Correspondence

Relieved somewhat of the heavy burden of staff wages and expenditure on medicines, we have been able to use money provided by the church to develop infrastructure such as buildings, beds, and equipment so that our hospitals, while still very modest, are able to offer a good service. I read this Series together with the excellent Lancet Commission Report on Global Surgery and Anaesthesia.1 We have seen progress in many areas but the calamitous state of surgical and anaesthetic care has until now been largely overlooked. It is good that this may be changing and in view of these articles on faith-based health care it will be important to ensure that such facilities are taken into account as we seek solutions. Surgical and anaesthetic care is integral to many of these units, providing an essential source of safe and accessible care of reasonable quality for many people. I declare no competing interests.

David McAdam [email protected] Chitokoloki Mission Hospital, Chitokoloki, Northwestern Province, Zambia 1

Meara JG, Leather JM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386: 569–624.

Climate change and health The report of the 2015 Lancet Commission on Health and Climate Change 1 is timely and welcome, particularly because of the emphasis on the health benefits of transition to sustainable ways of living. However, there is little in the report on the potential role of indigenous and local knowledge in both adaptation and mitigation responses for human health. This lack of attention is not confined to the health sector, and has been observed in other societal sectors that are the target of adaptation and mitigation efforts.2 430

Indigenous and local knowledge is the understanding, innovations, and practices of indigenous and local communities that have developed from experiences gained over the centuries and adapted to the local culture and environment.3 Many of the effects of climate change will be felt by communities in developing countries and indigenous communities on the margins of society. In these contexts, indigenous and local knowledge can certainly be used to provide benefits for human health. For example, in Pacific Island countries, agricultural practices based on indigenous and local knowledge, including crop diversification and food preservation, have been used as a strategy to ensure food security and enhance nutrition under climate change and variability.4 In north African countries, architectural designs based on indigenous and local knowledge have been used to adapt to heat stress and to conserve energy in urban settlements,5 and in Canadian Inuit communities, indigenous and local knowledge has been used to read changing weather and snow patterns, and thereby moderate climate-related health risks from hunting practices.6 There is a pressing need for further attention to the role of indigenous and local knowledge in climate change responses. We declare no competing interests.

*Natasha Kuruppu, Anthony Capon [email protected] International Institute for Global Health, United Nations University, 56000 Cheras, Federal Territory of Kuala Lumpur, Malaysia 1

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Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386: 1861–914. Kuruppu N, Willie R. Barriers to reducing climate-enhanced disaster risks in small islands through anticipatory adaptation. Weather Clim Extremes 2015; 7: 72–83. Convention on Biological Diversity. What is traditional knowledge? https://www.cbd.int/ traditional/intro.shtml (accessed July 1, 2015). Fletcher SM, Thiessen J, Gero A, Rumsey M, Kuruppu N, Willetts J. Traditional coping strategies and disaster response: examples from the south Pacific region. J Environ Public Health 2013; 2013: 1–9.

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Kamal A. The morphology of traditional architecture of Jeddah: climatic design and environmental sustainability. GBER 2014; 9: 4–26. Ford J, Cunsolo Willox A, Chatwood S, et al. Adapting to the effects of climate change on Inuit health. Am J Public Health 2014; 104: E9–17.

The Lancet Commission on Health and Climate 1 strongly urged the health sector to tackle climate change, especially from a mitigation perspective, which is a step forward from the traditional focus on health sector adaptation. We laud the authors’ portrayal of climate change not just as the “biggest global health threat”,2 but also the “greatest global health opportunity”, terms that resound with both a sense of urgency and optimism, qualities that are the hallmark of global health. While we welcome this surge of optimism, we also bring to attention some features of the report that must be approached with caution. First, the summary lacks adequate emphasis on the critical role of developed countries in mitigation. Instead, the “2200 coal-fired plants currently proposed”, were emphasised, which may be interpreted as disproportionate blame on developing countries. Many of these coal projects receive funding from governments of developed countries.3 If we are to ensure that no additional coal plants are constructed in developed or developing countries, a solid call for coal divestment should have been recommended by the Commission. Norway’s recent divestment shows how actions in developed countries can paralyse the further spread of coal use in the developing world.4 Second, the report gives an impression of developed countries, with available technology for better energy access and mitigation of climate change, as suppliers of solutions to developing countries. The report even recognises that “the bulk of technology transfer occurs between developed countries… [and] this does nothing to overcome the low availability of mitigation technologies in developing www.thelancet.com Vol 387 January 30, 2016

Climate change and health.

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