SEVENTY-FIRST WORLD HEALTH ASSEMBLY A71/10

Provisional agenda item 11.4 9 April 2018

Health, environment and climate change

Report by the Director-General

1. The Executive Board at its 142nd session took note of an earlier version of this report1 and
adopted decision EB142(5) (2018), in which it requested the Director-General, inter alia, to prepare a
report on actions taken on the interlinkages between human health and biodiversity, for consideration
by the Seventy-first World Health Assembly. Details of the Secretariat’s response to that request are
provided in a separate report.2

2. Known avoidable environmental risk factors cause at least 13 million deaths every year and
about one quarter of the global burden of disease. Air pollution alone causes about 6.5 million deaths a
year, or one in eight of all deaths, placing it among the top global risks to health.3

3. Member States are faced with a combination of both new and long-standing environmental and
health challenges. These challenges range from lack of universal access to clean household energy,
safe water and sanitation to the consequences of unsustainable development – such as air, water and
soil pollution and exposure to hazardous chemicals and more complex, chronic and combined
exposures in work and residential settings – in addition to ageing infrastructure, stagnating
environmental health progress and increasing inequalities, in all countries.

4. These challenges result in a triple burden of environmental risks, including the direct impacts of
emergencies; persistent and, in some cases, expanding infectious disease risks; and noncommunicable
diseases. For the latter, environmental risk factors are now of a comparable magnitude to other
established risks (tobacco consumption, diet, alcohol consumption and physical inactivity).

5. Human influences on the global environment continue to grow. They contribute to climate
change, considered potentially to pose the greatest threat to global health in the 21st century. Many
Member States have already suffered significant loss of life and damage to crucial health infrastructure
resulting from extreme weather events. Such developments threaten to undermine gains in health and
development and may also exacerbate migration and increase social and political tensions within and
between countries. In the absence of strong measures to cut carbon emissions and protect populations
from the effects of climate change, rising sea levels will submerge extensive and densely populated
coastal areas, including some entire small island nations, by the end of this century.

1
See document EB142/12 and the summary records of the Executive Board at its 142nd session, tenth meeting,
section 2.
2
See document A71/11.
3
Prüss-Ustün A, Wolf J, Corvalán C, Bos R, Neira M. Preventing disease through healthy environments: a global
assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016
(www.who.int/quantifying_ehimpacts/publications/preventing-disease/en/, accessed 23 March 2018). Estimates are based on
a combination of quantitative assessment and expert opinion.
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6. Although the paramount concern is to protect human lives and ensure well-being, environmental
degradation entails substantial economic costs for the health sector. Global health and welfare losses
from air pollution in 2013 are valued at US$ 5110 billion, or almost 7% of gross domestic product. 1
Approximately 10% of global gross domestic product is now spent on health care, 2 driven increasingly
by the costs of treating noncommunicable diseases. Failure to manage environmental risks and prevent
a growing disease burden will increase the strain on health services and on national and household
budgets.

7. The effects of human actions on the environment are an ethical and human rights issue, as they
will be felt by future generations and will have the most severe impact on the most economically,
demographically and geographically vulnerable populations.

CURRENT STATUS OF THE PUBLIC HEALTH RESPONSE TO

8. Responsibility for, and tools to tackle, many environmental determinants of health lie outside
the direct control of individuals or the health sector alone. Therefore, a wider societal, intersectoral
and population-based public health approach is needed.

9. A wealth of evidence demonstrates the health impacts of individual environmental exposures −

10. There have been notable successes in applying such evidence to intersectoral policy. Examples
range from removing lead from petrol in many countries to controlling the depletion of the ozone layer
and the associated health risks of ultraviolet radiation through the application of measures set out in
the Montreal Protocol on Substances that Deplete the Ozone Layer (1987).

11. In dealing with environmental, climate and other determinants of health, WHO promotes a
Health in All Policies approach, including coverage of health in environmental and labour regulations
and safeguards, assessment of the health impact of development projects and tackling several
environmental health issues in a single setting, community or system. Numerous examples of best or
good practice are available,3 but such integrated approaches are not applied universally and are seldom
directed to “upstream” environmental and social determinants (such as more sustainable and equitable
resource consumption, climate stabilization and protection of biodiversity and ecosystem services) that
in turn drive exposure to hazardous health conditions.

1
World Bank Group, Institute for Health Metrics and Evaluation. The cost of air pollution: strengthening the
economic case for action. Washington, DC: World Bank; 2016 (https://openknowledge.worldbank.org/handle/10986/25013,
accessed 23 March 2018).
2
For further information, see the WHO Global Health Expenditure Database (http://apps.who.int/nha/database,
accessed 23 March 2018).
3
Government of South Australia; WHO. Progressing the Sustainable Development Goals through Health in All
Policies: Case studies from around the world. Adelaide, Australia: Government of South Australia; 2017
(http://www.who.int/social_determinants/publications/hiap-case-studies/en/, accessed 23 March 2018.

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12. Many contemporary environmental risks to health are also interdependent and transboundary in
nature. Such risks range from the transfer of polluting industries’ dangerous work processes and
hazardous waste to poorer and less regulated countries to transboundary air pollution and radiation
risks and the burning of fossil fuels that drive global climate change. This transfer and extension of
risk is occurring against a background of decreased direct investment and the lifting of restrictions by
national governments, and the increasing influence of diverse, often politically and economically
powerful and multinational, private-sector actors.

13. At the same time, there is continuous demand for more commonly recognized “downstream”
environmental health interventions to deal with the direct and local effects of environmental risks to
health – most obviously in the case of responding to emergencies, which can, in turn, result in and
from environmental degradation.

14. The persistent burden of environmental disease and the evolving range of risks clearly call for a
strengthening of primary prevention. However, health sector engagement and investment have not
increased proportionately to meet the need. According to OECD, Member States typically allocate
about 3% of health expenditure to prevention, in contrast to the 97% allocated to curative medicine.1

15. In confronting challenges of this scale, incremental changes to deal with individual
environmental risks are not sufficient, while the environmental contribution to the global burden of
disease has remained almost static for a decade. The health sector must show leadership and work with
other sectors to assume its obligations in shaping a healthy and sustainable future.

THE TRANSFORMATION NEEDED: MORE EFFECTIVE UPSTREAM ACTION IN

16. The 2030 Agenda for Sustainable Development and its associated Sustainable Development
Goals provide the integrated framework for the ambitious changes needed to fulfil the commitments
made. The Goals and their targets provide the structure to identify and operationalize actions to
safeguard and enhance the upstream determinants of health, and to follow a sustainable pathway to
improved, and more equitably distributed health and well-being.

17. Health is relevant to all of the Goals, not just Goal 3 (Ensure healthy lives and promote well-
being for all at all ages). Within the scope of environmental and climate change, there are specific and
important opportunities for health gains through ensuring that health occupies a more dominant
position in the agendas relating to nutrition (Goal 2: End hunger, achieve food security and improved
nutrition and promote sustainable agriculture); water and sanitation (Goal 6: Ensure availability and
sustainable management of water and sanitation for all); clean energy (Goal 7: Ensure access to
affordable, reliable, sustainable and modern energy for all); decent work (Goal 8: Promote sustained,
inclusive and sustainable economic growth, full and productive employment and decent work for all);
sustainable cities (Goal 11: Make cities and human settlements inclusive, safe, resilient and
sustainable); responsible production and consumption (Goal 12: Ensure sustainable consumption and
production patterns); and climate change (Goal 13: Take urgent action to combat climate change and
its impacts).

1
OECD health data 2006, statistics and indicators for 30 countries [CD-ROM]. Paris: OECD; 2006.

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18. The Goals therefore provide an opportunity for the health sector to engage in broad, inclusive
and massively expanded primary prevention, effectively bringing together Principle 1 of the Rio
Declaration on Environment and Development (1992) (“Human beings are at the centre of concerns
for sustainable development. They are entitled to a healthy and productive life in harmony with
nature”) and Article 1 of the Declaration of Alma-Ata (1978) (“… the attainment of the highest
possible level of health … requires the action of many other social and economic sectors in addition to
the health sector”).

19. In the 21st century, health should therefore be central to discussions around drivers such as
production methods that pollute deleterious consumption and distribution patterns and disruption of
ecosystems. Moreover, the attainment of health should be promoted as an explicit aim, rather than an
afterthought, in decisions in key sectors such as energy, transport, technology, water and sanitation
and urban planning.

20. Investment in the capacity of the health sector for policy engagement and assessment and
monitoring of investments made in other areas of the economy would promote mutually beneficial
measures that would simultaneously protect health and the environment. This approach would, in turn,
avoid current or future economic costs and so allow reinvestment in health and sustainable
development.

21. For example, more sustainable urban transport systems that promote public transport, cycling
and walking would reduce air pollution, noise and risk of road traffic injuries, while also raising
physical activity levels. More generally, it is estimated that placing a price on polluting fuels in line
with their health impacts through air pollution would more than halve the number of premature deaths
globally due to air pollution, result in a 20% reduction in greenhouse gas emissions and generate some
US$ 3000 billion in tax revenues every year – equivalent to more than 50% of global health spending
by governments.1

22. Progress in tackling environmental and climate risks to health will need to be driven by national
health ministries, through leadership in intersectoral governance, evidence-based advocacy,
operational programmes and surveillance and monitoring.

23. The Secretariat is committed to using WHO’s mandates and core functions to support this
effort, as a priority for the forthcoming thirteenth general programme of work, 2019–2023.2 WHO has
also engaged fully in the global environmental negotiations, notably at the twenty-third session of the
Conference of the Parties to the United Nations Framework Convention on Climate Change
(UNFCCC) held in Bonn, Germany on 6−17 November 2017.

LEADERSHIP AND GOVERNANCE

24. In view of the wide scope of issues and the broad range of engaged actors, it is particularly
important for WHO to fulfil its constitutional mandate, namely, to “act as the directing and co-
ordinating authority on international health work” and “to establish and maintain effective

1
Coady D, Parry I, Sears L, Shang BP. How large are global energy subsidies? IMF working paper. International
Monetary Fund; 2015 (WP/15/105; https://www.imf.org/external/pubs/ft/wp/2015/wp15105.pdf, accessed 23 March 2018).
2
See document A71/4 for the latest draft.

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collaboration with the United Nations, specialized agencies, governmental health administrations,
professional groups and such other organizations as may be deemed appropriate”.

25. The resolutions and decisions of the Health Assembly and WHO regional committees, together
with the commitments of regional health and environment ministerial processes, provide guidance for
dealing with many individual environmental risks to health. However, the most recent WHO global
strategy providing an overarching and unifying direction for WHO’s work on health, environment and
climate change, dates from 1993.1

26. Over the past three decades, various legally-binding multilateral environmental agreements –
such as the UNFCCC (1992), the Minamata Convention on Mercury (2013), the Convention on
Long-range Transboundary Air Pollution (1979) and the Protocol on Water and Health to the 1992
Convention on the Protection and Use of Transboundary Watercourses and International Lakes (1999)
– which were adopted with health as a central justification have entered into force. Their mandates
present an important opportunity for health actors to shape environmental policy to protect and
promote health and to use their associated policy, technical and financial support mechanisms.

27. More importantly, the major policy and implementation decisions in all sectors are taken at the
national and subnational levels. Health actors need to be informed by evidence, connected through
institutional mechanisms that allow them to work with other stakeholders (for example, from urban
planners to city mayors) and empowered through regulatory frameworks that include health in
intersectoral policy-making.

PROVISION OF EVIDENCE-BASED POLICY OPTIONS AND ADVOCACY

28. The health sector has specific responsibility to inform policy-makers and the public on the
health impacts of climate and environmental change because of the importance that populations give
to health issues and the generally high quality of, and public trust in, evidence pertaining to health
matters.

29. There is a continuous need for evidence on the effectiveness of measures to tackle the
environmental root causes of disease and on the health impact of sectoral policies. As such decisions
often have wide-ranging effects, there is an associated need for capacity to assimilate, interpret and
communicate data and evidence from sources not traditionally used by health policy-makers. Evidence
of impacts on human rights and equity, public acceptance of measures and information on the
socioeconomic and financial costs to individuals and health systems are particularly important.

30. Progress in this field would also benefit from research that is more directly connected to policy
in health and related sectors. The Intergovernmental Panel on Climate Change provides a model for
delivering evidence that is policy-relevant but not policy-prescriptive, that could potentially be used –
for example through a special report on health and climate change – or adapted for other
environmental and health issues, including those at the national level.

1
WHO global strategy for health and environment, endorsed in resolution WHA46.20 (1993).

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SUPPORT FOR IMPLEMENTATION OF THE PUBLIC HEALTH RESPONSE TO

31. In order to meet the challenges posed by environmental and climate change risks, a reversal of
the current trend of reductions in human and financial resources for environmental health at the
national and international levels is required, in addition to a broader, integrated set of approaches and
skills.

32. Implementation must occur not only through influencing other sectors but also within the core
functions of the health sector. Thus, for example, climate change should be incorporated into risk
assessments, preparedness and response plans for health emergencies; climate resilience should be
integrated into the building blocks of health systems; and investments in the provision of energy, water
and sanitation for health facilities should be supported as a contribution to universal health coverage.

33. The need to provide targeted support for the most vulnerable nations and populations remains.
Such support will include a specific WHO initiative to protect the health of the people of small island
developing States from climate risks and to explore approaches to developing national health systems
based on climate resilience and sustainable development, in collaboration with the secretariat of the
UNFCCC and in partnership with the Fijian presidency of the twenty-third session of the Conference
of the Parties.1

34. Significant initial investments are needed in order to take action on environmental and climate
risks, but the benefits may be spread over years or decades, requiring new and innovative national and
international funding mechanisms. WHO has applied to the Green Climate Fund for accreditation and
will work with partners to increase the current low rate of health sector access to climate financing,
with an initial focus on small island developing States, followed by least developed and other
vulnerable countries.

MONITORING OF PROGRESS TOWARDS THE SUSTAINABLE DEVELOPMENT

35. Monitoring of progress towards the Sustainable Development Goals provides an opportunity
and entails an obligation to maintain political and public will to improve health and environmental
conditions.

36. Progress across all the Sustainable Development Goals is important for health. However, WHO
is responsible for collecting information on indicators under Goals 3, 6, 7 and 11, in addition to
information relating to progress towards the targets of other Goals (such as Goal 13, in relation to
which WHO collects information through a biennial climate and health country survey to produce the
WHO UNFCCC country profiles).2

1
Launch of special initiative to address climate change impact on health in Small Island Developing States.
(http://www.who.int/mediacentre/news/releases/2017/climate-small-islands/en/, accessed 14 March 2018).
2
For further information on the WHO UNFCCC Climate and Health Country Profile Project, see
(http://www.who.int/globalchange/resources/countries/en/, accessed 23 March 2018).

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37. In order to ensure coherence, it is proposed that tracking the progress of implementation of the
thirteenth general programme of work, 2019−2023 should be aligned with monitoring of progress
towards the Sustainable Development Goals. Monitoring should include: tracking of mortality from air
pollution and climate-sensitive diseases; access to water and sanitation and provision of hospitals with
energy, safe water and sanitation; and climate finance for health-related activities in low- and middle-
income countries.

ACTION BY THE HEALTH ASSEMBLY

38. The Health Assembly is invited to note this report.

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