Why climate change health policy needs ethics to achieve health equity and climate justice a call to action

It is indisputable that anthropogenic climate change is causing a number of serious threats to human health.1 Over 1,700 people died in the 2022 Pakistan floods, with 33 million affected2; The 2022 European heat wave killed 15,000 people.3 Both events are linked to climate change.4 There is a broad consensus that climate change will increase threats from emerging infectious diseases, and Covid-19 made the potential consequences clear.5 Food and water security will be under greater pressure with inevitable damage to the human population.6 Forced migration will bring known health risks.7 These threats are so persistent, widespread and serious that the need for a strong health voice in climate change policy is clear.8

It is less acknowledged that health policy must address serious ethical challenges. Mitigation of climate change requires systematic change in production and consumption methods and habits.9 Tackling climate change can deliver a range of important social and economic benefits, including the public health benefits of just moving to active travel, reducing particulate air pollution and switching globally to plant-based diets.10 However, at some point we will have to give up some good things, both in the health sector and elsewhere. Decisions about what costs are acceptable and who should bear them are extremely ethical. As we make the difficult choices that climate change requires, we must be clear about what we value and why. Therefore, policy responses to climate change must address issues of global and intergenerational justice, including reparation for loss and damage caused by climate change.

Ethics is also critical to practical health policy. Consider recent modeling that suggests climate change could expose 1.3 billion more people in East Africa, the Middle East, East Asia, Western Europe and North America to the Zika virus by 2050.11 From one perspective, this can be seen as a growing threat to public health with policy responses tailored in terms of health security. But fairness and long-term policy effectiveness require that responses to Zika also address its global burden and the reservoirs of the disease throughout its range. It must also front and center the tragedy of a climate-driven expansion of Zika in new, resource-poor settings that lack the health infrastructure to respond.

Also consider the effect of climate change on small island developing states.12 These low nations face an existential threat. In addition to the physical risks of extreme events, such as cyclones, flooding their homes poses complex, poorly understood mental health challenges.13 Physical lives can be saved by displacement, and many island peoples have complex and adaptive relationships with their surrounding seas. But the psychological impact of a lost homeland is complex, with significant challenges to mental health and well-being that can persist across generations.14 And surely justice demands that those facing existential threats receive some form of priority in climate change mitigation?

We believe ethicists have a critical responsibility here. In work led by the WHO Ethics and Governance Unit, in collaboration with the WHO Climate Change Unit, we will incorporate ethics into health responses to climate change at the global level. Engaging with key global and local actors, and using a generous mix of international cases, our work is driven by the belief that without interdisciplinary ethical awareness, climate change policy will fail to gain traction.15 If the policy ignores the health needs of the majority of the world’s population, it will be seen as unfair and will alienate those essential to its success. Approaches that recognize different values, goals and priorities, and acknowledge complex ethical, social and cultural differences, can increase the effectiveness of risk management and can influence choices for mitigation and adaptation. Now is the time for a coordinated, interdisciplinary ethical commitment to address the single greatest threat to our health. We must act now before health inequity is irreversibly embedded in climate change adaptation and mitigation responses.