[Worldwide changes in the environment and public health]

In recent years, there is a growing awareness that, as a result of human activities, large-scale environmental changes are occurring with resultant risks for human health. The most important of these are changes in climate and other aspects of the atmosphere, in land use and soil erosion, in the use and contamination of fresh water, and in biodiversity. The usual estimates of the health-related effects of environmental problems in The Netherlands ignore the current effects of global environmental changes outside the borders of The Netherlands, as well as the possible future effects of these changes in The Netherlands. It would be irresponsible to allow ourselves to be put at ease by these estimates. Health-care institutions are co-responsible for an adequate response to global environmental changes, not only because health care as such also contributes to environmental damage but also because medical and health-related research can help to further our understanding of the nature of these health risks and the possible countermeasures.