The World Health Organization’s marquee event at COP29 in Baku produced a document that captures the growing frustration felt by delegates, civil society, and people across the globe with UN climate negotiations: a “letter of intent” to form a coalition to continue discussions about taking action.

In stark contrast to the glitzy, Bill Gates-adorned fanfare of the inaugural COP Health Day in Dubai a year ago, the WHO-led high-level ministerial on Monday took place in a cramped, windowless meeting room – though, to be fair, the ground floor of Baku’s football stadium, the venue for COP29, has no windows.

Seasoned UN observers sensed the event, billed as a “round table” emphasising “sharing best practices” and “reinforcing sustained action,” was unlikely to make headlines. While Dubai’s celebration drew VIPs and global attention, this year’s event peaked at just 18 guest attendees on a Microsoft Teams call attended by Health Policy Watch.

The meeting resulted in the “Baku COP Presidencies Continuity Coalition for Climate and Health,” an acronym sure to catch on at the UN climate talks: BCPCCCH.

Thank you @COP29_AZ Presidency for establishing the Baku COP Presidencies Continuity Coalition on Climate and Health.

This initiative unites the visionary leadership of five COP presidencies that span this critical time for action, underscoring a commitment to elevate health… pic.twitter.com/QhDl91aeFN

— Tedros Adhanom Ghebreyesus (@DrTedros) November 13, 2024

The new coalition, coordinated by Azerbaijan in partnership with previous COP hosts Egypt, the United Arab Emirates, the United Kingdom, and the next host, Brazil, commits COP presidencies to ensure health is a central agenda item at future UN climate summits.

“By signing the Letter of Intent, we commit to a shared vision of a world where climate and health policies are not isolated but integrated into all aspects of governance and development,” Azerbaijan’s Minister of Health, Teymur Musayev, said in a press conference following the signing.

Musayev said the coalition was “not created for dialogue alone,” though provided few specifics on objectives beyond strengthening health initiatives agreed upon at past COPs.

‘Significant milestone’

WHO hailed the letter of intent as a “significant milestone,” while its director-general, Tedros Adhanom Ghebreyesus, said it “unites the visionary leadership” of COP host countries and shows “a collective will to prioritize climate and health now and for the future.”

Adding to the chorus of UN buzzwords, COP29 President Mukhtar Babayev called the coalition “another step towards synergistic action on climate and health.”

The agreement falls short of making health a formal topic in UN climate negotiations – long considered the holy grail for the health community – despite evidence climate change-related developments, from air pollution to extreme weather, cost nearly ten million lives annually.

While both the Azerbaijani presidency and WHO have issued press releases, the letter of intent itself has not been made public at the time of publication.

“With the Continuity Coalition, there is now a mechanism to foster presidency-led, high-level attention to health as the norm,” Dr Jeni Miller, executive director of the Global Climate and Health Alliance, told Health Policy Watch. “What we will be looking for is how it makes that a reality.”

Missing the mark

For communities on the frontlines of the climate crisis, the pledge to have future discussions about potential actions to protect health – and the celebratory tone adopted by ministers like Babayev and Musayev – miss the mark.

The loss of life from climate change and disease that could be prevented by nations living up to Paris Agreement Targets – an ambition so far absent at the midway mark in Baku – would save two million lives annually, WHO said in a report ahead of COP29.

Civil society stakeholders from frontline countries are demanding $5 trillion in annual funding as the bare minimum outcome of the summit to cope with the damage already incurred and to adapt and mitigate future climate change.

Nations are less ambitious than civil society in their demands, with most targets from developing countries, including the Arab and the African Groups, hovering around the $1-2 trillion range.

As the summit enters its second week and UN climate negotiations near the three-decade mark, words on a page, absent any legally binding or financial backing, are ringing increasingly hollow.

“I see a disconnect between the global conversation and discourse with the reality that countries are facing,” Nigeria’s Minister of Health, Mohammed Ali Pate, said following the signing ceremony including the countries that inaugurated the coalition.

“Nigeria and other countries are pulling within their limited resources,” Pate said. “We need to reconcile this divergence between global rhetoric and real action backed by resources for those who are bearing the brunt of climate change.”

What’s the point?

For frontline communities, the Baku coalition’s non-binding ‘promises’ are pyrrhic victories. But for the WHO and health advocates, they represent hard-fought institutional progress.

The fight for health to be recognised as a central concern in UN climate summit agendas has been an uphill battle, mirroring the decades-long struggle to force nations to acknowledge the role of fossil fuels in the climate crisis.

Just as it took nearly three decades of UN climate negotiations for the global community to finally commit to “transitioning away” from fossil fuels in Dubai last year – making headlines across the globe – the inclusion of health in the climate agenda is a victory that was won over decades.

The health breakthrough is also reminiscent of another recent milestone in global environmental negotiations. Just a month ago in Cali, Colombia, Indigenous communities were granted an official expert body seat in UN biodiversity negotiations after years of tireless advocacy, prompting emotional scenes from people and communities who fought relentlessly for recognition.

“The place that we have gained over the years for health at the COPs is now secured,” Dr Maria Neira, WHO’s health and climate lead, told Health Policy Watch. “We don’t need to fight every year to obtain this space.”

The coalition’s key achievement, while bureaucratic, is significant: after decades of fighting, health advocates and WHO officials will no longer have to relitigate the importance of health as a central concern in climate talks.

“Each victory has been a step forward in getting health into the climate conversation,” Miller said. “Negotiators and heads of state [now] recognise that when they are making decisions about climate action, they are making decisions about people’s lives.”

WHO can also claim the establishment of the Baku Coalition meets its basic goal for the talks – ensuring delegates recognize they’re negotiating the health of eight billion people – though the 18 attendees on Teams suggest the message may not have reached many member states.

That such a modest procedural win emerges as COP29’s headline health achievement however challenges WHO’s message, pushed through two decades of pre-COP media blitzes, that health – as the lived experience of climate change – would be “the argument” driving meaningful climate action.

So far, the evidence from Baku suggests that national delegations still aren’t listening.

Time saved?

It remains to be seen whether the time saved on bureaucratic wrangling with COP presidencies can translate into more careful tracking of achievements or barriers to fulfilling health-related commitments made at previous COP summits. 

At Glasgow’s COP26, the Alliance for Transformative Action on Climate and Health (ATACH) was launched with a promise to transform health systems to be more climate resilient. The coalition now includes 91 nations – half of UN climate summit participants – after Azerbaijan joined on Monday.

While WHO monitors commitments made by ATACH members to low-carbon and net-zero health systems, there is no oversight of whether these have translated into action.

Limited international funding available for health has gone largely unnoticed, even by the only country receiving support from the world’s leading climate fund, the Green Climate Fund (GCF).

Malawi is the sole recipient of a GCF grant targeting the health sector’s climate needs. Yet Malawi’s own climate minister, interviewed by Health Policy Watch this week, was unaware of the GCF-funded project in their country.

GCF has not responded to a request for comment.

Baby steps, urgent crisis

Last year seemed to mark another step forward in health action, with 150 nations signing a Health and Climate declaration during the first dedicated Health Day in three decades of climate talks.

The Dubai COP also featured a two-week series of climate side events at an expanded WHO Health Pavilion, highlighting the impacts of climate change on food systems, air pollution, household air pollution, energy, and biodiversity.   

But beyond the political rhetoric, it remains unclear the level of progress being made in getting health into formal adaptation and mitigation processes. 

Health-specific climate action remains severely underfunded, still capturing only 2% of adaptation funding and 0.5% of multilateral climate funding – unchanged since Glasgow five years ago. 

At COP29, health financing announcements have amounted to a single $10 million grant from the Islamic Development Bank to the WHO. 

WHO influence in jeopardy

The WHO’s influence in the funding arena is further complicated by its own financial instability.

Already grappling with a multi-billion dollar budget shortfall, the organization faces additional uncertainty with the possibility of the US, its biggest single donor, cutting funds when President-Elect Donald Trump returns to office in 2025. 

Trump withdrew from WHO in his previous term, and many in his orbit expect the incoming president to do the same this time around. 

Top WHO officials told Health Policy Watch last month another Trump withdrawal of funding reinstated by Biden would result in a “dramatically bad crisis” for the UN health agency. 

Brazil offers a glimmer of hope 

The buzz in the health world ahead of talks in Baku was to not  expect significant health outcomes from COP29. 

Finance was always going to dominate the agenda, and Azerbaijan – whose delegation has by some accounts never spoken at COPs before hosting this one – was unlikely to lead on the issue.

Looking ahead, Brazil’s hosting of COP30 offers a glimmer of hope to many in the health world.

Brazil’s president, Luiz Inácio Lula da Silva, has pledged to act on climate and protect the Amazon, reversing four years of the legacy left by his predecessor, Jair Bolsonaro, who denies climate change and allowed deforestation and exploitation of the tropical rainforest to expand at an unprecedented rate.

Brazilian officials have also committed to prioritizing health initiatives on next year’s agenda, already participating in high-profile WHO events in Geneva and Berlin ahead of the summit.

In Baku, Brazil’s health minister announced that equality will be a key focus of its upcoming COP presidency. And with universal health coverage deeply embedded in Brazil’s national identity, there’s cautious optimism that meaningful health and climate action might finally move from rhetoric to reality in Rio.

Image Credits: COP16, WHO , CIFOR-ICRAF.