It’s time we frame the climate change debate around health

As COP25 came to a close in Madrid last weekend, general reaction to what was supposed to be the climate event of the year, has been disappointment. Little to no agreement was found on climate markets; making and meeting commitments for climate financing, particularly for poorer countries, and the overall declaration of the conference was weakened to stating nothing further on countries’ individual pledges to raise decarbonisation targets.

In the context of the 2018 Intergovernmental Panel on Climate Change (IPCC) report, which estimated there is only a decade left to limit catastrophic climate change, and the grassroots global protest movements that have been seen, the progress seen in Madrid was more than disappointing. Next year’s COP26, which will be hosted in Scotland, has become a “make or break” moment for agreement on international commitments.

What can we do as the new decade of 2020 looms to get commitments and ambition from global leaders on new climate change agreement? The priority should be to look at the domestic interests of each government. There are various opportunities to make a stronger case for action on climate change by showing how it is already affecting their social, economic, and political local priorities. Some of the arguments for the co-benefits that come from both reducing greenhouse gas emissions and adapting to the impacts of climate change are well developed. For example, we are witnessing a massive investment in renewable energy in India, China, and elsewhere due to the benefits it provides for national energy security. One of the co-benefits for action on climate change which has so far been woefully under-explored is the link to health.

Climate change increases health risks

In the run up to this year’s conference, Lancet Global Health published an annual report highlighting the impacts of climate change on health. While this theme did gain some traction during the climate conference, with a one-day event, it was largely background noise, even when the launch of the report gained global media coverage ahead of the COP25 conference.

The Lancet report addresses three main areas: the impact of climate change on health, the twin impacts on the economy, and what countries are doing about it? Beyond the link between climate change and health, the report also focuses on current and past evidence to avoid any criticism of promoting fear based on modelling the future. One of the reports main findings shows that while temperatures have been rising steadily, this rise has been felt more acutely in densely populated areas with increased risks to health. This report is an important new piece of evidence on the link between climate change and health, a subject that has been under researched to date. It is clear that climate change is already affecting our health in different ways, with more frequent and extreme natural disasters, such as flooding or wildfire causing death and disability, regular heat waves that saw a record breaking number of exposures to extreme heat in 2018, gradual increases in temperatures leading to optimal conditions for the proliferation of mosquitos and the spread of malaria and dengue, and increased air pollution in towns and cities causing wide-ranging health impacts and contributing to over seven million deaths a year. This is just a sample of the many health impacts of climate change.

These direct health impacts will have wide-ranging consequences for economies. The supply of labour will be significantly affected from death and disability caused by extreme events such as flooding or wildfires. In addition, many hours of the day will become unworkable due to high temperatures, which will in particular impact the agricultural sector. The economic impact of extreme weather events in 2018 was estimated to be US$166 billion, no occurrences in low-income countries were covered by insurance. Meanwhile, 133.6 billion potential work hours were lost in 2018 due to rising temperatures.

How to raise ambition

While the link between climate change and health is increasingly recognised by national governments, it does not yet appear to be driving increased action. Based on preliminary research by the WHO, 70 countries either have, or are developing, a health strategy or plan for adapting to climate change. However, there is a marked disparity between those who have made commitments and have funding to spend on climate change adaptation, and the countries who have the biggest impact on climate change (and therefore need to do so). Beyond individual efforts, the WHO has also surveyed international responses, such as the Green Climate Fund, and found that not a single project has had a health focus.

There are many real-life examples of how action on climate change can bring co-benefits to improved public health. Addressing fossil fuel subsidies and adapting to extreme heat are two of these.

The price of fossil fuels in many countries is far below their true market cost. Besides the negative externalities that are not captured in their price, reflected by their negative impact on the environment and on human health, many countries offer fuel subsidies. A removal of these subsidies would begin to approach a reflection of their true market cost and prevent a series of non-communicable disease and millions of deaths, as well as addressing a major contributor to climate change. Fossil fuel subsidies, ranging from diesel, natural gas, and coal, cost over US$5.2 trillion, according to the IMF, and within OECD countries this has grown even further, being 50% larger in 2018 than in 2016. Besides contributing to better health and lowering carbon emissions, reducing fossil fuel subsidies can lead to indirect benefits in health and beyond, by freeing up public resources that can be reinvested into the health and other social sectors. In 2019, several countries moved to cut or eliminate fossil fuel subsidies, and notably, such as in Ecuador and Iran, these were met with significant public backlash and social protests. As these reforms were made in response to external factors and done principally in order to ease fiscal pressures, there was little planning and messaging of what the health and other benefits of reforms would be. OPM has recently supported Tunisia create an evidence base of the benefits of reducing fossil fuel subsidies and scaling up social programs that focus on the well-being of children. A new law related to social protection has been approved and is awaiting adoption in parliament, which will implement a new child grant, to be financed by a reduction in fossil fuel subsidies.

While acknowledging fuel subsidies as a complex, and politically challenging issue, large and significant changes can be made if all countries are supported in putting together plans that present a roadmap for reducing and eliminating fuel subsidies, (and eventually taxing fossil fuels) that take into account sequencing of reforms, identifying winners and losers from these, and ways to compensate losers in a way that avoids violent protest.

An example of how adaptation to climate change can bring significant health impacts is the issue of extreme heat. Cities in India are increasingly introducing heat-health policies and systems. One of the first was Ahmedabad, with the first Heat Health Action Plan launched in 2013. A devastating heatwave in the city in 2010 contributed to 1,000 deaths and motivated the city to introduce awareness raising and risk reduction measures on how to protect people from temperatures which reach 42°C (108°F) during heatwaves. The city now uses a simple colour-coded early warning ‘heat alert’ system, triggering protective action such as installing water dispensers and keeping shaded parks open. It has also led to hospitals implementing some “green” interventions to reduce temperatures, such as replacing black tar roofs with white tile roofs. We have supported the scaling-up of these heat-health measures, supporting an industrial cluster, Jharsuguda, in Odisha to carry out their own heat health study.

As we gear up to mobilise a greater level of effort, ambition, and commitment at the 2020 climate conference in Glasgow, we need to use more convincing arguments, which focus on national interest. The impacts of climate change on public health, and in turn the wider social and economic effects this will bring, need to be front and centre within a new narrative. To do this, as made clear by the Lancet Countdown report, the two communities of climate change and health researchers, campaigners and practitioners, need to come together and make the argument. Discussions at the national and international level on climate change, should follow suit.