Health sector leadership on climate and health: Reflections on COP28 and climate and health

Ed. note: This is the second in a series on COP28. Part 1 can be read here.

“Safeguarding people’s health in climate policies will require the leadership, integrity, and commitment of the health community. With its science-driven approach, this community is uniquely positioned to ensure that decision makers are held accountable, and foster human-centered climate action that safeguards human health above all else.” Executive Summary, The 2023 report of the Lancet Countdown on health and climate change.

The Declaration on Climate and Health issued at the 28th UN Climate Change Conference (COP28) in December failed an important test: it did not take a population health approach and call for the prevention (or what climate scientists call “mitigation”) of further climate change by, among other things, demanding an end to fossil fuel subsidies and the phase-out of fossil fuels, as the World Health Organization (WHO) and numerous other health organizations have done.

Instead, the declaration focuses mainly on adaptation, in effect accepting climate change and preparing to manage its impacts on communities and, in particular, on the health sector. This also was the case for the Joint Statement on COP28 from Canada’s ministers of health, the environment and climate change, and Indigenous services, who did not even mention mitigation. As I stated in my last piece: “This is a shameful betrayal of their duty to protect the health of the public. This is not leadership on climate change and health!”

While political leadership is lacking, health sector leadership is building. Hospital associations, professional associations, health authorities, health NGOs and academic health institutions, among others, as well as individual health professionals are demanding Canada, and in particular its provinces and territories, take a much stronger approach to reducing greenhouse gas (GHG) emissions and phasing out fossil fuels.

Together, the health sector is a large sector of society – around 12 per cent of GDP in 2023 – which means we have a large climate and ecological footprint (which we must reduce). We are an influential sector trusted by the public, and “evidence from the communications field confirms that discussing climate change in a health frame is the best way to motivate a population to action on climate change.” Moreover, we have an ethical duty to protect health and to do no harm, and given that the WHO has acknowledged that “Climate change is the single biggest health threat facing humanity,” the imperative to act is clear.

Health sector leadership on planetary health

It is important to recognize that the health sector has shown leadership in this area for many years. Organizations such as the Canadian Association of Physicians for the Environment (founded in 1994) and the Canadian Association of Nurses for the Environment (founded in 2009) have worked on the relationship between the environment and health, while the Canadian Coalition for Green Health Care (founded in 2000) works on reducing the environmental impact of Canada’s health-care system.

The focus has been on a broad understanding of the environment, encompassing not only climate change but pollutants, biodiversity loss, energy and materials conservation, nature contact and regeneration, waste management and more. More recently, the concept of planetary health has emerged, integrating all these issues. Several other key national health organizations have begun important planetary health initiatives:

The Royal College’s move to recognize planetary health was preceded by the University of Ottawa’s Faculty of Medicine and the Vancouver Coastal Health Authority, while the UBC Faculty of Medicine has established a Planetary Health Lab. In short, planetary health – and with it, climate change – has become an important issue among health professionals and leading health organizations in Canada.

In the lead-up to the COP28 Health Day, a number of these organizations and others sent a joint letter to Canada’s ministers of health and of environment and climate change calling for action in two areas of concern: Supporting health-care professional preparedness and health system readiness. Their recommendations included:

  • Providing funding to enable the AFMC to implement its Declaration on Planetary Health;
  • Going beyond the existing commitment to the WHO’s resilient, low-carbon health systems program and committing to the “high-ambition” commitment to “set a target date by which to achieve health system net zero emissions (ideally by 2050);”
  • Establishing and funding a climate change and health secretariat within Health Canada and in each of the provinces;
  • Developing a strong climate change and health research program through the Canadian Institutes for Health Research, and;
  • Asking for climate-resilient and sustainable health systems to be on the agenda for the next meeting of health ministers.

The provinces also need to commit to key global climate and health initiatives

While the federal government signed the COP28 declaration on behalf of Canada, it is the provinces and territories that run almost all of Canada’s health-care systems, so they too need to sign on to the declaration. The health sector must demand that the declaration be on the agenda at the next meeting of Canada’s health ministers and must urge the provinces and territories to sign on to it.

Similarly, the health sector must demand that not only the federal government but all the provinces and territories join the WHO’s Alliance for Transformative Action on Climate and Health and do what 29 other countries have done – make the stronger commitment to WHO’s  high-ambition net zero commitment and set a target date, at least by 2050 and preferably sooner, to achieve health system net zero emissions.

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1 Comment
  • Douglas Courtemanche, MD MS CRCSC & with Doctors for Planetary Health - West Coast says:

    This is an excellent summary of:
    1. the ethos of the climate crisis and it’s intersection with health
    2. the strong voices being raised within health care asking those in power (government, corporations, even banks) to to something
    3. the need for more mitigation as adaptation is not going to work
    4. the years of effort and the limited results
    5. the fact that “health” and particularly that of future generation is actually a major motivating factor for change

    Health professionals need to continue to speak up, speak strongly and ask for mitigation and to join forces to amplify our message.


Trevor Hancock


Dr. Trevor Hancock is a public health physician, a retired Professor of Public Health at UVic, and was a co-founder of both the Canadian Association of Physicians for the Environment and the Canadian Coalition for Green Health Care.

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