Better health is an important outcome from the 2015 United Nations (UN) landmark agreements for disaster risk reduction, climate change, and sustainable development. To achieve the best overall outcomes, an understanding of how health is included and can be further strengthened in these global processes and agreements is imperative.
HYOGO FRAMEWORK FOR ACTION POST-2015
Disaster Risk Reduction
Disasters affect human lives by causing injury and long-term impact as well as destroying lives and livelihoods around the world. In 2005, the Second World Conference on Disaster Reduction in Kobe, Japan, adopted the Hyogo Framework for Action 2005-2015: Building the Resilience of Countries and Communities to Disasters (HFA). HFA was the first plan to explain, describe, and detail the work that is required from all different sectors and actors to reduce losses in disasters. The plan was developed and agreed on with the many partners needed to reduce disaster risk—governments, international agencies, disaster experts, and many others—bringing them into a common system of coordination.
1
The HFA outlines the following 5 priorities for action:
1. Ensure that disaster risk reduction is a national and a local priority with a strong institutional basis for implementation.
2. Identify, assess, and monitor disaster risks and enhance early warning.
3. Use knowledge, innovation, and education to build a culture of safety and resilience at all levels.
4. Reduce the underlying risk factors.
5. Strengthen disaster preparedness for effective response at all levels.
These extremely important priorities form a framework for effective action; however, the absence of health and public health as an explicit component diminishes the overall conceptual framework for action. This lack is markedly demonstrated by the fact that 1.7 million people died in disasters between 2000 and 2012, and an estimated US $1.7 trillion of damage was sustained.
2
What does disaster risk reduction (DRR) mean to health colleagues? DRR activities are varied and aim to reduce the impact from disasters on loss of life, injury, or other health impacts; property damage; loss of livelihoods and services; social and economic disruption; or environmental damage. To build knowledge, evidence-based science should be considered in its widest sense to include the natural, environmental, social, economic, health, and engineering sciences. In addition, scientific capacities are interpreted broadly to include all relevant resources and skills of a scientific and technical nature.Reference Reid
3
Evidence-based science can play an essential role in these efforts by uncovering new ways to prevent, prepare for, and respond to disasters and determining which technologies are most effective in reducing disaster risk. As a result of scientific research, science and technology are already helping to save lives and livelihoods via programs to prevent infectious disease outbreaks with vaccination, to forecast floods, detect tsunami waves, and effectively communicate disaster risk to enhance community resilience.
Now significant developments in the evolution of the HFA provide an unparalleled opportunity to focus on the importance of health and public health as a necessary component to the overall framework. Specifically, 2015 will be marked by 3 landmark UN agreements:
∙ Framework for Disaster Risk Reduction (HFA Disaster Risk Reduction 2015, which will last 10 to 20 years, due for agreement in March 2015)
4
∙ Sustainable Development Goals (September 2015)
5
∙ Climate change agreements through the UN Framework for Convention on Climate Change (December 2015).
6
The importance and necessity of this effort are further underscored by the fact that at the conclusion of the UN International Strategy in Disaster Risk Reduction (UNISDR), the Scientific and Technical Committee report on using science for DRR at the global platform in May 2013 issued 4 recommendations. Because evidence-based science is not used enough to reduce disaster risks, these recommendations are intended to (1) encourage science to demonstrate that it can inform policy and practice, (2) use a problem-solving approach to research that integrates all hazards and disciplines, (3) promote knowledge into action, and (4) regard science as the key to the post-2015 framework for DRR (HFA2).Reference Southgate, Roth and Schneider
7
Proposed International Science Advisory Mechanism
Evidence-based science in health and public health for DRR is frequently upheld as good examples of improving knowledge. In part, this knowledge and other data have led the UNISDR Scientific and Technical Advisory Group to prepare a joint statement on establishing an international science advisory mechanism for DRR to strengthen resilience for the post-2015 agenda.
8
This statement reflects their commitment to work together to ensure that science, engineering, and technology as well as health science are embedded into disaster risk management, and that health can be identified here as a valuable part of the process. This statement presents an action agenda for DRR and resilience strengthening that proposes to (1) champion and reinforce existing and future programs and initiatives for integrated research and the scientific assessment of disaster risk, and (2) establish and promote an international science advisory mechanism for DRR to strengthen the evidence base to effectively reduce disaster risk and enhance resilience.
The current 5 activities that an international science advisory mechanism could include are summarized here:
∙ producing periodic reports on current and future disaster risks and on the status of efforts to manage such risks at global, regional, national, and local scales;
∙ monitoring progress toward internationally-agreed targets for reducing disaster losses and building resilience to disasters;
∙ providing guidance on terminology, methodologies, and standards for risk assessments, risk modeling, taxonomies, and the use of data;
∙ convening stakeholders to identify and address demands for scientific research, information, and evidence on disaster risk and resilience; and
∙ enhancing the communication of complex scientific information and evidence to support the decision-making of policy makers and other stakeholders.
By taking this plan on DRR between May and July 2014 to regional platforms in Africa,
9
,
10
the Americas,
11
,
12
the Pacific,
13
Asia,
14
,
15
and the European Ministerial Meeting,
16
much support for this approach was found. Health issues were particularly identified at these meetings as follows:
∙ The Africa Regional Platform in May 2014 stated that “Health is an imperative for disaster risk reduction and community resilience. Health status and targets should be among indicators for monitoring and reporting on disaster risk reduction achievements,”
9
which reflect health being identified as a distal outcome and co-benefit to DRR unless clear targets are agreed for monitoring the post-2015 DRR agenda.
∙ The Americas Regional Platform in May 2014 addressed health as a sector in particular and stated the following:
“Note that 89% of the countries in the Americas are implementing national initiatives on safe hospitals and improving the resilience of new and existing health care services in order to ensure continuity of operations in the event of a disaster.”
“Affirm that protecting essential services, particularly schools and hospitals, is a social priority, a collective and political responsibility and is crucial for achieving resilient communities.”
“Establish the development and implementation of safe school and hospital policies and programmes as a priority for action at the local, national and regional levels in order to protect and guarantee access to education and health services before, during and after disaster situations, as a contribution towards the achievement of the millennium development goals.”
11
During all of the regional platforms, the World Health Organization (WHO) in partnership with many organizations has been active in promoting recommendations for health and DRR
17
that address health as an outcome, a sector, and a valuable part of these agreements. These recommendations are as follows:
∙ Make people’s health and well-being an explicit outcome of the next global framework on DRR.
∙ Include health targets and indicators for monitoring and reporting on DRR.
∙ Strengthen action and resources to support health and other sectors that are vital for implementing DRR.
∙ Establish the safe hospitals initiative as a global priority for action to ensuring that new and existing health facilities remain operational in emergencies and disasters.
In addition, this report states that “A priority is to establish an International Science Advisory mechanism for DRR to strengthen the evidence and science base for developing good practice, and for improved monitoring and reporting, including the measurement of reduction of risks of injury, disease and disability due to hazards.” It also recommends that the International Health Regulations (2005) should be linked to the next framework on DRR to provide an international mechanism for the early detection, assessment, and rapid response to public health emergencies with the potential for international spread, as these regulations provide a legal mandate for countries to comply with installing capacities for the management of events that may constitute a public health emergency of international concern.
Preparatory Committee Meeting for the Third UN World Conference on DRR
To follow the process through to a final agreement for the HFA post-2015 agenda, because governments will be the signatories to the framework, the UN system requires that 2 preparatory committee meetings be held in July and November 2014 before the Third World Conference on Disaster Reduction is held in March 2015 in Sendai, Japan.
The first preparatory committee meeting (PREPCOM1) for the Third UN World Conference on Disaster Risk Reduction, July 14 and 15, 2014, in Geneva, Switzerland.
18
At this meeting, many governments requested more support for science, knowledge transfer, databases, monitoring, and analysis. Health and health-related issues were also included in some of the country statements.
A joint UN-PREPCOM1 statement from this meeting, which listed WHO amongst the 28 UN signatories, included the following sections relevant to health, where health is identified as a valuable part of DRR:
“The new framework should address all types of hazards which could result in disasters, including geological, hydro-meteorological, technological and biological hazards such as epidemics and pandemics. The link to societal hazards, such as conflict, social unrest and financial crises should also be considered because there are some commonalities in the approaches to managing the respective risks.”
“Strengthening science and research that informs disaster risk reduction policy and practice. In this regard, the UN system supports the proposed creation of an international science advisory mechanism to strengthen the evidence base for the implementation and monitoring of the new framework.”
UNISDR called for coherence and mutual reinforcement between a post-2015 framework for DRR, sustainable development goals, and the conference of parties to the UNFCCC in April 2014,
19
which was addressed in part at PREPCOM1.
Negotiations on HFA DRR post-2015 are likely to continue to the Third World Conference on Disaster Reduction, which will be held in Japan in March 2015.
Sustainable Development Goals
The outcome document of the 2010 Millennium Development Goals Summit requested that the UN Secretary-General initiated thinking on the global development agenda beyond 2015.
20
The outcome document of the 2012 Rio+20 Conference on Sustainable Development initiated an inclusive process to develop a set of sustainable development goals and called for DRR to be addressed with a renewed sense of urgency in the context of the sustainable development and poverty eradication. Furthermore, it called for more comprehensive strategies that integrate DRR and climate change adaptation considerations into public and private investment, decision-making, and planning. The UN General Assembly also strongly encouraged appropriate consideration to DRR and the building of resilience to disasters within the post-2015 development agenda.
The latest version of the zero order draft of the Open Working Group on Sustainable Development Goals, in July 2014,
21
identifies health as key in proposed goal 3 (Box).
BOXProposed Sustainable Development Goals
1. End poverty in all its forms everywhere.
2. End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.
3. Ensure healthy lives and promote well-being for all at all ages.
4. Ensure inclusive and equitable quality education and promote life-long learning opportunities for all.
5. Achieve gender equality and empower all women and girls.
6. Ensure availability and sustainable management of water and sanitation for all.
7. Ensure access to affordable, reliable, sustainable, and modern energy for all.
8. Promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all.
9. Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation.
10. Reduce inequality within and among countries.
11. Make cities and human settlements inclusive, safe, resilient, and sustainable.
12. Ensure sustainable consumption and production patterns.
13. Take urgent action to combat climate change and its impacts.
14. Conserve and sustainably use the oceans, seas, and marine resources for sustainable development.
15. Protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss.
16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels.
17. Strengthen the means of implementation and revitalize the global partnership for sustainable development.
In very brief summary, proposed goal 3—to ensure healthy lives and promote well-being for all at all ages—considers the need to address global maternal mortality ratio to less than 70 per 100 000 live births; ending preventable deaths of newborns and children younger than 5 years old; ending epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases; reducing by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being; strengthening prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol; and halving global deaths and injuries from road traffic accidents, among other topics. Of particular import for DRR, this proposed goal also states “strengthen the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks.” The negotiations will continue until September 2015.
CLIMATE CHANGE AND HEALTH
In 1992, countries joined an international treaty, the UNFCCC, to cooperatively consider what they could do to limit average global temperature increases and the resulting climate change, and to cope with whatever impacts were, by then, inevitable. The Kyoto Protocol was agreed with a second commitment period from 2013 to 2020. Now the pace moves forward to the UNFCCC’s 21st session of the Conference of the Parties (COP 21/CMP 11), serving as the meeting of the parties, which will be held in Paris, France, from November 30 to December 11, 2015.
Much of the scientific evidence comes from work conducted at the Intergovernmental Panel on Climate Change (IPCC), such as the IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation (SREX), particularly with respect to increases in the frequency and magnitude of warm daily temperatures and in the frequency of heavy precipitation, whereas confidence levels linked to droughts and fluvial floods were lower.
22
In March 2014, the IPCC released the report of Working Group 2, which updated the evidence on the health risks of climate change. The report highlighted the possibility of high-end climate scenarios, including warming by 4 to 7° C over much of the globe by 2100, which would lead to some critical thresholds being crossed. It concluded that climate change acts mainly by exacerbating existing health problems but also affects water, food, and nutrition security, and that the most vulnerable populations are those that are already most affected by climate-related diseases.
23
On August 27 to 29, 2014, WHO is hosting a 3-day conference on health and climate that will bring together leading experts in the fields of health and climate change to discuss strengthening health system resilience to climate risks and promoting health while mitigating climate change. The conference will make recommendations on policy options within each of these themes to maximize health benefits, and the specific contribution of the health sector to the objectives. In this way, the conference will build on the link between climate and health that was selected as the theme of the general discussion at the World Health Assembly (WHA) in May 2014. The outcomes conference will inform future WHA discussions on the renewal of WHO’s work on air pollution, climate change, and health.Reference Neira
24
It is hoped that the outputs will be integrated into the WHO Work Plan on Climate and Health, National Climate Adaptation Plans, IPCC reports, the Global Framework for Climate Services, and the Climate Change Agreements by COP 21/CMP 11 to be discussed in Paris at the end of 2015.
How Will Health and Public Health Be Part of These Agreements?
In summary, the 3 UN landmark agreements of a post-2015 HFA framework for DRR, sustainable development goals (SDGs), and the COP21/CMP 11 to the UNFCCC for climate change all include health and public health in their processes as part of the huge global negotiations.
Whereas health outcomes have been identified as an explicit goal apparently in the SDGs only, maybe more is needed in the HFA2 and the climate change agreements. So far health, as a distal outcome and co-benefit, could be emphasized more in the climate change agreements, linking to SDGs, and indeed in HFA2. Health sector recommendations are explicit in HFA2 negotiations, driven particularly by the Regional Platform of the Americas with WHO and the Pan American Health Organization. Health is a valuable part of the process and is reflected in the proposed international science advisory mechanism.
Health professionals should be more actively engaged in these international processes to ensure that health issues are addressed as clearly as possible. They can do this by supporting greater consideration of health outcomes, both as primary goals and as co-benefits, by helping to understand and develop the role of the health sector, and by strengthening the processes themselves, for example, by participating in an international science advisory mechanism, as recommended by WHO.
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Better health is an important outcome from the 2015 United Nations (UN) landmark agreements for disaster risk reduction, climate change, and sustainable development. To achieve the best overall outcomes, an understanding of how health is included and can be further strengthened in these global processes and agreements is imperative.
HYOGO FRAMEWORK FOR ACTION POST-2015
Disaster Risk Reduction
Disasters affect human lives by causing injury and long-term impact as well as destroying lives and livelihoods around the world. In 2005, the Second World Conference on Disaster Reduction in Kobe, Japan, adopted the Hyogo Framework for Action 2005-2015: Building the Resilience of Countries and Communities to Disasters (HFA). HFA was the first plan to explain, describe, and detail the work that is required from all different sectors and actors to reduce losses in disasters. The plan was developed and agreed on with the many partners needed to reduce disaster risk—governments, international agencies, disaster experts, and many others—bringing them into a common system of coordination. 1 The HFA outlines the following 5 priorities for action:
1. Ensure that disaster risk reduction is a national and a local priority with a strong institutional basis for implementation.
2. Identify, assess, and monitor disaster risks and enhance early warning.
3. Use knowledge, innovation, and education to build a culture of safety and resilience at all levels.
4. Reduce the underlying risk factors.
5. Strengthen disaster preparedness for effective response at all levels.
These extremely important priorities form a framework for effective action; however, the absence of health and public health as an explicit component diminishes the overall conceptual framework for action. This lack is markedly demonstrated by the fact that 1.7 million people died in disasters between 2000 and 2012, and an estimated US $1.7 trillion of damage was sustained. 2
What does disaster risk reduction (DRR) mean to health colleagues? DRR activities are varied and aim to reduce the impact from disasters on loss of life, injury, or other health impacts; property damage; loss of livelihoods and services; social and economic disruption; or environmental damage. To build knowledge, evidence-based science should be considered in its widest sense to include the natural, environmental, social, economic, health, and engineering sciences. In addition, scientific capacities are interpreted broadly to include all relevant resources and skills of a scientific and technical nature.Reference Reid 3 Evidence-based science can play an essential role in these efforts by uncovering new ways to prevent, prepare for, and respond to disasters and determining which technologies are most effective in reducing disaster risk. As a result of scientific research, science and technology are already helping to save lives and livelihoods via programs to prevent infectious disease outbreaks with vaccination, to forecast floods, detect tsunami waves, and effectively communicate disaster risk to enhance community resilience.
Now significant developments in the evolution of the HFA provide an unparalleled opportunity to focus on the importance of health and public health as a necessary component to the overall framework. Specifically, 2015 will be marked by 3 landmark UN agreements:
∙ Framework for Disaster Risk Reduction (HFA Disaster Risk Reduction 2015, which will last 10 to 20 years, due for agreement in March 2015) 4
∙ Sustainable Development Goals (September 2015) 5
∙ Climate change agreements through the UN Framework for Convention on Climate Change (December 2015). 6
The importance and necessity of this effort are further underscored by the fact that at the conclusion of the UN International Strategy in Disaster Risk Reduction (UNISDR), the Scientific and Technical Committee report on using science for DRR at the global platform in May 2013 issued 4 recommendations. Because evidence-based science is not used enough to reduce disaster risks, these recommendations are intended to (1) encourage science to demonstrate that it can inform policy and practice, (2) use a problem-solving approach to research that integrates all hazards and disciplines, (3) promote knowledge into action, and (4) regard science as the key to the post-2015 framework for DRR (HFA2).Reference Southgate, Roth and Schneider 7
Proposed International Science Advisory Mechanism
Evidence-based science in health and public health for DRR is frequently upheld as good examples of improving knowledge. In part, this knowledge and other data have led the UNISDR Scientific and Technical Advisory Group to prepare a joint statement on establishing an international science advisory mechanism for DRR to strengthen resilience for the post-2015 agenda. 8 This statement reflects their commitment to work together to ensure that science, engineering, and technology as well as health science are embedded into disaster risk management, and that health can be identified here as a valuable part of the process. This statement presents an action agenda for DRR and resilience strengthening that proposes to (1) champion and reinforce existing and future programs and initiatives for integrated research and the scientific assessment of disaster risk, and (2) establish and promote an international science advisory mechanism for DRR to strengthen the evidence base to effectively reduce disaster risk and enhance resilience.
The current 5 activities that an international science advisory mechanism could include are summarized here:
∙ producing periodic reports on current and future disaster risks and on the status of efforts to manage such risks at global, regional, national, and local scales;
∙ monitoring progress toward internationally-agreed targets for reducing disaster losses and building resilience to disasters;
∙ providing guidance on terminology, methodologies, and standards for risk assessments, risk modeling, taxonomies, and the use of data;
∙ convening stakeholders to identify and address demands for scientific research, information, and evidence on disaster risk and resilience; and
∙ enhancing the communication of complex scientific information and evidence to support the decision-making of policy makers and other stakeholders.
By taking this plan on DRR between May and July 2014 to regional platforms in Africa, 9 , 10 the Americas, 11 , 12 the Pacific, 13 Asia, 14 , 15 and the European Ministerial Meeting, 16 much support for this approach was found. Health issues were particularly identified at these meetings as follows:
∙ The Africa Regional Platform in May 2014 stated that “Health is an imperative for disaster risk reduction and community resilience. Health status and targets should be among indicators for monitoring and reporting on disaster risk reduction achievements,” 9 which reflect health being identified as a distal outcome and co-benefit to DRR unless clear targets are agreed for monitoring the post-2015 DRR agenda.
∙ The Americas Regional Platform in May 2014 addressed health as a sector in particular and stated the following:
“Note that 89% of the countries in the Americas are implementing national initiatives on safe hospitals and improving the resilience of new and existing health care services in order to ensure continuity of operations in the event of a disaster.”
“Affirm that protecting essential services, particularly schools and hospitals, is a social priority, a collective and political responsibility and is crucial for achieving resilient communities.”
“Establish the development and implementation of safe school and hospital policies and programmes as a priority for action at the local, national and regional levels in order to protect and guarantee access to education and health services before, during and after disaster situations, as a contribution towards the achievement of the millennium development goals.” 11
During all of the regional platforms, the World Health Organization (WHO) in partnership with many organizations has been active in promoting recommendations for health and DRR 17 that address health as an outcome, a sector, and a valuable part of these agreements. These recommendations are as follows:
∙ Make people’s health and well-being an explicit outcome of the next global framework on DRR.
∙ Include health targets and indicators for monitoring and reporting on DRR.
∙ Strengthen action and resources to support health and other sectors that are vital for implementing DRR.
∙ Establish the safe hospitals initiative as a global priority for action to ensuring that new and existing health facilities remain operational in emergencies and disasters.
In addition, this report states that “A priority is to establish an International Science Advisory mechanism for DRR to strengthen the evidence and science base for developing good practice, and for improved monitoring and reporting, including the measurement of reduction of risks of injury, disease and disability due to hazards.” It also recommends that the International Health Regulations (2005) should be linked to the next framework on DRR to provide an international mechanism for the early detection, assessment, and rapid response to public health emergencies with the potential for international spread, as these regulations provide a legal mandate for countries to comply with installing capacities for the management of events that may constitute a public health emergency of international concern.
Preparatory Committee Meeting for the Third UN World Conference on DRR
To follow the process through to a final agreement for the HFA post-2015 agenda, because governments will be the signatories to the framework, the UN system requires that 2 preparatory committee meetings be held in July and November 2014 before the Third World Conference on Disaster Reduction is held in March 2015 in Sendai, Japan.
The first preparatory committee meeting (PREPCOM1) for the Third UN World Conference on Disaster Risk Reduction, July 14 and 15, 2014, in Geneva, Switzerland. 18 At this meeting, many governments requested more support for science, knowledge transfer, databases, monitoring, and analysis. Health and health-related issues were also included in some of the country statements.
A joint UN-PREPCOM1 statement from this meeting, which listed WHO amongst the 28 UN signatories, included the following sections relevant to health, where health is identified as a valuable part of DRR:
“The new framework should address all types of hazards which could result in disasters, including geological, hydro-meteorological, technological and biological hazards such as epidemics and pandemics. The link to societal hazards, such as conflict, social unrest and financial crises should also be considered because there are some commonalities in the approaches to managing the respective risks.”
“Strengthening science and research that informs disaster risk reduction policy and practice. In this regard, the UN system supports the proposed creation of an international science advisory mechanism to strengthen the evidence base for the implementation and monitoring of the new framework.”
UNISDR called for coherence and mutual reinforcement between a post-2015 framework for DRR, sustainable development goals, and the conference of parties to the UNFCCC in April 2014, 19 which was addressed in part at PREPCOM1.
Negotiations on HFA DRR post-2015 are likely to continue to the Third World Conference on Disaster Reduction, which will be held in Japan in March 2015.
Sustainable Development Goals
The outcome document of the 2010 Millennium Development Goals Summit requested that the UN Secretary-General initiated thinking on the global development agenda beyond 2015. 20 The outcome document of the 2012 Rio+20 Conference on Sustainable Development initiated an inclusive process to develop a set of sustainable development goals and called for DRR to be addressed with a renewed sense of urgency in the context of the sustainable development and poverty eradication. Furthermore, it called for more comprehensive strategies that integrate DRR and climate change adaptation considerations into public and private investment, decision-making, and planning. The UN General Assembly also strongly encouraged appropriate consideration to DRR and the building of resilience to disasters within the post-2015 development agenda.
The latest version of the zero order draft of the Open Working Group on Sustainable Development Goals, in July 2014, 21 identifies health as key in proposed goal 3 (Box).
Proposed Sustainable Development Goals
1. End poverty in all its forms everywhere.
2. End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.
3. Ensure healthy lives and promote well-being for all at all ages.
4. Ensure inclusive and equitable quality education and promote life-long learning opportunities for all.
5. Achieve gender equality and empower all women and girls.
6. Ensure availability and sustainable management of water and sanitation for all.
7. Ensure access to affordable, reliable, sustainable, and modern energy for all.
8. Promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all.
9. Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation.
10. Reduce inequality within and among countries.
11. Make cities and human settlements inclusive, safe, resilient, and sustainable.
12. Ensure sustainable consumption and production patterns.
13. Take urgent action to combat climate change and its impacts.
14. Conserve and sustainably use the oceans, seas, and marine resources for sustainable development.
15. Protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss.
16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels.
17. Strengthen the means of implementation and revitalize the global partnership for sustainable development.
In very brief summary, proposed goal 3—to ensure healthy lives and promote well-being for all at all ages—considers the need to address global maternal mortality ratio to less than 70 per 100 000 live births; ending preventable deaths of newborns and children younger than 5 years old; ending epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases; reducing by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being; strengthening prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol; and halving global deaths and injuries from road traffic accidents, among other topics. Of particular import for DRR, this proposed goal also states “strengthen the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks.” The negotiations will continue until September 2015.
CLIMATE CHANGE AND HEALTH
In 1992, countries joined an international treaty, the UNFCCC, to cooperatively consider what they could do to limit average global temperature increases and the resulting climate change, and to cope with whatever impacts were, by then, inevitable. The Kyoto Protocol was agreed with a second commitment period from 2013 to 2020. Now the pace moves forward to the UNFCCC’s 21st session of the Conference of the Parties (COP 21/CMP 11), serving as the meeting of the parties, which will be held in Paris, France, from November 30 to December 11, 2015.
Much of the scientific evidence comes from work conducted at the Intergovernmental Panel on Climate Change (IPCC), such as the IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation (SREX), particularly with respect to increases in the frequency and magnitude of warm daily temperatures and in the frequency of heavy precipitation, whereas confidence levels linked to droughts and fluvial floods were lower. 22
In March 2014, the IPCC released the report of Working Group 2, which updated the evidence on the health risks of climate change. The report highlighted the possibility of high-end climate scenarios, including warming by 4 to 7° C over much of the globe by 2100, which would lead to some critical thresholds being crossed. It concluded that climate change acts mainly by exacerbating existing health problems but also affects water, food, and nutrition security, and that the most vulnerable populations are those that are already most affected by climate-related diseases. 23
On August 27 to 29, 2014, WHO is hosting a 3-day conference on health and climate that will bring together leading experts in the fields of health and climate change to discuss strengthening health system resilience to climate risks and promoting health while mitigating climate change. The conference will make recommendations on policy options within each of these themes to maximize health benefits, and the specific contribution of the health sector to the objectives. In this way, the conference will build on the link between climate and health that was selected as the theme of the general discussion at the World Health Assembly (WHA) in May 2014. The outcomes conference will inform future WHA discussions on the renewal of WHO’s work on air pollution, climate change, and health.Reference Neira 24 It is hoped that the outputs will be integrated into the WHO Work Plan on Climate and Health, National Climate Adaptation Plans, IPCC reports, the Global Framework for Climate Services, and the Climate Change Agreements by COP 21/CMP 11 to be discussed in Paris at the end of 2015.
How Will Health and Public Health Be Part of These Agreements?
In summary, the 3 UN landmark agreements of a post-2015 HFA framework for DRR, sustainable development goals (SDGs), and the COP21/CMP 11 to the UNFCCC for climate change all include health and public health in their processes as part of the huge global negotiations.
Whereas health outcomes have been identified as an explicit goal apparently in the SDGs only, maybe more is needed in the HFA2 and the climate change agreements. So far health, as a distal outcome and co-benefit, could be emphasized more in the climate change agreements, linking to SDGs, and indeed in HFA2. Health sector recommendations are explicit in HFA2 negotiations, driven particularly by the Regional Platform of the Americas with WHO and the Pan American Health Organization. Health is a valuable part of the process and is reflected in the proposed international science advisory mechanism.
Health professionals should be more actively engaged in these international processes to ensure that health issues are addressed as clearly as possible. They can do this by supporting greater consideration of health outcomes, both as primary goals and as co-benefits, by helping to understand and develop the role of the health sector, and by strengthening the processes themselves, for example, by participating in an international science advisory mechanism, as recommended by WHO.
Acknowledgment
James Smith, Consultant in Public Health Strategy (Sustainable Development), Public Health England, provided helpful comments on this report.