The health impacts of global climate change will depend not only on the biological consequences of this change but also on the overall vulnerability of societies and populations. In high-income countries, which are more likely to be located on the temperature-sensitive edge of disease-transmission, public health measures are sufficiently effective to prevent diseases like malaria from reemerging even when rising temperatures support the survival of vectors. In contrast, in many low-income countries in tropical climates, already in the midst of transmission zones, public health infrastructures are often much weaker, and the increasing vogue for cutting back on government expenditure means this is unlikely to change soon. How these countries cope with the relationship between climate change and disease transmission, therefore, may be more dependent on long-standing challenges for the public health system than on climate change per se.Moreover, as poor countries face the consequences climate change, they are likely to have to deal with multiple catastrophes simultaneously: shortfalls in agricultural production, destruction of infrastructure during storms and flooding, ecosystems collapsing, mass migration and refugees, and so on.
Countries will have to figure out which problems to prioritize. General investments in preventive public health, already on the chopping block today, are unlikely to rank as high priorities, compared to efforts to deal with the more visible and acute crises that climate change may provoke, such as storm recovery and breakdowns in civil order.
An added wrinkle in this analysis is the fact that many of the organizations charged with providing the vital services that offer societal resiliency to climate change -- such as water delivery, health care, education, mass communications, etc -- are no longer being run by the state, but are de facto or de jure being outsourced, either to for-profit companies or to nonprofits. This decentralization of delivery over vital services, while celebrated for its ability to deliver efficiency gains, will also greatly increase coordination and control challenges in the face of acute climate-change-related crises. Having excess or "surge" capacity may not be economically efficient, but it is often a requirement for effectiveness in the face of crisis.
And there's every reason to believe that the crises will in fact be severe, and nonlinear, as the same paragraph goes on to explain:
There continues to be a debate on the relative vulnerability of populations, with the UN reporting that lower-income countries would be worst hit by the predicted rises in global temperatures during the next century. Others argue that population responses to ecological changes are usually non-linear, leading to a sudden deterioration or improvement in infection control once a threshold is crossed.