The United Nations Framework Convention on Climate Change (UNFCCC) 28th Conference of the Parties, Dubai (COP28): Implications for lung disease
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Abstract
Climate change is the greatest health threat of the 21st century. Among the broad array of diseases impacted by climate change, respiratory diseases feature prominently. Increases in temperature and other changes in climate can increase air pollution, particularly ozone and particulate matter,1, 2 which, in turn, is associated with increase in all-cause mortality, respiratory disease and lung cancer.3, 4 Increases in atmospheric carbon dioxide concentration and temperature are driving significant changes in aeroallergen exposure,5 including longer pollen seasons, increases in atmospheric pollen concentrations6 and increases in pollen allergenicity. These somewhat invisible changes in the air we breathe are already having adverse health consequences, with, for example, very early onset of spring leading to increased asthma hospitalization.7 Climate change is also changing the frequency and intensity of extreme weather events. Exposure to extreme heat can exacerbate respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma, increasing the risk of hospitalization and death.2, 8 In recent years, unprecedented bushfires have taken place around the world, with extended continuous exposure of large populations to bushfire smoke resulting in adverse respiratory health impacts and deaths.9 The long-term consequences of such exposure are yet to be fully understood and quantified. In November 2016, the world's largest, most catastrophic epidemic thunderstorm asthma event took place in Melbourne, Australia, killing 10 people and causing thousands of others to require respiratory and asthma-related hospital care. Climate change has been suggested as a contributor to the event.10, 11 The United Nations Framework Convention on Climate Change (UNFCCC) is the international body tasked with coordinating global efforts to address climate change. Nearly all countries in the world are parties to the convention, and country representatives have met annually since 1995 at the Conference of the Parties (COP) to negotiate agreements regarding various topics at the intersection of climate change and food systems, adaptation, the energy transition, gender inequalities and more.12 One of the most notable COP outcomes was the Paris Agreement, which was adopted in 2015 (at the 21st Conference of the Parties, Paris, France, 30 November–11 December 2015 [COP21]) and commits countries to limit global warming to below 2°C. This now requires rapid and substantial reductions in greenhouse gas emissions stemming from the use of fossil fuels, referred to as climate change mitigation. Climate change mitigation is fundamentally important for respiratory health and the prevention of lung diseases. The adverse impacts of climate change on respiratory diseases are projected to worsen into the future if global mitigation efforts fall short of the Paris Agreement target (e.g., Lake et al.13; Zhang and Steiner14). Mitigation of climate change through, for example, a transition to sustainable transport (e.g., electric vehicles), public transport and active transport (e.g., walking, cycling) presents an enormous additional benefit to respiratory health.15 Such a transition not only reduces the extent of climate change and therefore the magnitude of its adverse impacts, but also reduces local air pollution from petrol and diesel vehicles, therefore improving respiratory health, and physical fitness (referred to as a health co-benefit). Mitigation of climate change is a global health opportunity the world cannot afford to miss. The latest COP in Dubai, United Arab Emirates (28th Conference of the Parties, 30 November–12 December 2023 [COP28]), featured, for the first time in the event's history, a thematic day dedicated to health (Figure 1). After years of advocacy efforts, this significant milestone marks a major achievement for organizations working in the health space. The key outcome is a powerful statement titled COP28 UAE Declaration on Climate and Health to which 149 countries are signatories.16 It implicitly, but very prominently, identifies the adverse impacts of climate change on respiratory health and the current opportunity to address this issue. The Declaration recognizes the urgency of taking action on climate change in order to protect health, and emphasizes ‘the benefits for health from deep, rapid, and sustained reductions in greenhouse gas emissions, including from just transitions, lower air pollution, [and] active mobility’.16 More broadly, it commits to pursuing better integration of health considerations into climate policy processes, and of climate considerations across health policy agendas.16 Photo source: Camile Oliveira. While the Health Day signifies a growing international attention to the nexus of health and climate change and could be seen as a sign of progress, member states still have failed to commit to the level of ambition necessary to mitigate climate change and secure a healthy future for all. In fact, COP28's conclusion text, named the Global Stocktake, failed to mention the vital need to phase out fossil fuels (calling instead on Parties to transition away from fossil fuels),17 resulting in great pushback from the health community and beyond. As such, COP28 failed to achieve the action on climate change required to protect the respiratory health of vulnerable peoples and populations around the globe. The extent to which future climate change will impact respiratory health depends on our ability to rapidly and equitably transition away from a fossil fuel economy. Healthcare providers have the opportunity to educate their patients on how climate change and pollution can impact their respiratory health, and how to stay healthy during heat waves, other weather extremes, and periods of elevated air pollution. Individuals have the opportunity to support regional and national policies aimed at promoting cleaner energy and protecting environmental health for vulnerable communities. Divesting from fossil fuel portfolios, both at an institutional and individual level, may serve as a strategy to indirectly promote a clean energy economy. For those occupying leadership positions in public health and healthcare administration, the present moment offers an opportunity to decarbonise our healthcare sector and invest in adaptation strategies, ensuring that our healthcare facilities and systems are well prepared to respond to the impacts of climate change on health. Open access publishing facilitated by Macquarie University, as part of the Wiley - Macquarie University agreement via the Council of Australian University Librarians. Paul J. Beggs reports a relationship with Lancet Countdown that includes: board membership. Camile Oliveira declares no conflicts of interest. Catharina Giudice reports a relationship with Columbia University that includes: anticipated consulting fees paid to individual.
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