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Mediating process		Health outcomes
	Direct
Exposure to thermal extremes		Altered rates of heat - and cold-related illness and death
Altered frequency and/or intensity of other extreme		Deaths, injuries, psychological disorders; damage to public health infrastructure
Temperature and weather changes
	Indirect
Disturbance of ecological system
Effects on range and activity of vectors and infectious parasites		Changes in geographic ranges incidence of vector-borne diseases
Altered local ecology of waterborne and foodborne infectious agents		Changed incidence of diarrhoeal and other infectious diseases
Altered food (especially crop) productivity, due to changes in climate, weather events, and associated pests and diseases		Malnutrition and hunger, and consequent impairment of child growth and development
Sea level rise, with population displacement and damage to infrastructure		Increased risk of infectious disease, psychological disorders
Levels and biological impacts of air pollution, including pollens and spores		Asthma and allergic disorders; other acute and chronic respiratory disorders and deaths
Social, economic and demographic dislocations due to effects on economy, infrastructure and resource supply		Wide range of public health consequences; mental health and nutritional impairment, infectious diseases, civil strife
Stratospheric ozone depletion		Skin cancers, cataracts and perhaps immune suppression; indirect impacts via impaired productivity and agricultural and acquatic systems

Major examples of global environmental change include: climate change, stratospheric ozone depletion, transboundary air and water pollution, acid precipitation, loss of biodiversity, desertification and deforestation. Human-induced climate change is due primarily to accumulation of GHGs in the atmosphere, resulting from activities such as combustion of fossil fuels, large-scale deforestation and the rapid expansion of irrigated agriculture. Both direct and indirect health impacts can be expected to occur as a result of climate change.

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