580 role in reducing a range of health impacts, including some vector-borne and other communicable diseases, and the effects of extreme events. One example is extension of vaccination coverage, although no suitable vaccines exist for some of the diseases most sensitive to climate change (e.g., dengue and schistosomiasis) or for many of the newly emerging infections. At the individual level, people should be encouraged to refrain from or to limit dangerous exposures (e.g.. by use of domestic cooling, protective clothing, mosquito nets). Such behavioral responses could complement any physiological adaptation that might occur spontaneously through acclimatization (to heat stress) or acquired immunity (to infectious diseases). In view of limitations to the forecasting of health impacts at this stage of our knowledge, an important and practical form of adaptation would be to improve large-scale monitoring and surveillance systems, especially for vulnerable populations and areas. Recently initiated efforts to observe and monitor aspects of the Earth's environment and ecosystems in relation to climate change now should incorporate health-related monitoring (Haines et al., 1993). Advances in climate forecasting and in the regional integration of ecological and health monitoring (including local vulnerability factors) will facilitate develop ment of early-warning systems. Finally, if health impacts of climate change are probable and serious, then the only effective long-term basis for mitigation lies in primary prevention at the societal level. This would require acceptance of the Precautionary Principle as the foundation of policy response. This, in turn, would suggest some fundamental, and therefore difficult, reorientations of social, economic, and political priorities. Meanwhile, care must be taken that alternative technologies do not introduce new health hazards. 18.6. Research Needs Development and validation of integrated mathematical models for the prediction of health impacts. Such models must draw on multiple scientific disciplines and should take maximal account of regional and local influences on the effects being modeled and on their interaction with other environmental stresses. Identification and analysis of current or recent settings in which the health impacts of local or regional climate changes (occurring for whatever reason) can be studied. The apparent recent changeable patterns of infectious diseases around the world may afford good opportunities for clarifying and quantifying the influences of climatic factors. Incorporation of health-related measurements in global, regional, and local monitoring activities. This Human Population Health risks, the evaluation of alternative indices for monitoring health (including the use of sensitive species as bioindicators), and the opportunity to detect and/or examine previously unsuspected or undocumented environment-health relationships. Some specific research needs include: Comparison of impacts of heat waves in urban and rural populations, to clarify the relative importance of thermal stress and air pollutants Examination of the interplay between climatic impacts on forests and other terrestrial ecosystems on the range and dynamics of vector-borne disease Study of factors influencing population vulnerability to climate change. 18.7. Concluding Remarks Forecasting the health impacts of global climate change entails unavoidable uncertainty and complexity. Human populations vary greatly in their vulnerability to climate changes and in their resources for protection and mitigation. Likewise, the responses of infectious disease vectors to changes in climate depend greatly on other concomitant environmental stresses and the adequacy of control measures and health care systems. Meanwhile, population health status continues to be influenced by a rich mix of cultural and socioeconomic factors. Hence, assessing the health impact of climate change requires a systems-based modeling approach that integrates information about climatic factors, other environmental stresses, ecological processes, and social-economic-political inputs and responses. Alongside the need for improved health impact assessment capability is a precautionary need to develop global, regional, and local monitoring systems for the early detection of climate-induced changes in human health. There have, indeed, been various recent events that, plausibly, might be early signals of such change. The increased heat-related deaths in India in 1995; the changes in geographic range of some vector-borne diseases; the coastal spread of cholera: Could these be early indications of shifts in population health risk in response to aspects of climate change? Of course, it is not possible to attribute particular, isolated events to a change in climate or weather pattern; other plausible explanations exist for each of them, and a number of different factors may combine to produce each event. However, it is important that we begin to assess patterns of change in the various indices of human health that will provide early insight and will assist further the development of predictive modeling. There is thus a clear need for enhanced research and monitoring activities. 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