The impact of COP26 on healthcare

COP26 didn’t extinguish all hope, but given the urgency of this crisis, the conference fell short, write Rita Issa and Jacob Krzanowski

CREDIT: This is an edited version of an article that originally appeared on The BMJ

Much of the activity at COP26 aimed to affirm the Paris Agreement’s commitment to ‘Keep 1.5°C Alive’. A 1.5°C increase above pre-industrial global temperatures is already incompatible with existence for many, including some Small Island Developing States; but heating beyond this point is seen by scientists as a cliff edge, moving us closer to the uncertain territory of climatic tipping points, ecosystem collapse and worsening climate, with severe consequences for all life on earth. In order to protect current and future generations, three key actions were debated; the need to mitigate future impacts by curbing carbon emissions today, adaptation to the impacts of climate for those who are, and will be, affected and, a process to establish liability and compensation for loss and damage for vulnerable and developing countries.

Empirical evidence suggests we are currently at 1.1°C of global warming, on average, compared to pre-industrial levels. The (non-binding) country commitments made at COP26 in Nationally Determined Commitments (NDCs) have us on track for 2.4°C. While we recognise that, in the tug-of-war of negotiations, commitments will, inevitably, be watered down compromises, what this means in practice, is – like a smoker who plans to quit on their next birthday – that the burden of painful decisions and dire consequences are offloaded onto future generations and already vulnerable communities.

Health and outcome at COP26

The COVID-19 pandemic has mobilised individuals, health systems and nation states to action on a scale, and with speed, rarely seen. For the health professionals among us at COP26 – having worked through the pandemic while keenly aware of the climate crisis as a greater public health threat – the absence of health at the centre of negotiations is a stark omission. Despite a lack of centrality, health was still represented with greater presence and impact than in previous years by the WHO’s health pavilion, a commitment from over 50 health systems to achieve carbon neutrality, a high-level acknowledgment of the triple nexus of climate change, migration and health, the delivery of a WHO report – and the climate prescription on behalf of 46 million healthcare workers – from Geneva to Glasgow, alongside a number of actions by doctors and medical students.

Beyond these health-wins, the outcomes set out in the Glasgow Climate Pact included consensus from governments to ‘revisit and strengthen’ their 2030 emission targets by 2022, double-fund adaptation by 2025 from 2019 levels, and renew commitment to the goal of $100bn per year of climate finance from developed countries. An important framework for establishing carbon markets, and a system of accountability around NDCs, was agreed upon, but many were left with serious hesitations that it can protect against further greenwashing.

A greater acknowledgment of nature and its role in supporting decarbonisation – ‘Nature-Based Solutions’ – was seen in a pledge to end deforestation by 2030. Encouragingly, this reflects a growing understanding of how the parallel crises of desertification, pollution, biodiversity loss and climate change are deeply entangled, with shared drivers and solutions. For sceptics, nature’s role at COP might just be an opportunity to offset country emissions that enables continued fossil fuel consumption, allowing ongoing delay and global inequity.

Missed opportunities

Unbelievably, this was the first COP to officially acknowledge the importance of reducing fossil fuels – yet an initial agreement to ‘phase out’ coal was altered to ‘phase down’ in the final hours. Clearly language matters. Climate change and its impacts are already here for many, and significant numbers of most affected countries weren’t represented, due to vaccine inequality, financial barriers and difficulties with the timely provision of visas. Meanwhile, the fossil fuel industry sent the largest delegation of any stakeholder.

Where next?

Globally, the health sector of the largest economies contributes to four per cent of global carbon emissions; at COP26 many countries committed to reducing their health sector’s carbon output and waste, with a view of reaching net-zero. Building on this foundation of mitigating global heating, the health community has begun mobilising towards climate-resilient health systems which are responsive, adaptive, net-zero (or, ideally, zero carbon) and minimally polluting. Simultaneous is the need for sustainable health systems, with resilient, engaged staff, prepared healthcare students and populations that are well-positioned to adapt to the demands of planetary crisis. At the centre of this strategy are public health principles that celebrate illness prevention by supporting healthy communities and addressing the causes of inequity which drive morbidity. Adaptation cannot be defined solely by the resilience of our facilities and, indeed, the most sustainable health service is one where the people it serves are free from illness.

Achievement of this vision can be accelerated and elevated by strengthening relationships within national and global health communities, and beyond, as the health community moves to better integrate and engage with the wider climate movement. A powerful voice for change and ambition, framing climate action through health provides a common shared language and universally agreeable goals. The WHO’s letter and report make a good start, with demands that encompass equity and environment, aligning closely with the concept of climate justice – a reshaping of climate action from a technical effort to cut emissions into an approach that understands that meaningful change can only come through focusing on championing human rights, overcoming social inequality and respecting planetary boundaries.

COP26 didn’t extinguish all hope. However, given the urgency of this crisis, the conference fell short, starkly underlined by limited representation from most impacted people, failures to reasonably address loss and damage, the appropriation of young people and the ultimate failure of strategies and consensus that would limit global heating to 1.5°C.

As ever, the conference’s effectiveness will be judged by the passing of time; the realisation of the Glasgow Climate Pact will be decided by leaders’ sense of ethics and belief in a global community, while civil society builds on the connections made in the streets of Glasgow.

Meanwhile the health community must continue to develop its identity as advocates and stewards, for a just and equitable transition, in service to the ‘more beautiful world our hearts know is possible’.