Blog by Simon Lenton, Co-Chair, British Association for Child and Adolescent Public Health

A good COP - bad COP routine?

"We cannot solve a crisis, without calling it as a crisis ... if solutions within the system are so impossible to find, then we should change the system itself" Greta Thunberg

Greta’s message to the world is simple. Climate change is the result of human activity on ecosystems; it will disproportionately affect children of the next generation and those least responsible for climate change will suffer most. It is as much a human rights issue as a political, economic or scientific concern. Effectively climate change is an unexpected outcome of an unregulated free global market that values consumption and profit over people or the planet. “Don’t listen to me, listen to the scientists” she says, quoting the IPCC reports  that outline the effects of climate change on future human health.

The SARS-CoV-2 pandemic has demonstrated that it is possible to “change the system” and many are calling for a “green recovery plan” meaning one based on the principles of sustainable development. The concept and philosophy of sustainable development is possibly the most important concept to emerge at the end of 20th century because it “attempts to improve the quality of all human life, while living within the carrying capacity of the planet, to ensure a quality of life both for people now and for generations to come”. The solutions for climate change are encapsulated in the phrase “today’s decisions for tomorrow’s children”.

The NHS often serves as an illustrative microcosm for the UK economy. The last decade has largely been consumed by more immediate preoccupations such as implementing NHS markets in England, managing within austerity measures and Brexit, leaving little time or thought for climate change and sustainable development. That must all change now in line with the ambitions of the English NHS Long Term Plan.

The UK has the 3rd highest emitting per-capita lifestyle, but was also the first G7 economy to pass a law to reduce climate emissions to “Net Zero” by 2050. Whether net zero is enough is open to debate, because it excludes hard to control (for Govt.) emissions such as methane from cows, emissions from production of goods overseas but consumed in the UK and flying. Net zero also assumes significant carbon capture using emerging technologies that are not yet proven.

The NHS is responsible for between 4-5% of the UK total carbon footprint, roughly half of this is related to transportation of people and the NHS supply chain with 20% related to pharmaceutical and supplies production, so how quickly the NHS can reach Net Zero will probably reflect how effectively the country as a whole can succeed. The NHS has reduced its carbon emissions by 18% between 2007 and 2017 proving it is possible, but future reductions will be ever more challenging to achieve and it will be important not to further disadvantage the most vulnerable in society in the process.

Central to the current climate debate and action is climate justice - fairness for future generations, yes, but also reparation for current and past generations.

A little history.

But first let us step back more than 30 years to 1987 which saw the publication of the landmark World Commission on Environment report Our Common Future (sometimes referred to as the Brundtland Report) where the concept of sustainable development was first clearly articulated as being “development that fulfils the needs of the present generation without endangering the needs of future generations”. In essence it stipulates that no environmental burdens, such as the build-up of greenhouse gases, plastic sea pollution, unmanageable amounts of all forms of waste, and the loss of natural habitats, should be inherited by future generations—thus establishing the principle of intergenerational equity.

The international political response to climate change began five years later in 1992 with the adoption of the UN Framework Convention on Climate Change (UNFCCC). This sets out the basic legal framework and principles for international climate change cooperation with the aim of stabilizing atmospheric concentrations of greenhouse gases to avoid “dangerous anthropogenic interference with the climate system.” The Convention entered into force on 21 March 1994, and is accompanied by annual international Conferences of Parties (COPs) to support global implementation.

Fast forward 25 years to the Conference of Parties (COP 25) held in Madrid last year, where despite the long history of climate change negotiations and running 40 hours over the scheduled time, no clear action to mitigate global climate change could be agreed. The International Institute for Sustainable Development (IISD) summarised the conference in their latest Earth Negotiations Bulletin, as being adversely affected by “disconnects between the demands of people and science, and between countries that want to look to the future, and those focused on the past”.

So what is the problem?

Most nations, with few exceptions, now accept the existence of climate change. The fundamental issue now is equity of response.

This question revolves around how to ensure that all people have the opportunity to benefit from climate change solutions, whilst simultaneously not experiencing an unequal burden of ongoing climate change impact.

The problem has its origins way back in the early industrial era when the “Northern nations” began consuming natural resources from around the world to support their economies thus denying “Southern nations” of opportunities for economic development. Stated crudely the richest 10% make 50% of the world’s income and are responsible for 50% of emissions while the poorest 50% receive 10% of the global income and are responsible the 10% of emissions. However, the poorest nations are often the most vulnerable to climate change because they are reliant on subsistence agriculture often in low-lying coastal areas or islands which are adversely affected by storms and rising sea levels.

This historical responsibility for climate change by developed nations is generally called the climate debt. It is argued that future climate change solutions should address the denied development opportunities and impacts of climate change on poor nations, from which the rich nations have benefited enormously. Wealthy nations with resources should therefore contribute most to the solutions especially for poor nations who will be most adversely affected and require sustainable solutions for the essentials such as energy supply, hospitals and schools and agriculture.

This concept of equity is captured in the UN Framework Convention on Climate Change with the complex phrase “common but differentiated responsibilities and respective capabilities (CBDR-RC)”. This conundrum appears to be the epicentre in climate change negotiations and why agreement could not be reached in the COP25 in Madrid. How should the burdens and opportunities of the transition to a low consumption economy be distributed? Some countries emphasise their “responsibilities” to poorer nations, recognising their climate debt, while others focus on “capabilities” meaning their capacity to manage and mitigate climate change. Finding a differentiated approach to equity has therefore become something of a tug-of-war between nations where so that each nation can contribute an amount proportional to their past, current and future development needs, without undermining their economic development, since the costs of tackling climate change in the short term will be considerable (but considerably less than future costs).

Until this issue of climate equity is resolved, practical action is likely to be limited as no country wants to incur economic costs and reduce their competitive viability in a global market. Interestingly Mark Carney, previously the Governor of the Bank of England, has recently been appointed (February 2020) as the UN Envoy for Climate Change and Finance. He recognises the environmental and social impact of doing business which is currently not costed into the goods or the service. It will be interesting to see whether the ideas behind the development of a circular economy where nothing is wasted can be embedded into global economics.

Climate justice is a movement which sees climate change and its solutions as an issue which should focus on human rights and equity to safeguard the human rights of the most vulnerable people and sharing the burdens and benefits of climate change and its impacts equitably and fairly. Climate justice recognises the development paradox that those who contributed least to greenhouse gas emissions will be most affected by climate change.

The 'For a Greener NHS' campaign

For a greener NHS campaign was launched in 2019 and is taking three steps to reduce emissions through the formation of an NHS Net Zero Expert Panel led by Nick Watts.

  1. Success will depend on reducing demand for the NHS through creating a healthier population largely achieved through a more vegetable-based diet, increased walking and cycling, and by creating healthier communities by tackling adverse health determinants.
  2. Within the NHS by using digital technologies (it is estimated that annually 6.7 billion road miles are from patients and visitors to the NHS), greater use of renewable energy supplies and reduction of all forms of waste.
  3. Creating resilient communities that are less adversely affected by extreme weather conditions, global epidemics, particularly for those who are most vulnerable, namely the young and old.

The Expert Panel will submit an interim report to NHS England in the summer, with the final report expected in the Autumn, ahead of the COP26 Glasgow (COP 25 was attended by more than 26,700 people) scheduled to take place now in early 2021. Will it be another good COP, bad COP argument next time?

Your personal agenda

The role of the NHS in supporting individuals, whether they be employees or patients, has yet to be fully explored, but a practical personal/individual agenda might include:

  • Energy - insulating and draught proofing your home, reducing thermostat settings, using low energy appliances and switching off when not in use, using renewable sources of energy, changing over to electric central heating boilers need replacing.
  • Waste - reusing containers, buying loose rather than packaged products, composting green waste and recycling everything that can be.
  • Transport - avoiding unnecessary car travel, sharing car journeys, walking or cycling to work, using a compact energy saving car, driving at moderate speeds, lobbying for better public transport, teleconferencing rather than meetings. Changing to electric vehicles when petrol/diesel vehicles need replacing.
  • Purchasing power - thinking about whole life costs, buying local goods or recycled products, buying repairable goods, avoiding disposable products, using local shops, taking local holidays and supporting ecotourism.
  • Food - try and grow your own, buy local food, organic food, Fair Trade goods and reduce red meat intake.
  • Leisure - join local environmental groups and groups supporting your local community.

Support "greener parenting

Could integrated Health Systems do more to support greener parenting?

  • More breast feeding, less formula cows milk, fewer plastic bottles.
  • Support early toilet training - less reliance on disposable nappies (3 billion a year in the UK alone).
  • Play - reduced reliance on limited life, non-repairable plastic toys.
  • Avoid indoor air pollution from volatile organic compounds (VOCs)
  • More book and toy libraries and "swap shops" possibly linked to repair cafes.
  • Reduce exposure to advertising and hence consumption.
  • More natural environment play spaces within easy access of homes.
  • Fewer car journeys, especially to and from school, more active journeys.
  • Clothes - recycled especially natural fibres.
  • Drinks - avoid sweet drinks in plastic bottles!

Thanks here to Lucy Reynolds for ideas on facilitating greener parenting.

In your professional role:

  • Become better informed about climate change, equity and health service provision so as to contribute to solutions.
  • Keep up to date on the impact of pollutants and nanoparticles on human health especially in pregnancy and early years.
  • Enable families to live healthier, happier lives especially reducing obesity and improving mental health by encouraging lower carbon lifestyles.
  • Help families manage their conditions more effectively and help tackle some of the determinants.
  • Reduce hospital outpatient attendance especially where a follow-up phone/video call or email is an equally effective alternative.
  • Design integrated health systems that focus on all forms of prevention and embed quality improvement in provision.
  • Volunteer to lead NHS greening projects - a leadership role.
  • Remember to switch off computers and printers when not in use.

Further reading / resources

Sustainable Development Unit -

Centre for Sustainable Healthcare -

International Institute for Sustainable Development – Reporting Services Division (IISD-RS) -

Intergovernmental Panel on Climate Change -

Mary Robinson Foundation, Principles of Climate Justice

Podcast Today Programme -

Circular economy -

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