As the world continues to burn fossil fuels, heatwaves and air pollution are getting worse, and increasing the pressure on human health. This is exacerbating the burden of non-communicable diseases (NCDs), which comprise the lion’s share of the world’s disease burden, experts at COP28 said on the opening day of the summit on Thursday.

“We all know that climate change is a health crisis. But if you combine this with NCDs, this is certainly a double crisis,” said Bente Mikkelsen, director of the Department of NCDs at the World Health Organization (WHO). She was speaking at an event on the COP28 sidelines called, “Unbearable Heat, Unbreathable Air – Finding Win-Win Solutions for Climate and Health.”

Deaths from non-communicable diseases comprise 75% of premature mortality (under age 70) globally. This number is only increasing as the world’s population ages, Mikkelsen noted. But most people don’t understand how global warming or what UN Secretary General Antonio Guterres called “global boiling” is adding to the NCD burden in multiple ways, she added.

Many NCD conditions, from kidney disease to cardiovascular conditions, are exacerbated by extreme heat exposures, Mikkelsen explained. While heatwaves killed 60,000 people in Europe alone in 2022, the global toll is not well known due to data gaps.

The combined death toll from heatwaves, vector-borne disease, and malnutrition could cause up to nine million deaths by the turn of the century, WHO has said based on assessments by the Intergovernmental Panel on Climate Change.

Air pollution is estimated by WHO to kill seven million people annually, although research published this week in The BMJ put the number much higher at 8.34 million deaths for outdoor air pollution alone.

This air pollution is caused by the same sources driving climate change – the burning of fossil fuels, waste, as well as heating and cooking with coal, kerosene, and biomass in traditional stoves.

“It is probably not that well known that 85% of air pollution [mortality] again, is attributed to non-communicable diseases,” Mikkelsen said, referring to the cardiovascular, respiratory, and cancers that are recorded as causes of death.

Health is not a formal part of the UN Climate process 

DUBAI, UAE -Despite being a pillar of the 1992 UN Framework Convention on Climate Change, health has never been a formal part of the agenda of UN Climate negotiations or the Conference of Parties (COP) process.

This year, health has gained a foothold as a COP thematic day, December 3, during which 63 health ministers are expected to arrive in Dubai. This is the first-ever such gathering at a climate conference.

While this may be an important symbolic event, climate change, air pollution, and the NCD epidemic – all major crises in themselves – need to be much more deeply interlinked, experts said.

Far more needs to be done to promote “integrated” solutions that also prevent global temperatures from exceeding the limits of human survivability across large swathes of the planet, experts at the side event, co-sponsored by the World Health Organization, the World Bank and the Clean Air Fund, said.

They called for a reduction in fossil fuel burning and subsidies to the industry along with increased investments in renewable energy broadly and within the health sector.

More formal moves to include health-related indicators and objectives in climate policies could also help the world meet a wide range of the 2030 Sustainable Development Goals, from reducing NCD deaths (SDG3) to healthier cities (SDG 11) and clean energy for all (SDG7), said panellists at the event, which was held at the SDG Pavilion.

Using clues from human physiology to improve climate strategies

“It’s likely that we’re under-estimating the thresholds [of heat tolerance] because we aren’t bringing human physiology into the discussion, because we all have different responses to extreme heat. Perhaps we have a non-communicable disease. Perhaps we’re aging and we’re more at risk,” Tony Capon, of Australia’s Monash University, a member of the World Meteorological Organization’s Heat and Health Network, said.

Tolerable levels of heat vary widely with the level of ambient humidity and ventilation, he pointed out, referring to the body’s sweat response. Simply moving air around with a fan can also cool people down, allowing them to tolerate higher temperatures safely.

Air conditioning, whose use is soaring in hot countries, is a “maladaptive response” to climate, said Capon. Not only does it increase carbon emissions, but it pushes hot air out of the homes and offices of the wealthy and out into the streets and neighbourhoods of the city, exacerbating the urban heat island effect for poorer communities and vulnerable groups.

Air pollution and heat wave deadly synergies  

Policymakers also need to pay closer attention to the interplay between air pollution and heat, Capon added.

“When we think about air pollution and heat together, our body’s response to heat can actually exacerbate the health impacts of air pollution. Because we breathe more deeply when it’s hot. And that means we breathe the pollution more deeply into our lungs, our hearts also working harder. And so it’s pumping those pollutants around our body more than it otherwise would be if it wasn’t a hot day,” he explained.

Based on such basic knowledge, health and climate actors can build more integrative solutions if they look at the full spectrum of health impacts from proposed climate strategies, he said. That also means focusing not only on greener energy but on investments in more low-carbon buildings, with good ventilation and on more sustainable cities and transport systems.

Solutions: Renewables, multisectoral response and finance

More sustainable solutions also need finance, and that’s still sorely lacking, said Arunabha Ghosh, CEO of India-based think tank Council on Energy, Environment and Water (CEEW). He noted that while Africa has vast solar energy potential, only 2% of climate finance is invested in the continent.

Multiple barriers are stifling Africa’s green energy expansion. Most climate finance supports mega energy projects, while much of Africa’s entrepreneurship is small and medium businesses. Smaller, distributed grid energy projects would be more suitable to many underserved communities, far removed from big cities but these are not getting the required attention currently. Countries where credit ratings make them poor bets for investors often are the most in need of these investments.

However, there are some hopeful signs of change, Ghosh said, noting that the World Bank was in a “seminal moment” in terms of prioritizing its climate and air pollution policies.

“If we can have air quality as one of those global challenges around which new programming for the World Bank will emerge, I think that really gives us a leg up,” he said. “We’ve got to start thinking about the linkages between health, the economy, climate and the broader SDGs as part of that new economic paradigm. And then look at the hierarchy of solutions.”

Providing further details on some of the new investment trends, the World Bank’s Jostein Nygard described moves afoot in Southeast Asia to support countries’ investment in air pollution solutions.

One key focus of that initiative is the heavily polluted Indo-Gangetic plain and Himalayan Foothills region, which extends from Pakistan across northern India and southern Nepal to Bangladesh. South Asia suffers from some of the heaviest air pollution in the world, with an estimated 4 million deaths annually from air pollution across countries in the region.

Bringing the environment and health departments of the countries to work together has been a challenge, but things are improving.

“We can now see that we gradually are getting an entry point that we need to further enhance the collaboration between environment and health,” Nygard said. “We are pretty optimistic about being able to move this process forward.”

Tax the windfall profits of the oil and gas sector to fund health facilities

Along with speaking out more forcefully about health and climate harmful policies in other sectors, the health sector can also show the way by shifting health facilities to renewables, Salvatore Vinci, an energy consultant for WHO, said.

He noted the recent WHO findings that nearly one billion people in lower-income countries lack access to a health facility with adequate energy infrastructure to power basic health services, he pointed out. An estimated 450 million people worldwide lack access to a health facility with any electricity at all.

Many health facilities in low-income countries are heavily reliant upon diesel fuel or expensive and unreliable grid conditions, he said, noting that in Somalia, the cost of electricity is $1 per kilowatt hour and in Yemen, the cost of diesel is $1.14 per litre of diesel. Those costs could be reduced by two-thirds if renewable power was installed, he said.

“Africa is the place with 60% of the best solar resources, but there is 1% of the solar installation,” Vinci said. “So we will talk about electricity and energy transition first, let’s talk about the most vulnerable population,”

The scale of investments needed is large, but they pale when compared to the profits the fossil fuel industry is making, he pointed out. “In 2022, the global oil and gas industry made a profit of $4 trillion, more than doubling the income of the previous years,” said Vinci. “If we have to electrify all the healthcare facilities in the world, we would need just $4.9 billion.”

See related story: COP28: Will a Petrostate Lead the Fight Against Climate Change?

Image Credits: Unsplash, Wikipedia, WHO/Diego Rodriguez.