‍“I pray that this renewed effort to focus on health and climate will also focus on consequential areas that are needed if we are to deliver relief to our people in a just and meaningful way. […] This world will not survive easily if we continue to decimate populations simply by reason of the lack of access due to poverty of nations or poverty of families and individuals. As we focus on so many other things, but without health we have nothing” – Mia Motley, Prime Minister of Barbados, at COP28

Climate change can be seen as “the greatest global health threat facing the world in the 21^st century.” With healthcare systems already operating under extreme weather conditions and climate impacts intensifying across the globe, the climate crisis has increasingly become a health crisis with a multitude of implications.

As with any health threat, prevention is better than a cure. While instant mitigation of greenhouse gas emissions is the most effective policy to prevent future harms, an effective response to imminent climate-induced health threats is needed now. When it comes to climate-induced health threats, we cannot count on progress in terms of vaccines immunizing people against the effects of heat waves, wildfires, droughts, or floods. Instead, we need to focus on effective adaptation efforts, long-term resilience-building, and addressing loss and damage (L&D).

Climate change is already responsible for over a third of heat-related deaths, and a billion hours of potential labour productivity were lost due to extreme heat exposure. Last year was yet another hottest year on record, and life-threatening temperatures are becoming more frequent. Furthermore, air pollution deaths attributable to fossil fuels are rapidly rising. Climate change threatens to roll back progress in global health in the areas of universal health care (UHC), life expectancy, and vaccination rates. Many of the climate-induced health threats are endemic in low-resource settings and unequally distributed across societies, with those who are contributing the least to the climate emergency also often being the ones who are most exposed and least able to cope with the consequences.

Interlinkages between climate change and health

Historically, the integration of the climate change and health fields started around disaster management and managing the adverse health impacts of extreme weather events like droughts, cyclones, wildfires, and floods. The field has since gradually expanded and now includes a large, complex, and multi-faceted catalogue of challenges for national and global public health and healthcare systems: 

• The need to decarbonize healthcare systems including through the end-to-end supply or value chain from product manufacturing, procurement, distribution, and use to waste creation and management.
• Adaptation as a key priority for healthcare systems to withstand climate shocks.
• Changing dynamics of climate-sensitive diseases and expanding spread of infectious diseases like malaria, dengue, cholera, once confined to warmer regions.
• Warm and wetter environments becoming more fitting to pathogens and vectors associated with newly emerging or previously eradicated infectious diseases, i.e., those from melting glaciers and thawing permafrost.
• Heat-related illnesses like heat stroke, heat exhaustion, and chronic kidney disease, and impacts of heat stress on maternal health, neonatal health, and mental health.
• Increased rates of mortality due to respiratory diseases connected with air pollution, as many outdoor air pollutants have a climate warming effect and greenhouse gas emissions can exacerbate outdoor air pollution.
• Flood-related health risks ranging from hypothermia, drowning, undernutrition, and injuries to the escalation of water- and vector-born infectious diseases and mental health problems.
• Rising sea levels causing saline intrusion into drinking water and thereby leading to increased rates of high blood pressure, pre-eclampsia, and premature births.
• Extreme weather events and erratic weather patterns leading to crop failure, harvest losses, and food insecurity, and malnutrition as staple crops like rice, wheat, and soybean are getting harder to grow due to hotter temperatures and unpredictable rainfall patterns, which also causes falling yields and nutritious quality.
• Increased pandemic risk due to deforestation and transmission of zoonotic diseases, like COVID-19, and the need for more effective ecosystem restoration and biodiversity protection in the face of climate change.

Health and the global climate negotiations

While the above list is long and while health is one of seven key components of human security (UNDP 1994), with some 200 national laws and policies regarding the climate and heath nexus in place across the globe (Grantham Institute), health has long been absent from UN climate summits.

Due to the health sectors’ vast and complex interconnections with climate change, this can be identified as a major oversight. The first time that the climate and health nexus was systematically raised during climate negotiations was at COP23 in Bonn in 2017, when the COP Presidency of Fiji mandated the World Health Organization (WHO) to prepare a thematic report. This report was launched the following year at COP24. However, it was only at COP26 in Glasgow in 2021 that the climate negotiations under the United Nations Framework Convention on Climate Change (UNFCCC) and the Paris Agreement included a health programme.

The COP28 Health Day and the COP28 UAE Declaration on Climate and Health, endorsed now by more than 150 countries, have been major developments in this regard. The Declaration was supported by aggregated pledges of USD 1 billion raised from countries, global funds, multilateral development banks, and philanthropies. There are now three COP decision documents which include a health reference: the decision on the UAE Just Transition work programme, the decision on the Glasgow–Sharm el-Sheikh work programme, and the decision on the operationalization of the new funding arrangements, including a fund, for responding to loss and damage (L&D).

Moreover, four other official COP28 documents—the Emirates Framework for Global Climate Resilience, the COP28 UAE Declaration on Sustainable Agriculture, Resilient Food Systems, and Climate Action, the COP28 Declaration on Climate, Relief, Recovery And Peace, and the Climate and Health Declaration—contain a health reference. The UAE Consensus brochure, an overview of the COP28 outcomes, mentions health twenty-three times, a testament to the climate-health nexus becoming more prominent in the negotiations. However, in the UAE Consensus’ categorisation of pledges, health is not listed as a standalone sector but integrated into the life and livelihood section, and most references indicate milestones achieved outside the climate negotiation process.

Conclusions

To better understand the nexus of climate change and health, it is important to examine the integration of health at the political as well as technical level and understand the different processes that play a role, including at the global, regional, and national level. The next article in this series will reflect further on the COP28 UAE Declaration on Climate and Health as well as the Climate Change and Health Resolution introduced at the 77^th World Health Assembly (WHA) in 2024, two important milestones on the way towards operationalizing the linkages between multilateral processes on climate change and on health.

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This article is the first of a three-part series on the nexus of climate change and health. All parts are available on the SLYCAN Trust homepage as well as the Adaptation & Resilience Knowledge Hub; they have also been compiled into a summary knowledge product that can be downloaded here.