Observations from COP27: Health Care Is Becoming a Bigger Part of the Climate Change Solution

Situated between the historic peaks of the Sinai Peninsula and the endangered coral beds of the Red Sea, the resort town of Sharm El-Sheikh provided a striking natural setting for the 27th annual Conference of Parties (COP27) global negotiations on climate change. This year’s meeting followed a watershed meeting for climate change and health considerations in Glasgow, where the first official U.S. delegation from the Department of Health and Human Services (DHHS) pledged U.S. participation in the COP26 Health Programme¹ alongside 51 other countries. Although this year’s meeting disappointed by not featuring health as one of its 11 themes, the momentum established in Glasgow continued, and this year’s discussions foreshadowed increasingly meaningful engagement of health ministries, systems, professionals, corporations, and philanthropic groups in addressing the health implications of the climate crisis.

Background

The authors of the United Nations Framework Convention on Climate Change (UNFCCC), which governs the annual COP meetings, recognized the importance of health in their objective of avoiding “dangerous anthropogenic interference with the climate system.”² The UNFCCC recognized health impacts in its definition of “adverse effects of climate change,” and Article 4 of the convention calls on countries to assess and minimize any adverse public health implications of climate actions.²

Despite the inclusion of health concerns from the start, the health community was late to engage in the COP meetings. The first climate and health summit, sponsored by the World Health Organization (WHO), did not occur until COP17 in 2011.³ Although there has been a growing presence of the health community at COP meetings since former WHO Director General Margaret Chan called for human health to be placed “at the heart of the climate change agenda” as part of the first World Health Day devoted to climate change in 2008,⁴ it was not until the COP26 Health Programme that a significant number of the world’s health ministries committed to concrete health sector climate actions. Those commitments—to low-carbon and climate-resilient health systems and the protection of the health of all people, with a focus on those most vulnerable—are a major step forward in achieving Director General Chan’s goal to place health in a central role in climate change deliberations.

What DHHS Brought to COP27

On 10 November 2022, the DHHS Office of Climate Change and Health Equity made two announcements⁵ in a side event at the U.S. Center in Sharm El-Sheikh: a) that $>100$ health sector organizations had committed to the White House/DHHS Health Sector Climate Pledge and b) that DHHS is launching a new initiative with National Health Service England to harmonize procurement standards for our national health systems over the coming year. The Climate Pledge calls on organizations from hospitals and medical schools to pharmaceutical companies and health insurers to meet the Biden Administration’s decarbonization goals⁶—including a 50% reduction in direct emissions of greenhouse gases by 2030 and net zero (and near total elimination of) direct and indirect greenhouse gas emissions by 2050—and to plan for resilience for their organizations and the communities they serve.

With dozens of health organizations signed on and $>\mathrm{1,000}$ hospitals now pledged to these goals (including the U.S. federal health systems within the Department of Defense, Department of Veterans Affairs, and Indian Health Service), roughly one in six U.S. hospitals are now committed to critical, urgent climate actions.⁷ Because the majority of health system greenhouse gas emissions are indirect (known as Scope 3 emissions in climate policy parlance) and the majority of those indirect emissions are associated with procurement of food, drugs, and other medical supplies, the initiative with National Health Service England is a significant first step in both establishing and globally harmonizing the path toward decarbonization for health system suppliers, many of which are global in scope.

What We Encountered

DHHS was certainly not the only major health organization bringing actions and deliverables to share at COP27. A high-level panel⁸ we participated in on the Alliance for Transformative Action for Climate and Health (the community comprising countries pledged to the COP26 Health Programme) featured the leadership of organizations such as The Global Fund,⁹ AstraZeneca,¹⁰ and the World Bank¹¹ making similar commitments to align their procurement requirements for medical supplies with science-based targets¹² for climate-smart, sustainable health systems. The significance of this cannot be overstated.

Health care has a climate footprint equivalent to 4.4% of global net emissions,¹³ so when mainstream organizations in global health and the health sector make public commitments to decarbonization on a global stage like COP27, the implications are not just symbolic but substantive. The health sector can have a uniquely compelling and credible voice at the table in the climate debates, but that voice resonates more deeply when we make solid commitments, rather than simply communicating about the health threats of climate change.

The official outcomes of COP27, especially those related to the creation of a fund for loss and damage and boosting of adaptation funding for low-income countries,¹⁴ have enormous implications for public health and the health sector as health ministries around the world try to catch up to other sectors in developing and implementing adaptation plans and securing climate adaptation funding.

Looking Forward to COP28

COP28 will take place starting 30 November 2023 in Dubai. The United Arab Emirates has already begun planning the agenda, querying the health community on how to make the conference a meaningful step toward achieving low-carbon, resilient health systems and the enhancement of public health through climate actions around the world. One thing is clear from my experience at COP27—this must be the year when climate actions for health are discussed, planned, and implemented. This work should proceed continuously in two parallel tracks: The health community must make decarbonization and climate resilience a priority, and the climate community must make health care and health-informed mitigation central to their work.

The events at any COP meeting are the result of months of negotiations and preparations that start at the previous COP and peak at a meeting that occurs in Bonn, Germany, each June. Each country’s health department, especially those participating in the COP26 Health Programme, should be engaging with their colleagues in other departments on their UNFCCC deliverables and milestones, namely adaptation plans, finance applications, and “nationally determined contributions”¹⁵ reports. But more importantly, the global health community should be raising climate actions front and center at all the meetings and events in their world, such as the World Economic Forum at Davos, the World Health Assembly, and the World Health summit, among others.

For the health community to become part of the solution to the climate crisis and not just a messaging theme, it will have to integrate climate actions into its own agenda, in addition to focusing on health in the climate agenda. The DHHS Office of Climate Change and Health Equity stands ready to do our part domestically and to support our global health colleagues around the world in this crucial activity.