The story so far: On December 3, the global health landscape is expected to reach a turning point. For the first time in 28 years of climate change negotiations, the climate-health nexus will take centre stage at the United Nations Conference of Parties (COP28) summit in UAE. The ‘groundbreaking Health Day at COP28’, as President-Designate Dr. Sultan Al Jaber put it, is expected to pose two questions: how public health can become resilient to climate change, and who will finance this transformation.
Growing evidence has highlighted the profound ways in which climate crises erode socioeconomic and environmental conditions. Unabated greenhouse gas emissions are triggering extreme weather events, air pollution, food insecurity, water scarcity and population displacement — which, in turn, alter the trajectory of vector-borne diseases and endanger public health infrastructures. And this chain of climate-related health events is not unfolding evenly around the world: Africa, Asia, South and Central America, and small island developing states, which have contributed the least to climate change, are bearing the brunt. In India, particulate air pollution is said to be the ‘greatest threat to human health’, and heat-related deaths may kill an additional 10 lakh people annually by 2090, according to data from the Lancet Countdown and the Climate Vulnerable Forum. If countries fail to meet emission targets set under the Paris Agreement, climate change-related events will cause at least 34 lakh deaths per year, by the end of this century. Addressing these issues, on December 2, 123 governments endorsed the COP28 Declaration on Climate and Health.
“A designated Health Day is a good start... a critical moment to make sure that health is recognised as the human face of climate change.”Dr. Githinji Gitahi, Amref Health Africa CEO
What does it mean to have a ‘Health Day’ at COP28?
In September, Dr. Al Jaber spoke in the backdrop of the New York Climate Week: “The connection between health and climate change is evident, yet it has not been a specific focus of the COP process — until now. This must change.”
Health is not a stranger to climate change talks. The United Nations Framework Convention on Climate Change (UNFCCC) recognises the health impacts of climate change; the 2016 Paris Agreement acknowledged the right to health; last year’s COP27 mentioned the human right to a clean, healthy and sustainable environment in its cover decision. “Health events have been held at COP for several years, including at the WHO Health Pavillion, but this is the first time there has been an official ‘Health Day’,” says Jess Beagley, policy lead at the Global Climate and Health Alliance (GCHA).
The designated Health Day, on December 3, is dedicated to discussing the “Health, Relief, Recovery and Peace”, as per the COP28 website. The entire day of health programming will also include the first-ever Health Inter-ministerial meeting, with ministers of health, environment, finance and other types of ministries joining in. At least 80 Health Ministries globally, top officials from the World Health Organization (including Director-General Tedros Adhanom Ghebreyesus) and about 500 practitioners, researchers, NGOs and representatives from the healthcare industry are expected to join in.
However, a “Health Day in itself doesn’t necessarily mean that health will be reflected in the negotiations,” said Dr. Jeni Miller, executive director of GCHA, at a pre-COP28 press briefing. Health may be part of the thematic programming but it is not explicitly integrated in the negotiation process as yet. “One of the things we need to see to determine whether this is truly a ‘Health COP’ is whether the focus on health carries on to negotiations,” she says. This doesn’t mean that health has to be mentioned in each negotiating streams, but leaders should be making decisions for health.
A lot is riding on COP28. Parties are expected to deliver the first-ever Global Stocktake, a comprehensive assessment of the progress made towards climate targets set by the Paris Agreement. The targets require signatories to restrict the rise in average worldwide temperatures to below 2·0°C, and to no more than 1 ·5°C, in comparison with pre-industrial levels. If health is included in the Global Stocktake, it would make health a key metric, and “ensure one of the ways we measure our progress on climate action is through assessing how we’re doing on public health”, Dr. Jeni said.
What is up for discussion?
The Climate and Health Declaration of COP28 is expected to include dialogue on mitigating emissions (where a fossil fuel phase-out will be challenged), health sector adaptation to climate change, mainstreaming of health into climate policies and the contentious question of climate financing for health.
The Declaration, however, doesn’t mention fossil fuels. It recognises the need for climate mitigation, “strengthening research on the linkages between environmental and climatic factors and antimicrobial resistance”; and “intensifying efforts for the early detection of zoonotic spill-overs” to prevent future pandemics. It does not mention pollution-related harms or identify ‘fossil fuels’ — coal, oil and gas — as a driver of health threats, or emphasise the need to end fossil fuel dependence. Fossil fuels are seen as the largest contributor to global climate change: they account for over 75% of global greenhouse gas emissions and nearly 90% of carbon dioxide emissions. Ms. Beagley adds, “Many governments seek to profit from the continued extraction and combustion of fossil fuels, despite the undeniable health harms.” Fossil fuels are not only the leading driver of the climate crisis, but fossil fuel extraction, transport, processing and combustion also harm local communities through air, water and soil pollution. Earlier this month, in a letter addressed to Dr. Al Jaber, more than 46 million health professionals called on countries to “commit to an accelerated, just and equitable phase-out of fossil fuels as the decisive path to health for all.”Read the full letter here.
“Health at the mercy of fossil fuels”, stated the subtitle of the 2022 report of The Lancet Countdown on Health and Climate Change. Anthony Costello, Professor of Global Health and Sustainable Development at University College London, said, “We are in a really dangerous situation in terms of climate change and the health consequences are enormous. It is imperative that we cut emissions, but most of the focus is still on adaptation.” To him, Dr. Al Jaber, who is the CEO of UAE’s state-run Abu Dhabi National Oil Company (ADNOC), presented a “colossal conflict of interest”. Take the Leviathan gas field, off the coast of Israel. ADNOC in partnership with BP bought up to 50% stake in the Israeli firm NewMed, which owns a 45% stake in Leviathan. A report found that projects like Leviathan, a designated “carbon bomb”, are expected to “significantly threaten the Paris Agreement climate targets”. [Leaked documents accessed by The Guardian also showed that the UAE planned to promote oil and gas deals during the climate talks.]
“Adaptation is essential, but we cannot adapt our way out of the crisis,” said British epidemiologist Sir Andy Haines at the press briefing, adding that a commitment to phasing out fossil fuels and transitioning to renewable energy would be an important health outcome. “We need to cut emissions very rapidly...If we move from fossil fuels to renewable energy, for instance, we reduce preventable deaths of air pollution as well as reduce the risk of dangerous climate change.”
The health sector itself needs to adapt too: the global carbon footprint of healthcare amounts to about 4-5% of total global emissions.“We need to decarbonise the health system itself. About 60% of those emissions are embedded in the supply chain,” said Sir Haines. Health talks are expected to focus on the health sector’s move towards net zero health supply chains.
“A fossil fuel phase-out is the only way to ensure good health and limit global warming, in addition to saving hundreds of billions of dollars in health care costs associated with air pollution every year, while reducing economic losses from extreme weather events with damages worth US$253 billion.”
Most G20 countries — including wealthy industrialised nations responsible for the majority of historic greenhouse gas emissions — have failed to centre health in their climate action, as per a 2023 analysis by the Global Climate and Health Alliance. Low- and middle-income countries like Burundi and Congo were found to be better at engaging with health concerns in their NDCs and meeting their health targets. “This is likely to reflect the undeniable links between health and environment - and disease and climate change - which cannot be ignored in these countries whose populations are enduring the most severe health impacts of climate change,” Ms. Beagley explained. Changing weather patterns and rising temperatures are altering the life cycle of vector-borne diseases; dengue and malaria, which disproportionately impact poorer, marginalised groups, are expanding their reach in tropical regions like India and South Africa, emerging research shows. India’s double burden of communicable and non-communicable diseases could also worsen with climate change.
Conversely, the scorecard found countries that integrated health into their climate policies saw visible “health gains”. Ms. Beagly explained the positive effects trickled beyond the healthcare sector also: sanitation structures ensure safe water supply, sustainable food systems promote healthy diets, active transport systems enable physical activity, and the phase-out of fossil fuels clears the air. Experts, including Amref Health Africa CEO Dr. Githinji Gitahi, emphasised that health has to be woven across streams at the COP negotiations -- which includes discussions on clean water, clean air, healthy foods, and sustainable cities. A ‘successful’ Declaration would require countries to include in their NDCs specific health targets and indicators (such as individual countries’ vulnerability assessments) needed to mitigate and adapt to health risks.
Source: Global Climate and Health Alliance
Finding the money
Then there is the matter of finance. Health crises triggered by to warming climate are expected to chart a financial toll of around $2-4 billion annually by 2030. Another estimate shows that 40% of climate-related poverty would be due to direct health impacts, as people’s income, productivity and health costs would soar. Dr. Al Jaber had previously called on private financial institutions, including development banks, to plug this need and “contribute generously” to the Green Climate Fund. On December 2, the Green Climate Fund, the Asian Development Bank, the Global Fund and Rockefeller Foundation pledged a new $1 billion finance pledge for climate and health. “This $1 billion sum is a tremendous addition to current levels of climate and health finance,” said Ms. Beagley. “It is also key that funding for climate and health be truly new and additional, and not pulled from other key areas...that are vital to protecting health, such as water and sanitation, food security, and humanitarian action.”
Climate adaptation, however, is inadequately funded: out of the adaptation funds disbursed by the Green Climate Fund, only about 10% of climate funds are relevant to human health, said Sir Haines. These sparsely cover “the kind of things we need — to build resilient health systems, supply chains for vaccines, drugs, medical equipment, an early warning system for extreme events and disease outbreaks for dengue and malaria.”
A fiscal route towards resilient health systems, built with the aid of private capital, rakes up the debate on climate financing. Climate finance, and the Loss and Damage fund in particular, has been a bone of contention in climate negotiations since it was principally agreed to in last year’s COP. Developed countries like the U.S., U.K. and Australia have so far rejected references to the common but differentiated responsibilities (CBDR) and climate reparations principles specified in the UNFCCC. Moreover, a recent report found that the developed nations bloc has failed to meet the annual $100 billion climate finance goal, with LMICs being forced to resort to high-interest loans (such as the one Dr. Al Jaber recommends for health systems) that add to their debt burden. Developing countries are thus calling for grant-based international public finance to help navigate a storm, strengthened in part due to wealthy nations’ emissions.
However, the present Declaration endorses climate-health funding from “domestic budgets, multilateral development banks, multilateral climate funds...”, along with philanthropies and private sector actors.
This year’s COP28 in Dubai is likely to see the controversial conversation about climate reparations likely to take center stage. | Photo Credit: AP
Ms. Beagley notes that developed countries share a responsibility not only to rapidly reduce their emissions but also to provide financial support in developing countries where health impacts fall heavily. We need “new and additional finance sourced from public sources to ensure funds are not diverted away from other climate, health and development priorities.”
“Adequate climate finance is a key determinant of health. Unless nations have the resources for the climate crisis, health will suffer.”Jess Beagley, Global Climate and Health Alliance
The legacy of the first Health COP
What counts as a ‘successful’ COP28? “Stakes are really high — we need to see that progress on one of the root causes of climate change... [we] will be looking at [a fossil fuel phase-out] as one of the metrics of whether this has been a ‘Health COP’ or not,” said Dr. Miller.
Other metrics include a just transition to renewable energy, commitment to reducing emissions, and grant-based climate financing. Health has to be weaved in and considered as a cross-cutting theme - how adaptation in other sectors strengthens and makes possible equitable healthcare. “Health is an ongoing conversation,” said Dr. Miller. “It is not just this year, one Health Day, and we’re done. We want to see health as an ongoing component... in the negotiations and in the decision making.”
Dr. Gitahi noted there may not be a conclusive negotiated outcome because health is not on the official agenda for COP28. While the Presidency has committed to including some language on health in the speech and the Declaration, it is unclear if health impacts will translate into negotiations and decision-making. At the same time, experts note it is not critical that health be explicitly mentioned in the negotiation outcomes for the outcomes to be positive for health. If a commitment to fossil fuel phase-out was made, it would be a positive outcome, whether or not public health finds mention.
Put differently, health has a seat at the COP28 table, but it remains to be seen whether it gets to chime in, or direct the path of future climate action.
- On December 3, the global health landscape is expected to reach a turning point. For the first time in 28 years of climate change negotiations, the climate-health nexus will take centre stage at the United Nations Conference of Parties (COP28) summit in UAE.
- The Climate and Health Declaration of COP28 is expected to include dialogue on mitigating emissions (where a fossil fuel phase-out will be challenged), health sector adaptation to climate change, mainstreaming of health into climate policies and the contentious question of climate financing for health.
- Health crises triggered by to warming climate are expected to chart a financial toll of around $2-4 billion annually by 2030. Another estimate shows that 40% of climate-related poverty would be due to direct health impacts, as people’s income, productivity and health costs would soar.
