Statement by the UHC Movement Political Advisory Panel at the occasion of the Health Day at the COP28 UN Climate Conference, 3 December 2023

As the international community gathers at the first-ever health day at COP28 today, we emphasize the need to build health systems that withstand the impacts of climate change while delivering health and well-being for all. We call on decision-makers to recognize UHC as a global and national priority in the midst of climate change and other complex emergencies and include investment in equitable and resilient health systems as part of the climate change response.

Climate change is the biggest global health threat of the 21^st century. It increases non-communicable diseases, facilitates the emergence and spread of infectious diseases, brings deadly weather events and drives health emergencies. Climate shocks and growing stresses such as droughts and rising sea levels undermine the environmental and social determinants of physical and mental health, such as clean air and water, sustainable food systems and livelihoods. Climate change also impacts the health and care workforce and infrastructure, reducing the capacity to provide health services that are needed to protect people. 

While no one is safe from climate change-related health risks, people in low-income countries and vulnerable communities, including women and children, are being hit the hardest by climate change. The death rate from extreme weather events in the last decade was 15 times higher in regions highly susceptible to climate change than in others. People in low-income and disadvantaged communities not only endure the most substantial health impacts but also often lack access to the high-quality, affordable health services they need, not only in their everyday lives but especially in the face of climate change. People in low-income and disadvantaged contexts, therefore, suffer from intersecting vulnerabilities: ill health, lack of access to health services and protection from financial hardship, and the impacts of climate change. 

In a turbulent world facing climate change and other crises, governments need to prioritize the health and well-being of populations more than ever. With more complex threats and challenges confronting people everywhere, healthier communities can cope better and thrive, even amidst the impacts of climate change. Countries with resilient and equitable health systems are better prepared to prevent and respond to health threats such as climate change and health-related crises. Climate change provides a strong impetus for countries to make progress towards UHC.

Governments now need to strengthen health systems to face increasing climate change pressure. While doing so, they have a crucial opportunity to address the environmental sustainability of health systems mitigate the impacts of climate change. To build health systems able to protect people's health and well-being, governments at all levels should focus on three key aspects:

• 1) Resilience: Governments should build resilient health systems capable of anticipating, responding to, coping with, recovering from, and adapting to climate-related shocks and stress, to bring about sustained improvements in population health, despite an unstable climate. Governments should start by putting health system resilience on their agendas while simultaneously “working to improve population health, ensuring an adequate health and care workforce, being responsive and efficient with an iterative management approach and providing social and financial protection.” They can further strengthen resilience by establishing institutional arrangements for enhanced collaboration  across health, social protection, and disaster management. 
• 2) Equity: Governments should ensure that health systems are designed in an equitable way to account for the intersecting vulnerabilities experienced by low-income and disadvantaged groups and communities that are hit the hardest by climate change. This also means introducing gender-sensitive policies and planning to minimise climate-induced disruptions to women’s health and care and to take into account their role as agents of climate action both in adaptation and mitigation. Decisionmakers must address current gaps and ensure access and affordability of health services for everyone, everywhere, prioritising the needs of the most vulnerable through financial protection to reduce impoverishing health costs due to out of people’s pocket payments. Countries must reorient their health systems towards primary health care as the most effective way to achieve UHC in the face of climate change in an equitable way. 
• 3) Greening the health sector: To address climate change, the health sector must also do its part. Healthcare contributes around 4.5% of carbon emissions, reaching almost 10% in certain countries and breaching our responsibility to “do no harm”. Cross-country comparisons demonstrate that these levels of carbon output are not required to deliver high-quality services, presenting a significant opportunity to reduce emissions while upholding the quality of care. Therefore, governments should work towards decarbonizing high-emitting health systems and the global healthcare supply chain.

As decision-makers meet at the first-ever health day at COP28, we call on them to strengthen health systems to achieve UHC and climate resilience. Climate change is the biggest global health threat of our time, and if we want to protect the health of everyone, everywhere, from its impacts, we can only do so by achieving UHC.

This message is issued by UHC2030 Co-Chairs, in consultation with the members of the UHC Movement Political Panel of UHC2030. We thank Helena Schmitt and Laetitia Bosio for their support in drafting and editing this statement.

Co-Chair of Steering Committee, UHC2030:

• Ms. Gabriela Cuevas Barron
• Dr. Justin Koonin

UHC Movement Political Advisory Panel, UHC2030:

• Ms. María Fernanda Espinosa Garcés, President of the 73^rd Session of the UN General Assembly
• Dr. Vytenis Povilas Andriukaitis, Former European Commissioner for Health and Food Safety
• Prof. Ilona Kickbusch, Chair, International Advisory Board, Global Health Centre, Graduate Institute for International and Development Studies Geneva
• Dr Sania Nishtar, Member of the Senate, Pakistan
• Ms. Emilia Saiz, Secretary General of United Cities and Local Governments
• Prof. Keizo Takemi, Minister of Health, Labour and Welfare, Japan

Photo: @ WHO / Martha Tadesse