PHM-Exch> [PHM NEWS] Global warming: WHO considering how to leverage health systems influence to drive mitigation and adaptation

Sat Jan 20 05:47:24 PST 2024

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From: David <dlegge at phmovement.org>
Date: Sat, Jan 20, 2024 at 12:03 PM

Good report but missing key issues

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<https://mailchi.mp/phmovement/eb154-22-climate?e=ade41a541f>
Global warming: WHO considering how to leverage health systems influence to
drive mitigation and adaptation

A new report on climate change (EB154/25
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ed7c89f30a&e=ade41a541f>),
to be considered at WHO’s forthcoming Executive Board meeting, explores how
health systems influence could be mobilised to accelerate action on global
warming, and how WHO itself could facilitate such mobilisation.
Appreciation PHM applauds this excellent initiative. In view of the
continuing resistance to curbing fossil fuel use, evident at COP28, WHO
needs to contribute more to driving action on global warming.

The report (EB154/25
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0f6ea3b31e&e=ade41a541f>)
provides a good description of the problems. It brings in the equity
dimension, by highlighting the health consequences of climate change faced
by the low- and lower-middle-income countries (floods, drought,
displacement, and conflict) and small island developing States, while
recognising the least contribution made by these countries to historical
global emissions.

EB154/25
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4ccc7fb629&e=ade41a541f>
also highlights the development pathways and economic choices that are
driving the climate crisis, and that are the direct causes of large health
impacts. The paper cites polluting energy systems, which cause millions of
premature deaths from air pollution each year; environmentally destructive
and unhealthy food systems that are contributing to noncommunicable
diseases; and urban planning and transport systems that result in
car-dependency, physical inactivity and road traffic injuries. These
parallel impacts on global warming and directly on health are important
because they underpin the logic of the ‘co-benefit’ argument.

The paper identifies several elements of a health system response to global
warming:

   1. being prepared (to respond to extreme heat, floods, and infectious
   disease);
   2. being climate resilient (including water and sanitation, sustainable
   food systems);
   3. reducing carbon emissions from the health sector; and
   4. working towards the achievement of health “co-benefits” (e.g. lives
   saved through improved air quality) through health promoting climate change
   mitigation in other sectors, notably, energy, food, transport and urban
   systems;
   5. encouraging ‘health actors’ to work across sectors to jointly
   safeguard key environmental determinants.

The paper then proposes a number of actions by the Secretariat which might
contribute to boosting the health system response. These include scaling up
its own existing work in:

   1. providing leadership and awareness raising,
   2. generating evidence, collecting data, monitoring trends and producing
   technical resources, and
   3. capacity building and country support.

Common but differentiated responsibilities and respective capacities The
commitment to boosting the health system response is appreciated. The
actions proposed are comprehensive and strategic.

However, while the rhetoric of climate change as “a fundamental threat to
human health” is welcome, the need for common but differentiated
responsibilities and respective capacities is absent from the
articulation.

The report does note the differential impact of global warming with LMICs
more affected, but it does not recognise that most of the mitigation effort
has to come from the past and present polluters, and while the LMICs
require considerable support for adaptation, the contribution that they can
make towards mitigation is less. The HICs must be committed to providing
financial support as part of common funds.

The reference to low-income countries identifying and rolling out renewable
energy access for healthcare facilities is misleading; the struggle in
these countries is to establish the minimum required healthcare facilities
with the minimum levels of assured energy access - of any sort.

The argument for co-benefits from climate friendly technologies is
important but needs to go along with free and facilitated technology
transfers (the respective capacities argument). The entire report sidelines
the climate justice perspectives of the developing countries and goes too
much with “the world is one” romance.  Privatisation and marketisation of
health systems will not strengthen climate resilience The Secretariat
mentions climate resilience as a central component of health development in
the context of universal health coverage and primary health care. However,
it fails to recognise the consequences of a marketised insurance-based
approach to UHC with the encouragement of private hospital care and private
practice. This scenario drives super-specialisation and overconsumption of
healthcare and poses further threats to climate resilience.

Robust primary health care has shown its capacity to address preventable
causes of mortality and morbidity. It also has the potential to address the
diverse threats associated with global warming including the increasing
burden of communicable diseases. The report fails to recognise the urgent
need to strengthen primary health care with a view to ensuring universal
access to health care and strengthening resilience to cope with health
emergencies/shocks (due to increased frequency of extreme weather events,
pandemics, etc) and action on the social determinants of health including
global warming. People power and the primary health care approach PHM also
urges the Secretariat to strengthen this paper, in relation to people power
and the primary health care approach, before submitting it to the Health
Assembly. The paper recognises clearly the importance of people power in
overcoming fossil fuel resistance and in pushing for adequate and equitable
funding for adaptation. It also recognises the potential power of the
‘global health community’ in curbing global warming.

However, it does not make the connection. The primary health care approach,
elaborated at Alma-Ata, envisages a ‘community health partnership’ for
health; healthcare personnel (at all levels) actively working with their
communities to define the risks and to mobilise against underlying causes.

A significant proportion of the population works in health care.
Overwhelmingly these are people who care about their community’s well-being
and health including the threat of global warming. There are already a
myriad of organisations and networks arising within the health system
advocating and mobilising around global warming.

The physical dynamics underlying global warming are global but the specific
risks are diverse and can be very localised. Within a state, different
regions or districts can have different exposures; consequences also vary
and vulnerabilities differ.
The PHC model makes provision for local healthcare agencies to identify and
advocate for localised adaptation and mitigation measures, in partnership
with their communities, as well as advocating around universal policies and
strategies.

Recognising local needs does not mean ignoring the forces and processes
operating globally. PHM urges WHO to encourage health care organisations
(policymakers, practitioners and CSOs) to participate in the UNFCCC
Subsidiary Body for Scientific and Technological Advice and the Subsidiary
Body for Implementation meetings to ensure that the health perspectives are
heard. Such participation can give global context to localised struggles.

*PHM urges the Secretariat to explore further actions which might gain
leverage from this ‘community health partnership’ in different districts,
at different levels. *

*PHM welcomes the item and welcomes the report in EB154/25. WHO can and
must contribute more to the drive for effective action on global warming.  *

The full PHM commentary on this item
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=5a1247efdb&e=ade41a541f>
provides
more detail and references.  See also Tracker links to previous discussions
of Climate change
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0b0aa4b96f&e=ade41a541f>
.

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See the WHO Tracker page for this EB154 session (here
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See PHM’s integrated commentary
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=644de855d9&e=ade41a541f>
on the full agenda of EB154 (or read the flipbook version
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a31e044944&e=ade41a541f>).
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