A panel discussion on social inequities and climate justice with the London School of Hygiene and Tropical Medicine’s Planetary Health Network.

As COP26 gets underway, all eyes are on Glasgow where world leaders have gathered for two weeks to discuss and work towards climate goals set by the Paris Agreement. Experts and activists will also be in Glasgow alongside the “green zone”, hosting a series of side events and workshops to educate the public and build awareness. With the world still reeling from and adapting to COVID-19—which postponed COP26 by a year—health and its interaction with the climate catastrophe are sure to be front-of-mind.

Keppel Health Review (KHR) hosted a panel discussion on social inequities and climate justice ahead of COP26 in collaboration with the London School of Hygiene and Tropical Medicine’s Planetary Health Network (PHN). Our panel consisted of Ans Irfan, a multidisciplinary global public health expert; Jess Beagley, a policy expert in health, environment, and climate change; and Rashmi Venkatraman, a global health professional focussing on human rights and systems level approach to migration, climate change, and communication challenges.

Drawing on their expertise and first-hand experience attending previous COPs, the panelists and audience discussed the inextricable link between global health equity and climate justice as well as the harmful environmental impacts of healthcare systems. Lastly, they shared perspectives on the actions that global health professionals and advocates can take to address social inequities and to mitigate environmental damage. 

The Discussion

Rashmi opened with a brief overview of what COP is like on the ground, describing it as “one of the most empowering and insane places you can be”. She outlined the structure of the event, in which countries are divided into different annexes dependent on their income-level. Ans expanded, discussing the unjust structures of COP in reproducing elitist and classist systems, which is commonly the case with institutions and events based in the Global North. As a result, the interests of corporations are often prioritised over those of the public in discussion and decision making.

For the first time, health has been chosen as a priority for COP in an endeavour to bring health to the fore in climate action decisions. As Jess pointed out, the conference has been aptly coined “the health COP” by the global health community. Importantly, the conference in Glasgow is the first COP since countries have resubmitted their Nationally Determined Contributions commitments and updates to adaptation plans, which are each country’s pledges to meet climate action targets. As nations reinstate their commitment to fighting the climate crisis during COP26, the health sector will be a major talking point. From a mitigation perspective, the healthcare system is contributing to the climate crisis and reducing its footprint is urgent. On the other hand, the climate catastrophe is already affecting the health of individuals and communities around the world, and thus the healthcare system must address its own environmental burden, while adapting to increasing levels of climate-related health outcomes. The health community has taken many actions ahead of COP26, several of which were mentioned during the panel discussion: an initiative on healthcare decarbonisation; a joint editorial coordinated by the UK Health Alliance on Climate Change; a COP26-focused World Health Organisation report; and the #HealthyClimate Prescription campaign.

The discussion then turned towards a paradox: the Hippocratic Oath taken by healthcare professionals states that a practitioner should “do no harm”, yet this pledge is arguably being undermined by the harmful environmental impact of healthcare itself. Healthcare contributes between 1–5% of global environmental impact, predominantly through the supply chain. As the climate crisis leads to increased death and disease, the environmental impact of the healthcare system counteracts its aim to improve health. Climate mitigation is therefore a priority for healthcare workers, and Rashmi argued that tackling the climate catastrophe requires that countries reshape healthcare delivery to reduce health systems’ environmental impacts.

In terms of global inequalities, some countries contribute a disproportionate amount of healthcare-related emissions commensurate with their population size. For instance, the United States’ healthcare system has the largest environmental impact, accounting for 27% of the global healthcare footprint. All countries have a role to play in tackling climate catastrophe; however, as Jess pointed out, those who are the most responsible for the crisis should be held most accountable. Although high-income countries agreed in 2009 to provide $100 billion per year to countries with limited resources, these commitments have not been actualised. Even still, there will be discussions to increase this commitment at COP26.

Considering long-term action after the two weeks of COP26, Ans stressed the importance of taking real steps to mitigate the climate crisis rather than covering the issue with a “pretty band-aid”. He focussed on the need for advocacy and pressuring those in power to take action, and noted the challenges of engaging the public and maintaining the momentum from COP26 into the future.

The attendees posed many thought-provoking questions to the panellists. Questions spanned a myriad of topics including the role of academia and the public health community in COP26 discussions; reducing health system waste and emissions; and using stories and human connection to advocate for policy change.

Priorities and Event Takeaways 

After two weeks of intense attention and discussion at COP26, world leaders will invariably turn their attention away from the climate crisis. How do we—as healthcare professionals, students, advocates, and the general public—keep pressuring those in power to prioritise the climate crisis?

Firstly, Ans warned that decision makers are likely to frame COVID-19 recovery and action on climate change as a dichotomy, whereby COVID-19 is discussed as a more immediate and individual threat and, accordingly, one that supersedes climate action in priority setting. Nonetheless, it is important to remember that they are fundamentally intertwined: if the climate catastrophe is an existential threat then we have to treat it as such, not sideline it for issues that are seen as more urgent in the short-term. 

Building on this point, all panelists stressed the importance of effective storytelling to communicate the connection between human health and environmental health. While statistics may appear more likely to influence decisions, using stories to clearly convey the impact the climate crisis has on daily life is likely to resonate more widely. As Jess remarked: “Advocacy should appeal to the head, the heart, and the pocket.” Meanwhile, Ans argued that the best advocacy we can do is learning how to “be a headache”—whether that be world leaders or those within our own networks. These are the people who make decisions on supply chains, medical testing, and may have influence in local and national priority setting. 

Lastly, Jess brought home the importance of pushing for change on a policy level, calling for health to be included in all environmental policies. Not only does incorporating health policy protect lives, it can bolster economic and public support as individual and population health are commonly prioritised above planetary health. 

Overall, the event made clear that while the climate crisis and its link to health are finally being acknowledged, there remains a long way to go in addressing inequities and achieving climate justice. Concluding on a positive note, the panel offered steps that can be taken through advocacy, policy, and system-level changes to accelerate action on the climate crisis. How will you follow COP26 and take action?