The main international climate conference, which brings together world leaders, campaigners, business and media annually, got off to a promising start this week. COP28 has finally set up the hard-fought-for loss and damage fund – to help the world’s poorest and most vulnerable countries pay for the irreversible impacts of the climate crisis. 

But behind the attention-grabbing parade of commitments and promises, there is a subtle yet significant shift in part of the focus of this year’s climate summit, which if handled correctly could have a major impact on all of us. 

That’s because on Sunday, COP28 is hosting the first-ever COP Health Day, where a record number of health ministers will come together for a dedicated session on the links between climate and health. 

Nearly ten years ago, the Paris Agreement committed countries to take account of the human right to health in all action on climate – and while it is regrettable that it has taken this long to come to the fore, this year’s development could be a game-changer for people across the world. 

It may not always be framed this way, but the climate crisis is fundamentally a health crisis – and, from extreme weather events to food insecurity, its impact on human health is overwhelmingly negative. This Health Day is a long-time-coming opportunity to put health more firmly on the climate agenda. 

And the most important crisis that must be addressed is the avoidable difference in health outcomes between different groups and populations – otherwise known as health equity. 

Consider this. What good does it do to treat people’s illnesses and then send them back to live, play, and work within the very conditions that made them sick? The quality of the air we breathe, of our local environment, our homes, jobs and education – play a greater role in determining our health and wellbeing, than access and use of health care services. 

It is not news that some groups in society systematically experience greater obstacles to health. Just think of the COVID19 pandemic grossly disproportional impact on ethnic minoritised groups. 

Climate change adds new layers of vulnerability; it exacerbates existing health inequalities, and it is arguably generating new ones. The IPCC estimates that about 3.5 billion people – nearly half of humanity – live in areas highly vulnerable to climate change. 

Climate-sensitive diseases transmitted by mosquitos, like dengue, chikungunya and yellow fever, affect low and middle-income countries disproportionately. There is great uncertainty still in health and scientific communities as to how these viruses will respond to the changing climate, but the trends are not positive. Dengue cases have already risen eight-fold globally since 2000, with a record 4.2 million cases recorded in 2022, and an increasing expansion of their geographical distribution. 

A focus on health equity can help achieve a fair transition to a more sustainable world. 

Yet only 2% of multilateral adaptation funding and 0.5% of overall climate funding is currently going towards health protection and improvement. Achieving health equity requires that all members of society are valued equally. We need to see urgent action on addressing the structural barriers to health, including racism, poverty and discrimination, in the design, goals and implementation of policies. 

That’s why the approval of funding arrangements for loss and damage has been a step forward in rectifying historical injustices and providing resources based on need. But much work still needs to be done. New analysis by Carbon Brief places the UK fourth in the list of nations with the biggest historical emissions, behind the US, China and Russia. Whilst the United Arab Emirates and Germany immediately announced a contribution of $100 million each to the loss and damage fund, the UK and the US came much short of that, with pledges of £60 million and $17.5 million dollars, respectively.

Health inequalities are also a reality in the UK. According to the Office for Health Improvement & Disparities, people in the most deprived neighbourhoods in England, certain ethnic minority and socially excluded groups (for example, vulnerable migrants or those experiencing homelessness) develop multiple long-term health conditions 10 to 15 years earlier than the least deprived communities, spending more years in ill health and dying sooner. 

That is why, at NEF we are working on a project that applies a health equity lens to climate policy and action in England. By strategically and intentionally examining their impact on underserved and historically marginalised people and communities, in early 2024 we will develop recommendations to inform better climate policy making and implementation. 

If done right, action on climate here in the UK can – and must – help us deliver more equitable health outcomes – from urgent investment to retrofit homes in the most deprived areas; to removing dirty fuel vehicles from our towns and cities. 

Global leaders at COP28 have the power and control to remove systemic barriers and prioritise health equity. The decisions they make over the next two weeks will help shape the distribution of money, power, resources and health outcomes at global, national and local levels – let’s hope they get a grip of this crisis and make the decisions which will help improve lives across the world.