anada is the second largest land mass in the world, making research on human health and global environmental change particularly relevant here. However there is no comprehensive approach to health aspects of global change in Canada.

The Health Issues Panel of the Canadian Global Change Program examined the implications of global change for human health. The aims were to identify and prioritize research themes in the health sciences related to global change, provide guidance for research funding and provide input to the policy sector on health implications of global change.

We discuss managing risks, the role of human values and ethics in shaping our views of the world and the public health role in sustainable development. Sustainable development involves establishing an economic structure that consumes only as much as the natural environment produces and emits only as much as the natural environment can absorb. It can be accomplished through reduced consumption, reduced economic development, recycling and reuse. This will require a restructuring of society. The adverse impacts on health of global change are, indeed, so serious that we must make these changes in society.

We developed a framework for health-related global change research in Canada. The framework consists of four categories, three based on threats to human health from different types of global change and a fourth recognizing the importance of human behavioral responses to global change. The first three categories are: threats to human health from industrial and agricultural pollution; from changes in the global environment; and from current and future patterns of population growth and levels of consumption. The fourth category is health-related human behavioral responses to global change.

The Panel surveyed leading health researchers and policy makers in Canada in order to identify priorities for health-related global change research. Two questionnaires were circulated to approximately two hundred institutions and individuals, the first seeking opinions on priorities for research and the second on barriers to implementation of interdisciplinary programs in global change. The results are discussed in the report and reflected in the recommendations.

We found wide agreement on the nature and importance of health problems caused by global change. Much of the research expertise is already available in Canada. It is hoped that the Research Councils will recognize the high priority of global change research related to human health and encourage research proposals in this area. We would also like to see the establishment of at least one national centre of excellence dedicated to health-related global change research.

A Canadian program in health-related aspects of global change should give priority to relevant Canadian features. We identified areas in which Canada could play a leading role internationally. Areas for improvement were also identified, including the need for development of longitudinal data bases, and the development of links and interdisciplinary thinking between the social sciences, natural sciences and health sciences.

The Health Issues Panel, recommends that:

1. Efforts should be undertaken to ensure that all members of the biomedical science community and all practicing health professionals in clinical and public health practice are made aware of the importance of health issues associated with global environmental changes and of the actions needed to minimize the impact of global change.
2. Governments in Canada and other developed countries should allocate a proportion of their health budgets to knowledge development and transfer for the prevention of diseases and health promotion, especially aspects related to global change.
3. Canada should take a lead role in facilitating the development and conduct of a long term international cooperative health research program related to global change.
4. Canada should develop model structures that can be used as prototypes for the conduct of multidisciplinary long term research related to global change.
5. The Canadian health research community should communicate to decision-makers the importance of global change issues to the future health of Canadians and the world.
6. Canada should foster communication between health researchers on global health issues in Canada and internationally.
7. Canada should establish surveillance systems to assess trends in population exposures and disease risks related to global change.
8. A National Centre of Excellence for multidisciplinary studies of the health impacts of global change, ways to ameliorate the adverse effects of global change, and ways to minimize the adverse affects of unavoidable global change should be established by the Research Councils, in collaboration with Federal and Provincial governments.

   In addition we recommend specific research priorities in each of the four categories of the framework on threats to health arising from:

9. Industrial/agricultural pollution: Priorities include improved disease surveillance systems and risk assessment of the effects of global air pollution on susceptible groups; research into the role of chronic exposure to toxic contaminants in drinking water; and methods of providing more effective waste management and water treatment.
10. Changes in the global environment: Priorities include research into the use of scientific information in political decision making; agricultural research on heat and drought resistant crops, pest control and food storage under adverse conditions; surveillance systems to monitor ground-level ultraviolet radiation, atmospheric ozone levels and skin cancer and cataract incidence rates; and epidemiologic research to assess the efficacy of sunscreens and other preventive regimens against skin cancer.
11. Consumption patterns: Highest priority should be for research on contraception for men and women as well as making existing contraceptions widely available. Other priorities are research on groundwater conservation and on the relation between human health and biodiversity.
12. Human behavioral responses to global change: Priorities should include broadly based research on human values and the environment, research into methods of mitigating the social dislocation of severe global change and research on health education and independence for women.

    Further recommendations address the issues of public health policy and action.

13. Public health action should include advisory messages about sun exposure, standard-setting and advice on protective clothing and health education directed at behaviour change.
14. There is an important advocacy role for health workers in advising national leaders to take action to limit the burden of greenhouse gases.
15. Public health should play an active role in health promotion, disease prevention and health care of migrant populations.
16. As violent weather disturbances are more and more recognized as a feature of global change, mass movement of refugees from environmental disasters may occur. Disaster preparedness is an important part of planning for global change.
17. The development of national food and nutrition policies in keeping with sustainable development and with the ability to respond to major disruptions that are likely to be associated with global change requires input from public health at the policy level.