Health, environment and climate change: WHO global strategy on health, environment and climate change: the transformation needed to improve lives and well-being sustainably through healthy environments: report by the Director-General

SEVENTY-FOURTH WORLD HEALTH ASSEMBLY A74/41 Provisional agenda item 33 10 May 2021 Health, environment and climate change WHO global strategy on health, environment and climate change: the transformation needed to improve lives and well-being sustainably through healthy environments Report by the Director-General BACKGROUND 1. In May 2019, the Seventy-second World Health Assembly adopted decision WHA72(9) on the WHO global strategy on health, environment and climate change: the transformation needed to improve lives and well-being sustainably through healthy environments.1 The decision included a request to the Director-General to report back to the Seventy-fourth World Health Assembly on progress made in the implementation of the strategy. 2. The strategy aims to provide a vision and way forward on how the world and its health community need to respond to environmental health risks and challenges up to 2030, and to ensure safe, enabling and equitable environments for health by transforming our way of living, working, producing, consuming and governing. It was developed using a broad consultative process with Member States. 3. The strategy builds on six strategic objectives: (i) Primary prevention: to scale up action on health determinants for health protection and improvement in the 2030 Agenda for Sustainable Development; (ii) Cross-sectoral action: to act on determinants of health in all policies and in all sectors; (iii) Strengthened health sector: to strengthen health sector leadership, governance and coordination roles; (iv) Building support: to build mechanisms for governance, and political and social support; (v) Enhanced evidence and communication: to generate the evidence base on risks and solutions, and to efficiently communicate that information to guide choices and investments; and (vi) Monitoring: to guide actions by monitoring progress towards the Sustainable Development Goals. 4. This report describes progress in implementing the WHO global strategy on health, environment and climate change, and opportunities for further action arising from the strategy. IMPLEMENTATION OF THE STRATEGY 5. Implementation of the strategy started in 2019 through activities involving Member States and through regional processes, with a view to devising regional action plans that set regional and country priorities. WHO has coordinated these regional processes, which include the 2019 high-level meeting 1 WHO global strategy on health, environment and climate change: the transformation needed to improve lives and well-being sustainably through healthy environments. Geneva: World Health Organization; 2020 (https://www.who.int/phe/publications/global-strategy/en/, accessed 17 March 2021). A74/41 2 that led to the adoption of the WHO South-East Asia regional plan of implementation for the global strategy on health, environment and climate change; the European Environment and Health Process; as well as other multilateral regional agreements, such as the WHO/United Nations Economic Commission for Europe (UNECE) Protocol on Water and Health and the Transport, Health and Environment Pan- European Programme. In the African Region, following the third Inter-Ministerial Conference on Health and Environment, a strategic action plan to scale up health and environment interventions in Africa 2019–2029 was adopted to implement the Libreville Declaration. In 2019–2020, the Regional Office for the Americas and PAHO coordinated a consensus-driven process with the Member States of the Region leading to the establishment of a regional environmental agenda on health, environment, and climate change for the 2021–2030 period. The agenda builds on the commitments set forth in the Sustainable Health Agenda for the Americas 2018–2030 and the Strategic Plan of PAHO 2020–2025: Equity at the Heart of Health. Numerous activities in support of countries have also been undertaken, in particular in the areas of water, sanitation and hygiene, climate change resilience and adaptation, ambient and household air quality, chemical safety, occupational health, urban health, nature and health, and environmental health inequality. 6. The COVID-19 pandemic has once more highlighted the close relationship between health and environment and revealed vulnerabilities in our systems. The pandemic has also provided a unique opportunity for building forward better, greener, cleaner and more equitably, as professionals around the world have been urging. WHO has therefore put out a Manifesto for a healthy and green recovery from COVID-19,1 and has listed more than 80 “actionables”, or practical steps, supporting the Manifesto,2 to prepare for, strengthen resilience to, and avoid future disasters of similar scale. Their application would accelerate implementation of the global strategy. 7. WHO has also released evidence-based guidance for the protection of health workers,3 other workers,4 and environmental transmission in the framework of the COVID-19 pandemic; and has launched the Hand Hygiene for All Global Initiative, a call to action to achieve universal hand hygiene5 to reduce COVID-19 transmission, prevent other outbreak-related diseases, and which critically contributes to combatting antimicrobial resistance. 8. Recognizing the importance of environmental protection and biodiversity in connection with infectious diseases and nutrition, and in close collaboration with the United Nations Convention on Biological Diversity and key United Nations partner agencies, WHO has been developing a plan of action on biodiversity and health to be presented at the fifteenth session of the Conference of the Parties to the Convention in 2021. 1 Further information is available on the WHO Newsroom webpage: https://www.who.int/news-room/feature- stories/detail/who-manifesto-for-a-healthy-recovery-from-covid-19 2 Further information is available on the WHO Newsroom webpage: https://www.who.int/news-room/feature- stories/detail/actionables-for-a-healthy-recovery-from-covid-19 (accessed 17 March 2021). 3 COVID-19: Occupational health and safety for health workers: Interim guidance. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/bitstream/handle/10665/339151/WHO-2019-nCoV-HCW_advice-2021.1- eng.pdf?sequence=1&isAllowed=y, accessed 17 March 2021). 4Considerations for public health and social measures in the workplace in the context of COVID-19. Geneva: World Health Organization (https://www.who.int/publications/i/item/considerations-for-public-health-and-social-measures-in-the- workplace-in-the-context-of-covid-19, accessed 17 March 2021). 5 Hand Hygiene for All. World Health Organization and UNICEF; 2020 (https://www.who.int/water_sanitation_health/sanitation-waste/sanitation/hand-hygiene-for-all/en/, accessed 17 March 2021). A74/41 3 9. In cooperation with UNICEF, WHO has released a baseline report and is advocating for the provision of water, sanitation and hygiene, waste management and environmental cleaning in health care facilities.1 Such fundamental environmental services and safety measures in health care facilities are critical to support their basic functioning, enabling them to provide quality care, reduce health care associated infections, and chemical and radiation hazards and risks to the community. WHO is also advocating for, and supporting the agenda on, providing sufficient and reliable electricity to health care facilities, essential for the delivery of health services.2 In response to a joint call from WHO and the ILO for the development and implementation of national programmes for occupational health for health workers,3 28% of countries reported that they had such programmes and action plans in place.4 10. As a platform for action between the health and energy sectors, WHO launched the Health and Energy Platform (HEPA) at the Seventy-second World Health Assembly in 2019 in order to strengthen the political and technical cooperation at global, regional and country levels.5 At regional level for example, the Regional Office for Africa is developing a United Nations joint proposal for the Sahel subregion (the United Nations renewable energy offer for the Sahel) to support implementation of the United Nations Integrated Strategy for the Sahel (UNISS). WHO has since participated in several high- level events to mobilize political commitment, and has promoted global and country implementation roadmaps, and demonstrated leadership in identifying and promoting key actions and an interdisciplinary approach. 11. At the twenty-sixth session of the Conference of the Parties to the United Nations Framework Convention on Climate Change WHO, together with governments and other partners, will deliver key messages on health and climate change, initiating climate and health vulnerability assessment, developing national profiles, promoting early warning systems, advocating for enhanced adaptation, mitigation and resilience measures, transitions to clean energy and transport, protection of nature, and supportive finance allocation.6 The goal of the special initiative on climate change and health in small island developing States7 is that by 2030 all health systems in small island developing States are resilient to climate variability and change and are reducing carbon emissions both to protect the most vulnerable from climate risks and to gain the health co-benefits of mitigation policies. Regional processes are 1 WASH in health care facilities: Global Baseline Report. Geneva: World Health Organization and UNICEF; 2019 (https://www.who.int/water_sanitation_health/publications/wash-in-health-care-facilities-global-report/en/, accessed 17 March 2021). 2 See also the progress report on water, sanitation and hygiene in health care facilities (document A74/43, H). 3 Caring for those who care: National Programmes for Occupational Health for Health Workers. Policy brief. Geneva, World Health Organization and ILO; 2020 (https://www.who.int/publications/i/item/9789240011588, accessed 17 March 2021). 4 See the WHO Weekly Operational Update on COVID-19 for 1 February 2021: https://www.who.int/publications/m/item/weekly-operational-update-on-covid-19---1-february-2021 (accessed 17 March 2021). 5 For more information, visit the HEPA webpage: https://www.who.int/initiatives/health-and-energy-platform-of- action (accessed 27 January17 March 2021). 6 For more information, visit the COP26 Key Messages on Climate Change and Health webpage: https://www.who.int/publications/i/item/cop26-key-messages-on-climate-change-and-health (accessed 17 March 2021). 7 Climate change and health in small island developing States. A WHO special initiative. Geneva: World Health Organization; 2018 (9789241514996-eng.pdf (who.int), accessed 22 March 2021). A74/41 4 ongoing, and conscious efforts are being made to ensure that issues faced, or to be faced, by small island developing States are included in all mainstream related activities.1 12. WHO has been developing additional key activities to support the implementation of the global strategy through leadership, evidence synthesis, modelling and health impact assessment, advocacy and monitoring. Examples include (a) the global assessment of ambient air quality, with an update due in 2021; (b) the global campaign to prevent lead poisoning;2 (c) the update of the WHO global air quality guidelines, to be published in 2021. Regional activities include the Regional Office for Africa’s engagement with the Climate and Clean Air Coalition and with UNEP on the Integrated Assessment of Air Pollution And Climate Change in Africa; and the Regional Office for the Americas and PAHO’s comprehensive climate change and health programme for the Caribbean small island developing States. The Regional Office for the Americas and PAHO also launched a call to action, in alliance with the first ladies of Latin America, to universalize access to safe water, sanitation and hygiene (WASH) services in health care facilities. OPPORTUNITIES FOR FURTHER ACTION 13. Opportunities for countries, with WHO support, include those given in the paragraphs below. These are fully supported by the Thirteenth General Programme of Work, 2019−2023 and its implementation framework, which both include climate change, health and environment among their cross-cutting flagships:3 • strengthening the health sector to scale up prevention, to employ risk assessment, management and communication, and to engage in cross-sectoral activities across all levels of government, to protect health and advance on the health and environment-related Sustainable Development Goals, as set out in the WHO Global Strategy on Health, Environment and Climate Change; • developing cross-sectoral governance mechanisms to generate policies that would play a key role in influencing health, environment and climate change matters by taking full account of the comprehensive impact of development and sectoral policies on health and well-being. Such mechanisms are often lacking, but would facilitate coordinated action to promote choices that would yield health and economic co-benefits; • fostering efforts to build forward healthier and greener in response to the COVID-19 pandemic;4,5 1 See also the progress report on the Plan of action on climate change and health in small island developing States (document A74/43, I). 2 For more information, visit the International Lead Poisoning Prevention Week webpage: https://www.who.int/campaigns/international-lead-poisoning-prevention-week (accessed 17 March 2021). 3 https://apps.who.int/iris/bitstream/handle/10665/324775/WHO-PRP-18.1-eng.pdf, https://www.who.int/about/what- we-do/thirteenth-general-programme-of-work-2019---2023 (accessed 17 March 2021). 4 For more information, visit the WHO Newsroom webpage: https://www.who.int/news-room/feature- stories/detail/who-manifesto-for-a-healthy-recovery-from-covid-19 (accessed 17 March 2021). 5 For more information, visit the WHO Newsroom webpage: https://www.who.int/news-room/feature- stories/detail/actionables-for-a-healthy-recovery-from-covid-19 (accessed 17 March 2021). A74/41 5 • promoting the implementation of a One Health approach1 for addressing zoonotic diseases, antimicrobial resistance, environmental determinants of health and food safety. ACTION BY THE HEALTH ASSEMBLY 14. The Health Assembly is invited to note this report and to consider the following draft decision: The Seventy-fourth World Health Assembly, having considered the report on the WHO global strategy on health, environment and climate change,2 decided to request the Director-General to report to the Seventy-sixth, Seventy-eighth and Eighty-second World Health Assemblies on progress made in the implementation of the WHO global strategy. = = = 1 For more information, visit the WHO Newsroom webpage: https://www.who.int/news-room/q-a-detail/one-health (accessed 17 March 2021). 2 Document A74/41.