From Glasgow to Belém: bringing health to the COP climate negotiations

There is strong evidence that our planet is beyond seven of nine boundaries, with at least three of the seven crises seriously and directly affecting public health: biosphere integrity, novel entities, and climate change.1 This triple crisis is further compounded by departures from multilateralism and increasing militarized geopolitical conflicts, demanding a historical increase of tax money for military, resulting in significantly reduced resources for sustainable development and population health. Specifically in terms of the climate crisis, it has been estimated that each dollar spent on the military generates over twice the greenhouse gas emissions of a dollar invested in civilian sectors. Moreover, reporting of military emissions under the Paris Agreement is voluntary, which means that national reporting rarely captures emissions from military activities in full.2 Instead of responding to the wake-up call and taking urgent action, major economies are turning back the wheel, as, for example, currently seen with important laws and regulations of the EU Green Deal (e.g., the Internal Combustion Engine Ban or the Corporate Sustainability Reporting Directive). Amid the climate crisis and stalled global negotiations to mitigate and adapt to its impacts, the global health community leverages its trusted voices to advocate for more ambitious global climate negotiations. Or, in the words of the Director General of World Health Organization (WHO): “Undoubtedly health stands as the most compelling reason for taking climate action.” Perhaps surprisingly, health has not figured prominently in conference of the parties (COP) climate negotiations so far. While “Health” is first mentioned in the 1992 United Nations Framework Convention on Climate Change (UNFCCC), recognizing that climate change has “adverse effects” on human health, and the “right to health” is written into the Preamble of the Paris Agreement 2015 (COP21), only recently health topics have become increasingly more prevalent at the annual COP climate conferences. Milestones include the COP26 (Glasgow) with the first WHO Health Pavilion in the Blue Zone of a COP conference; the first-ever Health Day at COP28 (Dubai), resulting in the Declaration on Climate and Health; and the Baku COP Presidencies Continuity Coalition for Climate and Health (COP29). This progress was enabled by the global health community mobilizing jointly with WHO for health at COP, and in turn COP activities driving and supporting strategic and programmatic development at WHO, such as the foundation of the Alliance for Transformative Action on Climate and Health (ATACH) (COP 26), the resolution on Climate Change and Health endorsed during the 2024 World Health Assembly (WHA 77), identifying climate change as a major threat to global public health, and guiding the development of WHO’s Fourteenth General Program of Work (GPW 14, 2025–2028), and specifically the Global Plan of Action on Climate Change and Health adopted by WHA78 (2025) signifying the implementation phase by WHO and Member States of the WHA77 resolution on climate change and health. There is significant progress in a relatively short time in bringing health to the COP climate negotiations. However, only since COP28 health has been adopted as an integral part, and only in the context of the Global Goal on Adaptation (GGA). The 2025 Global Conference on Climate and Health In preparation for COP30, the 2025 Global Conference on Climate and Health took place in Brasilia and was co-hosted by the Government of Brazil, WHO, PAHO, and ATACH and supported by the Rockefeller Foundation, Wellcome Trust, the Gates Foundation, and the governments of Spain and the UK with the goal to discuss and refine the draft Belém Health Action Plan,2 designed and presented for consultation by the Ministry of Health of Brazil as part of the presidency’s strategy and with input from over 600 stakeholders from 90 countries, including Brazil’s Ministry of Environment, the CEO of COP30, Health Ministers from Fiji and Senegal, and directors from the WHO, PAHO, and UNFCCC. This first pre-COP conference specifically dedicated to health marks another historic moment in bringing health to the COP climate negotiations. Overall, COP30 will be structured along six axes and 30 strategic objectives that guide the global response to the challenges posed by the climate crisis. One of these axes—Axis 5: Human and Social Development—includes Objective 16: promoting resilient health systems. In this context, under the lead of the Brazilian Ministry of Health, the Belém Health Action Plan is being developed as an umbrella for adaptation solutions and seeks the voluntary adoption by UNFCCC Parties at COP30. The 3-day conference was structured to mobilize support for the Plan and to collect and enrich experiences that could inform its implementation. The conference was organized along two Priorities (cross-cutting issues) and three Action Lines, reflecting the thematic pillars of the Plan. Priorities were (1) Health Equity and Climate Justice to propose adaptation measures that promote climate justice by addressing inequalities (socioeconomic, gender, racial-ethnic, nutritional, and health care access) worsened by climate change and (2) Leadership and Governance on Climate and Health with Social Participation to promote adaptation policy implementation through oversight by Health Ministries and ensure full, equitable participation of the civil society. Afternoon sessions featured thematic Working Groups designed to gather input and share experiences aligned with the Plan’s three Action Lines: (1) Health surveillance and monitoring (with a focus on strengthening health systems to address climate-related threats); (2) Evidence-based policy strategy and capacity building to accelerate evidence-based action through broad stakeholder cooperation; and (3) Innovation and production to promote innovation to meet health needs across diverse contexts. Sessions such as the Ideas Lab and evidence-to-policy discussions were central to this participatory approach. Following the lead of adopting health as an integral part of the GGA at COP28, the 2025 Global Conference on Climate and Health and the emerging Belem Health Action Plan3 have a strong focus on adapting the health sector to climate change. One plenary session and some discussions of Working Group 1 were dedicated to indicators. Following the first Global Stocktake at COP28, Parties adopted the UAE Framework for Global Climate Resilience and the UAE-Belém Work Programme to track progress towards the GGA targets. Building on this opportunity to develop indicators, the plenary session presented various monitoring and reporting frameworks relevant to climate and health, including monitoring processes at COP, and specifically GGA; WHO’s Global Survey on Climate and Health; ATACH; the Lancet Countdown; and indicators developed by the UK Health and Security Agency. The session explored opportunities how to align and integrate the different indicator frameworks; however, the role of the Belém Health Action Plan remained open for further discussion. In the context of the current COP negotiations, specifically the GGA, groups of independent experts were asked to develop indicators, including for health. Proposed indicators were presented to Parties at a mandated full-day workshop on the first day of the annual Subsidiary Body meeting in Bonn (SB62, June 2025). As an outcome, experts were asked to substantially reduce and refine the list of indicators for discussion at another mandated workshop between Parties and experts, now scheduled for 3 and 4 October in Bonn. The ambitious timeline is necessary to finalize the list of indicators for consideration and anticipated adoption by the Parties at COP30. The Belem Health Action Plan’s focus is on adaptation of the health care system. While mitigation is a core commitment under the Paris Agreement, addressed through various COP negotiation tracks, the Plan contributes to these efforts in targeted ways. It supports Just Transition and Finance in the context of health system adaptation and includes mitigation-related actions of the health sector through innovation and production (Action Line 3), while multisectoral policies with health co-benefits (Action Line 2) are not a prominent focus of the plan. Notably, some prominent speakers of the opening session, like Marina Silva, Brazilian Minister of Environment, and Alexandre Padilha, Brazil’s Minister of Health, urged the COP30 presidency to tackle the root causes of the climate crisis alongside adaptation, reinforcing the need for integrated approaches. A further refined version of the Plan was presented at an event at the United Nations General Assembly in September, hosted by the Brazilian Government. Further, a support document summarizing the Evidence on Public Policies for Climate and Health and a synthesis report on Social Participation, Climate Adaptation, and Health with a focus on Black, Indigenous, traditional, and local communities will be prepared. Finally, at COP30, the Plan will be presented and discussed on the Health Day for voluntary adoption by UNFCCC Parties. The presence of health at COP meetings has significantly broadened and deepened over the last 5 years, and the Belem Health Action Plan marks the next milestone. The Parties and the global health community should support its voluntary adoption and implementation as an important step in bringing health to the COP negotiation tables—as an entry door for the inclusion of health across all sectors and across all negotiations tracks, including mitigation, aiming for the phasing out of fossil fuels as the main root cause of climate change and for a win–win situation for the climate and global health. Conflicts of interest statement The authors declare that they have no conflicts of interest with regard to the content of this report.