<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">---------- Forwarded message ---------<br>From: <b class="gmail_sendername" dir="auto">David</b> <span dir="auto"><<a href="mailto:dlegge@phmovement.org">dlegge@phmovement.org</a>></span><br>Date: Sat, Jan 20, 2024 at 12:03 PM<br></div><br><div class="msg-7393347181509508984"><u></u>

    
        
        
        
        
        
        

    
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                            <h1 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:26px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">Global warming: WHO considering how to leverage health systems influence to drive mitigation and adaptation </h1>

<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">A new report on climate change (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ed7c89f30a&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB154/25</a>), 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.</p>

<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Appreciation</h2>
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. <br>
<br>
The report (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0f6ea3b31e&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB154/25</a>) 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.<br>
<br>
<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4ccc7fb629&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB154/25</a> 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. <br>
<br>
The paper identifies several elements of a health system response to global warming: 
<ol>
        <li>being prepared (to respond to extreme heat, floods, and infectious disease);</li>
        <li>being climate resilient (including water and sanitation, sustainable food systems); </li>
        <li>reducing carbon emissions from the health sector; and </li>
        <li>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; </li>
        <li>encouraging ‘health actors’ to work across sectors to jointly safeguard key environmental determinants. </li>
</ol>
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:

<ol>
        <li>providing leadership and awareness raising, </li>
        <li>generating evidence, collecting data, monitoring trends and producing technical resources, and</li>
        <li>capacity building and country support.</li>
</ol>

<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Common but differentiated responsibilities and respective capacities</h2>
The commitment to boosting the health system response is appreciated. The actions proposed are comprehensive and strategic.<br>
<br>
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.  <br>
<br>
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.  <br>
<br>
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.<br>
<br>
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. 
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Privatisation and marketisation of health systems will not strengthen climate resilience</h2>
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. <br>
<br>
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.
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">People power and the primary health care approach</h2>
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. <br>
<br>
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. <br>
<br>
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. <br>
<br>
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. <br>
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. <br>
<br>
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. <br>
<br>
<b></b><b>PHM urges the Secretariat to explore further actions which might gain leverage from this ‘community health partnership’ in different districts, at different levels. </b><br>
<br>
<b>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.  </b> 
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                            <p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">The full <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=5a1247efdb&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM commentary on this item</a> provides more detail and references.  See also Tracker links to previous discussions of <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0b0aa4b96f&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Climate change</a>. </p>

<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020"><span style="font-size:12px">The WHO Tracker and PHM item commentaries are produced as part of <b>WHO Watch</b> which is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=5a801b2f2b&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">People's Health Movement</a> in association with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=79439eb594&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Medicus Mundi International</a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ba9595899c&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Third World Network</a> and a number of other civil society networks. WHO Watch contributes to democratising global health governance, through new alliances, new information flows and by broadening the policy discourse.</span></p>

<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">See the WHO Tracker page for this EB154 session (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f274b70f30&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>). See PHM’s <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=644de855d9&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">integrated commentary</a> on the full agenda of EB154 (or read the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a31e044944&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">flipbook version</a>). To ensure that you receive Update Alerts <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c5798c19ea&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">subscribe</a> to the Updater. <br>
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<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020"><span style="font-size:12px">To provide feedback on this newsletter please write to <a href="mailto:editor@phmovement.org" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">editor@phmovement.org</a>.</span></p>

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