COP26 special report on climate change and health: the health argument for climate action

COP26 SPECIAL REPORT ON CLIMATE CHANGE AND HEALTH THE HEALTH ARGUMENT FOR CLIMATE ACTION

COP26 SPECIAL REPORT ON CLIMATE CHANGE AND HEALTH In memory of Ella Kissi-Debrah – and all other children who have suffered and died from air pollution and climate change. THE HEALTH ARGUMENT FOR CLIMATE ACTION Advanced proof Advanced proof COP26 special report on climate change and health: the health argument for climate action ISBN 978-92-4-003672-7 (electronic version) ISBN 978-92-4-003673-4 (print version) © World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no sugges- tion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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III/COP26 Special Report / The health argument for climate actionAdvanced proof Contents Forewords IV Acknowledgements VI Abbreviations VII Executive Summary VIII The health impacts of climate change 2 The health argument for climate action 4 Recommendations for climate change and health 8 1. Commit to a healthy recovery. 10 2. Our health is not negotiable. 14 3. Harness the health benefits of climate action. 20 4. Build health resilience to climate risks. 24 5. Create energy systems that protect and improve climate and health. 30 6. Reimagine urban environments, transport, and mobility. 36 7. Protect and restore nature as the foundation of our health. 40 8. Promote healthy, sustainable, and resilient food systems. 46 9. Finance a healthier, fairer, and greener future to save lives. 52 10. Listen to the health community and prescribe urgent climate action. 56 References 62 COP26 Special Report / The health argument for climate action Advanced proofIV / Foreword Extreme heat, floods, droughts, wildfires and hurricanes: 2021 has broken many records. The climate crisis is upon us, powered by our addiction to fossil fuels. The consequences for our health are real and often devastating. Climate change impacts health in all countries, but it hits people in low- and middle-income countries the hardest, especially small island developing states, whose very existence is under threat from rising sea levels. Any delay in acting on this global health threat will disproportionately affect the most disad- vantaged around the world. The COVID-19 pandemic is a visceral example of the inequitable impacts of such a global threat. To fully address the urgency of both these crises, we need to confront the inequal- ities that lie at the root of so many global health challenges. Health and equity are central to achieving the goals of the Paris Agreement and to making COP26 a success. Protecting health requires action well beyond the health sector, in energy, transport, nature, food systems, finance and more. The ten recommendations outlined in this report – and the action points, resources and case studies that support them – provide concrete examples of interventions that, with support, can be scaled up rapidly to safeguard our health and our climate. The recommendations are the result of extensive consultations with health professionals, organiza- tions and stakeholders worldwide, and represent a broad consensus statement urging governments to act to tackle the climate crisis, restore biodiversity, and protect health. Putting that into practice means investing in a healthier, fairer, and more resilient world. Advanced economies, in particular, have a once-in-a-generation opportunity to demonstrate true global solidarity, both in supporting an equitable response to COVID-19, and by making health central to the implemen- tation of the renewed climate commitments that they are making at COP26. It is the only way for us to get out of the current health crisis and prevent future ones. The health arguments for rapid climate action have never been clearer. I hope this report can guide policymakers and practitioners from across sectors and across the world to implement the transform- ative changes needed. Let’s get to work. Dr Tedros Adhanom Ghebreyesus Director-General World Health Organization Advanced proof COP26 Special Report / The health argument for climate action V/ Foreword As the last two years have shown us, public, planetary and economic health are inextricably linked. The race to a zero-emissions economy before 2050 is, therefore, a race to a healthy, clean and resilient future. As highlighted by the IPCC Sixth Assessment Report published earlier this year, we need to halve greenhouse gas emissions between 2020 and 2030 while reversing nature loss in order to reach net zero and limit global warming to a 1.5°C. But time is running short, and every fraction of a degree threatens to cause more death and economic destruction. This is going to require full systems change and collaboration across all sectors. As highlighted by this report, these include energy, transport, built environment and agriculture amongst multiple other sectors. However, we also need to act within the healthcare sector given the scale of the economy and emissions it represents. The World Health Organization estimates that globally the spending on health reached 10% of GDP in 2018, and Health Care Without Harm estimates that in 2019 the sector was responsible for 4.4% of net global emissions. We have seen good progress to date on the UN Race to Zero, where 46 healthcare institutions repre- senting over 3,200 healthcare facilities across 18 countries have joined. In addition to this, over 28% of major pharmaceutical and medical technology companies by revenue have joined the campaign. But we need to keep accelerating our efforts to both cut emissions and build resilience to the impacts of climate change, and move from ambition to action within the 2020s. As the healthcare sector is already demonstrating, health can enable transformational change in other sectors. At the same time, we must adapt to thrive in spite of impacts such as floods, droughts and extreme temperatures. Through the UN Race to Resilience, by 2030 we are mobilising businesses, investors, cities and regions to build the resilience of the 4 billion people most at risk. On top of that, we need to continue to improve the quality and delivery of accessible healthcare across the globe. The future of healthcare needs to be reimagined, where we can build a world that is zero carbon, resilient, and healthy for all. In this future, there is clean air, food security, more access to nature – a world where our children can thrive. I welcome the clear recommendations from this report which show the steps we must take together to build that future. Nigel Topping COP26 High-Level Climate Action Champion COP26 Special Report / The health argument for climate action Advanced proofVI / Acknowledgements The World Health Organization (WHO) would like to express its gratitude to all Member States, organizations and indi- viduals that participated in the WHO Regional Consultations on Climate Change and Health. These consultations were hosted by the WHO Civil Society Working Group to Advance Action on Climate Change, co-chaired by WHO and the Global Climate and Health Alliance, and in partnership with WHO regional offices and other health partners. The generous contributions of all the participants to the consul- tations were essential in developing the recommendations contained in this report. The development and production of this report were led by Arthur Wyns, Marina Maiero, Alexandra Egorova and Diarmid Campbell-Lendrum from the Department of Environment, Climate Change and Health, WHO. More than 150 organizations and 400 experts and practi- tioners contributed to this report through participation in workshops, peer review and the provision of insights and text. Special thanks are due to the following WHO experts: Heather Adair-Rohani, Hamed Bakir, Matthias Braubach, Daniel Buss, Carlos Corvalan, Jonathan Drewry, Sally Edwards, Sophie Gepp, Faustina Gomez, Nasir Hassan, Thiago Herick de Sa, Dorota Jarosinska, Vladimir Kendrovski, Antonios Kolimenakis, Lina Mahy, Mazen Malakawi, Marco Martuzzi, Guy Mbayo, Abraham Mwaura, Maria Neira, Sinaia Netanyahu, Tara Neville, Lesley Onyon, Genandrialine Peralta, Jessie Pullar, Saleh Rababa, Francesca Racioppi, Hussain Rasheed, Cristina Romanelli, Amy Savage, Oliver Schmoll, Aderita Sena, Elena Villalobos Prats, Johanna Wegerdt, Diana Weil, Nicola Wheeler and Naoko Yamamoto. WHO is grateful for the valuable inputs received from the Global Climate and Health Alliance and the WHO Civil Society Working Group to Advance Action on Climate Change, as well as from the following organizations and institutions: Association Nationale des Etudiants en Pharmacie de France; Australian Healthcare and Hospital Association; Brazilian Institute for Consumer Protection; Bupa; C40 Cities; Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health; Centre for Accountability and Inclusive Development; Clean Air Fund; Client Earth; Climate and Clean Air Coalition; Clinton Health Access Initiative; Convention on Biological Diversity; Earth Law Center; EAT; EnGen Collaborative; European Pharmaceutical Students’ Association; European Public Health Alliance; Family Planning NSW; Focus, Association for Sustainable Development, Slovenia; Four Paws; George Mason University Center for Climate Change Communication; Girls Must, Uganda; Global Alliance for the Future of Food; Global Consortium on Climate and Health Education; Green Health Wales; Health and Environment Alliance; Health and Environment International Trust, New Zealand; Health Care Without Harm; Health Concern Initiative Uganda; Health Declares; Indian Institute for Peace Disarmament and Environmental Protection; Infectious Disease Institute, Uganda; Institute for Health and Environment, Slovenia; International Organisation for Migration; International Federation of Medical Students Associations; International Federation of Red Cross and Red Crescent Societies; International Planned Parenthood Federation; Ipas; Jozef Stefan Institute; Ludwig Maximilians University; Mott MacDonald Group; MSI Reproductive Choices; Natural Resources Defense Council; NCD Alliance; National Health Service - Greener NHS Programme, United Kingdom; OraTaiao, Climate and Health Council, New Zealand; Physicians Association for Nutrition, South Africa; Public Health Wales; Red Cross Climate Centre; Royal Australasian College of Physicians; Save the Children; Center for Health and Human Rights, Uganda; UN Environment; UN Environment Programme World Conservation Monitoring Centre; United Nations Development Programme; United Nations Population Fund; University Student Chamber International; White Ribbon Alliance; World Business Council for Sustainable Development; World Economic Forum; YOUNGO Children and Youth Constituency to the United Nations; Youth Advocacy and Development Network, Uganda. Thanks are also due to the following individuals for their feedback and suggestions: Brigitte Alarcon, Tilly Alcayna, Lujain Alqodmani, Liana Anderson, Elena Ateva, Sophie Aylmer, Rizal Bahri, Kervelle Baird, Angela Baschieri, Eliza Basheer, Lynette Bassman, Naomi Baster, Jessica Beagley, Asma Ben Mrad, Hitesh Bhatt, Soumyadeep Bhaumik, Nathan Borgford-Parnell, Mukiibi Bright, Rachel Bustamante, Lori Byron, Anthony Capon, Sandra Cavalieri, Fatma Çelik, Tara Chen, Tiy Chung, Bethan Cobley, Dermot Coffey, Pushkar Sebastian Cordoba, Janine Coutinho, Alison Cox, Rasha Dabash, Deodato Da Costa Neto, Gordon Dakuu, Avriel Diaz, Gabriel O Dida, Emine Didem, Tracy Ditucci, Monika Dos Santos, Thomas Downs, Mohamed Eissa, Shannon Engstrom, Tracy Evans, Patty Fong, Paula Franklin, Luiz Galvao, Chuansi Gao, Paul Gibson, Lasha Goguadze, Tomaž Gorenc, Margaux Granat, Lorenzo Guadagno, Renzo Guinto, Andrew Haines, Anna Hazelwood, Charlotte Hicks, Richard Hixson, Emma Hoban, Robert Hughes, Suvi Huikuri, Anthony Huszar, Lakshmi Josyula, Uta Jungermann, Raju Kanukula, Josh Karliner, Natassha Kaur, Evci Kiraz, Ann Mette Kjaerby, Tord Kjellstrom, Jen Kuhl, Balkrishna Kurvey, Johan Kuylenstierna, Chloé Lebbos, Andrea Lee, Vijay Limaye, Frederic Lino, Daniel Mahadzir, Edward Maibach, Sujit Maji, Chris Malley, Brian Mayanja, Dave McConalogue, Igor Mekjavic, Chilekwa Mibenge, Jeni Miller, Clara Mourgues, Kari Nadeau, Rajen Naidoo, Rui Nakamura, Shweta Narayan, Zuzana Nordeng, Elspeth Oppermann, Mahesh Pandya, Eva Parker, Kim Perrotta, Nicky Philpott, Montira Pongsiri, Poornima Prabhakaran, Vincent Puke, Liz Purchia, Nikolai Pushkarev, Kristin Renzenbrink, Mónica Rodrigues, Aanu Rotimi, Raymond Ruyoka, Lourdes Sanchez, Rodrigo Sánchez Iturregui, Tianna Scozzaro, Drew Shindell, Laetitia Sieffert, Roop Singh, Cecilia Sorensen, Francisca Soto-Aguilar, Kam Sripada, Timothy Sserubiri, Anne Stauffer, Andrew Storey, Gail Sucharitakul, Jin Tanaka, Oksana Tarasova, Maurine Tukahirwa, SanYuMay Tun, Anaid Velasco, Joanne Walker, Clare Westwood, Juliet Whitley, Nanine Wyma, Angèle Zintsem and Lidija Zivcic. Advanced proof COP26 Special Report / The health argument for climate action VII/ Abbreviations BAR-HAP Benefits of Action to Reduce Household Air Pollution tool CaRBonH Carbon Reduction Benefits on Health calculation tool CBD Convention on Biological Diversity CCAC Climate and Clean Air Coalition CHEST Clean Household Energy Solutions Toolkit COP Conference of the Parties FAO Food and Agriculture Organization of the United Nations GAPH-TAG Global Air Pollution and Health Technical Advisory Group GBF Global Biodiversity Framework GDP gross domestic product HEAT Health Economic Assessment Tool for walking and cycling HEPA Health and Energy Platform of Action HNAP health national adaptation plan IPCC Intergovernmental Panel on Climate Change iSThAT Integrated Sustainable Transport and Health Assessment tool IUCN International Union for the Conservation of Nature NAPs national adaptation plans NBSAPs national biodiversity strategies and action plans NCDs noncommunicable diseases NDCs nationally determined contributions SDGs Sustainable Development Goals SIDS small island developing states SLCPs short-lived climate pollutants UHC universal health coverage UNFCCC United Nations Framework Convention on Climate Change V&A Vulnerability and Adaptation Assessment WASH water, sanitation and hygiene WHO World Health Organization Advanced proofCOP26 Special Report / The health argument for climate actionVIII / Executive Summary The 10 recommendations in the COP26 Special Report on Climate Change and Health propose a set of priority actions from the global health community to governments and policy makers, calling on them to act with urgency on the current climate and health crises. The recommendations were developed in consultation with over 150 organisations and 400 experts and health professionals. They are intended to inform governments and other stakeholders ahead of the 26th Conference of the Parties (COP26) of the United Nations Framework Convention on Climate Change (UNFCCC) and to highlight various opportunities for governments to prioritise health and equity in the interna- tional climate movement and sustainable devel- opment agenda. Each recommendation comes with a selection of resources and case studies to help inspire and guide policymakers and practi- tioners in implementing the suggested solutions. The next few years present a crucial window for governments to integrate health and climate policies in their COVID-19 recovery packages (recommendation 1) and international climate commitments (recommendation 2). While near- term pandemic responses will largely set the pace and direction of health and climate goals, ambitious national climate commitments will be crucial to sustain a healthy recovery in the mid- to long-term. To achieve the goals of the Paris Agreement, health and equity need to be placed at the centre of the United Nations climate negotiations going forward. The health benefits from climate actions (recom- mendation 3) are well documented and offer strong arguments for transformative change – and this is true across many priority areas for action: adaptation and resilience (recommenda- tion 4), the energy transition (recommendation 5), clean transport and active mobility (recom- mendation 6), nature (recommendation 7), food systems (recommendation 8) and finance (recom- mendation 9). The health sector and health community are a trusted and influential - but often overlooked - climate actor that can enable transformational change to protect people and planet (recommendation 10). © WHO Advanced proof COP26 Special Report / The health argument for climate action 1/Advanced proof Recommendations on climate change and health: 1 Commit to a healthy recovery. Commit to a healthy, green, and just recovery from COVID-19. 2 Our health is not negotiable. Place health and social justice at the heart of the UN climate talks. 3 Harness the health benefits of climate action. Prioritise those climate interventions with the largest health-, social- and economic gains. 4 Build health resilience to climate risks. Build climate-resilient and environmentally sustainable health systems and facilities, and support health adaptation and resilience across sectors. 5 Create energy systems that protect and improve climate and health. Guide a just and inclusive transition to renewable energy to save lives from air pollution, particularly from coal combustion. End energy poverty in households and health care facilities. 6 Reimagine urban environments, transport, and mobility. Promote sustainable, healthy urban design and transport systems, with improved land-use, access to green and blue public space, and priority for walking, cycling and public transport. 7 Protect and restore nature as the foundation of our health. Protect and restore natural systems, the foundations for healthy lives, sustainable food systems and livelihoods. 8 Promote healthy, sustainable, and resilient food systems. Promote sustainable and resilient food production and more affordable, nutritious diets that deliver on both climate and health outcomes. 9 Finance a healthier, fairer, and greener future to save lives. Transition towards a wellbeing economy. 10 Listen to the health community and prescribe urgent climate action. Mobilise and support the health community on climate action. COP26 Special Report / The health argument for climate action Advanced proof2 / The health impacts of climate change Climate change is the single biggest health threat facing humanity (1), and health professionals worldwide are already responding to the health harms caused by this unfolding crisis (2). The Intergovernmental Panel on Climate Change (IPCC) has concluded that to avert catastrophic health impacts and prevent millions of climate change-related deaths, the world must limit temperature rise to 1.5°C (3). Past emissions have already made a certain level of global temperature rise and other changes to the climate inevitable. Global heating of even 1.5°C is not considered safe, however; every additional tenth of a degree of warming will take a serious toll on people’s lives and health (4). While no one is safe from these risks, the people whose health is being harmed first and worst by the climate crisis are the people who contribute least to its causes, and who are least able to protect themselves and their families against it - people in low-income and disadvantaged coun- tries and communities (5). The climate crisis threatens to undo the last fifty years of progress in development, global health, and poverty reduction, and to further widen existing health inequalities between and within populations (6). It severely jeopardises the real- isation of universal health coverage (UHC) in various ways – including by compounding the existing burden of disease and by exacerbating existing barriers to accessing health services, often at the times when they are most needed (7). Over 930 million people - around 12% of the world’s population - spend at least 10% of their household budget to pay for health care. With the poorest people largely uninsured, health shocks and stresses already currently push around 100 million people into poverty every year, with the impacts of climate change wors- ening this trend (8,9). Climate change is already impacting health in a myriad of ways, including by leading to death and illness from increasingly frequent extreme weather events, such as heatwaves, storms and floods, the disruption of food systems, increases in zoonoses and food-, water- and vector-borne diseases, and mental health issues. Furthermore, climate change is undermining many of the social determinants for good health, such as livelihoods, equality and access to health care and social support structures (Figure 1). These climate-sensitive health risks are disproportion- ately felt by the most vulnerable and disadvan- taged, including women, children, ethnic minor- ities, poor communities, migrants or displaced persons, older populations, and those with underlying health conditions (7,10). Although it is unequivocal that climate change affects human health, it remains challenging to accurately estimate the scale and impact of many climate-sensitive health risks. However, scientific advances progressively allow us to attribute an increase in morbidity and mortality to human-induced warming (11), and more accu- rately determine the risks and scale of these health threats (12). In the short- to medium-term, the health impacts of climate change will be determined mainly by the vulnerability of populations, their resilience to the current rate of climate change and the extent and pace of adaptation (6). In the longer-term, the effects will increasingly depend on the extent to which transformational action is taken now to reduce emissions and avoid the breaching of dangerous temperature thresholds and potential irreversible tipping points (4). Climate-sensitive health risks Vector- borne diseases Malnutrition and food- borne diseases Respiratory illness Impacts on healthcare facilities Mental and psychosocial health Heat- related illness Injury and mortality from extreme weather events Zoonoses Noncommunicable diseases (NCDs) Water-borne diseases and other water- related health impacts Health outcomes Health systems & facilities outcomes Effects on health systems Vulnerability Exposure pathways • Extreme weather events • Heat stress • Air quality • Water quality and quantity • Food security and safety • Vector distribution & ecology Vulnerability factors • Demographic factors • Geographic factors • Biological factors & health status • Sociopolitical conditions • Socioeconomic factors Health system capacity & resilience • Leadership & governance • Health workforce • Health information systems • Essential medical products & technologies • Service delivery • Financing Climate change Advanced proof COP26 Special Report / The health argument for climate action 3/ Climate-sensitive health risks Vector- borne diseases Malnutrition and food- borne diseases Respiratory illness Impacts on healthcare facilities Mental and psychosocial health Heat- related illness Injury and mortality from extreme weather events Zoonoses Noncommunicable diseases (NCDs) Water-borne diseases and other water- related health impacts Health outcomes Health systems & facilities outcomes Effects on health systems Vulnerability Exposure pathways • Extreme weather events • Heat stress • Air quality • Water quality and quantity • Food security and safety • Vector distribution & ecology Vulnerability factors • Demographic factors • Geographic factors • Biological factors & health status • Sociopolitical conditions • Socioeconomic factors Health system capacity & resilience • Leadership & governance • Health workforce • Health information systems • Essential medical products & technologies • Service delivery • Financing Climate change An overview of climate-sensitive health risks, their exposure pathways and vulnerability factors. Climate change impacts health both directly and indirectly, and is strongly mediated by environmental, social and public health determinants. Figure 1 COP26 Special Report / The health argument for climate action Advanced proof4 / The health argument for climate action Taking rapid and ambitious action to halt and reverse the climate crisis has the potential to bring many benefits, including for health. Co-benefits are defined as: the positive effects that a policy or measure aimed at one objec- tive might have on other objectives, thereby increasing the total benefits for society or the environment (13). The public health benefits resulting from ambi- tious mitigation efforts would far outweigh their cost (14). Strengthening resilience and building adaptive capacity to climate change, on the other hand, can also lead to health benefits by protecting vulnerable populations from disease outbreaks and weather-related disasters, by reducing health costs and by promoting social equity. The health co-benefits from climate change actions are well evidenced, offer strong arguments for transformative change, and can be gained across many sectors, including in energy generation, transport, food and agricul- ture, housing and buildings, industry, and waste management (6,15). For example, many of the same actions that reduce greenhouse gas emissions also improve air quality, and support synergies with many of the Sustainable Development Goals (SDGs) (16). Some measures - such as facilitating walking and cycling - improve health through increased phys- ical activity, resulting in reductions in respiratory diseases, cardiovascular diseases, some cancers, diabetes and obesity (17). Another example is the promotion of urban green spaces, which facilitate climate mitigation and adaptation while also offering health co-benefits, such as reduced exposure to air pollution, local cooling effects, stress relief, and increased recreational space for social interaction and physical activity (18,19). A shift to more nutritious plant-based diets in line with WHO recommendations, as a third example, could reduce global emissions signifi- cantly, ensure a more resilient food system, and avoid up to 5.1 million diet-related deaths a year by 2050 (20). Research has shown that climate action aligned with Paris Agreement targets would save millions of lives due to improvements in air quality, diet and physical activity, among other benefits (21). However, many climate decision-making processes currently do not account for health co-benefits and their economic valuation. The 2021 WHO Health and Climate Change Global Survey of governments found that less than 1 in 5 countries have conducted an assessment of the health co-benefits of national climate miti- gation policies (22), while a 2021 WHO review of Nationally Determined Contributions (NDCs) found just 13% of current NDCs commit to quan- tifying or monitoring the health co-benefits of climate policies or targets (23). While there are significant health co-bene- fits available for various climate interventions, which can act as important ethical and economic incentives, some climate mitigation and adap- tation policies may not maximise health gains or may potentially cause harm. Additionally, several challenges and barriers remain for the comprehensive inclusion of health in the cost assessment of climate policies (24). It is therefore critical that health and other experts are fully involved in climate decision-making processes at all levels, to ensure health and equity consid- erations are well understood and accounted for when developing climate policies (25). Advanced proof COP26 Special Report / The health argument for climate action 5/ WHO Expert Working Group on the Health Benefits of Climate Change Mitigation In recognition of the growing field of research on the public health gains of climate change mitigation, and the importance of this evidence to catalyse global action to reduce greenhouse gas emissions, WHO has established an Expert Working Group on the Health Benefits of Climate Change Mitigation as part of its Global Air Pollution and Health Technical Advisory Group (GAPH-TAG). The Working Group brings together global experts to review and advise on actions that both address climate change and improve human health, primarily through improved air quality. As part of its work, the GAPH-TAG will provide guidance and tools to national stakeholders to carry out assessments of the health benefits or harms associated with interventions to reduce carbon emissions. By emphasising the health implications of climate mitigation policies and providing recommendations on best practices, the initiative will empower national health policymakers to elevate the health argu- ment for ambitious climate action, and ensure health is represented in national and global planning processes (26). © ADB COP26 Special Report / The health argument for climate action Advanced proof6 / Case study Building a healthy, resilient future in Small Island Developing States Small Island Developing States (SIDS) face a particular set of urgent health threats. They are uniquely vulnerable to the impacts of climate change, making up two thirds of the countries that suffer the highest relative losses from climate disasters each year. At the same time, they carry heavy burdens of noncommunicable diseases (NCDs), malnutrition, and now also the impacts of COVID-19. Together these threats are contributing to unprecedented economic, and even exis- tential, crises for these States. Most SIDS are classified economically as middle-income or above, though they face severe economic vulnerabilities and lack access to external support relative to their needs (27). In the face of all these challenges, SIDS have shared strengths. They are leaders in the interna- tional negotiations on climate change, have well-established regional support mechanisms and collaborative bodies, and have a rich history of commitment to health and sustainable develop- ment (28). Any effort to ensure a healthy future for SIDS must allow their people to survive and thrive by reducing global carbon emissions to mitigate climate impacts. It must also strengthen the resil- ience of health systems and health-determining sectors, such as food and nutrition, water and sanitation, and social protection, to protect and enhance the health and wellbeing of the people of SIDS in the face of a changing climate. WHO launched a Special Initiative on Climate Change and Health in SIDS at the 23rd Conference of the Parties (COP23) of the UNFCCC held in Bonn in 2017, in collaboration with the UNFCCC Secretariat and the Fijian Presidency of the COP23 (29). WHO, with SIDS Member States, devel- oped a Global Plan of Action, which sets out key actions to ensure all health systems in SIDS will be resilient to climate change by 2030 (30). The SIDS have been among the leaders globally in assessing risks and setting national agendas for climate change and health (31). WHO is reinforcing its strategic actions to support SIDS in addressing their top health threats. In June 2021, WHO hosted a SIDS Summit for Health that brought together SIDS heads of states, ministers of health, and others, to frame priority actions and intensify collaboration. In the outcome statement of the Summit, the representatives of SIDS put forward their commit- ments and calls to action to achieve a healthy, resilient future in SIDS (32). These include fully addressing health in the climate change movement, scaling up integrated care for NCDs and mental health needs, enabling healthy diets and biodiversity, pursuing equity in access to vaccines and other innovations, more equitable and resilient health systems, stronger workforces and supply systems, as well as sustainable financing for climate and health goals. They called for WHO to support a SIDS Leaders Group for Health and SIDS Voices for Health Forum, to amplify SIDS voices, promote collaborative action and galvanise targeted support (33). The efforts of SIDS highlight that governments can put forward a joint vision for health and devel- opment that addresses the acute needs of this critical time, prioritising the most vulnerable and disadvantaged regions and communities. Advanced proof COP26 Special Report / The health argument for climate action 7/ Monitoring the progress and barriers on climate change and health in SIDS The Health and Climate Change Country Profiles, developed by WHO and the UNFCCC Secretariat, are a key mechanism in WHO’s efforts to monitor national progress on health and climate change. Country profiles are prepared in collabo- ration with ministries of health and other partners such as ministries of the envi- ronment and national meteorological services. They allow countries to strengthen their national evidence base for decision-making and measure progress in building climate-resilient health systems. Close to 100 country profiles have been developed, including for many SIDS. As part of WHO’s monitoring efforts and the WHO Special Initiative on Climate Change and Health in SIDS, a series of SIDS country profiles were created, illustrating the progress made by island states to date in responding to the health threats of climate change. A dynamic data dashboard visualises the country profile data and allows SIDS policy makers to monitor key health and climate change indicators, including to assess the implementation of policies and plans, identify gaps in evidence, and better understand the barriers to achieving health adaptation and mitigation priori- ties, including for implementation and monitoring. COP26 Special Report / The health argument for climate action Advanced proof8 / Recommendations for climate change and health The recommendations outlined in the COP26 Special Report have been developed by health professionals, organisations and stakeholders worldwide, and represent a broad consensus statement by the global health community on the actions that are needed to tackle the climate crisis, restore biodiversity, and protect health. The recommendations were developed in consul- tation with over 150 organisations and over 400 experts and health professionals, through a series of consultations and workshops in all six WHO regions. They are intended to inform governments and other stakeholders ahead of the 26th Conference of the Parties (COP26) of the United Nations Framework Convention on Climate Change (UNFCCC). COP26 is considered a crucial moment for the world’s governments to commit to collective action on limiting climate change. The confer- ence aims to operationalise the Paris Agreement on climate change, and Parties to the agreement are expected to bring forward national climate plans reflecting their highest possible ambition. The ten recommendations, and their respec- tive action points, highlight the urgent need and numerous opportunities for governments to prioritise health and equity in the international climate movement and the sustainable develop- ment agenda. Each recommendation is accom- panied by a selection of resources and case studies to help inspire and guide policymakers and practitioners in implementing the proposed solutions. Advanced proof COP26 Special Report / The health argument for climate action 9/ © Adobe / Sutipond Stock COP26 Special Report / Health and Climate Change10 / Advanced proof 1 Commit to a healthy recovery. Commit to a healthy, green and just recovery from COVID-19. © Greenpeace / Vivek M. Advanced proof COP26 Special Report / The health argument for climate action 11/ The COVID-19 pandemic has highlighted the close relationship between the health of people and the health of the planet, and has further exacerbated existing social injustices and vulner- abilities in our communities and our health systems. The pandemic has also provided an opportunity for building forward better, greener and more equitably (34). The next few months and years provide a crucial window to align climate change and health goals. Governments can commit to a healthy and green recovery from COVID-19 by following an evidence-based path to a zero carbon, resil- ient, and inclusive global economy. This is in line with the WHO Manifesto Prescriptions and “Actionables”, which offer governments a list of priority actions to achieve a green and healthy recovery from COVID-19 (35). Action Points Commit to a healthy recovery. 1 Align climate and health goals. Align COVID-19 recovery efforts with the Paris Agreement goals and the WHO Manifesto for a healthy and green recovery. 2 Support a fossil-free recovery. Commit to 100% green stimulus spending and an end to all fossil fuel subsidies, while also ensuring energy access for all. 3 Prevent and prepare for the next pandemic. Improve the global capacity for pandemic prevention, prepared- ness, and response. 4 Include health in all policies. Strengthen and support implemen- tation of the Health-in-All-Policies approach at the national and subna- tional level. 5 Commit to vaccine equity. Commit to vaccine equity and address the inequal- ities that lie at the root of the current climate and health crises. 1) Align climate and health goals. Scientists, leaders, and the wider public have a growing understanding that unless everyone is safe, no one is safe when it comes to the multiple crises the world is grappling with. Short- term response and long-term recovery meas- ures and economic stimulus packages therefore need to tackle these crises in tandem. The health community has repeatedly urged governments to align their COVID-19 recovery efforts with the Paris Agreement goals and the WHO Manifesto for a healthy and green recovery (36). Recovery measures that align climate and health goals are driven by science, prioritise those interventions that bring health, social, cultural and environmental gains, and avoid locking in economic development patterns that will do permanent and escalating damage to the ecological systems that sustain all human health and livelihoods. Examples include setting meas- ures that help avoid a rebound to pre-pandemic air pollution levels, creating more people-cen- tred cities through improved active transport infrastructure (37), and ensuring the COVID-19 response strengthens health systems while reducing health inequities and other health risks at the same time (38). 2) Support a fossil-free recovery. The burning of fossil fuels is killing us; causing millions of premature deaths every year through air pollutants, costing the global economy billions of dollars annually, and fuel- ling the climate crisis (6). Governments and the private sector can support a green and healthy recovery from COVID-19 by: reforming energy subsidies so no public money goes to fossil fuel production; raising money from fossil fuel subsidy reform and taxes to be re-invested in a green recovery; ensuring that public money committed to energy-producing and -consuming activities goes to clean energy sources; while incentivising investments in clean energy and ensuring that no one is left behind in the energy transition (39,40). COP26 Special Report / The health argument for climate action Advanced proof12 / 3) Prevent and prepare for the next pandemic. The COVID-19 pandemic has exacerbated health inequities and vulnerabilities, both within and between countries (38,41). Governments can reverse this trend by prioritising healthcare investments for those most at risk, strengthening the capacity of the health workforce, stepping up surveillance and research, addressing the root causes of zoonotic diseases, and investing recovery resources to build climate-smart health systems that are resilient, sustainable and low-carbon (42,43). A crucial first step would be to adopt the findings of the Independent Panel for Pandemic Preparedness and Response in order to bolster global resilience and solidarity (44). 4) Include health in all policies. In order to tackle the converging crises of climate, nature, debt, and growing inequalities, and their grave consequences for the health of current and future generations, policy makers need to break out of their silos and strengthen collab- oration and a whole-of-government approach. Governments have many tools at their disposal to ensure COVID-19 recovery initiatives have a positive impact on public health and sustain- able development, such as Health Impact Assessments. They can strengthen and support implementation of the Health-in-All-Policies approach at the national and subnational level by improving coordination, monitoring, budgeting and advisory structures (45). A crucial first step would be for health ministries and organisations to prioritise climate change in their own activi- ties, policies and programmes. Secondly, health stakeholders should be included in all climate decision making processes, and vice versa. 5) Commit to vaccine equity. The global failure to share vaccines equitably is taking its toll on some of the world’s poorest and most vulnerable people. It will have a lasting and profound impact on socio-economic recovery in low- and lower-middle income countries. New variants of concern mean that the risks of infection have increased in all countries for people who are not yet protected by vaccination (46). As with any global crisis, until everyone is safe, no one is safe. To fully address the urgency of the climate and health crises, governments need to commit to vaccine equity and address the inequalities that lie at the root of so many global health challenges, including the climate crisis. Any inaction on tack- ling vaccine inequity and climate change will have the largest health consequences for the most disadvantaged communities. Worldwide access to COVID-19 vaccines offers the best chance for slowing the coronavirus pandemic, saving lives, and securing a global recovery that is centred around equity, resilience, and sustainability (47). Resources WHO Manifesto for a healthy and green recovery from COVID-19. Released by WHO in May 2020, the Manifesto calls for creating a healthier, fairer and greener world while resuscitating economies hit by the effects of COVID-19. The six Prescriptions of the Manifesto lay out concrete instructions for policy makers, national and local decision-makers, and other stake- holders, to contribute to a healthy recovery. These Prescriptions are accompanied by over 80 prac- tical steps for implementation at the national and local level. Æ The Global Recovery Observatory - an initiative by the Oxford University Economic Recovery Project and the UN environment programme – tracks the green recovery efforts of over 50 governments. The data- base showcases exemplary policy solutions, identifies opportunities, and direct governments towards more impactful and sustainable investment. Advanced proof COP26 Special Report / The health argument for climate action 13/ Æ The Universal Health Coverage partnership offers a political platform to ensure that all people and communities, without leaving anyone behind, receive the quality services they need, and are protected from health threats, without suffering financial hardship. Æ Five principles for a fossil-free recovery – The International Institute for Sustainable Development has formulated five principles to enable a fossil-free recovery: end fossil fuel production subsidies, reform fossil fuel pricing, support clean energy, incentivise investment in clean electricity, and implement a just transition. Æ Health professionals worldwide have called for a healthy, green recovery from COVID-19. In an open letter to G20 leaders, they urged governments to be guided by science-based decision-making and to avoid investing in polluting energy sources. Æ The recommendations for pandemic preparedness by the independent panel will allow us to curb the COVID-19 pandemic and ensure we are more resilient and better prepared for future disease outbreaks and other health risks. Æ The World Health Organization provides a useful set of recommendations and examples on Health-in-All Policies interventions that promote intersectoral collaborations. Case Studies Æ Aligning the climate and health goals of member states in the WHO European Region. The Working Group on Health in Climate Change, established under the European Environment and Health Process, brings together WHO Member States and other partners from the WHO European Region. The HIC provides a regional multilateral platform for dialogue and coop- eration, and supports the integration of health considerations into national climate policies across the region. Learn more here. Æ A city-led green recovery from COVID-19 in Italy. The city of Milan in Italy is working on a green recovery from COVID-19 that is rooted in the principles of equity and climate action. As part of the C40 Global Mayors COVID-19 Recovery Task Force, the city is cutting its emissions, freeing up public space, providing support to workers, and creating a more resilient and equi- table city. Learn more here. Æ Solar fridges for vaccines. An initiative developed by the GAVI Alliance is supporting health care facilities to use solar panels to power vaccine fridges. This ensures health care facilities, often with no other source of electrical power, are able to keep vaccines safe and ready to be used to prevent disease. Learn more here. Æ The future we choose - planning for a healthy recovery in Australia. Over 100 health professionals and stakeholders in Australia came together in a series of workshops to develop a set of possible scenarios for the country to recover from COVID-19 and tackle climate change. The potential alternative futures they developed show how important today’s policy decisions are for the health and wellbeing of people. Learn more here. Æ ASEAN countries join forces to exit the pandemic. In a united response to COVID-19, the countries of the ASEAN grouping developed the Comprehensive Recovery Framework, which outlines strategies to ensure that the economies in the region recover from the pandemic and emerge as more resilient, inclusive, and sustainable societies. Learn more here. Find more case studies on the WHO website. COP26 Special Report / Health and Climate Change14 / Advanced proof Our health is not negotiable. Place health and social justice at the heart of the UN climate talks. 2 © WHO Advanced proof COP26 Special Report / The health argument for climate action 15/ Climate change is the biggest global threat to human health, and the Paris Agreement is poten- tially the strongest health agreement of the 21st century (6). Health, therefore, is a powerful argu- ment to enhance climate ambition and reduce global inequality. In the lead up to COP26, the global health community has repeatedly called on govern- ments to submit ambitious climate plans. It urges for an ambitious outcome at COP26 that systematically places health and social justice at the heart of the UN climate talks, to safeguard the health of current and future generations. In the years to come, governments’ commitments need to be implemented swiftly and transpar- ently in order to avoid the worst climate impacts, reduce growing inequalities, and ensure health and prosperity for all. Action Points Our health is not negotiable. 1 Close the 1.5°C gap to stay alive. Lead a step-change in ambition and submit ambitious, healthy climate plans. 2 Scale up finance for vulnerable coun- tries to tackle the climate and health crises. Rebuild trust in the Paris process by delivering on the USD 100 billion/ year climate finance goal. 3 Step up support for adaptation and resilience. Operationalise the global goal on adaptation. 4 Increase action on loss and damage. Address the loss of life and damage to health that vulnerable countries and communities are facing. 5 Finalise the Paris Agreement Rulebook. Operationalise the most powerful global agreement to protect people and planet. 1) Close the 1.5°C gap to stay alive. The goal of the Paris Agreement - limiting global heating to well below 2 degrees Celsius and pursue efforts to limit temperature increase to 1.5 degrees - is arguably humanity’s most impor- tant public health goal (48). By COP26, govern- ments are expected to submit ambitious new near-term climate plans in the form of Nationally Determined Contributions (NDCs), as well as net-zero emission commitments. The global health community urges govern- ments to recognise the fierce urgency of this turning point in time and protect citizens from escalating climate change impacts. NDCs and net-zero commitments represent both near- and long-term policy goals for governments to protect the health of their citizens, while offering immediate and local health benefits (49,50). In recognition of the science (4), governments should submit “healthy NDCs” that: (i) are in line with the 1.5 degrees temperature goal; (ii) have provisions in place to protect the health and livelihoods of the most vulnerable people, including women, children and other disadvan- taged groups (51); and (iii) outline climate inter- ventions with clear health- and social co-benefits (52). For example, NDCs should include stand- alone reduction targets for air pollution and short-lived climate pollutants, such as methane, which would bring considerable climate and health benefits (53). Governments should also set net-zero green- house gas emission targets that are in line with health goals that: are as close to absolute zero as possible, are reached as soon as possible, build in near-term action to halve their green- house gas emissions by 2030, and ensure integ- rity and accountability. For high-income nations, net-zero carbon emissions should be reached by 2040 at the latest. COP26 Special Report / The health argument for climate action Advanced proof16 / 2) Scale up finance for vulnerable countries to tackle the climate and health crises. Climate finance is crucial to protect the most vulnerable countries, including from the wors- ening health impacts of the climate crisis. High- income countries have previously pledged to provide USD 100 billion a year by 2020 (54), however, this target has not been met and threatens to undermine the carefully built-up trust in the Paris Agreement process (55). Governments from high-income countries can restore this trust by delivering on the USD  100  billion/year goal for vulnerable coun- tries before COP26, thereby replenishing the funds of the UNFCCC’s financial mechanisms, such as the Green Climate Fund, Adaptation Fund, Global Environment Facility, and the Least Developed Countries Fund. At least half of financial contributions should go to adaptation efforts, and this should largely be in the form of grants, not loans. The majority of countries have identified the health sector as a priority for climate action. Therefore, efforts should be made to close the existing gap in health financing and capacity building. Governments at COP26 should also agree on a clear roadmap for a new, higher finance goal by 2025, as was agreed at COP21 (54). This should include a mechanism to ensure the transparent tracking of finance, the identification of barriers and bottlenecks to accessing climate finance, and capacity-building and technical support for vulnerable countries. 3) Step up support for adaptation and resilience. Parallel to reducing emissions, adaptation efforts are needed to reduce vulnerability to climate impacts, build resilience, and allow for equitable and sustainable development. Adaptation is a crucial pillar of the Paris Agreement and govern- ments agreed to establish a global goal on adap- tation (56). Climate adaptation is now embedded in policy and planning in most countries, to varying extents (57). A recent WHO survey, however, highlighted that only slightly more than half of all countries have a national climate change plan or strategy in place for health (22). At COP26, governments should agree on the implementation of the global goal on adapta- tion and develop methods to measure progress and ensure the necessary finance, including for health adaptation. Health adaptation and resil- ience need to be considered in all planning, implementation, communication, and trans- parency processes of the adaptation goal, and should be part of the global stocktake process. 4) Increase action on loss and damage. The losses and damages from climate impacts are already an existential threat today, and this is particularly the case for the loss of life and damage to health, wellbeing and livelihoods that many vulnerable countries and communities are experiencing. At COP26, governments need to recognise and address the reality that vulnerable countries and communities are facing. They need to oper- ationalise the Santiago Network on Loss and Damage, established at COP25, so it can provide the technical assistance countries need to cope with unavoidable climate damages. Moreover, the loss of life and the degradation of health from climate impacts should be an important consideration throughout climate negotiations on loss and damage, including in the Task Force on Non-economic Losses, the Task Force on Displacement and the workstream on action and support, as well as the operationalization of COP25 guidance to the Green Climate Fund on providing financial resources for activities rele- vant to averting, minimising, and addressing loss and damage (58). Advanced proof COP26 Special Report / The health argument for climate action 17/ 5) Finalise the Paris Agreement Rulebook. COP26 is the deadline for the Paris Agreement to be operationalised, after which all implemen- tation guidelines of the “Paris Rulebook” need to be in place (59). To ensure an ambitious climate regime that can deliver on the Paris goals and safeguard health, governments will need to agree on carbon market mechanisms (article 6 of the Paris Agreement), secure common timeframes for countries’ emissions-reduction targets (article 4.10), and lay the foundations for the first global stocktake in 2023 (article 14). Governments can operationalise the most powerful global agreement to protect people and planet by adopting the necessary rules to ensure an ambitious, transparent climate regime that leaves no one behind. The rules and regulations of the Paris Agreement carbon market mechanism should: (i) ensure that a portion of the proceeds from carbon markets are allocated to adaptation finance, (ii) ensure that human rights and the rights of Indigenous peoples and local communities are protected, and that social, health, and environmental safe- guards are in place, and (iii) ensure that carbon trading will go beyond offsetting emissions and instead lead to deeper emission cuts. Rules on common timeframes should ensure that the timeframe of national climate commitments - in the form of NDCs - does not lock in low ambition for extended periods of time, but rather aligns with the five-year ambition cycle of the Paris Agreement. Lastly, the rules and mechanism for the global stocktake should ensure transparency in assessing the collective progress towards the Paris Agreement goals, track how climate change is affecting our health, report on the needs and support provided for the health sector, and make clear recommendations on how ambition can be improved. Resources COP26 Health Programme The COP26 Health Programme has been established to bring stronger health focus and ambition to COP26. Among its activities there are two initiatives where countries can state their ambition to develop climate-resilient sustainable health systems. The 5 key health priorities for COP26 include: 1. Building climate-resilient health systems. 2. Developing low carbon sustainable health systems. 3. Adaptation Research for Health. 4. The inclusion of health priorities in Nationally Determined Contributions. 5. Raising the voice of health professionals as advocates for stronger ambition on climate change. Æ The WHO Health and Climate Change Global Survey monitors the progress governments are making in protecting and promoting health in response to climate change. The survey allows governments to assess the implementation of climate and health policies and plans, identify gaps in evidence, and better understand the barriers to achieving health adaptation and mitigation priorities. Æ The Healthy NDCs Scorecards by the Global Climate and Health Alliance (GCHA) evaluates new NDCs on their ambition and inclusion of health considerations. It highlights how many NDCs have integrated health into their mitigation and adaptation commitments and recommends areas of improvement for others. COP26 Special Report / The health argument for climate action Advanced proof18 / Case Studies Æ Quantifying the health benefits from reduced air pollution in Colombia’s NDC. In its new NDC, the Government of Colombia committed to reducing its emissions of greenhouse gases and short-lived climate pollutants, including black carbon. This will result in improved air quality for its citizens. In partnership with WHO and the Stockholm Environment Institute, the government is conducting a study to quantify the health co-benefits associated with imple- menting its climate commitments. Learn more here. Æ Developing ‘Healthy NDCs’ in Nigeria and Rwanda. The governments of Nigeria and Rwanda are assessing the significant health and economic gains they will attain by committing to more ambitious climate actions under their NDC, including by transitioning to cleaner and safer forms of energy in homes. Findings are detailed in a series of landmark studies. Learn more here. Æ Health co-benefits from NDC implementation in China. The climate policy efforts of China have the potential to bring large health co-benefits to the country. A recent study on the coun- try’s 2016 NDC targets revealed that between 225,000 and 368,000 premature deaths could be avoided in 2050 if NDC targets are achieved. Bolstering the argument for the need for increased ambition, the savings associated with these health co-benefits are greater than the cost of implementing China’s national climate policies. Learn more here. Æ Health stakeholder engagement in the development of South Africa’s NDC. Several South African health organisations have been engaged in the review process of the country’s updated NDC. The national health stakeholders provided the government with recommendations on how to ensure its climate policies adhere to health and equity benchmarks. Learn more here. Find more case studies on the WHO website. Æ Health groups in the United Kingdom of Great Britain and Northern Ireland, European Union, Chile, South Africa and worldwide have called on their governments to commit to healthy NDCs, highlighting entry points for increased ambition and the inclusion of health goals in the countries’ climate policies. Æ WHO provides a series of recommendations for health-promoting NDCs in a 2019 review of NDCs, including for health impacts, health adaptation, health co-benefits of mitigation and finance for climate and health. Æ The Lancet Countdown initiative tracks the connections between public health and climate change using a wide range of indicators. Æ Researchers at the University of Wisconsin have outlined the health and equity benefits of potential climate policies in the United States across a variety of sectors. Æ The Climate Ambition Alliance brings together countries, businesses, investors, cities, and regions who are working towards achieving net-zero CO2 emissions by 2050 and accelerating the transition toward the Paris Agreement goals. The alliance gathers support through the ‘Race to Zero’ campaign. Æ The Global Commission on Adaptation released a flagship report making the case for climate adaptation and providing specific insights and recommendations for key sectors, including health. Advanced proof COP26 Special Report / The health argument for climate action 19/ © WHO COP26 Special Report / Health and Climate Change20 / Advanced proof Harness the health benefits of climate action. Prioritise those climate interventions with the largest health, socio-economic and environmental gains. 3 © Shutterstock / Riccardo Mayer Advanced proof COP26 Special Report / The health argument for climate action 21/ The public health benefits from implementing ambitious climate actions far outweigh the costs, while strengthening health resilience and building adaptive capacity protects vulnerable populations from health shocks and promotes social equity (6). The health co-benefits from climate actions are well evidenced and offer strong arguments for transformative change (15). A large body of evidence now shows that climate action aligned with Paris Agreement targets would save millions of lives due to improvements in air quality, diet, and physical activity, among other benefits (21). Action Points Harness the health benefits of climate action. 1 Maximise and measure the health co-benefits of climate action at all levels of governance. Commit to promote, account for, and monitor the health co-benefits from climate inter- ventions and reflect them in decision making. 2 Honour everyone’s right to health. Recognise the human right to a safe, clean, healthy, and sustainable environ- ment, and adopt policies and processes that safeguard this right. 3 Bolster the science of health and climate change. Help close knowledge gaps and build capacity to research the health impacts of climate change and the health co-benefits of climate action. 1) Maximise and measure the health co-benefits of climate action at all levels of governance. Ambitious climate action leads to positive exter- nalities for social and health goals, also known as health co-benefits. The scientific and economic rationale for health co-benefits from climate adaptation and mitigation action is well estab- lished, and ranges from reductions in air pollu- tion (14) to more resilient health services (60), from reduced loss of life from extreme weather events to more active populations, to protected work conditions and increased productivity (61), from preserved cultural practices to strength- ened food security (21). Despite leading to near-term benefits and greater acceptance of necessary changes by stakeholders, the health co-benefits of interven- tions are rarely quantified or included in deci- sion-making processes or socio-economic valu- ations (62). Governments can strengthen the case for ambi- tious action by committing to measure, monitor and report on the health co-benefits from climate interventions, by incorporating health and social safeguards in policies at all levels of government, and by including estimates of both climate, health, and socio-economic benefits in decision-making processes for national policies, such as NDCs and net-zero commitments. 2) Honour everyone’s right to health. Everyone is harmed by the impacts of climate change to some degree, but these harms fall disproportionately on disadvantaged population groups - including women and girls, Indigenous communities, people in crisis, displaced people, and the poor (63). Similarly, Small Island Developing States and other countries and regions most at risk are bearing the brunt of the climate crisis, despite a negligible contribution to emissions. In order to challenge and reverse growing inequities and ensure no one is left behind, a rights-based approach to tackling the climate crisis is necessary. Momentum is growing to recognise the human right to health, life, and to a safe, clean, healthy, and sustainable environment. Examples of this can be found in the development of a resolution at the UN Human Rights Council (64), the estab- lishment and implementation of the Declaration on the Rights of Indigenous Peoples (65), and the COP26 Special Report / The health argument for climate action Advanced proof22 / growing number of litigation cases around the world (66). Governments should honour every- one’s right to health by placing health and equity central to policy making and the measurement of national progress. This can be done by adopting policies that safeguard the right to health, life, and a healthy environment, and ensure a pollution-free and productive environment for current and future generations to thrive. When health and equity are the guiding prin- ciples of governments, priorities for public spending should be determined by the extent to which they can improve population well- being, strengthen resilience and reduce inequal- ities. National health and equity strategies and commissions should also be in place to redress health and environmental inequalities, while equitable access to health services should be ensured for all. 3) Bolster the science of health and climate change. The science is clear: the health impacts of inac- tion on climate are overwhelming, while the health and social benefits of action could facil- itate the necessary changes we need to make (4,67). A strong science base exists, detailing how climate change impacts our health, how we can increase the resilience of the most vulnerable, what are the most effective climate interventions to reach climate and health goals, and how large the health co-benefits are from taking climate action (68,69). There are a wide range of tools available to assess the health and economic co-benefits from climate policies. These tools allow policy makers to asses health gains from mitigation targets, such as the health gains from reduced air pollu- tion, the health benefits from urban environ- ments with increased walking and cycling, the effect of transport on air pollution, the impact of urban green spaces on health exposures, and much more (70). However, regional and thematic knowledge gaps remain, and more funding and support is needed to build capacity for research, moni- toring, and implementation efforts on health and climate change, especially in under-resourced and at-risk regions. Local and indigenous knowl- edge systems also play a crucial role in ensuring knowledge is translated into locally-relevant policies and actions. At the same time, govern- ments should ensure their decisions on climate mitigation, adaptation, and health protection are guided by the best available science and practical experiences, are not influenced by misinforma- tion campaigns and other forms of corporate capture, and follow the Precautionary Principle to protect people’s health and the climate. Resources Achieving health benefits from carbon reductions. The Carbon Reduction Benefits on Health calculation tool (CaRBonH) allows policy makers to quantify the health and economic consequences achieved through improvements in country-level air quality from domestic carbon reductions. The tool accounts for and monitors the health co-benefits from climate interventions and reflects them in decision making and policies, such as the NDCs. The 2018 version of the tool is tailored to countries from the WHO European Region, while the updated version will be available to countries globally in 2021. Æ The Low Emissions Analysis Platform is a tool that is widely used by governments to assess the health benefits of climate change mitigation actions from reduced air pollution. Over 30 NDCs have used it to asses health benefits. Advanced proof COP26 Special Report / The health argument for climate action 23/ Æ The Climate and Clean Air Coalition (CCAC) is a voluntary partnership of governments, intergovernmental organisations, businesses, scientific institutions and civil society organisations working at the nexus of climate and air quality, delivering multiple benefits from the mitigation of short-lived climate pollutants: methane, HFCs, black carbon and tropospheric ozone. Æ A report by the UN Special Rapporteur on Human Rights and the Environment shares best practices in implementing the right to a healthy environment. These include access to information, public participa- tion, and access to justice and effective remedies. Æ A research GAP report on gaps and trends in research on climate and health, which was developed by the WHO-civil society working group on climate change and health, provides an overview of geographical and topical knowledge gaps on the science around climate change and health. Æ The Pathfinder Initiative is creating a global collection of the policies and technologies that yield multiple benefits for people and planet. The initiative’s aim is to show how the implementation of well-designed policies and technologies can yield multiple benefits for both health and environment. Case Studies Æ Assessing the health benefits of fossil fuel subsidy reform and carbon taxation in Pakistan’s NDC. The government of Pakistan, in collaboration with WHO and global experts, has highlighted the substantial health and economic benefits from raising climate ambition through energy policy interventions and investments. Learn more here. Æ Bangladesh connects the dots between climate, pollution and health. The government of Bangladesh used a modelling tool known as LEAP-IBC to evaluate the local air quality impacts of adopting policies that mitigate climate change. Learn more here. Æ Monitoring the right to a healthy environment in the Pacific. Several SIDS - including Fiji, Kiribati, Marshall Islands, Micronesia, Nauru, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu – have established the Secretariat of the Pacific Regional Environment Programme, which supports Pacific Island states to share environmental and health data, tools, and assessments. This collaborative initiative assures communities their right to a healthy environment is protected and monitored. Learn more here. Find more case studies on the WHO website. COP26 Special Report / Health and Climate Change24 / Advanced proof Build health resilience to climate risks. Build climate-resilient and environmentally sustainable health systems and facilities, and support health adaptation and resilience across sectors. 4 © Bill & Melinda Gates Foundation Advanced proof COP26 Special Report / The health argument for climate action 25/ As observed during the COVID-19 pandemic, health systems and facilities are at the forefront in protecting people from acute threats, including from the rising health impacts of climate change (71). Although health is recognised as a priority sector vulnerable to climate change impacts (72), billions of people still lack access to the most basic services that are required to protect their health (73). The climate crisis places stress on the capacity of health systems to prevent, adapt and respond to increased health risks, while at the same time all health systems contribute to the climate crisis through their greenhouse gas emissions. In order to protect the health of populations from the effects of climate change and avoid widening health inequities, countries must build low-carbon, sustainable, climate-resilient health systems and facilities (60). Action Points Build health resilience to climate risks. 1 Regularly assess health vulnera- bilities and adaptation capacities. Conduct iterative climate change and health vulnerability and adaptation assessments (V&As). 2 Develop and implement an evidence- based adaptation plan for health. Regularly assess health vulnerabil- ities and adaptation capacities and develop an ambitious Health National Adaptation Plan (HNAP). 3 Strengthen the climate resilience and environmental sustainability of health systems and facilities. Improve access to, and affordability of, climate-resilient and environmentally sustainable care while strengthening the capacity of health systems and facilities to protect and improve the health of all people in an unstable and changing climate. 4 Close the financing gap for health adaptation and resilience. Invest in health adaptation and resilience and help close the health financing gap. 5 Protect health and advance climate justice by implementing health-pro- moting interventions in other sectors. Develop synergies between health, climate change, and other devel- opment goals by investing in health-de- termining sectors, such as water, energy, and food and agriculture. 1) Regularly assess health vulnerabilities and adaptation capacities. In order to adequately respond to the impacts that climate change has on the health of people and the operations of health systems, a first critical step for governments is to assess the climate-sensitive health risks they are exposed to, which populations and geographical areas are most vulnerable and disadvantaged, and to what extent health systems are capable of responding to these health risks. Vulnerability and Adaptation (V&A) assessments thereby provide an important foundation for any government’s response to climate risks and provide the evidence base for health adaptation planning that is sensitive to underlying vulnerabilities and inequities. V&As also improve the understanding, provide a baseline for ongoing monitoring of the health impacts of climate change, provide the opportunity for building capacity, help to identify health and gender inequities, and strengthen the case for investment in health protection (74). Governments should conduct iterative climate change and health V&As, both to safeguard the public health of their populations, as well as the resilience of their health systems and facilities. The evidence gathered through these V&As should inform the development of comprehen- sive and ambitious health national adaptation plans (HNAPs). COP26 Special Report / The health argument for climate action Advanced proof26 / 2) Develop and implement an evidence-based adaptation plan for health. National Adaptation Plans (NAPs) are an official part of the UNFCCC and international climate efforts. They allow countries to identify medium- and long-term adaptation needs and develop and implement strategies and programmes to address those needs. Led by the Ministry of Health, a HNAP sets out a health-specific adap- tation plan. In addition to information related to the main health impacts of climate change and adaptation options to address these, a HNAP should offer a strategy to engage other health-determining sectors, such as the water, sanitation, transport, or energy sector, ensure the necessary finance, and help to build the institutional, organisational and technical capacity for the government to effectively build health systems that are more resilient to future health shocks as well as to the impacts of climate change (75). A comprehensive HNAP should be informed by the evidence gathered in a climate change and health V&A (74). The WHO operational framework for building climate-resilient health systems can be used to ensure plans are compre- hensive (76) and quality criteria for HNAPs have been developed building on lessons learned by countries (77). 3) Strengthen the climate resilience and environmental sustainability of health systems and facilities. Around the world, billions of people still lack access to the most basic services that are required to protect their health, whether from COVID-19, climate change, or any other risk (71). Many regions of the world with the highest vulnerability to climate change are also those with the lowest health care coverage. The most disadvantaged groups in any society are gener- ally also more vulnerable to climate risks (78). Health systems and health care facilities are our first line of defence against climate-related shocks and stressors and, at the same time, their operations often impact the environment and populations’ health with unsustainable practices related to water, sanitation, waste, energy use, and procurement and supply chains. Climate- resilient and environmentally sustainable health care facilities contribute to a high quality of care and accessibility of services, and by helping reduce facility costs also ensure better afforda- bility. They are, therefore, an important compo- nent of universal health coverage (UHC) (79,80). Governments should commit to increase access, affordability, and sustainability of essential health services, and enhance the capacity of the health workforce. This will ensure health systems and facilities are able to protect and improve the health of all people in an unstable and changing climate. High-income countries should support low-income and vulnerable countries in providing climate-resilient and envi- ronmentally sustainable healthcare. Policy makers can achieve both climate resilience and environmentally sustainable health care in tandem by implementing actions around 10 key components, summarised in the WHO opera- tional framework for building climate-resilient health systems. Focused interventions aiming to strengthen both the climate resilience and environmental sustainability of health care facil- ities should also address (i) energy, (ii) the health workforce, (iii) infrastructure, technologies and products, and (iv) water, sanitation, hygiene and healthcare waste (Figure 2). Global, regional, and national monitoring systems should be strengthened so that progress towards the climate resilience and envi- ronmental sustainability of health systems and facilities can be assessed and evidence-based assessment can inform the need for targeted investments and interventions. Advanced proof COP26 Special Report / The health argument for climate action 27/ Functions to strengthen the climate resilience and environmental sustainability of health systems and facilities (60). Figure 2 4) Close the financing gap for health adaptation and resilience. Health is the sector where demands for climate support are most frequently left unmet. Whereas approximately two-thirds of Nationally Determined Contributions to the Paris Agreement cite the importance of health (49), and 50% of countries have developed strategies on climate change and health (22), a much lower proportion of countries have health adaptation plans in place, and less than 0.5% of multilateral climate finance is allocated to health projects (6). Finance for health adaptation and resilience is a no-regrets investment that ensures the sustain- able development of economies while protecting vulnerable populations (81). Governments should help close the health financing gap by allocating 50% of their climate finance to adap- tation and removing existing barriers to finance for health adaptation and resilience. 5) Protect health and advance climate justice by implementing health- promoting interventions in other sectors. Human health is largely determined by sectors beyond the immediate control of the health sector, such as through the water, sanita- tion and hygiene (WASH) sector, energy, food and agriculture, environment, transportation, housing, as well as through gender norms, roles and relations, and other social determinants of health. Health resilience can therefore only be achieved through coordinated and integrated policies across sectors and policy areas. Without a holistic and systemic approach to tackling growing health inequities across society, it will be impossible to achieve the SDGs. Governments can improve both health resilience and multiple SDGs by investing in health-de- termining sectors (for example by developing COP26 Special Report / The health argument for climate action Advanced proof28 / Resources The COP26 Presidency Initiative on Climate-Resilient Health Systems An initiative on climate-resilient health systems was developed as part of the COP26 Health Programme. The initiative aims to increase the resilience of health systems globally and consists of an extensive technical support package for countries, which was developed by WHO in collaboration with multiple partners. Æ The Compendium is a global repository of interventions for improving health by creating healthier envi- ronments. It contains a comprehensive collection of over 500 actions and is based on WHO and other UN guidance. It covers a broad range of areas such as air pollution, water, sanitation and hygiene, climate change, chemicals, radiation, and food systems. Æ The WHO toolkit on climate change and health contains a wide variety of technical guidance and support tools for countries to increase the resilience of their health system, including support on vulnerability and adaptation assessments, early-warning systems, building resilient health systems and facilities, and national adaptation planning. Æ The Risk-Informed Early Action Partnership brings together a wide range of stakeholders with the aim of making 1 billion people safer from disaster by 2025. Æ The WHO guide for climate-resilient water safety plans allows policy makers and planners to manage the health risks associated with climate change in the water, sanitation and hygiene sector. Æ The ClimApp is a mobile phone app that translates climate services into personalised adaptation strat- egies to cope with heat and cold stress. The App predicts heat and cold stress and provides person- alised health risk warnings and advice for individuals, governments and companies, supporting deci- sion-making for adaptation strategies. climate-resilient sanitation and water safety plans), by prioritising the achievement of Universal Health Coverage and healthy lives and well-being (SDG3) as an overarching policy goal, by ensuring coordination across sectors and by monitoring synergies and trade-offs from actions in health-determining sectors (82). Advanced proof COP26 Special Report / The health argument for climate action 29/ Case Studies Æ Building climate-resilient health systems in Lao People’s Democratic Republic and Cambodia. In Cambodia and Lao People’s Democratic Republic, the impacts of climate change are increasingly posing risks to people’s health and straining the countries’ health systems. Since 2019, both countries have been piloting a project to help increase the resilience and capacity of their health systems to respond to these climate-sensitive health risks. Learn more here. Æ Improving health surveillance in Ethiopia. A project implemented in Ethiopia aimed at enhancing the capacity of the country’s health surveillance and early warning systems in order to ensure the health system is resilient and prepared to respond to a range of climate sensitive diseases. Learn more here. Æ Strengthening health resilience in Sao Tome and Principe. The government of the island nation Sao Tome and Principe adopted a multisectoral, all-of-government approach to strengthen its health resilience against climate change impacts. It implemented a range of measures, from training and awareness raising, to the construction of new facilities and infrastructure, the establishment of information sources, and the acquisition of materials and equipment needed for addressing climate emergencies. Learn more here. Æ Climate-resilient and environmentally sustainable health care facilities in Fiji. The government of Fiji has launched national guidelines to ensure the country’s health care facili- ties are resilient to climate shocks and stresses, while at the same time being environmentally sustainable. Fiji’s efforts in the health care sector complement its track record of leadership on climate action. Learn more here. Æ Protecting workers from extreme heat in Nicaragua. Sugarcane farmers, and other agri- cultural workers in Nicaragua, are increasingly exposed to extreme heat, which can lead to serious illnesses, such as chronic kidney disease, and a loss of productivity. The Adelante Initiative was set up to provide scientific evidence of workplace interventions that can protect these workers, such as by providing adequate water, rest and shade. The initiative hopes to inform other at-risk industries on how to keep workers safe from extreme weather. Learn more here. Æ Understanding the dangers extreme heat on maternal and neonatal health in Africa. A research consortium on climate, heat, and maternal and neonatal health in Africa, bringing together partners from three continents, aims to help close the research gaps on the impact of heat exposure on maternal and neonatal health in sub-Saharan Africa. Learn more here. Find more case studies on the WHO website. COP26 Special Report / Health and Climate Change30 / Advanced proof Create energy systems that protect and improve climate and health. Guide a just and inclusive transition to renewable energy to save lives from air pollution, particularly from coal combustion. End energy poverty in households and health care facilities. 5 © DFID Advanced proof COP26 Special Report / The health argument for climate action 31/ Over 90% of people breathe unhealthy levels of outdoor air pollution, largely resulting from the burning of the same fossil fuels that are driving climate change (83). Phasing out fossil fuels drastically reduces pollution and offers immediate and local benefits for society and the economy. Even though achieving clean air will require ambitious action across many sectors, such as transport, industry, agriculture, waste management, and land use, the energy sector is the largest emitter of greenhouse gasses and air pollutants (84). Therefore, tackling air pollu- tion is one of the crucial ways in which energy systems can improve and protect health. The technologies and policies that are needed to protect both climate and health from unhealthy energy generation and use already exist. When done well, the rapid transition to clean, renewable energy, such as solar, wind, geothermal and wave energy, can also strengthen resilience, create jobs, reduce energy poverty, and fulfil a growing need for energy in developing economies (85,86). Action Points Create energy systems that protect and improve climate and health. 1 Phase out polluting fossil fuels. Avoid environmental, health and economic damage by delivering sustainable energy for all. 2 Let us breathe clean air. Adopt WHO air quality guidelines and tackle air pollution. 3 Invest in clean solutions for household energy. Bring clean heating, lighting, and cooking solutions to the billions of people who currently lack them. 4 Power the health sector with clean energy. Ensure all health systems and facilities have access to renewable energy. 5 Ensure a just transition for workers and communities. Provide support, training, and opportunities for those transitioning out of the fossil fuel sector and ensure occupational health and social safeguards for workers in the clean energy sector. 1) Phase out polluting fossil fuels. The combustion of fossil fuels causes large environmental, health, and economic damage, and is a major contributor to air pollution, which kills 7 million people every year(87). This air pollution includes short-lived climate pollut- ants (SLCPs), such as black carbon, methane, and ground-level ozone, which also threaten human health. The science is unequivocal that the burning of fossil fuels leads to air pollution deaths (88,89). Governments need to end all support for fossil fuel energy, both domestically and abroad, in line with the long-term objectives of the Paris Agreement and best available science (90). This should include an absolute end to fossil fuel subsidies by 2025 and the complete phase out of coal - the most polluting and harmful of fossil fuels - by 2030 in OECD countries at the very latest, and by 2040 in non-OECD countries. At the same time governments should significantly increase investments in energy efficiency and renewable energy, ensuring an inclusive and just transition (91,92). In addition to a rapid phase out of fossil fuel subsidies, effective taxa- tion is needed. Pricing the negative health and economic externalities from burning fossil fuels can help ensure the transition to an energy system that protects and improves climate and health. 2) Let us breathe clean air. WHO data shows that 9 out of 10 people breathe outdoor air that exceeds the WHO guideline limits for air pollutants. Air pollution particu- larly increases morbidity and mortality from the noncommunicable cardiovascular and respiratory diseases that are the major causes of global mortality; it also increases the disease burden from lower respiratory tract infections and increases preterm birth and other causes of death in children and infants, which remain a major cause of the disease burden in low- and middle-income countries (93). COP26 Special Report / The health argument for climate action Advanced proof32 / Governments should prioritise clean air, including by switching to clean energy sources, by promoting more sustainable and efficient energy uses and policies, stimulating electrifica- tion, and by implementing interventions across different sectors. They should adopt measures to achieve the WHO Air Quality Guidelines, monitor air quality levels, measure and report the health gains from air pollution reductions, ensure the adoption of legal air quality targets and delivery frameworks, hold the private sector accountable, and include air quality targets in their energy policies. 3) Invest in clean solutions for household energy. Around one third of the global population - 2.6 billion people - are exposed to harmful levels of household air pollution due to the lack of access to clean cooking solutions, causing millions of deaths annually (94). The prime source of house- hold pollution is from the use of inefficient stoves fuelled with wood, biomass, animal waste, char- coal, kerosene and coal for household cooking, heating, and lighting (95). Such inefficient use of fuels in residential settings is estimated to be responsible for up to 50% of black carbon emissions globally, illustrating the important and short-term benefits that accelerating access to clean cooking can have for both health and climate (96). Governments should fast-track the transition to clean cooking and heating fuels and tech- nologies and help reliably electrify households while expanding renewable energy. Improving the energy efficiency and insulation of homes and buildings will also help reduce consump- tion, reduce energy poverty, and improve health outcomes. The clear benefits to climate, health, gender equity, and the economy will largely favour peri-urban, rural, and marginalised communities, and women and children, making these policies an important element of equitable climate solutions. 4) Power the health sector with clean energy. On the one hand, thousands of health centres across low- and middle-income countries are not connected to the grid and lack electricity (97), while, on the other hand, the global health care climate footprint makes up nearly 5% of green- house gas emissions (98,99). These two issues can be tackled simultaneously by supporting health systems to have a reliable source of power with 100% clean, renewable electricity. Governments in low- and middle-income coun- tries can reduce energy poverty, improve access to health care, and strengthen resilience by prior- itising the roll-out of renewable energy across their health system. In combination with the provision of other essential services, such as water, sanitation and hygiene, this would help provide health care to the millions of people who are currently still served by health care facilities with no access to electricity, while leapfrogging to clean energy sources (94). 5) Ensure a just transition for workers and communities. Renewables provided close to 12 million jobs worldwide in 2019, and the development of renewable energy supports governments in achieving the double goal of reducing emissions while offering social and economic benefits (86). Scaling up renewables is also crucial in ensuring a green and healthy recovery from COVID-19 (71). To ensure the expansion of renewable energy is sustainable and benefits local livelihoods, policy makers need to put in place social, environmental, and equity safeguards for the sector. At the same time, workers, communities, and regions who are transitioning away from polluting sectors should be offered support, training, and opportunities to transition to more sustainable sectors (100). To ensure that just transition measures effec- tively improve people’s health, transition plan- ning should go hand-in-hand with health impact assessments. Lastly, fossil fuel companies and operators have a duty for remedial action to clean up and, to the extent possible, undo the harmful impacts of the pollution they caused (101). Advanced proof COP26 Special Report / The health argument for climate action 33/ WHO Global Air Quality Guidelines In 2021, WHO published the updated global Air Quality Guidelines, providing recommendations on air quality guideline levels as well as interim targets for six key air pollutants - particulate matter, ozone, nitrogen dioxide, sulphur dioxide and carbon monoxide. In addition, good practice statements are included. The new guidelines provide clear evidence of the damage that air pollution inflicts on human health, at even lower concentrations than previously understood. The guidelines identify the levels of air quality necessary to protect public health worldwide, and serve as a reference for assessing if, and by how much, the exposure of a population exceeds levels at which it causes health concerns. Achieving the recommended air quality guideline levels will deliver substantial health benefits glob- ally. For example, around 80% of premature deaths attributed to PM2.5 exposure in the world could be avoided if countries attain the annual guideline levels for PM2.5. Guideline levels for specified pollutants can be used as an evidence-informed reference to help deci- sion-makers in setting legally binding standards, and are a useful instrument with which to design effec- tive measures to achieve pollutant emission and concentration reductions, and therefore, to protect human health (93). Pollutant Averaging time 2005 AQG level 2021 AQG level PM2.5, μg/m³ Annual 10 5 24-houra 25 15 PM10, μg/m³ Annual 20 15 24-houra 50 45 O3, μg/m³ Peak season b - 60 8-houra 100 100 NO2, μg/m³ Annual 40 10 24-houra - 25 SO2, μg/m³ 24-hour a 20 40 CO, mg/m³ 24-houra – 4 μg = microgram, PM2.5 = fine particulate matter, PM10 = particulate matter, O3 = ozone, NO2 = nitrogen dioxide, SO2 = sulphur dioxide, CO = carbon monoxide, AQG = Air Quality Guideline. a 99th percentile (i.e. 3–4 exceedance days per year). b Average of daily maximum 8-hour mean O3 concentration in the six consecutive months with the highest six-month running-average O3 concentration. Note: Annual and peak season is long-term exposure, while 24 hour and 8 hour is short-term exposure. COP26 Special Report / The health argument for climate action Advanced proof34 / Resources The Health and Energy Platform of Action The global Health and Energy Platform of Action (HEPA) aims to ensure universal access to clean and sustainable energy to protect health. The initiative has a strong focus on clean cooking solutions and the electrification of health care facilities and supports the development of global and country imple- mentation roadmaps for its priority areas of action. Æ The Energy Progress Report offers a global snapshot on energy access, energy efficiency, renewable energy, and international cooperation, and provides an overview of clean energy goals for each country. Æ The Clean Household Energy Solutions Toolkit (CHEST) provides information resources and tools for decision-makers to design and implement clean household interventions to protect health and climate. For example, the WHO Benefits of Action to Reduce Household Air Pollution tool (BAR-HAP) allows users to assess the costs and benefits of interventions to reduce house- hold air pollution. Æ The BreatheLife Campaign brings together a range of proven solutions and best practices to both reduce air pollution and implement mitigation strategies. Æ The COP26 initiative on Low Carbon Sustainable Health Systems provides support to govern- ments and health care institutions to ramp up climate action in health systems and facilities. Æ A Global Road Map for Health Care Decarbonisation, developed by Healthcare Without Harm, provides a navigational tool for achieving zero emissions along with climate resilience and health equity. The roadmap offers detailed interventions, fact sheets, and trajectories. Æ The Global Green and Healthy Hospitals Network has developed a collection of Energy Case Studies of health care systems from around the world. Æ The Powering Past Coal Alliance is a coalition of national and sub-national governments, busi- nesses, and organisations advancing the transition from unabated coal power generation to clean energy. They support governments to capitalise on the health co-benefits of reducing coal use. Advanced proof COP26 Special Report / The health argument for climate action 35/ Case Studies Æ Decarbonising health care facilities in Colombia. The San Rafael de Pasto hospital in Colombia has been running an ambitious climate program for almost a decade. The hospital’s management believes environmental health is crucial for its patients’ recovery process and has taken far-reaching steps to lower its environmental footprint. Learn more here. Æ Net-zero healthcare. In 2020, the National Health Service England committed to become the world’s first net zero national health service. For the emissions it can control directly, the National Health Service aims to reach net zero by 2040, and by 2045 for the emissions it can influence. Learn more here. Æ The first time air pollution has been listed as a cause of death. Ella Adoo-Kissi-Debrah, a young girl living in London, died in 2013. An inquest found air pollution was the cause of her death and this was listed on her death certificate. The case reaffirms everyone’s right to clean air and could have legal implications to more strongly enforce this right. The Coroner for the case made recommendations for the United Kingdom Government, local authorities, and other public and medical bodies to improve public awareness and information about air pollution. Learn more here. Æ Clearing the air for households in Kenya. A project in Kenya is helping to roll out training on household air pollution to community health volunteers. Many Kenyan households still rely on burning wood or biomass for household cooking and heating, leading to dangerous levels of air pollution and contributing to emissions. Health workers can help households make the switch to clean cooking solutions. Learn more here. Æ Solar-powered health facilities in Cox’s Bazar, Bangladesh. The town of Cox’s Bazar in Bangladesh struggles to provide reliable power to its residents and more than 900,000 Rohingya refugees hosted in informal camps and spontaneous settlements. To improve the living and health conditions of the affected population and its environmental footprint, the International Organization for Migration has been harnessing solar energy to power its facili- ties inside and outside the refugee camps, addressing the urgent health and WASH needs of host communities and refugees. Learn more here. Find more case studies on the WHO website. COP26 Special Report / Health and Climate Change36 / Advanced proof Reimagine urban environments, transport, and mobility. Promote sustainable, healthy urban design and transport systems, with improved land-use, access to green and blue public space, and priority for walking, cycling and public transport. 6 © WHO / S. Volkov Advanced proof COP26 Special Report / The health argument for climate action 37/ Cities consume over two-thirds of the world’s energy, are important centres of transport, housing, and business, and are responsible for over 60% of greenhouse gas emissions (102). Transport alone - of which a large part is connected to cities and urban environments - is responsible for 24% of the CO2 emissions from fuel combustion (103). Supporting the switch to cleaner and more active transport has large environmental, health, and social benefits. The promotion of active travel, such as walking and cycling, along with accessible public transport, improved digital connectivity, and better urban and regional planning can deliver compact cities, well-connected rural areas, and enables access to opportunities, and public spaces (37). Improved urban transport and mobility can also help protect people from the risk posed by COVID-19 while supporting economic recovery (104). Action Points Reimagine urban environments, transport, and mobility. 1 Phase out the internal combustion engine and reduce private car use. End the sale of petrol and diesel vehi- cles and support a shift away from private car use. 2 Prioritise walking, cycling and public transport. Prioritise walking and cycling as healthy low-carbon modes of transport. 3 Create people-centred cities. Integrate health and equity and nature considerations into urban and trans- port planning to create compact and future-proof cities. 1) Phase out the internal combustion engine and reduce private car use. Emissions from transport largely come from road travel – cars, buses, and trucks - and this is increasing (105). To meet the goals of the Paris agreement, there needs to be a rapid global shift away from vehicles powered by an internal combustion engine, such as through bans on new sales of petrol and diesel vehicles by 2030 and bans on their use in highly populated areas, such as city centres, by 2025. Near-term reduc- tions in freight and logistics, maritime shipping, and air travel are also needed. The switch to vehicles with substantially lower emissions, such as electric vehicles, in situations where cars, vans and other transport options are needed, would lead to improved air quality, improved respira- tory and cardiovascular health, and reduced noise pollution and road traffic injuries. Ultimately, however, the use of individual cars needs to fall rapidly to improve both climate, health, and equitable mobility. In the short term, low-emission and car-free zones in towns and cities can help remove the most polluting vehi- cles from urban centres. A rapid phase out of the internal combustion engine is also needed in public transport systems to ensure equi- table access to clean and sustainable transport options for everyone. Governments can play an important role in setting targets and planning for the needed shift away from private car use and towards increased use of clean public and non-motorised transport options. 2) Prioritise walking, cycling and public transport. Walking causes no emissions and is a form of transport available to nearly all. Emissions related to cycling can be more than 30 times lower for each trip than driving a car powered by fossil fuels, and about ten times lower than driving an electric car, when comparing the life cycle of each travel mode (106). Both walking and cycling have major health benefits, such as reducing the risk of many chronic health COP26 Special Report / The health argument for climate action Advanced proof38 / conditions and improving mental health and wellbeing (107). Accessible, affordable, and clean public transportation can make mobility more inclusive. Governments should shift their investment priorities and secure large investments to bridge the historical investment gap for walking, cycling and public transport. High walkability should be paired with increased safety and accessible, affordable, and clean public transportation to meet the needs of people with mobility chal- lenges and increase transportation options and access to public space for all. 3) Create people-centred cities. By 2050, close to two thirds of the world popu- lation will be living in urban areas (108). Cities with a strong focus on public transport, access to blue and green spaces, and high walkability will be more accessible, provide more equal access to goods and services, and provide a healthier living environment (109). Examples of compact cities, such as the 15-min city, Superblocks, and the car-free city, have proven to prevent diseases and promote health, improve social wellbeing, while also addressing climate change and environmental degradation. They have also been demonstrated to support higher urban resilience to the effects of public health meas- ures, such as lockdowns. To ensure cities are future-proof, governments should integrate health, equity, and nature considerations into urban and regional planning policies and interventions, including in economic impact and cost-benefit assessments. They should promote land-use policies and interven- tions that deliver diverse, compact, green, and well-connected cities, and secure sustained funding and resources for delivering on healthy urban environments for both humans and nature. Resources Sourcebook to integrate health in urban and territorial planning WHO and its partners have developed a sourcebook for urban planners, city managers, health professionals, and practitioners to integrate health in urban and territorial planning. Along with a second sourcebook on improving urban transport and health in developing cities, these resources show how an integrated approach to health can influence decisions in sectors, such as housing, transport, energy, and water and sanitation. Æ The Health Economic Assessment Tool for walking and cycling (HEAT) calculates the health benefits and economic impact of increased proportions of urban walking and cycling. Æ The Integrated Sustainable Transport and Health Assessment tool (iSThAT) calculates the air pollution emissions from bus, car, and motorcycle traffic, as well as the health and economic impacts these cause. Æ A global action plan on physical activity 2018–2030 sets out an ambitious vision for a more active world, and the policy changes that are needed to achieve it. Æ The Pan-European Master Plan for Cycling Promotion offers a blueprint to promote cycling as a climate- friendly zero-emission healthy and sustainable active form of mobility all over Europe. The Cycling Cities campaign calls on governments to invest in cycling as a critical public health, access, and climate solution. Æ The WHO Healthy Cities network is a global movement working to put health high on the social, economic and political agenda of city governments. Advanced proof COP26 Special Report / The health argument for climate action 39/ Case Studies Æ The 15-minute city. The hyper-connected ‘15-minute city’ is already becoming the new normal in several major cities. The city network C40 has set out a City Agenda for a Green and Just Recovery, outlining the necessary steps to make this a reality in cities around the world. Learn more here. Æ The world’s first zero-emission ambulance. The National Health Service England aims to deliver the world’s first zero-emission ambulance by 2022, and transition their fleet by 2032, showing the transition to cleaner forms of transport is possible for any type of vehicle. Learn more here. Æ The multiple benefits of cycling. In the Netherlands, a country known for its promotion of cycling as a mode of transport, the health and economic benefits of Dutch active transport policies have been estimated to prevent around 6,500 deaths each year, and increase average life expectancy by 6 months. Learn more here. Æ Urban Health in Ghana. The city of Accra in Ghana has joined the Urban Health Initiative to help transform itself to a more liveable city with cleaner air, and it is piloting tools and approaches other cities will be able to emulate. Learn more here. Æ The health benefits of open streets in Latin America. Open streets are increasing the public space to support social distancing while allowing increased physical activity, active transport, and reducing health risks, such as air pollution emissions and road traffic injuries, among others. Learn more here. Find more case studies on the WHO website. COP26 Special Report / Health and Climate Change40 / Advanced proof Protect and restore nature as the foundation of our health. Protect and restore nature as the foundation for healthy lives and livelihoods. 7 © Glen Bowes Advanced proof COP26 Special Report / The health argument for climate action 41/ Healthy human societies are dependent upon biodiversity and healthy ecosystems - as the source of clean air, water, healthy soils, shelter, medicines, food, pollination and for the regu- lation of pests, disease, climate and extreme weather events. Human pressures, from land and sea use change such as deforestation, over- exploitation of resources, pollution, intensive and unsustainable agricultural practices, to unsafe management, trade and consumption of livestock and wildlife, and invasive alien species all undermine these services (110). Nature-based solutions have the potential to provide over one third of the CO2 emissions reductions needed by 2030 to meet the goal of keeping climate warming to 1.5°C, while they can maximize gains for health and well-being, particularly for the most vulnerable and disad- vantaged populations (111). Communities that have traditionally been custodians of lands and waters, such as Indigenous communities, are well-placed to help protect and restore ecosystems as the foundations for healthy lives and livelihoods. Action Points Protect and restore nature as the foundation of our health. 1 End our destruction of nature. Halt the destruction and degradation of biodiversity and carbon-rich ecosys- tems as soon as possible. 2 Protect and restore the ecosys- tems we all depend on. Commit to protecting at least 30% of the land and sea by 2030, prioritizing areas of high importance for biodiversity and the delivery of ecosystem services. 3 Recognise the interconnections between human, animal and ecosystem health. Integrate a One Health approach to ensure prevention and early detection of health risks. 4 Promote nature-based solutions and a nature-based recovery. Avoid additional harm to nature and build forward better from the pandemic through nature-based solutions that jointly support biodiversity, health, and climate action. 5 Protect people and planet by imple- menting new global biodiversity framework. Commit to reversing biodi- versity loss by 2030 and develop ambi- tious plans and programmes to support an ambitious post-2020 global biodiver- sity framework. 1) End our destruction of nature. Increasing energy consumption, overexploita- tion of natural resources and unprecedented transformation of land-uses, freshwater and seascapes have led to changes in climate and the accelerating decline of biological diversity worldwide (112). The increasing destruction and degradation of biodiversity and carbon-rich and ecosystems is negatively impacting lives and livelihoods. To end our destruction of nature, govern- ments should avoid any further biodiversity and ecosystem loss or degradation. Important first steps to achieve this goal are: to reduce deforestation and any further degradation of forests, non-forest terrestrial ecosystems, and coastal ecosystems, to support Indigenous peoples and local communities to maintain or regain stewardship of their traditional lands and waters, and to implement ambitious National Biodiversity Strategies and Action Plans (NBSAPs) as part of commitments under the Convention on Biological Diversity (CBD). Incentives that are harmful to biodiversity, such as perverse subsidies, should be eliminated or reformed (71). COP26 Special Report / The health argument for climate action Advanced proof42 / 2) Protect and restore the ecosystems we all depend on. Protecting biodiversity and limiting climate change are mutually supporting goals and can often be addressed together. Actions to protect, sustainably manage and restore natural and modified ecosystems can bring many co-benefits for health, biodiversity and climate goals(113). Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is reducing access to water, clean air, hindering food and nutri- tion security and increasing the risk of disease emergence (114). Many Indigenous peoples and local communities have acted as knowledgeable keepers of land- and seascapes and are crucial leaders in biodiversity protection. Jointly achieving climate and biodiversity goals is therefore essential for sustainably and equi- tably providing benefits to people. Governments can protect and restore carbon-rich and biodi- verse ecosystems in many ways, such as through the promotion of sustainable agricultural prac- tices, the protection of Indigenous rights, urban greening, sustainable ocean management, rewil- ding and other ecosystem restoration efforts. Governments should commit to protecting and restoring at least 30% of the land and sea by 2030 (115). 3) Recognise the interconnections between human, animal and ecosystem health. Healthy communities rely on well-functioning ecosystems. They provide clean air, fresh water, medicines and food security, help to limit disease and stabilize the climate. But biodiversity loss is happening at an unprecedented rate, impacting human health worldwide and increasing the risk of infectious diseases (116,117). Climate change can amplify these threats. One Health or other integrated approaches to health must jointly address all dimensions of health, including the health of people, animals, plants and their shared environment, through a whole-of-government, whole-of-society approach. To improve the prevention and early detection of health risks from biodiversity loss, governments should mainstream a ‘One Health’ approach across all policies that address health and environmental sustainability (118). 4) Promote nature-based solutions and a nature- based recovery. Overall, COVID-19 stimulus packages have had more harmful than beneficial effects on the environment, even though over half (55%) of global Gross Domestic Product (GDP) depends on healthy ecosystems (119,120). Nature-based solutions that jointly place a value on biodiver- sity, human health and long-term benefits are essential to maximizing the potential of climate adaptation and mitigation strategies for both people and planet. Governments plans for a post COVID-19 recovery, including plans to reduce the risk of future epidemics, need to go further upstream than the early detection and control of disease outbreaks (71). Governments can promote nature-based recoveries by minimising stimulus packages that cause additional harm to nature, and by directing at least 10% of the overall recovery investment to protecting and restoring nature. This can help to create new jobs while protecting those for whom the pandemic has hit hardest, such as communities in rural and low-income areas. 5) Protect people and planet through a new global biodiversity framework. Interconnected climate, nature crises and ineq- uity threaten the health and livelihoods of present and future generations (121). Governments can protect both people and planet by adopting an ambitious global biodiversity framework at the 15th Conference of the Parties (COP15) of the CBD and developing NBSAPs that meaningfully Advanced proof COP26 Special Report / The health argument for climate action 43/ Resources Expert Working Group on Biodiversity, Climate, One Health, and Nature-based Solutions The Expert Working Group on Biodiversity, Climate, One Health, and Nature-based Solutions, co-hosted by WHO and the International Union for the Conservation of Nature (IUCN), develops guidance and tools for One Health approaches and Nature-based Solutions. This supports decision makers to identify co-benefits and trade-offs for human and ecosystem health, strengthen social and ecological resilience, while supporting a healthy, green, and just recovery from COVID-19. Æ The CBD and WHO published a state of knowledge report on biodiversity and health in 2015, synthesising the interlinkages between both agendas. Æ In order to ensure that Nature-based Solutions reach their potential to address societal challenges, IUCN has developed a Global Standard and quality criteria for Nature-based Solutions. Æ A new WHO-IUCN Expert Working Group on Biodiversity, Climate, One Health and Nature-based Solutions guides decision makers toward a healthier, greener, and more sustainable future as they navigate the challenges of the post-COVID-19 era. Æ The GreenUr tool calculates the impact of urban green spaces on health exposure, including cardiovas- cular disease. Æ The Friends of Ecosystem-based Adaptation network shares experiences and knowledge on harnessing nature and ecosystem restoration when adapting to climate change. Æ The UN Decade on Ecosystem Restoration is a global campaign to protect and restore ecosystems in the next decade. Æ The youth-led organisation Youth4Nature are empowering young people around the world to mobilise around nature and climate goals. consider synergies for biodiversity, climate and health. An ambitious global biodiversity frame- work that is aligned with climate and health objectives is crucial to sustainably support human and societal needs, including clean air, water, food and nutrition security, energy, devel- opment of medicines and pharmaceuticals and freshwater, which, together with other services delivered by healthy ecosystems, underpin good health. In order to protect both people and planet, the post-2020 Global Biodiversity Framework (GBF) must adopt a roadmap to safeguard and restore nature by 2030. It should be supported by concrete and measurable targets and indica- tors that also consider the important interlink- ages between health and biodiversity, support the 2030 Agenda for Sustainable Development, and be a truly global framework. At COP 15, the CBD will also adopt a global action plan on biodi- versity and health which should contribute to supporting the Global Biodiversity Framework and meaningfully foster coordinated science and policy development across the environ- ment, health and other relevant sectors. COP26 Special Report / The health argument for climate action Advanced proof44 / Case Studies Æ An international agreement to protect the world’s largest rainforest. In September of 2021, the IUCN Congress approved a motion to protect 80% of the Amazon rainforest and restore at least half of its degraded forests by 2025, while also ensuring indigenous peoples and local communities govern and administer new protected areas that overlap with their territories and recognises their local governance authorities by 2025. Learn more here. Æ Eight cities rewilding their urban spaces. Cities across the world - including Singapore, Dublin, Sydney and Barcelona - are working to create open spaces and “rewild” their communi- ties, to combat the global loss of nature while bringing health benefits to communities. Learn more here. Æ A Planetary Health approach to rainforest conservation in Madagascar. The Manombo Special Reserve in Madagascar protects the vital habitat for many critically endangered plant and animal species, while also providing medicine and food security to local communities. Learn more here. Æ Prescribing nature in Canada. PaRx is Canada’s first national, evidence-based nature prescription program, driven by healthcare professionals who want to improve their patients’ health by connecting them to nature. A growing body of research suggests that spending time in nature has a wide range of positive effects on human health, from reduced chronic disease to improved mental health, immune function, and birth outcomes. Learn more here. Æ A nature-positive green recovery in Pakistan. The government of Pakistan is implementing a “Green Stimulus” plan to recover from COVID-19 while creating jobs and restoring the coun- try’s natural ecosystems. Learn more here. Find more case studies on the WHO website. Advanced proof COP26 Special Report / The health argument for climate action 45/ © Sasin Tipchai COP26 Special Report / Health and Climate Change46 / Advanced proof Promote healthy, sustainable, and resilient food systems. Promote sustainable and resilient food production and more affordable, nutritious diets that deliver on both climate and health outcomes. 8 © CIAT Advanced proof COP26 Special Report / The health argument for climate action 47/ Current food systems, and particularly indus- trial production methods, are driving global trends towards malnutrition in all its forms, climate-damaging environmental impacts, and undermining health and economic develop- ment. Global agriculture and food production systems are currently the single largest driver of nature and biodiversity loss, are responsible for about one quarter of global greenhouse gas emissions, and contribute significantly to air pollution. Moreover, diseases caused by either food insecurity, or consumption of unhealthy diets, are now the single largest cause of global ill health, and land use change is the single biggest environmental driver of new disease outbreaks (122). The effects of climate change are likely to make these health risks even worse. For the health of people, animals, and the planet, there is a need for a rapid transition to sustain- able, safe, and healthy diets for all. Currently, our food systems are making us ill with approx- imately 1 in 5 deaths - 11 million deaths every year - associated with unhealthy diets, as well as an additional 2.7 million deaths each year from zoonoses directly linked to our food systems (123,124). The numbers are staggering: 690 million people are hungry, 2 billion people have micronutrient deficiencies, and there are over 670 million adults with obesity (125). A food production transformation would require, on average, a more than doubling of the consumption of nutritious foods, while reducing the consumption of unhealthy foods and bever- ages by more than half. The implementation of just three changes - reducing food waste and loss, improving livestock management, and the adoption of healthy, largely plant-based diets - could reduce the emission of methane, one of the most potent greenhouse gasses, by 65–80  Mt/year over the next few decades (current global anthropogenic methane emis- sions are approximately 370 Mt/year) (126). Sustainable food production requires a shift in how we grow, harvest, process, transport, market, consume, and dispose of food, with health and sustainability central to all trans- formative actions. This includes the vital area of farming, which could be transformed by ending subsidies harmful to health or the environment, subsidising nature-positive production, and by high-income nations consuming more plant- based diets and cutting food waste. Action Points Promote healthy, sustainable, and resilient food systems. 1 Nourish our future. Improve access to diets that are nutritious, sustainable, and affordable. 2 Remove harmful agricultural subsidies. Remove financial and other incentives that support high emission, unhealthy food options and agricultural practices. 3 Support a just agricultural transi- tion. Prioritise a rapid transition away from unsuitable farming practices that damage the environment and risk human health. 4 Mainstream biodiversity for nutri- tion and health. Mainstream biodi- versity interventions in food systems to strengthen resilience, increase food security, improve nutrition, lower emis- sions, and protect our vital natural resources. 1) Nourish our future. Access to a healthy, sustainable, and affordable diet is a human right, not a privilege. Currently, sustainable healthy diets are unaffordable or inaccessible for over three billion people (125). A food system transformation which places health and sustainability at its core will have health, environmental, and economic benefits - both nationally and globally. This transformation could prevent approximately 11 million deaths per year globally, or between 19% to 24% of total adult deaths (123,127). It is essential to reduce agricultural emissions, preserve the world’s remaining biodiversity, restore degraded land and depleted oceans, and end malnutrition in all its forms. COP26 Special Report / The health argument for climate action Advanced proof48 / To make this a reality, governments should adopt sustainable food system policies that ensure the provision and accessibility of nutritious, sustainable, diverse, affordable, and safe food options (128). Policies should place emphasis on overcoming cost barriers to nutritious foods, reducing food inequities, and preventing food loss and waste. Governments already have many existing policy tools and initiatives at their disposal to drive this change. These include: establishing dietary guidelines with sustainability criteria to guide all policy action; fiscal policy meas- ures such as taxation and subsidies to support healthy dietary patterns; product reformulation to reduce levels of unhealthy fats, sugars, and salt in the food supply; harnessing the potential of public food provisioning and procurement; labelling to inform consumers of products’ nutri- tion and environmental profile; school feeding programmes; nutrition-sensitive agriculture; integrated One Health approaches; supply chain policies; and food waste reduction measures. 2) Remove harmful agricultural subsidies. Globally, governments provide nearly US$600 billion in agricultural subsidies every year. However, subsidies and other financial mech- anisms often support the production and consumption of commoditised unhealthy and unsustainable food options, such as indus- trial intensive meat production, palm oil, and sugar (129). These incentives distort the true cost of unhealthy and unsustainable products compared to alternatives that are better for both human health and the environment. Governments should implement policies that promote sustainable farming practices by removing and repurposing both the financial and non-financial incentives that support and support high emission, unhealthy food options and agricultural practices. By diverting subsidies and other incentives away from unhealthy prod- ucts and towards sustainable agriculture and diverse and resilient food chains, governments can ensure a growing population has access to healthy diets at affordable prices and within planetary boundaries. 3) Support a just agricultural transition. The transition to more nutritious food and an ecologically friendly food system needs to take place in a fair and just way. High-income coun- tries must take the primary responsibility for mitigating the emissions produced by their food systems while supporting low-income countries to ensure climate-resilient and sustainable food systems. Protecting and strengthening the tradi- tional food systems of Indigenous Peoples, local communities, and small- and medium enter- prises is also crucial to ensure their sustaina- bility, resilience and efficiency (130). Governments should support and work with farmers, and those working in the agricultural sector and rural areas, particularly women, to transition to more sustainable agriculture and food systems as global diets change, and to enhance local, traditional, Indigenous and agro- ecological approaches to food production. A just agricultural transition should also improve workers’ rights, social protection, and occupa- tional health and safety, which is often compro- mised due to the nature of the work or the working conditions (131). A just agricultural tran- sition can be facilitated by guaranteeing markets for suitable and healthy products and with the transfer of finance, training and technology to more sustainable practices. 4) Mainstream biodiversity in food systems to strengthen resilience, increase food security, and lower emissions. Biodiversity is a foundational pillar for food security, nutrition, and dietary quality. By main- streaming health and biodiversity considerations and interventions, governments can support a transition toward more sustainable food systems and healthy and nutritious diets (122). Advanced proof COP26 Special Report / The health argument for climate action 49/ Governments can improve food security and lower emissions of food systems by taking ecosystem-based, ‘One Health’ and traditional food system approaches to improving nutrition and protecting biodiversity. Examples of this include: promoting Indigenous crop varieties; adopting integrated pest management practices; improving soil health management; supporting the production and consumption of local foods, including neglected and underutilised species high in nutritional quality; restoring vegetation in catchments; promoting the sustainable management of fish habitats; improving sustain- able post-harvesting methods; making healthy local foods accessible for school-aged children; supporting smallholder farmers and Indigenous communities in the production of biodiverse foods; regulating food marketing and labelling; and incorporating sustainability into national dietary guidelines and preventing food industry influence on such guidelines. Resources Guiding principles for sustainable healthy diets The guiding principles for sustainable healthy diets, developed by the Food and Agriculture Organisation (FAO) and WHO, offer ways in which to promote diets that are healthy and have low environmental impacts. These guiding principles allow governments to leverage the role of food consumption and diets in contributing to the achievement of climate action and other SDGs. Æ WHO guidance on mainstreaming biodiversity for nutrition and health provides governments with a framework for integrating biodiversity in food-based interventions. Æ The EAT-Lancet planetary health commission provides guidelines on how to feed a future population of 10 billion people a healthy diet within planetary boundaries. Æ The Biodiversity for Food and Nutrition Project uses Indigenous food biodiversity as a lens to address malnutrition, farmer livelihood resilience, and sustainability. Æ The Committee on World Food Security has developed Voluntary Guidelines on Food Systems and Nutrition, which enable more inclusive and sustainable food systems for healthy diets for all. Æ The G20 Matera declaration on food security, nutrition and food systems offers a call to action on food systems as part of a green recovery from COVID-19. Æ The European Environmental Bureau provides key facts and recommendations to cut emissions from agriculture. COP26 Special Report / The health argument for climate action Advanced proof50 / Case Studies Æ Dietary guidelines that are good for health and planet. Canada, Switzerland, Sweden, Qatar, Norway, Brazil, and Germany all include environmental considerations in their national dietary guidelines. Learn more here. Æ Building food and nutrition resilience in the Philippines. In response to the COVID-19 pandemic, the Mayor’s Office of Quezon City in the Philippines established an inter-depart- mental task force to strengthen the city’s food security efforts. The task force provides emer- gency aid to citizens, while implementing a food security plan for long-term recovery with expected co-benefits for climate, the environment, and human health. Learn more here. Æ Food recovery in the United States. More than one-third of food produced in the United States ends up in the landfill, where it releases methane gas and contributes to climate change. At the same time, 1 in 6 people in the United States experience food insecurity. To address these intersecting issues, the state of California, along with health facilities in the region, are piloting several food waste prevention projects and policies. Learn more here. Æ Promoting food security and health for Amazon communities. A support network for traditional and Indigenous communities in Brazil aims to ensure food security, health services, and territorial protection for local communities during the COVID-19 pandemic. Their actions are focused on supporting public services and direct help for communities, including mobile hospital boats, educational campaigns, and on-site distribution of hygiene kits and food, as well as providing support with territorial forest protection and development. Learn more here. Æ Climate smart agriculture in Kenya. The Kenyan organisation Sylvia’s Basket advocates for improved access to healthy, safe and nutritious food in Africa. Since 2016 they have supported organic and agroecological farming practices in the region, including through the establish- ment of organic farms, supporting small-scale farmers to establish their own kitchen gardens, and a training program. Learn more here. Find more case studies on the WHO website. Advanced proof COP26 Special Report / The health argument for climate action 51/ © WHO COP26 Special Report / Health and Climate Change52 / Advanced proof Finance a healthier, fairer, and greener future to save lives. Transition towards a wellbeing economy. 9 © CIAT Advanced proof COP26 Special Report / The health argument for climate action 53/ Financial decisions made in the coming months and years can either lock in economic develop- ment patterns that will do permanent and esca- lating damage to the ecological systems that sustain all human health and livelihoods, or, if wisely taken, can promote a healthier, fairer, and greener world (71). In recovering from COVID-19, financial reform will be unavoidable. By transitioning towards a wellbeing economy, financial systems would be redirected to prior- itise human needs rather than unsustainable economic growth. Action Points Finance a healthier, fairer, and greener future to save lives. 1 Stop funding pollution. End harmful subsidies for fossil fuels, both domesti- cally and abroad. 2 Close the health financing gap. Invest in health adaptation and resilience and help close the health financing gap. 3 Ensure public finance does no harm. Prevent investments in unsustainable and polluting activities that threaten communities’ health and wellbeing. 4 Provide debt relief to vulnerable nations. Show global solidarity for those most impacted. 1) Stop funding pollution. Fossil fuels were subsidised by $5.2 trillion in 2017 - over 6% of global GDP – and estimates for 2020 suggest only 18.0% of COVID-19 recovery spending, and only 2.5% of total spending, is expected to enhance sustainability (132,133). Evidence shows the elimination of these harmful subsidies would lower global greenhouse gas emissions, reduce air pollution deaths, and allow an increase in social welfare spending (134). To avoid increasingly harmful levels of global heating, plans for an absolute end to direct government support for any coal, oil, or gas use needs to be put in place by the end of 2021, and the phase-out of coal should be completed by 2030 in OECD countries and by 2040 in non-OECD countries. Governments should therefore end harmful subsidies and other financial incentives that support the production and consumption of fossil fuels, put a price on carbon, and re-orient funds in favour of clean, renewable energy sources, and social welfare. To ensure an inclusive and just transition, financial and technical support and equity safeguards need to be in place to support the most vulnerable and avoid energy poverty. 2) Close the health financing gap. Health is acutely underfunded in most regions, and this is especially true when it comes to climate finance. Health is the sector where demands for climate support most frequently are left unmet. Whereas approximately two-thirds of Nationally Determined Contributions to the Paris Agreement cite the importance of health (49), and half of all countries have developed strategies on climate change and health (72), a much lower proportion of countries have health adaptation plans in place, and less than 0.5% of multilateral climate finance is allocated to health projects (6). Finance for health adaptation and resilience is a no-regrets investment that ensures the sustain- able development of economies while protecting vulnerable populations (81). Governments should help close the health financing gap by removing existing barriers to finance for health adaptation and resilience, increasing finance for locally-led climate action, and by reforming and reallocating health-harmful subsidies to health systems strengthening. 3) Ensure public and private finance do no harm. Even though governments around the world signed onto the Paris Agreement and its goal of making finance flows consistent with a pathway COP26 Special Report / The health argument for climate action Advanced proof54 / towards low greenhouse gas emissions and climate-resilient development (135), global banks have invested USD 3.8 trillion in fossil fuels in the last 5 years alone (136). Governments should systematically prevent investment in unsustainable, maladaptive or polluting activities that threaten communities’ health and wellbeing. For example, commit- ting to no new fossil fuel infrastructure while investing in the rapid reduction of methane emissions would be a valuable investment in the future of our people and planet (126) and a rapid end to environmentally- and health- harming subsidies would allow funds to be redirected towards social and health goals. Incorporating health metrics into environ- mental, social, and governance criteria for sustainable finance is another example of how to avoid harmful investments. Governments’ fiscal policies should ensure that public and private finance does no significant harm, promotes public health, and respects climate safety and reflects the real cost of carbon in line with the damage it causes. 4) Provide debt relief to vulnerable nations. The debt of vulnerable nations has risen to unsustainable levels, largely due to rising global inequities and worsening climate and health impacts. Developing countries currently need an estimated USD 70 billion a year to adapt to climate change (137). Additional to pledging international climate finance, high-income coun- tries must signal solidarity by providing debt relief. Several groupings of climate-vulnerable countries have called for international financial relief in the wake of COVID-19 to include more systemic changes, for example by providing targeted support to climate-vulnerable countries and leveraging green investments (138,139,140). Climate-vulnerable nations, such as SIDS, are calling on institutions and governments to enhance the accessibility of climate finance and strengthen capacity-building for vulnerable developing countries (28), since currently only 2% of climate finance reaches small island states and only 14% goes to least-developed countries (141). Resources Finance for health and climate change WHO provides technical guidance and support to countries to access international funds that allow for the implementation of health-relevant adaptation and mitigation actions. This includes Readiness funds from the Green Climate Fund, as well as the Global Environment Facility and Adaptation Fund. Æ The WHO Health and Climate Change Survey of governments highlights countries’ personal experiences with climate and health finance, both in terms of the progress governments have made, as well as bottle- necks and barriers to finance they experience. Æ The Finance for Biodiversity Initiative gives out Nature Performance Bonds through which countries can have their debt payments reduced and use the savings on environmental interventions. Æ The Adaptation Gap Report by the UN Environment Programme highlights that the financial gap for adaptation is not closing and that it is particularly large for health adaptation. Æ The Glasgow Financial Alliance for Net Zero unites firms and banks to accelerate the transition to net zero emission in the financial system. Advanced proof COP26 Special Report / The health argument for climate action 55/ Case Studies Æ Phasing out coal financing for community health in Indonesia. Indonesia plans to stop building new coal-fired plants after 2023 and has announced it will end all new financing for overseas coal projects. Research has shown the country could take more ambitious steps by phasing out many old coal plants sooner, which would lead to huge health benefits. Learn more here. Æ Increased climate finance pledge by Germany. Germany announced in June 2021 that it will increase its climate finance pledge from €4 billion per year currently to €6 billion per year by 2025 to support the Paris Agreement. Learn more here. Æ Supporting Indigenous communities with carbon farming in Australia. The Aboriginal Carbon Foundation supports carbon farming projects led by Indigenous Rangers and Traditional Owners in Australia and connects communities who supply carbon credits with organisations and corporations seeking to offset their carbon pollution. This carbon trading scheme generates employment for sustainable land and sea management while offsetting the carbon footprint of participating organisations. Learn more here. Æ Swapping debt for nature in the Seychelles. The government of the Seychelles and Seychelles’ Conservation and Climate Adaptation Trust have conducted the world’s first debt- for-nature swap for ocean conservation. The countries debt was restructured in return for developing a Blue Economy and supporting marine protected areas. Learn more here. Find more case studies on the WHO website. COP26 Special Report / Health and Climate Change56 / Advanced proof Listen to the health community and prescribe urgent climate action. Mobilise and support the health community on climate action. 10 © WHO Advanced proof COP26 Special Report / The health argument for climate action 57/ Health leaders everywhere have been sounding the alarm on climate change and are already taking steps to protect their communities and health facilities from worsening climate impacts. Increasingly, health care systems and organi- sations are also leading by example within the health sector, reducing their own emissions and strengthening resilience. The COP26 Presidency has established a Health Programme (142) that, among other activities, encourages countries to state their ambition to develop climate-resilient, low carbon, sustain- able health systems. Governments should also make use of the status of health professionals within communities, and leverage their political, economic, and moral influence to advocate for climate and health, stand in solidarity with the most vulnerable, and ensure a healthy future for today’s children and youth (48). Action Points Listen to the health community and prescribe urgent climate action. 1 Train the health workforce to respond to climate change. Update health curricula and provide training and support to prepare health workers. 2 Take climate action in the health care sector. Transition to climate-resil- ient and sustainable health care. 3 Enable health professional advo- cacy on climate change and health. Support peers and colleagues to effec- tively communicate on climate change and health. 4 Protect the health of future gener- ations. Support youth and vulnerable populations to protect the health of future generations. 1) Train the health workforce to respond to climate change. No health system can function without its work- force, and there is an urgent need to invest in health workers for shared dividends in health, jobs, economic opportunity, and equity (143). For health workers to be able to respond to climate change, however, improved and addi- tional training, resources, research, and support programmes are needed. Health professionals need to be trained and empowered to recognise, anticipate and treat the symptoms of the climate crisis – mani- fested through shifting disease patterns, rising vulnerabilities, and increasing extreme weather events – as well as understand and respond to the effect of health inequities on vulnerabilities and health risks from climate impacts. With the right training and support programmes, health workers also play an important role in reducing the environmental footprint of health care itself and ensuring health systems are resilient and well-functioning. Health leaders and policy makers can enable a prepared health workforce by updating health curricula and by providing additional and continued training and support programmes on climate change and health, while improving professional standards to include criteria on climate and health. These programmes should reach the widest range of health professionals across disciplines and specialties. 2) Take climate action in the health care sector. Transition to climate- resilient, low-carbon, sustainable health care. The health care sector is one of the world’s largest employers and makes up close to 10% of global GDP (144). Health leaders therefore have an opportunity to use the ethical, economic, and political influence of the sector to drive the necessary changes to face the climate crisis. COP26 Special Report / The health argument for climate action Advanced proof58 / Health care contributes to climate change through unsustainable energy consumption, transport, products and waste, while at the same time health systems are increasingly vulnerable to climate impacts (60). Health care can lead by example and align with the ambition of the Paris Agreement by becoming climate-resilient and reducing its own climate footprint. It can do so by implementing low-carbon health care delivery and operations, decarbonising its supply chain, and moving toward net zero emissions. At the same time, it can build resilience by preparing its facilities, and the wider health system, for climate impacts and the shifting burden of disease, and support community health and resilience. High ambition and high emitter countries should set a target date by which to achieve health system net zero emissions – no later than 2050. All governments should deliver a baseline assess- ment of greenhouse gas emissions of the health system, as well as an action plan or roadmap to develop a sustainable low carbon health system (including supply chains). Roadmaps also need to consider human exposure to air pollution and the role the health sector can play in reducing exposure to air pollution through its activities and actions. 3) Enable health professional advocacy on climate change and health. Health professionals are trusted communica- tors and are embedded in local communities, making them powerful advocates for global to local efforts to reduce emissions and protect people from climate change (145). They are ideally placed to communicate the health risks of climate change, and to promote policies that protect public health from climate impacts. Governments and health leaders can support the health community to effectively engage on climate change and health, including through meaningful involvement of health professionals in climate decision-making - in particular those who represent communities most affected and at risk. Additionally, the health care setting should be used to raise awareness on the health risks posed by climate change, including by providing patient education materials, commu- nication training, action alerts and timely infor- mation on environmental developments that influence the health and wellbeing of patients, policy statements, and research digests. 4) Protect the health of future generations. The life of every child born today will be profoundly affected by climate change (146), and current climate commitments are nowhere near enough to protect our children, grandchildren and future generations (147). Every year, envi- ronmental factors take the lives of 1.7 million children under five (148), and one billion children are already at extremely high risk of the impacts of the climate crisis (149). Governments should invest in children’s health for lifelong, intergenerational, and economic benefits. By monitoring how children flourish today, but also how growing inequities and envi- ronmental threats from fossil fuel economies are destroying their future, policy makers would have a better sense of the costs and benefits of policies and practices, and the transformational changes needed. By enacting these changes, governments can listen to and partner with young people and other disadvantaged groups by including their voices and skills, for the sake of the planet’s sustainable and healthy future. Advanced proof COP26 Special Report / The health argument for climate action 59/ Resources Healthy Climate Prescription to COP26 The Healthy Climate Prescription, a letter from the health community worldwide to COP26 national climate negotiators, calls for effective action to limit warming to 1.5C, increased financing from high-income countries to support low-income countries’ transitions, and strengthened investment in adaptation and resilience. Æ The Nurses Climate Challenge is an international campaign to mobilise nurses to educate 50,000 health professionals on the impacts of climate change on human health. Æ The Climate and Health Alliance has produced a communication guide to empower health professionals to talk publicly about climate change and health, while a new communication guide by Healthy Energy Initiative India provides guidance to healthcare professionals in India. Æ The Youth-Driven Recovery Plan developed by the World Economic Forum’s Global Shapers Community, a network of 14,000 inspiring young people, features 40 policy recommendations to help policymakers integrate the voices of the next generation into recovery efforts. Æ The Declaration on Children, Youth and Climate Action, developed by youth groups and partners in the lead up to COP25, is the first commitment of its kind to accelerate inclusive, child and youth-centred climate policies and action at national and global levels. Fifteen governments have signed it thus far. Æ The Race to Zero brings together more than 40 health institutions, from 18 countries, on every continent, representing more than 3,000 hospitals and health centres, who have joined the UNFCCC Race to Zero with a commitment to net zero health care by 2050. Æ Climate Impact Checkup is a calculator that helps health care institutions anywhere in the world measure their GHG footprint. It provides a starting point to measure, manage, and support mitigation goals and action planning no matter where a facility is located. Case Studies Æ RISE - Southeast Asia Alliance for Health and Climate. The RISE Southeast Asia Alliance was set up in 2020 to mobilise health care leadership for climate action, resilience, and a healthy recovery in South-East Asia. The network supports healthcare leaders in taking climate action by offering opportunities for capacity building and advocacy in South- East Asia. Learn more here. Æ Health professionals calling for climate action. A large variety of health groups have organ- ised around the need for more ambitious climate action, e.g. by calling for a healthy recovery, urging their governments to adopt more ambitious NDCs, and releasing calls to action for COP26. Æ Doctors for Climate in Poland. Polish health and medical experts have issued a statement that accelerating climate change already impacts people’s health in Poland and beyond – and that these effects will continue to worsen. A first in the country, the Doctors for Climate appeal calls on decision-makers to take urgent, decisive and timely measures to protect the climate, for the health and lives of current and future generations. Learn more here. COP26 Special Report / The health argument for climate action Advanced proof60 / Æ Keeping the community safe through Humanitarian Youth Clubs in Kiribati. The Humanitarian Youth Club initiative increases awareness of sexual and reproductive health- care during a crisis and builds connections between youth leaders and the communities in which they live. Youth volunteers are trained in sexual and reproductive healthcare priorities in an emergency and help prepare their community for the impact of king tides and other crises. Learn more here. Æ Training climate and health leaders in the Caribbean. A fellowship programme at the University of the West Indies is training a cohort of Caribbean health professionals and prac- titioners with knowledge and skills on climate change and health. The program focuses on promoting an interdisciplinary One Health approach, tackling the environmental determi- nants of health, and the prevention and control of COVID-19. Learn more here. Find more case studies on the WHO website. Conclusion Climate change is the single biggest health threat facing humanity. And while no one is safe from the health impacts of climate change, they are disproportionately felt by the most vulnerable and disadvantaged. Protecting people’s health from climate change requires transformational action in every sector, including on energy, transport, nature, food systems and finance. The public health bene- fits from implementing these ambitious climate actions far outweigh their costs. Health leaders everywhere have been sounding the alarm on climate change and are increas- ingly taking steps to protect their communities from worsening climate impacts, while reducing their own emissions. The ten recommendations in this report highlight the priority actions governments need to take to confront the climate crisis, restore biodiversity, and protect health. By enacting these urgent changes, governments can ensure a healthy future for our children, grandchildren and future generations. Advanced proof COP26 Special Report / The health argument for climate action 61/ © United Nations COP26 Special Report / The health argument for climate action Advanced proof62 / 1 Climate change and health: Report by the Secretariat. A61/14. Geneva: World Health Organization; 2008 (https://cdn.who.int/media/docs/default-source/climate-change/report-by-the-secretariat-on-climate-change- and-health.pdf, accessed 20 September 2021). 2 Healthy Climate Prescription. 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