Domenico Vito

The long-awaited integration of health concerns into the UN’s annual Climate Change Conference finally materialized at COP28 in Dubai last December, nearly three decades after its inception. 

While climate change’s profound impacts on natural systems and biodiversity have long been acknowledged, it’s the human toll – the devastation wrought by fires, floods, storms, and droughts – that commands widespread attention.

In this reflection article we are gonna share reasoned observations over the health discussions brought at COP28.

PART I: The Historical ministerial health declaration

First of all we need to acknowledge that the emergence of the Health Day at COP28 in the earliest days of the second week marked a pivotal moment, convening close to 50 health ministers, , to address the pressing nexus of climate change and public health. 

Their collective efforts culminated in the adoption of the COP28 Climate and Health Declaration, a landmark agreement endorsed by 142 countries, including Canada.

This marked the inaugural occasion where an entire day of the conference was dedicated exclusively to health-related issues, signaling a paradigm shift in the conference’s agenda. As the world grapples with escalating climate crises and their human repercussions, the spotlight on health at COP28 offers a vital opportunity for reflection and action.

Starting with the positives, it’s heartening to report on Canada’s participation in a Health Day event, attended by our federal health minister, where the country committed to a significant declaration. 

This declaration notably voiced concerns about the detrimental effects of climate change on health and emphasized the urgency of addressing these issues. It highlighted the potential health benefits of substantial reductions in greenhouse gas emissions, although its scope was primarily confined to emissions within the health sector. Furthermore, it advocated for various measures such as just transitions, lower air pollution, active mobility, and sustainable diets, albeit lacking specific details.

However, the declaration’s shows a strong emphasis on adaptation over mitigation, with adaptation being mentioned six times compared to just one mention of mitigation. This inclination towards adaptation is echoed in the Joint Statement on COP28 from Canada’s Ministers of Health, Environment and Climate Change, and Indigenous Services. Notably absent from the statement are any references to mitigation efforts, fossil fuel reduction, or subsidies. Instead, the focus remains solely on adapting health systems to climate change and mitigating risks such as extreme heat exposure

Countries committed to eight “common objectives” identified in the declaration. These are not particularly well structured and a bit of a mish-mash, but here are the key points as I see them, structured around key themes:

  • First, there is a focus on the social determinants of health and health equity, with three of the common objectives addressing inequalities within and among countries: meeting Sustainable Development Goals; pursuing health-enhancing adaptation policies “across a range of sectors, including food and agriculture, water and sanitation, housing, urban planning, health care, transportation and energy;” and maximizing health gains for disadvantaged and vulnerable groups.
  • Another common objective referred to “addressing the environmental determinants of health,” although it was mostly concerned with a narrower “One Health” approach to antimicrobial resistance and pandemic prevention.
  • Three common objectives referred to the health sector, with one specifically directed to reducing the climate impact of the health system by “promoting steps to curb emissions and reduce waste in the health sector.” The other two addressed the need for the system to prepare for and respond to climate-sensitive diseases and health risks and, more broadly, preparedness to address “mental health and psychosocial wellbeing, loss of traditional medicinal knowledge, loss of livelihoods and culture, and climate-induced displacement and migration.”
  • The eighth common objective focused on research and knowledge development: “Strengthening trans- and interdisciplinary research, cross-sectoral collaboration, sharing of best practices, and monitoring of progress at the climate-health nexus.”

Source (1) 

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In summary, while there are positive aspects to be celebrated, such as Canada’s commitment to addressing climate change’s impact on health, there is a notable gap in prioritizing mitigation strategies. 

This emphasis on adaptation, evident in both the declaration and subsequent ministerial statements, highlights the need for a more comprehensive approach to tackling the health challenges posed by climate change.

PART II: Health arguments in the negotiation texts

Global Stocktake 

The Global Stocktake (GST) serves as the evaluation mechanism for the Paris Agreement’s progress, akin to a “report card” aiming to boost ambition in Nationally Determined Contributions (NDCs). It encompasses both technical and political dimensions. Technically, discussions have ensued through roundtables and written submissions post-COP26. Health features prominently in six dedicated submissions, with numerous others touching upon its significance. The synthesis report acknowledges health’s relevance in climate action, citing it 13 times, particularly emphasizing co-benefits. Politically, the focus lies on subsequent sessions like SB58 and COP28, tasked with charting the course for the next round of NDCs.

Among the main contentious issues are debates over the approach to fossil fuels—whether to phase out, phase down, or transition away from them. Additionally, the finance aspect poses challenges, with the failure to meet the $100 billion annual goal by 2020 and concerns regarding overall support for transitioning (including finance, technology, and capacity building). A critical divergence exists between advocating for specific policy prescriptions versus offering general guidance.

In the final decision on GST, health finds mention concerning the right to health and a clean, healthy, and sustainable environment. Adaptation strategies focus on enhancing resilience against climate-induced health impacts and fostering climate-resilient health services. Moving forward, countries are expected to leverage the GST’s political decision to inform their next set of NDCs, advocating for heightened ambition and integrating health considerations, as highlighted in the technical discussions.

Loss and Damage

Losses and damages in health encompass both physical and mental impacts of Extreme Weather Events (EWEs) and Slow-Onset Events (SOEs), along with challenges related to climate-sensitive diseases, access to health services, and climate-induced migration amidst resource scarcity. At COP28, discussions centered on the host agency for the Support Network for Loss and Damage (SNLD) and its operationalization, following a delayed decision from SB58 in June 2023.

The outcome includes the decision to locate the network at UNDRR/UNOPS for an initial five-year term, renewable every five years thereafter. Operationalization efforts are set to commence promptly, including the selection of a host-office location and the recruitment of a director and team. Meanwhile, the UNFCCC secretariat will continue supporting developing countries until the SNLD is fully operational. Upcoming steps entail a meeting of the Advisory Board from March 12-15, alongside the Executive Committee of WIM.

Regarding financial aspects, health losses and damages fall under the category of “non-economic” losses, underscoring their non-tradability. The decision to establish a Loss and Damage Fund, adopted on day one of COP28, designates the World Bank as its host for an initial four-year term following eight months of deliberation. However, critical questions remain unresolved, such as determining interest rates and defining needs-based allocations. The fund’s operationalization hinges on capitalization, with only $792 million secured thus far, a mere fraction of what’s required.

Mitigation Work Program

Mitigation efforts are pivotal in curbing the pace of global warming and mitigating climate-related health risks, offering additional health co-benefits. The Mitigation Work Program (MWP), spanning four years, has been a subject of contention. Initially, it surfaced as an “informal tool” for discussions, with varying emphasis on fossil fuels. While health wasn’t prominently discussed, a report adopted within the process touched upon its importance, particularly concerning air quality, road safety, and job creation. Themes for upcoming workshops in 2024 remain to be confirmed.


Finance stands as a linchpin for climate and health initiatives, necessitating increased funding and enhanced utilization. Recognizing the interplay between finance and equity, there’s an assertion that robust health integration yields high returns on investment. Discussions pivot around public finance versus broader financing flows, with a central agenda item being the establishment of a New Collective Quantified Goal, intended to supplant the $100 billion USD target. Notably, while acknowledging disparate estimates, progress towards this target remains a point of contention. Insights from the High-Level Expert Group on Climate Finance underline the substantial financial requirements, especially for emerging markets and developing countries, estimated at $2.4 trillion USD annually. Discussions also revolve around broadening the contributor base to enhance financial support.

PART  III : Health future and present commitments by countries

Island Health in the Philippines:

The Philippines, an archipelago with diverse ecosystems, grapples with the health implications of climate change. Rising sea levels, extreme weather events, and vector-borne diseases pose significant threats. Understanding the unique challenges faced by island communities is crucial for developing effective health strategies.

EU – One Health Initiative:

The European Union adopted  a comprehensive approach through its One Health initiative. Recognizing the interconnectedness of human, animal, and environmental health, the EU aims to create a harmonized strategy to address emerging health threats. This commitment has been expressed 

Healthy Hospital Initiatives:

Around the globe, hospitals are recognizing the need to adapt to climate change. Healthy Hospital initiatives focus on sustainable practices, energy efficiency, and resilience, ensuring that healthcare facilities not only provide care but also contribute to environmental well-being.

Malaria and Global Preparedness:

Malaria remains a major global health concern exacerbated by climate change. Efforts to combat the disease involve international cooperation, research, and the development of emergency plans. The pressing need for a coordinated response is highlighted by the inclusion of the term “Pres emergency plan of” in the provided keywords.

Italy’s Coastal Challenges:

Italy, with its vast coastal areas, faces unique climate-related challenges. An aging population adds complexity to healthcare considerations. The country is implementing an innovative worldwide early warning system within its health system to mitigate the impact of climate change.

Argentina’s Mental Health Readiness:

Argentina recognizes the importance of mental health readiness in the face of climate challenges. By mainstreaming climate and health considerations into all policies, the country aims to foster resilience and preparedness among its population.

Engaging Communities and Perspectives:

A critical aspect of addressing climate and health issues is community engagement. Initiatives that incorporate diverse perspectives and actively involve communities contribute to more effective and sustainable solutions.

Tuvalu and Fiji: Building Healthcare Resilience:

Small island nations like Tuvalu and Fiji are acutely aware of the existential threat posed by rising sea levels. These nations are actively working to build healthcare resilience, acknowledging the need for adaptation and preparedness in the face of climate-induced challenges.



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