The climate emergency could be the ultimate health opportunity, says WHO’s Maria NeiraBMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2217 (Published 04 October 2023) Cite this as: BMJ 2023;383:p2217
Maria Neira wanted to be a diabetologist—that was until she went to work with Médecins Sans Frontières in El Salvador and Honduras, treating people displaced to refugee camps during the armed conflict.
“That’s when I discovered public health and changed completely from the curative to the preventative. I wanted more impact from my interventions,” she says. “I then did a masters in public health—but I really learnt about it in the refugee camps, not at university.”
Neira later spent five years working in eastern Africa, as a public health adviser to the Mozambique Ministry of Health and as a UN public health adviser in Kigali, Rwanda. And for nearly two decades she has headed up WHO’s department of environment, climate change, and health.
Over that time, she says there have been advancements—including in how public health officers consider climate as part of their work and the development of international air quality guidelines—but never at the speed or with the ambition she would like.
Politicians—stop talking, take action
“Climate change is one of the biggest public health areas. I don’t see any aspect where climate change will not have an undermining capacity,” she says. “I know that this sounds a little bit provocative, but climate change could be the ultimate opportunity for public health.”
Neira believes implementing the Paris Agreement would be the best action governments could take. “It would reduce traffic in our cities, reduce air pollution, protect the sources of water, create greener development and more sustainable food production, and make our lives less sedentary, with fewer chronic and non-communicable diseases,” she says. “It could be—it should be—the public health treaty we are all dreaming of.”
But when it comes to politics, Neira wants politicians to stop talking and start taking action.
“The speeches where they say how bad this will be for the next generation. ‘We will be held responsible by our children and our grandchildren. We need to protect the future for our children.’ Fine, we are all in agreement—that’s why we’re here. So, tell me, what you are planning to do?
“Sometimes you see big politicians talking and using the language of activists, which is great. But then don’t forget that you have the power. You are the prime minister. So don’t tell me, tell yourself and then make the right decisions.”
Is COP effective?
One source of fanfare, grand speeches, and air miles is the annual UN climate conference of parties (COP), which enters its 28th year this November in the United Arab Emirates. “That means that for 28 years we have been celebrating COP’s fixing of the problem of climate change. When you need 30 years to tackle a problem that is supposed to be one of the biggest that humanity is facing, maybe your sense of urgency is not so clear.”
There have been moments of hope. She speaks of COP26 in Glasgow, which ground out a historic health commitment1 whereby 50 countries pledged to create low carbon and sustainable health systems. “That was the first time the health argument infiltrated the climate conversation,” Neira says. “This is rewarding for health professionals.”
At COP28, the first ever “health day” will take place at the conference on 3 December. It will focus on the fragility of public health systems worldwide, the urgent need to adapt these systems in response to climate change, and the financial toll of climate related health crises.
In Neira’s view, the health argument is the “ultimate argument to motivate” and one that will “completely change the speed and the ambition in our negotiations on climate change.”
“The health argument is a positive means of saying ‘you will obtain this for your health—you will reduce asthma, you will reduce lung cancer, you will have this, this, this, and in addition you will reduce the cost to the health system.’ It can be the engine, it can be the ultimate motivation for combatting climate change and doing something more fundamental,” she says.
“The moment an old woman in London understands the connection between climate change and her grandson’s asthma. Wow. When you have parents and grandparents understanding the impact on the health of children, that’s irreversible.”
Stop fighting nature
There is another way tackling climate change can aid our health: pandemic preparedness.
“If we destroy the ecosystems that protect us and make us less vulnerable to pandemics—then we are destroyed. If we want to prevent pandemics in the future, we need to create those green walls,” Neira says.
That’s why just a few months after the covid-19 pandemic started her team put together “prescriptions for a healthy and green recovery.”2 The manifesto sets out six actions she describes as “totally common sense.”
“The first was to stop fighting with nature. Nature is the one that gives you the air you breathe, the water you drink, and the food you eat. So, stop the destruction of ecosystems and biodiversity. Be a little bit wiser and you will see that this is a fantastic barrier against future pandemics,” she says. The other five include transitioning to clean sources of energy, urban planning, setting up sustainable food systems, and stopping subsidies to fossil fuels.
For Neira the argument is simple—it’s not the planet that needs saving, it’s us.
“If you don’t protect nature, nature will not protect you. This arrogance we have sometimes in saying, ‘I need to protect the planet.’ No. The planet is the one allowing you to survive,” she says. “Without this, without these ecosystems and without nature, we are nothing. We could disappear tomorrow.”
Commissioning and peer review: