What’s next for the climate and health agenda?

The aftermath of the “apocalyptic” flash flooding in Pakistan in 2022 may have been the moment the world woke up to the impact that climate change has on health. The surge of water created perfect breeding grounds for mosquitoes, causing malaria and dengue cases to spike drastically. Massive cholera outbreaks erupted as sewage-infused flood water contaminated drinking water. Routine illnesses became life-threatening as people stuck on inland islands were unable to reach care. “The realization that the world is having is that this is no longer about polar bears on ice drifts,” said Martin Edlund, chief executive officer of Malaria No More. “It's about the images that we saw in Pakistan of families floating their children in makeshift rafts to try to escape a flood that covered 30% of the landmass.” Health brings a human face to climate change. People falling ill in crowded displacement camps during historic droughts. Others dying of extreme heat during the Hajj to Mecca. Malaria cases sprouting up in regions that didn’t have them previously. A warming world could lead to at least 21 million additional deaths by 2050 from extreme heat, stunting, diarrhea, malaria, and dengue. The impacts of climate and health are also expected to drive some 44 million people into extreme poverty during that same time frame. But the conversation only pivoted at last year’s COP 28 climate conference in Dubai — pushing health from the margins to a more prominent role on the climate agenda. This led to more focused conversations on the issue, political commitments, and an increase in pledged funding. It was the first COP to dedicate a day to health and almost 150 countries signed a ministerial declaration. Multilateral development banks signed a joint statement and donors committed over $1 billion to the issue. This momentum continued into last month, when countries adopted a climate and health resolution at the World Health Assembly that calls upon governments to ensure they have environmentally sustainable health systems and to integrate climate in their data collection systems, among other things. But there's a difference between recognizing the link and responding to it with actual investments, said attendees at the Forecasting Healthy Futures summit last week in Baku, Azerbaijan — the city that will host COP 29 in five months. They called for real action and cautioned against a backslide in working to prioritize health on the climate agenda. "We need to be doing things. And by doing things, I mean, not announcing financial commitments, and not announcing plans or pilots — but together we need to be ensuring that countries are enabled to be actually doing things on the ground that impact where people are most at risk,” Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told the audience. “We don't have the luxury of time.” The world spent almost $1.3 trillion in annual climate investments in 2021/2022 — but only 2% of adaptation funding and 0.5% of multilateral climate funding are funneled toward projects that protect or improve health. And yet, it’s estimated low- and middle-income countries need at least $11 billion annually to adapt to climate’s impacts on health. Sidelining ministers of health Traditionally, ministries of environment and finance play an elevated role in discussions around climate change. They are the ones that have crafted national mitigation and adaptation plans — and so health needs weren’t necessarily included. Health ministers also haven’t often had a seat at the table in integrating their agendas into climate finance proposals. “Too often, ministries of health are still sidelined in the climate conversation,” Edlund said. And it’s not necessarily the health sector's area of expertise. It’s not used to integrating weather data into its work — whether it be at the clinician level or the Ministry of Health. Other sectors are more advanced in that way, such as the agricultural sector, which has long been in tune with changes in the climate. But climate change analysis can help the health sector better understand and map out the health risks within their own borders, conference attendees said. If rainy seasons shift and intensify, or a cyclone is about to hit, the health sector can plan, pre-position supplies, and respond more effectively. “We are actively working to make climate and weather data more accessible and supporting early-warning systems to predict the climate-based malaria outbreaks so that our partner countries can deploy malaria interventions, at the optimal time,” David Walton, the U.S. global malaria coordinator for the President's Malaria Initiative, told the audience. Straightforward access to finance Accessing climate financing has also been complicated for health players. Funding institutions have different requirements but a country may need to tap into a variety of financing options — such as a grant from one institution and debt from another — but that’s not easy. “It's incredibly daunting to have to do separate risk assessments, separate applications and evidence requirements,” Edlund said. Last year, the World Bank committed to allocating 45% of new financing to climate-related projects. It also aims to double the number of people its health programming reaches. The Global Fund, the world's largest grant financier of health care, has also committed to spending over 70% of its funding in the 50 most climate-vulnerable countries. “I think we're on the verge of material resources being kind of in the system and starting to operationalize those commitments and priorities from major funders,” Edlund said. Financial institutions are also working to create better coordination among themselves on the nexus between climate finance and health. This month, the Development Bank Working Group for Climate-Health Finance, which was established last year and includes multilateral development banks and public development banks, launched a new road map for climate-health finance. "What we've been able to do through the group and the launch of the road map is to define how collectively we're going to be addressing the climate and health crisis,” Tamer Samah Rabie, global program lead for climate and health at the World Bank, told the audience. This work will include working to understand the “best buys” — interventions that are most impactful, scalable, and feasible — and to increase efforts for development banks to co-finance projects, which will help scale solutions, he added. The World Bank, International Finance Corporation, Global Fund, Green Climate Fund, and Rockefeller Foundation have also come together to analyze their investment frameworks on climate and health to try to develop a more common approach, said John Fairhurst, head of private sector engagement at the Global Fund. This will help them better understand where they overlap and where they diverge. “It's the framework of how we invest so that we can make it more consistent and more transparent for how countries access funding in this climate and health space,” he said. “It means countries can then look at — almost like a menu.” The Global Fund launched partnerships last year with both the Green Climate Fund and the World Bank which also work to better coordinate health and climate investments. For these partnerships, they will focus on working in specific countries on joint programming. “It means we can kind of blend our funding in a way that helps countries access financing better,” he said, adding that these countries will then become the case studies for how they deploy funding on climate and health moving forward. The Global Fund has long worked with the World Bank on co-investments in other areas, he said, whereas the partnership with the Green Climate Fund is new — the conversations are just starting. “The truth is we still need to formally integrate climate as a lens into how we're thinking about our programs. Some of what we're doing is kind of this natural response to what we see, as opposed to a kind of formal climate change and health strategy,” he added. There’s also a need for countries to be supported with modeling, which philanthropies can help with, Edlund said. Several funders have a high bar for evidence — such as the need to clearly show that investments are directed toward a health burden or risk attributable to climate change. And there’s a need to support countries in developing their own investment priorities for adaptation to ensure solutions are driven by countries and that they are context-specific, Fairhurst said. The Green Climate Fund is currently only funding two projects targeting the health sector — in Laos and the Cook Islands. But according to a spokesperson, over the past two years, the fund has seen more health-specific climate proposals. The spokesperson also said another $460 million has been committed to support 13 nonhealth sector projects that do have health benefits, such as those linked to air quality. It also funds efforts to support countries with the preparation for receiving funds and has invested over $5.2 million in assisting 15 countries to conduct climate change and health vulnerability assessments, which has led to the development of national health adaptation plans. Centralizing health Last year’s COP 28 will be a hard act to follow for the climate in health movement. The upcoming COP 29 in Baku is not expected to have as much of an emphasis on health. The organizers are currently planning to have a thematic day that includes health but alongside other important conversations around human capital, jobs, education, children, and youth. “I don't think that they're dismissive of the health angle and the health argument but neither are they prioritizing it on their action agenda,” said Kelly Willis, who leads Forecasting Healthy Futures. But there's still time for public opinion to influence the agenda, she said. It’s one of the reasons the Forecasting Healthy Futures summit was held in Baku in the leadup to COP 29, and she’s invited conference participants to submit their perspectives on what’s important to the COP 29 organizers. “I think now is more important than ever for the climate and health movement to be pressuring COP 29 to elevate the issue,” she said. “We don't necessarily need all the fanfare of the Dubai Health Day, necessarily. What we do need is to know that health is now being more consistently considered as we debate all the other aspects of climate.” And one way to do that more broadly is to change the metrics around how the world measures the impacts of climate. This would include moving away from discussions about the 2 degrees Celsius increase in global temperatures, which she said largely isn’t meaningful to the majority of the world’s population. “Let's start talking about: Here's a health index and this is the extent to which global warming and climate change is impacting overall public health worldwide, and no country is immune from it,” Willis said. Editor’s note: Forecasting Healthy Futures facilitated Devex’s travel and logistics for this reporting. Devex retains full editorial independence and control of the content.