Cop-out: the climate crisis and Universal Health Coverage

Dylan Bruce, Save The Children

One World placard

Image: Markus Spiske, Unsplash

This year COP28 in Dubai hosted the first ever designated ‘Health Day’, which presented a fantastic opportunity to bring health into climate spaces, share evidence and insights with decision-makers and make the case for financing health as a critical frontier in climate resilience.

However, it is just as important that we as health advocates and policymakers meet in the middle and bring the climate crisis into our health spaces.

The message finally got through: the climate crisis is a health crisis. At COP28, 124 countries signed the Declaration on Climate and Health, which aims to galvanise action to prepare health systems for the impacts of climate change. Not only that, the Health Day saw US$1 billion of funding provided for both mitigation and adaptation programmes, with a focus on strengthening and decarbonising health systems, and protecting vulnerable communities.

Amazing! Show’s over, time to go home everyone – we won…. Right?

Not quite.

The $700m contributed to the loss and damage fund is the equivalent of less than 0.2% of the irreversible economic and non-economic losses developing countries are facing from the climate crisis each year. Most of this money is not new or additional and has been drawn from the same pot as wider climate finance and repackaged as ‘loss and damage’. How can we ensure self-sufficiency and domestic funding for health systems if low- and middle-income economies are haemorrhaging from a crisis they did not create?

The Climate and Health Declaration is positive, but health has historically been overlooked in climate finance considerations and there is a long way to go in ensuring it is fully integrated. That is all not to mention how these inadequate pots of money for climate and health get spent, and how we ensure that equity and climate justice is at the heart of their distribution and implementation. There is a great deal of work yet to be done within our own community of policymakers, advocates, and practitioners – and it is time to get our own house in order.

Whether it is in pursuing decarbonisation in health systems while maintaining and expanding service coverage, considering how the climate crisis will shape the diseases and outbreaks of the future, or planning for the adaptation of health systems to new environmental conditions – we have a great deal of work to do. We need to use global health moments like the World Health Assembly – where in 2024 there will be the first resolution on climate and health in 10 years – or the World Health Summit to start making and scrutinising plans.

The climate crisis is not going away. More than ever, it is shaping health outcomes in a wide variety of ways that we are still accounting for. It has direct effects, like extreme heat or weather, flooding and monsoons which can develop into

humanitarian emergencies which can rapidly weaken already fragile health systems. The climate crisis also has the potential to destroy fragile health infrastructure, making it extremely hard for precarious health systems to cope with the fall out. It can lead to reduced crop yields due to droughts and dramatically reduce nutritional levels and access to clean drinking water while accelerating the spread of disease carrying vectors like mosquitoes – all resulting in increased child mortality. Perhaps most dangerously, as the climate crisis erodes the natural environment, it is driving new human-animal interaction and bringing with it the risk of zoonotic diseases with pandemic potential.

In all these ways, the climate crisis can also be understood as a multiplier of vulnerabilities. In times of crises, children, especially girls, face greater risk of ill health, violence, and exploitation. When families face economic hardship, they are more likely to restrict access to nutritious foods, take children out of school and marry off their young daughters.

In this context of vulnerability, it is urgent that everyone has access to quality health care and that health systems are resilient and strong. Now more than ever, Universal Health Coverage is a vital goal for human welfare and dignity. The climate crisis poses a new challenge for UHC – a fresh weight for health systems to bear. Considering that we are already dealing with weak and climate-damaged health systems at the primary health care level in most low and middle income countries, GHIs and policy makers need to understand ground realities better, consult and listen to those who are coping with the climate crisis on a day to day basis, and start developing people-centred plans and budgets which can address challenges on the ground in realistic ways. It is apparent that this is not the case, considering the inadequate levels of promised funding to address the crisis.

This intersection of climate and health is a growing priority for Save the Children UK, and we are going to be working with our partners at the country level and globally to think more about the challenges raised in this blog and what we can do to protect children. Expect to see more from us on this in the future as we take up this challenge and bring it to decision-makers. Let’s use 2024 as the year we finally integrate the climate crisis into our priorities, and bring our expertise to bear on processes that are changing the landscape of health.

This UHC day let’s keep in mind that the climate crisis needs to be addressed for communities to be safe and healthy. If this is not the case, UHC will continue to slip further and further out of reach for the most vulnerable and those who have been marginalised.