Giving the climate policy ratchet a healthy turn
Authors: None The Lancet Planetary Health
Journal: The Lancet Planetary Health (2021)

We began 2020 talking about the potential for “a super year for the environment”. With major international meetings scheduled on climate change and biodiversity, it was set to be a pivotal time for both agendas. Little did we know that an emerging infectious disease would quickly spread to global pandemic proportions, pushing other considerations down the political agenda. Suffice to say both meetings were postponed until 2021, and so we are once again talking about the coming year as a pivotal moment for the environment. But this time with the ongoing pandemic and the politics of a post COVID-19 recovery hanging over proceedings. In this issue we focus on the upcoming climate negotiations and links with health. The Paris Agreement set a goal to keep global average temperatures well below 2°C above preindustrial temperatures. Countries then submitted nationally determined contributions (NDC's) which embody national efforts to reduce greenhouse gas (GHG) emissions and adapt to the impacts of climate change. The first set of NDC's were insufficient. However, nations are asked to revise their NDC commitments at regular intervals and should, in principal, submit increasingly ambitious commitments over the coming years, something known as the “ratchet mechanism”. The upcoming Glasgow climate summit (COP 26, November, 2021) is expected to be a key moment in this cycle because it is the first-time countries are being asked to increase their level of ambition. Given the small time window we have left to keep climate warming well below 2°C, a failure to significantly ratchet up collective GHG mitigation commitments will make keeping climate change within relatively safe limits increasingly unlikely. If there is a need for a deadline to motivate action, we have it and it's November, 2021. A modelling study in this issue by Ian Hamilton and colleagues explores the potential GHG and population health effects that would be likely to result in 2040 from the NDCs in place at the end of 2020 (current pathway scenario) and for two more ambitious scenarios. The study focuses on energy, food system, and transport sectors for nine representative countries and also explores the potential benefits of more ambitious interventions consistent with the Paris Agreement and the SDG's (the sustainable pathways scenario). They go on to investigate the potential for additional health benefits if countries were to more explicitly address health in their revised NDCs (health in all climate policies scenario). They find that the sustainable pathway scenario would avoid many millions of deaths per year through mitigation of direct greenhouse gas emissions and associated actions that reduce air pollution, improve diets, and increase physical activity compared with our current pathway. Even greater benefits are possible if health is considered explicitly in all policies. As Margaret Chan puts it in her linked Comment “achieving net zero emissions is the most important global health intervention now and for decades to come”. In a related Article in this issue Niheer Dasandi and colleagues use content analysis and natural language processing methods to examine the diverse ways in which public health is incorporated in NDCs. They find that high income countries tend not to mention health in their NDCs, while relatively greater engagement with health was found in LMICs and small island developing states. There was also an association between NDC health coverage and population exposure to temperature change and air pollution. This follows broader patterns of global inequalities. These findings are supported by a linked Comment by Collin Tukuitong and Paula Vivili on climate impacts on health in small island developing states. A final Article in this issue by Imogen Tennison and colleagues explores health care's response to climate change focussing on NHS England. They model emissions (1990 to 2019) including direct and indirect emissions through NHS assets and the wider supply chain, as well as patient and visitor travel. In 2019, the NHS's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient admission episode. In a related Comment Andrea MacNeill and colleagues outline principals for sustainable health systems. There are already some promising NDC revisions submitted ahead of Glasgow. We hope the research and comment herein will contribute to the evidence supporting more ambitious NDCs in the coming months and help pave the way for health care that operates within planetary boundaries. Accelerating towards net zero emissions: the most important global health interventionDuring my time as Director-General of the WHO, we achieved a 62% reduction in the number of malaria deaths from 2000 to 2015, a 53% decrease in childhood mortality from 1990 to 2015, and extensive improvements in infection rates, mortality, and treatments in neglected tropical diseases. However, the greatest global health intervention is yet to be fully implemented. Climate change is already affecting the wellbeing of populations in every world region1 and, in the coming decades, could result in an annual global death toll in the hundreds of thousands2 and affect the health of hundreds of millions of people. Full-Text PDF Open AccessPlanetary health care: a framework for sustainable health systemsIn 2018, the Intergovernmental Panel on Climate Change announced that to restrict global temperature rise to 1·5°C, greenhouse gas emissions must decrease 45% by 2030 compared with 2010, and reach net zero by 2050.1 In 2020, the UK National Health Service (NHS) committed to achieving net zero greenhouse gas emissions by 2040.2 This precedent-setting decision by one of the world's largest health systems firmly positions the health sector at the vanguard of environmental sustainability and affirms the indivisibility of planetary health and health-care delivery. Full-Text PDF Open AccessClimate effects on health in Small Islands Developing StatesSmall Islands Developing States (SIDS) from the Pacific region have been acknowledged for their role in highlighting the negative effects of the climate crisis on the lives and livelihoods of Pacific islanders on a global scale. Contrary to expectations, SIDS leaders were able to elevate the needs of small vulnerable states in the lead up to the signing of the Paris Agreement.1 The Paris Agreement is the most important global agreement on reducing the emissions of harmful greenhouse gases by the family of nations. Full-Text PDF Open AccessThe public health implications of the Paris Agreement: a modelling studyA greater consideration of health in the NDCs and climate change mitigation policies has the potential to yield considerable health benefits as well as achieve the “well below 2°C” commitment across a range of regional and economic contexts. Full-Text PDF Open AccessHealth care's response to climate change: a carbon footprint assessment of the NHS in EnglandThis work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions. Full-Text PDF Open AccessEngagement with health in national climate change commitments under the Paris Agreement: a global mixed-methods analysis of the nationally determined contributionsA focus on health in the NDCs follows broader patterns of global inequalities. Poorer and climate-vulnerable countries that contribute least to climate change are more likely to engage with health in their NDCs, while richer countries focus on non-health sectors in their NDCs, such as energy and the economy. Full-Text PDF Open Access