The 2023 United Nations Climate Change Conference (COP28) is underway in Dubai and there is much at stake. At Mathematica, we have been providing data-driven insights to decision makers in the health sector for over five decades and have deep experience in monitoring, evaluation, and learning. For these reasons, we are keenly interested in the outcomes from two COP28 agenda items: the first-ever Health Day at a COP and the operationalization of the global goal for climate adaptation.
Putting health at the heart of climate change
Until quite recently, the links between climate change and human health remained on the periphery of wider climate discourse. But a steady stream of data has developed into a torrent of evidence on these connections, forcing the issue into greater prominence and setting the scene for a day focused on climate and health at this year’s COP. This event will draw ministers of health and public health experts together from around the world, representing an historic opportunity to bring health into mainstream climate dialogue. At the same time, policymakers and experts could return home with new impetus to prioritize climate action within their national health sectors.
With so much at stake, we will be looking for progress on three key fronts:
- Affirming the clear link between greenhouse gas emissions and human health. Each year, an estimated 8.7 million people die worldwide because of fossil fuel–generated particulate air pollution. As expressed in an open letter on fossil fuels from leaders in the global health community, this year’s health focus means that COP28 should take the opportunity to clearly affirm the linkage between fossil fuel emissions and human health, and to use that affirmation to drive increased urgency in global emission reduction efforts.
- Building climate resilient and carbon neutral health systems. Health systems are on the frontlines of responding to climate shocks and stressors, which exert extraordinary pressures on their ability to deliver critical services. Indeed, 67 percent of global cities surveyed by the Lancet Countdown expect climate change to “seriously compromise their public health assets or infrastructure.” At the same time, health care is itself also a part of the climate problem, contributing a sizeable 4.4 percent of net global emissions. Frameworks exist for building resilient and carbon neutral health systems, but COP28 will need to drum up increased financing to help operationalize them. This is particularly true for countries in the “global south,” where health systems tend to be less resilient and the least responsible for the historical emissions that have emanated from the health sector.
- Measuring progress on climate and health. The current evidence on what works to minimize the effects of climate on health is inadequate. The World Health Organization examined 2,181 articles to find that only seven percent of them examined the health impacts of adaptation and mitigation efforts, and only three articles focused on the impacts of adaptation efforts on health. This evidence gap has wide-ranging implications for climate adaptation, especially given that health represents one of the ultimate barometers of success or failure in adapting to a changing climate. Any accelerated global action to address the connections between climate and health must also be accompanied by investments to measure the effectiveness of these interventions.
Monitoring the vital signs for progress on adaptation
The issue of insufficient measurement is symptomatic of a much wider problem concerning limited evidence on climate adaptation. This is why we are also hoping for progress on the global goal for adaptation (GGA).
In 2015, the well-known global goal for climate mitigation was established as part of the Paris Agreement, which aimed to keep temperature rises below 2 degrees Celsius (while aspiring to 1.5 degrees). The Paris Agreement also established the lesser-known global goal for adaptation on paper, but it was never actually operationalized. It has taken eight years of deliberations to make meaningful progress on fleshing out the GGA's framework, indicators and metrics, due in part to significant definitional challenges and complexities. During that time, hundreds of billions of dollars have been spent on adaptation efforts ($106 billion in public finance to developing countries from 2016-2021 alone) and we don't have a strong grasp on what progress has been made.
It is urgent that the GGA is fully operationalized at COP28, which we hope will lead to three critical outcomes:
- Increase the global uptake of adaptation measurement. The operationalization of the GGA should provide clearer guidance on adaptation definitions, indicators, and metrics. The transparency and accountability provided by the GGA should also foster greater commitment to adaptation reporting internationally. This will be particularly important for National Adaptation Plan (NAP)s, with more than 60 percent of countries currently not tracking their NAP's implementation.
- Maximize impact with more adaptation coordination. Adaptation efforts are largely fragmented, lacking the scale needed to lead to the systemic transformation. A coherent GGA framework would encourage greater integration of otherwise disconnected adaptation efforts across programs, policies, projects, and sectors and at different scales locally, nationally, and internationally.
- Catalyze adaptation financing. Climate adaptation remains chronically underfunded ($21 billion, 2021) relative to adaptation needs ($387 billion, 2023). The introduction of more robust metrics and reporting arrangements should make it easier to track climate adaptation finance flows and to understand the returns on the investments that are being made. This would be catalytic for incentivizing increased investment to reduce the adaptation financing gap going forward.
The post-COP prognosis
In short, COP28’s focus on health and the operationalization of the global goal for adaptation has the potential to be transformative. It could help ramp up the actions being taken to protect human health from the far-reaching and worsening impacts of climate change. It could also represent a watershed moment for evidence on climate adaptation more widely, creating a foundation to better understand progress and impact locally, nationally, and internationally. Alternately, COP28 could fall short of these outcomes—results will likely be shaped by wider deadlocks or breakthroughs on critical, related issues. But whether or not the outcomes are as transformative as we hope, Mathematica will continue to partner with the global health and adaptation measurement communities to generate the rigorous, data-driven insights needed to make evidence-based progress on both fronts.