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In the wake of COP28, some advice for the health sector on where next

Introduction by Croakey: In the wake of global climate negotiations at the COP28 meeting in December, many participants have reflected upon the event’s outcomes for health.

Writing in the BMJ last month, Professor Liz Grant from the University of Edinburgh said the COP meeting navigates two great global systems: the planet’s natural climate system which supports all life, but which is being destroyed by human actions, and in turn is destroying the ecosystems on which all life depends; and a human made global finance system which also purports to support all life and livelihoods, but which is destroying much of the world’s natural systems and as a consequence also destroying humanity.

“The health day humanised the climate conversations, making explicit what had been hidden beneath global stocktake analysis, nationally determined contributions planning, methane agreements, and loss and damage commitments,” she wrote. “Beneath all the figures and graphs are people who are suffering because of the way that we have been living.”

Meanwhile, authors from the Global Climate and Health Alliance, Health Care Without Harm and the London School of Hygiene and Tropical Medicine, have issued a number of calls to action to the health community in response to commitments and actions from COP28 that “are not commensurate with the scale of the threat”.

These include a call for members of the health community from the global north to partner more effectively with allies from the global south to increase representation through sharing of passes to attend negotiations and through providing financial resources.

“Better representation from the global south can ensure that policy calls are grounded in global realities and match the priorities of people living in regions already most affected by climate change and who are forging solutions,” they wrote in the BMJ this week.

Associate Professor Angie Bone, a public health physician, academic at Monash Sustainable Development Institute, and a Board Member of Doctors for the Environment Australia, writes below about her first experience of a COP, and highlights the importance of “raising our voices to call for our governments to take strong and equitable climate action, particularly so in a year when almost half the world’s populations are voting in elections”.


Angie Bone writes:

Although I have worked in climate and health at various intensities and across government organisations in the UK, France, and Australia for over 15 years, I had never attended a United Nations Framework Convention on Climate Change Conference of the Parties (aka COP) – until this most recent one.

I had watched their successes and failures from afar and I had heard the criticisms of COPs – the influence of lobbyists, the trade fair atmosphere, the separation of civil society organisations from negotiators, and the glacial progress.

But I also appreciated the complexity of gaining consensus across 198 member states, each with differing resources, influences and priorities. The sorts of competing agendas I’d had to deal with at state and national level when working on multisectoral issues, but enormously amplified.

And I had observed the gradual acceptance of the relevance of human health to the process and outcomes, thanks to persistent advocacy by the World Health Organization (WHO) and other partners. I was excited that COP28 was finally going to be the ‘health COP’ with the first ever dedicated health day and climate-health ministerial meeting in 28 years of COPs.

So, I was delighted to be invited to be the ‘health day’ lead as part of Monash University’s in-person delegation to COP28.

After several years of COP attendance, Monash had applied for and been granted a pavilion in the hallowed ‘blue zone’, the section of the conference reserved for official negotiations and accredited participants.

Attending COP aligned with Monash’s strategic plan ‘Impact 2030’ which identifies three interdependent challenges of the age – climate change, geopolitical security and thriving communities – with Monash focusing its research and education capabilities across its nine campuses in six countries to respond to these challenges.

Also on the delegation were some fantastic colleagues from health (shout out particularly to Associate Professor Zerina Lokmic-Tomkins who provided me with huge support in running our health events) and also colleagues from other sectors and disciplines who had their own ‘days’ event programs to manage.

Being part of such a diverse delegation provided a great opportunity to connect across disciplines, faculties, and campuses and to explore connections and synergies in our projects that we might not otherwise have had.

With Monash being the only university in the Indo-Pacific with a blue zone pavilion, we endeavoured to use it as a platform for the region to showcase expertise and have challenging conversations – about solutions and justice, and science and emotions, connecting again with others we may not have met without the opportunity of the pavilion.

Between us we held, or participated in, over 100 events during the two-week period in a variety of formats. Some of the most memorable for me were those where personal experiences were shared such as those from representatives of Pacific countries and First Nations.

While having the pavilion provided many opportunities, there were some disadvantages – the main one being fewer opportunities to engage beyond the pavilion. This was exacerbated by the layout at Dubai Expo 2020, which was extremely spread out, scattered across multiple buildings and not always easy to navigate.

Monash was fortunate to be in the building next to the health pavilion, meaning I was able to attend a handful of events on days other than health day, but a good 20-30 minutes’ walk from others in the blue zone.

Reflections and advice

Thus, the reflections that follow are based on what I have read and heard about COP28, as well as my observations.

Is the COP process worth engaging with?

Yes, I firmly believe that, as others have said, it’s the best we have, given how our international governance has evolved with the UN essentially a broker for 198 sovereign states. My Monash colleagues have provided an excellent explainer here if you are interested in learning more.

I often hear politicians blamed for slow progress in responding to climate change. But even the most well-intentioned have to manage multiple interests (some of which are powerful and vocal) which can constrain how much or how far they feel they can go.

This underlines the importance of raising our voices to call for our governments to take strong and equitable climate action, particularly so in a year when almost half the world’s populations are voting in elections.

But we cannot rely solely on governments and the COP process to make the transition to low emission economies; all parts of society have a role to play. Governments are unlikely to act at the scale and pace needed unless they believe they have the support to do so.

It is worth going to COP as a member of a Research and Independent Non-governmental Organisation (RINGO)?

Yes, I think there is value in attending, particularly if you can connect with policy makers and negotiators and be available to support them with the evidence they need.

And of course, there is benefit in meeting in person existing and potential collaborators with much useful dialogue happening informally alongside events.

I was conscious, however, that there was a whole RINGO constituency sharing information and connecting, but on this occasion didn’t have the time to engage.

And it is true that a lot of the conference does feel rather like a trade fair, with limited opportunities for connection between civil society and policy makers in general.

That said, the Australian Government did a great job in hosting various platforms for connection and briefings before, during and after the event.

Did the health sector make an impact?

Yes, certainly. There was a palpable ‘buzz’ in the lead up to and for a few days beyond the health event and a lot of celebration and congratulation.

It was clear there had been a huge effort to land the various outcomes that have been described elsewhere.

It was also a great opportunity for the Australian Government to announce its new National Health and Climate Strategy and joining of WHO’s Alliance for Transformative Action on Climate and Health.

I was really pleased to hear from a colleague in another sector that this was the first time he’d really understood the relevance of health after hearing Professor Ollie Jay and Dr Andrew Forrest talk about limits to global survivability to heat and humidity as a massive driver for accelerating transition to green energy.

The author with MInister Ged Kearney and the National Health and Climate Strategy. Photo provided.

What should the health sector focus on for the next COP(s)?

While there were some significant achievements for climate and health, it was notable that health ministers were not part of the formal negotiations.

I had the impression that there was a tendency to frame health solely in terms of consequences of climate change, as opposed to the health benefits of emissions reduction being an integral part of the case for transition.

Although the main UAE consensus included text about the need to ‘transition away’ from fossil fuels, albeit with many loopholes, the health declaration was entirely silent on fossil fuels.

Some have even suggested that there was a risk of ‘health-washing’.

I would like to see the health community more deliberately and intentionally working with other sectors, supporting their efforts to transition to equitable low-carbon policies and practices, providing robust evidence of health benefits.

For this to happen at the global scale, it first needs to happen at the domestic scale – and throughout the year, not just at COP.

Our current siloed approaches to research and policy disciplines are often a barrier. I would like to see dedicated investment and expertise developed in bridging sectoral divides across both research and policy spaces.

What will I do differently if I go to another COP?

If I were to attend a future COP, I’d like to spend more time listening to countries’ perspectives on how the research community can best support them in their climate and health actions and input into future COPs.

My hope is that I would be able to engage more deeply in supporting those shaping the process and outcomes of the negotiations, including deeper engagement with the RINGO constituency.

I’d also want to delve more deeply into the interface between health and all the other COP themes to help bring a greater planetary health perspective to bear.

In conclusion, I am very grateful to have experienced a COP. This was the first truly global conference I’d been to, and I did get a sense that momentum for change is finally building.

I left feeling that a transition to low carbon ways of living is inevitable, but with a nagging dread that we’ve collectively left it so late that the transition will be disorderly and far from just.

The more we do now to reduce emissions, prepare for change, and support those most affected, the softer the blows.

• Angie Bone is a public health physician and associate professor of practice in planetary health at Monash Sustainable Development Institute. She is a Board Member of Doctors for the Environment Australia. She will be attending the first ever global meeting of the World Health Organization’s Alliance for Transformative Action in Climate and Health in March 2024.

Further reading

BMJ: COP28: the Health Day was a call to action from the health community worldwide

BMJ: The health community must build on commitments from COP28 to deliver healthy outcomes for all

The Lancet Planetary Health: COP28 reflections

The MJA Insight: Human health finally on the radar, but COP28 still disappoints

Clean Air Fund: COP28: Seven takeaways for clean air, climate and health


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