From social reform to social transformation : human ecological systems and adaptation to a more hostile climate.

Improving public health frequently involves bringing about societal change. Increasingly large-scale and complex problems such as climate change pose significant threats to human health and impel re-conceptualisation of environment–human interrelationships, affording them the complexity they deserve and the opportunity to think ‘ecologically’. Large-scale problems often trigger a large-scale response, but these attempted solutions may be slow to materialise, a poor fit to the local context, unsustainable and are often poorly evaluated. There is also a place for locally relevant community-managed activities, aimed not only at reducing adverse health impacts caused by the very large problem of climate change but also by improving other determinants of environmental health and poverty. One such potential case, in Ethiopia, is described.