Strengthening Health Systems for Planetary Health. HSR2024 – 8th Global Symposium on Health Systems Research
As Chair of the Alliance for Health Policy and Systems Research, I had the honour of addressing the Global Symposium on Health Systems in Nagasaki, Japan.
You can read my full speech below.
Rt. Honourable Helen Clark
Strengthening Health Systems for Planetary Health
HSR2024 – 8th Global Symposium on Health Systems Research
Nagasaki, Japan.
Plenary Session, 19 November 2024
Thank you to the organisers from Health Systems Global and Nagasaki University for inviting me to address you today.
Our theme - how health systems can be strengthened for planetary health - is timely; not only because the annual United Nations Conference of Parties to the Framework Convention on Climate Change is ongoing in Azerbaijan, but also because climate change is an existential threat to humanity. So, I’m delighted to speak to this community on such an important issue for me personally, and for the Alliance for Health Policy and Systems Research which I chair. Let me make three points.
First, let me be blunt – global and national governance is failing to address climate change and its threats to planetary health adequately. We have breakthroughs at the global level – as with the Paris Agreement of 2015, which are then followed by years of arguing about how to implement it, including how to finance it, and with too little action at national level.
The scale of the challenge is well known. People around the world are facing record-breaking threats to their wellbeing and survival. Far from declining, greenhouse gas emissions reached an all-time high in 2023. The world is not on track to meet the Paris Agreement’s targets – in fact, the 1.5 degrees Celsius threshold which countries agreed to try to stay below has already been breached in the twelve months from February 2023 to January 2024.
WHO has called climate change the greatest public health threat of the 21st century. The evidence continues to mount on how human health is being undermined, with the Lancet Countdown Reports each year documenting that thoroughly.
These impacts come at a time when hard won gains in global health are also under pressure from the COVID-19 pandemic and its long tail, and from the many conflicts around the world. The pandemic pushed many more people into poverty and governments into much more debt; the conflicts have had spillover impacts on the cost of living for us all and have hit the poorest the hardest.
It is little wonder therefore that progress on health is stagnating, that global life expectancy has declined for the first time in thirty years, and that only sixteen per cent of the Sustainable Development Goals’ targets are on track to be met by 2030.
The 1992 United Nations Framework Convention on Climate Change (UNFCCC) provides the overarching framework for addressing climate change. Associated with it are a range of processes – all relevant directly or indirectly to health, including Vulnerability and Adaptation assessments, Health National Adaptation Plans, Nationally Determined Contributions, and Long-term Low Emissions and Development Strategies).
At the 29th UN Climate Change Conference of the Parties in Baku, there are both a health pavilion and a health day, thanks in no small part to the hard work of WHO. Close to ninety countries have committed to developing climate-resilient health systems.
Yet, the health sector could be more fully engaged in these global and national policy processes around climate change. For example, this year’s Lancet Countdown Report notes that the number of governments mentioning health and climate change together in their annual UN General Debate statements fell from fifty per cent in 2022 to 35 per cent in 2023. WHO reports that 91 per cent of Nationally Determined Contributions to the Paris Agreement do include health considerations, but that only a third identify health co-benefits of climate change mitigation and only eleven per cent include an emission reduction commitment for the health sector.
Overall, the global failure to address climate change effectively is not just a policy failure; it is also a profound failure to ensure equity and justice. Low-income countries have contributed only around eight per cent of emissions historically, but are experiencing some of the most severe climate impacts.
This is why discussions at this year’s COP around climate finance flows to low- and middle-income countries, including through the Loss and Damage Fund, are so crucial – both to support adaptation and mitigation by those countries, and as an acknowledgment that the historical responsibility for the stock of greenhouse gas emissions in the atmosphere lies with the high-income countries.
Central to the UN Framework Convention on Climate Change is the principle of common but differentiated responsibilities. While all countries share a responsibility to act, the high-income and historically high-emitting states bear a greater responsibility and should provide support to others accordingly.
Second, how can health systems contribute to climate justice and address the impacts of climate change on health equity?
Health systems can contribute to a just transition to a net zero future by consciously acting to mitigate and adapt to climate change while also improving health equity. This requires nuanced and strategic thinking, and a change of tactics.
The Intergovernmental Panel on Climate Change’s sixth assessment report drew attention to the principles of equity and fairness, inclusivity and participation, responsibility and accountability as key principles which must drive mitigation and adaptation efforts.
Equity in climate change adaptation and resilience-building measures is essential to ensure that all communities, especially those with limited resources, have access to adequate healthcare and protection from climate-related health risks.
Inclusive decision-making processes are needed to achieve this, and these should engage and support women, youth, marginalised communities, Indigenous Peoples, and local populations to lead. Sharing power with those who are directly and disproportionately affected will help ensure that solutions are more impactful and sustainable. The health sector needs to look at its own governance, and who makes decisions.
Clearly health systems can improve their readiness to be frontline responders to climate disasters. Health policies can help build climate resilience – national health and climate change adaptation plans can drive this. And health-driven climate policies can improve equity if they are directed toward supporting marginalized groups. There needs to be a focus on designing policy with co-benefits—like for the reduced respiratory illness which comes from cleaner air, and the health benefits from transport systems which prioritise safe walking and cycling.
As well, health systems should be reducing their own emissions by looking for sustainability across their entire operations from energy and transport to the materials they use and how they dispose of them. This really is a case of physician heal thyself.
Third, realising the promise of the Paris Agreement to steer the world away from catastrophic climate change to a net zero future requires cross-society and whole of government action. That must include health policy and systems researchers. Like all communities, this one can do more.
Throughout my career in public life, I have seen the importance of evidence in achieving policy goals. Researchers supply that evidence, and we must arm policymakers and communities with it to inspire climate action.
I am only too well aware that we live in an age when skilled populist politicians refuse to accept what scientific evidence is telling them, and instead steer a course based on misinformation on everything from public health to climate change, broader economic and social policy and foreign relations.
This is all the more reason for the health policy and systems research community to step up its efforts to bring compelling evidence about the need for change to the public in ways that the lay person can comprehend. We need to improve public health and science communication so that it reaches beyond the academic publications and conferences to reach wider and diverse publics. The populist anti-health, anti-science narrative has to be beaten at its own game.
We must also encourage long view leadership among policy makers. I have been a health minister, and I know how easy it can be to be overwhelmed by public dissatisfaction with the length of hospital waiting lists and times for treatment.
But health ministers also know that the demand for services will grow exponentially if the drivers of that growth are not addressed. Just as we know that the lung cancer and emphysema wards of a hospital would be overflowing if we failed to address rates of tobacco smoking, so our respiratory illness wards and emergency and other services will be overwhelmed without tackling air pollution, preparing to respond to the climate change threats we already face, and reducing our emissions.
So, we need to provide national and local policymakers with the evidence of what is coming down the track if they do not act. We need to show how health policy and health systems can mitigate, adapt, and build climate resilience. There is a need for more country-specific evidence to guide action, translating global evidence to the local realities, and fostering greater learning across and between countries.
At the Alliance for Health Policy and Systems Research, we subscribe to the principles which the IPCC highlighted as essential. The climate crisis is one of five focus areas in our new strategy. We are already supporting researchers in many countries in this area (and if you are interested in hearing more, please join the Alliance’s session tomorrow morning).
The Alliance will play its part in supporting this community to deliver health policy and systems research which enables the just transition. I know you are all committed – this plenary is evidence of that. I know how important and critically impactful this work can be, and we need more of it. Planetary health and the just transition cannot remain abstract frameworks or aspirations. I know this research community can make a major contribution to moving these concepts to reality.
Thank you.