The 28^th meeting of the Conference of the Parties(COP28) to the United Nations Framework Convention on Climate Change (UNFCCC) and the Paris Agreement took place at the end of 2023 in Dubai, UAE. Regarding the integration of global climate change and health agendas, it marks a milestone event with a COP28 Health Day, the COP28 UAE Declaration on Climate and Health, the first Climate and Health Ministerial, and several official COP28 documents and outcomes referencing the climate and health nexus.

However, beyond these encouraging signals, it is important to understand where health can become part of the formal negotiation agenda and be incorporated in meaningful ways—for example, related to decarbonization of health systems, adaptation, health-related impacts of loss and damage, just transition of the healthcare workforce, finance, technology transfer,capacity-building, or the empowerment of relevant actors.

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Health and the Global Goal on Adaptation (GGA)

COP28 resulted in the adoption of a Framework for the Global Goal on Adaptation (the UAE Framework for Global Climate Resilience) as well as a new two-year work programme, the UAE-Belém work programme on indicators. While the Paris Agreement includes a clear target for climate change mitigation, there was a lack of guidance on the overall goal regarding adaptation.

The COP28 decision mandates global time-bound goals for adaptation action that focus on specific sectors or dimensions, with health among the seven dimensional targets. In paragraph 9/c, the decision urges stakeholders to pursue the objective of “attaining resilience against climate change related health impacts, promoting climate-resilient health services, and significantly reducing climate-related morbidity and mortality, particularly in the most vulnerable communities”.

A health metric under the GGA health target could be an important component of adaptation reporting and contribute to the recognition of quantitative and qualitative aspects of health data as a key part of adaptation assessments. The UAE-Belém work programme was established to develop indicators for measuring and assessing progress towards the targets of the framework towards COP30, which includes the development of specific health targets and indicators.

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Health and Nationally Determined Contributions

Instituted under the Paris Agreement, Nationally Determined Contributions (NDCs) outline countries’ plans for mitigating and adapting to climate change (and potentially for responding to L&D). According to the WHO, 91% of the available NDCs now include health considerations, compared to 70% of those reporting in 2019. The healthcare sector is one of the three sectors most often prioritised for adaptation in NDCs.

Most often, countries refer to the health co-benefits of climate action. Based on these statistics, poorer and climate-vulnerable countries that contribute least to climate change, and small island developing states specifically, are more likely to engage with health in their NDCs. Higher levels of population exposure to temperature change and ambient air pollution are also associated with higher health coverage in NDCs. Developed countries were more likely to not mention health in their NDCs.

The next and third cycle of NDCs (NDCs 3.0) is due in 2025,with the deadline for country submissions set to February 10^th,2025, nine months ahead of COP30.

Conclusions and the way forward

Getting ahead of the curve and supporting a strong health sector response to the climate emergency is urgently needed. The challenges of the health sector related to access to affordable medicine and vaccine justice during the COVID-19 pandemic as well as other global health crises have shed light on the reality that the contemporary world is still largely dominated by narrow national interests and socioeconomic inequalities, which prolonged many of these crises. However, these challenges also highlighted the essential role of effective multilateral institutions in challenging the status quo and contributing to the establishment of pharmaceutical equity. The public health sector has thus valuable evidence to inform multilateral climate negotiations.

While Azerbaijan and Brazil both signed the Climate and Health Declaration and Brazil also co-sponsored the WHA Climate Change and Health Resolution, it remains to be seen how prominent the climate and health nexus agenda will be at future UNFCCC COPs. On the one hand, the initial announcements of priorities from Azerbaijan’s COP29 Presidency do not provide immediate connections to the climate and health agenda, focusing instead on technology transfer, peace, tackling leftover pollution from Soviet heavy industry,and preventing water shortages linked to dwindling supplies from the Caspian Sea. However, the newly released thematic priorities of the COP29 Presidency proposes health to share a thematic day with the topics of human capital,children and youth, and education.[i]

The agenda for the climate and nexus advocacy for the next two years could include the following key priorities:

1. Specify and develop health targets and provide financial support for the GGA
2. Engage with the Loss and Damage Fund (health impacts as non-economic losses)
3. Advocate for climate and health in the new global climate finance goal (NCQG)
4. Support health references in the third cycle of NDCs and their implementation
5. Mainstream health across mitigation, just transition, technology, and other item

On the other hand, the commitment of Brazil to the nexus of climate change and health under the G20 Presidency framework as well as the most recent engagements of the Brazilian Health Minister in the discussion on climate and health nexus at the World Economic Forum in Davos are signals that health might find a prominent place the climate negotiation at upcoming climate summits.

The upcoming G20 presidencies of Brazil and South Africa also confirmed the priority of the climate and health nexus. It is thus likely that health will feature high on the agenda of the COP30 Presidency of Brazil.When it comes to potential new items, it would be important that the climate and health community organize to advocate for a framework for reduction of air pollution through the massive reduction of emissions to enter the formal climate change negotiations and to consider working towards a dedicated climate and health fund proposal to be established inside or outside the UNFCCC and announced at COP30.

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This article is the third 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.

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Reference

[i]COP29 website (2024). In Solidarity for a Green World. https://cop29.az/en