Where in the world is the Climate/Health Nexus at COP21?

Yassen Tcholakov, Elizabeth Wiley, Lujain Al-Qodmani, World Medical Association

Climate change has been described by the Lancet Commission as one of the greatest threats to human health in the 21st century. The numerous health consequences of climate change are complex and multifaceted – ranging from direct impacts, such as those of heat exhaustion and trauma due to extreme weather events, to indirect phenomena such as shifting patterns of disease associated with changing transmission conditions, vector migration and much more complex impacts that are mediated through societal systems including health impacts of forced migration and conflict.

The foundation of the COP21 Climate Conference is parties’ Intended Nationally Determined Contributions (INDCs). These contributions represent parties’ commitments and plans to address climate change on a national and/or subnational level. As of November 30, 2015, 156 INDCs representing 184 of the 196 parties to the UNFCCC had been submitted. An analysis of these documents found almost two-thirds of represented parties’ INDCs integrated health (65.8%). There was significant variation across regions with African States (88.9%), Asian States (69.1%) and Latin American & Caribbean States (81.8%) demonstrating leadership in integrating health, while Western European & Other States (13.8%) and Eastern European States (13%) less frequently incorporated health in INDCs. Furthermore, 90 parties include health in the context of adaptation, while only 28 mention health in the context of mitigation.

Figure 1. Map of Health in INDCs (blue indicates inclusion of health)


Health has received a modest amount of attention in the Paris Agreement negotiations. A few key textual locations have been considered by parties for direct references to health within the language of the agreement:

  • Preamble / General objectives / purpose: referring back to the Principles of the Convention and the necessity to combat adverse impacts of climate change;
  • Adaptation: to reflect the efforts in including health in national adaptation plans;
  • Mitigation: to leverage climate change and health co-benefits.

As responding to climate change represents one of the greatest global health opportunities of the 21st century, the Paris Agreement can be perceived as one of the most important health treaties of the century. Of significant importance is that key issues are adequately addressed and health can contribute to building the narrative required to increase commitments to key issues in the agreement namely:

  • Common But Differentiated Responsibilities and Respective Capabilities (CBDR-RC) and equity: Integration of CBDR-RC, gender equity and intergenerational equity is closely tied to recognition of the social determinants of health;
  • Long term goal: fundamentally, the extent to which climate change is tolerable is dependant on the evaluation of adaptation potential of all sectors including health; therefore, setting an ambitious mitigation objective within the agreement needs to be informed by the health sector;
  • Loss and damage: adequately valuing health losses can galvanise early and effective climate action while also creating mechanisms to address health consequences of extreme whether events;
  • Decarbonisation and technology transfer: clean energy technologies and a transition away from fossil fuels has direct health benefits and can be used to make the case for further investment and financing.

In short, although challenging, addressing climate change is an ethical, economic and health imperative – the greatest health opportunity of the 21st century. The contributions that the health sector can make to climate action are multiple including, but not limited to, providing expertise to climate decision makers, as well as advocating for and contributing to the development of national commitments in terms of mitigation and adaptation.


Yassen Tcholakov, MD MIH, McGill University (Montreal, Canada)
Elizabeth Wiley, MD, JD, MPH, University of Maryland (Baltimore, MD, USA)
Lujain Al-Qodmani, B. Med. Sc., MD, Kuwait University (Kuwait, Kuwait)