Climate Change and Health. International Law’s Tools for a Double Crisis

Climate Change and Human Health: A Worrying and Uneven Linkage
The year 2020 not only brought the COVID-19 pandemic; it was also a year of intense and prolonged heat waves around the world that affected the physical and mental health of thousands of people. Record temperatures that year resulted in a new maximum of days and people exposed to abnormal periods of heat relative to the 1986-2005 annual average (Romanello et al., 2021), and even during 2022 heat waves, with peaks up to 50 degrees Celsius, have had devastating effects since April for the nearly one and a half billion people inhabiting northern India, Bangladesh, and southern Pakistan (Hinry, 2022).

Today we know that there is a worrying link between climate change and human health, which is no stranger to challenges such as the one posed by COVID-19. In addition to cardiovascular and respiratory conditions directly associated with extreme temperatures (McMichael & Lindgren, 2011), more than half of all known infectious diseases have been aggravated at some point by abnormal temperature variations (Mora et al., 2022). While scientific advances and international collaboration have made possible the production of vaccines against the coronavirus, thus reducing its danger in many countries, climate change as a cause of the worsening of infectious diseases is still far from being curbed. The greenhouse gas (GG) emissions that cause it continue on a trajectory to increase the planet’s temperature by more than two degrees Celsius by the end of this century (Climate Action Tracker, 2021).

While the climate crisis affects all populations, the health impacts are unfairly unequal as they are most acutely felt by people living in poverty (Pörtner et al., 2022, p. 11), whose GG emissions (cause of climate change), are insignificant compared to those of higher-income sectors (Bruckner et al., 2022). This means that diseases caused or exacerbated by extreme weather are less likely to be prevented or treated in people who lack access to health systems or who experience some form of invisibilization or exclusion (Parry et al., 2019). Thus, poverty and lack of accessible and quality medical services that currently affect half of the world’s population (WHO, 2021b) exacerbate the climate crisis as a health crisis (Romanello et al., 2021).

Against this backdrop, it is necessary to identify how countries can reduce the health vulnerability of their populations to climate change. International law offers tools for this from various fields. This article maps and reviews the contributions made by international climate change law, the human rights perspective, and global health initiatives, all of them with transcendence in national and regional legislation and public policy measures so that the analysis places particular emphasis on the progress that Mexico and other countries in the Latin American region have consolidated in this regard. Finally, it concludes that, despite the existence of these multiple pathways to address health crises, their fragmentation, lack of adequate financing, and the preeminence of mitigation over adaptation are persistent challenges. Until they are overcome, comprehensive health protection in face of climate change is far from being a reality.


Tools of International Law against the Health Crisis
Although preventing global temperature increases also prevents potential health effects, scientific knowledge has increasingly shown that the health impacts of climate change are not a matter of the future, but are already tangible (Pörtner et al., 2022). That is the reason why the regime established by the United Nations Framework Convention on Climate Change (UNFCCC, see box), around which international climate change law largely gravitates, has only in recent years addressed the link between it and human health. Two tools stand out in this area: National Adaptation Plans (NAPs) and Nationally Determined Contributions (NDCs).

As tools for planning strategies to reduce health vulnerability arising from the effects of climate change, NAPs were developed in 2010 by the Conference of the Parties (COP) to the UNFCCC, when it adopted the Cancun Adaptation Framework during its 16th session. This framework outlined the objective of intensifying adaptation to climate change in the so-called “developing” countries and, therefore, among other actions, urged countries to include programs in various areas, including health, in their NAPs (UNFCCC, 2010). Currently, 38 countries have issued their NAPs, and of these, 12 belong to the 33 countries in the Latin American and Caribbean region.

Even though Mexico started in 2018 the steps for the formulation of its NAP (IPCC, 2018), to date the plan has not been published. Nevertheless, the actions that have been taken at the regional level in terms of planning to reduce the vulnerability of health to climate change are noteworthy. For example, in 2014 the state of Veracruz prepared a plan for adaptation to climate change in health terms, which specifies and schedules strategies, lines of action, and goals aimed at increasing the resilience of the state’s population to diseases related to climate variation (Azamar Arizmendi et al., 2014), based on a diagnosis that provides information on the health conditions linked to climate change in that state, given its particular biophysical and socioeconomic context, as well as its morbidity and mortality.

The second tool conceived from international climate change law for countries to implement measures to reduce health vulnerability are the NDCs, established in the 2015 Paris Agreement. Article 3 of the agreement envisages the NDCs as the tool from which countries are to carry out and communicate their efforts to, among other objectives, increase adaptive capacity. Although the agreement does not explicitly attribute addressing health to the NDCs, health is now understood as an essential issue to achieve the adaptation objective set by the NDCs (Grambsch & Menne, 2003), especially by stating in its preamble that countries should promote the right to health when taking measures to address climate change.

States Parties to the Paris Agreement are required to submit their NDCs every five years. To date, 154 countries have registered their new or updated contributions with the UNFCCC Secretariat, including Mexico (the United Nations registry for each country and its NDCs is available at https://unfccc.int/NDCREG).

However, according to an analysis conducted by the Global Climate and Health Alliance, not all of them recognize and respond to the link between climate change and health (GCHA, n. d.). In particular, the contributions from Argentina, Colombia, and Mexico show a divergence between the magnitude of health impacts identified and the level of ambition of actions to counteract them.



Obligations Inherent to the Human Right to Health
Since the United Nations Human Rights Council adopted its first resolution on the link between human rights and climate change (UNHCHR, 2008) the various bodies and procedures of the universal and regional human rights systems have widely recognized the negative impact of rising global temperatures on the full enjoyment of multiple rights, including the human right to health. In 2016 the United Nations High Commissioner for Human Rights examined the relationship between obligations and responsibilities arising from the human right to health and actions to address climate change (UNHCHR, 2016), and recommended states, among other issues, to develop sustainable and resilient health systems and infrastructure, promote universal health coverage, and ensure participation and dissemination of information on climate impacts and natural disasters.

In December 2021, the Inter-American Commission on Human Rights (IACHR) adopted Resolution 3/21, “Climate Emergency: Scope of Inter-American Human Rights Obligations,” in which, recognizing that the health of certain groups exhibits greater vulnerability to climate change (children, women, migrant workers, the elderly, and persons with disabilities), it urges states to guarantee the human right to health of these groups by developing preventive plans in health care and protecting hospitals in the event of emergencies produced by rising global temperatures.

Thus, countries that have ratified treaties that recognize the human right to health as a part of their commitments under the UNFCCC, such as the International Covenant on Economic, Social, and Cultural Rights and the Protocol of San Salvador (see box), must translate the aforementioned recommendations into legislative, public policy, and access to justice measures to make this right effective in the context of climate change. Therefore, the instruments and subsequent resolutions of the universal and regional human rights systems constitute a guiding tool for the work of governments, law makers, and national and regional judicial branches, while at the same time accompanying the work of civil society organizations.

These social organizations are increasingly turning to national courts to demand that governments fulfill their commitment to mitigate climate change (Setzer & Higham, 2021). In such climate litigation, civil society supports its arguments on human rights standards in order to claim health impacts linked to the climate crisis and to induce the State to comply with its obligations in this matter. That was the case of “Youth v. Colombia”, in 2018, in which a group of young people assisted by a civil society organization successfully raised their arguments, founded on international human rights law, before the Colombian Supreme Court of Justice, which ruled in their favor (Plataforma de Litigio Climático para América Latina y el Caribe, n. d.). The court considered that climate change endangers the realization of multiple fundamental rights, including the right to health, and ordered various government entities (the defendant) to adopt measures aimed at reducing deforestation in the Colombian Amazon (Corte Suprema de Justicia de la República de Colombia, 2018), as the loss of forest cover is a major source of carbon dioxide emissions causing the increase in global temperature. 


Expansion and Strengthening of Public Health Systems 
Attention to global health challenges, such as disease control or response to health crises, is coordinated by the World Health Organization (WHO). Founded in 1948, this specialized agency of the United Nations draws the guidelines for member states to promote health. Two initiatives emanating from the WHO that stand out for their relevance in addressing the health crisis exacerbated by climate change are the expansion of public health systems, through Universal Health Coverage (UHC), and their strengthening to monitor and reduce the health risks derived from the increase in global temperature. Both are tools from which the WHO provides technical assistance, coordinates international cooperation, and guides the actions of countries to achieve the highest possible level of good health for their inhabitants.

The first tool, the UHC, consists of ensuring that all people can receive the medical services they need without incurring in catastrophic costs and falling into poverty because they have accessed the health care they needed (WHO, 2011). Its background dates back to 2005 when the WHO Assembly approved resolution WHA 58.33, urging countries to expand healthcare coverage by ensuring the adequate and equitable distribution of good quality health infrastructure and human resources. Six years later, by adopting resolution WHA 64.9, the Assembly reiterated the call on governments to strive to achieve universal and affordable health coverage and access for all, based on equity and solidarity.

Given the instrumental value of UHC in eradicating poverty and, therefore, reducing health vulnerability, this global initiative was established, through the recommendation of the United Nations General Assembly, as one of the targets of the 3rd Sustainable Development Goal of the 2030 Agenda, on ensuring healthy lives. This is target 3.8, which countries have committed to achieving by 2030: “achieve universal health coverage […], access to quality essential health services, and access to safe, effective, affordable, and quality medicines and vaccines for all” (United Nations General Assembly, 2015, p. 19). The monitoring of the indicator corresponding to that target reveals progress in all regions of the world toward its fulfillment, as the global average coverage rate has increased from 64% in 2015 to 67% in 2019 (UNDESA, 2021). Despite this progress in general terms, if we take a closer look at the situation in each country, it is possible to identify particular challenges that still prevent us from ensuring universal and affordable health services, so that no one is left behind in receiving the medical care needed to prevent and treat the health impacts caused by climate change. For example, the number of hospital beds in Mexico (1.4 per thousand inhabitants) is lower than the average for Latin American countries (2.1 per thousand inhabitants) (OECD/The World Bank, 2020, p. 28). In turn, out-of-pocket spending by Mexicans on health services represents 41% of total spending, which is higher than the Latin American average (34%).

The second WHO initiative relevant to overcoming the challenges posed by climate change is the call to strengthen the capacity of health systems to monitor and reduce its impact on public health. The WHO Assembly made this recommendation to member countries in its resolution WHA 61.19, which also included the call to incorporate health measures into climate change adaptation plans. Since then, WHO has issued three technical guides to support health sector planning and adaptation to climate change risks (WHO, 2017, 2019, 2021a). However, insufficient financial resources have been one of the major obstacles for countries to implement this tool. In the case of Mexico, although public spending on health has increased over the last two decades, its share of the national gross domestic product is still below the six percent recommended by the WHO and is even lower than the average for Latin American countries (Cid & Marinho, 2022).

It Is Time to Overcome the Challenges
Faced with the health crisis resulting from the combined effects of climate change, poverty, and the lack of accessible and quality medical services, international law offers tools for addressing it from various fields: the specific field of climate change, human rights, and global health initiatives that propose commitments and guidelines for countries to reduce the vulnerability of health of their populations through legislative measures, planning, and implementation of public policy and access to justice.

The cases of Mexico and other Latin American countries illustrate the progress of actions promoted by these three fronts of law; however, each one has separate trajectories, and this is evident through the actions of national scope. For example, NAPs often fail to fully consider the human rights perspective (Viveros-Uehara, 2021), or, when resolving climate litigation, courts omit to interpret the normative content of human rights under climate change commitments or global health initiatives (Viveros-Uehara, 2022). This, together with other obstacles such as the lack of adequate financing and the preeminence of mitigation over adaptation, implies a missed opportunity to combine the potential that each branch of law brings to understanding and addressing an increasingly complex problem.

The worrying and uneven link between climate change and human health is not an issue for the future. The impacts are already a matter of the present and will continue to be tangible, as the global temperature will continue to rise until mid-century, under all GG emission scenarios (Masson-Delmotte et al., 2021). We have the tools both to prevent a further increase in global temperature (mitigation) and to reduce vulnerability to present and projected changes (adaptation). It is urgent to implement them and take advantage of their potential. However, as long as each one is adopted without promoting convergence with other areas of international law, lacks adequate financing, or detracts from the urgency of adaptation, comprehensive protection of health in the climate change context is far from being a reality. 


 

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