Can Greater Health Focus at Glasgow Climate Conference Motivate Tougher Action on Global Warming?
Countries will have a full agenda at the upcoming climate conference in Glasgow, facing pressure to take drastic action before the ravages of global warming become irreversible.

This year’s 26th UN Climate Change Conference of the Parties (COP26), will be a critical moment of decision on climate policies, as the clock runs down before the more severe ravages of global warming become irreversible.

Against the panoply of issues under debate, health is getting more attention from this year’s COP26 organisers as a potentially powerful motivating factor for action – although it remains to be seen if that can also translate into more concrete climate commitments from countries. 

“The COP26 presidency has for the first time ever in the history of climate negotiations put a special emphasis on health – and developed a dedicated Climate Health Programme specifically for COP,” Marina Maiero, a Technical Officer in Partnership and Advocacy as part of WHO’s Climate Change and Health team, told Health Policy Watch.  

“Health and the health sector will be more powerfully represented at this COP than ever before,” adds Josh Karliner, International Strategic Director of the global NGO Health Care Without Harm – which promotes greening the healthcare sector.

“While health has never been, and may never be, at the center of the climate negotiations, per se, due to the very technical nature of these talks, protecting people’s health from climate change is increasingly central to the climate conversation in and around the COP,” said Karliner in an interview with Health Policy Watch

“In the lead up to COP 26, COVID-19 has heightened awareness of the intimate connections between climate change and health for climate negotiators and health policy makers alike. Indeed, the UK COP Presidency has made health a scientific priority,” he said.

‘Belated recognition’ – but still not a central theme  

Health advocates have long maintained that placing human health at the heart of climate negotiations is critical to mobilising the political will required to meet the 2015 Paris Agreement target of keeping global warming under 1.5°C.

Even so, the health and climate nexus still remains on the sidelines of the formal  conference proceedings – with nary a mention on the COP26 programme to date.  

That reflects the long road yet ahead to convince most countries to take up health-related climate commitments, says Sir Andrew Haines, professor of environmental change and public health at the London School of Hygiene and Tropical Medicine. 

“There is a belated recognition of the importance of health in the climate change agenda – although it’s not one of the official themes,” Haines told Health Policy Watch

“The UK Government is becoming more interested, although its main focus is on decarbonisation of the health care sector, building on the NHS Commitment to achieve net zero emissions by 2040 for direct and 2045 for indirect emissions,” he points out. 

Though the UK government, which serves as the incoming president of the COP, has a number of initiatives focused on health, health does not yet have a strong role in the negotiations,” Dr Jeni Miller, Executive Director of the Global Climate and Health Alliance, told Health Policy Watch.

Already in November 2020, just before the Glasgow COP26 conference was postponed due to the COVID pandemic, the UK Government produced a series of key messages, case studies and essays on climate change and health – drawing on contributions from WHO, Wellcome Trust, LSTHM, and the Global Climate and Health Alliance (GCHA).   

Health and climate change COP26 campaign aims of the UK COP26 Presidency.

Promoting Health & Climate Nexus  

In fact, environmental health experts in WHO, academia and the NGO world, have spent years promoting the health and climate nexus as integral to the climate narrative. 

The fruits of those efforts are evident in the recent Intergovernmental Panel on Climate Change (IPCC) report, which refer in more detail than ever to the impacts of climate change on human health and well-being. See related story:

Climate Scientists Issue ‘Red Alert’ for Humanity – and Health 

The findings of the report are a “big red neon sign” alerting those in the traditional “climate camp” that health is becoming a more salient climate issue, says Dr Kim Knowlton and Dr Vijay Limaye, of the Natural Resources Defense Council (NRDC).  

“Hopefully there will be a lot of energy around climate-health adaptation, given the findings of the Working Group I report that’s just come out,” they told Health Policy Watch

“It finds that many climate impacts are already ‘locked in’ and that makes adaptation – finding ways to limit the health-harming effects of climate change that are already occurring and hammering frontline communities – even more critical,” said Knowlton and Limaye. 

The authors of the IPCC report project an increase in extreme heat exposure, heavy rainfall, drought, fire weather, and warming oceans.

Strong country responses to climate & health threats still lacking 

Cycling in Fortaleza, Brazil – the city strengthened its active transport plans as part of a WHO co-sponsored Healthy Cities Partnership. Cycling also reduces carbon emissions from transport.

However, so far, responses fall far short of the mark in most countries –  which continue to develop and subsidize polluting fossil fuel-based energy sources that create air pollution as well as climate emissions, and build unhealthy cities that lack access to green spaces, healthy mobility, housing, and foods. 

“There are major gaps in considering the health effects of climate change and health in adaptation policies or the co-benefits of GHG mitigation [in countries’ NDCs],” said Haines.  

He points to a recent analysis of the Nationally Determined Commitments (NDCs) of 40 nations – that looked at how governments’ national climate commitments recognise and respond to the linkages between climate change and health.

The “climate and health scorecards” point to gaps in all three policy domains: assessing the health effects of climate change; integrating plans for more climate resilient health systems into climate adaptation strategies, and choosing climate mitigation strategies that also optimise “health co-benefits.” 

Such co-benefits are huge, ranging from healthier plant-based diets to shifting urban transport systems to walking and cycling to stimulate physical activity, reduce climate emissions and air pollution – which kills over 7 million people a year

In the 15 countries with the highest greenhouse gas emissions, the health impacts of air pollution alone are estimated to cost over 4% of GDP. And yet most countries have yet to recognise in their NDCs how the health gains from investments in clean energy will reduce air pollution deaths.  

Health care services – 4.4% climate footprint, pollution & waste 

Essential health care procedures generate huge amounts of disposable waste.  Portrayed here are preparations for COVID vaccine administration in Argentina.

Along with that, there is enormous pollution and waste produced by health care services as such – from plastic disposables to energy intensive building operations.  All of that leaves a climate footprint – responsible for some 4.4 % of global climate emissions. And yet Argentina is the only country so far to explicitly include health care emissions reductions in its revised 2021 NDC strategy. 

“We can conclude that national governments’ understanding of climate change as a threat to health is quite limited but probably greater amongst low-income nations,” said Haines.

“Some countries have shown some progress [on achieving their climate targets] and some have integrated health, which is positive news,” agrees Maiero. “But it’s not enough.”

At the broader level, even the most updated commitments made so far by countries are insufficient “to really have global action that will allow the world to keep global temperature rises below 1.5 degrees Celsius”, WHO and other experts point out.

“The overall concern is that none of [the NDCs] are ambitious enough,” Maiero observed. 

The projected changes in extremes are larger in frequency and intensity with every additional increment of global warming, finds the IPCC Working Group I report.

Climate change leading to more & more deaths 

Against the political indifference, however, a growing body of evidence has sharpened our appreciation of how climate change is directly increasing mortality – from factors like extreme heat and extreme weather – not to mention more indirect issues like food insecurity.  

“Recent findings [show] that between 1991-2018, over a third of global heat-related deaths could be attributed to climate change,” said Knowlton and Limaye. “The [IPCC] report [demonstrates that] avoiding half a degree Celsius (0.9°F) of average warming could mean avoiding those deaths – that is, we could see far fewer heat-related health harms globally, plus fewer illnesses and deaths from more severe wildfires, hurricanes, floods, and other climate change-fueled extremes.”

“That’s a safer, healthier world that we need to fight for and demand from our global leaders,” said Knowlton and Limaye. 

“It’s also a world in which people, families, businesses and governments are less burdened by healthcare-related expenses tied to hospital care and emergency room treatment of health problems triggered by these climate-fueled hazards,” they said. 

Hopes from COP26 – health more prominent in NDCs and carbon markets 

The 26th UN Climate Change Conference of the Parties, will be a critical moment of decision on climate policies.

This year, once more, WHO will be asking UN member states at COP to include explicit references to health and equity in their NDC climate commitments – in line with WHO’s guidelines for a green and healthy recovery from COVID-19

“Our straightforward hope is that…everything negotiators and policy makers will do, they will do it in the name of health, because they recognise that taking action on the climate means improving the wellbeing and health of their population,” said Maiero.  

“We want to make sure that going forward, health and equity are the guiding compass of the Paris regime,” she adds. “We want to convey the clear message that health benefits from climate action…[and] investing in climate will improve health and actually compensate [countries].”  

COP26 also is a key moment to finalise the Paris Rulebook, the guidelines for  implementation of the Paris Agreement. Clear guidance to countries regarding the strengthening of national climate plans, and their implementation, will help transform the landmark agreement into a functioning system. 

And health needs to be central to the discussions surrounding the Rulebook – to ensure that rules governing carbon prices and markets yield co-benefits to health, and not more harmful impacts.  

Climate commitments also lack mechanisms for monitoring, tracking – and most of all – funding 

Another key area of concern  is the current lack of monitoring and tracking of countries’ NDC commitments, once they are made. 

At present, NDCs are largely a “wish list” of countries’ planned climate actions, however, there is no mechanism to enforce implementation, or even to monitor progress, Maiero and others say.  

“My personal concern is how we are really going to monitor data,” said another member of WHO’s climate team. “There is no system in place that can force the country to implement [its NDC].”

The climate system is also falling behind in terms of financing climate action in developing countries. 

“It’s great to have these plans and commitments to potentially do something, but we have noticed that…there is a massive gap for developed countries to commit finance and there’s a massive gap for developing countries to receive it,” say the WHO sources. 

Gaps in climate finance need to be filled to enable low- and middle-income countries to take vital action to both reduce and adapt to climate change – in line with their NDC/ climate commitments. 

Low- and middle-income countries heavily depend on climate finance to achieve their climate plans. 

This massive discrepancy is “extremely worrying for WHO, knowing that even though a lot of vulnerable countries now have these climate plans in place, there are no funds for them to actually achieve these plans,” said a member of WHO’s climate team. 

Donors and rich industrialised countries committed to raise at least US$100 billion in climate finance annually at the COP15 in Copenhagen more than 10 years ago. 

In 2018, an estimated US$78.9 billion in climate financing was mobilised – coming close to the goal. In other years, the world has fallen dismally short. 

Only 2% of all climate finance goes to health-related climate adaptation plans, such as making health systems more climate-resilient. 

And none of the key financial institutions, such as the World Bank and Green Climate Fund, that contribute to climate financing have dedicated funds for the health sector. 

The climate system lacks an “agile institution that’s really looking at accelerating disbursement,” says Maiero. And ministries of health lack any intermediate institution that can help health ministers access financing.

“These are the obstacles at the moment, maybe COP26 will actually help sort out all of these problems finally.”

COP26 ‘Health Programme’ focuses on green & climate resilient health systems

“The COP26 Health Programme is one of the three COP26 flagship science projects, alongside work on the Climate Risk Assessment and Vision for Net Zero,” said Maiero. “It is not yet visible on the COP26 agenda, but there will be special health events within the science and innovation day.”

In terms of the COP26 Health Programme, which bears the logo of the COP26 Presidency, the key priorities are focused more narrowly on health systems, including calling upon countries to invest in building greener and climate resilient health systems.  

Right now, only 50% of countries have a national health and climate change strategy, and half of those enforce its implementation, WHO’s climate team members note.

“[The Health Programme] is an important complement to the IPCC report, because it points to the urgency of taking swift action,” point out Knowlton and Limaye. 

“The health sector is increasingly participating in UN climate action, stepping up to do its part to implement the ambition of the Paris Agreement,” asserts Karliner.  

“Not only are health sector non-state actors representing thousands of hospitals from every continent taking concrete actions and committing to net zero health care through their participation in the UNFCCC Climate Champions’ Race to Zero, we are also expecting significant commitments to health care climate resilience and decarbonization from several national governments over the next couple of months as part of the COP 26 Health Programme. 

“This brand new initiative, a collaboration between the UK COP Presidency, WHO and Health Care Without Harm, is engaging with ministries of health from around the world to secure agreement for aligned action,” said Karliner. 

Health sector responsible for 4.4% of global greenhouse emissions

With responsibility for 4.4% of climate emissions, reducing the carbon footprint of health-care services is critical, Karliner and other backers of the COP26 Health Programme underline.

Countries are urged to create a roadmap to developing more sustainable and low carbon health systems – with the goal of achieving net zero emissions for health by 2050. 

Embedding sustainability involves everything from the planning and development of more efficient building energy systems, better waste management and medicines procurement – strategies that Health Care Without Harm is promoting around the world.   

“The sooner sustainable, low carbon health services are developed, the more cost effective they can be: reducing air pollution and therefore the ensuing demand for healthcare, by avoiding becoming locked into high carbon service delivery; and by not having to retro-fit sustainable solutions later,” states the concept note for the Health Programme. 

However, the ‘commitments’ will be made as non-binding declarations by health ministries – leaving questions about how much follow-up will really occur. 

Health side events at COP26

The 2021 Global Conference on Health & Climate Change will convene at the margin of the COP26 UN climate change conference.

Alongside the formal events, WHO and a number of partners are also hosting a Global Conference on Health and Climate Change to call on countries, businesses, and institutions to drive a “green, healthy and resilient recovery from COVID-19.”

The conference, scheduled for 6-7 November will feature thematic sessions on health related aspects of: biodiversity, food systems, sustainable infrastructure, clean energy, cities – and health as part of NDC commitments.  

“Weighing in both the impacts of health-damaging business-as-usual policies and the massive health co-benefits of ambitious climate policy, drives climate policies that are more ambitious and health-promoting,” states a press release for the conference, being held in collaboration with the Global Climate and Health Alliance (GCHA) and the UK Health Alliance on Climate Change.

WHO Special COP26 Report – Health Argument for Climate Action

For COP26, WHO also is developing a special report on health and climate change, ‘The Health Argument for Climate Action,’ that will be submitted to the COP26 presidency at the beginning of the summit.   This follows on from a series of high-level statements made by WHO Director General Dr Tedros Adhanom Ghebreyesus  during May’s World Health Assembly and last year, on the importance of climate action and a “green recovery” from COVID-19.

“The risks posed by climate could dwarf that of any single disease. … there’s no vaccine for climate change,” Tedros has repeatedly pointed out

The WHO Special Report will present the latest evidence on the health impacts of climate change, provide scientific findings on the health co-benefits of taking climate action, and offer ten high-level recommendations to climate change policy makers at COP26.

A public consultation of a draft version of the report is underway to receive action-oriented comments on the health recommendations. The report “hope[s] to represent the unified voice of the global health community at the COP26 UN climate conference in Glasgow,” said WHO. 

“This year is crucial for international climate action, with far-reaching consequences for the long-term health and resilience of communities and societies,” WHO said in announcing the consultation earlier this month. 

“The COP26 Special Report hopes to place health and equity front and center at COP26.

“WHO and the global health community are calling on governments to commit to more ambitious climate action, to place health and social justice central, and to commit to a healthy recovery from COVID-19.”

“While there is still much to be done to integrate health into the various areas under negotiation at the UNFCCC [UN Framework Convention on Climate Change],…this year marks a turning point for health sector engagement in the intergovernmental process from which there will be no turning back,” said Karliner. 

“Health care climate action in these global negotiations, national policy and local government will only grow. And it is none too soon,” he added.

Image Credits: IPCC, Commons Wikimedia, UK COP26 Presidency, City of Fortaleza, Gobierno de Provincia de Neuquen, Argentina, IPCC, COP26, WHO.

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