Blindspots on the Climate Crisis in Global Health Governance
Blindspots on the Climate Crisis in Global Health Governance
Newsletter Edition #202 [The Files In-Depth]
Hi,
At the cusp of the UN Climate Summit [COP28 meeting], we explore the framing of, and the possibilities in the governance of the climate crises as a global health challenge.
My colleague Nishant Sirohi brings you this pertinent analysis that maps together the evolution of the climate crisis as a challenge that has upended how we think about addressing global health issues. We republish this piece with the permission of the Observe Research Foundation.
Couple this with the podcast we published last week, where Peter Sands from The Global Fund talks about the overlapping challenges at the intersection of health and the environment. (This was based on an interview we did earlier this year.)
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I. ANALYSIS
Blindspots on the Climate Crisis in Global Health Governance
By Nishant Sirohi & Priti Patnaik
First published here: Vikrom Mathur and Aparna Roy, Eds., Converging Paths: Global Governance for Climate Justice and Health Equity, November 2023, Observer Research Foundation.
The conversation around climate change is now several decades old, and numerous international norms have recognised the health impacts of the climate crisis. Despite the ubiquitous nature of climate change impacts, however, there are few legal commitments, if at all, to address the health dimensions of the climate crisis.
Climate change-related health risks and strains on the health system are no longer future abstractions. They have been extensively documented, and there is enough evidence that the effects have been disproportionate on disadvantaged and vulnerable communities whose right to health and access to healthcare is often under threat due to socio-economic disparities. Yet, there are only a few established partnerships within the United Nations (UN) system that explicitly focus on the global health implications of climate change. Over the years, global health law has failed to address the real consequences from the climate crisis, including severe health consequences and loss of lives. It has been estimated, for example, that more than 70 percent of infectious disease outbreaks emerge from zoonotic spillovers.
This article argues that, as the world grapples with the lingering effects of the COVID-19 pandemic, the global health community should seize the opportunity to integrate actions on climate change to address environmental concerns into existing and new global health mechanisms. These mechanisms, such as the International Health Regulations and a proposed Pandemic Agreement, must be fortified to address the intersection of the climate crisis and health. It is imperative to integrate universally recognised environmental rights and climate change laws with global health laws to address both climate change and future infectious disease outbreaks.
1. WHO’s Approach to Climate-induced Health Challenges
The World Health Organization’s (WHO) institutional strategy to respond to climate change has several pillars. These include WHO’s advocacy efforts to spotlight health risks associated with climate change; its collaborations with various programs and the UN system to address climate challenges; its ongoing review and monitoring of scientific developments using health and climate countries profiles; its support for national projects that merge climate change and health initiatives; and its commitment to prioritise capacity building.
The elements of WHO’s policy are shaped by World Health Assembly resolutions and the outcomes of WHO’s Health & Climate Change conferences.
1.1. Resolutions of the World Health Assembly on Health and Climate Change
The World Health Assembly (WHA), which governs WHO, uses its powers in norm-creation to define strategies and direct action on global health challenges posed by climate change. For example, in Resolution A51/21 of 1998, the Assembly recognised WHO’s critical role in working with international partners to address the health consequences of climate change. The Resolution also stressed the importance of incorporating a health perspective into global discussion and actions on climate change.
Building on this commitment, Resolution WHA 61/19 of 2008 emphasised the significant impact of climate change on global health, urging collective action and adaptation. Since then, however, little progress has been made in addressing the impacts of climate change on health.
Starting in 2009, the Assembly began adopting the focused five-year work plan. The current work plan for 2019 – 2023 is focused on integrating the One Health Approach to prevent and control infectious outbreaks.
1.2. WHO’s Health and Climate Change Conferences
Furthermore, WHO’s Health & Climate Change conferences have emerged as a platform for stimulating global political dialogue on these intertwined issues of health and climate. They have also shaped the organisation’s institutional framework to combat climate change-related public health risks.
The UNFCCC’s 2015 Paris Agreement, primarily a climate-focused instrument, has been lauded as the “potentially strongest health agreement of this century” for explicitly linking climate action and the right to health. It stated: “Parties should, when taking action to address climate change, respect, promote and consider their respective obligation on … the right to health.”
This accord not only influenced WHO’s Health & Climate Change conferences but also conferred the necessity of collaborative efforts between health and climate change. For example, the 2016 edition emphasised enhancing the implementation of the Paris Agreement, and the 2018 conference launched an initiative to address climate change and health issues in Small Island Developing States.
1.3. WHO’s Reactive Approach to Climate Change
WHO’s strategic framework addressing climate-induced health risks is undoubtedly comprehensive. However, it appears to be reactive rather than proactive. The gap between WHO’s aspirations and actual outcomes underscores the complexities and challenges of harmonising global health and climate change governance. To be sure, the climate-health nexus is gradually gaining wider recognition in the UN framework.
2. Right to Health and a Healthy Environment
The right to health, as outlined in Article 12 of the International Covenant on Economic, Social and Cultural Rights, has been codified in numerous legally binding international treaties, regional instruments and national constitutions. The right to health mandates States to ensure everyone can access the highest standard of physical and mental health, and compels the State to maintain minimum core obligations to consistently improve health conditions and avoid any regressive measures that diminish the fundamental entitlement.
2.1. General Comment 14 on UN Committee on Economic, Social and Cultural Rights
The broader understanding of the right to health includes improving “all aspects of environment and industrial hygiene.” This perspective was highlighted in General Comment 14 of the UN Committee on Economic, Social and Cultural Rights, which emphasised that healthy environmental conditions are a fundamental determinant of health. Therefore, it is imperative to note that the right to health, which hinges on progressive realisation and resource availability, not only bridges the gap between environment and human rights but also underscores the environmental factors as a fundamental requirement for the realisation of the right to health.
2.2. In the Human Rights Council
The UN Human Rights Council has repeatedly emphasised the correlation between a healthy environment and the human right to health. In 2021, the Human Rights Council formally endorsed the human right to a healthy environment. This commitment was reinforced when the UN General Assembly recognised that a clean, healthy and sustainable environment is a universal human right. Additionally, the UN Human Rights Committee, in its General Comment no. 36, has also emphasised the significance of environmental protection for the enjoyment of the right to life. The Human Rights Committee has ruled in multiple instances that a State’s failure to prevent environmental damage can equate to a violation of the right to life, considering such degradation as a major threat to present and future generations’ right to life.
Furthermore, both the UN High Commissioner for Human Rights and the UN Special Rapporteur on Human Rights and the Environment have drawn attention to the nexus between environmental degradation and infectious diseases, as seen in the COVID-19 outbreak. The UN Special Rapporteur on the Issue of Human Rights Obligations relating to the Enjoyment of a Safe, Clean, and Sustainable Environment asserts that “biodiversity is necessary for ecosystem services that support the full enjoyment of a wide range of human rights, including the rights to life, health, food, water, and culture.”
2.3. Health and Climate Change at the Regional Levels
Regionally, instruments and institutions have reflected similar concerns. For instance, the African Commission on Human and People’s Rights, the Inter-American Commission, the Inter-American Court of Human Rights, and the European Court of Human Rights have consistently recognised the connection between a healthy environment and human rights. They frequently highlight how environmental degradation infringes upon these rights. However, even with this widespread recognition, there is limited action to address the health challenges posed by climate change. The latest draft of the Negotiating Text of the WHO Pandemic Agreement does not adequately reflect this critical nexus.
3. WHO Pandemic Agreement, Climate Change and a Right to Healthy Environment
In October 2023, WHO’s Intergovernmental Negotiating Body (INB) released a draft of the Negotiating Text of the WHO Pandemic Agreement, which attempts to offer a framework for States to collectively respond to future pandemics. However, the draft Negotiating Text, across its 29 pages and 36 Articles, falls short of addressing the compounded challenge of climate change and zoonotic spillover in the context of global public health. Specifically, the draft overlooks the impacts of anthropogenic environmental shifts—such as climate change, biodiversity loss, land degradation, and wildlife trade—on escalating pandemic risk.
A new Pandemic Agreement must recognise the inherent link between climate change conditions and the right to health. The current Negotiating Text does not align with existing obligations under international environmental and climate change laws. The current text does not promote the implementation of these norms, neither through binding rules (hard law obligation) nor through non-binding, more flexible measures (soft law approach).
Compared with INB’s Zero Draft, which has also been criticised widely for missing the mark on human rights and for its soft law language, the Negotiating Text has further alienated the provisions related to climate change and health rights. For instance, while the Zero Draft articulated “the right to health” under Article 4, Guiding Principles and Rights, the Negotiating Text omits any mention of the right to health and has no reference to a right to a healthy environment. Moreover, references to “climate change” have diminished, appearing only once in the Negotiating Text, as opposed to twice in the Zero Draft.
3.1. The ‘One Health’ Approach
The Negotiating Text of the Pandemic Agreement approaches climate change in the context of health through the “One Health” approach. The One Health approach emphasises integrated efforts and collaboration across institutions, governance regimes and disciplines to optimise the health of humans, animals and the environment. It emerged from a workshop hosted in New York City in September 2004, organised by the Wildlife Conservation Society and the Rockefeller University. Its prominence grew after the inaugural One Health Summit, in Davos, Switzerland in February 2012.
By bridging the gap between these interconnected health sectors, ‘One Health’ seeks to address cross-sectoral challenges, particularly in preventing zoonotic disease spillover and underscores the interdependence of human health on environmental conditions. The Negotiating Text, for the first time, defines “One Health approach” under Article 1 (d).
At first glance, the definition seems to bring coherence among the triad of animal, planet and human health and integrate existing international environmental and climate change law obligations. However, a closer inspection of Article 5 of the Negotiating Text, which lays down provisions to operationalise the One Health framework, lacks adequate specificity.
Despite wide recognition of the climate change and health nexus, the environmental dimension of ‘One Health’ has not been addressed enough to advance action on climate change-induced health challenges. There are no specifics yet on whether, and how, countries will raise resources to implement these provisions effectively to make a difference. Articles 5 (6) read with Article 21, propose to develop a Conference of Parties system, similar to the UNFCCC, and defer developing appropriate modalities to address the measures, including those related to One Health.
It is important to note that although the One Health approach has received broad endorsement, various concerns have been raised by developing countries and experts and academicians alike. For instance, developing countries argue that the One Health approach, with its strong emphasis on standard-setting and regulatory harmonisation, undermines the principle of ‘common but differentiated responsibilities’. Furthermore, the developing countries view it merely as a massive system for collecting data that will not be able to ensure equitable benefits-sharing. Analysts, for their part, critique the One Health approach for its narrow focus on human medicine and inadequate engagement with environmental stakeholders, and for overlooking environmental health factors like climate change and implementation challenges in developing countries, given the limited funding.
This oversight not only jeopardises efforts in preventing zoonotic spillover and safeguarding public health but also misses an opportunity to boost pandemic prevention measures. By integrating the right to a healthy environment, the envisaged Pandemic Agreement would be instrumental in emphasising critical environmental interventions, enhancing collective resilience against future pandemics.
4. The Cost of Inaction
Many scholars have argued that WHO must declare the climate crisis as a public health emergency. Like in many other forums, however, WHO member states are divided along familiar Global North-Global South lines on who pollutes and who suffers the consequences. Yet the debate is more complex and pervasive than merely putting labels on countries, who will need to get over their narrow interests to collectively respond to the challenges. The impact of the failure to do so is already being witnessed.
Health emergencies such as COVID-19, like the epidemics and pandemics that came before, have magnified the interface between health and climate change. Given the sheer urgency of the climate crisis, the governance of health-related impacts of environmental degradation has to be proactive. Global health agencies, such as WHO and the Global Fund, must stop working in silos to swiftly address these transboundary and complex challenges. This would mean making difficult political decisions by member states and donors alike.
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