The health sector has a multitude of complex interconnections with climate change, but they have not yet been adequately explored and operationalized through multilateral policy and negotiation processes. The UAE Declaration on Climate and Health at the UNFCCC COP28 in 2023 as well as the Climate Change and Health Resolution introduced at the 77^th World Health Assembly (WHA) in 2024 are two important milestones towards stronger interlinkages between the two global agendas.

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The UAE Declaration on Climate and Health

The highlight of the COP28 Health Day was the official adoption of the Climate and Health Declaration. It is a political declaration that acknowledges climate change impacts on health, and as such, it is a nonbinding, aspirational call to action. To draft the Declaration, the UAE collaborated with Germany, Fiji, Kenya, Malawi, Netherlands, UK, and USA, which were also early endorsers at the World Health Assembly (WHA) in Berlin in May 2023. At COP28, the Declaration was endorsed by 123 countries. By June 2024, 151 countries signed the Declaration, with China and Turkey among the countries signing after the official deadline. South Africa, India, Russia, and Saudi Arabia did not sign, with India, the lead country of the G20 Climate and Health Initiative, citing reservations about committing to reducing fossil fuel use in the health sector.

The Climate and Health Declaration was supported by aggregated pledges of USD 1 billion raised from states, philanthropy, global funds, and multilateral development banks. The large share of mobilised funding is not new and additional, as roughly USD 800 million are pre-committed and -earmarked and not yet available, according to Vanessa Kerry, the World Health Organization (WHO) Special Envoy for Climate Change and Health. There was also a record number of health ministers and senior health officials attending the historically first Climate and Health Ministerial at COP28, with 49 health ministers attending and many innovative ideas being discussed by some 1,900 climate and health community members at the Health Pavilion convened by the WHO and Wellcome Trust.

The Climate and Health Declaration has two main objectives:

1. Resilient and low-carbon healthcare systems
2. Resilient communities, with a specific focus on the most vulnerable populations

Its ambition is to bring the United Nations Framework Convention on Climate Change (UNFCCC) and WHO processes closer together and work towards better integration and synergies between the climate and health sectors. In order to do so, the Declaration proposes to adopt the “One Health” approach – incorporating the health of humans, animals, and environments, thus also introducing the work on pandemic prevention, preparedness, and response to climate negotiations. It also makes references to anticipatory action and early warning, mental health, traditional medicine, displacement and migration, and poverty, while the largest section is dedicated to finance.

The Climate and Health Declaration articulates both mitigation and adaptation action, but it has a stronger emphasis on climate impacts and adaptation. Although the operationalization of the Loss and Damage Fund was one of the main highlights of COP28, there is no reference to loss and damage in the text. Some advocates perceive the commitments worthy, but broad and specifics not sketched out. Some others point out that the Declaration is not enforceable, lacks specific timelines, opens loopholes and lost the support of a few critical countries that may limit its concrete impact. Finally, some advocates focusing on the process pointed out the need to identify priorities, commit finances, align country commitments, and improve data and progress tracking. Another important question is how health indicators, for example related to air pollution, could be better integrated into global measures of progress on climate change.

Significantly, although the Climate and Health Declaration speaks about the need for “deep, rapid, and sustained reductions in greenhouse gas emissions,” the phase-out of fossil fuels is not explicitly mentioned. This omission left the Lancet, whose 2022 Countdown Report was entitled “Health at the Mercy of Fossil Fuels,” worried about the health sector’s complacency. They alleged that health might be serving as a distraction from mitigation targets and, in this regard, introduced the concept of “health washing” as the final deal does not go far enough. This might also be the context of the WHO press conference held after COP28, during which the WHO Director General singled out a fossil fuel phase-out as a major issue for the health sector.

The WHA Climate Change and Health Resolution

In the aftermath of the COP28 and following the UNFCCC, the WHO member states at the 77^th WHA adopted a Climate Change and Health Resolution on May 29^th, 2024. Developed by the Netherlands and Peru and proposed by eighteen states, the Resolution identifies climate change as a major threat to public health, catalogues the existing threats, and sets out a framework to build climate-resilient and sustainable health systems. While the WHO’s 13^th General Programme of Work for 2018-2023 did not include a specific climate priority, the newly adopted 14^th General Programme of Work for 2025-2028 features transformative action on climate and health as the first among six strategic objectives.

The Resolution unfolds with cross-textual references to previous WHA decisions and WHO documents (which date as far back as 2008) mandating work on climate, environment, and health and air pollution, chemicals, and waste. It highlights an ambition to decrease the carbon footprint of the health sector (estimated at 5% of total global carbon emissions) and the need to integrate climate into health monitoring systems while calling on national governments to actively participate in the Alliance for Action on Climate Change and Health (ATACH): a WHO-led mechanism and a platform for coordination on the climate and health nexus as well as exchange of knowledge and best practices, which currently includes 77 states.

In correspondence to the Climate and Health Declaration, the WHA resolution also includes references to the UNFCCC, the Paris Agreement, the Intergovernmental Panel on Climate Change (IPCC), the Sustainable Development Goals (SDGs), finance, research and science, gender, and vulnerability, urging countries to pursue multilateral collaboration and the “One Health” approach.

The above are the main convergences between these major climate and health community documents. However, what needs to be highlighted is that, unlike the Climate and Health Declaration, the WHA Resolution explicitly mentions the principles of common but differentiated responsibilities (CBDR) and L&D. Finally, in one additional convergence with the Climate and Health Declaration, the WHA Resolution also does not entail any reference to an explicit fossil fuel phase-out and thus extends the concerns about the health sector distraction and complacency.

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Conclusions

The UAE Declaration and the WHA Resolution indicate a growing momentum to integrate health and climate change processes in a more meaningful and effective way. Looking from a climate change angle and especially at the negotiations under the UNFCCC and the Paris Agreement, the next article in this series will take a deep dive into the technical and political workstreams and some key entry points for health in the global climate negotiations, including the Global Goal on Adaptation and Nationally Determined Contributions.

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This article is the second 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.