WHO Member States appeared to give strong backing to a proposed new WHO roadmap to reduce air pollution’s health impacts – with the ambitious global goal of cutting mortality attributable to human-produced sources by 50% by 2040. 

At the same time, a draft Climate Change and Health Action Plan, also aired at Saturday’s WHO Executive Board meeting, received a slightly more conditional approval – with further negotiations on the final draft set to take place ahead of the World Health Assembly in May. 

Notably, the African group, China and other developing countries asked for a bigger emphasis on “common but differentiated responsibilities (CBDR)” – a longstanding equity principle in climate negotiations that holds historical emitters to a higher bar of responsibility for climate action. 

Some developing countries also asked WHO to emphasize climate “resilience” more – as compared to climate mitigation measures like clean energy that have powerful, long-lasting health benefits. The draft text, however, makes no mention at all, however, of phasing out fossil fuels – a political compromise that only one lone NGO, Health Action International, protested during the debate.  

In line with the process established at this EB session, the board postponed a decision on approving the air pollution road map, as well as a decision to move ahead with a third initiative measure on a “Lead-free future, accelerating lead phaseout in paints, building materials and other products. 

With the sole exception of emergency aid to Gaza, a decision on how to advance all of the three dozen other decisions and resolutions before this month’s EB has been postponed until the final days of the EB session next week. That is due to the burgeoning financial crisis provoked by the United States announced withdrawal from the WHO  – and the resulting uncertainty about how to maintain funding for existing programmes, let alone launching new initiatives.    

Air pollution roadmap – big leap forward 

The WHO air pollution roadmap represents a big leap forward in ambition in comparison to its predecessor, which included no such global goal, or concrete targets at all.

As such, it exemplifies, perhaps, growing awareness in member states about the broad range of health impacts of air pollution  – estimated to cause some 6.8 million deaths annually. 

The proposed new global goal, which would have to be adopted by the May World Health Assembly, comes in the leadup to a major WHO conference on Air Pollution and Health, being convened in Cartagena, Colombia, in March 2025. 

There, member states are also being asked to raise their ambition on air pollution action with national commitments to mitigate sources and reduce peoples’ exposures. This includes improving systems for air quality monitoring and warning, as well as equipping health sector actors to assess and advocate for clean air measures such as: shifting to low-emissions transport modes; cleaner energy production; better waste management; and healthier household energy use as well as urban planning.  

In Saturday’s EB discussion most member states described air pollution as a critical health issue – requiring aggressive action along the lines suggested in the road map. China, however, said that WHO should more fully “consider the differences of levels in socio economic development, air pollution, pollution control, capacity and health impact of air pollution among countries, clarify the fixed targets, … and  assess the feasibility off achieving a 50% reduction in the population attributable fraction of mortality from anthropogenic source of air pollution by 2040.”

In fact, the road map states that countries with very high pollution levels should aspire to reduce their concentrations to one of the “interim targets” set out by WHO for better air quality.

The cost of implementing the air pollution road map  – through an accelerated programme of WHO work with countries on monitoring and acting for better air quality and health – is estimated at about $39 million over the coming six years and beyond. However, the most immediate costs of some $4 million are already funded in the 2024-25 budget. 

At $5.6 million, the costs of a campaign to advance a “lead free future” are even more modest, according to the financial assessments that have accompanied every new initiative tabled at this year’s EB session. 

However, sources told Health Policy Watch that member states are at odds over whether they should approve most of the resolutions before this year’s EB, as is the tradition, but conditional on funds being found somehow – or alternatively triage the most important priorities and affordable measures for advancement – while leaving others in abeyance at this year’s WHA. 

Climate change  – a bold new approach    

Like its air pollution counterpart, the WHO climate and health initiative also takes a much bolder and more holistic approach to the issue, as compared to previous action plans.  

It asks asking member states’ health sectors to take a stronger lead in climate mitigation efforts that also benefit health: 

 “Through stronger engagement in the circular economy and through the reduction of greenhouse gas emissions and other climate-changing pollutants, such as black carbon, through more sustainable energy-use choices, agricultural practices, transport options, reduced food loss and waste, city densification and use of industrial technology and practices, 

“As well as through support for healthier diets in low-income populations, with special attention to women of reproductive age, while promoting a shift to healthier and more environmentally sustainable diets among higher-income groups.”

The draft also encourages member states to “limit or reduce actions that cause emissions in other countries through manufacturing, shipping or energy production,” as well as to “promote demand-side mitigation that encompasses changes in infrastructure use, end-use technology adoption, and sociocultural and behavioural changes.”

In the past WHO’s climate and health initiatives focused more on “adaptive” actions such as promoting health sector resilience to climate change through measures such as improved early warning systems for climate sensitive disease outbreaks. 

Ultimately the aim is to see health-beneficial measures and outcomes as stronger elements in countries’  nationally determined climate contributions under the Paris Agreement.” 

Increasing health sector access to climate funding 

Another key aim of the WHO strategy is to work with countries to increase health sector access to climate-related funding.  Until now, the health co-benefits of climate mitigation or adaptation are not consistently quantified or considered in countries’ climate pledges – or in the consequent climate finance that may flow from national determined commitments (NDCs). Nor are the health co-benefits of actions systematically tracked as part of climate mitigation and adaptation assessment.  

The plan also would work to ensure that health facilities are more climate resilient and environmentally sustainable. 

According to a recent WHO assessment, some 12-15% of the health facilities in Sub Saharan Africa and South Asia lack access to any electricity, and some 50% of health facilities in Sub Saharan Africa lack a reliable electricity supply.  Overall, one billion people worldwide are served by health clinics and hospitals without reliable electricity. Moreover, much of the electricity provision in low- and middle income countries is via expensive and unreliable diesel backup generators – that could be replaced with low-carbon wind or solar options, if adequate climate finance was made available. 

However, the Green Climate Fund, the world’s largest provider of climate finance, has so far  failed to include significant funding to Africa in its renewable energy funding portfolio.    And in the single GCF project approved last year for the health sector, in Malawi, energy infrastructure was ignored. See related story.

Against Rising Fossil Fuel Emissions, WHO and COP29 Hosts Call For More ‘Healthy’ Climate Commitments by Countries

While some low-income countries balked at the emphasis on mitigation given their negligible historic contribution to climate emissions  – others stressed that what they need mostly is finance to pave the way towards a healthier, low-carbon future.

Ethiopia, speaking on behalf of the African bloc called for:  “holistic solutions to the climate and  health nexus: more substantial and accessible funding mechanisms to support climate and health

integration, especially in Africa and other developing countries, specific attention to address vulnerable populations who are disproportionately affected by the impacts of climate change, stronger focus on building climate resilient health systems, including strengthening healthcare infrastructure to withstand extreme weather events, capacity building to healthcare workers and implementing adaptation strategies for greater resilience in health systems.”

Added Senegal, “We want to make our health system more resilient, and we are looking at submitting a request to the Green Fund for financing. We are also doing our best to bring down greenhouse gas emissions and take other mitigation measures. We’re trying to develop a plan for investing in renewable  clean energy too.” 

‘Major Opportunity for WHO to lead’

Developed countries such as Belgium, Italy and the United Kingdom, meanwhile, welcomed the more holistic emphasis on healthier and more low-carbon cities, foods and manufacturing methods – as integral to the emerging approach to climate and health. 

“This is a major opportunity for WHO to lead Member States toward bolder commitments and more tangible actions with clear mandates for all stakeholders,” Belgium stated. 

“In addition a health and climate in all policies approach is fundamental to address the health impact of the triple environmental crisis in a comprehensive and coherent, coherent manner.

“We must adopt public policies with climate and health co-benefits, such as shaping sustainable and healthy diets, encouraging active mobility and supporting an economy that values health and well being, rather than investing in activities that harm people and the planet.” 

Only Russia, a major oil-producing nation, spoke out explicitly against the plan, saying, “we would want to, again, express our concern about the gradual extension and the activity of WHO on climate related issues. This risks diluting the mandate of the organization interfering with the activities of other competent international forum, and there’s an inefficient use of the WHO resources, which are already very limited.”

Climate action budget is ambitious – but first part is funded

In fact, the $161.5 million price tag makes the proposed climate and health action plan one of the most costly to be considered at this EB – second only perhaps to aid for Gaza ($648 million – which WHO says it intends to raise through emergency appeals. 

As for climate and health, the $38 million required for the current 2024-25 budget period is already funded in WHO’s existing budget plans  – including through a major donation announced by the Wellcome Trust to WHO at the October World Health Summit in Berlin. 

The Wellcome donation was made in the context of WHO’s new “Investment Round” initiative – which has sought to accelerate the pace of voluntary budget contributions from member states and philanthropies. 

Also, WHO’s past climate and health work has yielded new revenues for the countries themselves to act, pointed out WHO’s Assistant Director Ailan Li.

“WHO has mobilized over 150 million US dollars for low and middle income countries to address the health impact of climate change over the past years. 

“Through these resources, WHO has supported countries to develop national assessments and national health adaptation plans, which are now in place in about 50 member states,” she said, citing Uganda and Brazil as the most recent examples. 

“I think this is a good progress.”  

Image Credits: Chris LeBoutillier, INGImage, WHO/Blink Media, Nana Kofi Acquah, WHO, WMO, WHO/Bill & Melinda Gates Foundation.