and, therefore, de-emphasizes prevention. This has led to measuring health by its absence, by disease, or death rates (Stokes et al. 1982).
The holistic model is exemplified by the World Health Organization as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO 1946).
Holistic health is a system of preventive care that takes into account the whole individual, one’s own responsibility for one’s well-being, and the total influences – social, psychological, environmental – that affect health, including nutrition, exercise, and mental relaxation (Heritage 1995).
The holistic model expanded the medical perspective as well as introduced the idea of positive health. The WHO definition was long considered unmeasurable; the terms were vague. Measuring “well-being” required subjective assessments that contrasted sharply with the objective indicators favored by the medical model.
The wellness model was developed through the WHO Health Promotion Initiative, which proposed moving away from viewing health as a state, toward a dynamic model that presented it as a process or force (WHO 1984).
The idea of health was amplified in the Ottawa Charter to “the extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities” (WHO 1986).
Health is also measured in terms of resilience, “the capabilities of individuals, families, groups and communities to cope successfully in the face of significant adversity or risk” (Vingilis and Sarkella 1997). Applied to population health, the definition might include elements such as the success with which the population adapts to change such as shifting economic realities or natural disasters.
An ecological definition of health is: “A state in which humans and other living creatures with which they interact can coexist indefinitely” (Last 1995).
Human health is also defined by the impacts of climate change on health. Because of increased temperatures and more frequent and intense extreme weather events, the number of direct injuries and deaths will increase, along with infectious diseases, whether food, water, or vector-borne; respiratory and cardiovascular diseases are expected to rise due to worsened air pollution and extreme heat (Louis and Phalkey 2016).
The severe drought is associated with harm to human health. “With Earth observations indicating increasing variability in precipitation patterns around the globe, the need to understand the health effects of drought is as great as the need to understand the health effects of flooding and extreme precipitation” (Balbus 2017).
The climate change will increase the numbers of individuals exposed to extreme events and, therefore, to subsequent psychological problems such as worry, anxiety, depression, distress, loss, grief, trauma, and even suicide. It can also lead to mental health risks if they provoke migration, whether people are forcibly displaced, resettled, or choose to leave. Participating in group-based ventures that emphasize identity, citizenship, and the augmenting of social capital can change behavioral norms around mental health and climate change (Berry et al. 2018).
Pollutants like ozone and small particulates cause and exacerbate a range of health conditions, including heart disease, stroke, respiratory infections, lung cancer, and more. The progression of climate change is expected to increase the number of deaths and hospitalizations caused by air pollution (Ospina 2018).
The vector-borne disease outbreaks can increase around the world. A recent report noted that climate change would likely amplify the transmission of dengue, especially in Latin America (CDC 2016). In addition to taking climate mitigation measures, it will also be necessary to take adaptation measures, such as strengthening health systems, improving preparedness, and developing early warning systems (Louis and Phalkey 2016).
The goal of improving health in a context of climate change presents a potential paradox: on the one hand, efforts need to be made to mitigate climate change, but, at the same time, there is a clear need to encourage development in lower and middle income countries in order to reduce poverty and to improve health. The two objectives can be achieved, but, as emphasized by the Lancet Commission, the opportunities that they are offer are tempered by very serious challenges, and difficult decisions will need to be made at a political level (Watts et al. 2015; Louis and Phalkey 2016).
The relationship between human beings and the environment throughout time has been crucial to establish the impact of disease on society.
When we look at the domestication of animals at the dawn of humanity, we see that the close contact between the two exposes people to a variety of diseases. Many human diseases are related or derived from animal diseases. Smallpox is very similar to cowpox, tuberculosis and diphtheria are originally from cattle, and there are also other diseases we share with cats and dogs (Ponting 1995).
Deforestation is another example of how human actions impact human health: for example, it creates new environments for mosquitos that carry malaria.
The growth of societies also exposes people to a new range of infectious diseases, given the greater population concentration. Diseases like dysentery and cholera are related to a lack or deficiency of sanitation systems or to contaminated water. Poor water quality and irregular waste disposal are responsible for diseases such as leptospirosis, diarrheal diseases, hemorrhagic dengue fever, hepatitis, and others. Air pollution is responsible for respiratory diseases and allergies, the predatory occupation of hills is the cause of landslides, deforestation, and the cutdown of riparian forests causes the sedimentation of bodies of water, etc.
Therefore, the health of human beings does not relate only to the opposition of currently not having any diagnosed disease. The state of natural elements is considered when assessing whether these elements are healthy and whether their use will produce health or disease in the future.
Evidently, the relationship between health and the environment cannot be considered exclusively in the biomedical perspective, although it is extremely relevant.
Consequently, according to Labonte (1996), health problems may fit into three categories: biomedical, based on disease and actions to treat symptoms and eradicate the disease; disease prevention, based on the promotion of healthy behaviors to prevent disease; and the creation of physical and social environments that promote the health and the well-being of individuals based on policies that seek social change through the development of healthy public policies.
Social Determinants of Health
All around the world, poverty and poor living conditions remain one of the most important causes of disease. Although mortality rates by infectious diseases have dropped, the number of diseases related to lifestyles and diet changes increased. Chronic malnutrition or hunger makes people much more vulnerable to infection. One example is child mortality rates. They keep dropping but not uniformly throughout all social classes (PNUD 2007).
Six million kids die each year before the age of 5 because of extreme poverty, which expresses the vulnerability of the poorer strata of the population (UNICEF 2015).
Such deficiencies in human development bring attention to the profound inequalities we’ve been witnessing around the world. Since 2015, the 1% richest in the world held more wealth than the rest of the planet (BCS 2016).
Therefore, social inclusion and exclusion can be understood as determining in the health-disease process and produces a significant impact on social equity.
With the decrease of mortality by infectious diseases, chronic noncommunicable diseases (CNCD) are currently the most important cause of death in the world, having caused 38 million deaths in 2012, more than 40% of which premature and avoidable, affecting people younger than 70. Approximately 80% of CNCD deaths take place in middle- to low-income countries, most related to the circulatory system, cancer, diabetes, or chronic diseases of the respiratory system (WHO 2014).
CNCDs have to do with complex, multivariable factors, and significantly change the quality of life of affected people, producing subjective and objective changes expressed by biological and behavioral changes. The most important risks of CNCDs are related to unbalanced diets, sedentarism, smoking, and psycho-emotional disorders (Ribeiro et al. 2012).
Although these factors are centered around the individual, strategies to tackle CNCDs must include both interventions to promote behavioral changes and individual changes and population-based interventions related to living and work conditions and education.
Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death.
Within countries, there are dramatic differences in health that are closely linked with degrees of social disadvantage. Differences of this magnitude, within and between countries, simply should never happen (WHO 2008).
The social determinants of health (SDH) are the “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life which include economic policies and systems, systems shaping the conditions of daily life which include economic policies and systems, development agendas, social norms, social policies and political systems” (WHO 2017).
The idea that health is produced socially implies recognizing that health determinants are mediated by social systems and influenced by the excluding social relations that operate these systems.
Environmental Determinants of Health
The current economic system – in which the environment is conquered because not only of survival but also of the pursuit of profit and capital accumulation to maximize the power of the most important economic and political agents – aggravates and accelerates ecological imbalances, stimulates excessive growth, wastefulness, and the production of items that are not necessary to improve the quality of life and which are inaccessible to the majority of the population, thus, expanding social inequality.
The increase in production and the supply of material goods marks the environment with soil and air contamination, the amount and quality of water, etc., which demonstrates that the health risks of this model transcend the realm of production and affects not only workers but also the population in general.
Navarro et al. (2002) highlighted that environmental change, demographic increase, and the mobility allowed by international means of transportation and trade have been promoting the adaptation and the change of pathogens, which further dilutes the traditional separation between north and south and brings closer the epidemiological profile of developed and developing countries, the negative side of the so-called globalization.
Geography researches have been contributing greatly with studies on patterns of spatial and temporal distribution of health and disease conditions in each given population. The mapping of health and disease conditions has been an important tool to understand the spatial distribution, the incidence and prevalence of disease in a given territory, and the establishment of possible correlations with known or suspected factors that could be causing that distribution (Ribeiro 2005).
The first studies of medical geography were concerned, above all, with the global distribution of the most important diseases. It was observed that climate is a determining factor in the distribution of diseases, especially those communicated by vectors that depend on adequate conditions for survival and reproduction. Other studies show that socioeconomic disparities, the access to health services, and the quality of the environment also influence the health of specific populations and that, at the local level, there is a greater influence of environmental contamination on health (Ribeiro 2005; Newton and Bower 2005).
Therefore, the health of individuals is also associated with what humanity creates and does, to social interactions, to the policies adopted by the government, including healthcare mechanisms, the teaching of medicine, nursing, to education, and to environmental interventions.
Having a new perspective on health and disease also means being sure that we as a species need to be responsible to the planet, that is, survival is our central concern.
The critique to the consumer society, wastefulness, and to the limits of production started a discussion in the field of Economics that included the areas of Science and Ethics, as well as the Social Sciences and the debate on spirituality and political action.
In this context, nonanthropocentric ethical-legal preservationist models emerge.
(a) Biocentrism understands humans as part of nature and does not admit aggressions of any kind to life in any of its forms (Lanza and Berman 2010); (b) For Ecocentrism or holism biodiversity has value on itself, moving beyond the idea of ecology as a science, through deep evaluations of ecological awareness, questioning the capacity of the current society to fulfill basic human needs such as love, safety, and the access to nature (Devall and Sessions 1985; Naess 1986; Warwick 1986); and (c) Gaianism affirms that life and the global environment are part of the same self-regulating system (Lovelock 1998).
Thus, the perception of this fundamental unity of life – according to which humans are neither “separate from a reality that’s been reduced to an object,” nor “the measure of all things” – points to the essential elements of “deep ecology,” which highlight values such as simplicity, self-sustained development, and nonviolence, and has been the most popular nonanthropocentric model among environmentalists (Santana 2002).
In this perspective, sustainable development consists in the possible and desirable conciliation between development, environmental preservation, and an improvement in the quality of life.
Climate Change and Health
There is abundant evidence showing that human activities are changing the climate and that climate change will produce significant impacts on health, both nationally and globally.
Climate change and health issues move beyond national borders, and impacts on health and climate change in some countries most probably will affect the health of other countries. “The influences of weather and climate on human health are significant and varied. Exposure to health hazards related to climate change affects different people and different communities to different degrees” (USGCRP 2016).
Some changes in the global environment affect human health cumulatively, such as the disposal of chemical pollutants in the water and soil, which bioaccumulate, and the destruction of multiple natural habitats, as well as the extinction of species, which reduce genetic resources and destroy natural landscapes (Confalonieri et al. 2002).
Other processes are also systemically important, such as the state of the climate and the ozone layer, which represent global risk factors for human health. Moreover, environmental degradation processes, such as the use of pesticides, produce a long-distance effect due to ocean and air currents (Confalonieri et al. 2002).
Human health may be harmed in the following ways: problems with reproduction and a decrease in the population of the species; changes in the immune system; behavioral anomalies; unusual thyroid function and other hormonal changes; tumors and cancer; male feminization and female masculinization; and congenital malformations (Confalonieri et al. 2002).
Besides the direct effects of global changes in health, there are indirect effects, which are often hard to quantify because the ecological mechanisms and social processes involved are complex (Confalonieri et al. 2002). For instance, multiple factors influence the dynamics of vector-borne diseases, as well as environmental factors (vegetation, climate, hydrology); socio-demographic factors (migrations and population density); biological factors (the life cycles of insects that are vectors for infectious agents); and medical-social factors (the immunological conditions of the population; the effectiveness of local health systems, etc.), which may potentialize their effects on human health (OPAS 2008).
Hunger, draught, extreme climate events, and regional conflicts – all probable consequences of climate change – are a few factors increasing the incidence and severity of diseases, as well as contributing to other adverse impacts on health. Therefore, it is imperative to address climate change as to the local, regional, national, and global decision-making process.
Climate can also affect the quality of water and food in specific areas, with implications in human health. Moreover, the effects of global climate change on mental health and well-being are part of the general impact of climate on human health.
Therefore, in order to promote health, we must identify the determinants of the health-disease process and act on them. Since they have to do with people’s living conditions, these determinants are extremely significant especially at the local level, where the daily lives of individuals take place (Buss and Ferreira 2002).
Vulnerability, Impact, and Adaptation to Climate Change
Scientific studies from the most different areas warn us against various types of global problems: global warming, the hole in the ozone layer, water pollution, desertification, and the reduction in the amount of potable water, for instance. Biologists, chemists, forest engineers, and agronomists have been showing how important these issues are scientifically. Nations realized that the preservation of the species depends on environmental preservation. Even those who believe that new technologies could provide solutions to the environmental crisis ponder their costs, especially in developing countries (Penna 1999; Barnett et al. 2001).
The environmental consequences of climate change – both the observed and the foreseen, such as sea level rise, changes in precipitation causing floods and droughts, heat waves, hurricanes, more intense storms, and worsened air quality – will directly and indirectly affect health.
One useful approach for us to better understand how climate change affects health is considering specific exposure pathways and how they can lead to human diseases. Exposure pathways differ throughout time and space, and climate change exposure affects different people in different communities at different levels. Threats related to climate change can also accumulate throughout time, leading to long-term changes in the resilience of health.
The fact that someone is or is not exposed to health threats or sick or suffer with other adverse consequences of this exposure to health depends on a complex set of vulnerability factors. Vulnerability is understood as the aspects of a given population, system or set of assets that makes them more or less susceptive to the negative impacts of a threat. Such aspects or factors may be physical, demographic, socioeconomic, cultural, environmental, and institutional, depending on the approach used (Setti et al. 2015).
Exposure is the contact of an individual with one or more biological, psychosocial, chemical, or physical stressors, including stressors affected by climate change. Contact can occur once or repeatedly throughout time, or only at one site or in a broader geographical area.
Sensibility is the degree to which people or communities are affected by climate variability or change.
The adaptative capacity is the capacity of communities, institutions, or people to adjust to potential risks, and resilience is their capacity to prepare, plan, absorb, recover, and adapt more successfully to adverse events.
Vulnerability operates in various levels, from the individual to the community, and affects all people in some degree. For individuals, these factors include behavioral choices and the degree to which this person is vulnerable based on their level of exposure, sensibility, and adaptative capacity. Moreover, vulnerability is also influenced by the social determinants of health (USGCRP 2016).
In communities or the society as a whole, health results are strongly influenced by adaptative capacity factors, including those related to natural and human environments, governance, management, and social organization (USGCRP 2016).
Certain health-adverse effects can be avoided if decisions result from the identification of vulnerable populations and the assurance of the access to preventive measures.
Asthma, respiratory allergies, and airway diseases
Cardiovascular disease and stroke
Food-borne diseases and nutrition
Heat-related morbidity and mortality
Human developmental effects
Mental health and stress-related disorders
Neurological diseases and disorders
Vector-borne and zoonotic diseases
Weather-related morbidity and mortality (IWGCCH 2010)
Climate change can, therefore, affect human health in two main ways: first, changing the severity or the frequency of health problems that are already affected by climate factors and second, generating unprecedented or unforeseen health problems or health threats where they did not happen before.
The areas that are already suffering with health-threatening climate events – such as heat waves or hurricanes – will probably suffer further, with even higher temperatures and increased rainfall and storms. Other areas will be introduced to new climate-related health threats, such as areas that were not affected by the proliferation of toxic algae or by water-borne diseases. These areas may face risks in the future because higher water temperatures allow the proliferation of health-threatening microorganisms (USGCRP 2016).
Intersectoral Policies for Sustainable Development and Health Promotion: Strategies Toward Improving the Quality of Life
The World Commission on Environment and Development (UN 1987) established sustainability as a new paradigm for development, that is, “that which satisfies the needs of current generations without compromising the capacity of future generations to satisfy their own needs.”
What they are seeking is a form of development that is environmentally sustainable in the access and use of natural resources and the preservation of biodiversity; socially sustainable as to the reduction of poverty and social inequalities and a promoter of justice and equity; culturally sustainable in the conservation of the system of values, practices, and symbols of identity which, despite its constant evolution and change, determine national integration throughout time; politically sustainable as to strengthening democracy and assuring the access and the participation of all in public decisions.
The approach to these ideas allows the assertion that the health and environment sectors are interrelated, that is, they address cross-cutting issues whose amplitude extrapolates specific areas and, therefore, should be permanently encompassed by all areas.
According to the output document of the 3rd International Conference on Health Promotion, which took place in Sundsvall, Switzerland (1991), environment and health are interdependent and inseparable, and should be priorities to development and be given precedence in the everyday management of government policies (WHO 1991).
The UN Declaration on Human Environment, signed in Stockholm (1972), highlighted that “man has the fundamental right to freedom, equality and adequate conditions of life, in an environment of a quality that permits a life of dignity and well-being…” Similarly, with a focus on quality of life, the First International Conference on Health Promotion, carried out in Ottawa (1986), established that “Good health is a major resource for social, economic and personal development and an important dimension of the quality of life,” an understanding that was later confirmed in other conferences (WHO 1986).
Human quality of life depends on the quality of the environment, which also drives balanced, sustainable forms of growth. However, quality of life is also linked to unprecedented forms of identity, cooperation, solidarity, and participation, as well as different forms of accomplishment – through work, creativity, recreation, etc. (Leff 2004).
Social participation and the involvement of local communities are crucial for the effectiveness of public policies.
Sustainable development must be based on people and their communities to conserve biodiversity and natural processes that maintain life, as well as on good planning and impact management.
The idea of ecodevelopment discussed by Sachs (2007) suggested a new style of development and a new (participatory) focus for planning and management strategies, guided by an interdependent set of ethical premises: meeting basic human needs, promoting the self-confidence of populations involved, and cultivating ecological prudence.
In terms of policy, participation refers to the goal of including as many social groups as possible in decision-making processes. The participation of more social groups increases the likelihood that civil society will deem government policy legitimate. However, certain participating groups have more power than others and may dominate policy-making processes to promote their own ends in ways that undermine social goals (Murphy 2012).
Decision-making processes need to incorporate mechanisms that require planning to meaningfully reflect the needs of future generations. Accordingly, policy approaches should be examined to assess the extent to which views and preferences of weaker groups, including future generations, are reflected in ultimate decisions (Murphy 2012).
Participation is a right and duty of all the people in society who value a positive coexistence based on the principles of freedom, morality, solidarity, and justice. Participation is an achievement, an endless process that is always being carried out. It assumes commitment, involvement, presence in actions, and an open dialogue with stakeholders, as well as the consideration of their contributions and potentials (Demo 1988).
The training of individuals and communities to take greater control over the factors that affect their lives, transferring the power over health from the professional domain and a biomedical paradigm to a social model (South 2014), is fundamental for the implementation of intersectoral policies to meet the SDGs.
Intersectorality is an integrate solution for problems that cannot be addressed through sectoral – usually fragmented – policies.
It is a holistic perspective, represented by the idea of transdisciplinary awareness. Everything is interdependent and phenomena can only be truly comprehended by observing the context in which they occur (Capra 2004).
Therefore, for this holistic perspective, the world is an integrated whole, a network of interconnected phenomena, a self-organized organism (Capra 2004), and health is understood as a large system, a multidimensional phenomenon that affect physical, mental, social, and spiritual aspects which are constantly affected by interdependent biogenetic, environmental, socioeconomic, political, and cultural factors.
Intersectoral actions assumes openness to dialogue and negotiation toward the convergence of interest, such as the shared planning and evaluation between sectors. Intersectoral approaches must assure an active dialogue between forms of knowledge and practices.
More than access to high-quality medical/healthcare services, we need to address the entirety of the social determinants of health, which requires healthy public policies, actual intersectoral articulation of the public sphere, and popular mobilization.
Health promotion and quality of life are ideas can be brought together through healthy public policies that operationalize such interaction. Healthy public policies demand intersectoral action (Buss 2000), and the Sustainable Development Goals (SDGs) have been materializing this into a new social institution.
The goal of this agenda is to improve and protect the quality of life of the population based on a new development paradigm, based on changes not only in life styles, but also in the organization of the society and in governance for sustainable development, changes that would allow humanity to maintain a constant level of natural capital, that is, to keep the supply of raw materials for the human economy and the absorption of waste by ecosystems unaltered, while promoting social justice and inclusiveness.
Climate change has been a subject of serious international negotiations with a trend of broadening participation in those deliberations, but, for the most part, it continues to be led by environment departments and constituencies. Much of the reason the environment departments took such a predominant position in all matters relating to climate change – including mitigation and adaptation – is rooted in the establishment of the Intergovernmental Panel on Climate Change (IPCC) (Drexhage 2008).
In political and institutional terms, global governance means advancing intersectoral practices and promoting the relationship with the society. Criteria for preserving environmental health must increasingly be included in the decision-making process and in public policies that affect health.
More democratic, participatory, inclusive, and efficient forms of government that place social, economic, environmental, and health equity at the center of its results
Implementation of wealth distribution and social protection policies
Better fiscal policies that incentivize sustainable policies and actions at different sectors for different social agents
Greater energy efficiency in the use of natural resources, making use of adequate technological innovations
Mitigation of greenhouse gas emissions to tackle climate change
Profound changes in global trade, making it substantially fairer, establishing specific protections for the most fragile nations
Assuring universal food and nutrition safety
Assuring equitable access to water and sanitation services
Creating decent jobs and labor, etc.
As argued throughout the entry, human and environmental health are intimately linked. The complexity of problems that affect and determine the health of the population is a challenge for public health, given that health is not just biological (the absence of disease) but includes social, cultural, environmental, and economic aspects, as well as life styles.
Similarly, the environment does not include only natural aspects but also technological, social, economic, political, historic, cultural, technical, moral, ethical, and aesthetic ones. Moreover, several other factors determine the level of social vulnerability, including biological susceptibility, socioeconomic status, cultural competency, and constructed environment.
Therefore, implementing intersectoral policies that promote health and the environment is strategic and fundamental to reduce inequalities and promote sustainable development.
The development of partnerships between different sectors, the increase in participatory processes, and the implementation of multisectoral actions are strategies that should be adopted by political leaders, local organizations, and citizens committed to meeting the SDGs and with the continuous and progressive improvement of health conditions and the quality of life of the population, forming and strengthening a social pact between local authorities, community organizations, and public and private institutions.
While the SDGs propose an ample agenda of promotion of equity and sustainable development in the territories, in order for these changes to take place, the synergy between actors and structures of the government and the civil society will be necessary, not isolated or opposite actions. Collaboration must take place through dialogue and the development of a joint project. To do that, promoting the exercise of political participation and the governance of democratic societies – in which health and the environment are political priorities, expressed through the implementation of healthy public policies – is essential.
- Balbus J (2017) Understanding drought’s impacts on human health. Lancet Planet Health 1(1). https://ac.els-cdn.com/S2542519617300086/1-s2.0-S2542519617300086-main.pdf?_tid=afda262d-42bf-4c5e-96b5-be4cdfe35bdf&acdnat=1542381820_25aca1916261542ac749ec4d715e2a6c
- Banco Credit Suisse – BCS (2016) Global Wealth Databook 2016. http://publications.credit-suisse.com/tasks/render/file/index.cfm?fileid=AD6F2B43-B17B-345E-E20A1A254A3E24A5
- Barnett TP, Pierce DW, Schnur R (2001) Detection of anthropogenic climate change in the world’s oceans. Science. https://doi.org/10.1126/science.1058304
- Berry HL, Waite TD, Dear KBG, Capon AG, Murray V (2018) The case for systems thinking about climate change and mental health. https://www.researchgate.net/publication/324146598_The_case_for_systems_thinking_about_climate_change_and_mental_health
- Buss PM (2000) Promoção da saúde e qualidade de vida. Cien Saude Colet. https://doi.org/10.1590/S1413-81232000000100014
- Buss PM, Ferreira JR (2002) O que o Desenvolvimento Local tem a ver com a promoção da saúde? In: Zancan L, Bodstein R, Marcondes WB. Promoção da saúde como caminho para o desenvolvimento local: a experiência de Manguinhos-RJ. Rio de Janeiro. Abrasco/FiocruzGoogle Scholar
- Capra F (2004) A teia da vida, 9a edn. Cultrix, São PauloGoogle Scholar
- CDC – Centers for Disease Control and Prevention (2016) Climate change and extreme heat. What you can do to prepare? CDC, Atlanta. https://www.cdc.gov/climateandhealth/pubs/extreme-heat-guidebook.pdfGoogle Scholar
- Confalonieri UEC, Chame M, Najar A, Chaves SAM, Krug T, Nobre C, Miguez JDG, Cortesão J, Hacon S (2002) Mudanças Globais e Desenvolvimento: Importância para a Saúde. Informe Epidemiol do SUS 11(3):139–154. http://scielo.iec.gov.br/pdf/iesus/v11n3/v11n3a04.pdfGoogle Scholar
- Demo P (1988) Participação é conquista. Cortez, São PauloGoogle Scholar
- Devall B, Sessions G (1985) Deep ecology: living as if nature mattered. Gibbs M. Smith, Inc./Peregrine Smith Books, Salt Lake CityGoogle Scholar
- Heritage S (1995) The American Heritage medical dictionary. Houghton Mifflin Co., Boston. ISBN-13: 978-0618428991Google Scholar
- IPCC (2014) Climate Change 2014: impacts, adaptation, and vulnerability. Part A: global and sectoral aspects. Contribution of working group II to the fifth assessment report of the intergovernmental panel on climate change. Cambridge University Press, Cambridge/New York, p 1132. http://www.ipcc.ch/report/ar5/wg2/Google Scholar
- IWGCCH – Interagency Working Group on Climate Change and Health (2010) A human health perspective on climate change. A report outlining the research needs on the human health effects of climate change. Environmental Health Perspectives and the National Institute of Environmental Health Sciences, Triangle Park. ISSN 0091-6765. https://data.globalchange.gov/assets/be/e7/e8af30e920e7a4c27c173af785a6/climatereport2010.pdfGoogle Scholar
- Labonte R (1996) Estrategias para la promoción de la salud em La comunidad. In: Organización Panamericana de la Salud (ed) Promoción de la salud: una antologia. OPS, Washington, DCGoogle Scholar
- Lanza RP, Berman B (2010) Biocentrism: how life and consciousness are the keys to understanding the true nature of the universe. BenBella Books, DallasGoogle Scholar
- Last JM (1995) Dictionary of epidemiology, 3rd edn. Oxford University Press, New York. ISBN-13: 978-0195141696Google Scholar
- Leff E (2004) Saber ambiental: sustentabilidade, racionalidade, complexidade, poder, 3a edn. Vozes, PetrópolisGoogle Scholar
- Louis VR, Phalkey RK (2016) Health impacts in a changing climate – an overview. Eur Phys J. https://doi.org/10.1140/epjst/e2016-60073-9
- Lovelock JE (1998) A Terra como um organismo vivo. In: Wilson EO (ed) Biodiversidade. Ed. Nova Fronteira, Rio de JaneiroGoogle Scholar
- Naess A (1986) The deep ecology movement: some philosophical aspects. Philos Inq. https://doi.org/10.5840/philinquiry198681/22
- Navarro MBM, Filgueiras ALL, Coelho H, Asensi MD, Lemos E, Sidoni M, Soares MSC, Oliveira TA (2002) Doenças Emergentes e Reemergentes, Saúde e Ambiente. In: Minayo MCS, Miranda AC (eds) Saúde e ambiente sustentável: estreitando nós. Fiocruz, Rio de JaneiroGoogle Scholar
- OPAS/OMS (2008) Mudanças climáticas e ambientais e seus efeitos na saúde: cenários e incertezas para o Brasil. Disponível em, Brasilia. http://bvsms.saude.gov.br/bvs/publicacoes/mudancas_climaticas_ambientais_efeitos.pdfGoogle Scholar
- Ospina C (2018) Beyond Environmental Change: How Climate Change Affects Public Health. Climate Institute. Available in: http://climate.org/beyond-environmental-change-how-climate-change-affects-public-health/
- Penna CG (1999) O estado do planeta: Sociedade de consumo e degradação ambiental. Record, Rio de JaneiroGoogle Scholar
- PNUD (2007) Relatório de Desenvolvimento Humano 2007/2008. Combater as alterações climáticas: Solidariedade humana num mundo dividido. Programa das Nações Unidas para o Desenvolvimento, New York. http://hdr.undp.org/sites/default/files/hdr2007-8-portuguese.pdfGoogle Scholar
- Ponting C (1995) Uma história verde do mundo. Civilização Brasileira, Rio de JaneiroGoogle Scholar
- Ribeiro H (2005) Geografia da saúde e doença aplicada à poluição do ar em São Paulo. In: Ribeiro H (org.). Olhares Geográficos: Meio Ambiente e Saúde. São Paulo: Senac São PauloGoogle Scholar
- Ribeiro GA, Cotta RMM, Ribeiro SMR (2012) A Promoção da Saúde e a Prevenção Integrada dos Fatores de Risco para Doenças Cardiovasculares. Cien Saude Colet. https://doi.org/10.1590/S1413-81232012000100002
- Sachs I (2007) Rumo à ecossocioeconomia. Teoria e prática do desenvolvimento. Cortez, São PauloGoogle Scholar
- Santana HJ (2002) Os crimes contra a fauna e a filosofia jurídica ambiental. In: Anais do 6° Congresso Internacional de Direito Ambiental. São PauloGoogle Scholar
- Setti AFF, Ribeiro H, Gallo E, Alves F, Azeiteiro UM (2015) Climate change and health: governance mechanisms in traditional communities of Mosaico Bocaina/Brazil. In: Leal Filho W, Azeiteiro UM, Alves F (eds) Climate change and health: improving resilience and reducing risks, 1st edn. Springer, Berlin. https://doi.org/10.1007/978-3-319-24660-4_19CrossRefGoogle Scholar
- South J (2014) Health promotion by communities and in communities: current issues for research and practice. Scand J Public Health. https://doi.org/10.1177/1403494814545341
- Stokes J, Noren J, Shindell S (1982) Definition of terms and concepts applicable to clinical preventive medicine. J Community Health. https://doi.org/10.1007/BF01324395
- UN (1987) Report of the World Commission on Environment and Development. Our Common Future. Available in: https://ambiente.files.wordpress.com/2011/03/brundtland-report-our-common-future.pdf
- UNICEF (2015) Progress for children: beyond averages – learning from the MDGs. ISBN 978-92-806-4806-5Google Scholar
- USGCRP (2016) The impacts of climate change on human health in the United States: a scientific assessment. In: Crimmins A, Balbus J, Gamble JL, Beard CB, Bell JE, Dodgen D, Eisen RJ, Fann N, Hawkins MD, Herring SC, Jantarasami L, Mills DM, Saha S, Sarofim MC, Trtanj J, Ziska L (eds). U.S. Global Change Research Program, Washington, DC, p 312. https://doi.org/10.7930/J0R49NQX
- Warwick F (1986) Approaching deep ecology: a response to Richard Sylvan’s critique of deep ecology. Centre for Environmental Studies, University of Tasmania, HobartGoogle Scholar
- Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, Chaytor S, Colbourn T, Collins M, Cooper A, Cox PM, Depledge J, Drummond P, Ekins P, Galaz V, Grace D, Graham H, Grubb M, Haines A, Hamilton I, Hunter A, Jiang X, Li M, Kelman I, Liang L, Lott M, Lowe R, Luo Y, Mace G, Maslin M, Nilsson M, Oreszczyn T, Pye S, Quinn T, Svensdotter M, Venevsky S, Warner K, Xu B, Yang J, Yin Y, Yu C, Zhang Q, Gong P, Montgomery H, Costello A (2015) Health and climate change: policy responses to protect public health. Lancet. https://doi.org/10.1016/S0140-6736(15)60854-6
- WHO (1946) Constitution of the World Health Organization. http://www.who.int/about/mission/en/
- WHO (1986) The Ottawa Charter for health promotion, Ottawa. http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
- WHO (1991) Sundsvall statement on supportive environments for health. In: Third international conference on health promotion, SundsvallGoogle Scholar
- WHO (2008) Closing the gap in a generation. Health equity through action on the social determinants of health. WHO Press, World Health Organization, GenevaGoogle Scholar
- WHO (2014) Global status report on noncommunicable diseases. Attaining the nine global noncommunicable diseases targets; a shared responsibility. World Health Organization, Geneva. ISBN 978 92 4 156485 4Google Scholar
- WHO (2017) Social determinants of health. http://www.who.int/social_determinants/en/