A warming warning: Why climate crisis is a public health emergency

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After a tumultuous period marked by lockdowns, losses, and unprecedented disruptions, the global community found solace in the World Health Organisation’s (WHO) declaration that COVID-19 no longer constituted a Public Health Emergency of International Concern (PHEIC). However, this respite is accompanied by an enduring reality: The end of one crisis does not signify the end of challenges to human health. As aptly observed by the WHO Director-General, ‘‘In the face of overlapping and converging crises, pandemics are far from the only threat we face”. Climate change is one such looming threat—with profound health implications.

The undeniable and intrinsic link between human and planetary health underscores the urgent need to address climate change as a pressing public health issue. As climate change approaches critical tipping points, its impact on human health grows increasingly evident. Thus, it is no surprise that the WHO has formally recognised climate change as the 'single biggest threat to health in the 21^st century’. This acknowledgement has spurred global calls for classifying climate change as a public health emergency, resonating across various sectors and regions.

The undeniable and intrinsic link between human and planetary health underscores the urgent need to address climate change as a pressing public health issue.

Can climate change be legally classified as a public health emergency? This article examines the imperative to recognise climate change as a public emergency, highlighting its profound impact on human health and the classification challenges under the International Health Regulations (IHR). It probes the intersection of global health governance and the urgency of climate action. 

PHEIC and the international health regulations

The importance of a PHEIC lies in its role as the highest alert issued by the WHO regarding a health crisis. Regulated by the IHR, its declaration mandates immediate action, compelling States to prioritise coordinated responses to health crises with global implications. Far beyond a mere signal for attention, it is a normative imperative for states to develop their core capacities to handle the emergency.

When a PHEIC is declared, it invokes state obligations to uphold accountability and responsibility in detecting and managing health crises, which some scholars compare to erga omnes obligations. Under the IHR, states are duty-bound to strengthen their national health systems and to notify the WHO of such threats in the manner specified under the regulations.

Additionally, the declaration of a PHEIC highlights the imperative for governance and coordinated responses to environmental health crises, emphasising global cooperation to fortify health security worldwide. This cooperation facilitates resource mobilisation, rallying political and financial support for response efforts, and streamlining funding for research and development endeavours.

The declaration of a PHEIC highlights the imperative for governance and coordinated responses to environmental health crises, emphasising global cooperation to fortify health security worldwide.

Another crucial aspect of recognising a health crisis as a PHEIC is the WHO's ability to coordinate a global response by issuing temporary recommendations under Article 49 of the IHR. These recommendations issued alongside PHEIC declarations signify a harmonised approach to managing health risks at borders, aiming to curb disease spread while minimising interference with international traffic and influencing trade and travel policies. Such declarations alert the international community to emerging or escalating health crises, stressing the importance of coordinated global responses to mitigate pandemic risks. As such, a PHEIC declaration serves as a proactive instrument, alerting the international community to emerging or escalating health crises and emphasising the importance of coordinated global responses.

Legal shortcomings in climate change as a PHEIC

Climate change, recognised globally for its profound impacts on public health, presents a complex challenge in its classification as a PHEIC. Despite the clear repercussions of climate change on human health that warrant consideration, legal intricacies present obstacles to its formal acknowledgement as a PHEIC.

The foremost challenge lies in aligning climate change with the stringent definition of a ‘PHEIC’. According to the IHR, a PHEIC means an extraordinary event which is determined, as provided in these Regulations: (i) to constitute a public health risk to other States through the international spread of disease and (ii) to potentially require a coordinated international response. An ‘event’ is delineated as a ‘manifestation of disease, or an occurrence that fosters the potential for disease’, and a ‘disease' encompasses any illness or medical condition, regardless of its origin, that poses or could pose significant harm to humans. However, while undeniably a phenomenon, climate change does not fit neatly into this definition. Instead, the WHO’s emergency response framework characterises climate change as a ‘risk factor’ capable of catalysing health emergencies rather than constituting an emergency in its own right. Nonetheless, scholars contend that given its capacity to exacerbate human morbidity and mortality, climate change constitutes a totalising event in itself.

The WHO’s emergency response framework characterises climate change as a ‘risk factor’ capable of catalysing health emergencies rather than constituting an emergency in its own right.

The ‘public health risk’ concept also presents an enigmatic challenge in health outbreak management. The elusiveness of the concept of risk, particularly in the context of climate change, presents questions of ambiguity regarding the risk’s extent, magnitude, or immediacy, which remains unspecified. While risk determination is typically made on a case-by-case basis by Emergency Committees, assigning risk to a multifaceted issue like climate change can create complexities in resolving questions of causation. Moreover, the temporal aspects of climate change also introduce additional complexities. Since climate change can manifest in short-term extreme events (such as heatwaves, floods, and cyclones) and slow-onset events (such as rising sea levels and ocean acidification), this variability adds layers of intricacy to assessing climate change as a PHEIC.

The assessment of climate change as a PHEIC is complicated by procedural flaws, adding complexity to the evaluation process. Determining whether climate change warrants designation as a PHEIC involves weighing the event's significance against the potential disruption it could cause to international trade. However, historical instances reveal that despite the severe health implications of large-scale catastrophes, they have not been classified as PHEICs due to this consideration. The varied manifestations of climate change across different regions, each with varying socio-economic impacts, introduce the possibility that economic and trade interests may overshadow health concerns in the decision-making process.

Further, concerning procedural technicalities, the declaration of climate change as a PHEIC cannot be predicted due to inconsistencies in how apparent health catastrophes have been evaluated. Scholars have argued that there needs to be more consistency in the justifications dictating which criteria were considered met and how the requirements were satisfied.

Determining whether climate change warrants designation as a PHEIC involves weighing the event's significance against the potential disruption it could cause to international trade.

Why should it be treated as a public health emergency anyway?

Despite the constraints imposed by international law, it is crucial to recognise climate change as a significant public health concern. This assertion is supported by compelling scientific evidence demonstrating the intricate relationship between the health of the planet and the health of its inhabitants. The science clearly shows that climate change is a threat multiplier, and people are paying the price for their health. The 2019 Lancet Countdown report highlighted the close connections between deteriorating health and climate change. The Intergovernmental Panel on Climate Change's Sixth Assessment Report also issued an ultimatum of ‘now or never’, concluding that climate risks are appearing faster and will become more severe sooner than expected, making adaptation difficult as global heating intensifies.

What sets climate change apart from other drivers of health emergencies is the complexity of climate change impacts. A warming world is opening the floodgates to new ways for people to get sick. This ongoing ‘climate health crisis’ is expected to further contribute to rising global morbidity and mortality and social and economic suffering in the years to come. Estimates predict climate change will cause an additional 14.5 million deaths by 2050.

Climate change also threatens public health by undermining decades of progress in healthcare.  A glaring example is how climate change can spread infectious diseases rapidly. Research indicates that climate change has the potential to reshape global mammalian virome, paving the way for zoonotic spillovers that can lead to new outbreaks and even future pandemics. It is projected to become the leading upstream risk factor for disease emergence, surpassing issues such as deforestation, wildlife trade, and industrial agriculture. To make things worse, climate change can exacerbate the onset of future pandemics. Failure to address this risks prematurely claiming victory over global health efforts.

The science clearly shows that climate change is a threat multiplier, and people are paying the price for their health. The 2019 Lancet Countdown report highlighted the close connections between deteriorating health and climate change.

Furthermore, declaring climate change a Public Health Emergency can catalyse proactive responses and bridge the gap between rhetoric and action. Despite mounting evidence of its health implications, political inertia and discord persist in international climate negotiations. The WHO has the potential to galvanise political will by officially acknowledging climate change as a health emergency. Such a declaration could bolster efforts to mitigate climate-related health risks and compel nations to prioritise climate action in their policy agendas. Additionally, it illuminates the shortcomings of current climate change frameworks and spurs the adoption of more effective strategies to address the crisis.

Simply put, it is imperative to recognise climate change as a public health emergency due to its profound implications for human health and well-being. By acknowledging the urgency of this issue and mobilising global action, policymakers can mitigate the adverse health effects of climate change and safeguard the health of current and future generations. Failure to address these risks exacerbates existing health crises and undermines global efforts to promote public health and well-being.

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Nishant Sirohi is a Law & Society Fellow at Transitions Research 

Lianne D’Souza is a Research Assistant at the Low Carbon Society Programme, Transitions Research

• Healthcare
• Climate Change
• India
• Climate Action
• climate change
• Covid-19
• Global health
• health crises
• human health
• IHR
• morbidity
• mortality
• Pandemics
• PHEIC
• WHO
• Zoonotic diseases

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