By: Katy Indvik, MSc
Policy Engagement Specialist, SALURBAL Project  

The conclusion of the twenty-fifth session of the Conference of the Parties (COP 25) in Madrid last week is a reminder of the many connections between climate change, health, and equity, and of the enormous costs of inaction.

An ever-mounting body of scientific evidence points to an urgent need for a drastic and immediate reduction in global greenhouse gas (GHG) emissions if we are to avoid the most extreme and devastating impacts of climate change, including health impacts. Yet a recent United Nations report indicates that we are not on track to limit global warming to 1.5 or even 2° C, and that the goals established by governments around the world are not nearly ambitious enough. Despite commitments last week from some of the worlds smaller and most climate-vulnerable nations, most of the world’s largest emitters -many of the worlds wealthiest nations- were “missing in action or obstructive” during the international negotiations. 

Climate change affects health unequally

Available research indicates that there are complex connections between the ways climate change is affecting the environment and human health, and that climate change affects people differently in different places. Climate change results in increased intensity and frequency of heat waves, air pollution episodes, infectious diseases, malnutrition, forced migration, and conflict. Much of the progress that has been made to-date in the field of global health is threatened by these impact.

Inequity in the living conditions of different groups of people (the “social determinants of health”) is responsible for most health inequities, which can often be most starkly witnessed in urban environments where informal settlements exist side-by-side with gated communities. Climate change is already affecting the conditions in which people live and work across the planet and contributing to an increase in social inequities that in turn exacerbate health inequities.

Health equity exists when everyone has a fair opportunity to attain their full health potential, and no one is disadvantaged from achieving this potential. // Health inequities occur when unfair and unjust differences in health exist and create additional disadvantages for already disadvantaged groups. 

The relocation of COP25 due to an ongoing social revolution sparked by extreme social inequality and linked to health care inequities in Chile highlights the interconnectedness and urgency of these issues. A recently published article from the SALURBAL project highlights the stark differences in life expectancy between different areas of Santiago, the nation’s capital. Women born on one side of the city can be expected to live up to 18 years less than their counterparts born in a wealthier neighborhood.  

Non-communicable diseases (NCDs, such as diabetes, cardiovascular disease, or cancer) and climate change present critical, global challenges. Understanding and communicating the ways city and national governments can address both NCDs and reduce greenhouse gas emissions simultaneously (known as “co-benefits”) presents tremendous opportunity for creating political will for action.

The food choices, energy choices and transportation choices that people make every day are inextricably connected to human health and the health of the planet. Certain foods, such as ultra-processed foods, meat and other animal products, have a role in increasing both NCD risk and GHG emissions. The emissions from burning coal and other fossil fuels to produce electricity contribute to respiratory diseases and climate change. The way we move around a city, such as commuting by car, contributes to our individual GHG emissions and affects our level of physical activity, and even our mental health. Understanding the impacts of these choices is important, but for many people, their options are limited. 

Creating co-benefits of climate action in cities

Health co-benefits offer a powerful and largely un-tapped argument for driving climate action. In the face of insufficient national and international climate action, city- and local-level action is assuming an increasingly critical role. Local authorities need to think about equity when designing and implementing climate actions in order to avoid unintended consequences, such as rapid displacement and gentrification. For example, well-crafted urban air pollution regulations can have important co-benefits for health and climate change mitigation. Nevertheless, fuel taxes, roadway tolls, and other interventions designed to promote a low-carbon transition can increase inequities already affecting disadvantaged, vulnerable populations.

Policymakers need relevant evidence about the co-benefits of urban policies over time in order to effectively identify inequities, identify priority areas for action, and develop evidence-based policies and interventions.

The TransMiCable cable car, inaugurated in December of 2018 in Bogotá, Colombia, serves approximately 21,000 passengers each day and connects Ciudad Bolivar, a low-income neighborhood in the periphery of the city, to central transport stations. The launch of TransMiCable was accompanied by a series of urban improvements to provide recreational resources (like parks, libraries, and community centers), housing improvements, and risk-reduction programs to community members. The cable car provides a much-needed transportation alternative and has drastically reduced travel time for residents. Reduced travel time, less congestion, and a system run on solar power means that the project also helps reduce greenhouse gas emissions and air pollution. The program was designed with the input of community members and other stakeholders. Researchers are working to evaluate the specific health and environmental impacts of the project.

These types of local-level policies and interventions that focus on improving equity and strengthening communities can address climate change, promote health, and improve equity.

To support effective policy action, it’s essential that city governments partner with academia to implement comprehensive policy evaluations and engage in systems thinking to support the design of future interventions.

The SALURBAL project is funded by the Wellcome Trust’s Our Planet Our Health initiative, which was the first large biomedical foundation to direct specific attention to climate change.