Academic Webinar: Health Risks of Climate Change

Wednesday, September 27, 2023
Aly Song/Reuters

Planetary Health Policy Director, Harvard T.H. Chan School of Public Health, Harvard University


Vice President for National Program and Outreach, Council on Foreign Relations

Elizabeth Willetts, planetary health policy director at the Harvard T.H. Chan School of Public Health, leads the conversation on the health risks of climate change.

FASKIANOS: Welcome to today’s discussion of the Fall 2023 CFR Academic Webinar Series. I’m Irina Faskianos, vice president of the National Program and Outreach here at CFR. Thank you for joining us.

Today’s discussion is on the record and the video and transcript will be available on our website, CFR.org/academic if you would like to share these materials with your colleagues or classmates. As always, a CFR takes no institutional positions or matters of policy.

We are delighted to have Liz Willetts with us to discuss health risks of climate change. Dr. Willetts is the planetary health policy director at the Harvard T.H. Chan School of Public Health at Harvard University. She has more than twenty years’ experience mobilizing knowledge and engagement on biodiversity, climate change pollution, food systems, and community health for marginalized populations. Previously, Dr. Willetts was a longstanding member of the policy reporting team at the International Institute for Sustainable Development, and a writer and editor for the Earth Negotiations Bulletin and The Lancet.

She’s authored and led multiple interagency science policy briefs on climate change for the World Health Organization and authored a regional policy guide on “Operationalizing the Environmental-Health Nexus” for the UN Economic and Social Commission for Asia and the Pacific. And she wrote a working policy paper for CFR, for our Global Health Program, entitled “Managing the Health Risks of Climate Change,” which we shared as part of your background reading for this call. She’s also a clinician and served long-term roles in resource-poor primary care medical clinics, in Micronesia, the United States, and Central America.

So, Liz, thanks for being with us. I can think of nobody better to lead this conversation than you. If you could begin by talking about the relationship between climate change and health and provide an overview of the major health risks of climate change.

WILLETTS: Sure. And thank you so much, Irina, and to CFR for inviting me here to this panel. I wanted to open just simply stating I am daunted by the topic, as I think anyone would and should be, as well as the incredible expertise on the attendance list here. Wanted to briefly mention, I see experts in science, policy, law, diplomacy, anthropology, other socioeconomic fields, as well as higher education. And wanted to emphasize that my expertise and focus is on the space between. So the science to policy and the policy to practice, and how we mobilize ideas and people in new ways, how we analyze the policy architecture in which we have to work, apply knowledge, and make decisions. And so, the views that I am attempting to bring to this conversation and this community of practice are from a transdisciplinary perspective.

So thank you very much for tuning in. Andy Haines and I were asked to write a paper for the CFR on climate change and health security, as Irina mentioned, and specifically on the norms and frameworks used to consider both of these individually and in combination. So from this, there were several key questions related to what Irina just posed in terms of the health risks of climate change.

First is, what is a health risk in terms of global health security as we know it? Does climate change create health risks recognized under frameworks for health security? And to whom do these norms and frameworks and climate change and health security serve? And, for that reason, is it possible to address the health security risks of climate change based on who is served by the definition of health security? Are we considering the health risks of climate change across the full spectrum of international climate law? Now, at this time and 2022 to 2023, that includes health risks and impacts across three pillars: mitigation, adaptation, and loss and damage. Finally, what is the policy architecture for managing health risks of climate change at the global scale?

We set upon writing this paper to consider all of these questions. And for those of you who have begun to look at managing the health risks of climate change, what we find is we’re really working through several theories of change at the same time. We’re attempting to find multiple dimensions for transformational change in climate change and health, but we’re also looking to mobilize behavior change to address global, and expanding, and interrelated crises related to the environment and impacts of anthropogenic activity. So I want to just to frame the picture a bit with these attempts at collective action at change.

And the first we have, in 1997, the Kyoto Protocol under the UN Framework Convention on Climate Change. It aimed for collective action by charging countries with individual emission reduction goals. That had limited success. So 2015 with the Paris Agreement we made a new commitment to a new type of collective action to commit countries to a global temperature goal. That has also had mixed success—limited success. And so now we’re seeing other theories of change for how we shift our behavior, our consumption, our production, and our action to address climate change. And that includes through rights-based approaches, looking at, you know, creating a moral shift, and creating accountability for individuals and for states in terms of tools for litigation and agenda setting. At the same time, we’re trying to look through health agendas and find instruments to guide action on climate change.

So this spectrum of tools is being used at the same time and is becoming more and more urgent, and is very much related to the health risks of climate change and how we can address them. So I had also a couple of examples I wanted to bring to frame the problem as I see it, as one of mobilizing ideas and people in these science to policy, policy to practice spaces. We have loads of statistics on the health risks of climate change in terms of the emergencies we see, what’s happening in terms of droughts and floods, the bursting of dams, the air pollution, which in the United States has now come over like an umbrella across the country in terms of the wildfires we’re seeing in Canada. Then also, in other countries, the new outbreaks of infectious disease, dengue and malaria, and a whole host of other conditions that are higher priorities in other countries. There are tons of statistics. The news shows us new examples of these every day.

So the statistics I wanted to show here are related to the policy architecture that we’re working with to get a little bit more of a framing for how we’re addressing the health risks. So 198 countries participate in the UNFCCC, the UN Framework Convention on Climate Change, the global decision-making body for climate action. And the majority of those countries committed in 1994 to this space when the convention entered into force. Sixteen years after that, countries agreed to advance implementation by establishing a reporting mechanism on adaptation. And that was a means of galvanizing collective action and sharing of best practices for addressing the impacts of climate change. National adaptation plans emerged in 2010. In 2022 in an assessment only thirty-eight of 198 countries had national adaptation plans.

And only fifteen of those national adaptation plans were—actually had in place a monitoring and evaluation framework to assess if the plans were effective at protecting communities, habitat, infrastructure, and ultimately health and the social determinants of health at the individual and population level. This is one tool, but a big one. And I think these numbers show us that we’re not managing the health risks of climate change well, and/or we could say the framework to do it under the UNFCCC is not achieving the goal. In the interim, in the last years, health national adaptation plans, different NAPs—HNAPs, have emerged under ministries of health. This is the attempt of the health sector—ministry of health sector—to create a comprehensive framework for managing the health risks of climate change at the national scale. As of now, approximately seventy countries have some form of a health national adaptation plan developed or in development. So that’s 35 percent of countries. That’s still not getting the job done. And that is not under the UNFCCC. That is under the global health and health institutional framework agenda.

Another key statistic that I just want to bring out as an indicator that we haven’t really gotten this right, and that our health risks are significant and increasing, is this. Less than ten years ago, around 2005, a new term—indeed, a new emotion emerged to reflect, in English, the stress of our inability to address the impacts of anthropogenic activity on the global environment. In other words, the stress of encroaching planetary boundaries, that term is solastalgia. It’s the distress of a changing natural environment while being in that environment. Essentially, we have changed our emotional spectrum and our language because we have not figured out how to manage the health risks of climate change. And this really is a true indicator of whether or not we’re managing the health risks of climate change well or sufficiently.

So here comes a question is, are we addressing these under the UNFCCC climate regime? Are we addressing them under the global health agenda? Can we do it under both? In brief summary, climate change creates health risks that are emergent, immediate, chronic, and slow onset, and that affect the state of health of individuals and for communities, as well as the social determinants of individuals and communities. This is a tremendous risk. This is a global health security risk. So to go back to one of the framing questions for the paper we did to CFR, I can’t get to all of them in the time I have here but perhaps in the Q&A, I want to highlight a couple. And so let’s go back to the question of, what is a health risk in terms of global health security as we know it?

If we look at the definitions, norms, and frameworks for the field and institutions of global health security, “health risks,” put it in quotes, “are communicable. Health emergencies aren’t interoperable. They are focused on addressing communicable risks.” Climate change is not considered a health risk or a health emergency under the definitions, norms, and frameworks for global health security. Similarly, we don’t actually know what a pandemic is. We operate as if a pandemic, which is a health emergency in global scale, is merely communicable.

Yet, global environmental changes have health incidences that are worldwide, multidimensional health hazards are hitting most countries, 99 percent of the global population breathes air pollution. The UN special rapporteur on the environment calls the realities of chemical exposure a silent pandemic, because there’s this universal exposure to over five thousand chemicals, including the ones that reprogram our physiology and are heritable across generations. These are not considered pandemics. Planetary health and encroaching planetary boundaries do not fall under the definition or framing of pandemic, or the institutions aimed to address pandemics. And that includes climate change.

So a concluding question there is, will we achieve global health security if we do not have the right scope for the definitions, norms, and frameworks, and if we do not include climate change in it? Major institutional structures that we looked at have not approached this gap. The International Health Regulations, the scope of the Global Fund, although in part they’re looking at that, Centers for Disease Control, the Global Health Security Index, USAID maintain a robust paradigm of global health security that does not include climate change. In the new negotiations for a pandemic instrument under the WHO, some call it the pandemic accord, there are brief provisions on multilateral environmental agreements for climate and for biodiversity. But over many, many months and rounds of negotiations, these provisions have not developed or advanced. It’s unclear whether they’re going to move forward if the pandemic accord moves forward.

So this is a brief highlight to indicate our architectures are still operating in very significant silos. And I would just conclude by saying it’s—in terms of climate change and health, it’s not enough to frame and create arguments for health co-benefits of climate action. We need to change the definition, the norms, and frameworks that make up the policy architecture in which we work, move, mobilize, and act. And there’s a tremendous amount to do. So over to you Irina, to see if we got that first question. (Laughs.)

FASKIANOS: (Laughs.) Thank you so much, Liz. That was a fantastic overview for all of us. And now we’re going to turn to our group.

(Gives queuing instructions.)

So with that, I am going to take the first question from Pam Chasek. She has raised her hand.

Q: Hi, can you hear me?


Q: Hi, Liz. Pam Chasek. For the purpose of this, Manhattan College, but also executive editor of the Earth Negotiations Bulletin.

One of the big things that we find, both at the domestic and the international level, is this notion of protecting one’s turf and the siloization of policies. And we see that definitely with this intersection of health and the environment, or specifically climate change, where the two sides don’t talk to each other as well as they should. And that integration of health concerns into the UNFCCC, as well as bringing climate change to the WHO. But the same thing happens at the national level with regard to ministries. And so I’m wondering if you have any recommendations for how we can cross those silos in this case and also these recommendations may go elsewhere. Thanks.

WILLETTS: Shall I take that one, Irina, or?

FASKIANOS: Yes. Let’s—I like going one by one, so that we—

WILLETTS: So, before I answer anything, I would like to say that Pam has been a mentor of mine. And so when I said I might be a little humbled and intimidated by the guest list, I would say you’re—a true expert has asked a question here. Thanks for attending, Pam.

This question of the national-level integration is really the crux of the problem, because we can’t move implementation, you cannot fulfill a multilateral environmental agreement, unless you have robust implementation. And that’s going to depend on integrating at the national level. And I’ll also answer—in addition to this question, I’m going to answer one I saw on the chat related to—let me see if it’s here—can nations differentiate between natural and climate change occurrences in their actions?

And so if—first of all, in terms of resources, many countries don’t have the personnel, the human capacity, the financial capacity to think about these things in silos. They have to get together. And so addressing climate change, environmental issues, and health issues all at the same time makes financial sense. It’s really a matter of how do we shift those mandates? How do we get budget lines that cross ministries of environment and ministries of health. If ministries of health are developing health national adaptation plans but don’t have a budget line to act on them, they’re not going to move forward. And so there has to be a bigger shift at looking at the architectures at the national level, like Pam pointed out, and how the ministry of finance is going to mobilize them.

And there are other ministries that are involved too. Food systems are the core of many environmental health problems. If the ministry of agriculture is not involved there, if there’s not a health component to the mandate of ministry of agriculture or if there’s not a climate component, we’re not going to address these intersecting problems. But the increasing issue here is national problems, national environmental health risks, are being reflected also at the planetary boundary level. So fulfilling a multilateral environmental agreement should help address planetary boundaries on climate change, should also help affect interrelated changes at the national level. It’s a tall task. It involves a lot of capacity building, looking at language, looking at the capacity of health. Can health move beyond the scope of infectious disease at the national level? Can the environment move beyond singular foci? It’s a huge capacity problem. And I think it’s a true area to invest more time and money.

FASKIANOS: Thank you. And the question that you pulled from the Q&A box was written by Nicole Ambar De Santos, who’s an undergraduate student at the Washington University in St. Louis.

So I’m going to take the next question, a raised hand from Mojúbàolú Olúfúnké Okome at Brooklyn College.

Q: Good afternoon. Well, this is a subject that every part of the world is concerned about. I spent the last year in Nigeria. And there’s a National Institute for Policy and Strategic Studies. And climate change is one of the thematic areas that they are looking at to advise the Nigerian government on policy that should be made. You know, I agree with you that the norms, and architecture, and framework should change. And that the responses right now are not—they’re woefully inadequate. But who’s going to lead the change? And then also, whom should we hold accountable when inadequate, and really ineffective policies are made? Even the very small baby steps that have been made are often walked back when it comes to committing resources to do the work. So how really can the idea that this change is not only necessary, it’s imperative—how is it going to get through all our thick skulls on this, because it’s very frustrating. There are all kinds of—there are many devastating climate change-induced catastrophes. Floods, you know, fires, and all that. And they kill huge numbers of people. The pandemic is still with us, you know, although it’s now controlled a bit, and there will be more in the future. So how do we really take this seriously and who leads the change?

WILLETTS: Thank you so much for the question. And I think I hear the urgency and importance in your voice, and the interest in solving this problem. How are we going to do it? And I would say, my first thought when you say, who is going to lead? I would say, as someone who’s multiple decades into life, the energy and momentum of youth around the world, including their presence at events such as the UN General Assembly, the UN Framework Convention on Climate Change, the Global Youth Biodiversity Network—massive momentum from youth who are not only motivated by, for example, solastalgia and eco-emotions, but they come equipped with information, and data, and tremendous energy to affect change at every scale of government.

It is overwhelming. It is bewildering. It is impressive. And I think the more we can identify and equip those youth leaders, the more we are going to affect—inspire ourselves and fight for that change. This collective action issue, as I mentioned, 1997 the Kyoto Protocol, 2015 the Paris Agreement, they’re not working very well. But now we’ve got this enormous campaign of youth energy. Let’s see what they can do to help us figure this out.

You asked another question. And I wanted—I’m trying to remember what it was related to motivating action, but it made me want to raise the—kind of recall the human right to the environment, which was adopted under the UN General Assembly last year. Oh, accountability. You mentioned accountability. So if we’re trying to get accountability for individuals, for stakeholders, and to create a framework for accountability for states and businesses, taking a greater look at the UN human right to—or, everyone’s human right to a clean, healthy, sustainable environment, a rights-based approach that comes with a framework of principles, is a really good start.

Because it shows what stakeholder—what information stakeholders should come to the table with to address these issues. It also shows what obligations states have to provide that information so that we’re making better consumption and production decisions, that we make better consumer decisions, that we hold businesses accountable to an agreed framework. That’s at state level. It could be kind of mobilized into the city level. It’s agreed at the global level. Rights-based approaches are a real—considered to be a real tool and the necessary part of our theory of change. So that needs to be part of.

And then in terms of leadership and costs, I think businesses are already paying attention to these details. And the infrastructure industry is already looking at rules and whether it maps out to cost ten years later. If they are only putting in $100,000 to make sure they meet the metric related to an airport resilience standard, but they can see ten years down the road the cost is going to be a million, they’re investing, you know, $200,000 to 300,000 (dollars) now to prevent the other $700,000 of costs they’re expecting in the future. How can we make those case studies more obvious? Maybe that’s part of the toolset.

FASKIANOS: I’m going to take a written question from Jeffrey Sturchio, who is visiting scholar for the Institute of Applied Economics at Johns Hopkins.

How can COP28 take best advantage of a planned day on climate and health? Or will this just be a day devoted to talk, with no subsequent actions on climate and health?

WILLETTS: This is a great question. I’m really glad that you asked this, Jeffrey. And I think I will answer it by saying what it should not do. What it should not do this Health Day is be merely a publicity. A publicity is useful at a traditional academic business conference. A publicity is not optimizing the potential of an intergovernmental negotiation. The UNFCCC and COP28 is an intergovernmental negotiation. It’s not a normal conference. So anything related to health and Health Day should recognize this is climate law. This is the circus of international environmental law. How do you impact that? How do you impact the stakeholders and the attendees there?

If the outcomes and conversations of Health Day don’t have a lot to do with international environmental law and the decisions negotiators need to make this year, it will not maximize its impact. The more we can connect health conversations and commitments to the actual negotiations on the agenda, the greater likelihood there’s going to be impact, the greater likelihood they will be heard by the influencers in the room, and the greater likelihood that going into 2024 we’re shifting the conversation, because we’re marrying the conversation. The outcome of a health day may or may not be a formal commitment at the global level. If it takes the nature of being an agreed commitment at the global level, to an institution, to a forum, to the UN, it may have greater impact than if countries’ ministers of any sector commit to their own efforts back home, which will only translate to political commitments that have short timeframes.

So a commitment to a greater forum, to parts of the UNFCCC, if there’s recognition of that commitment within the COP28 outcome then what you’re doing is you’re entering the law space and you’re creating a synergy there. And that that would be my thinking on that.

FASKIANOS: Terrific. Thank you.

I’m going to go next to Fordham University’s International Political Economy and Development program. Please identify yourself, and there you go. You’re unmuted.

Q: Thank you. I’m Genevieve, again, in the IPED program at Fordham. Thank you for being with us today, Dr. Willetts.

So my question is when we look at the negative effects of climate change on human health we often see asymmetries in the severity of who is affected because not all voices get an equal say at the table. So what suggestions do you have for policymakers in better mitigating risk for indigenous and/or marginalized groups?

WILLETTS: That’s almost a technical question, in some ways. I could answer that in a science direction and a policy direction and kind of in a human catalyst direction, and my first thought is to think about science.

So I worked with WHO to develop the WHO review of IPCC evidence last year, essentially looking and reading the AR6 as a clinician and then translating it into a public health document that could be interpreted in the categories—the normal categories for public health and in terms of medical diagnoses, trying to understand it in terms of global burden of disease.

So to answer your question how do we create better parity to address the risks, one way to do that is to really mobilize science from the communities that are being affected. That is a gap in the current IPCC.

If you look at where most of the research comes from or who’s performing the research or the health conditions assessed we’re not as broad as we need to be. We’re not looking at necessarily the most marginalized and then we’re not translating the science for the most marginalized into policy action.

Someone else in this Q&A has touched on nutrition so I just want to use this as an example. If you look at the IPCC projections for climate mortality they have—they have three conditions that are the risks—are the greatest risks for mortality. One of them is childhood malnutrition.

That is a condition that low-income countries and countries in vulnerable states are going to face much more than higher income countries. Malnutrition, top three for climate mortality. So food systems are critical. And, yet, if you look at how food systems and food policy has been addressed under the UNFCCC it’s not looking to address the kinds of impacts on food systems that could be very meaningful, especially for Global South and low-income countries where they’re going to be really hit hard by this.

Food systems need a thread of consideration for mitigation, the cause—30 percent of emissions, 8 percent of which are from food loss and waste. Adaptation, looking at these health impacts; malnutrition, how to deal with that; how to deal with the malnutrition and chronic disease implications of mass migration; how to deal with loss and damage in food systems, the fact that economic and noneconomic losses greatly center on changes and disruptions to the agricultural sector; this is not being done to any significant level. And if we really want to address some of the greatest health impacts for marginalized communities including—I believe you mentioned indigenous communities—this needs to be a better focus. And you also expressed your question as not only the subject, like, dealing with the problem but getting the voices to the table.

I think there have been strides in the last years to build stakeholder voices in these spaces and I look forward to seeing what COP28 will bring to the table, especially since there’s more literature coming forward that’s recognized in health journals and other places, that’s bringing indigenous scholarship to the table.

So I look forward to seeing more and more of that and how Health Day may highlight that, and I hope it does.

FASKIANOS: Fantastic. I’m going to go next to Brisa Oliveira de Avila. If you could accept the unmute and identify yourself that would be great.

Q: Hello, everyone. Yes. So my name is Brisa. I am in the master’s program with the School of International Affairs at Penn State.

And I was wondering what are your thoughts. We’ve been seeing, you know, recently with these heat waves and such how this impacts, of course, all of us in the day-to-day life and I’ve been seeing a lot of movement around how this impacts particularly workers, right—either workers from, you know, obvious—agricultural and stuff like that who were directly impacted by heat but also, you know, us who work maybe in offices and such.

How do you feel that it adds to the policy the fact that this impacts private businesses, private stakeholders who are maybe the forces hiring all these people and they’re responsible for them and, you know, if they have—you can consider or not that this is a work environment-related accident, right, in the workforce or, you know, how long can we wait possibly for them to start putting up policies privately, let’s say, and how that affects, you know, in the more broad sense of the global health because, you know, maybe we’re going to have to start locally to then reach a global level in this. And not only work, but, you know, every other private institution that is already getting a toll because of this climate change.

WILLETTS: Thank you for the question.

I think it’s eye opening for me just because I don’t spend a lot of time on the occupational policies. But it’s really an interesting area because—I think you said you were from Penn State. So the workforce issues in Pennsylvania may be very, very different than what is happening in sub-Saharan Africa, for example, agricultural or physical labor workers who deal with environmental conditions on a daily basis.

But if there are drastic changes to the ability of the workforce to engage and support the economy, as you said, worldwide that’s a really important topic to start talking about but also to start using in the tool belt and how do we do that.

I think I’ll defer the rest of the question just because I don’t have the statistics and literature on that. But how do we think about the workforce and use statistics related to the economic impact of employees to affect change, it’s a good question and how can the health sector, since I come from a planetary health, public health, global health background—how can the health sector get behind that. It’s a good question.

FASKIANOS: Thank you.

So I’m going to take the next question from Esmirna Mateo, who’s an undergrad student at the City College of New York, who has a few questions based on your response to the question about who can make the change. And Esmirna comments: It sounds like the weight or leading for a change burdens the youth. What can seniors who have worked years in government and have connections do? The youth care because it will affect them in their future so why can’t those who already have power access to make change also be advocates?

WILLETTS: It’s a really interesting social question and I’ve seen it before. A couple of things come to mind.

One is this idea of burdening youth and certainly that is an issue. Intergenerational equity, the idea that future generations are inhibited or harmed by activities of today and kind of business operations of today, pollution of today, is a big deal.

So at the same time that we’re seeing especially among youth this eco-anxiety, solastalgia, new environmental psychology field. We’re also seeing tremendous energy and interest in action and engagement and creating change.

So we have these two things, really, coming at the same time. How do we create bridges there? I would say if they’re—if you’re an influencer, if you have an impactful post in science policy law, community development, any of these places, create an opportunity to bring in sharp, ambitious youth to be part of that.

It’s a struggle to have a burden that you cannot address. So if we are burdening youth then perhaps the first response is give the voice and the opportunity for action to youth to kind of contribute to handling this—these issues at every scale.

This is a—I come with a transdisciplinary view. There are tremendous gaps between disciplines. If finding new ways for change is of interest and within the scope and opportunity of yourself or other people what kinds of disciplinary bridges can be made and that’s a second place I would advocate for real impact—real impactful change as starting points.

FASKIANOS: Thank you. I’m going next to Clemente Abrokwaa with a raised hand.

Q: Hi. Thank you so much for this wonderful talk on this important topic.

I have two questions. One is actually not a question; I’m just wondering about that. But the first one is looking at when the topic is important and looking at the conditions in Africa the health sector is in shambles.

They don’t have—even in some countries, you know, the hospitals don’t have even beds and medication is a problem. So I’m just wondering, how serious this—the climate health—you know, change in health, how seriously it can be taken, you know, in Africa by African leaders when, you know, the immediate need is for people to get medication or the basic needs of health.

My second question is actually not a question but if you could elaborate on the—and you mentioned the pandemic accord, just what it is just for me. Yeah. Thanks.

WILLETTS: Thank you for the question and I couldn’t agree more. I think environmental health risks take back seats to other issues, especially issues that might be more emergent or immediate or for which we have real treatments and expertise to deal with.

That being said, I think the—you know, many health systems in those situations with low resources, lack of beds, can’t deal with a pandemic either. So if our definition of global health security is only focused on pandemics, which we can’t deal with well, and isn’t scoped to consider other environmental health risks it’s almost shooting ourselves in the foot to really understanding what we’re dealing with or how we’re trying to spend money.

How can countries and health systems that don’t have a lot of resources even begin to grapple with the idea of climate change? Perhaps there are different ways to look at it even if there aren’t immediate resources to deal with the health problems such as cost.

Some systems may deal with really obvious problems such as droughts impacting the actual infrastructure of health centers. Some may deal with destruction of buildings and things like this. Some may deal with limitations to employees showing up to work related to XYZ other reasons.

But is there a way to create more cost analysis of five-, ten-, fifteen-year scenarios and a scoping of the burden of disease related to the environment that makes sense and is useful to those types of health systems.

There’s tremendous opportunity to look at global burden of disease of climate change—global burden of disease of any encroaching planetary boundary but of climate change and then to also look at the national burden of disease due to climate change. We’re not doing that, and I think the IPCC review did a tremendous amount of work—a thousand pages, so many researchers, so many volunteer expert reviewers, so many journal articles.

But still it’s skewed. We don’t yet have a good regional breakdown, a good national breakdown of the kinds of risks that are going to be faced and that could be extremely useful tool to mobilize and invest in.

And then the other question I would just pose in there is, you know, one of the real risks of climate change, as with various environmental natural hazards, is migration and then how does that play into stability. Political leaders, national leaders, governments, are—will need to think about stability of government and political circumstances in the face of climate change.

The numbers for projections for migration are astounding, and the other thing that isn’t mapped out related to that is where are people going to go. So one environmental health risk, one natural hazard, could mobilize entire communities, entire subregions, to another subregion, kind of transferring a bit of instability and risks to another place and the health burden that comes with that.

And we—I think these are undeveloped topics, and as a clinician and public health professional the main thing that gets ignored is not the emergencies, the kind of physical traumas, the injuries, diseases that need antibiotics, and things like that.

The things that are ignored are what happens if all the schools are destroyed just like they happened in Pakistan? What are those kids going to do? What is that going to affect for their cognition, their cognitive development, their emotional development, the cohesiveness of their families? What is it going to mean for their risk of chronic disease?

Typically, if there’s malnutrition in the first two years of life, so under nutrition, that might lead to stunting or wasting or just severe malnutrition, the risk of developing diabetes and metabolic diseases is far greater for that population.

So if you have whole communities migrating related to environmental threats there’s a huge health problem that may be addressed with kind of emergency humanitarian operations in the first months or year.

But then there are sequential health issues. So social determinant of health issues, chronic disease issues that are not going to be addressed in our current framework and for which wherever this mass migrating population goes to that health system is not going to be ready for that, and there are all sorts of details that are coming out in the literature probably under assessed but the rates of domestic violence tend to go up.

What does that mean for women’s health care? What does that mean for reproductive health? What does that mean for pediatric health? All sorts of really interesting questions.

So it gets very complex very fast and I would say we’re just at the kind of a smidge of development of understanding health beyond a few diseases and looking at it as a spectrum in terms of the state of health and then barely even touching the social determinants that are going to come after that.

That’s going to be expensive, it’s going to have issues for stability, and as you can tell there’s so much to talk about in this issue. So I really thank you for that question.

Quickly, the pandemic accord—out of the COVID-19 pandemic the mad rush to figure out how to deal with health emergencies, how to deal with pandemics because the rollout of response and production of vaccines and identification of all sorts of metrics related to surveillance was quite slow and poor and not cohesive and not equitable across countries.

And so the attempt was to create a new instrument, a new kind of health law, if you will, to govern the operations of response related to pandemics under the interpretation that they’re a communicable disease.

So this is a really interesting big-picture topic because we don’t have a clear answer on the origins of COVID-19. Huge focus on zoonoses and that’s related to land use change, biodiversity loss, climate change, and all sorts of other environmental drivers.

So if that’s the case and a pandemic of infectious disease has caused such a problem and our response to that is to make a treaty that addresses just this we haven’t really addressed the full scope of health risks that could come from various environmental changes and the—so inherently the—you know, health experts are trying to figure out how to create a better operating framework and to consider some drivers although climate change is only a very limited piece of that right now.

It’s supposed to conclude in the next year but there’s a lot of debates on how effective it can be and whether it will conclude on time.

FASKIANOS: Great. I think that was Sheri Fink’s question, an adjunct associate professor in the School of Public Health at Tulane University. And we have a similar question from—or in the same vein from Marybeth MacPhee, a professor of public health at Roger Williams University: If national global approach is to addressing climate change and health, what is the potential for taking regional approaches, particularly for adaptation? That level seems to make more sense for systems problems and WHO has a regional architecture in place.

WILLETTS: I think the interest in regional approaches is strong. I think it has not been developed sufficiently on the environment or the health side, and specifically if we’re looking at planetary health risks it has not been developed to consider kind of integrated environmental health risks and the spectrum of risks.

But it’s important politically. Regional approaches can address transboundary issues so any kind of air pollution coming from agricultural methods, dust that goes across different borders, floods that go across different borders, coastal issues that go across. So many different problems actually need a regional approach that it needs to be developed more and politically that can be very advantageous for kind of a sharing best practices platform so that national governments can see how to take better action collectively and efficiently and then also for governments to create kind of a collective position when we’re trying to create global agreements and advance global discussions such as under the UNFCCC in one direction or another. Having a regional approach can be impactful if we can get there.

In terms of health, some of the structures for development and—economics and development, structures for kind of environment sustainable development are more advanced than some of the health structures and some of the health structures are more focused on really narrow areas. The whole one health approach has been adopted as a term in a number of circles including global circles, national circles, looking at regional circles.

But, again, it won’t be able to address the full spectrum of challenges and currently doesn’t address climate change unless it really expands to a broader scope of environmentally comprehensive one health and—or even to take forward some planetary health ideas.

FASKIANOS: Fantastic. All right.

We’re going to go next to the raised hand from Melissa Valeria Bisner, and please identify yourself, Melissa.

Q: Hello. Melissa Bisner here.

FASKIANOS: And what university?

Q: Fairleigh Dickinson University.


Q: I have a question, though. Does global warming have something to do with climate change? Because I think it does because, you know, like, the—I think, like, the weather is constantly going, you know, like, up and down. Like, it’d be warm the one minute and then it’d be cold the next.

FASKIANOS: Great. Thank you.

WILLETTS: Thanks, Melissa. Yes, absolutely it does. They are connected.

FASKIANOS: OK. Let’s go next to—I’m looking at all the—we only have a few minutes left so where should we go? OK. From Ava Eszenyi at Indiana University.

The United States is a complex capitalist market that will always favor profit. How can we combat corporate lobbying that prevents climate change and regulation?

WILLETTS: Well, this is a PhD topic. I would use a positive example that will be interesting to watch and I recommend watching it for the results.

This year the UNFCCC has made a requirement that any attendee to COP28 disclose, essentially, whether or not it has—that that person is representing a corporate interest, specifically the fossil fuel industry.

This is fairly significant because in the past up to—I think someone actually calculated this specific number—660 lobbyists from the fossil fuel industry had attended UNFCCC climate COPs in the past.

So your question is about how do we make change and how do we face the real numbers and power of lobbyists from industry and I think the UNFCCC this year is attempting to try to do that by making it more visible because, essentially, for those who have never been to the UNFCCC it’s just a big arena, almost like a big group of tents with a lot of people wearing badges with their name on them and you don’t necessarily know where someone is representing. Or they may be affiliated in a different way than their badge—their delegation indicates.

So this is a really interesting development. There is a lot of industry voice at UN environment meetings. It’s not just the fossil fuel industry. The food industry, the pharmaceutical industry, all of these companies have real kind of weight in the game in terms of decisions that are made to change rules or frameworks or commitments or obligations.

So, you know, according to the SDGs a big focus was on partnerships, multi-stakeholder partnerships—SDG 17. This perspective that change cannot come unless everyone’s at the table is present. But how can that be shaped to make sure that there’s balance and parity?

I think in the health sector this is quite interesting because there are some health players who’ve been involved in quite a few UN environmental meetings but the health professionals themselves such as clinical researchers, the folks on the front line, have not and so now we’re in this new stage of bringing those voices in to help balance out the other voice of kind of a market-based approach.

How can we do that more? How can we make it more visible and how can we make sure that attendance of these decision making spaces such as global negotiations has a balanced multi-stakeholder presence?

I think it’s a great question and keep an eye on it. We’ll see what kinds of reports or media articles come out of that visibility of who’s who and who’s there.

FASKIANOS: Well, unfortunately, we are out of time. We have lots of questions, written questions, and raised hands. I’m sorry that we can’t get to you all.

But, Dr. Liz Willetts, this has been a fantastic hour. Thank you for sharing your analysis, information, insight. We really appreciate it and we look forward to following your work at Harvard. Thanks to all of you for being part of this conversation.

As a reminder, the next Academic Webinar will be on Wednesday, October 4, at 1:00 p.m. Eastern Time. Tamar Gutner, associate professor of international affairs at American University’s School of International Service, will talk about the international financial architecture.

In the meantime I encourage you to learn more about CFR’s paid internships for students and fellowships for professors at CFR.org/careers. You can follow us at @CFR_Academic on X and visit CFR.org, ForeignAffairs.com, and ThinkGlobalHealth.org for research and analysis on global issues.

Again, thank you for being with us today and thank you to Dr. Willetts.

WILLETTS: Thank you so much for having me and for listening to my views. I really am humbled by this attendance list here today. Thank you.


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