By Ana V. Diez Roux, MD, PhD, MPH, Co-Principal Investigator of the SALURBAL Project and Director of the Drexel Urban Health Collaborative (UHC).

Originally posted by the Drexel Urban Health Collaborative.

Last week, I travelled to the 2025 Climate Conference of the Parties (COP30) in Belém, Brazil. The Climate COP is the decision-making body for the United Nations Framework Convention on Climate Change (UNFCCC). It meets annually to assess progress on climate change and negotiate global climate agreements (you can read more here). In addition to the country delegates, COP includes “observers”, such as Universities (including Drexel) and many other organizations with an interest in the topic. I travelled to COP30 to represent SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America), a project unique and ambitious, and the most hopeful (and I think transformative) scientific initiative that I have ever been part of (these days, a little bit of hope is no small thing…..).

SALURBAL team members joined via Zoom from Brazil, Colombia, and the United States. Together, we presented findings and resources generated by the SALURBAL-Climate project. Our presentation was part of a series of events hosted by the “Health Pavilion”, a World Health Organization (WHO) sponsored stand within the “Blue Zone” of COP. We shared initial results showing the impact that climate change is already having on health and health equity in cities of the region. We also launched the SALURBAL Portal and City Profiles, designed to make information about climate change and its impact on urban health visible and hopefully useful to support city climate change mitigation and adaptation policies.

For those who have never been to a COP before (I had not), it is a unique experience. In many ways it is similar to conferences that scientists attend, in other ways it is dramatically different because of its sheer size and because of the many different types of groups that participate. But the main thing that makes it different is that the “conference” or “exhibition” aspect is only peripheral to the main event: the international negotiations aimed at solidifying the type of agreement needed to finally act decisively to prevent the worst consequences of climate change for humanity. Sadly, to “observer” attendees like myself, these negotiations, what they are about, who the main voices are, and what the contentious issues are, are much less visible than the many exhibition booths battling to make a statement of some sort – sometimes profound and truthful, other times performative and self-promoting – in a cavernous and very noisy hall.

Attendees include scientists (although they are far from the majority), politicians and government representatives, NGOs, industry, the private sector, and international organizations (including development banks), as well as many grass-roots organizations advocating for environmental justice, the land rights of indigenous peoples, clean energy, the elimination of fossil fuels, and veganism, among other causes. All these groups have things to say, and they say them in different ways – through the sizes of the exhibition booths (Saudi Arabia and China had among the largest booths… ), through carefully-curated panels and power points, through “virtual” reality experiences (yes, this too) , through press conferences and various side events, and through demonstrations within and outside the enormous hall, demonstrations against coal and fossil fuels, against deforestation, in defense of the Paris agreement, and in support of the rights of indigenous peoples among others.

It has been noted that Belém, Brazil was chosen for the COP30 to highlight the importance of the Amazon rainforest, as well as the threats of deforestation, and to emphasize Brazil’s commitment to protecting this vital ecosystem and the communities that live there. References to the rainforest abounded, from the photos and exhibits at the airport that all passengers walked through when they landed, to events and works of art hosted in the venue itself, including a large glass case with ash collected from recent wildfires across Brazil. But beyond its symbolism as “the gateway to the Amazon”, to me, Belém had a more profound significance as one of the many cities all over the globe struggling with chaotic urban development, inadequate infrastructure (including housing, water, and sanitation, and transportation), as well as profound social inequities connected to its history and its economy. The increasing effects of climate change are only magnifying these problems.

The metropolitan area of Belém includes nearly 2.5 million people. At one point in its history, Belém was relatively wealthy, as can be seen in the beautiful examples of Portuguese colonial architecture scattered throughout the city, many sadly dilapidated. This wealth of course was the result of extractive industries, including sugar and rubber industries that contributed to environmental degradation, and benefited from the exploitation of local indigenous communities, as well as enslaved Africans. Some estimates suggest that as many as 60% of Belém residents live in poverty in neighborhoods called “Baixadas”, or low areas close to rivers (the favelas of Belém). Many residents are of Indigenous or African descent. At one COP sponsored event, I watched a moving documentary describing how past urban developments, including the recent urban development supported by COP30, had prioritized the tourist- oriented areas and had failed local communities whose basic infrastructure needs remain unaddressed. Sadly, it was a familiar story of displacement and abandonment, not unlike similar stories in cities all over the world.

My last day in Belém I visited the Ver-O-Peso public market, a sprawling open market selling fruits and vegetables, meat, herbal remedies (a huge section), arts and crafts for tourists, and an enormous fish market, fish of many types, with beautiful names like tambaquí, pacú, and piracuru, all river fish from the Pará river as well as from the many other rivers that constitute the Amazon River system and the Amazon delta. Two Brazilian women visiting Belem that day from the outskirts of the city befriended me. I learned from them that the day was a holiday, which is why the market lunch section was so packed. It was Dia da Consciência Negra (Day of Black Consciousness), a holiday established to recognize Afro- Brazilians and encourage public discussion of racism, social equality, and inclusion, certainly relevant to the many conversations going on at COP30. My Brazilian friends, a historian and a sociologist, invited me to join them at their table, and I had a lunch of delicious fried fish overlooking the beautiful river, a river with which many residents feel a strong spiritual connection.

That afternoon, when I returned to COP hoping to attend an event called “the People’s Plenary” I learned that all activities had been cancelled because of the fire that broke out in a stall not far from the Health Pavilion where I had presented. Earlier in the week, torrential rains had flooded the venue grounds. Many parts of the venue were hot, despite the noisy air conditioning and many fans. Some said that all this – the heat, the floods, the fire – were appropriate reminders for the many COP30 visitors like me. There was an unmistakable irony to it: COP30 delegates and visitors, hot, wet, and scared by fires.

Many years ago, I had ambitions to take a boat in Iquitos and travel to Manaus down the Amazon River (and eventually to Belém), sleeping in a hammock on a cargo boat. I never made it. But over 30 years later, I did, after all, visit Belém, although in circumstances I never would have predicted back then, when we were worried about social inequities, military dictatorships, and human rights but not climate change, as all environmental concerns seemed remote and only something rich countries had the luxury to think about (how wrong we were!). Visiting Belém, not the exhibitions at the COP pavilion but the city of Belém itself, with its mixture of beauty, chaos, stark environmental inequities, and its people striving for a better life, reminded me of the human face and the urgency of the challenges before us, in which social justice, climate change, and our economic system are inextricably connected.

It is hard to know at the time I am writing this what will come of COP30, and whether any of it will have any real impact. But what we know so far is not promising. Despite this being billed as “the implementation COP”, few concrete actions emerged. Most importantly, despite the objections of several nations (hats off to Colombia and the 80+ nations who spoke out), the final agreement includes no concrete plan to transition away from fossil fuels, which scientists believe is fundamental to achieving the Paris targets. The agreement also commits to no firm plans for countries to meet the emissions reductions necessary to prevent catastrophic global warming. The few positive aspects of the agreement (e.g., on supporting adaptation in lower-income countries, and ensuring that a transition to green energy is fair to all peoples), as well as the Belem Health Action Plan supported by WHO, have limited or no funding attached. Not a very hopeful outcome: the barriers and special interests opposing real change, including the fossil fuel industry and the so-called “petrostates”, are enormous (as an example there were 1600 authorized fossil fuel delegates compared to only 360 from indigenous communities). But some say it could have been worse and believe that some multilateral agreement is better than none at all…

It is true that some wins emerged outside the formal negotiations, for example Brazil recognized four new indigenous territories and launched an ambitious plan to stop deforestation. A parallel plan outside the UN system has already emerged to continue conversations on a “just transition away from fossil fuels”, including a meeting co-sponsored by Colombia and the Netherlands in April 2026. Will more meetings help? If the UN cannot do it, are there other ways to advance the agenda and commitments that are really needed? Maybe not, maybe it’s just wishful thinking. But as we say in SALURBAL, “haciendo posible lo imposible” (making the impossible possible) is sometimes the only choice.