What do the COP26 negotiations mean for children and young people’s health?
Dr Rosie Spooner is a paediatric trainee with Severn Deanery, and the Deputy Chair of the Climate Change Expert Reference Group at RCPCH.
In 2015 the Paris Agreement, signed by 192 states, agreed to limit global warming to well below 2°C, pursuing efforts to limit warming as close to 1.5°C as possible. Achieving this relies on all countries reducing greenhouse gas emissions, the primary source of which is the burning of fossil fuels. The UN’s Intergovernmental Party on Climate Change warns that 2°C of warming would mean “widespread and severe impacts on people and nature. A third of the world’s population would be regularly exposed to severe heat, leading to health problems and more heat-related deaths.” It is estimated that there will be 250,000 additional deaths per year by 2030, from malnutrition, malaria, diarrhoea and heat stress. Children and young people will bear the brunt of these effects (WHO 2021). As paediatricians, we will be called upon to treat the devastating health consequences of climate change.
Each day focused on a different topic, ranging from finances and transport to cities and gender. These topics fed into top-level negotiations
Six years on from Paris, COP26 in Glasgow was a chance to review progress and make further commitments. Although this might feel far removed from the role of a paediatric trainee, I attended COP26 as an observer on behalf of the Centre for Sustainable Healthcare (CSH) where I have been a part-time education fellow since 2019. Over 30,000 people attended the enormous conference site, representing 1,600 NGOs, alongside country delegates and other officials.
Each day focused on a different topic, ranging from finances and transport to cities and gender. These topics fed into top-level negotiations, often occurring behind closed doors. Outside the negotiating chambers, hundreds of events were taking place simultaneously and it was difficult to know where to focus my attention. After the first morning I was already suffering from content overload.
I met with health ministers or their delegates from several countries and explained the importance of citing health in their national climate change strategies
For an outsider, the process was bewildering; UN officials are as partial to acronyms as medics and I quickly became well versed in CMAs, NDCs, SMIs, RINGOs*. As an observer my role was to push ‘the health agenda’, specifically for reference to the health impacts of climate change to be included in the official text. Several other NGOs including the Global Health Climate Alliance, Healthcare without Harm and IMFSA had a presence and together we met daily to discuss progress and strategy. I met with health ministers or their delegates from several countries and explained the importance of citing health in their national climate change strategies as well as the importance of including the co-benefits of mitigation. Although our text was read out by the Panama delegate in the official negotiating hall it was never supported by enough countries to be adapted into the final text. Currently only 3% of countries’ climate change plans connect to health system changes and only 50% have a health system adaptation strategy, showing a stunning lack of acknowledgement of the impacts this will have on health and health care.
Disappointingly, the outcome of the negotiations, now called the Glasgow Climate Pact, is not ambitious enough to limit global warming to 1.5°C, despite strong language in support of the most recent scientific reports from IPCC. If all emissions and net zero pledges were honoured, we would still reach between 1.7°C (most optimistic) and 2.7°C by 2050. Worryingly there are few details of how countries plan to deliver on their pledges despite the promise they will return next year to another COP meeting to review the plans.
How will paediatric care change in order to deliver these necessary reductions in greenhouse gas emissions? What are the clinical implications?
In terms of health system change, 50 countries signed a WHO pledge to create climate resilient, low carbon, sustainable health systems, including 14 countries that have set a target date of reaching net zero emissions by 2050. All four UK health services have committed to net zero carbon emissions in line with the government’s commitment for the whole of the country to be net zero by 2050. The NHS in England has committed to being net zero by 2045, Scotland has committed to being a net zero carbon emissions health service by 2045, and in Wales the ambition is to reach net zero by 2030.
How will paediatric care change in order to deliver these necessary reductions in greenhouse gas emissions? What are the clinical implications? These questions require further research to help inform health system managers and clinicians but work is now underway in various specialities, including surgery, anaesthetia, nephrology and emergency medicine. Positively, the National Institute for Health Research (NIHR) has pledged £20 million to help fund health research. It intends on deploying this funding quickly and effectively to inform how and where to make health systems changes to both mitigate and adapt our care to the realities of a warming world.
At an individual clinician level you can make changes to reduce your personal carbon footprint at home but also learn how to bring this into our clinical practice though including the principles of sustainable healthcare into quality improvement projects. We can also use our voice as clinicians to speak out about this issue at a health organisational level and at a wider policy level. In 2019, I approached the CEO of my hospital trust and asked that they declare a climate emergency, set a net zero target and make a working group to address climate change in the hospital. Amazingly, she was open to this and, with support from others, the Trust has done all those things. In showing leadership and engagement in building more sustainable health systems, the Trust has been awarded a £13.7 million grant from the Public Sector Decarbonisation Scheme.
No matter what scale of change you choose to act at, it is important to balance despair with hope.
At a policy level, paediatricians have a role in speaking out and using our voice to demand better health for children now and in the future through system wide actions to address causes of climate change, a role that RCPCH has taken on in earnest.
Finally, being well grounded in the facts of what we are facing is important but should not create such nihilism so as to stop us from working towards achieving a healthy and sustainable future for children and young people. No matter what scale of change you choose to act at, it is important to balance despair with hope.
* CMA is the short form for the group of the countries who have signed and ratified the Paris Agreement; Nationally Determined Contributions; Sustainable Markets Initiatives; Research and Independent Non-Governmental Organisations
