1. Chapter 19: Health and Climate Change in International Negotiations
Protecting our Health from Professionals Climate Change: a Training Course for Public Health
Chapter 19: Health and Climate Change in International Negotiations

2. THE UNFCCC
UNFCCC
Convention
What is the United Nations Framework Convention on Climate Change (UNFCCC)?
International treaty to address challenges of climate change
192 countries have ratified
Entered force on 21 March 1994
The Kyoto Protocol
The Convention
Recognizes the global, shared problem
Provides a framework for discussion
Supports first steps: Reporting, assessment, planning
Establishes principle of "common but differentiated responsibilities"
Covers both mitigation and adaptation
Over a decade ago, most countries joined an international treaty – the United Nations Framework Convention on Climate Change (UNFCCC) – to begin to consider what can be done to, in a concerted manner at global level, to reduce greenhouse gas emissions and to cope with whatever temperature increases are inevitable.
A few years later, a number of nations approved an addition to the treaty: the Kyoto Protocol, which has powerful legally binding) measures.
The UNFCCC Secretariat, located in Bonn, supports all institutions involved in the climate change negotiation processes, particularly the Conference of Parties (COP) and the two Subsidiary Bodies and their Bureaux.
The Convention on Climate Change sets an overall framework for intergovernmental efforts to tackle the challenges posed by climate change.  It recognizes that the climate system is a shared resource whose stability can be affected by industrial and other emissions of carbon dioxide and other greenhouse gases.  The Convention enjoys near universal membership, with 192 countries having ratified. The Convention entered into force on 21 March 1994.
For the purpose of the Convention, “Adverse effects of climate change” means changes in the physical environment or biota resulting from climate change which have significant deleterious effects on the composition, resilience or productivity of natural and managed ecosystems or on the operation of socio-economic systems or on human health and welfare.
Under the Convention, governments:
Gather and share information on greenhouse gas emissions, national policies and best practices;
Launch national strategies for reducing greenhouse gas emissions and adapting to expected impacts, including the provision of financial and technological support to developing countries; 
Cooperate in preparing for adaptation to the impacts of climate change.

3. The Climate Change Negotiations
The Conference of the Parties (COP) is the prime authority of the UNFCC Convention. It is an association of all member countries (or “Parties”) and usually meets annually for a period of two weeks. These sessions are attended by several thousand government delegates, observer organizations, and journalists. The COP evaluates the status of climate change and the effectiveness of the treaty. It examines the activities of member countries, particularly by reviewing national communications and emissions inventories; it considers new scientific findings; and it tries to capitalize on experience as efforts to address climate change proceed.
A Subsidiary Body for Scientific and Technological Advice (SBSTA) counsels the COP on matters of climate, the environment, technology, and method. It meets twice a year.
A Subsidiary Body for Implementation (SBI) helps review implementation of UNFCCC and deals with financial and administrative matters. SBI meets twice each year.
Several expert groups exist under the Convention.
Partner agencies include the Global Environment Facility (GEF) who channels grants and loans to poor countries to help them address climate change, as called for by the Convention.
The Intergovernmental Panel on Climate Change (IPCC) provides services to the Convention, although it is not part of it, through publishing comprehensive reviews every five years of the status of climate change and climate-change science, along with special reports and technical papers on request.

4. The Kyoto Protocol Reaffirms responsibility of all countries
The Kyoto Protocol is an international legally binding agreement to reduce greenhouse gas emissions worldwide. The Kyoto Protocol is linked to the UNFCC Convention.
The Kyoto Protocol was adopted in Kyoto, Japan, on 11 December 1997 and entered into force on 16 February The major feature of the Kyoto Protocol is that it sets binding targets for 37 industrialized countries and the European community for reducing greenhouse gas emissions.
As of 14 January 2009, 183 countries and 1 regional economic integration organization (the EEC had ratified the Kyoto Protocol.
The Protocol’s first commitment period began in 2008 and ends in 2012.
The targets set amount to an average of five per cent against 1990 levels over the five-year period The major distinction between the Protocol and the Convention is that while the Convention encourages industrialized countries to stabilize GHG emissions, the Protocol commits them to do so.
Recognizing that developed countries are principally responsible for the current high levels of GHG emissions in the atmosphere as a result of more than 150 years of industrial activity, the Protocol places a heavier burden on developed nations under the principle of “common but differentiated responsibilities.”
The COP15 to be held in Copenhagen, Denmark, to be held in December 2009 will set the ground for the global agreement that will replace the Kyoto protocol as from 2012.
Reaffirms responsibility of all countries
Sets GHG targets for industrialized countries
Signed and ratified      
Signed, ratification pending      
Signed, ratification declined     
 Non-signatory
Map taken from:

5. UNFCCC: Practical Mechanisms
CDM
Clean Development Mechanism
GEF
Adaptation
Fund
Kyoto protocol
Reaffirms responsibility of all countries
Sets GHG targets for industrialized countries
Emissions Trading/ Clean Development Mechanism (CDM)
Allows countries to "buy" emissions reduction elsewhere.
Adaptation funds
2 % of CDM to be available for developing countries
Supplemented by voluntary funds
The Kyoto mechanisms.
Under the Treaty, countries must meet their targets primarily through national measures.
However, the Kyoto Protocol offers them an additional means of meeting their targets by way of three market-based mechanisms.
Emissions Trading.
The Clean Development Mechanism or CDM allows emission-reduction (or emission removal) projects in developing countries to earn certified emission reduction (CER) credits, each equivalent to one tonne of CO2. These CERs can be traded and sold, and used by industrialized countries to a meet a part of their emission reduction targets under the Kyoto Protocol. The CDM projects must qualify through a rigorous and public registration and issuance process designed to ensure real, measurable and verifiable emission reductions that are additional to what would have occurred without the project.
Joint Implementation.
The mechanisms help stimulate green investment and help Parties meet their emission targets in a cost-effective way.
The Adaptation Fund was established to finance adaptation projects and programmes in developing countries that are Parties to the Kyoto Protocol. The Fund is financed mainly with a share of proceeds from CDM project activities.  The share of proceeds amounts to 2% of certified emission reductions or CER issued for a CDM project activity.

6. The Nairobi Work Programme (NWP)
The Nairobi work programme on impacts, vulnerability and adaptation to climate change:
Assists all Parties, in particular developing countries, including LDCs and SIDS;
To improve their understanding and assessment of impacts, vulnerability and adaptation
To make informed decisions on practical adaptation actions
Has nine areas of work
Climate-related risks and extreme events
Adaptation planning and practices
Socio-economic information
Methods and tools
Data and observations
Economic diversification
Research
Climate modeling, scenarios and downscaling
Technology for adaptation
The NWP is mandated by the Subsidiary Body for Scientific and Technological Advice (SBSTA) as a five-year programme ( ).
Its objective is to assist all Parties, in particular developing countries, including the LDCs and Small Island Developing States (SIDS), to:
Improve their understanding and assessment of impacts, vulnerability and adaptation to climate change
Make informed decisions on practical adaptation actions and measures to respond to climate change on a sound scientific, technical and socio-economic basis, taking into account current and future climate change and variability.
The NWP is structured around 9 areas of work, and during the 1st phase, which ended in June 2008, workshops and expert meetings allowed Parties identify gaps and needs and recommendations for possible next steps in each area of work (Climate-related risks and extreme events; Adaptation planning and practices, Socio-economic information, and Climate modelling, scenarios and downscaling).
The 2nd phase of the NWP emphasises on activities dealing with economic diversification and adaptation planning and practices, as well as community, national and regional activities, including those based on education, training and awareness-raising.
In addition, the following forms of engagement will be enhanced throughout the second phase: (1) Calls for Action, (2) Action Pledges, (3) Engaging the private sector.
More at:

7. NWP Implementation and Health
Sectoral adaptation priorities for health
Carry out research, surveys, and outreach
Develop a general health strategy across agencies
Greater campaign on climate change and health for children
Develop programmes and training to empower the health community
Develop Strategy for climate-related risks in the health sector
Utilize traditional knowledge
3 modes of implementation
Activities mandated by the SBSTA
Furthering the reach of mandated activities
Catalyzing new and innovative action
NWP Partner organizations, institutions, experts and communities
Action Pledges- action by partners to engage with and enhance the work of the programme
The implementation of the NWP involves:
Activities mandated by the SBSTA, such as workshops, technical papers, etc
Furthering the reach of mandated activities (outreaching: Disseminating outcomes as widely as possible, Creating reader-friendly versions of UNFCCC products)
Catalysing new and innovative action by organizations within and outside of the UNFCCC process
The workshop on Adaptation planning and practices (Rome, 2007) recommended organizations active in health, such as (WHO to develop and standardize key indicators to monitor changes in health impacts and the effectiveness of climate-related risk reduction and adaptation measures and develop a strategy for climate-related risk reduction and adaptation in the health sector.
Research institutes at the national, regional and global levels should undertake research, risk mapping, capacity-building, training and outreach to address The research community should validate traditional knowledge and practices in order to improve and reinforce scientific research focused on practical actions to address climate related risks and impacts in the areas of agriculture, water resources, coastal zones and health.
The workshop on Climate-related risks and extreme events (Cairo, 2007) recommended (a) Carry out research and surveys on climate change impacts and health outcomes, especially regarding the changing distribution of diseases, the identification of new risk areas and options to reduce health impacts, and subsequently disseminate the results widely to decision makers, health practitioners and communities; (b) Develop programmes and training to empower the health community to plan and implement adaptation to climate variability and change; (c) Develop a general health strategy across agencies for distribution through medical entities that includes a common portfolio with methods and tools, best practices aimed at climate proofing the health sector and risk management techniques; (d) Develop a campaign on climate change and health for children through learning-oriented (e.g. school curricula) and creativity-oriented activities (e.g. competitions on campaign content).

8. NWP: WHO’s Call for Action
WHO pledges to carry out the following specific actions
Strengthening of health systems
Outreach and advocacy
Monitoring, surveillance and forecasting
Health development
Research and knowledge
Partnerships
In the health sector constraints include insufficient understanding and recognition among health practitioners of the need for adaptation planning, and the overall lack of vulnerability and adaptation assessments for different health outcomes.
WHO is committed to support the implementation of NWP. It will do the following:
Build capacity for the integration of climate-based information and services through collaboration dialogues, such as agricultural and food security outlook forums or health outlook forums, especially for malaria.
Undertake risk-mapping of health impacts. Develop and standardize key indicators to monitor changes in health impacts and the effectiveness of climate-related risk reduction and adaptation measures.
Carry out research and surveys on climate change impacts and health outcomes, especially regarding the changing distribution of diseases, the identification of new risk areas and options to reduce health impacts. Disseminate the results widely.
• Develop a general health strategy across agencies that includes a common portfolio with methods and tools; best practices aimed at climate proofing the health sector; and risk management techniques.
• Develop programmes and training to empower the health community to plan and implement adaptation to climate variability and change, using existing centres of excellence and facilitating the development of new centres where needed.
• Develop a campaign for climate change and health for children.

9. National Adaptation Programmes of Action or NAPAs
NAPAs provide an important way to prioritize urgent adaptation needs for Least developed countries
They draw on existing information and community-level input to identify adaptation projects required now in order to enable these countries to cope with the immediate impacts of climate change.
National Adaptation Programmes of Action (NAPAs) provide an important way to prioritise immediate adaptation needs – those for which further delay would increase vulnerability and/or costs at a later stage for Least Developed Countries. NAPAs draw on existing information and community-level input to identify adaptation projects required now in order to enable these countries to cope with the immediate impacts of climate change.
Focus of NAPAs: the NAPAs focus on urgent and immediate needs – those for which further delay could increase vulnerability or lead to increased costs at a later stage. NAPAs should use existing information; no new research is needed. They must be action-oriented and country-driven and be flexible and based on national circumstances. Finally, in order to effectively address urgent and immediate adaptation needs, NAPA documents should be presented in a simple format, easily understood both by policy-level decision-makers and by the public.
The NAPA process: The steps for the preparation of the NAPAs include synthesis of available information, participatory assessment of vulnerability to current climate variability and extreme events and of areas where risks would increase due to climate change, identification of key adaptation measures as well as criteria for prioritizing activities, and selection of a prioritized short list of activities.

10. The Bali Action Plan
The Bali Action Plan identified adaptation as one of the five key building blocks (shared vision, mitigation, adaptation, technology and financial resources) for a strengthened future response to climate change now, up to and beyond 2012
At COP 13 in Bali, Conference of Parties launched a comprehensive process to enable the full, effective and sustained implementation of the Convention through long-term cooperative action, now, up to and beyond The mandate regarding this process is contained in decision 1/CP.13, called the Bali Action Plan.
The AWG-LCA is expected to complete its work and present an agreed outcome for adoption at COP 15 in 2009 in Copenhagen.
The Bali Action Plan identifies adaptation as one of five key building blocks for a strengthened future response to climate change. The other four elements are mitigation, technology, finance and a shared vision for long-term cooperative action. Adaptation in the Bali Action Plan pays special focus on Developing countries that are particularly vulnerable to the adverse effects of climate change, which include LDCs and SIDS, and Countries in Africa affected by drought, desertification and floods.
The Bali Action Plan determines essential actions to adapt to the inevitable impacts of climate change and promote climate-resilient development.
This process began at COP13 and its mandate is to deliver an agreed outcome on the future climate change regime at COP 15 next year in Copenhagen.
One of the key objectives of the Bali Action Plan is to enable climate-resilient development and to reduce vulnerability of all Parties, in particular the poorest ones that will be hit the hardest

11. The UN System Coordinated Action on Climate Change
Chief Executive Board (CEB) initiated a process of aligning its strengths into a coordinated approach to climate change. The objective is to support (UNFCCC, as well as support in a coordinated way the efforts of member states at national, regional and global levels in tackling the multifaceted challenge presented by climate change.
The High-Level Event on Climate Change, convened by the Secretary-General on 24 September 2007, to galvanize political consensus, saw the unequivocal commitment of world leaders to concerted action.
This CEB document represents a first stage in defining key areas of action and an effective coordination structure for the UN system. It highlights its critical role in the area of science, assessment, monitoring and early warning as a basis for informed action. It articulates its contribution in supporting global, regional and national action within the four key areas of ongoing negotiation within the UNFCCC: mitigation, adaptation, technology and finance. The document also addresses key sectors for UN system action.

12. The Global Environment Facility or GEF
A global partnership among 178 countries to address global environmental issues while supporting national sustainable development initiatives
The designated financial mechanism for the UNFCCC (among others)
GEF supports projects in Climate Change Mitigation and Climate Change Adaptation
The Global Environment Facility (GEF) is a global partnership among 178 countries, international institutions, non-governmental organizations (NGOs), and the private sector to address global environmental issues while supporting national sustainable development initiatives.
GEF is the designated financial mechanism for a number of multilateral environmental agreements (MEAs) or conventions; as such the GEF assists countries in meeting their obligations under the conventions that they have signed and ratified. These conventions and MEAs provide guidance to the two governing bodies of the GEF: the GEF Council and the GEF Assembly.
GEF activities complement and enhance the work of the Montreal Protocol. Today the GEF is the largest funder of projects to improve the global environment. Since 1991, GEF has achieved a strong track record with developing countries and countries with economies in transition, providing $8.26 billion in grants and leveraging $33.7 billion in co-financing for over 2,200 projects in over 165 countries. GEF provides grants for projects related to the following six focal areas: biodiversity, climate change, international waters, land degradation, the ozone layer, and persistent organic pollutants. 
GEF projects in climate change help developing countries and economies in transition to contribute to the overall objective of the UNFCCC "to achieve [...] stabilization of greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system.”
As the financial mechanism of the UNFCCC, GEF allocates and disburses about $250 million dollars per year in projects in energy efficiency, renewable energies, and sustainable transportation. Moreover, it manages two special funds under the UNFCCC — the Least Developed Countries Fund and the Special Climate Change Fund. 
GEF supports projects in:
Climate Change Mitigation: Reducing or avoiding greenhouse gas emissions in the areas of renewable energy, energy efficiency, and sustainable transport
Climate Change Adaptation: Aiming at increasing resilience to the adverse impacts of climate change of vulnerable countries, sectors, and communities.

13. International Climate Change Agreements Are Key but…..
Limitations on mitigation actions
Kyoto Protocol inadequate to meaningfully reduce climate change, so far
Possible mitigation measures have very different health implications
No obligations for developing nations tat will become large emitters in near future
Problems with adaptation
Funding from rich nations is voluntary and complex to access
Health is poorly represented

14. Health in the Climate Change Negotiations
Health should be central
Main reasons for concern (e.g. disasters, food shortage, displacement disease) are health and wellbeing issues
Most energy and environment decisions (e.g. choice, use of fuel sources) have major direct health implications
Addressing climate change = sustainable development = health protection
The effects of climate change on health are receiving increasing attention as a central concern for policy-makers and the public. Human beings are already exposed to short and long-term health risks of climate change. Climate-sensitive diseases and health conditions today kill millions and climate change threatens to increase these disease burdens and erode the environmental conditions that support good health and well-being of mankind.

15. We Need More on Health at the UNFCCC
COP14, Poznan, Poland, December 2008: WHO supported youth representatives enact the importance to include health as a main dimension in climate change negotiations
The UNFCCC COP 14 held in Poznań, Poland, 1st to 12th December 2008 ended with a clear commitment from governments to shift into full negotiating mode next year in order to shape an ambitious and effective international response to climate change, to be agreed in Copenhagen at the end of A key event at the Conference was a ministerial round table on a shared vision on long-term cooperative action on climate change. The round table provided the opportunity to lay the foundations for further work on the components of an agreed outcome at COP 15 in Copenhagen. Further, it sent a clear message regarding the need to continue to build momentum on the many points of convergence among all nations.
The WHO side event and panel discussion held during COP14 at COP14 is about:
raising awareness about health as one of the main neglected impacts of climate change;
clearly state what we know about climate change and its health risks; and
establishing what we still need to know to improve the effectiveness of actions.

16. UNFCC Convention Addresses Health
UNFCCC text definition
“Adverse effects of climate change: changes in the physical environment or biota resulting from climate change which have significant deleterious effects on the composition, resilience or productivity of natural and managed ecosystems or on the operation of socio-economic systems or on human health and welfare.”
UNFCC COMMITMENTS
Paragraph 1 (f): All Parties…shall “take climate change considerations into account, to the extent feasible, in their relevant social, economic and environmental policies and actions, and employ appropriate methods, for example impact assessments, formulated and determined nationally, with a view to minimizing adverse effects on the economy, on public health and on the quality of the environment, of projects or measures undertaken by them to mitigate or adapt to climate change”
Paragraphs 4, 8 and 9: developed countries’ responsibilities to assist developing countries to adapt to climate change, with particular attention to the LDCs.
Article 4.1 (f)
Takes climate change considerations into account, to the extent feasible, in their relevant social, economic and environmental policies and actions, and employ appropriate methods, for example impact assessments, formulated and determined nationally, with a view to minimizing adverse effects on the economy, on public health and on the quality of the environment, of projects or measures undertaken by them to mitigate or adapt to climate change.
Decision 5/CP.7
Recognizes that the problems of poverty, land degradation, access to water and food and human health remain at the centre of global attention, need synergies and channels to achieve sustainable development Decides that implementation of the activities in the area of health, among others, to be supported through the Special Climate Change Fund and the Adaptation Fund, and other bilateral and multilateral sources.

17. National Communications to UNFCCC
National Communications Annex I
National Communications from Non-Annex I Parties
All Parties must report on the steps they are taking or envisage undertaking to implement the Convention
Under the Convention, all Parties should report on the steps they are taking to implement the Convention (Articles 4.1 and 12).
Most of the 41 Annex I Parties submitted their first report (known as a "national communication") in 1994 or 1995, their second in 1997–1998 and the third after 30 November The fourth national communications were due on 1 January 2006; by 15 June 2008, UNFCCC secretariat had received  40 communications.
Since 1996, Annex I Parties should also submit an annual inventory of their greenhouse gas (GHG) emissions to the Secretariat..
All Parties must report on the steps they are taking or envisage undertaking to implement the Convention (Articles 4.1 and 12).  In accordance with the principle of "common but differentiated responsibilities" enshrined in the Convention, the required contents of these national communications and the timetable for their submission is different for Annex I and non-Annex I Parties.  Each non-Annex I Party shall submit its initial communication within three years of the entry into force of the Convention for that Party, or of the availability of financial resources (except for the least developed countries, who may do so at their discretion).
Source: UNFCC, 2009

18. Health is One of the Top Priorities Identified in National Communications
That concern is consistent with Parties to the Convention on Climate Change.
Adaptation
All countries should continue to address adaptation needs and to help the most vulnerable countries adapt.
Convergence on the need for a framework for action on adaptation, laying out the range of actions to promote country-driven adaptation strategies with a view to galvanizing existing resources or drawing on a large number of additional funds (be based on the precautionary principle).
Climate-related risks for human health include increases in temperature, water stress, disease outbreaks, etc...
Low-lying and other small island countries, countries with low-lying coastal, arid and semi-arid areas or areas liable to floods, drought and desertification, and developing countries with fragile mountainous ecosystems are particularly vulnerable to the adverse effects of climate change

19. Current Representation of Health in Climate Change Mechanisms and Funding Support
Is identified as a priority in 32 out of 38 (84%) UNFCCC National Adaptation Plans of Action (NAPAs) from the poorest countries
Is the focus of 31 of 430 (7%) projects submitted for NAPA funding
Has received ~ $2.5 million of $1.3 billion (0.2%) of support granted under the UNFCCC
Is represented by ~20 of the 10,000 participants (0.2%) in the Climate Change Conference of the Parties

20. World Health Assembly and Climate Change
The formal health sector is increasingly taking responsibility for protecting and promoting health in response to the challenge of climate change. The global health agenda is set by the annual World Health Assembly (WHA), comprising the 193 WHO Member States.
In 2008, the WHA passed a resolution on climate change and health, drawing attention to the threat posed by climate change to the achievement of the Millennium Development Goals and health equity.
The resolution calls on WHO to strengthen its work in raising awareness about the health implications of climate change, supporting capacity building and research in health protection from climate change in countries, and urging action by the health sector within Member States.
This resolution is a political milestone for the full involvement of the health community in the climate change agenda: it drew overwhelming support from the Assembly
Prepare the global work plan for scaling up WHO’s technical support to Member States (to be tabled at EB as draft);
Develop capacity to assess and address the implications of climate change for health and health systems, including tools and methodologies;
Promote further research and pilot projects;
Develop and implement strategies and measures relating to climate change and their cost-effectiveness;
Assess health impacts of potential adaptation and mitigation measures undertaken by other sectors.

21. WHO Global Action Plan 2009
Aim: Support health systems in all countries, identify strategies and actions, share knowledge and good practices
4 objectives for WHO:
Advocacy and awareness raising
Engage in partnerships with other UN agencies and other sectors at national, regional and international levels
Promote and support the generation of scientific evidence
Strengthen health systems to cope with the health threats posed by climate change
Planned outputs:
Enhance capacity for assessing and monitoring the health vulnerability, risks and impacts due to climate change
Identify effective strategies and actions to protect human health and particularly the most vulnerable groups
Share knowledge and good practices on health system actions
WHO Global Workplan on Climate Change and Health aims to support health systems of all countries, but in particular, those of low and middle income countries and small island states.
Recommended reading: Submission by the World Health Organization to the UNFCCC, 2009