Social Issues

Jessica Stern, U.S. special envoy to advance the human rights of LGBTQI+ persons, discusses the current state of LGBTQ+ rights globally. Ruth Messinger, global ambassador for American Jewish World Service, moderates. TRANSCRIPT FASKIANOS: Welcome to the Council on Foreign Relations Social Justice Webinar Series. I’m Irina Faskianos, vice president of the National Program and Outreach here at CFR. This series explores social justice issues and how they shape policy at home and abroad through discourse with members of the faith community. As a reminder, this webinar is on the record and the audio, video, and transcript will be made available on CFR’s website, CFR.org, and on the Apple podcast channel, Religion and Foreign Policy. And, as always, CFR takes no institutional positions on matters of policy. We’re delighted to have Ruth Messinger and Jessica Stern with us for today’s discussion on “Global LGBTQ+ Rights.” Ruth Messinger will moderate the conversation. She is the global ambassador for American Jewish World Service. She was the president and CEO of the American Jewish World Service, a position she held from 1998 to 2017. And prior to her work with AJWS, Ruth worked in New York City government serving as a city council member representing the Upper West Side and later as Manhattan Borough president. She’s also a member of CFR’s Religion Advisory Committee, a member of CFR. And she is going to set the stage for this conversation, drawing upon her experience of the work that the American Jewish World Service has done with the LGBTQ+ community around the world, have a conversation with our distinguished speaker, Jessica Stern, and then we will turn to all of you for your questions which you can either write or raise your hand. So with that, Ruth, thank you for doing this. And over to you to introduce. MESSINGER: OK. Thank you so much, Irina. And I just want to say to the Council, I think many of us out there who are members or attendees of Council functions feel a very special place for the fact that you have a social justice stream of work, that you feature webinars that talk about global social justice. And in this instance, and my guest says on a couple of other recent instances, you have highlighted the issues of LGBT concern globally, because not enough people focus there. We have a very special guest. I’m going to introduce her to everybody and ask her a couple of sort of open-ended questions. And then, as Irina mentioned, later in the discussion I’m going to talk a little bit about the American Jewish World Service work in the same arena. But Jessica Stern plays on the big scale. She was appointed by President Biden, and she is our country’s special envoy to advance the human rights of lesbian, gay, bisexual, transgender, queer, and intersex persons. And that means leading the efforts of the United States to protect LGBTQI people globally, but also to advance their interests. So to protect them from discrimination and violence on the one hand, but also to see if they can—if she can promote advocacy for them to be treated equitably in their own communities. Jessica comes to the State Department with an amazing history working on LGBT rights and on human rights. She led Outright International, which is a global LGBTQI+ human rights organization. She was its executive director for ten years. She had observer status at the U.N. which is. again, really important. And she built the world’s largest COVID LGBTQI+ grantmaking program. She also quintupled the budget of her organization, something we were almost able to do at the American Jewish World Service. But before this, Jessica was for many years a researcher and advocate at Human Rights Watch, at Amnesty International, and at the Center for Constitutional Rights. She has a long history of multilateral engagement, so I’m not going to actually read all of that. I think she’ll let us know some of the groups that she works with internationally at the U.N. level and on behalf of the United States. Because I don’t want to take too much time away from her, but I do want to say that she provided the first LGBTQI+ testimony in a U.N. Security Council hearing and has frequently served as an advisor to the U.N., including as a founding member of the U.N. Women LGBTI Reference Group. She is a published author. She is often cited in the media. She is the recipient of numerous honors, including from Crain’s, Gay City News, and the Metropolitan Community Church—well-loved by many of us. She is an adjunct associate professor and has taught LGBTQI+ rights at Columbia University’s School of International and Public Affairs. Jessica, it’s quite a—it’s quite a bio, and it’s quite a dedication to these issues on a global scale. And I guess really the first question, because it’s a question that I think the public sometimes asks, is why are LGBTQI+ rights a priority in United States foreign policy? STERN: Thank you so much for that warm welcome, Ruth. And I’m a big fan of yours and have admired your career over a long time. So I feel like I am really very fortunate today to have the opportunity to be in conversation with you. I would say to have you all to myself for an hour, but all to myself plus fifty of our friends listening, and everyone who will read the transcript afterward. So, you know, thank you for this opportunity. And I just also want to thank the Council on Foreign Relations for increasing its commitment to LGBTQI-inclusive foreign policy. This is now my second opportunity to speak at a CFR event in this role, which is really a great sign about how CFR is trying to educate its members and educate the world, really, about why LGBTQI+ rights have to be taken seriously. So why is this a U.S. foreign policy priority? I’m so glad you asked that question. Some people think—hopefully, you’re getting applauded in the background, Ruth. You know, some people hear LGBTQI issues, and they think: Why do those people get so much attention? They’re talking about special rights or new concepts of rights. And that’s just not the case. What we’re actually trying to do with U.S. foreign policy is tackle the overrepresentation of LGBTQI+ persons among those who experience discrimination, violence, stigma, bullying, exclusion in schools and healthcare settings, and are denied recognition before the law. And so we try to give attention to this issue set to redress those wrongs. And we find that LGBTQI issues are literally connected to every single part of U.S. foreign policy. If we’re trying to eradicate HIV and AIDS, then we have to be working on LGBTQI issues because there’s an overrepresentation of men who have sex with men among key populations. If we’re talking about national security, then we have to recognize that LGBTQI people are often among those targeted by extremist organizations, and terrorists. And actually, LGBTQI+ people can be almost like a canary in the coal mine and a bellwether of—that can be used for atrocity prevention. Or maybe one more example is American economic interests. People sink or swim together. And so if LGBTQI people are prevented from accessing the formal labor market, they’re the last hired and the first fired, then that has an impact not only on American economic prosperity, but on all of our trade relationships. So there’s so many ways that this intersects with the U.S. government’s priorities. And I think President Biden and Secretary Blinken have been very clear in saying: We shouldn’t just be talking about LGBTQI+ rights in June at Pride. We should be doing this work year-round. MESSINGER: I think that’s an amazing answer. And I would just—we’re going to continue to talk about your work in a minute, then leave the AJWS work to a little later. But I just loved your answer, because I get this often on behalf of American Jewish World Service. And I get it from people who love the organization, love the idea that we do international human rights at the grassroots level, but then when they hear—some of them—that we have a big LGBTIQ+ portfolio, their response is, well, I care about those rights too, but when it comes to the rest of the world there are other things that are more important. So why is it you have such a large portfolio? And of course, the answer is precisely what you said. If people are high on the list of those who get discriminated against or treated with various forms of intolerance or oppression, then that is the mark of a society that is not honoring human rights. So I liked your talking about canary in the coal mine. So now I’m going to ask you the toughest question, which is: When you think about the work you’ve been doing for well over a decade, and now the perspective that you have as a member of the U.S. State Department, you know, what’s your—what’s your report on the state of the world for LGBTQI+ rights? How are we doing? STERN: It is the hardest question, actually, because people want to hear that the moral arc of the universe, you know, bends towards justice. And it does, I really believe that. But I want to be really clear that it is not business as usual in terms of homophobia, transphobia, biphobia, interphobia. We have two things happening simultaneously. On the one hand, strong and vibrant LGBTQI activists and organizations around the world and amazing allies like AJWS. We’ve made remarkable legal and policy progress, including over the course of my lifetime. And, you know, if you’ve lived in the United States, then you know there was a time when marriage equality was almost unfathomable, or that, you know, Pride events were unfathomable. But, you know, really over our lifetimes we’ve seen LGBTQI rights increasingly be socially accepted, so much so that we actually managed to see bipartisan support for the Defense of Marriage Act in Congress. And of course, Congress doesn’t agree on that many things. So it’s really quite a testament to— MESSINGER: Especially now, when they don’t agree on anything. But yes. STERN: But the truth is, we’re also seeing the weaponization of LGBTQI+ issues, to advance other agendas—like undermining democracy, like turning out conservative voter bases, like distracting from economic inequality, the price of food inflation. And so LGBTQI+ rights have also become very visible. In fact, I would argue that LGBTQI+ rights are more visible than the community itself has political power and substantive equality. And so just a few examples. Last night I went out to dinner with some friends. And one of my friends said to me, did you hear about the attack that just took place in Beirut on a group of LGBTQI activists? And what happened was a right-wing extremist group, I believe it was called the Soldiers of God, had attacked LGBTQI people who were marching through the streets of Beirut, pelting them with rocks and stones, causing three people to be seriously injured enough to go to the hospital. And part of what was so disconcerting, Ruth, is that I didn’t even hear about it until last night. And the reason I didn’t hear about it is because you can’t keep up with all of the acts of violence and all of the attacks on LGBTQI+ people’s rights, even in my position. And so I want to be really clear that the state of the world for LGBTQI people is crisis. And we need more friends. And we need more allies. And we need to make clear—and this is part of why I think this conversation really matters—we need to make clear that when we hear about attacks on LGBTQI people, it’s not just somebody else’s problem. People don’t actually have such strong views about such a small minority for no reason. LGBTQI people consume a great deal of political airways in country after country around the world because we’re used as a political symbol. And so I’m very worried about the state of the world. And if I had one ask of people listening, and I know there are a lot of experts in in the room today—the virtual room, and I hope to that they’ll jump in with their questions and wisdom. But, you know, one of my asks would be: How can we make clearer to allies what’s at stake for them in protecting LGBTQI people? This is not a niche issue. This issue set affects all of us. MESSINGER: Well, I think—I think that’s a fantastic perspective. I think that we—you know, some of this is starting at home. We also need to make it clear, given some of what’s going on in the country right now, I suspect, that the fact that you exist—I don’t mean you, personally—but the fact that you exist in this job, that this is a thoughtful and central concern of the United States State Department, drives some members of Congress crazy, for not understanding that gay rights are human rights, for not understanding that these are, in fact, bellwether signs of how our country, as well as other countries, are or are not flourishing. So I love what you said. And I love your description. And we’ll come back to some of that later. I did just want to take a few minutes to note here the point-counterpoint. So Jessica is involved in representing the United States government through the State Department and looking at these issues globally. And as you’ve heard, when she does the state of the LGBTQI+ world it’s not so great. American Jewish World Service, as some people may be aware, is a is an individual, international human rights organization based on Jewish principles and values, but working exclusively at the ground level. We have grantee partners basically in the non-Jewish world across seventeen countries in Africa, Asia, Latin America, and the Caribbean. And I chose to ask if I could talk a little bit about our work for this specific reason that of our 522 grantee partners, 176 are working on issues of sexual health and rights. And of that group, most of them are at least somewhat involved with LGBTQI+ rights. And some of them are exclusively involved with those rights. And in this current fiscal year, we have granted over $3 ½ million to support LGBTQI+ work. And we currently fund 101 organizations in eight countries where that is their exclusive work. And I just want to say that that is for the same reasons that Jessica spoke. In those countries, whatever other work we’re doing, whatever level of—whatever you would like to call it—democracy and justice exists on the part of the government, this is a key indicator of whether or not the fundamental ideas of human rights are or are not respected. And to be very blunt about it, and Jessica will talk about this I’m sure some more, but in the world two-thirds of LGBTQI+ people have experienced some degree of violence. And in nearly seventy countries, being LGBTQI+ is a criminal offense. And in some countries, it’s punishable by death. So we choose—as Jessica works on global scene—we choose to fund these small groups, and I’ll give some examples later, but that are organizing, that are protecting the rights of their members, that are speaking up against their government policies, that are sometimes going to court. But that are often, as Jessica implied, just basically concerned with literally the physical protection of their members. So, Jessica, having said that globally the picture is, like, not as great as we’d like it to be, why don’t you next give us examples of some successes and where you’ve seen policy change, and where you’ve actually seen your role as representing the United States on these issues make a positive difference. STERN: Thanks for bringing in the dimension of the importance of civil society, and specifically civil society fighting for LGBTQI+ organizations, Ruth. I hope we’ll come back to that as a concept, because I don’t think this work can succeed without LGBTQI civil society organizations and allies having access to resources. But there are successes. There have been lots of successes, both in the mandate that I work on and, you know, on the world stage for LGBTQI+ rights. Let me just say, today there are five special envoys for LGBTQI+ rights around the world, which is a very good thing. Of course, there are roughly two hundred countries in the world. So there’s like a little bit of a gap between where we are today and where we want to be. But most of those positions are relatively new. So the trend is towards inclusion. One of the things I’m really proud of is the expansion of LGBTQI+ reporting in the annual Human Rights Report published by the Department of State. You know, if you aren’t familiar with the Human Rights Reports, they are an incredibly important source of information, sometimes the sole source of evidence used in asylum adjudication claims. And so it’s very important that we have robust LGBTQI+ information in them. And even though the department overall is streamlining the Human Rights Reports, because there had been less inclusive reporting than we would have wanted to see, our office has been able to expand that section, including issues as varied as corrective rape, conversion therapy practices, harmful and unnecessary surgeries on intersex persons, attacks on Pride festivities, the inability of LGBTQI+ organizations to legally register. And so I would say that if we continue in the vein that we’re going in, the Human Rights Report will actually become one of the richest data sources updated on an annual basis about the state of the world for LGBTQI+ people, which we’re very proud of. In March, my office worked with our Bureau of International Organizations and the U.S. mission to the U.N. to facilitate the second-ever Security Council Arria on LGBTQI+ issues. And you might be wondering, why does that matter? Well, it matters because what the Security Council says and does impacts every part of the U.N.’s work. It is the most powerful body. And if LGBTQI issues are not a part of its portfolio of work, then we’re being overlooked in the space where decisions are made and resources are allocated. Unfortunately, we haven’t gotten into the official sessions, you can imagine some of the governments that might have blocked those efforts, but the way we develop a mainstreaming strategy is through side events, among others. And the U.S. government made a number of pledges in that space, including about our commitment to increasing LGBTQI work in our broader peace and security agenda. I think another great example comes from executive order—well, I won’t—I won’t say it by number, because then I think I’m getting a little nerdy for the audience. It’s a nerdy audience, so that might be OK. But the president’s 2022 executive order from June, 14075, that actually asked the Department of State, USAID, Treasury, and the Department of Health and Human Services to develop an action plan towards working to ban conversion therapy practices around the world. So we released that action plan in May of this year. You can find it online. And it basically gives us a mandate to work to oppose these harmful and often torturous practices. MESSINGER: That’s fantastic. STERN: I’ll just end with one last example. You know, one thing that we’ve done that I think is really important, is we’ve also helped to give out some basic tools to make inclusive diplomacy easier. And this is very bureaucratic, but it’s through the effective use of bureaucratic tools that we ensure it’s not just one special envoy or one office that knows how to do this work. So we’ve massively revamped the annual Pride cable that we come out with so that every embassy understands the do’s and don’ts for how to defend and advocate for this population. MESSINGER: So I think that’s really important. And I would just—you know, to underscore what Jessica was saying about their work in some countries and how basic it is—just as one example. In Kenya, as a success story, we in the American Jewish World Service support the National Gay and Lesbian Human Rights Commission. And it took us a battle in the supreme court in Kenya to allow that group to register as an NGO, because the Kenyan NGO Coordination Board had decided that any organization that had the word “gay” or “lesbian” in its name could not be a member of its NGO panel. So, you know, talking about bureaucratically means to exclude and group on rights. And we won that battle. And then two of our grantees worked to put Dr. Dennis Wamalwa on the Kenya National Commission on Human Rights, which makes him the first openly intersex person to attain such a position in Africa. So it’s exactly what Jessica is saying, that even though she’s working significantly on a global level and at the interactions of the U.S. and other governments, that work is buttressed by the—by the unbelievable efforts being made by LGBTQI+ people and their organizations on the ground to affirm their rights and to tackle the bureaucracies in their own countries. Jessica, not to—not to leave bad news till near the end, can we just talk a little bit about the state of legislation in Uganda right now? STERN: Hmm. Many people in this conversation have been following the struggle of the LGBTQI+ movement in Uganda for a long time. There have been documentaries made about the community, including God Loves Uganda and Call Me Kuchu. And really, the work of the community to defend their rights has become an international story because LGBTQI+ Ugandans have felt that their own government wasn’t protecting them, and they needed support from allies around the world just to be safe. Unfortunately, the community took a major hit this year when President Museveni signed the anti-homosexuality act into law, which, I would argue, is one of the most extreme, far-reaching, and dangerous anti-LGBTQI+ laws in the world. And there are many reasons for this. But the government of Uganda already had criminalized sodomy. So this is really an attack on free speech, assembly, association, and allyship for LGBTQI+ persons. Just to name some of the provisions of it, if a landlord suspects that someone is LGBTQI+, they can’t rent to them and they have to actually report them to the police. In fact, anyone who suspects someone of being a member of the LGBTQI+ community is under a mandatory obligation to report them to authorities. So if I lived in Uganda and these eyeglasses that I’m wearing right now were to break or the prescription would become dated, I would have to decide do I feel safe going to my own doctor because that doctor could turn me in. So there’s no such thing as confidentiality, even in health care, even with your lawyer, even with your—a member of your clergy. So it’s incredibly unsafe. And one of the most ominous provisions of the anti-homosexuality act is that it effectively bans and criminalizes LGBTQI+ activism. So it makes it very difficult for LGBTQI activists and organizations to operate. Makes it very difficult for their allies to show up for them. And, of course, this is on top of criminal punishments for homosexuality that rise to life imprisonment and even the death penalty. So it’s quite extreme. We could go on about all the provisions of the law, but you get the gist. MESSINGER: Yeah. And I think I raised that not only because it is bad news, and I do want people to understand that there’s a lot of bad news on this front around the world, but also because this has been, like, a decade-long battle. We worked very closely with a fantastic LGBTI community, I think it’s like now ten years ago, who fought Museveni in court and stopped the passage of a similar law, or reversed it in the courts. And it was then not the law for a while. And so he’s gone back to, again, this fierce effort to enact it into law. And the law—as you pointed out—the law this time is infinitely more draconian. I did want to ask you one question. I don’t know how much it’s the case today, but I know that a few years ago it seemed pretty clear that some of the anti-gay sentiment was being stirred up by visiting American Evangelical pastors who either thought it was their job to spread their negative message globally, or—and/or, like, were being frustrated and not being able to get more anti-gay work going in the United States so they decided to go elsewhere in the world. And I know that at the time that I was on top of some of this, they were really poisoning the well by telling uninformed communities that gay people were all pedophiles and would literally kidnap and destroy their children unless they outlawed them. And I’m just wondering how much of that is still an issue, and if there’s anything that the United States government stateside can do to stop any of that activity. STERN: I just want to say, the argument that Ruth is pointing out—this notion that LGBTQI+ people are pedophiles, is an argument that I thought was maybe from my childhood, but wouldn’t be a reality as an adult, as more and more people come out, as more and more people realize that they have LGBTQI+ people in their family, in their congregation, at work. But actually, there’s been a radical resurgence of this argument. And it takes different forms. LGBTQI people are child abusers, kidnapping children, infiltrating schools, grooming children. And I just want to be clear: All of these are lies. They’re myths. And the speed with which these arguments—that take the exact same form—have spread from region to region is not a coincidence. And so I think your point is right, Ruth, that there are clearly U.S.-based right-wing extremists that are promoting these myths around the world and stoking the flames of anti-LGBTQI+ sentiment. Some of you may have followed that there’s an organization based in Tempe, Arizona that’s been labeled as a hate group by the Southern Poverty Law Center. I think so as not to give them airtime I won’t mention them by name in this space. But they traveled from Arizona to Kampala really on the eve of the signing of the anti-homosexuality act. And their executive director was, you know, standing next to the first lady, and apparently advocating for conversion therapy practices. So there’s two things that are true. One thing that’s true, is that U.S.-based extremists, many of whom have been discredited here at home, are exporting their strategies, U.S.-based arguments, and their money to other countries around the world and then trying to repackage them and sell them as African family values. The other thing that’s also true is that LGBTQI haters exist in every country in the world. So it’s not only that people are leaving the U.S. and exporting these ideas. There’s often an enabling environment in other countries as well, which can make for really toxic partnerships. MESSINGER: Right. And by the way around the world, without getting specific, some of the LGBTIQ+ groups that we have funded have been—all of their work has been literally just simply to try to educate locally to people who think they’ve never met a gay person, think they couldn’t possibly have a gay person in their families, and have adopted a whole set of negative—not only negative stereotypes, but then translate those into policy at the church, or at the school, or in the government. And need simple education, which some of our groups have undertaken to do. We’re now, I think, open for questions. So we’ll hear from the moderator when there are specific questions. But let me just get one more question into you, Jessica, first. And that is, in this sort of role that you have in the State Department on behalf of the United States government and globally, what are your priorities? STERN: Drink more coffee, sleep less, have more time in the job. You know, it’s hard to set a list of priorities because you actually almost want it to be infinite. But you can’t, because there are only so many hours in the day. We’re not effective if we tackle everything. So the broad framework for my office is the Presidential Memorandum on LGBTQI+ Inclusion in U.S. Foreign Policy and Foreign Assistance that President Biden issued on February 4, 2021. It provides a sort of high-level framework. With the amount of time that we have left where we know this office will continue to exist, we have several core priorities. So one is fighting conversion therapy practices worldwide. I think this issue is the great equalizer, because conversion therapy practices exist in every country on the planet. They take very ugly forms, everything from forced starvation, to forced medicalization, so-called corrective rape, the list really goes on and on. Sometimes at the leadership of families or religious leaders, sometimes at the hands of medical professionals, and sometimes even at the hands of government. You mentioned Uganda. The anti-homosexuality act in Uganda has this sort of ominous clause that seems to suggest that rehabilitation, also known as so-called conversion therapy practices, could be one of the forms of punishment. And I just want to be really clear, you can’t forcibly change someone’s sexual orientation, gender identity, or intersex status. So it doesn’t work and it creates lasting harm. A second priority for my office is strengthening and resourcing LGBTQI+ civil society organizations and their allies. And there are a lot of different policy directions that priority goes into. Let’s start with some of the simple ones. The ability to legally register an LGBTQI+ organization. In country after country, LGBTQI+ organizations are blocked from being able to operate. And if you don’t have legal status, it’s very hard to open a bank account, it’s very hard to get a grant, it’s hard to rent an office. And if something terrible happens and you have to advocate for your community, you really don’t have the credibility before the government that you would want. More examples. The ability of LGBTQI people to celebrate Pride in all of its beautiful, diverse rainbow and glitter forms. You know, Pride has joyful components, but fundamentally it’s an opportunity to assert political priorities and be in community. And in country after country, Prides are coming under attack and they’re being banned. So there are many provisions there. You know, I always feel like governments come and go, but community-based organizations are rock solid. They’re steady. They’ll be there, whether there’s a friend in the presidency or not. A third priority of mine is broadly working to support recognition by multilateral systems that LGBTQI+ rights are human rights. You know, when you said my bio you said I’ve done a lot of work in that space. I have done a lot of work in that space, and I have to say we still have so much work to do. We’re still fighting for recognition. And the reason why the multilateral arena really matters is because it’s bigger than one country, right? And, actually, if you look at the major impact litigation cases that have happened around the world on sodomy and things like that, on the NGLHRC case in Kenya that you were referencing, U.N. data and U.N. standards on concepts like the right to privacy or HIV prevalence is cited in case after case. So we need the multilateral system to recognize that LGBTQI+ people exist. And I could go on, but I think that’s just the tip of the iceberg. MESSINGER: Fantastic. No, no, I’m going to—I’m going to go to a couple of questions. So, Jesse Bernstein, who has worked on this field for a great deal of time, has a question. Can we get Jesse to ask this question directly? Moderator, operator? Should I just read it? There he is. OK, Jesse, go. Q: Thanks, Jessica and Ruth. It’s a real pleasure to join you both today. My question is, do we need to rethink or reconsider any of our approaches to advancing LGBTQI+ rights, given the crisis that was described? Are there new lines of effort that need to be developed or new allies we should be considering? And what aren’t we doing that we should be? Thanks. MESSINGER: Jessica, you’re muted. STERN: Thanks. Thanks so much for that question, Jesse. And for those of you who don’t know Jesse, he has a long history of being a tireless advocate for LGBTQI+ persons. So it’s great to have him here. So that’s a multipart question. One thing I just want to acknowledge is that I think governments—we need more governments that care about LGBTQI people. And we need the governments that care about LGBTQI people to be better coordinated. I think you’ll find it’s sort of a patchwork quilt. And in some cases, we’re working very closely with other governments and in other places, you know, there’s a really long way to go. Whenever I visit a country, one of the first things that I do is I bring together all of the ambassadors from countries that care about LGBTQI+ rights to have a policy-level conversation. And I often start with an icebreaker which is: When was the last time you got together to talk about the policy priorities for this community? And the answer is usually, we saw each other at Pride or we engaged around this very specific crisis issue. And so I think that that shows that there’s actually a great resource we could tap into if we just were more proactive in identifying and working towards priorities together. I think a second priority that I want to identify is spending more money on this issue. Right now, the amount of funding that goes to support LGBTQI rights at the international level is less than $1 out of every $100 in development assistance. Let me say that again, so that everybody hears that. Less than $1 out of every $100 in development assistance worldwide. So what we know from the evidence is that LGBTQI people experience violence and discrimination in higher numbers. And what we know from the evidence is that we underinvest in this community. So if we really believe in justice and equality, we need our money to reflect our values. And then I guess the third point that I want to emphasize comes back really to where I started, which is this can’t just be an issue that we think about during Pride month. LGBTQI people are being attacked year-round. And if we had more concerted attention from more allies, we wouldn’t be living with the realities that we’re experiencing right now. So there’s a lot of lessons learned. We just need to persuade more people to partner with us. MESSINGER: Oh, fantastic. OK, I’m going to go next to a question from Keith Richburg, which sort of digs into the heart of U.S. policy and how the U.S. functions in the world. Keith. Q: Hi, can you hear me? MESSINGER: Yes, perfectly. Q: Great. Yeah. My question was simply that, to Jessica, what do you think the U.S. should do specifically in a case like Uganda? Do you suggest we cut off aid, for example, to Uganda and other countries passing these kinds of anti-LGBTQ laws? And if we go that route, doesn’t that create an opening for countries like China and Russia, which we know couldn’t care less about the countries passing these kinds of LGBTQ laws? I saw a story in Politico saying that the Biden administration has a dilemma. So what do you think? STERN: Thanks, Keith. That actually is reflective of what I think is sort of the heart of the debate in foreign policy. If the U.S. defends the human rights of marginalized and vulnerable groups, will it cost us potential allies? And will other world powers swoop in and benefit? And I would argue that that’s a false dichotomy, that many of our allies are drawn to us and prioritize the U.S. because of our values and because we’re fighting for inclusion and equity for all people. There are countries around the world where the U.S. is not very popular with the government but is extremely popular with the people. And part of the reason is because of our commitment to democracy, free and fair elections. freedom from corruption. So I think it’s a very complex issue. On the question of whether or not we should cut aid to countries over their LGBTQI+ track record, I want to say that it’s too simple and too problematic to simply say yes or no. I want to underscore that no country in the world has a perfect track record on LGBTQI+ issues. The U.S. doesn’t have a perfect track record on LGBTQI+ issues. So the first thing that we would do in any situation is ask local LGBTQI activists, what strategies do you want? What do you think is on the table? What is going to help you? And what’s going to create a desired effect? If the U.S. arbitrarily cuts aid for schools, clean drinking water, climate justice in the name of LGBTQI issues, then who’s going to suffer? Not only everyone in the country, but LGBTQI+ people are going to be blamed. And that could actually fan the flames of backlash and violence against them. We have a lot of tools at our disposal. We can impose visa restrictions on people that violate the human rights of LGBTQI+ people. Those are extremely effective. There are a lot of officials in other governments that want to come to the United States to send their kids to school, to obtain medical care, et cetera, to go on vacation. We have the ability to review country status under AGOA. Whether or not you receive favorable trade status with the U.S. depends in part on your human rights track record. We have the ability to exercise our authority in international financial institutions like the World Bank. We have the ability to issue business advisories and travel warnings. We have the ability to decline meetings with foreign heads of state that want their photo taken with President Biden, but to have access to senior U.S. government officials there also has to be an alignment of priorities. So I think we have a lot of tools at our disposal. And we have to decide with surgical precision which ones are most appropriate in each situation. MESSINGER: Fantastic. Barbara McBee, you have a question. Although, I think your question might only relate to domestic situations. But we’ll give—let Jessica give it a try. Q: Thank you both. Thank you, Jessica, for the work you do. Thank you, Ruth. Thank you so much. And my question is, not just, as I was thinking about what you said, not just U.S., but there is a rise of people who are able to deny us services, or association, or access, claiming their religious rights. So given that, whether it’s U.S. or abroad, what are our recourses with such an ability? Because to use religion, I guess, we’re just supposed to back off. It’s a sacred thing. But actually, it’s not. It’s being used as a tool. STERN: Barbara, you have such good energy. Thank you so much for that question. Q: Thank you. STERN: Ruth, I wonder if you want to kick it off, just given your own career? Because I do think it has a specifically domestic component, and then I can follow you. MESSINGER: Sure. Well, I mean, I think it’s—you know, you’re—we are all dealing with this. You know, well, mostly they used to tell us, you know, like my freedom to do certain things stops it at—you know, like, before I punch you in the face, you know? And so this is a little bit of like there are conflicts of rights. We talk about freedom of rights, freedom of religion. But right now, we see in a variety of areas, not just the LGBTQI+ area, that freedom—religious freedom is being used and abused in various ways. So I think it’s—I want to pick up a piece of language from Jessica—it’s like, looking at changes in law or practice with surgical precision, because you don’t want to pass laws that are going to be found unconstitutional. You know, it’s this whole question of can—you know, this ridiculous amount of time that we spent in America deciding who can bake a cake. I mean, that wasn’t what it was, but can bakers deny the sale of their goods? So, Barbara, you raise it in some very serious contexts in terms of, like, hospital policy and organizational policy. And it’s really, for me at my mind, it’s not so different from the international model that Jessica was talking about. We could be much more careful about which hospitals, organizations we do business with as a country, which ones we provide full tax-protected status to. And we can pay a little bit of attention to their human resource and human rights policies. And, of course, I’m quite clear that they will say—which is what the bakers basically said—like, you know, freedom of—it’s entirely my right. But these freedoms have to be sorted out and looked at, because sometimes they conflict with each other. That’s what I would say domestically. And we’ve seen some serious efforts to both well limit the rights of organizations that were denying rights, and also to, you know, provide some incentives for people who are doing things the right way. Jessica. STERN: You know, I’m just keeping an eye on the time. And I see that Ani Zonneveld has had her hand up. And I have a feeling it could be a good continuation of Barbara’s question. MESSINGER: OK, so go ahead. I just saw Ani’s name here, but not the question. Ani, go ahead. Q: Hi, Jessica. Hi, Ruth. Ani Zonneveld, Muslims for Progressive Values. I actually wanted to highlight, we do have conversion therapy going on here in the United States with some of the Muslim therapists. And also did you know, Jessica, that the Organization of Islamic Cooperation and that organization you were referencing from Arizona have partnered up in implementing, and funding, and promoting their definition of family values? And this is being implemented through the 57 countries of the OIC, the Organization of Islamic Cooperation, through the U.N. mechanisms, as well as at the national level. And we see that here in the United States how the protests being led by conservatives and the teaming up of the conservative Muslim with a Christian right in opting out of the inclusive curriculums in public schools, et cetera. So there is a correlation between the domestic and the international. And at the international level, at the State Department, how are you going to be addressing this through the OIC? Thanks. MESSINGER: Thanks. OPERATOR: We will take our next question from Guthrie Graves-Fitzsimmons. MESSINGER: Well, Jessica was going to respond to Ani. OPERATOR: Yes. MESSINGER: But go ahead. Let’s get Guthrie’s question out. Let’s get the last—we have two questions. pending in the box. Let’s get them both out, and Jessica and I will try to sort them out. So Guthrie first. STERN: All right. Q: Hi, thank you for having this conversation. Guthrie Graves-Fitzsimmons with the Baptist Joint Committee for Religious Liberty. And I’m thinking about the Synod on Synodality happening starting tomorrow at the Vatican, amid speculation that the Catholic church might change some of its policies in regard to LGBTQ people. Jessica, are you seeing any signs of religious change in terms of the global policy landscape? MESSINGER: OK, that’s great. And let me get the last question now from my good friend, Katherine Marshall. Katherine, go ahead. Q: Hi, I’m Katherine Marshall, Georgetown University. I’m curious as to what your strategy is in the U.N. specifically. We’re hearing very worrying reports that family has really become almost a third-rail issue that’s almost not mentioned, with different kinds of alliances taking form around these issues. So how do we respond to that? MESSINGER: All right. Jessica, why don’t you take a crack at all of those pieces? And then we’ll try to do a little bit of just ending that. STERN: Triage. No, that sounds great. And thanks for taking a few questions to get multiple voices in. Ani, I didn’t know that there’s an alliance between the OIC and the organization in Arizona. I’d love information on that. I think that’s incredibly important and sort of revelatory for me. So if—I think you know how to reach me, but please do reach out. That would be something I’d like to follow up on. I will say that the OIC has over the past month been more proactive at the U.N. in attacking efforts to mainstream and protect LGBTQI+ programming and policies at the U.N. So that partnership may actually have been part of the catalyst for it, which would be very helpful to know. So how to address it? I think I’d like to get a little more information before having a full response on that. I think it was Guthrie. Guthrie, thanks for giving me an opportunity to say something positive. I am seeing a lot of forward momentum in the religion space on this. One of the most important steps forward that I’m seeing is that more people of faith are coming out as LGBTQI people. And more LGBTQI+ people are coming out as people of faith. And I think that’s essential because there is this myth that LGBTQI people are anti-religion. And that’s never been the case. Intersectionality is a reality. And a lot of people who I know firsthand experience discrimination and violence because they’re members of the LGBTQIA plus community find safe harbor in their higher power and their religious community, that is there for them when often their government or their own family isn’t. So I want to say that at the outset. I want to also use the example of what’s happening in the Vatican and with the pope as, surprisingly, another space where there’s been real forward momentum. Some of you may have seen that in January of this year Pope Francis gave a very public and widely distributed interview with the Associated Press where he said that sodomy laws are wrong, and that sodomy should be decriminalized around the world. And I see that Ruth just looked up startled at that point, so I think that’s an indication really of what a huge announcement it was. I also know that Pope Francis has been very intentional about meeting with members of the LGBTQI+ community, receiving information from parents of LGBTQI+ Catholics, and even meeting with transgender refugees from Latin America. In fact, he very famously gave grants for transgender women from Latin America found themselves as refugees in Italy and were really impacted severely by COVID. And he not only heard their case, he made a grant, and then he made it public that he made a grant to them. So these are very strong indications of an evolving position, at least of the pope. And of course, everyone heard the news, which I think broke yesterday, of the pope’s response to questions from four or five conservative Catholic theologians on the eve of the Synod. And his announcement, his response in great detail, was—he was asked about equal marriage and its place within the Catholic Church. And while he didn’t go so far as to say there’s a place for equal marriage, in fact he condemned it, he said that blessing LGBTQI+ relationships do have a place in the Catholic Church. And I’ve spoken with a lot of Catholics over the past day, and a lot of tears of joy have been shed in response to that historic decision. So there’s a lot of progress happening. And, Katherine, just to get to your question, what does the U.N. strategy look like? Even the concept of family has become so politicized. We’re currently in a fight over the definition of family at the U.N. in the Human Rights Council right now. The crux of the fight is: Is there one form of the family or are there many forms of the family? Now, we all know the truth is there are many forms of the family. There are single-parent families, there are grandparents that take care of their grandchildren, there are families that live with intergenerational households, there are straight families, there are queer families. It takes all kinds. What is the strategy at the U.N.? It’s layered, but one of the strategies is to lift up the—lift up the voices of governments and activists from the Global South. And part of the reason why that’s so incredibly important is because there’s a myth that spread at the United Nations that only LGBTQI—the only governments that care about LGBTQI rights are in the Global North. And that’s simply not the case. So it is probably a longer conversation than we have time for with four minutes left, but I think that’s one of the most important strategies. And I will also add, we need leadership from the secretary-general and all U.N. agencies on this issue. MESSINGER: No, I mean, it’s—you know, it’s the endless story for the last half-century of the United Nations is, like, when in some instances does it actually—I mean, a Katherine knows this better than anybody—but is actually leading international battles for justice and equity, and when is it sort of trailing behind, you know, its own its own countries, its own naysayers. Jessica, we don’t have much time left. So I wanted to ask you to say how now—now, obviously, some of the people who are online with us are doing this also pretty much full-time in their organizations, but many are not. And what would you say about how people can be better allies to the global movement for LGBTI+ rights? STERN: I would say two things. Do no harm. But do something. So the first principle of, you know, good foreign policy is don’t make things worse for the people who you’re trying to help. I think that should make sense. We’ve seen efforts where international solidarity has gone awry because local communities, local leaders were not consulted. So please, always consult LGBTQI activists and thinkers at the country level. And the second piece is so important. I sometimes see paralysis around LGBTQI+ issues, where people care but they’re so afraid of getting it wrong. They don’t know where to start. They think it’s overwhelming. But you can make progress if you ask LGBTQI+ persons, what is the low-hanging fruit? What is the long-term strategy? And how can we help? So it’s actually quite simple: Do no harm, but do something. MESSINGER: That’s beautifully said. And I would just add to that the point that where we totally dovetail on that is that the work AJWS is very often in these countries where national policy is bad and national policy may be getting worse. But where there always turn out to be LGBTI+ groups—some of them, like, unbelievably beleaguered and literally hiding. But even when they’re hiding, they know exactly what they need. And sometimes they need support. Sometimes they just need recognition. Sometimes—to complete the interface in this webinar—sometimes, we need to bring those groups and those countries to the attention of the State Department because they are the leaders in the fight for equity and they deserve some attention and recognition, as well as our financial support. And I would also just say that, you know, some of these groups should just be praised when talking about doing something, because they do the most basic thing. And that is that they give LGBTQI+ people a place to literally hang out. We have a staff member of ours, you can find it on—the AJWS website is AJWS.org. And it lists the work that we do. And as I said, these groups are in our sexual health and rights portfolio. You can find descriptions of a lot of these groups. They’re just wonderful. But a member—a new member of our staff actually traveled recently to Africa to see some of our work. And one of the things that he said, remembering his own past as a young gay person, was in the same way that being on Fire Island meant something to him because it was a safe space, he sees in every one of the groups of ours that he visited throughout the globe that one of the things they do is simply provide a safe space for other LGBTQI people to be with each other, to get some support, to be able to gather strength and resilience for going out into the, literally and figuratively, the streets of their countries to try to function in a place in which their fundamental human rights are not protected. So I want to thank Jessica. Not—I want to thank her for her hour talking with us and answering questions, but I really want to thank her for doing this work, day-in and day-out. Not only as a—as a—through her career, but doing it right now in government and the State Department, that for many, many, many reasons, has, like, lots and lots of other issues and priorities. We were talking before the call as to whether or not the government will be open when Jessica came on the call. But she takes up a fundamental issue. And I think she’s made it clear how fundamental it is of human rights in countries around the world and makes that a key piece of the policy and practice of the U.S. State Department and the U.S. government. And she deserves our thanks for that. FASKIANOS: Wonderful. And I just want to echo those thanks from the Council on Foreign Relations, Jessica Stern, for all your work in this space and for being with us today; and of course, Ruth Messinger, for navigating this conversation. I’m sorry, we could not get to all the questions, but we will just have to have another discussion on these issues, which are so important. We encourage you to follow the State Department’s work, Jessica’s department at the State Department on Democracy, Human Rights, and Labor on X. It’s at @StateDRL. And you can follow Ruth at @Ruth_Messinger. And so we look forward to continuing the conversation. And thank you both again for today’s really rich conversation. We appreciate it. MESSINGER: Thank you, Irina, and thank you to the Council. STERN: Thank you to Ruth, Irina, and the Council. And thank you all for tuning in. END

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? FASKIANOS: Yes. 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. FASKIANOS: Great. 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. (END)