Intended for healthcare professionals


Why COP28 must be a health COP

BMJ 2023; 380 doi: (Published 13 March 2023) Cite this as: BMJ 2023;380:p589
  1. Emma L Lawrance, lead policy fellow for mental health123,
  2. Mala Rao, director, Ethnicity and Health Unit45
  1. 1Institute of Global Health Innovation, Imperial College London, London, UK
  2. 2Grantham Institute for Climate Change and the Environment, Imperial College London, London, UK
  3. 3Mental Health Innovations, London, UK
  4. 4Ethnicity and Health Unit, Imperial College London, London, UK
  5. 5NIHR Applied Research Collaboration, Northwest London

Global leadership appears not to recognise that the climate crisis is a public health crisis, write Emma L Lawrance and Mala Rao

The start of the year is a time of reflection, of looking forward to the future and resolving to make life changes with positive improvements. Making resolutions is important and worthwhile; it signals the optimism that a better future is possible and can inspire others to join shared goals.

Our reflections this year were rather different, with 2022 ending with our attendance at the United Nations’ Conference of Parties’ COP27 summit. Wandering through the cacophony of noise and myriad pavilions—where nearly 50 000 participants congregated, making it the largest COP to date—was extraordinarily energising.1

To the casual observer it would appear that people from around the world had gathered at COP to agree to act, united by the common desire to protect the health of the planet and humanity. Giving young people an opportunity to have their voices heard, appeared to confirm this.2 However, there was a darker side to COP27: it was attended by the largest group of people representing the fossil fuel industry. Moreover, the banners adorning the conference buildings spoke to “science,” “energy,” “food,” and the “environment,”—but not to health. Despite approximately 189 million people in economically developing countries being affected by extreme weather events annually since 1991, global leadership appears not to recognise that the climate crisis is a public health crisis.34

Public health has been notably historically absent from COP discussions, with even WHO’s involvement in its deliberations being relatively recent. Encouragingly, COP27 saw human health—including, critically, mental health—beginning to receive greater attention. For the first time, conference resolutions referred to the need for governments’ climate action to “respect, promote, and consider their respective obligations on human rights, including the right to [the] highest attainable standard of physical and mental health.” The text also refers to the human right to a “clean, healthy and sustainable environment.”

While public health champions perceived this as a small, but significant step towards health becoming the priority in COP negotiations, it was the agreement of a “loss and damage” fund to provide financial assistance to climate vulnerable countries that was promoted as the hallmark achievement by the global political leadership. The fund is welcomed—despite countries with vested fossil fuel interests preventing improvements in the commitments to reduce the use of fossil fuels—but greenhouse gas emissions continue to rise globally, though at decreasing rates. Tipping points for climate breakdown are surpassed, and the resulting human mental and physical health toll escalates at alarming speed, especially in the most climate vulnerable regions.

In this regard, it is disheartening that economic growth remains the key goal of most countries, despite the UN Secretary General Antonio Guterres warning that we are “in a life-or-death struggle for our own safety today and our survival tomorrow,” and the rapidly worsening climate disasters highlighting that climate emergency is a health emergency.56 Consequently, the true metric of COPs’ successful deliberations should be the safeguarding of the health and wellbeing of people. By this metric, world leaders are failing, as the cost to lives and livelihoods of climate breakdown grows.

Health professionals can help ensure we do not miss the “brief and rapidly closing window of opportunity to secure a liveable and sustainable future for all.”7 As trusted experts in society, they must inform themselves and the public about the health co-benefits of climate action and the costs of climate inaction. They can help the public imagine and demand a fossil fuel-free future that lets us all breathe easier. They need to highlight how fossil fuels are toxic to human health and help end the fossil fuel industry’s pernicious influence in discouraging climate action through its well funded political advocacy. Indeed, health leaders need to attend every COP, starting with COP28, in the rooms where climate policies are developed and to demand that health becomes the core currency of future negotiations.

Health leaders can be the change agents in their own health systems (e.g., to decarbonise services they provide and to educate fellow staff). They can also join organisations, such as the WHO and the Global Climate and Health Alliance, in their campaign for inclusion of health metrics in the UN Framework Convention on Climate Change’s Global Stocktake to assess countries’ collective progress towards climate goals and the Global Goal on Adaptation.8910 Health leaders and practitioners can also support investment in people, as well as infrastructure, to adapt to climate change in their communities of influence.

The launch of the Office of Climate Change and Health Equity in the US is an encouraging sign that political leadership is beginning to recognise the inextricable link between health and wellbeing and climate change.11 Health leaders must promote this understanding globally. Let’s resolve to make this the year when all decision makers at COP28 are persuaded to act on this central truth.


  • Competing interests: none declared.

  • Provenance and peer review: not commissioned, not peer reviewed.

  • Acknowledgments: We are grateful to Richard Powell for his helpful comments and suggestions on the first draft of this paper.