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On December 3, 2023, delegates convened for the first ever “Health Day” at the 28th United Nations Conference of the Parties (COP28)—a milestone achieved through a collaboration among the COP28 presidency, the World Health Organization (WHO), and the Wellcome Trust. The deliberations issued the COP28 UAE Declaration on Climate and Health, a detailed, nonbinding, aspirational call to action signed by over 140 countries, including the United States and China. The declaration was paired with the commitment of over $1 billion in financing (some of it reportedly not new money) for mitigation, adaptation, and other projects related to climate and health.
Climate change has been called “the greatest global health threat facing the world in the 21st century,” owing to rising awareness of the hugely damaging health impact of ever more extreme weather events, the accelerated spread of dangerous infectious diseases as weather patterns change, and the carbon burden of the health sector itself. The COP28 Health Day brought much-needed overdue attention to this complex intersection of climate change and global health and helped lay out a pathway for future diplomacy. Still, the real work remains: to clarify precise priorities, raise ample financing to lower greenhouse gas emissions, invest in health-specific adaptations that build enduring resilience in vulnerable communities, align country commitments, and improve data and track progress. Ultimately, of course, national leaders will make the political and financial decisions that determine the future trajectory of health and climate.
Compared to the $85 billion raised throughout the COP, the $1 billion in health-specific pledges are an early, quite modest beginning. The declaration successfully highlighted both mitigation (emissions reduction) and adaptation measures as critical to health goals. In the meantime, vexing concerns over any accelerated phasedown of fossil fuels convinced many energy-endowed countries—most notably, India, Russia, Saudi Arabia, and South Africa—not to sign on. COP28 will be remembered in part for successfully elevating climate and health discussions. However, it will ultimately be judged by what concrete policies and programs advance in individual countries and regional and international bodies and whether a clean health infrastructure, effective health services, and a robust health work force will be erected to protect vulnerable communities against the threats posed by climate change. A critical test will be how skillfully the leadership of future conferences systematically drives the climate and health agenda forward.
Q1: Why was there a Health Day at COP28? What did it hope to achieve?
A1: Since its first meeting in Berlin in 1995, COP has met annually and produced dramatic, signature international agreements such as the Kyoto Protocol in 1997 and the Paris Agreement in 2015. But COPs up until 2023 had not dedicated a day to health, despite growing evidence of climate change’s impact on health and the improved grasp of the healthcare sector’s sizable contributions (e.g., through health-related energy usage, transport, and buildings) to global emissions.
Several major reports, released just before COP28, added to an already burgeoning evidentiary foundation. The Lancet Countdown’s 2023 Global Report on climate and health demonstrates the rising danger from high temperatures and heat-related illness, increased transmission of dengue and other mosquito-borne diseases, and material losses due to extreme weather, which increased 23 percent in 2023. A National Academy of Medicine report notes that “healthcare must first be accountable for its own decarbonization,” and calls on national health leaders to intensify mitigation efforts to reduce health system emissions—which account for 8.5 percent of total emissions in the United States—while also pursuing adaptation efforts to strengthen resiliency. Unitaid published an analysis demonstrating that just 10 medicines and other health technologies are responsible for 3.5 megatons of carbon emissions per year, and released a new strategy to incorporate climate considerations into product development and manufacturing.
Health Day was intended to build consensus on both the need for greater action as well as specific, concrete priorities at the intersection of climate and health. To inform the deliberations, the COP28 Presidency, the Global Fund, the Green Climate Fund, the Rockefeller Foundation, the WHO, and various other partners and institutions published the COP28 Guiding Principles for Financing Climate and Health Solutions. These principles include, among others, promotion of inclusive and equitable approaches to climate and health finance, embedding climate and health goals within financing strategies, and supporting innovative research and development. To demonstrate public support ahead of Health Day, the WHO collected over 42 million signatures from health professionals for its Uniting for Health and Climate Action call. Throughout the conference, the WHO, Wellcome Trust, and others also hosted a COP28 Health Pavilion that offered diverse events highlighting climate and health issues.
Q2: Were any major agreements concluded?
A2: A total of 143 countries signed on to the COP28 UAE Declaration on Climate and Health. The declaration included calls to facilitate a One Health approach (incorporating the health of humans, animals, and ecosystems), improve early warning systems and climate-ready health workforces, and combat inequality, among other priorities. Progress on these actions will be assessed through regular convenings such as the WHO-hosted Alliance for Transformative Action on Climate and Health, which includes 75 governments and other partners who have committed to building low-carbon and climate-resilient health systems and integrating health considerations into climate policy.
While an important display of global solidarity and political will, the declaration is not enforceable, lacks specific timelines, and lost the support of a few critical countries that may limit its concrete impact. China eventually signed on—once Health Day proceedings were underway, and only after encouraging remarks by COP28 president Sultan Ahmed Al-Jaber—but India, Saudi Arabia, Russia, and South Africa did not follow China’s example. India openly cited reservations about committing to reducing fossil fuel use in the health sector as it seeks to reach ambitious national development targets. With the world’s largest population, a burgeoning health sector, and the third-largest CO2 emissions of any country, India’s abstention could be difficult to reverse in the future. The decision to omit specific language calling for a phaseout of fossil fuels from the declaration was, apparently, not sufficient to sway these dissenting countries.
Recent WHO findings tallied that only 2 percent of adaptation funding and 0.5 percent of overall climate financing are allocated to health projects. In addition to the $1 billion commitment at COP28, donors pledged $777 million at a side forum hosted by Reaching the Last Mile to finance eradication of neglected tropical diseases (NTDs). NTDs are preventable viral, parasitic, and bacterial diseases that affect over 1 billion people globally, especially impoverished populations, despite the availability of low-cost treatment. Transmission is accelerating as climate change disrupts weather patterns and expands host habitats. The United Arab Emirates and the Bill & Melinda Gates Foundation—which cosponsored the forum—each gave $100 million to the fund, and the United States contributed $114.5 million.
Q3: What directions could negotiations on climate and health take after COP?
A3: COP28 brought governments together for the first time to consider the health dimensions of climate change and set an important precedent for including these issues in future diplomacy around mitigation, adaptation, and resilience goals. The climate and health declaration, endorsed by over 140 countries, elevates health security as a critical component of climate strategy, and acknowledges the health sector’s role in climate change and climate resilience. The declaration embraces a shared commitment to decarbonization and is aligned with the recent U.S. National Climate Assessment in spotlighting climate change as having “profound negative effects on human health.” It remains to be seen whether there will be a Health Day at future COPs. An annual, one-day COP convening dedicated to health will be essential to create a regular dialogue on what is known, what progress is under way, and what more countries and other partners need to do to implement and expand commitments.
The debate on health and climate is not immune to broader tensions. Countries who rely on fossil fuels to power energy-hungry health sectors will likely continue to contest fossil fuel phaseout. Wins in the health space may be dependent on wider, slower diplomatic progress. Important in this regard, the Global Stocktake, which was agreed at the end of COP by all parties (including all major emitters) calls on countries to “transition away from fossil fuels in energy systems” and argues that economy-wide emission reduction targets need to encompass all sectors, health included.
In 2023, the world experienced extreme weather events, unprecedented heat, and widening outbreaks of malaria, dengue, and other pathogens—all acute health threats undeniably exacerbated by the pace of climate change. Public health and climate can no longer be treated as parallel issues. If, looking ahead, COP is to integrate health and climate effectively and meaningfully, it will need to tackle several barriers. The cultures and politics of climate and health are quite different. Funding siloes are rigid and encourage turf battles, while priorities and funding prospects often remain vague and uncertain, and data is often woefully insufficient. To integrate policy and programs across health and climate in places like the United States, for instance, requires confronting the deep political divisions surrounding climate (whereas global health has historically enjoyed strong bipartisanship). In other areas of the world in the midst of a populist, nationalist moment, making the case for climate and health may not be so simple or straightforward. To fill an immediate, glaring gap, the next COP should prioritize creating a community of skilled professional practitioners—rapidly and systematically—that possess expertise and operational experience in both domains. That community’s voice could prove terribly important in shaping future decisions on the challenges ahead.
Maclane Speer is a program manager with the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C. J. Stephen Morrison is senior vice president and director of the Global Health Policy Center at CSIS.
The authors wish to thank Katherine E. Bliss, Stephanie Segal, and Michaela Simoneau for their input throughout the drafting process.
