Positioning health at the forefront of climate negotiations

February 08, 2024


Positioning health at the forefront of climate negotiations

February 08, 2024

Jeni Miller

Executive Director, Global Climate and Health Alliance

Dr. Jeni Miller is Executive Director of the Global Climate and Health Alliance, where she coordinates the joint efforts of national, regional and international health organizations addressing climate change. The Alliance works to minimize the health impacts of climate change and to maximize the health benefits of climate solutions, through leadership, advocacy, policy, research, and engagement. On behalf of the Alliance, Dr. Miller co-chairs the WHO-Civil Society Working Group on Climate and Health. She has two decades’ experience working on policy- and systems-change strategies to improve community environments for health, in leading initiatives addressing childhood asthma, childhood obesity, climate change, health equity, and healthy community redevelopment. Miller received her doctorate from the University of California – Berkeley.

Positioning health at the forefront of climate negotiations

In December 2023, 49 health ministers and over 60 ministers from other ministries gathered in Dubai for the first inter-ministerial meeting on climate and health held at the annual United Nations climate change conference, COP. While long overdue, the adoption of a dedicated health day at COP28 was not a surprise, as the health impacts of climate change have never been as visible as they are today.

Much of the political discourse on climate change is around emissions, finance and technology, yet the impacts of climate change affect the health of everyone. This is evident in the global impact felt in 2023, the hottest year on record, during which increased death and disability from extreme temperatures were recorded across almost all regions.1 Last Summer, wildfires in Canada and Hawaii underscored the severity of climate-related events, leading to smoke-covered cities in North America and significant casualties in Hawaii. As I write, wildfires in Chile, exacerbated by the current heatwave, have already caused more than 100 deaths.  Globally, flooding and superstorms are increasing the risk of disease outbreaks, while climate change-driven drought, impacting food production, exacerbates hunger and famine. In the Middle East, rising exposure to dust storms and water stress are growing concerns, highlighting the urgent need for climate action.

Health at COP28: a small step in the right direction

COP28 achieved notable health successes, including the Declaration on Climate and Health, advancements in the Global Goal on Adaptation (GGA), and consensus on establishing a Loss and Damage Fund to provide compensation for climate-vulnerable countries.

The Declaration on Climate and Health, formulated with input from governments in the months leading up to COP28, has garnered signatures from 149 countries to date. This widespread support signals acknowledgment of the crucial link between climate change and health, and the urgent need for action, along with emphasising the importance of preparing and strengthening health systems. The declaration also recognises that many sectors determine health. Clean air, water, sanitation, and access to nutritious food, play pivotal roles in safeguarding people's health.

Established under the Paris Agreement, the GGA aims to establish collective commitments and funding for national adaptation needs. Agreed upon for the first time at COP28, it includes language addressing the necessity to strengthen health systems, especially in vulnerable regions. Though the wording requires further strengthening with measurable targets, indicators, and clear accountability, and badly needs to be underpinned by appropriate levels of funding, this represents a positive step forward.

Countries that contribute the least to driving climate change are often those experiencing the worst impacts, but lack the time and resources to adapt and protect themselves. In some cases, the climate impacts are so extreme that adaptation isn't feasible. Developing nations have long called for funding to respond to the impacts from climate change that they haven’t been able to adapt to, and at COP28, we finally saw the operationalisation of the Loss and Damage Fund. While a crucial step in compensating vulnerable nations, the current pledge of US$700 million from wealthy nations only covers 0.2% of the projected annual need of US$400 billion.2

These measures signal recognition among countries of the link between climate change and health, and their readiness for action, however the negotiated outcomes from COP28 fall far short of the urgency and ambition required for effective climate response. Notably, fossil fuels were explicitly mentioned for the first time, with a commitment to transition away from them in the energy sector. However, it is far from a firm commitment to a full and just phase-out of fossil fuels, containing language that leaves loopholes and potential room for expanding oil and gas use.3

Maintaining momentum beyond COP28

A louder health voice in climate policy
As the damaging impacts of climate change on health become increasingly evident, involving the health community in climate negotiations, and placing health at the heart of decision-making, is vital. 

Approaching climate change through a health lens results in distinct policy decisions that directly benefit the health and wellbeing of people, locally and in the near term. Among the best examples is cutting air pollution and fossil fuel use. Even if technologies like carbon capture and storage could help control greenhouse gas emissions (this has not yet been demonstrated), they don't mitigate the harmful air pollution impacts of fossil fuel use. Air pollution currently kills around 7m people a year, and 99% of people on the planet breathe air that exceeds the World Health Organisation’s air quality guidelines.4 Eliminating fossil fuel use would both mitigate climate change and make a substantial difference to the impacts of air pollution. Similarly, transitioning to electric vehicles, alone, reduces greenhouse gas emissions but falls short of the extensive health benefits associated with active transport. Safe bikeways, sidewalks, and walking to public transportation, offer opportunities for physical activity and contribute to substantial health gains, as well as influencing mental and social well-being.

Despite record health-sector participation at COP28, with around 1,900 health professionals present, the fossil fuel sector had over 2,400 representatives.5 To ensure the health voice prevails, a well-organised and informed health community is essential. Integrating climate change into health training and advocating for health ministries to actively participate in shaping national commitments and policies that address climate change is crucial. We look forward to seeing an even greater, and increasingly well-informed, health presence at future COPs.

Investment in health systems
Strengthening our health systems is imperative to respond to the challenges of a changing climate. All health professionals need necessary training, and hospitals and clinics require proper infrastructure for effective response to weather events.

Historically, public health relied on past weather patterns for planning interventions and requirements. We're now in a time when the past is not an indicator of what's happening in the future. Adapting to future changes necessitates a shift from traditional approaches. Public health systems need real-time data and modelling, and early warning systems to let them know what is coming, whether a heat wave, a storm or period of poor air quality, so they can then take action that protects people as well as possible.

We also need to acknowledge the scale of the challenge we are facing. We're currently on a trajectory towards a world that would see nearly 3°C of global warming over the pre-industrial era.6

All the disasters and health impacts we're seeing are at 1.5°C or less. We cannot adapt to a 3°C world. Strengthening health systems alone won't suffice; addressing emissions in energy, transportation, and food systems is essential to protect public health.

A necessary equitable pursuit
Many people in the world lack access to basic primary healthcare. Healthier populations are more resilient to climate threats, which means we must invest in universal health coverage worldwide.

Solutions like renewable energy, solar power and wind power, can improve healthcare in remote or low-income areas. Solar power, for instance, provides an independent energy source for hospitals and clinics without a formal grid, enhancing healthcare accessibility.

For low-income and developing countries, scalable solutions are crucial. Wealthy nations, especially those contributing significantly to the climate crisis, have a responsibility to support vulnerable nations. While this is a moral imperative and necessary to ensure global health equity, it is also in every nation’s self-interest. The climate crisis transcends borders, and affects all of us. We must all step up and make a united global effort to ensure the well-being, and indeed survival, of us all.



1 United Nations. Hottest July ever signals ‘era of global boiling has arrived’ says UN chief. July 2023. Available from
2 Green Central Banking. ECB warns climate laggard banks of penalty escalation. December 2023. Available from
3 Wise, Jacqui. COP28 decision to “transition away” from fossil fuels is hailed as milestone but loopholes are decried. BMJ 2023;383:p2941.
4 WHO. Billions of people still breathe unhealthy air: new WHO data. April 2022. Available from
5 NPR. A record number of fossil fuel representatives are at this year's COP28 climate talks. December 2023. Available from
6 SEI, Climate Analytics, E3G, IISD, and UNEP. (2023). The Production Gap: Phasing down or phasing up? Top fossil fuel producers plan even more extraction despite climate promises. Stockholm Environment Institute, Climate Analytics, E3G, International Institute for Sustainable Development and United Nations Environment Programme.

A guest blog from Jeni Miller, executive director, Global Climate and Health Alliance

Visit The longevity equation: climate resilience for health in the Middle East to learn more

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of Economist Impact or any other member of The Economist Group. The Economist Group cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.

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