Reflections on the COP28 UAE Declaration on Climate and Health. Where it fails

Ed. note: Dr. Trevor Hancock was a co-founder of both the Canadian Association of Physicians for the Environment and the Canadian Coalition for Green Health Care. This is the first of four columns on the most recent COP conference.

It has taken a long time – almost 30 years – for health to have a significant presence at the UN’s annual Climate Change Conference but it finally happened during December’s COP28 (the Conference of the Parties to the UN’s Framework Convention on Climate Change) that took place in Dubai.

For the first time, there was a day actually devoted to health.

It is surprising, and quite alarming, that health has not been front and centre all along given that, when you get right down to it, our concern about climate change has always been about our own health and wellbeing. Yes, climate change will massively disrupt natural systems and have significant impact on all plant and animal life. But the impacts of fires, floods, storms and drought on people and the human implications of major ecological changes are what really make the headlines.

The health impacts of climate change have long been a concern for the Intergovernmental Panel on Climate Change. Its First Assessment Report, in 1990, raised concerns about the unjust impacts on vulnerable human settlements and populations.

The World Health Organization (WHO) commissioned a special report on climate change and human health in 1996, the year after the first COP, and by 2008, the WHO was acknowledging “Climate change is the single biggest health threat facing humanity.” But it was not until COP26 in Glasgow in 2021 that health became an issue at the annual conference, and not until COP28 in Dubai was there a full day devoted to it.

The Health Day at COP28 brought together nearly 50 ministers of health – including Canada’s Mark Holland – representing various jurisdictions. It resulted in a Climate and Health Declaration that to date has been endorsed by 142 countries, including Canada.

So, what did the declaration say (and what did it not say), and what are the implications for health professionals and the health sector in Canada? In this first article, I review the weaknesses in the declaration; in Part 2, I look at the actual and potential climate and health leadership role of the health sector in Canada; in Part 3, I  discuss ways in which the health sector can strengthen Canada’s mitigation actions at the societal and community level as well as within the health sector itself; and in Part 4 I discuss the implications for Canada’s health sector, with particular reference to health system and community adaptation and resilience in the face of climate change.

The good news

Let’s start with the good news, which is that there was a Health Day, our federal minister of health did attend and Canada did sign on to the declaration.

It was also good news that at the outset the declaration itself expressed “grave concern about the negative impacts of climate change on health” (but without actually indicating what that impact is) and recognized “the urgency of taking action.” It noted “the benefits for health from deep, rapid and sustained reductions in greenhouse gas emissions” (GHGs) – although in practice, it only addressed them in terms of health-sector emissions. It also called for “just transitions, lower air pollution, active mobility, and shifts to sustainable healthy diets” – although they were never mentioned again, and no details were provided.

While adaptation is mentioned six times in the declaration, mitigation is only mentioned once.

It also had a lot to say about adaptation to climate change – “the transformation of health systems to be climate-resilient, low-carbon, sustainable and equitable, and to better prepare communities and the most vulnerable populations for the impacts of climate change.” But while adaptation is mentioned six times in the declaration, mitigation (climate change talk for what the health sector would call primary prevention) is only mentioned once.

Where the Declaration on Climate and Health fails

Climate change is driven largely by increasing levels of atmospheric carbon dioxide (CO2 was responsible for about 60 per cent of the heating influence caused by human-produced greenhouse gasses in 2021), mainly coming from fossil fuels (91 per cent in 2022) and methane (16 per cent in 2021), much of which comes from fossil fuels. Yet, while the declaration “noted” the health benefits of reduced GHGs, it did not actually call for any reductions in GHGs – never mind deep, rapid and sustained reductions – as a vital step to protect health, nor did it even mention fossil fuels like coal, oil or gas.

This is a long way from the much stronger position of the World Health Organization. In its Special Report on Climate Change and Health issued at COP26 in 2021, WHO was explicit: “The burning of fossil fuels is killing us; causing millions of premature deaths every year through air pollutants, costing the global economy billions of dollars annually, and fuelling the climate crisis.” It called for the phase-out of polluting fossil fuels, recommended “an end to all fossil fuel subsidies,” and proposed “raising money from fossil fuel subsidy reform and taxes to be re-invested in a green recovery.”

This position was re-iterated at COP28 by Maria Neira, director of public health and environment at WHO, who said: “We urgently need all leaders at COP28 to call for a phase out of fossil fuels and safeguard the health of global populations from the climate crisis.” In addition, the Global Climate and Health Alliance, the leading global convener of more than 160 health professional and health civil society organizations around the world addressing climate change, called on the G20 Health Ministers (of which Canada is one) to “stand shoulder to shoulder with the global health community’ in recognizing that “a full phase-out of fossil fuels is a public health imperative.”

That neglect of mitigation is also very evident in the Joint Statement on COP28 from Canada’s Minister of Health, Minister of the Environment and Climate Change and Minister of Indigenous Services. Not a single mention of mitigation, fossil fuels, a fossil fuel phase-out or fossil fuel subsidies. The statement focuses exclusively on “adapting our health systems as our climate continues to change” and the need to “protect the population from extreme heat.”

Clearly, the world’s health ministers, and specifically Canada’s minister, could not bring themselves to be clear, blunt and proactive in defence of health. Instead of calling for a phase-out of fossil fuels, they yielded to their national governments, the petrostates and the fossil fuel industry by avoiding the topic altogether.

This is a shameful betrayal of their duty to protect the health of the public. This is not leadership on climate change and health!


Countries committed to eight “common objectives” identified in the declaration. These are not particularly well structured and a bit of a mish-mash, but here are the key points as I see them, structured around key themes:


  • First, there is a focus on the social determinants of health and health equity, with three of the common objectives addressing inequalities within and among countries: meeting Sustainable Development Goals; pursuing health-enhancing adaptation policies “across a range of sectors, including food and agriculture, water and sanitation, housing, urban planning, health care, transportation and energy;” and maximizing health gains for disadvantaged and vulnerable groups.
  • Another common objective referred to “addressing the environmental determinants of health,” although it was mostly concerned with a narrower “One Health” approach to antimicrobial resistance and pandemic prevention.
  • Three common objectives referred to the health sector, with one specifically directed to reducing the climate impact of the health system by “promoting steps to curb emissions and reduce waste in the health sector.” The other two addressed the need for the system to prepare for and respond to climate-sensitive diseases and health risks and, more broadly, preparedness to address “mental health and psychosocial wellbeing, loss of traditional medicinal knowledge, loss of livelihoods and culture, and climate-induced displacement and migration.”
  • The eighth common objective focused on research and knowledge development: “Strengthening trans- and interdisciplinary research, cross-sectoral collaboration, sharing of best practices, and monitoring of progress at the climate-health nexus.”


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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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