COP 18-Day 7: Health

inside: WHO’s five key messages on the links between climate change and health Considering the health implications of energy poverty

a daily multi-stakeholder magazine on climate change and sustainable development

out reach.

3 December 2012

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contents.

1 WHO’s five key messages on the links between climate change and health 2

Climate change and health in the Koh-e-Baba mountains: Lessons from Afghan women

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Climate change and health beyond-2015: The sustainable development agenda

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The health sector: Sustainability must start at home

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Climate change and child health: A looming threat to development progress

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Considering the health implications of energy poverty

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7 Linking climate change and health in Sustainable Development Goals: A Least Developed Country perspective

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Protecting health from climate change

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Interview: Dr Diarmid Campbell-Lendrum

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10 The Doha declaration on climate, health and wellbeing: Health must be central to climate action

11 New game buzzing at COP18 12 How the fight against climate change can help tackle poor health conditions

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13 COP18 side event calendar 14 Reflections from COP18, Week One pic: US Army Africa

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CONTRIBUTING WRITERS Content Coordinator for the Climate Change & Health edition: Lujain Al-Qodmani, IFMSA Habiba Amiri and Amy Jennings

COAM

Maria Neira

Dr Diarmid Campbell-Lendrum

WHO

Jade Neville British Council Climate Champion

IFMSA

Dr. Rajendra K. Pachuari IPCC

Arthur Cheung Kirstin Donaldson

World Vision

Fanny Joubert

EcoAct

Dr Iqbal Kabir

Ministry of Health & Family Welfare, Bangladesh

Mohini Dutta and Ben Norskov Antidote Games

Professor Jonathan Patz

Rennie Qin

WHO

Global Health Institute, University of Wisconsin-Madison IFMSA

Kandeh K. Yumkella UNIDO

COP 18 | DAY 7

WHO’s five key messages on the links between climate change and health Maria Neira World Health Organization Action on climate change is sometimes portrayed as competing with other objectives, for attention or resources.

In contrast, the WHO considers that addressing the climate challenge can reinforce another universal goal – protecting and enhancing human health.

1. The impact on human health is among the most significant measures of climate change damage – and health can be a driving force for public engagement in climate solutions.

Conservative estimates indicate the climate change already causes over 140,000 additional deaths a year, and undermines the environmental determinants of health, such as food, water, shelter, and freedom from disease.

Surveys from around the world have shown that when people are introduced to the connections between climate and health, they place avoiding health impacts at the top of their climate change concerns.

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Protection and enhancement of health is an essential pillar of sustainable development, and of the response to climate change. A more integrated and intersectoral approach can improve policy coherence and increase efficiency.

Health is not just an important social and economic sector, but is also the ‘bottom line’ of sustainable development.

Poverty alleviation, ensuring security of food, water, and energy, providing protection from disasters, and maintaining ecosystem goods and services; are as important to health as any medical intervention.

Integrated approaches can also be more efficient than ‘endof-pipe’ solutions for individual problems. For example, analysis of the overlapping concerns of health impacts of air pollution, energy security and climate change, suggest that it is approximately 50% more expensive to tackle each problem independently, compared to addressing them together.

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Well-designed policies to increase resilience to climate change, and mitigate greenhouse gas (GHG) emissions, can also greatly improve health, health equity and gender equality.

The health impacts of disasters and climate sensitive diseases are more than 300 times greater in countries which cannot provide essential health services. This is a consequence not only of poverty and weak health services, but also inequity. Within countries, the burdens of climate sensitive diseases are many times higher in the poorest sectors of society, and the scale and nature of health risks can vary dramatically between women and men. Achieving universal coverage of preventive and curative health

measures, guaranteeing environmental determinants of health, and ensuring that health programmes are climate resilient, would simultaneously promote health, climate change adaptation, and equity.

At the same time, well-designed actions to mitigate climate change could bring major health gains. For example, indoor air pollution is currently responsible for over 2 million deaths, and outdoor air pollution over 1.3 million deaths every year – placing it among the top risks to global health, alongside such killers as smoking, undernutrition and obesity. Improving access to cleaner energy sources and technologies would reduce climate change, and save millions of lives over the coming decade, particularly of women and children in low and middle income countries.

4. Progress in protecting and enhancing health should be tracked and monitored, both within the health sector, and other health-determining sectors, such as water and energy.

The MDGs provided a critical benchmark in meeting the basic needs of the world’s poorest populations, with human health occupying a central role. As this approach is broadened through the design of SDGs, consultations with civil society indicate a strong interest in maintaining human health as a core measure of development progress. Measures such as air quality, and access to improved, climate resilient water and sanitation facilities, can help to make the link between health, environment, and people’s everyday lives – a real motivation for sustainable development.

5. Health impacts and co-benefits should be valued in selecting and financing climate change adaptation and mitigation policies.

Health is at the heart of the UNFCCC. Article 1 specifies avoiding impacts on human health and wellbeing as one of the three main motivations for climate action. In Article 4, the Convention calls on countries to assess the health implications of adaptation and mitigation decisions – which are often both positive and large. Taking these benefits into account also makes sense economically: the IPCC concluded that the health cobenefits of reductions in air pollution associated with reductions in GHG emissions may offset a substantial fraction of mitigation costs.

What next?

There is some encouraging progress on integrating climate change and health. UNFCCC technical programmes, and national submissions, now commonly cover health.

However, more still needs to be done – health is almost absent from the climate adaptation funding streams, and there is little effort to value the health co-benefits of mitigation efforts, thereby increasing ambition to achieve development as well as climate goals. As for so much of the climate agenda, the challenge is in converting the clear scientific evidence into the political will and means to bring positive change

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COP 18 | DAY 7

Climate change and health in the Koh-e-Baba mountains: Lessons from Afghan women Habiba Amiri and Amy Jennings Conservation of Afghanistan Mountains The effects of Climate change and the implications for the health of local communities in Koh-e-Baba Mountains, central Afghanistan are not just theoretical problems for the women and families that inhabit this area. Poor health and poverty are exacerbated by environmental degradation and a reduction in the quality of ecosystem services, and climate change, by further damaging ecosystems, worsens this situation.

agricultural crops of potatoes and wheat reflect the diet of the local communities, but have limited potential to provide an income here. Land degradation, due to the cultivation of a low diversity of crop species and gathering fuel for inefficient stoves, causes an increase in natural hazards and disasters such as flooding, landslides and drought.

The Clean Cookstove and Natural Regeneration project was one of the first projects undertaken by COAM. It was supported by United Nations Environment Programme (UNEP), the Embassy of Finland and the Linda Norgrove foundation. The initiative has been welcomed by these communities and it works. The project is a package of interventions designed to build communities’ resilience to climate change; central to the project is the provision of new cleaner cookstoves to households. In this region the main cause of land degradation is from over harvesting of rangeland plants for fuel, and these clean cookstoves use half the fuel of traditional stoves, and because the stoves are installed with proper chimneys, they not only save lives, but drastically improve the quality of life of many women, who spend over 6 hours a day in smoky kitchens.

As part of the project, over 70,000 tree saplings have now been planted in the Koh-e-Baba, which act as a carbon sink and provide alternative sources of fodder, fuel, shelter, shade, building materials and income from sale of timber. It is hoped that this project will be scaled up to other areas of Afghanistan.

pic: young boy on a rangeland at 4300 m in the Koh-e-Baba mountains

As witnessed by Conservation of Afghanistan Mountains (COAM, a community based natural resource management initiative established in 2010), the decline of natural resources, fuel sources, medicines from native plants and decreased soil fertility impact these communities daily.

80% of Afghanistan’s population live in semi-arid rural areas and experience effects of climate change that people in temperate developed countries need not yet think about.

“30 years ago we walked outside our home for fuel, 20 years ago we had to go over there, now we have to buy fuel or spend half a day gathering enough to cook the evening meal.”

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The impact of climate change on this area is very real to the women who live here. There is an increase in their daily work burden; the gathering of fuel, wild foods and medicinal plants is becoming more difficult; competition over limited resources, such as pasture lands and clean water, has increased; whilst land degradation leads to reductions in income. The main

Women – especially those living in rural areas like the Koh-eBaba and the central highlands of Afghanistan – often have a particularly deep understanding of local ecosystems, stemming from daily practical experience and motivated by a need to survive the harsh seasons. Women are also sensitive to ill-health around them, not only when it affects a child or a family member, but also when the environment is affected, and there is an intuitive understanding that the two are linked. Information provided by women can contribute greatly to the design of practical adaptation strategies.

Valuable lessons can be learned from the grassroots level

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MORE INFO COAM is a fully non-profit, Afghan NGO promoting and facilitating community development and natural resources management in Bamyan province, Central Afghanistan.

Website: www.myafghanmountains.org For information on the Clean Cookstove and Natural Regeneration project:

www.unep.org/afghanistan, www.lindanorgrovefoundation.org

ABOUT THE AUTHORS Habiba Amiri, has been the Country Director of COAM since 2010 and is a role model for Afghan women.

Amy Jennings has been supporting COAM for a year with their conservation projects.

COP 18 | DAY 7

Climate change and health beyond-2015: The sustainable development agenda Professor Jonathan Patz Global Health Institute, University of Wisconsin-Madison The Outcome Document from the recent Rio+20 Summit, “The Future We Want”, recognises that health is both a precondition for, and an outcome of, sustainable development. Climate change affects health through a myriad of exposure pathways, each presenting simultaneously both challenges and opportunities for sustainable health and development.

Interventions targeting either adaptation or mitigation of climate change, therefore, can have multiple health and societal benefits – the key is to find root points of leverage where a single policy might have numerous beneficiaries.

The relationship between health and all three original (1992) Rio Conventions – on Climate Change, Biological Diversity, and Desertification was recently documented in “Our Planet, Our Health, Our Future”, a collaborative effort between the World Health Organization (WHO) and all three Rio Conventions. In particular, the report revealed both risks and interdependencies. Climate change will directly lead to net negative health impacts, including through extreme weather events, spread of vector-borne disease, diarrhoeal disease, food security and malnutrition. Natural capital, such as biodiversity, underpins ecosystem services – upon which health and societal wellbeing depend – but are threatened by climate and land use change. Just a few measurable benefits that ecosystems provide mankind include flood protection, disease regulation, and water purification. Desertification leaves populations vulnerable to water quality degradation, water scarcity and droughts, decreases agro-ecosystem productivity and increases food scarcity/malnutrition.

If human society could advance from a carbon-intensive economy to a green economy, human health opportunities would abound. For example, reducing fossil fuel combustion might not only reduce the extent of climate change, but more immediately such intervention would improve air quality, and if done in the transportation sector, could potentially increase ‘active’ transport that subsequently would lower the risk of obesity and associated chronic diseases. This is just one policy example of how addressing climate change can both enhance sustainable development and save lives.

Sustainable development remains the central context of the post-2015 development agenda. Yet, at this juncture it is critical to acknowledge how health is inextricably linked to ecosystems and our earth’s climate; this awareness is especially salient in the UNFCCC process toward developing a set of post-2015 Sustainable Development Goals (SDGs). With the centrality of health as both an input and outcome, and climate change as a cross-cutting issue, a new level of intersector awareness and collaboration is warranted, especially as revised targets and indicators are being drafted for the SDGs.

Furthermore, establishment of appropriate indicators will help ensure that interventions in any sector will lessen, rather than add to, the disease burden. WHO, in fact, is now strongly advocating a holistic “Health in All Policies” approach which accepts that population-wide health is determined by many sectors beyond solely health. The role of weather variability and health is obvious for thematic areas such as water and sanitation, food security and nutrition, and disaster management, as well as climate change specifically. Outcome indicators might include: annual mortality rates from climate-sensitive diseases (i.e. the sum of all vector-borne disease, diarrhoeal disease, malnutrition, and weather-related disasters etc.); household dietary diversity scores as an output indicator for food security; and percentage population with access to weather/climate-resilient infrastructure (such as water sources and hygienic sanitation facilities for example).

pic: DFID - UK Department for International Development

Health should also be a key consideration for other areas.

Representative outcome indicators in the area of energy, for example, might include the percentage of households using only modern, low-emissions heating, cooking and lighting technologies that meet emission and safety standards; or measuring the burden of disease attributable to household air pollution could be another outcome indicator. Indicators for the reliability of energy supply to health facilities are also important. In jobs, healthy workforces are a precondition for sustainable development, and indicators such as the proportion of workplaces that comply with national occupational health and safety standards (an output indicator), or measuring occupational disease and injury rates (an outcome indicator) merit consideration.

Clearly the health of our human population depends on the healthy conditions across all societal sectors and natural systems. Climate change, now solidly tied to our carbon-intensive economy, challenges all communities working on core elements of sustainable development.

Human health has been relatively sidelined in the UN Framework Conventions, but now needs to be better interwoven into the process of defining the next set of global development goals

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COP 18 | DAY 7

The health sector: Sustainability must start at home Arthur Cheung, International Federation of Medical Students’ Associations The health sector’s role in protecting the health of populations extends beyond provision of services, and includes a responsibility to minimise the health sector’s environmental footprint.

In many countries, the health sector accounts for a significant proportion of economic activity as well as environmental health impacts, which occur as a result of natural resource use and waste and emissions. Unsustainable practice in the health sector undermines public health, while sustainable practice results in health co-benefits.

Recognition of the health sector’s role in sustainability is increasing, with the recent establishment of initiatives such as the Global Green and Healthy Hospitals Network.

The health sector can contribute by: • i ncreasing awareness of the health impacts of unsustainable practice, and the health co-benefits of moving to sustainable practice, both within the health sector and in the wider community; • p rioritising primary and preventative interventions which lower the need for subsequent resourceintensive interventions; and • shifting to sustainable practice in the delivery of health interventions where they are needed.

Representing over 1.3 million medical students globally, the International Federation of Medical Students’ Associations (IFMSA) works in a number of areas at the interface of climate change and health. At the national level, we seek to support action on the transition to, and/ or the development of, sustainable health facilities.

Hospitals, in particular, are energy and resource intensive.

This comes with a significant financial cost and large climate footprint. Indeed, climate-friendly hospitals are themselves more resilient to supply and climate variability. This is equally relevant for small rural clinics where electricity is scarce or unreliable. The following are elements of a climatefriendly hospital, with examples of possible interventions: Energy: • Generation: use renewable and secure supply, generated on-site where appropriate. For example, the use of wind, hydro, or solar power (including in car parking buildings), and on-site solar water heating.

• E fficiency: use motion-sensor and energy-efficient lighting, energy-efficient appliances (such as refrigerators), turning off appliances when not in use, productive use of waste heat, and shift thermostats closer to environmental temperature in mechanically conditioned spaces.

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Water: • Supply and treatment: integrate hospital systems with municipal water and sanitation infrastructure

to protect public health more broadly, and reduce the burden on medical services. Where onsite production and treatment is necessary, e.g. due to poor infrastructure development or remoteness, consider rainwater harvesting and utilise affordable treatment technology such as bio-digestion systems from which methane gas production can be used as a fuel source.

• E fficiency: use low-flow devices, vigilance against water loss/leakage, recycled water for irrigation/ toilet flushing, use drought-resilient plants in landscaping, and avoidance of bottled water.

Waste management: Reduce, reuse, recycle, compost. In particular, utilise alternatives to incineration (e.g. disinfection followed by landfilling), including sorting of non-medical waste from hazardous material, and minimising the need for waste transport where possible.

Transportation: Reduce transport requirements (e.g. through use of telemedicine, locally grown food, and efficient/accessible siting of health facilities near public transport), encourage active transport and public transport (e.g. by providing cycle shelters and changing rooms, and discounting public transport fares) and purchase energy efficient fleet vehicles.

Building design and purchasing constitute major foci for action: The health sector is a major consumer, wielding demandside power to shift markets to greener and healthier products across the lifecycle from resource extraction to disposal.

Appropriate building design contributes to savings and efficiencies across all of the above categories. In particular, incorporating ‘passive systems’ when building hospitals can enable energy and heat generation, storage and transfer with little or no assistance from electrical or other non-renewable energy sources. These methods include insulation, sunshading devices, natural light, natural/passive ventilation, building angling to maximise wind cooling, and employing roof gardens, which cool buildings.

Finally, indicators that measure progress on these initiatives are powerful drivers of integrated solutions and should be incorporated into the Sustainable Development Goals as part of the post-2015 development framework.

We are fortunate to have the choice of win-win scenarios for the health and climate communities.

As Dr Maria Neria, Director of the Department of Public Health and Environment at the World Health Organization stated, “It is clear that the health sector can also play a leadership role in mitigating climate change… by getting our own house in order.”

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MORE INFO Report: A Comprehensive Environmental Health Agenda for Hospitals and Health Systems Around the World:

http://bit.ly/YDJwhV www.greenhospitals.net

COP 18 | DAY 7

Climate change and child health: A looming threat to development progress Kirstin Donaldson World Vision Governments, policy makers and the international development community have been slow to recognise that the ‘bottom line’ of climate change is the risk it entails to people’s health.

Despite warnings from United Nations Secretary General, Ban-Ki Moon and World Bank President, Jim Yong Kim that climate change has the potential to undo progress towards the Millennium Development Goals, research into the health impacts of climate change and adaptation strategies is not attracting the attention it deserves.

As a child-focused organisation, World Vision is concerned by growing estimates of climate-related morbidity and mortality. The World Health Organization estimated in 2004 that global warming was causing 140,000 excess deaths annually. By 2012, the Climate Vulnerability Monitor’s estimate had climbed to 400,000, mostly due to hunger and communicable diseases.

Climate change, therefore, has the potential to exacerbate existing global health challenges and buck an otherwise positive trend in improvements to health around the world.

Since 1990, there has been a 42% reduction in child mortality – due largely to improved vaccination coverage, simple technologies like insecticide-treated bednets, and better responses to diarrhoeal disease and pneumonia. Data on hunger gives an incomplete picture, but figures suggest that even in the wake of the 2008 food, financial and fuel crises, undernutrition is declining globally – and progress has been more pronounced than previously estimated. Yet too many children are still dying from largely preventable causes like birth complications, pneumonia, diarrhoea and malaria.

Chronic undernutrition affects one in four children worldwide with serious and potentially life-long consequences.

Climate change is increasing pressure on fragile ecosystems the world’s poor depend on, placing communities under greater stress. Three of the main preventable childhood killers – malaria, diarrhoea and undernutrition – are highly sensitive to climatic conditions. The International Food Policy Research Institute estimates that reduced calorie availability due to climate change will result in a 20% increase in child malnutrition by 2050. Increasing incidence of diarrhoeal and respiratory diseases could occur as a result of floodwaters introducing contaminants into water supplies. The Intergovernmental Panel on Climate Change states that “larger increases of climatesensitive diseases (including malaria, dengue and cholera) are expected mid-century, particularly in developing countries with high disease burdens.”

Governments and communities need access to more and better information – localised and costed – in order to make decisions about which climate adaptation options will best support health outcomes. Examples looking at particular

pic: DFID - UK Department for International Development

diseases at national or sub-national levels are beginning to emerge, but overall this body of work is embryonic; a recent World Bank report stated that the authors were “not aware of any studies that project weather extremesrelated health risks in developing countries for different levels of global warming.”

The long causal chains between climate change and health impacts will inevitably give rise to degrees of uncertainty, and responding effectively will require the international development community to work in a more integrated fashion across sectors such as health, food security, and water and sanitation. But these challenges must not delay action. The distribution of the climaterelated health burden exemplifies the intergenerational and international injustices of climate change; children in developing countries today have done little to contribute to the problem, yet they will suffer around 90% of the resulting disease burden. Focusing our attention on how best to alleviate this burden not only makes sense from a development perspective – it is also a moral imperative

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ABOUT THE AUTHOR Kirstin Donaldson is a Senior Policy Officer with World Vision Australia. A graduate of the University of Melbourne in International Development and History, she has a keen interest in the impacts of climate change on international development.

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COP 18 | DAY 7

Considering the health implications of energy poverty Kandeh K. Yumkella UN Industrial Development Organization (UNIDO) Energy powers human progress. From job generation to economic competitiveness, from strengthening security to empowering women, energy is the great integrator: it cuts across all sectors and lies at the heart of all countries’ core interests. Now more than ever, the world needs to ensure that the benefits of modern energy are available to all and that energy is provided as cleanly and efficiently as possible. This is a matter of equity, first and foremost, but it is also an issue of urgent practical importance – this is the impetus for the UN Secretary-General’s Sustainable Energy for All (SE4ALL) initiative.

This initiative has been launched in a time of great economic uncertainty, great inequity, high urbanisation, and increasing youth unemployment. It is also a time where there is emerging consensus on the need to act cohesively and urgently towards global issues such as sustainable development and climate change. How we capture opportunities for wealth and job creation, for education and local manufacturing, will be the key to catalysing any real revolution. Addressing a transition to a radically different, and inclusive, energy system is a generational challenge. Understanding the interactions with public health is critical in making this a successful transition. We have seen numerous commitments under SE4ALL related to supporting public health and energy in a holistic way, such as the delivery of ‘Solar Suitcases’ to provide portable power supplies for health workers and improvements in health clinics in Uganda.

Health and energy The various aspects of the interactions between public health and energy range from energy needs for medical facilities, to implications from power system air pollution, refrigeration for immunisation drugs, or the use of traditional fuels for cooking and heating. The impacts span the globe, from the EU to subSaharan Africa. We will briefly focus on these interactions as they relate to those populations that lack access to modern, clean, energy services in developing economies.

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Approximately three billion people do not have access to modern cooking fuels and technologies. This has clear and significant impacts on social and economic development, adverse health consequences, and gender impacts. The adoption of the Millennium Development Goals (MDGs) has helped to focus global attention on providing the

basic human needs of all people. Nonetheless, despite significant achievements during the past decade, there are still large segments of the global population that may not attain access to basic services within their lifetime. This situation is unacceptable. The UN General Assembly has responded by declaring 2012 as the International Year of Sustainable Energy for All. While household energy for cooking tends to get less public policy attention than electrification, both issues must be addressed to achieve universal access to modern, clean energy services by 2030. As an example, almost half of developing countries (68 of 140) have established targets for access to electricity, while very few countries have set targets for access to modern fuels (17 countries), and even fewer countries for access to improved cooking stoves (11 countries). There is a clear correlation between access to modern cooking facilities and social and economic development. Appropriate fuels and technologies are readily available for all conceivable scenarios. Modern fuels include natural gas, liquefied petroleum gas, diesel, and renewables such as biodiesel and bio-ethanol. Technology options required to make use of modern fuels or use traditional fuels more efficiently, such as improved cooking stoves, also exist.

Despite some good precedents and many programmes and technology developments over the last three to four decades, the scale of the issue remains enormous, and there is a need to change the pace at which it is addressed.

pic: EU Humanitarian Aid and Civil Protection

Women’s health These are global issues. But all around the world energy is also a woman’s issue. In the developing world, access to modern, clean energy services can be a matter of life and death. Women are the principal energy providers for their households in many places, performing the daily labour and making decisions about household energy resources and usage, whether foraging for firewood – which may expose them and their daughters to personal safety risks – or spending their scarce resources on kerosene for smoky inefficient lighting.

COP 18 | DAY 7 It is also women who suffer the disproportionate health impacts of their energy-related choices. Exposure to smoke from hazardous methods of cooking, heating, and lighting kills nearly two million people annually, mostly women and children, and millions more suffer from exposure-related diseases. To put this in context, more women worldwide are severely burned each year than are diagnosed with HIV and Tuberculosis combined. At the community level, a lack of energy access at medical clinics impedes the ability of medical personnel operating in both rural and urban facilities to provide adequate treatment and care. It is currently estimated that 200,000 to 400,000 healthcare facilities in developing countries lack access to reliable electricity. This means that vaccines and blood cannot be safely stored, diagnostic equipment is often useless, and operating rooms cannot function at night.

Almost any procedure can wait until morning, except for childbirth, and most women in agricultural settings finish

their daily chores before going to the clinic in the evening hours. Those most at risk from a lack of reliable electricity therefore are women. Worldwide, 358,000 women die during pregnancy and childbirth every year, when maternal mortality can be reduced by around 70% with the provision of minimal lighting and appliance operating services.

It is clear that the health impacts of providing energy services and the implications of living without those services are considerable. We are working closely with the World Health Organization to ensure that these varied interactions and possible synergies are captured and better understood. Measurement and reporting will be fundamental to successful tackling of these issues

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MORE INFO www.sustainableenergyforall.org

Linking climate change and health in Sustainable Development Goals: A Least Developed Country perspective Dr Iqbal Kabir Ministry of Health & Family Welfare, Bangladesh There is now widespread agreement that current trends in energy use and population growth will lead to continuing – and more severe – climate change. The changing climate will inevitably affect the basic requirements for maintaining health: clean air and water, sanitary environments, sufficient food and adequate shelter. Many diseases and health problems are likely to be exacerbated by climate change.

Surveys from around the world show that over 90% of the National Adaptation Plans of Action (NAPAs) on climate change created by Least Developed Countries (LDCs) identify health as a sector that will suffer adverse impacts of climate change. Despite this, the issue is currently neglected in the climate change mechanisms. A recent World Health Organization (WHO) review concluded that less than 3% of the international funding on climate change adaptation has been directed to projects with the specific aim of protecting health.

Bangladesh is among the most vulnerable to the adverse effects of climate change, due to its geographical and socio-economic conditions, despite that fact that it has been, like all LDCs, one of the smallest contributors to global greenhouse gas (GHG) emissions. As a disaster prone country, Bangladesh frequently experiences extreme weather events such as floods and cyclone salinity intrusions which have both direct and indirect adverse health impacts.

The Climate Change and Health Promotion Unit (CCHPU) of Bangladesh’s Ministry of Health and Family Welfare believes reducing GHG emissions and the carbon footprint of health care facilities through activities such as energy conservation, environmental improvement through safe disposal of medical waste, more efficient water use and supply, and transport can all result in health co-benefits.

To achieve this, there are basic steps the health sector can take from improving hospital design to reducing and sustainably managing waste, using safer chemicals, sustainably using resources such as water and energy, and purchasing environmental-friendly products.

Health is a precondition for all three dimensions of sustainable development. Accordingly, nutrition and noncommunicable disease (NCD), together with emerging diseases in a changing climate, should have separate set targets in terms of both process and outcome indicators within a post-2015 development framework.

The CCHPU remains focused on sustaining current Millennium Development Goal (MDG) achievements in health, but is also moving forward to provide a LDC perspective for input into current discussions on Sustainable Development Goals (SDGs), and will be emphasising the need for them to include targets and indicators on nutrition, NCDs and climate change, and urban health issues

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ABOUT THE AUTHOR Dr Iqbal Kabir is Coordinator of the Climate Change and Health Promotion Unit in the Ministry of Health & Family Welfare, Bangladesh. He is also a PhD candidate, University of Newcastle, Australia and a member of the Bangladesh Delegation at COP18.

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COP 18 | DAY 7

Protecting health from climate change Dr. Rajendra K. Pachuari Intergovernmental Panel on Climate Change The focus assessment report of the Intergovernmental Panel on Climate Change (IPCC) very clearly stated that warming of the climate system is inevitable. The report is based on the observation of a wide range of variables, by which we can tell that the climate of this earth is changing.

In the report: “Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation”, published by the IPCC in November last year, it was stated that heat-waves and extreme precipitation events will increase in both frequency and intensity in the future. We need to prepare for these events. Heavy rain increases the likelihood of flooding, and with it, the possibility of large outbreaks of disease as a result of these floods – one of the greatest challenges that health specialists will face.

In some cases, it may be necessary to create new infrastructure. For instance, if the pattern of rainfall changes in the future so that there are heavy concentrations of extreme precipitation events, we may need infrastructure to impound and store the excess water, thereby protecting life and property and making use of the water that does fall.

We know that an increase in diarrheal disease is likely, as well as shifts in the patterns of disease connected to changes in disease vectors that are probable due to future extreme weather events. I think that this is an area which has been largely under researched and believe we need to carry out detailed investigations on the impacts of climate change on human health in different areas of the globe.

The impacts will not be uniform across the world, and therefore it is necessary for people at the community level to work together to create a foundation of knowledge on a basis of which we can adapt and take measures to prevent some of the impacts on human health.

An important fact to stress is that the most vulnerable sections of society – those who will be the most affected – happen to be those least equipped to deal with these impacts. I’m referring partly to the poor living in developing countries, like Bangladesh, and on Small Island States, which are particularly vulnerable to the impacts resulting from flooding and the sea level rise. I would also like to highlight that, as far as climate change is concerned, we need to integrate policies dealing with this challenge with those of overall development polices. Unless we are able to do that, the effectiveness of the actions we take would remain limited. I believe that if we are to bring about sustainable development, it is critically important that our knowledge of the impacts of climate change – based on projections we have and the means by which we can adapt to some of these impacts – are mainstreamed and reflected in the polices themselves.

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pic: Bangladesh floods, Richard P J Lambert

I want to emphasise however, that adapting to climate change is not going to be adequate. What we really need is a combination of adaptation and mitigation, because neither one alone will be adequate to deal with future challenges. Mitigation of emissions of greenhouse gases (GHGs) carries with it a whole range of benefits, which make the overall cost of taking these actions very low. We must realise that while adaptations take place at a local level we – as a global community – have to mitigate the emissions of GHGs if we want to ensure that the impacts will not disproportionately and adversely impact some of the world’s most vulnerable communities. These communities are the poorest of the poor, and we have an ethical responsibility to see that everything within our means is done to deal with this challenge. This will require not only adaptation measures and the creation of institutions at the local level but globally, every attempt to reduce the emission of GHGs must be made. Because, ultimately, this is the only way we can stabilise the climate of this planet

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ABOUT THE AUTHOR Rajendra Kumar Pachauri has served as the chairperson of the IPCC since 2002. He is also head of Yale University's Climate and Energy Institute (YCEI). Previously, he has been Director General of The Energy and Resources Institute (TERI), a research and policy organisation in India, and chairman of the governing council of the Indian National Agro Foundation (NAF), as well as the chairman of the board of Columbia University's International Research Institute for Climate and Society.

COP 18 | DAY 7

interview. Dr Diarmid Campbell-Lendrum Dr Campbell-Lendrum has played key roles in the 2008 World Health Assembly Resolution on climate change and health, and is a lead author of the health chapter of the forthcoming 5th Assessment Report of the Intergovernmental Panel on Climate Change (IPCC).

You are participating in the preparation of the IPCC 5th Assessment Report. Could you give us an update on the scientific evidence of climate change on health?

Nationality: British Country of Residence: Switzerland

Current Position: Climate Change and Health Team Leader within the Public Health and Environment department at the World Health Organization (WHO)

The evidence of climate change on health is already strong in the 4th Assessment Report of the IPCC. It states that climate change is already increasing the global burden of disease, through malnutrition, vector borne disease and diarrhoea.

My view is that the evidence since then provides further reinforcement of current and future health effects. We also now have much more evidence that climate change mitigation can bring very large, immediate and local co-benefits for health.

The clearest example is air pollution. A large contributor to indoor air pollution is burning of coal and biomass on inefficient stoves in developing countries.

Much of outdoor air pollution comes from the fossil fuels used in transport and electricity generation. Shifting to clean energy sources can particularly reduce the strong warming effect of short-lived climate pollutants such as black carbon, and at the same time improve air quality and decrease the burden of respiratory diseases. The 5th assessment report will need to assess this new evidence.

Given the scientific evidence we have, is health prioritised enough by governments and the UNFCCC? Yes and no. Parties put health at the centre of the UNFCCC. Health is in Article 1 and Article 4 of the Convention. It is actually one of the key justifications behind climate change action. Health is starting to come through in the operational mechanisms in the UNFCCC. However, recognition needs to be followed by concrete plans and action. Countries need to identify health as a priority. We think that the evidence for the effects of climate on health is as strong as other sectors, and the evidence for health co-benefits of mitigation much stronger.

So, we think that firstly, there needs to be recognition of health in adaptation through technical support and funding. Secondly,

financing mechanisms in mitigation should prioritise those interventions which bring health co-benefits.

International Federation of Medical Students’ Associations (IFMSA) interviewed one of Green Climate Fund representatives here in Doha.

According to him, "Health is not a priority”.

How can we address this issue and add more financial support for health sector?

In terms of demand from countries, or the general public, it is a priority. About half of Parties cited health impacts in their plenary presentations at COP17, and almost all least developed countries (LDCs) identified it as an urgent priority in their National Adaptation Programmes of Action. Whether this is reflected in climate finance is another question – there is good evidence that other fields have been prioritised above health. We are not asking for special treatment, but health should be considered on the same basis as, for example, agriculture, water resources or disaster risk reduction.

But we also need to be collaborative rather than competitive, as many of the most important health decisions are taken in these areas, rather than the formal health sector. We also need to do our homework. The lack of funding is partly because the health community has focused more on short term needs, and has only recently started to engage fully in climate change. We need to communicate evidence clearly, to make clear that we have organised plans to protect health from climate change, and the capacity to implement them. Health is now doing this, and should be in a much stronger position for finance.

People sometimes describe climate change as a Christmas tree – any problem can be hung on it like a decoration. We need to avoid the temptation just to pay lip service – we have to be serious, and focused on doing what is most effective to protect and promote health at the same time as addressing climate change

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Interview by Rennie Qin from International Federation of Medical Students' Associations (IFMSA).

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COP 18 | DAY 7

The Doha declaration on climate, health and wellbeing: Health must be central to climate action COP18, December 2012 Health and medical organisations from

to be made the one of the central

Recognising health in all policies and strengthening health systems globally can advance human rights and help create safe, resilient, adaptable, and sustainable communities.

priorities of global and national

We call for:

around the world are calling for the protection and promotion of health

policy responses to climate change.

The protection of health and welfare is one of the central rationales for reducing emissions in Article One of the United Nations Framework Convention on Climate Change (UNFCCC). Article Four requires all countries to consider the health implications of climate adaptation and mitigation. Yet health is being overlooked in the development of responses to climate change, and its importance undervalued by policymakers, business and the media.

Human health and wellbeing is a basic human right and contributes to economic and social development. It is fundamentally dependent on stable, functioning ecosystems and a healthy biosphere. These foundations for health are at risk from climate change and ecological degradation.

Health as a driver for mitigation and adaptation The impact of climate change on health is one of the most significant measures of harm associated with our warming planet. Protecting health is therefore one of the most important motivations for climate action.

Climate change is affecting human health in multiple ways: both direct – through extreme weather events, food and water insecurity and infectious diseases – and indirect – through economic instability, migration and as a driver of conflict.

The risks to health from climate change are very large and will affect all populations, but particularly children, women and poorer people and those in developing nations. Urgent and sustained emissions reductions as well as effective adaptation are needed.

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What we seek from climate action

Climate action can deliver many benefits to health worldwide. Reducing fossil fuel consumption simultaneously improves air quality and improves public health. Shifting to cleaner, safer, low carbon energy systems will save millions of lives each year. Moving to more active lifestyles and expansion of and access to public transport systems can improve health through increased physical activity and reduced air pollution. Improving insulation in homes and buildings can protect people from extreme temperatures and reduce energy consumption. All of these changes will provide significant economic savings. Climate action that recognises these benefits can improve the health of individuals and communities, support resilient and sustainable development, and improve global equity.

1. The health impacts of climate change to be taken into account domestically and globally • Health impacts and co-benefits to be fully evaluated, costed and reflected in all domestic, regional and global climate decisions on both mitigation and adaptation; • Health and environmental costs to be reflected in corporate and national accounts; and • Assessment of loss and damage from climate change to include impacts on human health, wellbeing and community resilience, as well as impacts to health care infrastructure and systems.

2. Investment in climate mitigation and adaptation to be significantly increased on a rapid timescale • P riority given to decarbonisation of national and global energy supplies; • C essation of fossil fuel subsidies globally and greater funding for renewable and clean technologies; • F unding for programmes to support and protect health in vulnerable countries to be significantly increased; and • I nvestment in adaptation and mitigation programmes that can demonstrate health benefits to be substantially increased; 3. The health sector and the community to be engaged and informed on climate action • T he health sector to be engaged and included in the processes of designing and leading climate mitigation and adaptation worldwide; • N ational and global education programs to increase public awareness of the health effects of climate change and promote the health cobenefits of low carbon pathways; and • M ore inclusive consultation processes in global climate negotiations to reflect the views of young people, women and indigenous peoples.

COP 18 | DAY 7 Our Future Human health is profoundly threatened by our global failure to halt emissions growth and curb climate change. As representatives of health communities around the world, we argue that strategies to achieve rapid and sustained emissions reductions and protect health must be implemented in a time frame to avert further loss and damage.

We recognise that this will require exceptional courage and leadership from our political, business and civil society leaders, including the health sector; acceptance from the global community about the threats to health posed by our current path; and a willingness to act to realise the many benefits of creating low carbon, healthy, sustainable and resilient societies.

“You cannot tackle hunger, disease, and poverty unless you can also provide people with a healthy ecosystem.”

Gro Harlem Brundtland

Signatories to the Doha Declaration on Climate, Health & Wellbeing Climate and Health Alliance, Australia Health and Environment Alliance (Europe) Health Care Without Harm Climate and Health Council (UK) C3 Collaborating for Health NHS Sustainable Development Unit (SDU) International Federation of Medical Students' Associations (IFMSA) OraTaiao: The NZ Climate & Health Council World Medical Association (WMA) The Centre for Sustainable Healthcare The Humanitarian Centre Healthy Planet (UK) List to be continuously updated online here:

www.dohadeclaration.weebly.com

New game buzzing at COP18 Mohini Dutta and Ben Norskov Antidote Games “Welcome to the struggle between humans and mosquitoes" Games can be a serious affair, especially when the fate of Humans and Mosquitoes lies in the balance, like in the game "Bitten!"

Bitten! is a battle between ‘Mosquito’ and ‘Human’ players currently taking place at COP18.

The game is played by passing cards to represent a variety of actions, for example: Humans are "Bitten" by Mosquitoes (threatening a Malaria infection) or can "Clean Out" the "Breeding Grounds" to quell the growth of Mosquitoes, depending on the individuals and cards they encounter. A changing climate often benefits Mosquito players.

Creating productive ways for people to interact is a difficult challenge at any large conference. The game Bitten! makes those interactions more fun and frequent, while raising awareness of the ways in which climate change affects mosquito breeding grounds and Malaria infection.

"The game has injected an atmosphere of genuine connectivity and collaboration at the COP," says Pablo Suarez of the Red Cross/Red Crescent Climate Centre. "Games are a great way to capture the complexities of climate risks, creating fun interactions, learning, and dialogue."

Bitten! was created by Antidote Games for the Climate Centre, and was funded by the Climate and Development Knowledge Network

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Be PaperSmart: Read Outreach online 4 easy steps to using the Quick Response (QR) Code COP18 is a ‘PaperSmart’ conference so we are encouraging our readers to subscribe on our mobile optimised website to receive the daily e-version of Outreach: www.stakeholderforum. org/sf/outreach, or download today’s edition by scanning the QR code.

1. Download a QR code reader on your phone or tablet 2. Open the QR code reader 3. Scan the QR Code with your camera 4. Today's Outreach pdf will automatically download to your phone or tablet

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COP 18 | DAY 7

How the fight against climate change can help tackle poor health conditions Fanny Joubert EcoAct Clean Development Mechanism (CDM) projects can of course reduce greenhouse gases (GHG) emissions, but they also have the potential to improve the living conditions of local populations, and notably health conditions. While the future of such projects is being discussed in Doha, we present the example of an improved cookstoves project in Kenya, in the Mbeere district.

The need to improve cookstoves efficiency has increased in the developing world, as nearly 2.4 billion people worldwide rely exclusively on the combustion of low quality biomass fuels, in inefficient traditional stoves, for cooking.

These methods of cooking account for nearly 10% of global energy consumption and lead to negative, although avoidable, consequences regarding public health.

The current cooking practice in Kenya is the use of the traditional cooking method, popularly known as ‘threestone’ cooking stove, which is the cheapest stove to produce, requiring only three suitable stones of the same height on which a cooking pot can be placed over a fire. This traditional cooking technique has very low thermal efficiency and often lacks operational chimneys to ventilate the smoke outside the kitchen, causing indoor air pollution with devastating effects on respiratory health, especially for women and children, who spend most of their time in poorly ventilated households.

By contributing to indoor pollution, three-stone cooking stoves cause a range of diseases such as acute respiratory infections, eye problems, breathlessness, childhood pneumonia, lung cancer, and bronchitis. The World Health Organization (WHO) estimates cookstove domestic smoke to be one of the top five threats to public health in developing countries. More than 10 million people in Kenya live in households that cook on traditional open fires in built-in kitchens and, in Kenya, exposure to indoor air pollution is thought to be responsible for approximately 14,300 deaths per year.

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In this context, the project consists of the development of a programme of activities (PoA) in Kenya within the framework of the CDM implemented by the UNFCCC. The development of a PoA will allow the implementation of several small individual projects (CDM Programme of Activities - CPA) under one single programme. This approach helps to reduce transaction costs related to the UNFCCC project registration, by enabling the development of the

pic: traditional 'three-stone' cooking stove, Mark Jordahl

project in several regions of the country. Indeed, for most African countries, single CDM projects provide low carbon emissions reductions – and thus generate few carbon credits – making these projects hardly financially viable.

To overcome this barrier, this project aims to produce and distribute more than 100,000 improved wood cookstoves to rural households within eight districts in Kenya.

The specific model developed here, named Konsava, went under several prototypes and improvements to reach the desired performance. It is more energy-efficient thanks to its ceramic heart that improves combustion and retains heat while optimising the cooking temperature, and thus wood consumption (with near 60% of wood savings). In addition, the stove fume emissions level appeared very low compared to the baseline open-fire mode of cooking.

Combined with a reduction in wood consumption, improved cookstoves reduce exposure to indoor air pollution. These effects will be particularly beneficial to women and children, who are most often present during cooking.

This example demonstrates that CDM projects can be an efficient way to improve the health conditions of local populations benefiting from the scheme. This should be borne in mind by negotiations during the on-going COP18 discussions

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MORE INFO www.en.eco-act.com

COP 18 | DAY 7

COP18 side event calendar

MONDAY 3rd DECEMBER

DATE TIME

VENUE

TITLE

ORGANISERS

All day

Renaissance Doha City Center Hotel

Agriculture, Landscapes and Livelihoods Day 5: Solutions for People in Drylands and Beyond

CGIAR, CTA, FANRPAN, QNFSP and World Bank

11:30—13:00

Side Event Room 8

On the road to 2050 – improving the EU climate policy

Ecologic Institute and Climate Strategies

13:15—14:45

Side Event Room 4

Carbon Capture and Storage: Opportunities in the GCC region.

Qatar and ClimateNet

13:30 - 14:45

Doha Sustainability Climate Change and the International Court of Justice: The Role of Law Expo, QIEC

14.15 – 16.00

Intercontinental Hotel

Building resilience through sustainable management of mountain water resources and closing the gap between policy and implementation (session at Mountain Day)

Water and Climate Coalition

15:00—16:30

Side Event Room 8

Des OMD aux ODD: mieux lutter contre le changement climatique, un enjeu clé pour l'Afrique

Réseau Action Climat - France (RAC-F)

15:00—16:30

Side Event Room 10

Legacy to future events: The Brazilian GHG strategy for Rio+20 implemented CDM voluntary cancellation

Secretariat of the UNFCCC

16:45—18:15

Side Event Room 7

Peoples' Voices In Policy Choices: A Low Carbon vision for sustainable India

LAYA, Bread for the World (BfdW) and Welthungerhilfe

18:30 - 20:00

Side Event Room 2

Climate Action and Advocacy in the South: Civil society activist share achievements and challenges

CAN International

20:15—21:45

Side Event Room 2

Achieving development and addressing the drivers of land use change

Union of Concerned Scientists (UCS)

20:15—21:45

Side Event Room 7

How to Integrate Migration into Adaptation Strategies and Planning

International Organization for Migration (IOM)

Yale University

Building Sustainable Health Systems: Focus on Climate Resilience A Side Event organised by

Monday, 03 Dec 2012 - 18:30-20:00, Side Event Room 4 Programme: Moderated by Dr Maria Neira – Director of the Public Health and Environment, WHO Opening remarks by a High Level representative of the Government of Qatar H.E. Mr. Arvinn Eikeland Gadgil, State Secretary for International Development, Norway - Keynote presentation on “Health and Sustainable Development” H.E Julia Duncan-Cassell, Minister of Gender and Development, Liberia - Gender, Climate Change and Health Mr Michel Jarraud, WMO Secretary-General - Climate services for the health community: an overview of the WHO/WMO collaboration under the Global Framework on Climate Services Ms Aira Kalela, GGCA/WEDO and Former Director General Finnish MoE - Social determinants of health and gender equity in CC Representatives of Bangladesh, Botswana, Nigeria, Uganda, South Africa – Prioritising Health in National Action Plans and Strategies and the role of Health in the post-2015 MDG agenda

In collaboration with:

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COP 18 | DAY 7

Reflections from COP18, Week One Jade Neville British Council Climate Champion

Rennie Qin International Federation of Medical Students' Associations

With the excitement of Young and Future Generations (YoFuGe) day over, the first week at COP18 drew to a close. Progress within the negotiations slowly but surely indicates that final agreements are beginning to form. On Friday, Christiana Figueres announced that by the end of Saturday, documentation and text would be produced for all Ad-hoc Working Group and Subsidiary Body issues, giving delegates piles of reading to look forward to on Sunday!

Health is unique in the sense that it is that it is both an endpoint of climate change effects on other sectors and also a capacity that is much needed for the development of other sectors. For this reason, it must be considered as a central principle in all negotiations. Protecting health in climate change is not just about its inclusion in the text, but also in its implementation.

Yet the issue has largely been absent from the discussions that took place in Doha last week.

On Friday afternoon, a press briefing with Chairman Fahad Bin Mohammed Al-Attiya focused on Qatar's Commitment to Civil Society Engagement on Climate Change Issues. “As it is Friday, all around the city hundreds of mosques are giving their sermons. What is interesting is that 150 of those mosques are giving their sermons on climate change and on the environment, which is exciting news. It seems the message is being received by a wide range of communities as we speak.”

The place of health in the COP18 negotiations is two-fold.

Firstly, it can be used as powerful motivation for climate change mitigation. In the Ad Hoc Working Group on the Kyoto Protocol (AWG-KP) negotiations this week, the Alliance of Small Island States (AOSIS) and Least Developed Countries (LDCs) mentioned health as a moral argument for ambitious mitigation pledges. Arguably the best way to protect health in climate change is for temperature rise to stay below 1.5°C.

As the British Council delegation are gearing up to give presentations on climate change in schools and universities across Doha next week, there are additional signs that the conference is rousing interest and discussion in the area.

According to Fahad Bin Mohammed Al-Attiya, this year’s COP has witnessed unprecedented participation from NGOs within the region. Around 50 Arab NGOs are in attendance, with the presidency supporting regional NGOs to increase participation and community support. Outside of the COP, Friday night also saw The Indigenous Environmental Network present the Middle Eastern premier of The Carbon Rush in Doha.

Secondly, health has to be protected in adaptation. In the soonto-be closed Ad Hoc Working Group on Long-term Cooperative Action (AWG-LCA) negotiations, there are many areas for its inclusion. Health should be considered as a central principle in the shared vision and part of the social and economic consequences of response.

COP18 President Abdullah Bin Hamad Al-Attiyah also announced that Qatar is planning a green transportation system to get more people in Doha using public transport.

Headway is clearly being made but, with Qatar having higher carbon dioxide emissions per capita than any other nation, is this sparked new interest within the country really significant enough?

Outreach is made possible by the support of

A health-in-all-policy approach should be incorporated into inter-sectoral responses. Health must be a part of technology transfer, capacity building and finance discussions. It was therefore disappointing that there was a distinct lack of mention of health in these areas during last week’s negotiations.

In the SBI discussions, it is positive to see that public health education is already a part of Article 6. Negative health impacts have to be recognised as one of the key damages associated with climate change. Health impact, risk assessment and management, as well as insurance cover for health, must be included as a part of the new loss and damage work programme.

The Ad Hoc Working Group on the Durban Platform for Enhanced Action (AWG-ADP) negotiations open an exciting area for many health co-benefits of climate change mitigation to be incorporated in, as well as traditional economic cobenefits. We shall follow the negotiations with an eye on health co-benefits as AWG-ADP shapes up in the coming week

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