Everyone agrees that this spotlight on climate change is much needed and interest should continue to gain momentum. However, do these discussions lack focus and, more importantly, do they take into account fundamental values? Are we clear about our objectives during negotiations, in our research, programmes and policies? Do these objectives reflect genuine concerns based on social justice?

Global warming and extreme weather events are a serious and immediate threat to health and human development and a genuine concern. Hundreds of thousands of human beings are dying each year as a result of climate change (without even mentioning those who survive, living far below acceptable standards and who are just the tip of the iceberg).Yet, we face even greater concerns. Now, more than ever, there is clear social injustice where the poorest and most marginalized populations, those already suffering from lack of clean water, nutritious food and any kind of safety net, are hit the hardest by climate change. Ironically, they contribute the least to carbon dioxide emission.

Most of the tools to address the problem are missing. Very little research has been conducted so far on how climate change impacts on people’s health, on how it affects the different populations groups and – more importantly – on how to address the staggering health inequities that increasingly are a result of climate change.

The trilogy of the Global Forum’s core values – namely health, equity and research – that are mainstreamed in its Strategy 2008-2014 and its work are rarely addressed in climate change discussions. Greater awareness needs to be raised and the Global Forum would like to acknowledge three reports where all three fundamental values are addressed. The first one is the Final Report of the Commission on Social Determinants of Health, which stresses that “there is still a need for much research into the type of action most likely to affect the triangulated relationships between social factors, environmental change and health equity.” The second report was launched in May 2009: “The anatomy of a silent crisis” by the Global Humanitarian Forum (GHF), highlighting that “Intensified research on the human impact of climate change is imperative”. The third report, “Managing the health effects of climate change” by the UCL Lancet Commission, makes several recommendations on the research needed, and warns that "the limited research and structural adaptation in low-income and middle-income countries are likely to deepen social inequality related to climate change."

Health as a right

In a rather spectacular move, the British Medical Journal and the Lancet published simultaneously on 19 September 2022 the same Editorial stating that failure to agree radical reductions in emissions in Copenhagen will bring a “global health catastrophe”. In a separate Letter published in both medical journals, doctor’s organizations in many countries urged physicians to demand that their politicians act now to implement strategies that will benefit the health of communities worldwide. Research was however left out.

Equity as a principle

It has been predicted that the loss of healthy life years resulting from global environmental change could be 500 times greater in low-income African countries that in Europe. Data also shows that those most affected by climate change within those countries are the poor, women, children, the elderly and people living in vulnerable areas. Yet, the most vulnerable regions of a country are often the less proactive in adaptation planning for a particular hazard, be it flood, storm or drought. To make matters worse, national policies and interventions often fail to target these areas and populations. More research is needed to understand how to best protect these populations.

If policies and programmes, at their inception, do not have a special focus on health equity across both vulnerable regions and populations, they may end up increasing health disparities. On one hand, the wealthier tend to benefit in a disproportionate manner from interventions, due inter alia to differing capacities to adapt to changing conditions and to better access. On the other hand, some policies - such as carbon taxes - can in some instances be regressive, i.e. the relative financial burden is greater for low-income groups, and therefore result inequitable. Other policies may drastically increase the price of basic food. So when we ask ourselves: “What do we want to achieve?” the reply should not be “better health outcomes on average for the population”, but “better health outcomes in each and across every segment of the population”. It is thus of paramount importance to mainstream equity issues in all climate science and activities, research being key to tackling this issue of equity. This can be done for example through the systematic collection of data on mortality and morbidity disaggregated by socioeconomic indicators. Encouraging representatives of those who are most vulnerable to climate change, such as women, to participate in the design and implementation of research, and to contribute to key institutions would be a way to better protect those most affected by climate change.

High-level discussions need to address these concerns in order to have a chance to reduce health disparities. The World Climate Conference 3 that took place from 31 August to 4 September 2022 covered mainly aspects of adaptation linked with climate change and had a strong focus on the need to scale-up both the amount of existing climate data as well as to promote its availability and ultimately its use for the benefit of humanity. The need for evidence-based strategies was well emphasised throughout the conference, but the Global Forum Senior Officers felt that aspects of equity were not sufficiently addressed, apart from three working sessions; “Gender and climate”, “Climate and communities” and “Climate and human health”. Equity considerations were therefore promoted by the Global Forum for Health Research at the various interdisciplinary sessions held during the experts segment of the conference. The official WWC-3 Conference Statement is available here: http://www.wmo.int/wcc3/documents/WCC-3_Statement_07-09-09_mods.pdf

Research as an indispensable tool

The World Bank released its World Development Report 2010 on 15 September. The Global Forum welcomes the report’s emphasis on equity matters. Of interest, is a figure showing the imbalance of spending in research. While global subsidies for petrol products amount to some $150 billion annually only $10 billion are spent annually by public institutions on energy research. The report states that an additional $100 billion to $700 billion are needed every year in R&D and for the development of new technologies from public and private sources.

Research is needed for the careful design, monitoring and evaluation of policies and programmes, to address the many challenges relating to climate change and health issues. The most important concern is the limited capacity for research in low- and middle-income countries, which is most likely to increase health inequalities related to climate change. Another concern is that research topics should not be driven by donor’s own interests but by those who are in need. In terms of key issues that still need to be investigated are: factors that convey vulnerability, differences in vulnerability within and between populations; changes that need to be made in health care, emergency services and other health protection strategies; win-win solutions – for both climate and health equity.

For more information on the Global Forum activities on climate change, please see here. For questions or interview, please contact Sylvie Olifson-Houriet

In addition, the Global Forum held a related session on Climate change, innovation and health equity during Forum 2009 in Havana, Cuba, on 18 November 2009. Chair, moderator and presenters included: Fiona Godlee, Editor-in-chief of the BMJ; Kumanan Rasanathan, WHO, and Sarah Walpole (see related paper in WHO Bulletin, Oct 2009); Jaime Terán Reyes, INISER; Dziedzom Komi De Souza, Noguchi Memorial Institute; and Gilma Mantilla, IRI.