What Would Make the Next UN Climate Conference (COP28) the First True “Health COP”?
UN Climate Change Conference, June 2023, Bonn, Germany.

The United Arab Emirates, hosts of the upcoming UN Climate Conference (COP28), have promised to deliver the first COP with a health focus. In addition to focusing attention on the existential human health risks of climate change, it is vital that a “Health COP” delivers commitments that maximize the health gains that can be obtained from more aggressive mitigation and adaptation. However, stalemates on finance and mitigation negotiations during the recent COP28 preparatory talks in Bonn (SB58) have left this December’s conference with a mountain to climb. 

The annual June UN climate meeting in Bonn in preparation for COP28 stalled, with tensions stemming from the failure of wealthy countries to deliver on their commitment to provide $100 billion per year to support low-income countries’ action on climate change. Meanwhile, major fossil fuel-producing countries took advantage of this impasse to oppose constructive discussion on climate change mitigation, and to block progress towards phase-out of the fossil fuels responsible for dangerous warming trends. 

In Bonn, governments came close to failing to agree even on the proposed agenda for the Bonn meeting itself. When finally set, the agenda omitted any mention of the crucial Mitigation Work Programme, where agreement is urgently needed on more rapid reductions of emissions of CO2, as well as short-lived, but powerful, climate change drivers like methane. 

In order to ensure the necessary time and attention is directed to negotiating solutions to the monumental threats our planet faces at COP28, these same delays cannot occur in Dubai at COP 28 (30 November-12 December). Willingness to meet commitments on climate finance, and to enter constructive discussions on mitigation, will be prerequisites for the talks to begin in earnest. 

Worsening trends 

These political developments are all the more worrisome in light of recent trends. 

A recent report from the World Health Organization noted that if our high emissions trajectory continues, nine million people per year will die annually from climate-related causes by the end of the century.

People around the world are already enduring climate impacts, from heatwaves, wildfires and air pollution, to floods and extreme storms. Climate change is also exacerbating crop losses and the spread of infectious diseases, as well as migration. The extraction and use of oil, gas, and coal harms people’s health, and is incompatible with a healthy climate future. That’s all the more reason that COP28 must deliver a commitment to phase out all fossil fuels, and a just transition to renewable energy for all.

Health considerations gaining more traction

Due to warmer climates, international travel and urbanization, one or more of the leading arboviruses are now present in most countries of the world.

While Bonn has left COP28 with plenty to do, the United Arab Emirates, host of this year’s climate negotiations, has committed to elevate attention to health. The country will deliver an official, Presidency-level health programme, including an official “Health Day” for the first time ever, as well as an inter-ministerial meeting on climate and health.

This is welcome. For years, the health community has hammered at the door of climate summits, exhorting delegations to acknowledge how health and climate are intertwined, and to protect people’s health from the impacts of a warming climate. 

The 2015 Paris Agreement invoked the “right to health” as a fundamental rationale for climate action. Even so, language about the “right to a clean, healthy and sustainable environment,” was nearly deleted from the final outcome text of COP27, only to be reinstated at the last minute.  

Despite these kinds of setbacks, it was clear at the Bonn meeting that health is at last penetrating deeper into the global climate negotiations. Country delegates integrated health references into discussions on the Global Stocktake, the Global Goal on Adaptation, and Loss and Damage in meaningful ways. This is unprecedented. 

We have argued that health and climate are connected, and must be addressed together. Our persistence is bearing fruit: we are now seeing the beginning of a crucial cross-pollination between the climate and health worlds – good news for people, and for the planet.

Health needs to be a driver for meaningful action, including mitigation and finance

However, as health gets further integrated into climate talks, it is essential that it serves as a driver for faster, more collective, and more meaningful action – including on critical mitigation and finance elements – as action in both of these areas is essential to protect and support people’s health in this era of multiplying climate crises. Greater investment in health systems and health adaptation, both vitally important steps, are not by themselves enough to protect people’s health.

If COP28 is to be the Health COP, it must do better than Bonn

The COP28 negotiations, and all those to follow, must go further than Health Days if people are truly to be at the centre of the climate agenda.

Most of all,  for COP28 to really achieve “Health COP” status, it must steer us away from dangerous tipping points and catastrophic levels of warming. Concretely this means a number of things, all of which must be supported by adequate finance and means of implementation: phase-out of fossil fuels; a just transition to renewable energy; and maximizing health gains of ambitious climate actions across sectors, spanning mitigation, adaptation and loss and damage.

Full phase-out of fossil fuels

COP28 must deliver the full phase-out of fossil fuels, and a just energy transition that does not saddle developing countries with outdated energy technologies and health-harming pollution. And it must deliver climate finance that enables all countries to make the necessary transitions to have clean energy access for all, and adapt and respond to climate impacts. 

Oil and gas projects in Africa are set to quadruple; projects in the Congo Basin, the world´s second largest rainforest, pose a major risk to regional and global climate stability.

Energy access is essential for health: governments must incentivize, invest in, and support a just clean energy transition, rapidly ramping up renewables to expand energy access, even while we simultaneously kick our fossil fuel addiction. Renewable energy can help overcome the lack of electricity access currently experienced by over 750 million people worldwide, positively influencing social determinants of health with reliable and clean cooking, heating, lighting, healthcare services, and education-related technology.

Governments must also take fast action to cut methane emissions – a short-lived super-pollutant with more than 80 times the warming effect of CO2 (in the short term) – as part of the swift energy, food system, and waste system transitions needed to limit warming.

Fossil fuel lobbyists have no place at COP 

Delegates at COP27 included over 600 corporate lobbyists from fossil fuel companies. Fossil fuel corporate lobbyists have no place at COP28 or in the climate policy-making space. 

Fossil fuel companies with the highest overshoot of the IEA’s net zero emissions scenario, in terms of planned oil and gas extraction.

For decades, these same fossil fuel companies have sown doubt and hidden evidence about climate change, and reaped massive profits, while people around the world have paid the price with our health and our lives. Governments banned the tobacco industry from involvement in decision-making on controls to protect people from the health harms of tobacco; they should just as firmly not allow the fossil fuel industry to dictate our climate and health policies. In response to growing concerns, the UNFCCC will, for the first time this year, require all participants – including lobbyists at COP28 –  to disclose their affiliation. This is a small step in the right direction.

Addressing “co-morbidities of climate change”

COP28 should also address the many “comorbidities of climate change”, such as unsustainable agriculture, urban sprawl, biodiversity loss, and air pollution. The recent forest fires in Canada are but one example of the vicious cycle we are in: climate change drives extreme events, which in turn both contribute to worsening climate change and intersect with and aggravate other serious environmental and health impacts.

Climate change is impacting people’s health now. At COP28, governments must invest in adaptation measures, including building greater resilience of healthcare and public health systems, and in integrating health considerations into adaptation across other sectors. Leaders must also grasp that while adaptation is essential, adapting to a world that has warmed by 2.8°C will prove well nigh impossible – so they must hold fast to their commitments to limit warming to as close to 1.5°C as possible.

Integrating health into finance for adaptation and mitigation

COP28 must integrate health into financing for adaptation, mitigation and loss and damage, with substantial new and additional funding across these areas. Between 2018 and 2020, only 0.3% (14 million USD) of climate adaptation finance was allocated to health sector adaptation, though 13.9% of adaptation was allocated to sectors benefiting health. Meanwhile, according to donor tracking, approximately 7% of bilateral health Official Development Assistance, (ODA) (US$1.58 billion) contributes to climate adaptation, though figures may be lower in reality due to misreporting. Very little synergistic investment is made in health and climate mitigation

Finance and technical assistance for low-income countries are critical for protecting people’s health through climate preparation and response, and to make the system transformations required for a healthy, sustainable future. It’s unclear whether or not the recent Summit for a New Global Financing Pact in Paris made meaningful progress in this direction. 

Within the health sector, health civil society and ministries of health are increasingly discussing climate action, from local and national to regional and global levels. With a health focus at COP28, we hope to witness a record number of health ministers in attendance. 

The health community is working to make health systems low-carbon and climate-resilient and to integrate climate change into health professional and health worker education and training. We must go further, divesting health associations and organizations from fossil fuels, and addressing climate change in global health investments and programmes. We are also using our influence to push for effective climate action that protects people’s health, and for climate solutions that secure a stable, livable, and equitable future for humanity.

We need a true Health COP

What should world leaders do to make COP28 a true Health COP? It’s a welcome start to have a Health Day and an inter-ministerial meeting that brings health ministers to COP as part of their national delegations. To be a true Health COP, however, COP28 must deliver an end to the fossil fuel era, deliver financial and technical support to countries most impacted and least responsible for climate change, and bring climate progress centred on people’s health and well-being. 

Dr Jeni Miller is the Executive Director of the Global Climate and Health Alliance, an alliance of more than 150 health professional and health civil society organizations addressing climate change.
Jess Beagley is the Policy Lead of the Global Climate and Health Alliance, an alliance of more than 150 health professional and health civil society organizations addressing climate change.











Image Credits: Pixabay, Jess Beagley, Rainforest Foundation and Earth Insight, 2022.

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