The undersigned organisations called upon Parties at COP28 to adopt ambitious outcomes that protect and promote the health of people and the planet. The organizations underscore the essential nature of climate action that protects the human right to health and the human right to a clean, healthy and sustainable environment.

As described by the Intergovernmental Panel on Climate Change (IPCC), climate change has profound direct and indirect impacts on health and wellbeing, driving injury and deaths from heatwaves and other extreme weather events, wildfires, vector-borne and water-borne disease transmission, food and water insecurity, poor non-communicable disease outcomes, adverse maternal-child health outcomes and threats to sexual health and reproductive rights, and negative mental health impacts. Ecosystem degradation is also associated with zoonotic disease transmission and risk of pandemics. The burden falls most heavily on vulnerable populations with the least capacity to address them. Meanwhile, action to address climate change delivers health gains and opportunities through clean air, nutritious diets, physical activity, safe water, and healthy living environments.

With the first-ever Health Day due to take place at COP28 on 3rd December, including the adoption of a Ministerial Declaration on Climate and Health, we also urge ambitious decision-making and action across negotiations to protect and promote health. This requires a Health in All Policies (HiAP) approach to climate action. The protection of human health necessitates accelerated progress across all dimensions of the United Nations Framework Convention on Climate Change (UNFCCC) policymaking, coordination, and action across sectors.

In order to avoid further costly health losses and damages, adaptation and mitigation must be viewed hand in hand, supported by necessary finance. Without urgent mitigation, the limits of adaptation, which are already vital in many settings, will rapidly be exceeded, with catastrophic impacts on physical and mental health. Health systems are challenged to deliver universal health coverage even at current levels of warming, with the majority of countries (108/194) experiencing worsening or no significant change in service coverage since the launch of the SDGs in 2015. Climate change is poised to undermine decades of progress in global health.

In order to protect and promote health, action on climate and health must include and extend far beyond healthcare systems - the majority of health and climate determinants lie outside the healthcare sector itself. Health outcomes of climate action across sectors should be considered and evaluated alongside economic priorities.

As such, COP28 must deliver:

A complete phase-out of fossil fuels and commitment to no new fossil fuel infrastructure to reduce emissions in line with the Paris Agreement, preventing the acceleration of climate-induced threats to human health and wellbeing. Replacing fossil fuel power by a just transition to renewable energy, which is fair, fast, complete, and funded, is a public health imperative.

○ In November 2023, leaders of organisations representing 46.3 million health professionals signed a letter calling on the COP28 Presidency and Parties at COP28 to commit to an accelerated, just and equitable phase-out of fossil fuels and invest in a renewable energy transition as the decisive path to health for all. This follows other recent calls coordinated by the World Health Organization, the World Organization of Family Doctors, and the Clean Air Fund.

○ Ending fossil fuel dependence is needed to achieve emissions reductions of 43% by 2030 and 60% by 2050 compared to 1990 levels to achieve the 1.5°C target and hold climate change within the limits of adaptation to protect people.

○ In addition to preventing health threats of climate change, fossil fuel phase-out provides the opportunity to save 3.6 million lives annually, with associated cost savings. In some settings, the health savings due to clean air equal the cost of implementing the intervention to reduce emissions.

○ Reliance on dangerous distractions such as carbon capture and storage, geoengineering, or coal co-firing with ammonia, even if demonstrated to work at scale, will not deliver the same health gains as a just transition to renewable energy in terms of reduced health harms of air pollution from fossil fuel extraction and combustion, nor the health harms on local communities of air, water and soil pollution from fossil fuel extraction and processing, nor occupational risks to fossil fuel workers.

○ Methane, the primary component of fossil gas (commonly referred to as natural gas), which is also emitted in coal and oil extraction, is a precursor for ground-level ozone and several toxic co-pollutants. Fossil gas is not a transition fuel due to its health and broader climate impacts.

○ Reliable and affordable access to safe electricity and decent work (including a safe work environment) are critical social determinants of physical and mental health. They should be achieved through a renewable energy transition.

○ Historically and presently, prominent and wealthy polluters must move as soon as possible to make this transition domestically while supporting reductions in consumption and, critically, providing support to enable just changes in developing countries.

○ The health impacts of fossil fuel extraction on the health of local communities must not be repeated when extracting critical minerals to support renewable energy infrastructure.

2. Adaptation planning and monitoring that centres on health and wellbeing outcomes.

○ Healthy populations are both a pillar of resilience and a mark of effective adaptation across sectors.

○ Healthy outcomes require adaptation across the healthcare and health-determining sectors such as water and sanitation, agriculture, and housing. These considerations should be addressed in National or dedicated Health National Adaptation Plans.

○ The Global Goal on Adaptation should be a standing agenda item at future meetings.

○ Parties should adopt targets and metrics as part of the Global Goal on Adaptation Framework at COP28. In particular, outcomes-based health targets and metrics should be included.

3. A Loss and Damage Fund that is fit for purpose and technical assistance by the Santiago Network to quantify health losses and damages better.

○ Operationalisation and capitalisation of the Loss and Damage Fund and agreement on a host for the Santiago Network are essential to protect health and wellbeing and respond to communities' needs.

○ Loss and damage funding must be rapidly accessible and flexible and respond to the health and broader needs of affected communities, including public health. Insurance and loans are not sufficient to serve this purpose.

○ Quantifying current and future health-related losses and damage is necessary to understand the full extent of health-related losses and damages, including non-economic and slow-onset losses and damages, and how to improve the required response. However, optimised data is not a prerequisite for action.

4. Rapidly scaled climate finance strategically allocated for health outcomes.

○ The 100bn USD climate finance target is overdue. Developed countries must deliver this shortfall, including a doubling adaptation finance by 2025. Healthy climate action is impossible without adequate finance.

○ Ambitious targets should be agreed upon for the post-2025 New Collective Quantified Goal, covering mitigation, adaptation, loss, and damage.

○ Climate finance should be optimised for health, with strategic allocation of finance to projects which offer high returns on investment due to improved physical and mental health outcomes and associated economic savings. Reciprocally, health finance must also be maximised for climate action.

○ New announcements for climate and health finance must not divert funds away from other actions for health and climate change. Still, they must instead consist of new and additional finance and consider how existing health and climate finance can be optimised to build on synergistic actions for health and climate.

○ Finance for climate and health must respond to the needs of the most vulnerable populations and must be based on grants, not loans, to avoid reinforcing cycles of debt, poverty, and ill-health.

○ Notably, universal health coverage could be achieved with approximately one-seventh of the funds currently spent on fossil fuel subsidies worldwide. In contrast, fossil fuel subsidies by G20 countries cause health impacts six times greater than the subsidies' cost.

5. A Global Stocktake decision that protects and promotes health and wellbeing

○ The global stocktake (GST) decision should call on Parties to submit enhanced NDCs with 1.5°C aligned economy-wide 2030/2035 targets before COP30.

○ Guidance should be provided to countries on how to more deeply integrate physical and mental health considerations into NDCs and LT-LEDS, including developing national plans for sustainable, low carbon, resilient health systems and mitigation and adaptation action across health-determining sectors and means to quantify the health and economic co-benefits of such actions, all supported by cross-sectoral coordination.

○ Health should be considered a theme in the adaptation section of the GST decision rather than as a sector since the links between health and climate action extend beyond the health sector alone.

6. Food and agriculture systems which promote nutrition security, including sustainable healthy diets

○ To protect human health and the climate, agriculture systems should promote agroecology, Indigenous foodways, and a transition away from industrial livestock farming while protecting smallholder farmers. This would have substantial co-benefits for physical and mental health.

○ Policies should be implemented to reduce emissions, including promoting the consumption of plant-rich, sustainable, healthy diets and reducing food loss and waste, as identified by the IPCC. A transition to sustainable healthy diets could save 11 million premature adult deaths annually from undernutrition and diet-related non-communicable diseases, while improved distribution could simultaneously reduce waste and promote nutrition security.

7. Climate action to protect most affected and vulnerable population groups and communities, guided by their meaningful engagement and empowerment

○ Climate action at the global, regional and local levels should consider the impacts on and expertise of the most impacted population groups and communities.

○ Those most impacted by climate change, including Indigenous Peoples, women, children, adolescents and youth, older people, people with disabilities, and other marginalised groups, are also at the forefront of implementing necessary solutions and should be engaged and empowered at all levels of policy development and implementation to protect human rights and equity and ensure intergenerational justice.

Finally, congratulations to the UNFCCC Secretariat for strengthening its conflict of interest policy as announced at SB58 in June 2023, and request the UNFCCC Secretariat to continue its progress by limiting the influence of fossil fuel companies and other unhealthy commodity industries from influencing or undermining UNFCCC policymaking, comparable to the exclusion of the tobacco industry from policymaking under the World Health Organization Framework Convention on Tobacco Control.