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      The global health community at international climate change negotiations

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          Abstract

          SUMMARY BOX Health played a central role in the recent Conference of Parties 28 (COP28): witnessing the first official ‘Health Day’, the first COP climate-health ministerial, endorsements of a declaration on climate change and health by 149 countries, the highest number of climate and health-related side-events, and funding commitments of US$1 billion dedicated to climate and health. In this first-ever quantitative analysis of the health community’s attendance at UN climate conferences between 1995 and 2023, we show a steady increase in absolute attendance of health actors, with the highest attendance of health actors at COP28 (n=1612) compared with the lowest attendance at COP1 (n=17). Yet, the percentage of health delegates remained largely constant over time in relation to the overall number of attendees. Although a small number of Ministers of Health attended individual COPs between 1995 and 2022, COP28 was attended by approximately the same number of Health Ministers (n=52) as in all previous COPs combined (n=53). While parties and representatives of the UN and its Specialised Bodies increasingly embrace the health narrative, crucial climate change commitments continue to lag. Without fundamental social change, without phasing out fossil fuels, and without climate justice, the health narrative for climate change cannot bring what it promises: health for all. With 2023 shattering climate records across the world following decades of unprecedented warming,1 the United Nations Framework Convention on Climate Change Conference of Parties 28 (UNFCCC COP28) in Dubai was the first UN climate change conference to feature an official ‘Health Day’ and witnessed the largest-ever turnout of the global health community. The threat of climate change to human well-being and planetary health2 3 has previously received little attention at the annual COPs, despite ever-growing scientific evidence warning of the increasing health dangers. Climate change is here and it kills The widespread negative health impacts of climate change are indisputable, ranging from the (re-)emergence, and increased spread of infectious diseases and increasing non-communicable diseases to escalating exposure to extreme events and climatic shocks undermining the environmental, social, physical and psychosocial determinants of health.2 3 These climate-related health impacts are not equally experienced. Structural inequalities exacerbate the vulnerability of specific population groups—such as low-income communities,4 5 migrants and displaced people,6 7 ethnic minoritised and Indigenous peoples,4 people with existing health conditions, as well as sexual and gender minoritised people,8 9 children10 and women going through pregnancy and childbirth.11 Populations most impacted tend to be those least responsible for greenhouse gas (GHG) emissions and those less likely to be prioritised in climate change policies.12 13 With negative health trends expected to intensify under all emission scenarios, limiting average global warming to 1.5°C averts further detrimental health impacts and simultaneously delivers health cobenefits, including cleaner air, active transport and healthier diets.3 Health offers climate change a human face Different ways of framing societal issues can change how priorities are discussed and addressed. Several studies indicate that presenting a positive vision of a healthier, more sustainable common future (ie, using a ‘health’ framing) may increase social and political support for climate action across societal groups and political boundaries.14 15 With health being central to many broad-scale regulations and legislations (eg, air quality or food/water standards), health institutions can also build on their institutional capacity to engage directly and meaningfully in climate change policy-making.15 Illustratively, in 2009, the US Environmental Protection Agency was able to regulate several GHG gases under the Clean Air Act—based on their authority to protect public health—while environmental legislation to reduce emissions earlier stalled in Congress.16 The health community as agents of change The global health community views climate change as an important and growing cause of health harms17 and increasingly engages with efforts in support of stronger climate action to protect patients, communities and the planet; initiating action to reduce GHG emissions in their professional work, supporting and contributing to building more climate-resilient, sustainable and low-carbon health systems, producing scientific evidence on the links between climate and health, implementing public health measures to prevent and reduce the severity of climate-related health risks, mobilising non-violent protests and spearheading various advocacy efforts.15 Health professionals are among the most trusted professions around the world,18 19 tending to have close relationships with local communities. Therefore, they are uniquely positioned to advocate for just, health-responsive climate action. The global health community has actively taken part in UN climate change conferences for over a decade. Yet, health activities have largely been limited to siloed side-events and advocacy efforts, with limited influence on the formal negotiations. Recently, however, health has taken a more pivotal role in proceedings; at COP23, the WHO was tasked for the first time to deliver a special climate and health report for COP2420; and during COP26 a dedicated health programme was developed providing a platform for countries to commit to building climate-resilient, sustainable, low-carbon health systems. As of September 2022, 91% of the Nationally Determined Contributions (NDCs) under the Paris Agreement have incorporated health goals and targets.21 The most recent COP28 convened the first-ever climate-health ministerial and saw the endorsement of a political declaration on climate and health by 149 countries, potentially fostering further integration of health within the UNFCCC. Furthermore, COP28 hosted the highest number of climate and health-related events (over 200), saw funding commitments of over US$1 billion dedicated to climate and health and US$778.2 million to neglected tropical diseases (NTDs), and motivated more countries to join the Alliance for Transformative Action on Climate and Health (ATACH), a WHO-hosted multinational network dedicated to building climate-resilient, low-carbon healthcare systems. The health community at international climate change negotiations: in numbers While the largest-ever turnout of the global health community at COP28 was widely celebrated, there has been no previous quantitative analysis of the health community’s attendance since the first 1995 COP in Berlin. Here, we analysed health actors’ attendance among representatives of Parties, Observer States and Observer Organisations. These data may further support the assessment of the influence of health and the health community in international climate change negotiations. A broad definition of ‘health community’ or ‘health actor’ was applied, including any person who provides healthcare or treatment, represents a government on matters related to health, works for an organisation or institution primarily focused on human health, or works for organisations representing patients or people with disabilities. The detailed methodology, limitations and data can be found in the online supplemental materials. 10.1136/bmjgh-2024-015292.supp1 Supplementary data A steady increase in absolute attendance of health actors at UN climate conferences between 1995 and 2023 was observed (figure 1A), with the highest attendance of health actors at COP28 (n=1612), compared with the lowest attendance at COP1 (n=17). However, this increase was correlated with a general increase in the number of COP participants over time (online supplemental table 4 1; online supplemental figure 1), with peaks in attendance at key climate change diplomacy moments such as COP15 (2009; Copenhagen Accord), COP21 (2015; Paris Agreement) and COP28 (2023; Global Stocktake). The percentage of health delegates in relation to the overall number of attendees remained largely constant over time (figure 1B; online supplemental table 4). Health actors were predominantly present as observers (Non-Governmental Organisations (NGOs), Intergovernmental Organisations (IGOs) and UN Specialised Agencies or Related Organisations; figure 1A,B). Participation of government representatives from Ministries of Health has likewise steadily increased in absolute numbers (figure 2A), although some were representatives from combined Health and Environment Ministries (eg, Belgium). Furthermore, while a small number of Ministers of Health attended COP1-27, COP28 was attended by approximately the same number of Health Ministers (n=52) as in all previous COPs combined (n=53) (figure 2B). This may be at least partially explained by additional funding and travel support provided by the COP28 Presidency to 29 Ministers of Health from low and middle-income countries (LMICs), and the inclusion of health in official UNFCCC programming. In absolute numbers, most Party and Observer State health actors were from the Asia-Pacific states (n=585) and African states (n=504; figure 3A), LMICs (n=1007; figure 3B), or non-Annex 1 countries (n=1239; figure 3C) over 1995–2023, representing a major part of those most impacted by climate change. Note, due to a lack of summary data, we could not extend these subgroup analyses meaningfully beyond absolute numbers (see limitations in the online supplemental material for further details). Figure 1 Health actors' attendance at United Nations Framework Convention on Climate Change (UNFCCC)’s COP28 (1995–2023). (A) The absolute number of health actors attending COP1-28. (B) Percentage of health actors attending COP of total participation, grouped by Parties and Observer States and Observer Organisations (representatives of UN Secretariat and Related Bodies, UN Specialised Agencies or Related Organisations, Intergovernmental Organisations [IGOs], Non-Governmental Organisations [NGOs] and for COP28 representatives of Global Climate Action, Host Country Guests, and Temporary Passes). Note, Parties are those that have ratified the Convention and fully engage in negotiations. Observer States are those that have not yet completed their ratification of the Convention, and, therefore, do not yet have the right to vote on decisions. Observer Organisations do not have the right to vote on decisions and have more limited access to the convening (eg, they do have access to the plenary sessions, but not to smaller Party discussions). See the online supplemental material for further details on the methodology, including limitations. Figure 2 Party and Observer State representatives associated with the Ministry of Health at COPs (1995–2023). (A) Representatives of the Ministry of Health, or Ministry of Health & Environment. (B) Ministers of Health or Ministers of Health & Environment. This figure focuses on representatives of Party and Observer State delegations, excluding representatives from Observer Organisations. See the online supplemental material for further details on the methodology, including limitations. Figure 3 Party and Observer State health actors’ attendance at United Nations Framework Convention on Climate Change (UNFCCC) COP 1–28 (1995–2023) by United Nations (UN) regional grouping and World Bank (WB) country income grouping. This figure excludes representatives from Observer Organisations as no information for their country is provided in UNFCCC documentation. (A) UN regional grouping. Note, health actors’ attendance from Western European and other states has been particularly driven by the attendance of Belgium delegates as part of the combined Ministry of Health and Environment (ie, Santé publique, Sécurité de la chaîne alimentaire et Environnement). (B) World Bank (WB) country income grouping. Parties with no classification available include formerly existing countries (eg, Yugoslavia), country groups (eg, European Union) and those pending release of national account statistics (eg, Venezuela). See the online supplemental appendix for further details on the methodology, including limitations. (C) Commitment to the Convention. Those with no classification include former countries (Yugoslavia, COP6) and Palestine (COP26). The largest-ever turnout of the global health community at COP The rising number of health actors present at UN Climate Conferences cannot be called a success in and of itself; our analyses show limited relative growth of health actors present. Indeed, overall participation has grown considerably, from around 2000 participants during COP1 to 80 000 participants during COP28. Not only did health actors’ attendance increase over the past years, so did the attendance from health-harming sectors, including 2500 fossil fuel representatives at COP28—a fivefold increase since COP26.22 This is happening against a backdrop of oil and gas companies continuing to attract investment, expand infrastructure and report record-breaking profits.3 23 Simultaneously, air pollution from fossil fuel burning results in millions of global deaths yearly while the planet approaches the critical 1.5°C planetary boundary.3 Notably, our dataset (1995–2023) identified 87 participants with health functions (eg, Health & Safety Officers) in organisations involved in fundamentally health-harming practices such as the exploration, production, refining, distribution, marketing or import/export of oil, coal, petroleum or gas. This suggests that not all health actors present at COP represent the interests of public health. As a part of the overall rapid increase in the health community’s mobilisation on climate change, the increased health actors’ attendance at COPs might have brought increased attention to the health argument for climate action within UN spaces and international negotiations. The marked increase in the number of Health Ministers and senior representatives from Ministries of Health at COP28 might arguably have strengthened recognition of the role of health in international climate negotiations and might have enabled stronger collaboration between climate and health policy-makers within national delegations and beyond. Continued capacity development for, and representation of, Ministries of Health to meaningfully engage in future UN climate conferences would contribute to sustained and strengthened recognition of health as a pillar for climate change policies. Health success at COP28 is accompanied by discomfort The health perspective offers a compelling and urgent case for ambitious climate action, underscoring the vital role of the health community in driving climate action. When climate policy is aligned with health objectives, the narrative of climate action transforms into a tale of enhanced health and well-being, promoting equity for all. Health renders the effects of climate policies palpable in people’s everyday lives. Simultaneously, the COP28 health successes also come with considerable discomfort. While the health narrative is increasingly embraced, crucial climate change commitments continue to lag. Consensus-based decisions have failed to reflect Parties’ commitment to the imperative phase-out of fossil fuels, with combined pledges in NDCs putting the world on track for around 2.5°C of warming (exceeding climate tipping points)24 and loss and damage funds remaining insufficient to protect most at-risk communities. The question lingers whether health is being used to increase the acceptability of initiatives or organisations that minimally advance climate action (ie, the so-called ‘healthwashing’). Specifically, within the COP28 context, does the current focus on health and celebration of the increased health community presence distract from the fact that climate change commitments remain inadequate to avert imminent climate breakdown?25 Furthermore, as differential exposure, sensitivity and adaptive capacity (all impacting vulnerability) result in uneven distributions of climate-related health impacts, often reflecting sociodemographic inequities and marginalisation, a focus on equity within the climate-health realm is imperative to establishing a meaningful, environmentally just transition.4 26 27 This includes ensuring the inclusion of diverse voices, perspectives, expertise and lived experiences within climate change negotiations, as well as the climate health community—particularly of those living in regions most affected.28 While there is a relatively larger presence of Party health actor representatives from the Global South (with most Party health actors’ representing African or Asia-Pacific states in absolute numbers), they also represent most Parties to the Convention and most of the world’s population. There remains a significant need to increase the Global South participation of health actor representatives, including those representing non-Party delegates such as NGOs.29 30 Importantly, representation alone does not necessarily equate to more inclusive decision-making or equal access to power, speaking engagements and informal/formal processes. Prioritising inclusive advocacy efforts that centre equity and address structural barriers to meaningful participation would enable just and transformative decision-making, involving further reductions in global GHG emissions and supporting those most affected by climate change.31 Conclusion In this quantitative analysis of the health community’s attendance at UN climate conferences between 1995 and 2023, we show a steady increase in absolute attendance of health actors, but limited relative growth compared with overall COP participation. These new indicators may support the assessment of the engagement of health and health actors in international climate change negotiations. However, further (qualitative) research is needed to assess the direct influence health actors have on climate change decision-making processes and whether increasing health actor’s presence at COP produces more health-responsive climate policies and agreements. Climate commitments fall short of what is needed, and vested interests within capitalistic structures may continue to foster profit over people’s well-being. While celebrating tentative successes, the health community should continue to emphasise the need to protect the health of current and future generations to ensure climate action matches the magnitude of the threat. This should encompass continued strategic engagement with COP processes, a broader focus on health that extends beyond healthcare and promoting climate action alongside health cobenefits. Without fundamental social change, without phasing out fossil fuels, and without climate justice, the health narrative for climate change cannot bring what it promises: health for all.

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          The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms

          Executive Summary The Lancet Countdown is an international research collaboration that independently monitors the evolving impacts of climate change on health, and the emerging health opportunities of climate action. In its eighth iteration, this 2023 report draws on the expertise of 114 scientists and health practitioners from 52 research institutions and UN agencies worldwide to provide its most comprehensive assessment yet. In 2022, the Lancet Countdown warned that people’s health is at the mercy of fossil fuels and stressed the transformative opportunity of jointly tackling the concurrent climate change, energy, cost-of-living, and health crises for human health and wellbeing. This year’s report finds few signs of such progress. At the current 10-year mean heating of 1·14°C above pre-industrial levels, climate change is increasingly impacting the health and survival of people worldwide, and projections show these risks could worsen steeply with further inaction. However, with health matters gaining prominence in climate change negotiations, this report highlights new opportunities to deliver health-promoting climate change action and a safe and thriving future for all. The rising health toll of a changing climate In 2023, the world saw the highest global temperatures in over 100 000 years, and heat records were broken in all continents through 2022. Adults older than 65 years and infants younger than 1 year, for whom extreme heat can be particularly life-threatening, are now exposed to twice as many heatwave days as they would have experienced in 1986–2005 (indicator 1.1.2). Harnessing the rapidly advancing science of detection and attribution, new analysis shows that over 60% of the days that reached health-threatening high temperatures in 2020 were made more than twice as likely to occur due to anthropogenic climate change (indicator 1.1.5); and heat-related deaths of people older than 65 years increased by 85% compared with 1990–2000, substantially higher than the 38% increase that would have been expected had temperatures not changed (indicator 1.1.5). Simultaneously, climate change is damaging the natural and human systems on which people rely for good health. The global land area affected by extreme drought increased from 18% in 1951–60 to 47% in 2013–22 (indicator 1.2.2), jeopardising water security, sanitation, and food production. A higher frequency of heatwaves and droughts in 2021 was associated with 127 million more people experiencing moderate or severe food insecurity compared with 1981–2010 (indicator 1.4), putting millions of people at risk of malnutrition and potentially irreversible health effects. The changing climatic conditions are also putting more populations at risk of life-threatening infectious diseases, such as dengue, malaria, vibriosis, and West Nile virus (indicator 1.3). Compounding these direct health impacts, the economic losses associated with global heating increasingly harm livelihoods, limit resilience, and restrict the funds available to tackle climate change. Economic losses from extreme weather events increased by 23% between 2010–14 and 2018–22, amounting to US$264 billion in 2022 alone (indicator 4.1.1), whereas heat exposure led to global potential income losses worth $863 billion (indicators 1.1.4 and 4.1.3). Labour capacity loss resulting from heat exposure affected low and medium Human Development Index (HDI) countries the most, exacerbating global inequities, with potential income losses equivalent to 6·1% and 3·8% of their gross domestic product (GDP), respectively (indicator 4.1.3). The multiple and simultaneously rising risks of climate change are amplifying global health inequities and threatening the very foundations of human health. Health systems are increasingly strained, and 27% of surveyed cities declared concerns over their health systems being overwhelmed by the impacts of climate change (indicator 2.1.3). Often due to scarce financial resources and low technical and human capacity, the countries most vulnerable to climate impacts also face the most challenges in achieving adaptation progress, reflecting the human risks of an unjust transition. Only 44% of low HDI countries and 54% of medium HDI countries reported high implementation of health emergency management capacities in 2022, compared with 85% of very high HDI countries (indicator 2.2.5). Additionally, low and medium HDI countries had the highest proportion of cities not intending to undertake a climate change risk assessment in 2021 (12%; indicator 2.1.3). These inequalities are aggravated by the persistent failure of the wealthiest countries to deliver the promised modest annual sum of $100 billion to support climate action in those countries defined as developing within the UN Framework Convention on Climate Change. Consequently, those countries that have historically contributed the least to climate change are bearing the brunt of its health impacts—both a reflection and a direct consequence of the structural inequities that lie within the root causes of climate change. The human costs of persistent inaction The growing threats experienced to date are early signs and symptoms of what a rapidly changing climate could mean for the health of the world’s populations. With 1337 tonnes of CO2 emitted each second, each moment of delay worsens the risks to people’s health and survival. In this year’s report, new projections reveal the dangers of further delays in action, with every tracked health dimension worsening as the climate changes. If global mean temperature continues to rise to just under 2°C, annual heat-related deaths are projected to increase by 370% by midcentury, assuming no substantial progress on adaptation (indicator 1.1.5). Under such a scenario, heat-related labour loss is projected to increase by 50% (indicator 1.1.4), and heatwaves alone could lead to 524·9 million additional people experiencing moderate-to-severe food insecurity by 2041–60, aggravating the global risk of malnutrition. Life-threatening infectious diseases are also projected to spread further, with the length of coastline suitable for Vibrio pathogens expanding by 17–25%, and the transmission potential for dengue increasing by 36–37% by midcentury. As risks rise, so will the costs and challenges of adaptation. These estimates provide some indication of what the future could hold. However, poor accounting for non-linear responses, tipping points, and cascading and synergistic interactions could render these projections conservative, disproportionately increasing the threat to the health of populations worldwide. A world accelerating in the wrong direction The health risks of a 2°C hotter world underscore the health imperative of accelerating climate change action. With limits to adaptation drawing closer, ambitious mitigation is paramount to keep the magnitude of health hazards within the limits of the capacity of health systems to adapt. Yet years of scientific warnings of the threat to people’s lives have been met with grossly insufficient action, and policies to date have put the world on track to almost 3°C of heating. The 2022 Lancet Countdown report highlighted the opportunity to accelerate the transition away from health-harming fossil fuels in response to the global energy crisis. However, data this year show a world that is often moving in the wrong direction. Energy-related CO2 emissions increased by 0·9% to a record 36·8 Gt in 2022 (indicator 3.1.1), and still only 9·5% of global electricity comes from modern renewables (mainly solar and wind energy), despite their costs falling below that of fossil fuels. Concerningly, driven partly by record profits, oil and gas companies are further reducing their compliance with the Paris Agreement: the strategies of the world’s 20 largest oil and gas companies as of early 2023 will result in emissions surpassing levels consistent with the Paris Agreement goals by 173% in 2040—an increase of 61% from 2022 (indicator 4.2.6). Rather than pursuing accelerated development of renewable energy, fossil fuel companies allocated only 4% of their capital investment to renewables in 2022. Meanwhile, global fossil fuel investment increased by 10% in 2022, reaching over $1 trillion (indicator 4.2.1). The expansion of oil and gas extractive activities has been supported through both private and public financial flows. Across 2017–21, the 40 banks that lend most to the fossil fuel sector collectively invested $489 billion annually in fossil fuels (annual average), with 52% increasing their lending from 2010–16. Simultaneously, in 2020, 78% of the countries assessed, responsible for 93% of all global CO2 emissions, still provided net direct fossil fuels subsidies totalling $305 billion, further hindering fossil fuel phase-out (indicator 4.2.4). Without a rapid response to course correct, the persistent use and expansion of fossil fuels will ensure an increasingly inequitable future that threatens the lives of billions of people alive today. The opportunity to deliver a healthy future for all Despite the challenges, data also expose the transformative health benefits that could come from the transition to a zero-carbon future, with health professionals playing a crucial role in ensuring these gains are maximised. Globally, 775 million people still live without electricity, and close to 1 billion people are still served by health-care facilities without reliable energy. With structural global inequities in the development of, access to, and use of clean energy, only 2·3% of electricity in low HDI countries comes from modern renewables (against 11% in very high HDI countries), and 92% of households in low HDI countries still rely on biomass fuels to meet their energy needs (against 7·5% in very high HDI countries; indicators 3.1.1 and 3.1.2). In this context, the transition to renewables can enable access to decentralised clean energy and, coupled with interventions to increase energy efficiency, can reduce energy poverty and power high quality health-supportive services. By reducing the burning of dirty fuels (including fossil fuels and biomass), such interventions could help avoid a large proportion of the 1·9 million deaths that occur annually from dirty-fuel-derived, outdoor, airborne, fine particulate matter pollution (PM2·5; indicator 3.2.1), and a large proportion of the 78 deaths per 100 000 people associated with exposure to indoor air pollution (indicator 3.2.2). Additionally, the just development of renewable energy markets can generate net employment opportunities with safer, more locally available jobs. Ensuring countries, particularly those facing high levels of energy poverty, are supported in the safe development, deployment, and adoption of renewable energy is key to maximising health gains and preventing unjust extractive industrial practices that can harm the health and livelihoods of local populations and widen health inequities. With fossil fuels accounting for 95% of road transport energy (indicator 3.1.3), interventions to enable and promote safe active travel and zero-emission public transport can further deliver emissions reduction, promote health through physical activity, and avert many of the 460 000 deaths caused annually by transport-derived PM2·5 pollution (indicator 3.2.1), and some of the 3·2 million annual deaths related to physical inactivity. People-centred, climate-resilient urban redesign to improve building energy efficiency, increase green and blue spaces, and promote sustainable cooling, can additionally prevent heat-related health harms, avoid air-conditioning-derived emissions (indicator 2.2.2), and provide direct physical and mental health benefits. Additionally, food systems are responsible for 30% of global greenhouse gas (GHG) emissions, with 57% of agricultural emissions in 2020 being derived from the production of red meat and milk (indicator 3.3.1). Promoting and enabling equitable access to affordable, healthy, low-carbon diets that meet local nutritional and cultural requirements can contribute to mitigation, while preventing many of the 12·2 million deaths attributable to suboptimal diets (indicator 3.3.2). The health community could play a central role in securing these benefits, by delivering public health interventions to reduce air pollution, enabling and supporting active travel and healthier diets, and promoting improvements in the environmental conditions and commercial activities that define health outcomes. Importantly, the health sector can lead by example and transition to sustainable, resource-efficient, net-zero emission health systems, thereby preventing its 4·6% contribution to global GHG emissions, with cascading impacts ultimately affecting the broader economy (indicator 3.4). Some encouraging signs of progress offer a glimpse of the enormous human benefits that health-centred action could render. Deaths attributable to fossil-fuel-derived air pollution have decreased by 15·7% since 2005, with 80% of this reduction being the result of reduced coal-derived pollution. Meanwhile the renewable energy sector expanded to a historical high of 12·7 million employees in 2021 (indicator 4.2.2); and renewable energy accounted for 90% of the growth in electricity capacity in 2022 (indicator 3.1.1). Supporting this, global clean energy investment increased by 15% in 2022, to $1·6 trillion, exceeding fossil fuel investment by 61% (indicator 4.2.1); and lending to the green energy sector rose to $498 billion in 2021, approaching fossil fuel lending (indicator 4.2.7). Scientific understanding of the links between health and climate change is rapidly growing, and although coverage lags in some of the most affected regions, over 3000 scientific articles covered this topic in 2022 (indicators 5.3.1 and 5.3.2). Meanwhile, the health dimensions of climate change are increasingly acknowledged in the public discourse, with 24% of all climate change newspaper articles in 2022 referring to health, just short of the 26% in 2020 (indicator 5.1). Importantly, international organisations are increasingly engaging with the health co-benefits of climate change mitigation (indicator 5.4.2), and governments increasingly acknowledge this link, with 95% of updated Nationally Determined Contributions (NDCs) under the Paris Agreement now referring to health—up from 73% in 2020 (indicator 5.4.1). These trends signal what could be the start of a life-saving transition. A people-centred transformation: putting health at the heart of climate action With the world currently heading towards 3°C of heating, any further delays in climate change action will increasingly threaten the health and survival of billions of people alive today. If meaningful, the prioritisation of health in upcoming international climate change negotiations could offer an unprecedented opportunity to deliver health-promoting climate action and pave the way to a thriving future. However, delivering such an ambition will require confronting the economic interests of the fossil fuel and other health-harming industries, and delivering science-grounded, steadfast, meaningful, and sustained progress to shift away from fossil fuels, accelerate mitigation, and deliver adaptation for health. Unless such progress materialises, the growing emphasis on health within climate change negotiations risks being mere healthwashing; increasing the acceptability of initiatives that minimally advance action, and which ultimately undermine—rather than protect—the future of people alive today and generations to come. Safeguarding people’s health in climate policies will require the leadership, integrity, and commitment of the health community. With its science-driven approach, this community is uniquely positioned to ensure that decision makers are held accountable, and foster human-centred climate action that safeguards human health above all else. The ambitions of the Paris Agreement are still achievable, and a prosperous and healthy future still lies within reach. But the concerted efforts and commitments of health professionals, policy makers, corporations, and financial institutions will be needed to ensure the promise of health-centred climate action becomes a reality that delivers a thriving future for all.
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            Views of health professionals on climate change and health: a multinational survey study

            Climate change arguably represents one of the greatest global health threats of our time. Health professionals can advocate for global efforts to reduce emissions and protect people from climate change; however, evidence of their willingness to do so remains scarce. In this Viewpoint, we report findings from a large, multinational survey of health professionals (n=4654) that examined their views of climate change as a human health issue. Consistent with previous research, participants in this survey largely understood that climate change is happening and is caused by humans, viewed climate change as an important and growing cause of health harm in their country, and felt a responsibility to educate the public and policymakers about the problem. Despite their high levels of commitment to engaging in education and advocacy on the issue, many survey participants indicated that a range of personal, professional, and societal barriers impede them from doing so, with time constraints being the most widely reported barrier. However, participants say various resources—continuing professional education, communication training, patient education materials, policy statements, action alerts, and guidance on how to make health-care workplaces sustainable—can help to address those barriers. We offer recommendations on how to strengthen and support health professional education and advocacy activities to address the human health challenges of climate change.
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              Climate change and child health: a scoping review and an expanded conceptual framework

              Climate change can have detrimental effects on child health and wellbeing. Despite the imperative for a fuller understanding of how climate change affects child health and wellbeing, a systematic approach and focus solely on children (aged <18 years) has been lacking. In this Scoping Review, we did a literature search on the impacts of climate change on child health from January, 2000, to June, 2019. The included studies explicitly linked an alteration of an exposure to a risk factor for child health to climate change or climate variability. In total, 2970 original articles, reviews, and other documents were identified, of which 371 were analysed. Employing an expanded framework, our analysis showed that the effects of climate change on child health act through direct and indirect pathways, with implications for determinants of child health as well as morbidity and mortality from a range of diseases. This understanding can be further enhanced by using a broader range of research methods, studying overlooked populations and geographical regions, investigating the costs and benefits of mitigation and adaptation for child health, and considering the position of climate change and child health within the UN Sustainable Development Goals. Present and future generations of children bear and will continue to bear an unacceptably high disease burden from climate change.

                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2024
                18 April 2024
                : 9
                : 4
                : e015292
                Affiliations
                [1 ] Barcelona Supercomputing Center (BSC) , Barcelona, Spain
                [2 ] departmentBritish Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care , University of Cambridge , Cambridge, UK
                [3 ] departmentHeart and Lung Research Institute , University of Cambridge , Cambridge, UK
                [4 ] departmentAfrican Unit for Transdisciplinary Health Research (AUTHeR) , North-West University , Potchefstroom, South Africa
                [5 ] Physicians Association for Nutrition South Africa , Pinelands, South Africa
                [6 ] departmentInstitute of General Practice, Family Medicine and Preventive Medicine , Paracelsus Medical University (PMU) , Salzburg, Austria
                [7 ] departmentCentre on Climate Change and Planetary Health , London School of Hygiene and Tropical Medicine , London, UK
                [8 ] departmentJulius Center for Health Sciences and Primary Health , Ringgold_8124University Medical Centre Utrecht , Utrecht, Netherlands
                [9 ] departmentDepartment of Public Health , Ringgold_6993Erasmus Medical Center , Rotterdam, Zuid-Holland, Netherlands
                [10 ] Ringgold_222607The National Ribat University , Khartoum, Khartoum, Sudan
                [11 ] departmentFaculty of Medicine , Ringgold_54562Alexandria University , Alexandria, Egypt
                [12 ] departmentDepartment of Environmental Health Sciences, Mailman School of Public Health , Ringgold_5798Columbia University , New York, New York, USA
                [13 ] departmentMelbourne Climate Futures , Ringgold_2281The University of Melbourne , Melbourne, Victoria, Australia
                [14 ] departmentBrigham and Women’s Hospital , Ringgold_1811Harvard Medical School , Boston, Massachusetts, USA
                [15 ] Ringgold_8947Wye Valley NHS Trust , Hereford, Herefordshire, UK
                [16 ] departmentFaculty of Medicine of Tunis , Ringgold_37964University of Tunis El Manar , Tunis, Tunisia
                [17 ] Ringgold_29480Grant Government Medical College and Sir J J Group of Hospitals , Mumbai, Maharashtra, India
                [18 ] International Federation of Medical Students' Associations (IFMSA) , Copenhagen, Denmark
                [19 ] departmentFaculty of Pharmacy , Ringgold_54562Alexandria University , Alexandria, Egypt
                [20 ] Ringgold_428721International Pharmaceutical Federation , The Hague, South Holland, Netherlands
                [21 ] departmentFaculty of Pharmacy , Ringgold_88597University of Algiers 1 , Alger, Algeria
                [22 ] International Pharmaceutical Students’ Federation , the Hague, Netherlands
                [23 ] Ringgold_91536World Medical Association , Ferney-Voltaire, France
                [24 ] departmentCentre on Climate Change & Planetary Health and Centre for Mathematical Modelling of Infectious Diseases , London School of Hygiene & Tropical Medicine , London, UK
                [25 ] Catalan Institution for Research and Advanced Studies (ICREA) , Barcelona, Spain
                Author notes
                [Correspondence to ] Dr Kim Robin van Daalen; kim.vandaalen@ 123456bsc.es
                Author information
                http://orcid.org/0000-0001-6955-9708
                http://orcid.org/0009-0007-9366-8817
                http://orcid.org/0009-0005-1325-5939
                http://orcid.org/0000-0002-1294-7408
                http://orcid.org/0000-0002-1002-6971
                http://orcid.org/0000-0001-8976-5744
                http://orcid.org/0000-0002-8386-6736
                http://orcid.org/0000-0002-7916-1717
                http://orcid.org/0000-0003-1142-8267
                http://orcid.org/0000-0002-8245-6591
                http://orcid.org/0000-0002-2209-0858
                http://orcid.org/0000-0003-3914-8152
                http://orcid.org/0009-0008-3804-5489
                http://orcid.org/0009-0001-7350-0458
                http://orcid.org/0009-0000-6447-4262
                http://orcid.org/0009-0005-3515-3052
                http://orcid.org/0000-0003-3939-7343
                Article
                bmjgh-2024-015292
                10.1136/bmjgh-2024-015292
                11029429
                38637120
                98969b09-48f7-4aa3-a280-d3003524224b
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 06 February 2024
                : 31 March 2024
                Funding
                Funded by: HORIZON EUROPE;
                Award ID: 101057131
                Award ID: 101057554
                Funded by: Royal Society Dorothy Hodgkin Fellowship;
                Award ID: DH150120
                Funded by: NIH;
                Award ID: R00 ES033742
                Categories
                Commentary
                1506
                Custom metadata
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                global health,decision making,environmental health,public health

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