Health is on the agenda at UN climate negotiations. Here's why that's a big deal

Heat wave after heat wave swept across the planet this year, their intensity and length pushed to never-before-seen extremes by human-caused climate change.

The heat isn't just uncomfortable: it kills. And it's the clearest signal that climate change is making the Earth a more unhealthy, dangerous place.

The health toll of climate change will come under the spotlight at this year's international climate negotiations in Dubai, known as COP28, where for the first time the meeting will feature prominent conversations about exactly how a warming planet hurts people. At the first-ever "Health Day" Sunday, and throughout the conference, world leaders, health ministers from dozens of countries, and a wide array of health organizations are expected to make the case that climate action will lead to immediate, dramatic improvements in global wellbeing.

The new inclusion of health into the climate meeting addresses an urgent need and is an important step forward, says Diarmid Campbell-Lendruma, who leads the climate change and health team at the World Health Organization (WHO).

"Our first priority is strong action to mitigate carbon emissions," he says. "That is our shared goal. We can't guarantee a livable future unless we drive down the fossil fuels that cause climate change."

The inclusion comes just after the World Meteorological Association announced that 2023 is the hottest year ever recorded.

A long time coming

Campbell-Lendruma has attended COP meetings for 20 years. At his first, in 2003, there were two health-focused attendees: him and a colleague from the WHO.

Since then, momentum has gathered, but slowly. That's at least in part because for many years, climate change was presented as a future problem, says Kristi Ebi, a climate and health expert at the University of Washington who has been involved in climate and health research for decades.

"But as science has advanced and as climate change has proceeded, it's a different world today," says Ebi. "Where we see people suffering and dying right now from climate change. And that does completely change the dynamic."

Climate change's harms have become more obvious, and dangerous, in recent years. A 2022 summer heat wave in Europe killed an estimated 60,000 people, and this year's extreme heat harmed many more.

Public health organizations are seeing a resurgence of insect borne diseases like malaria that were on the cusp of being controlled. Children born today, says Lujain Alqodmani, a doctor and president of the World Medical Association, will live every day of their lives in a world shaped by climate change–one that is hotter, with more intense weather, and harder on their developing bodies.

The negotiating documents that came from the first international climate agreement in 1992, recognized that climate change would have an "adverse effect" on human health. Twenty-four years later, the 2015 Paris Agreement followed up, recognizing the worldwide right to a healthy environment.

This year, representatives from health ministries from more than 90 countries are attending the talks. Hundreds of doctors, nurses, and other medical professionals are also in Dubai.

"This is the first true opportunity to bring the health voice to the climate community," says Estelle Willie, director of health policy at the Rockefeller Foundation, a major funder for climate and health initiatives worldwide.

How climate change hurts human health

There are many climate risks to the global health system, and those risks are growing. Extreme heat is the most obvious. But climate disasters also damage health infrastructure, like clinics and hospitals, which prevents people from getting care after disasters.

Climate change makes those disasters more intense. Unprecedented rainfall in Pakistan in 2022, for example, drove floods so voluminous they covered one third of the country, displacing millions and causing long-lasting health ripple effects. Climate change is affecting food security in many parts of the world. And it is increasing the risks of disease, sometimes in unexpected ways.

Githinji Gitahi is a doctor based in Kenya and CEO of the African Medical and Research Foundation, or Amref. In recent weeks, floods in his country have caused more than 100 deaths. The initial disaster is only the beginning of the health risk, he says, because the flooding is causing issues with water and sanitation systems.

"That means that there is likely to be a cholera outbreak in many of these areas where there was flooding," Gitahi says.

Burning fossil fuels also produces local air pollution that kills millions every year. In the U.S., particles from coal burning killed an estimated 460,000 people over 65 in the past 20 years. But deaths drop as soon as plants close or air-cleaning filters are installed. Because the health benefits start when pollution stops, cutting fossil fuel burning could save millions of lives quickly, says Sir Andy Haines, a researcher at the London School of Hygiene and Tropical Medicine.

"As we move towards clean, renewable energy, we reduce these preventable deaths from air pollution, as well as reducing the risk of climate change, dangerous climate change," says Haines.

What could happen at COP28?

The health community's priority at the UN climate talks in Dubai is advocating for a swift and complete phase-out of fossil fuel use, says Miller.

"We've got to stop making the problem worse," she says.

Such an agreement is unlikely to occur. A debate about whether to "phase out" or "phase down" fossil fuel use derailed negotiations at last year's COP27. Many oil-producing countries favor agreements that would allow fossil fuel burning to continue if "abated," or with its carbon emissions offset or captured. Simply phasing down fossil fuel use, would fail to address the particulate pollution that causes millions of deaths annually worldwide, says Miller, of the Global Climate and Health Alliance.

But continued discussion of a fossil-fuel-phase out is a priority, says Alice Bell, head of climate and health policy at the Wellcome Trust, a major funder of initiatives worldwide.

"We want something more explicit to be said about the phase out of fossil fuels," says Bell. "That was one of the things that was really watered down last year, and was really disappointing last year at COP27. And is one of the things people are really ready for a fight about this year."

Countries also need financial help to deal with the problems climate change is already causing. Less than 1% of the global funding directed toward climate change is earmarked for health issues. But on Saturday, international development banks and funds like the Green Climate Fund, as well as nonprofits like the Rockefeller Foundation, announced $1 billion in new commitments to fund health and climate-related projects. Jess Beagley, policy lead of the Global Climate and Health Alliance, wrote in a statement that the commitment is "a tremendous addition to current levels of climate and health finance."

More than 120 countries have also endorsed a declaration explicating the link between climate change and human health. It's a step toward integrating health considerations into the negotiations more formally, says Bell.

"The Paris accord in 2015 recognizes a right to health. And I think we need to see that fleshed out a bit to see what does that mean," she says.

Inevitably, that means addressing the fundamental driver of climate change: fossil fuel burning. The concept of tackling the root cause or an illness, rather than treating the symptoms alone, is both intuitive and imperative to many healthcare practitioners.

"You can't be in the business of healing people by making them sick," says Shweta Narayan, a healthcare advocate based in India who works for the nonprofit Health Care Without Harm.