COP26 and beyond: long-term climate strategies are key to safeguard health and equity
Authors: Arthur Wyns, Jessica Beagley
Journal: The Lancet Planetary Health (2021)

Greenhouse gas emission reductions are a lifeline for humanity. In the lead up to the COP26 UN Climate Conference, governments worldwide were expected to submit strengthened emission reduction targets for the year 2030 (in the form of nationally determined contributions; NDCs), as well as mid-century, long-term low greenhouse gas emission development strategies (long-term strategies; LTSs). However, as of one week before the conference, countries responsible for just 55% and 32% of global greenhouse gas emissions had submitted NDCs and LTSs, respectively.1ClimateWatchNDC Enhancement Tracker. World Resources Institute.https://www.climatewatchdata.org/2020-ndc-trackerDate accessed: October 24, 2021Google Scholar, 2UNFCCCCommunication of long-term strategies. United Nations Framework Convention on Climate Change, 2021https://unfccc.int/process/the-paris-agreement/long-term-strategiesDate accessed: October 24, 2021Google Scholar At present, emissions reductions in NDCs fall far short of the level needed to avoid harmful levels of global heating and protect health, and are instead projected to lead to around 2·7°C of warming by the end of the century.3UNFCCCNationally determined contributions under the Paris Agreement. Revised note by the secretariat. United Nations Framework Convention on Climate Change, 2021https://unfccc.int/documents/307628Date accessed: October 25, 2021Google Scholar While it is paramount that governments commit to, and implement, emission reduction targets with a 2030 horizon, the importance of LTSs cannot be overlooked. By developing an LTS, governments set out a mid-century vision to cut greenhouse gas emissions and improve climate resilience, while simultaneously achieving national development objectives.4UNFCCCParis Agreement. United Nations Framework Convention on Climate Change, 2015https://unfccc.int/sites/default/files/english_paris_agreement.pdfDate accessed: October 19, 2021Google Scholar LTSs provide an overarching government vision that should inform both near-term climate targets, such as the NDCs, and long-term climate goals, such as the achievement of net-zero emissions and climate resilience. LTSs can thereby ensure consistency across national climate policies and avoid the lock-in of carbon-intensive pathways. In other words—when well designed—an LTS can provide a roadmap for action to achieve the long-term goals of the Paris Agreement and safeguard the health of current and future generations. Here, we examined the LTSs submitted to the UNFCCC by 31 parties (30 countries and the European Union) as at July 30, 2021, for their consideration of human health and equity. These LTSs represent 44 (23%) of the 191 parties to the Paris Agreement and account for 31·8% of current global greenhouse gas emissions.5Climate WatchGHG emissions.https://www.climatewatchdata.org/ghg-emissionsDate: 2020Date accessed: October 24, 2021Google Scholar Based on the quantifiable information provided, the total greenhouse gas emission level of those parties that have submitted long term strategies prior to COP26 is estimated to be 14·3 Gt CO2 eq (95% CI 13·6–14·9) in 2030, which represents a 26% (95% CI 22–29) emissions reduction compared with 2010 for the same parties.3UNFCCCNationally determined contributions under the Paris Agreement. Revised note by the secretariat. United Nations Framework Convention on Climate Change, 2021https://unfccc.int/documents/307628Date accessed: October 25, 2021Google Scholar We find that the majority of LTSs include health (29 [94%] of 31) and equity (24 [77%] of 31) considerations. We identify five themes with which LTSs relate their long-term climate policy goals to health and equity: consideration of health as a long-term outcome; inclusion of health co-benefits in decision making, goal setting, and monitoring; achievement of health resilience and adaptation; financial reforms beneficial to climate and health goals; and consideration of equity in long-term climate policy goals (table).TableRecurring themes on health and equity in long-term climate strategiesDefinitionCoverage in LTS (n=31)ExampleHealth as a long-term outcomeConsideration of health as a guiding principle for climate policymaking.18 (58%)Indonesia: "In line with Indonesia's constitution (UUD 1945, Article 28 H) which emphasizes the state obligation to guarantee decent life and healthy environment for all citizens, Indonesia's commitment to the Paris Agreement has been translated into : …(iii) long-term strategy on low carbon and climate resilience (LTS-LCCR)."Inclusion of health co-benefits in decision making, goal setting, and monitoringRecognition of health co-benefits arising from climate change mitigation or adaptation.28 (90%)Mexico: "Some mitigation actions, generally associated to fossil fuels reduction, generate economic savings because of their positive health impacts. The actions focused on SLCPs reduction are a clear example of measures that contribute to improving air quality, and thus improve health."Health resilience and adaptationInclusion of health adaptation measures.14 (45%)Spain: "Likewise, these efforts should be coordinated to provide integrated responses to challenges such as water use and management, adverse environmental events, land degradation and desertification, the impact on ecosystems or infrastructure on the coast, as well as health protection of people."Financial reforms beneficial to climate and health goalsInvestments, subsidies, or other financing policies pertaining to health16 (52%)South Africa: "As a member of the G20, where countries have committed to phasing out inefficient fossil fuel subsidies, South Africa has indicated willingness to identify and minimise their harmful impacts, taking cognisance of its developmental state. The subsidies undermine the competitiveness of renewable energy, divert financial resources from development of priority sectors and services such as education, health, and infrastructure; and encourage the extraction and overconsumption of fossil fuels (as they are under-priced)."Equity in long-term climate policy goalsReferences to equity, including those relating to justice, vulnerability, disparities, and welfare24 (77%)USA: "Existing health disparities and other inequities increase vulnerability to climate health impacts like heat waves, degraded air quality, and extreme weather. Low-income families are the most vulnerable to disruptive events that cause the household breadwinners to miss work."LTS text excerpts are for illustrative purposes only and do not provide a comprehensive representation of the scope or level of ambition of respective LTS; translations of text excerpts were conducted by the authors. LTS=long-term strategy. Open table in a new tab LTS text excerpts are for illustrative purposes only and do not provide a comprehensive representation of the scope or level of ambition of respective LTS; translations of text excerpts were conducted by the authors. LTS=long-term strategy. 18 (58%) of the 31 LTSs include safeguarding of the health, wellbeing, and prosperity of populations as a key outcome of achieving a net-zero and resilient society by the middle of the century. Examples of this include safeguarding the human right to health as laid out in the preamble of the Paris Agreement (eg, Marshall Islands); as well as the adoption of health goals in governments' economic development models (eg, Canada), national environment policies (eg, UK), national climate laws (eg, Spain), and constitutions (eg, Indonesia). The widespread inclusion of health as a long-term outcome in LTSs indicates that safeguarding health is a useful guiding principle for the development of long-term climate strategies, and can steer governments in articulating both the long-term vision and near-term action needed to limit global temperature increases and protect health. Nearly all LTSs (28 [90%]) promote the health co-benefits which would arise from implementing their long-term mitigation and adaptation targets, and this across various sectors and through a variety of health co-benefits, including the general improvement of population health (eg, Costa Rica); a reduction in air pollution and associated health impacts (eg, UK); reduced exposure to other health risks, such as heatwaves (eg, Spain); reduced deaths and injuries from extreme weather events (eg, Denmark); improved nutrition and reduced hunger (eg, Indonesia); reduced health-care costs (eg, Benin); reduced health inequities (eg, Canada); and others. However, only 14 (45%) LTSs quantified or monitored the health co-benefits of at least one LTS target, highlighting a significant policy gap between the recognition of health co-benefits in long-term climate policy goals, and their inclusion in quantifiable climate change targets and policies. 14 (45%) LTSs include targets and interventions to strengthen health resilience, while 16 (52%) highlight the potential benefits to climate and health goals from financial reforms such as subsidies, tax, or pricing schemes. 24 (77%) are at least partly informed by equity considerations in setting long term climate and health goals, although only nine (29%) contain quantifiable equity targets or interventions. Our review shows that most long-term climate strategies are at least partly guided by health and equity considerations. The five themes identified here provide a useful lens to evaluate the ways in which health and equity are featured, and offer a set of benchmarks against which LTSs can be regularly assessed. To protect global public health from irrevocable damage to the natural systems upon which life depends, health and equity should be integrated into both near-term and long-term climate policy. There is significantly less guidance in the Paris Agreement on the scope of LTSs, compared with NDCs. The LTSs submitted to date by countries from across regions and income groups exemplify the range of ways in which health is considered as part of climate policymaking. This should now be scaled up, with consistent and concrete integration of health considerations as standard practice. In the wake of COP26, governments should deliver more ambitious and comprehensive LTSs based on the latest UNFCCC guidance. Adequate technical and financial resources should also be considered for developing and implementing LTSs, and examples of good practice should be recognised to serve as inspiration for others. The first Global Stocktake, which runs from COP26 until COP28 in 2023, will deliver a verdict on the extent to which countries' short-term and long-term policies are compatible with achieving the goals of the Paris Agreement, and thereby their adequacy in safeguarding a healthy future. Our review highlights how current LTSs contain a variety of entry points for safeguarding health and equity by the middle of the century, but generally still lack the necessary targets, ambition, and means of implementation to turn these goals into reality. We declare no competing interests.