ATACH or Detach? Health systems in the COP28 agenda

By guest contributors Renzo Guinto, Rudolf Abugnaba-Abanga, Susannah Mayhew, Karen Ceballos

Our organization, Health Systems Global (HSG) – the international professional society for health policy and systems research (HPSR) – actively participated in the 28^th Conference of Parties (COP28) of the United Nations Framework Convention on Climate Change (UNFCCC) held on November 30 – December 12, 2023 in Dubai, United Arab Emirates (UAE). Some of us from HSG’s Thematic Working Group (TWG) on Climate-Resilient and Sustainable Health Systems were physically present in Dubai to help advocate for the inclusion of health systems into the COP28 agenda.

This year’s COP is particularly momentous for the global health community. After 27 years, COP28 held the first Health Day in the history of COP, culminating with the launch of the COP28 UAE Declaration on Climate and Health which was endorsed by 140+ countries. More than fifty ministers of health were physically present to deliver statements expressing commitment to address climate change and strengthen their health systems to protect their citizens’ health. Throughout the conference, there were dozens of health sector-led side events, some of which were held at the Health Pavilion, which was administered by the World Health Organization (WHO).

In addition, as of December 10, 84 nations have joined the Alliance for Transformative Action on Climate Change and Health (ATACH). Building on the health commitments made during COP26 in Glasgow, Scotland two years ago, ATACH is a new global initiative led by WHO, with technical and financial support from other major global health organizations, which will assist countries in building climate-resilient and low-carbon national health systems in the coming years. We were delighted that the number of countries ‘attaching’ to ATACH has been increasing. With this rising momentum, we, the HPSR community, must harness our tools, skills and capacities to support these ATACH countries and accelerate their climate adaptation and mitigation efforts. This requires us HPSR professionals, many of us with social science and public health backgrounds, to break barriers and begin to work closely with environmental epidemiologists, environmental health specialists, and other professionals who work on the climate-health nexus.

Moreover, a $1 billion climate and health fund was also announced – contributors to this fund include the Green Climate Fund, the Asian Development Bank, The Global Fund, and the Rockefeller Foundation. More money could be expected in the coming years, especially since a consortium of 41 multilateral development banks, governments, and philanthropies also launched the Guiding Principles for Financing Climate and Health Solutions. We anticipate that some of these funds may go to international advocacy as well as climate and health research. However, we feel that the biggest chunk must go to strengthening and capacitating national and local health systems, especially those in highly vulnerable low- and middle-income countries that contributed little to climate change yet bear a disproportionate share of its impacts. Funders expressed that this fund will heavily support ATACH countries, which helped convince some countries to join at the last minute. Moreover, in the spirit of fairness, decoloniality, and accountability, the new climate and health fund must intentionally ensure the meaningful participation of the vulnerable in its management, decision-making, and monitoring.

Nonetheless, despite the health achievements – such as ATACH – made during the first week of COP28, we also observed how health slowly got ‘detached’ from the COP28 agenda during the second week. There were still some health side events held in Dubai, but the majority of health attendees had already left. Moreover, COP28’s ultimate outcome is not as ‘pro-health’ as its first week, especially the health day, made it appear. Furthermore, health systems issues remain neglected compared to discussions of direct health impacts. One begins to think that the health festivities of the first week – the events, speeches, and launches – may just be part of ‘health-washing,’ in preparation for a controversial, watered-down, and largely predetermined negotiation outcome. Indeed, the final UAE Consensus lacks strong language around fossil fuel phaseout, calling instead for a vague “transitioning away”. This incident should serve as a lesson for us in global health – we must ensure that health is not just an ‘opening salvo,’ a footnote or an ornament. To ensure that health systems are adequately ‘attached’ to COPs, we, as HPSR community, must proactively engage not only during the COP, but in the pre-COP deliberations, such as those happening at the country level and those convened by the UNFCCC’s various governing and subsidiary bodies. HPSR scholar-practitioners can help analyze and navigate these negotiation and decision-making spaces which define the ultimate outcomes of COPs that occur many months after.

Finally, there were other COP28 victories worth celebrating, such as the formal creation of the Loss and Damage (L&D) Fund that will provide financial assistance to vulnerable nations suffering from irreversible climate change impacts. The HPSR community must engage more closely with the L&D discussions, as there is a need to incorporate the population health and health system losses and damages brought about by climate change to ensure that there is additional funding for health systems strengthening. Doing so presents many political, technical, and operational challenges, for instance when it comes to measurement – which health system L&D must be counted, and how such can be quantified and monetized? Hence, more scholarship and innovation are needed in this area, and the HPSR community can surely be of help.

What do we do next in order to make sure that health remains ‘attached’ to the climate agenda in 2024? As a Thematic Working Group, we commit to working with HPSR professionals to:

• Hold health ministers and international and national health organizations accountable for the promises made during COP28, so that many of the plans presented become realized and funds committed become available and disbursed to those in greatest need;
• Continue advancing the climate change and health systems agenda through education, research, capacity building, and policy influence;
• Showcase scholarship and practice in HSG’s upcoming 8th Global Symposium on Health Systems Research on November 18-22, 2024 in Nagasaki, Japan, with the theme “Building Just and Sustainable Health Systems Centring People and Protecting the Planet” (submit your individual abstracts and organized session proposals now);
• Plan our advocacy efforts for COP29, which will be held in Baku, Azerbaijan on November 11-22, 2024. The second half of COP29 overlaps with HSR 2024 in Nagasaki; hence, our TWG will try to be present in both COP29 and HSR 2024, and;
• Participate in pre-COP29 deliberations happening at the country level (with ministries of health, as well as climate negotiators) as well as those organized by the UNFCCC’s governing and subsidiary bodies.

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About the authors:

Renzo R. Guinto, Chair of Health Systems Global’s Thematic Working Group on Climate Resilient and Sustainable Health Systems, is the Director of the Planetary and Global Health Program of the St. Luke’s Medical Center College of Medicine in the Philippines.

Rudolf Abugnaba-Abanga, TWG Vice Chair for Africa, is a PhD candidate at the University for Development Studies, Ghana.

Susannah Mayhew, TWG Vice Chair for Europe, is Professor in Health Policy, Systems, and Reproductive Health at the London School of Hygiene and Tropical Medicine, United Kingdom.

Karen Ceballos, TWG Coordinator, is Research Fellow for Climate Change and Health Systems at the Planetary and Global Health Program of the St. Luke’s Medical Center College of Medicine, Philippines.

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