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Sector silos in climate action- A missed opportunity to prioritize health equity

Climate change poses a global challenge with severe adverse implications for human health [1]. The biggest burden of climate change disproportionately affects disadvantaged populations; both globally, such as inhabitants of small-island states or megacities, poor populations or displaced populations, as well as within countries, for instance people living in heat-prone urban areas, outdoor workers, people with chronic conditions, or pregnant women. This leads to diverse socioeconomic challenges and exacerbates global inequities in health. There is a scientific consensus that health equity and climate change are interconnected issues, and promoting health equity is crucial for effective climate action [2].

The past few decades have seen increased interest in the intersection of climate change and health [3]. The health effects of climate change often appear to be at the forefront in international forums and discussions, demonstrating that both governments and international organizations recognize the urgency of addressing this global challenge. There also seems to be a shared understanding of the necessity for coordinated and collaborative policy efforts to address climate change for equitable health outcomes. The recent COP28 lifted the political profile of the climate-health nexus and to mainstream health into the global climate change agenda. COP28 has established a climate health ministry and dedicated a full day to health to bring together ministers of health, environment, climate, finance and other sectors in support of more ambitious action to address the rapidly growing burden of climate change on health [4].

However, a deeper look at current research presents a different narrative. There appears to be a significant research gap with respect to health equity inclusion in the context of climate change policymaking. Even where the policy studies on climate change have touched upon equity concerns, health equity in particular falls behind gender equity, racial equity and social justice, although these are all connected. Furthermore, we lack analytical frameworks guiding the examination of barriers to integrate health into climate-related adaptation [5]. It is not clear whether this research gap is due to limited empirical documentation of efforts to understand the integration of health equity into climate change policies or if such efforts are, indeed, lacking. However, inadequate research in this area also implies that health equity has not received significant attention in the response to climate change raising questions regarding the commitment, knowledge, and demand from policymakers to address this growing threat. A possible entry point could be via efforts to achieve (more) climate justice, as has been suggested for the German context [6].

It has been argued that in the constantly evolving landscape of climate change and health equity, the need for integrated policies is paramount. Policies across different sectors related to climate change should be coherent with each other to provide much needed strategic directions, improve policy coherence, and increase the visibility of climate change related health equity issues [7]. Despite the increasing expectation for policymakers to collaborate across disciplines for more inclusive climate change and health policies, available information indicates that their responses often seem to stay isolated within their specific domains [3]. The lack of acknowledgment regarding the connections between environmental concerns and the impact of equity on health within policies highlights a segmented approach to planning and decision-making concerning climate change. Compartmentalized plans and policies are a significant missed opportunity, making it challenging to address equity concerns and understand the intersection.

Having said this, it is understandable that integrated policy development is easier said than done, given the norm of siloed policymaking in many countries [8]. Deeply rooted structural factors can impede progress in forming and implementing a coherent agenda related to climate change. Countries may face traditional institutional and political constraints to developing integrated policies, both in general and concerning climate change and health. This tendency to develop policies in isolation limits the ability of both sectors to collaborate and formulate comprehensive plans [9].

Achieving integrated climate change and health policies remains challenging until systemic barriers are addressed. While global governance mechanisms, ongoing debates, and advocacy for integrated health and climate policies may influence and exert pressure on countries to develop holistic policy responses, this alone may not be sufficient to catalyze changes in national policy-making processes. Effectively integrating health equity into climate change policy and decision-making requires institutionalizing health implications in decision-making and fostering a cultural shift [10]. This is critical not only to address climate change and health nexus but also to achieve various other Sustainable Development Goal targets.


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