Last year, the world emerged from the worst of the Covid-19 pandemic only to face a spate of weather disasters, and the hottest 12 months on record. The topic of climate change and health, their interrelated causes and solutions, has become more important than ever.
Health became a focus at the COP28 UN climate change conference in Dubai, where fossil fuels and energy targets largely took centre stage. The UAE presidency put the topic on the agenda with the first ever health-themed day at a COP, and first climate-health ministerial meeting.
In Dubai, 143 nations including China and 20 Latin American and Caribbean states, signed the Declaration on Climate and Health. According to a press release, the declaration aims to “place health at the heart of climate action” and is the first time governments have come together to acknowledge their responsibility to “protect communities and prepare healthcare systems to cope with climate-related health impacts such as extreme heat, air pollution and infectious diseases.”
A study published on the eve of COP28 found that the number of people who die prematurely every year from air pollution has risen to 8.3 million. It further found that 5 million of those deaths are tied to pollution from fossil fuel use, though the declaration does not mention fossil fuels.
Heat-related illness and deaths are also on the rise, with 189 million people exposed every year to extreme weather-related events, according to the COP press release.
What explains the sudden interest in health issues at COP28? And how might the introduction of climate-and-health-related objectives translate into action at the national level?
About time: Adapting the health sector to climate change
The attention given to health issues at COP28 reflects the importance attached to the topic following Covid-19, according to Wenjia Cai, director of Lancet Countdown Asia, and a professor in earth system science at Beijing’s Tsinghua University.
To address the nexus between climate change and health, the declaration focuses on enhancing the health sector’s capacity for adapting to climate change. Its stated objectives include: working with the most climate-vulnerable peoples to boost the roll out of adaptation policies; improving the capacity of health systems to respond to climate-sensitive diseases; attending to the effects of climate impacts on human wellbeing; and mitigating future pandemics by enhancing the detection of diseases that spill over to humans from other animals.
Also featured are the objectives of combatting inequalities among countries, eradicating poverty and famine, improving food nutrition and security, and enhancing climate adaptation in agriculture, housing, transport and energy.
While climate adaptation in healthcare is very important, burning fossil fuels is the main driver of climate changeYuan Yating, analyst at iGDP, a Beijing-based thinktank
As these goals show, health is intertwined with a great many other climate-related issues and encompasses many aspects of wellbeing. The impact of climate change on health – both direct and indirect – cannot be ignored, and the issue of adapting the health sector to a climate-changed world must be addressed.
The Sixth Assessment Report of the IPCC, the UN’s climate science body, indicates that climate change is having a serious impact on human health, with an additional 2.5 million deaths per year expected globally by 2100 as a result of it, Cai points out.
“The amount of investment in health-related research has grown significantly in recent years,” says Cai. “The US, for example, invested US$260 million into climate-and-health research in 2023, eight times more than in 2022, and the focus on climate and health from other major economies has also increased significantly.”
Financing: $2.7 billion promised for health
The question of financing goes to the heart of everything. On the same day the declaration was signed, the UK, Asian Development Bank and nine charitable foundations pledged $1 billion to tackle the climate–health crisis. On Health Day, the UAE, along with several philanthropies, announced $777 million for eradicating neglected tropical diseases. So, in just two days, combined financing commitments reached $1.777 billion.
The amount seemed to have risen further at a press conference given by the presidency on 4 December. Taking stock of the previous four days, COP28 President Sultan Al Jaber said that $2.7 billion had been committed to healthcare, though he did not specify where the additional $1 billion came from. (The COP28 press office has been approached for comment on this figure.)
Details are lacking on how those funds will be used to help healthcare systems tackle climate change, says Yuan Yating, assistant analyst at the Institute for Global Decarbonization Progress (iGDP), a Beijing-based thinktank.
“Countries’ ability to engage in climate adaptation and mitigation largely depends on their fiscal capacity,” she says. “But those that are most vulnerable to climate change – developing countries and small island states, for example – often have to rely on international fiscal support for action on climate. At present, only 2% of climate adaptation funding and 0.5% of multilateral climate funding is available to be spent on health.”
Yuan adds: “That money can still make a big difference if used for energy efficiency and carbon reduction in developing countries’ healthcare systems. While climate adaptation in healthcare is very important, burning fossil fuels is the main driver of climate change.
Bringing health into national climate plans
Significantly, the declaration sets out that signee nations will “[take] health into account, as appropriate, in designing the next round of nationally determined contributions (NDCs)”.
NDCs are the climate action plans that every UN member state must submit every five years, with the next instalments being due in 2025. How will nations incorporate health issues into their NDCs? For Wenjia Cai, three elements are involved: principle, action and objective-setting.
Firstly, says Cai, the core purpose of tackling climate change is to protect life and health, and this should be written into NDCs as the “guiding principle”.
Then comes action, Cai explains: “If three projects for action on climate are backed with similar levels of investment, but one delivers greater health benefits, then that one can get higher priority.”
Finally, objective-setting, meaning that health impacts are taken into account when setting targets for emissions reduction. “If incorporating public health impacts into emissions reduction targets reveals that keeping temperature rise within 2C is not a bold enough ambition, then efforts should focus on 1.5C instead,” Cai adds.
Reducing emissions from the health sector
In addition to adaptation, the declaration also targets mitigation, that is, the reduction of carbon emissions from healthcare itself.
The sector is estimated to be responsible for about 5% of global greenhouse gas emissions, and at current rates of growth, these emissions could triple by 2050. They come from three sources: directly from healthcare facilities (including ambulances); from electricity generation to power such facilities; and indirect emissions from supply chains, including from producing and transporting medicine, food and hospital equipment. These indirect emissions account for the bulk (71%) of healthcare emissions.
The declaration proposes: “Promoting steps to curb emissions and reduce waste … such as by assessing the greenhouse gas emissions of health systems, and developing action plans, nationally determined decarbonisation targets, and procurement standards for national health systems, including supply chains.”
There are existing blueprints that signatories can look to. In 2021, the international NGO Health Care Without Harm (HCWH) published its Global Road Map for Health Care Decarbonisation. That set out three core pathways for reducing emissions from healthcare systems globally: decarbonising infrastructure and service operations; decarbonising supply chains in the sector; and decarbonising the wider social and economic environment.
“Planning and implementing projects in line with the three pathways described in the HCWH roadmap will help healthcare globally to significantly reduce its greenhouse gas emissions,” says Yuan Yating. If the pathways are followed, “cumulative emissions reduction in the sector between 2014 and 2050 could reach 44.8 billion tonnes of CO2 [equivalent],” she adds.
More attention needed on health
At the declaration’s unveiling, the director-general of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus, reiterated that the link between climate and health has been badly neglected: “The climate crisis is a health crisis, but for too long, health has been a footnote in climate discussions.”
From the number and type of activities on the COP28 agenda, climate and health issues would appear to have been paid unprecedented attention at a COP. But it received comparatively limited coverage in COP-related reporting on international mainstream media websites.
Wenjia Cai also believes that the topic does not receive enough public attention. Referring to data from the Lancet Countdown’s China report on health and climate change, Cai says: “In the mainstream media that we track on [Chinese social media platform] Weibo, climate change features in an average of 1,400-plus posts per year, with health issues referenced in only 8.5% of those posts. In the official print media, provincially, health issues come up only 6% of the time in the context of climate change. It’s a fairly low proportion.”
In China, Cai believes that there needs to be more investment in climate and health research. Only two such projects are currently part of China’s National Key Research and Development Program, and “the investment may be less than 30 million yuan [US$4.223 million] per project”.
Last year, the Lancet Countdown also published a South America-focused report on health and climate, detailing the severe impacts being felt by people across the continent due to increasing environmental changes. Describing its findings on health trends and responses to them as “grim and of genuine concern”, its researchers delivered a clear message: “Trust the science. Now that we know, we must act.”