Editing IPCC:AR6/WGII/Chapter-7 (section)

=== 7.4.6 Climate Resilient Development Pathways ===

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Climate resilient development is a set of trajectories that strengthens sustainable development and efforts to eradicate poverty and reduce inequalities while promoting fair and equitable reductions of GHG emissions. Climate resilient development also serves to steer societies towards low-carbon, prosperous and ecologically safer futures (Chapter 1). ''All pathways to pursue climate resilient development will involve balancing complex synergies and trade-offs (very high confidence; Chapter 18).'' Pathways to climate resilient development can be pursued simultaneously with recovering from the COVID-19 pandemic (Cross-Chapter Box COVID in Chapter 7; Ebi et al., 2021).

Meeting commitments against the following seven existing global priorities would facilitate CRDPs and transformational futures for health, well-being, conflict and migration ( ''high agreement, medium evidence'' ):

# Fully implementing the WHO Operational Framework for building climate-resilient health systems ( [[#WHO--2015b|WHO, 2015b]] )
# Achieving Universal Health Coverage (UHC) under SDG 3 (good health and well-being)
# Achieving net zero GHG emissions from healthcare systems and services
# Achieving the SDGs more generally
# Adopting mitigation policies and technologies that have significant health co-benefits (see Cross-Chapter Box HEALTH)
# Meeting the objectives of the Global Compact for Safe, Orderly and Regular Migration
# Inclusive and integrative approaches to climate-resilient peace

These transformations map across all five of the system transitions identified in Chapter 18: energy systems; land, ocean, and ecosystems; urban and infrastructural systems; industrial systems; and societal systems.

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==== 7.4.7.1 Fully Implementing the World Health Organization Operational Framework ====

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The WHO Operational Framework for building climate-resilient health systems was designed to increase the capacity of health systems and public health programming to protect health in an unstable and changing climate ( [[#WHO--2015b|WHO, 2015b]] ). The guidance defines a climate-resilient health system as ''one that is capable to anticipate, respond to, cope with, recover from and adapt to climate-related shocks and stress, so as to bring sustained improvements in population health despite an unstable climate'' . Full implementation of this framework has the potential to achieve transformational adaptation; the fundamental attributes of health systems would change to anticipate and effectively manage the population health and healthcare risks of climate change. This includes having the knowledge, capacity, tools and human and financial resources for health systems to extend beyond soft limits to adaptation.

The WHO framework outlines 10 key components (Figure 7.15) that, when achieved, will:

* Guide professionals working in health systems and in health determining sectors (e.g., water and sanitation, food and agriculture, energy, and urban planning) to understand and effectively prepare for the additional health risks posed by climate variability and change
* Identify the main health functions that need to be strengthened to build climate resilience, and to use these to develop comprehensive and practical plans (e.g., the health component of National Adaptation Plans (H-NAP))
* Support health decision makers to identify roles and responsibilities to implement this plan for actors within and outside the formal health sector

[[File:41456f250ec9aaf0cf80c4ba91cab066 IPCC_AR6_WGII_Figure_7_015.png]]

'''Figure 7.15 |''' '''Ten components of the WHO operational framework for building climate-resilient health systems with links to the building blocks of health systems.''' Source: [[#WHO--2015b|WHO (2015b)]] .

Achieving full implementation of the WHO Operational Framework requires determination and commitment—with associated funding—from the health community specifically and health-determining sectors more generally. Identifying priority areas is an immediate step required to commence this implementation process, which will vary across different contexts. Active engagement with Communities of Practice to share lessons and experiences would be a useful approach to support national and sub-national efforts; examples of this already exist (e.g., the Climate Change Community of Practice in Canada and the ‘weADAPT’ initiative under the auspices of the Stockholm Environment Institute).

Table 7.9 summarises selected characteristics of health systems as they might be under SSP1 (a world aiming to sustainable development), SSP2 (a world continuing current trends) and SSP3 (a world with high challenges to adaptation and mitigation), with systems under SSP1 being most consistent with climate resilient development. The table highlights the importance of investments that promote sustainable and resilient development to decrease vulnerability, no matter the magnitude and pattern of climate change. Adapting under SSP3 would be challenging even under pathways of limited additional climate change.

'''Table 7.9 |''' Characteristics of future health systems under three SSPs; modified from [[#Sellers--2017|Sellers and Ebi (2017)]] .

{| class="wikitable"
|-
!
! SSP3

! SSP2

! SSP1

|-
| Basic characteristics

| Reactive; failure to adapt; siloed information channels and national governance; limited partnerships

| Incomplete planning; new information incorporated as convenient; occasional partnerships

| Proactive; adaptively managed; frequent partnerships; inter-disciplinary

|-
| Leadership and governance

| Little focus at national and international levels on climate change and health; minimal planning conducted

| Planning for climate change and health, but not comprehensive and often side-tracked by other issues

| Strong climate change and health planning apparatus, including health components of national adaptation plans; regional/international partnerships

|-
| Health workforce

| Climate change and health not often incorporated into training; few provisions for new training programmes or funding for increase health worker positions in climate change-relevant specialties; health disparities not addressed

| Climate change and health not systematically incorporated into training; new training programmes insufficient to fill gaps in demand; limited attention to addressing health disparities

| Systematic inclusion of climate change and health in worker training; expansion of funding and training; financing and incentive mechanisms to address health disparities

|-
| Health information systems

| Assessments of vulnerability and adaptation rarely conducted, if ever; information not useful for planning; minimal risk monitoring or research

| Vulnerability and adaptation assessments occasionally conducted, but generally of poor quality; early warnings incomplete; fiscal and political constraints on research

| Vulnerability and adaptation assessments regularly conducted and used in planning; robust early warning networks; research agenda focused on vulnerable communities

|-
| Climate-resilient and sustainable technologies and infrastructure

| Facilities sited and constructed without climate consideration incorporated; medical supply chains not modified

| Capital cost serves as a key factor in siting and construction; increasing vulnerability of facilities to shocks

| Health infrastructure designed to be robust to storms/floods, with redundant systems added to ensure continuity of care

|-
| Service delivery

| Policies to manage environmental health hazards generally not followed; care practices not modified to accommodate climate information; few changes to emergency management procedures; health inequities worsen

| Environmental health policies are not robust; marginal improvements in care practices; risk assessments and communication inadequate; no shift in health inequities

| Policies to manage environmental health hazards regularly reviewed; practitioners review care practices and adjust as appropriate based on local climate and health conditions; robust communication tools developed; health service improvements reduce health inequities

|-
| Climate and health financing

| Few funds devoted to climate change and health activities, particularly in low- and middle-income countries; few if any financing partnerships between high-, low- and middle-income countries; very weak regional and international coordinating bodies due to funding constraints

| High-income countries generally form robust financing mechanisms; fiscal pressures in low- and middle-income countries constrain their financing abilities; financial partnerships formed across countries, but financing often not robust; regional and international coordinating bodies receive inadequate funds

| Robust funding streams for climate change and health; climate change and health activities receive continuing financial support; effective financing partnerships; regional and international coordinating bodies effectively funded

|}

Stress testing is an approach for evaluating the extent to which health systems are prepared for a future different from today ( [[#Ebi--2018a|Ebi et al., 2018a]] ). These desk-based exercises identify a desirable future outcome, such as successfully managing an extreme heatwave, flood or storm with characteristics outside the range of recent experiences. The exercises move beyond identifying ''likely'' challenges from hazardous exposures to specifying policies and measures that could be successful under a different climate and development pathway. The exercises consider socioeconomic and political factors that can influence the extent of health system vulnerability and other factors that can affect health system demands by impacting population health. Stress testing is designed to identify conditions under which it would be difficult for the health system to maintain its essential functions and to identify interventions that could maintain essential system functions despite climate-related shocks and stresses.

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==== 7.4.6.2 Achieving Universal Health Coverage Under SDG 3 (good health and well-being) ====

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UHC is when all people have access to the health services they need, when and where they need them, without financial hardship ( [[#WHO--2021b|WHO, 2021b]] ). Achieving UHC is one of the targets in the SDGs. However, climate change is threatening to undermine the achievement of UHC through negative health outcomes and healthcare system disruptions ( [[#Salas--2019|Salas and Jha, 2019]] ; [[#Phillips--2020|Phillips et al., 2020]] ; [[#Kadandale--2020|Kadandale et al., 2020]] ; [[#Roa--2020|Roa et al., 2020]] ). Climate change adaptation and UHC progress are closely linked to one another, as both may improve health and achieve health equity ( [[#Salas--2019|Salas and Jha, 2019]] ). Supporting UHC is key to securing population health under a changing climate as well as addressing structural inequalities ( [[#Roos--2021|Roos et al., 2021]] ; [[#Aleksandrova--2020|Aleksandrova, 2020]] ; [[#Phillips--2020|Phillips et al., 2020]] ). Many regions of the world with the highest levels of vulnerability to the health impacts of climate change also have low levels of UHC; an integrated approach to UHC planning that incorporates climate change will have great benefits particularly in improving health equity ( [[#Salas--2019|Salas and Jha, 2019]] ).

The COVID-19 pandemic has shown some countries taking positive steps to achieving UHC. For example, Ireland nationalised healthcare for the duration of the pandemic and many countries, including Australia, have enhanced their telehealth services, which has enabled specific groups to access health services, particularly those in rural and remote settings, and has allowed continuous care to the community ( [[#Monaghesh--2020|Monaghesh and Hajizadeh, 2020]] ; Cross-Chapter Box COVID in Chapter 7).

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==== 7.4.6.3 Achieving Net Zero GHG Emissions from Healthcare Systems and Services ====

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The healthcare system is a core component of UHC, supporting climate-resilient and environmentally sustainable healthcare facilities ( [[#Corvalan--2020|Corvalan et al., 2020]] ). Health systems are large carbon polluters and have the potential to look beyond traditional ‘green’ initiatives towards a more fundamental, longer-term redesign of current service models, with health practitioners participating actively in this process ( [[#Charlesworth--2018|Charlesworth and Jamieson, 2018]] ). In the largest and most comprehensive accounting of national healthcare service emissions, the UK’s National Health Service (NHS) quantified its health services’ emissions and identified that 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS ( [[#Tennison--2021|Tennison et al., 2021]] ).

The health sector has considerable opportunity to reduce its own carbon footprint and by doing so would contribute to mitigation efforts and help reduce health burdens associated with GHG emissions ( [[#Vidal--2014|Vidal et al., 2014]] ; [[#Duane--2019|Duane et al., 2019]] ; [[#Charlesworth--2019|Charlesworth and Jamieson, 2019]] ; [[#Charlesworth--2018|Charlesworth et al., 2018]] ; [[#Guetter--2018|Guetter et al., 2018]] ; [[#Bharara--2018|Bharara et al., 2018]] ; [[#Frumkin--2018|Frumkin, 2018]] ) ( ''high confidence'' ). The UK’s NHS has committed to becoming the world’s first net zero national healthcare system. Other examples of recent and ongoing initiatives include those undertaken by the Kaiser Permanente and the Gundersen Clinics in the USA, Health Care without Harm in the Asia Pacific region, and the Green Hospital Initiative in New Delhi ( [[#Frumkin--2018|Frumkin, 2018]] ; [[#Bharara--2018|Bharara et al., 2018]] ).

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==== 7.4.6.4 Achieving the SDGs Would Increase Resilience in Health-Determining Sectors and Contribute to Reducing the Risks of Involuntary Displacement and Conflict ====

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The SDGs are globally agreed objectives that integrate the economic, environmental and social aspects of sustainable development to end poverty, protect nature and ensure that all people enjoy peace and prosperity. The SDGs were developed under the principle that the goals are integrated and indivisible, such that progress in one goal depends on progress in others ( [[#WHO--2016b|WHO, 2016b]] ). Promoting health and well-being is not the sole responsibility of the health sector; it is also partially determined by strategies, policies and options such as poverty reduction, promoting gender equality, ensuring all people enjoy peace and prosperity, eliminating nutritional insecurity and ensuring availability and sustainable management of water and sanitation ( [[#Morton--2019|Morton et al., 2019]] ; [[#Bennett--2020|Bennett et al., 2020]] ). Unique themes in the SDGs for health policy and systems research include social protection, access to health services, stronger and more effective multi-sectoral collaborations beyond the health sector to address the upstream drivers of health and well-being, and participatory and accountable institutions to strengthen civic engagement and local accountability within health systems ( [[#Bennett--2020|Bennett et al., 2020]] ).

For example, clean water, sanitation and hygiene are essential to human health and well-being. Unsafe water and sanitation and a lack of hygiene caused an estimated 870,000 associated deaths in 2016 ( [[#WHO--2021c|WHO, 2021c]] ). Only 71% of the global population has access to safely managed drinking water services; only 45% of the global population has access to safely managed sanitation services; and 60% has basic handwashing facilities in their home. About 25% of healthcare facilities lack basic water services, exposing workers and patients to higher infection risks. More than 80% of countries reported in 2018 that they lacked sufficient funding to meet national WASH targets. As detailed in [[#7.2.2.2|Section 7.2.2.2]] , Box 7.3, [[#7.3.1.4|Section 7.3.1.4]] and [[#7.4.2.3|Section 7.4.2.3]] , the burden of climate-sensitive WBDs would be reduced if WASH targets were met.

WHO developed a Global Action Plan for Healthy Lives and Well-Being for All that brings together multi-lateral health, development and humanitarian agencies to support countries in accelerating progress towards the health-related SDGs ( [[#WHO--2021c|WHO, 2021c]] ). Themes include sustainable financing to reduce unmet needs for services, community and civil society engagement to generate knowledge to inform policymaking and health responses, addressing the socioenvironmental determinants of health, ensuring health and humanitarian services are available in fragile and vulnerable settings, research and development, and greater implementation of digital health delivery. In 2020, enhanced collaboration through the Global Action Plan provided support for an equitable recovery from the COVID-19 pandemic in, for example, Lao People’s Democratic Republic, Pakistan, Tajikistan, Somalia, South Sudan, Malawi, Nepal and Columbia, highlighting the potential for multi-sectoral integration of economic, environmental and social aspects of sustainable development to maintain essential health services and core public health functions during shocks and stresses ( [[#WHO--2021a|WHO, 2021a]] ).

Meeting the SDGs also contributes towards reducing involuntary displacement and conflict, as assessed in Sections 7.4.6.6 and 7.4.6.7.

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==== 7.4.6.5 Adopting Mitigation Policies and Technologies that Have Significant Health Co-benefits ====

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Substantial co-benefits from climate action can result from investing in health systems, infrastructure, water and sanitation, clean energy, affordable healthy diets, low-carbon housing, public transport, improved air quality, and social protection. These benefits are in addition to the avoided health impacts associated with climate change (see Cross-Chapter Box HEALTH in Chapter 7).

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==== 7.4.6.6 International Policy Frameworks for Migration that Contribute to Climate Resilient Development ====

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Climate-related migration, displacement and immobility in coming decades will coincide with global and regional demographic changes that will produce a widening distinction between high-income countries that have aging, slow-growing (or in some countries, shrinking) population numbers and low-income countries that have rapidly growing, youthful populations. Given this dynamic, coordinated national and international strategies that integrate migration and displacement considerations with wider adaptation and sustainable development policies may contribute to climate resilient development. Since AR5, the international community has established a number of agreements and initiatives that, with continued pursuit and implementation, would create potential for climate-related migration to be a positive contribution towards adaptive capacity-building and sustainable development more broadly ( [[#Warner--2018|Warner, 2018]] ).

The 2018 Global Compact for Safe, Orderly and Regular Migration provides an important opportunity for planning for and responding to future climate-related migration and displacement ( [[#Kälin--2018|Kälin, 2018]] ). Among its 23 objectives, the Compact explicitly encourages the international community to implement migration policies that facilitate voluntary migration and actively prepare for involuntary displacements due to climate change, especially in low- and middle-income countries. The Compact’s objectives include reducing barriers to legal and safe migration, and facilitating the freer flow of remittances between sending and receiving communities. By doing so the Compact aims to increase the potential for migration to make positive contributions to sustainable development and to adaptive capacity-building. It also contains specific provisions pertaining to climate- and disaster-related migration and displacement. Objective 2 of the Compact aims at reducing drivers of involuntary or low-agency migration and recommends that states establish systems for sharing information on environmental migration, develop climate adaptation and resilience strategies harmonised at sub-regional and regional levels, and cooperate on disaster risk prevention and response. Other objectives in the Compact relevant to climate-related migration include Objective 5 (increasing pathways for regular migration) and Objective 19 (facilitating migrants’ ability to contribute to sustainable development). Objective 18, which links migration with skills development, is consistent with the ‘migration with dignity’ approach to displacement risks ( [[#McNamara--2015|McNamara, 2015]] ; [[#Kupferberg--2021|Kupferberg, 2021]] ). The 2018 Global Compact on Refugees observes that climate hazards increasingly interact with the drivers of refugee movements. The guidelines this Compact provides to governments regarding actions for addressing the causes of refugee movements and considerations for assisting and supporting refugees are useful for governments seeking guidance for all forms of displacement more generally, including displacement linked to climate change.

Pursuant to the Paris Agreement, a task force was struck by the Warsaw International Mechanism to make recommendations to the Conference of the Parties to the UNFCCC on how to reduce the risks of climate-related displacement. Its 2018 report recommended that parties work towards development of national legislation, cooperate on research, strengthen preparedness, integrate mobility into wider adaptation plans, work towards safe and orderly migration, and provide assistance to people internally displaced for climate-related reasons. Such recommendations dovetail strongly with the objectives of the Compacts on Migration and Refugees as well as the Sendai Framework for DRR and the 2030 SDGs. The SDGs, which include multiple goals and targets in which migration plays an explicit role in fostering development ( [[#Nurse--2019|Nurse, 2019]] ), may be seen as completing the international policy arrangements necessary for addressing future climate-related migration and displacement.

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==== 7.4.6.7 Inclusive and Integrative Approaches to Climate-Resilient Peace ====

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CRDPs to reduce conflict risk rely on a shift in perspective from framings around resource scarcity and security to sustainable natural resource governance and peace (Brauch et al., 2016; Barnett, 2018; Dresse et al., 2018; [[#Day--2020|Day and Caus, 2020]] ). Recognising that conflict results from underlying vulnerabilities, development that reduces vulnerability offers the best win-win option for building sustainable, climate-resilient peace rather than specific security-focused interventions ''(high confidenc'' ''e'' ). To this end, meeting the SDGs represents an unambiguous path to reducing conflict risk in a climate-changed world ( [[#Singh--2021|Singh and Chudasama, 2021]] ). There is growing acceptance in the development community, despite reservations about the securitisation of climate, that instability and conflict exacerbated by climate change has the potential to undermine development gains ( [[#Casado-Asensio--2020|Casado-Asensio et al., 2020]] ; [[#Day--2020|Day and Caus, 2020]] ).

Core to achieving climate-resilient peace are new ways of working that involve cross-issue and cross-sectoral collaboration and integration as a default to policy and programming. The Security Council Resolution 1325 Women and peace and security (S/RES/1325 (2000)) and the Sustaining Peace Agenda (A/RES/70/262 (2016)) are notable examples of this. The 2020 UNEP report on gender and security recommends integrated policy frameworks, better financing to strengthen women’s roles in peacebuilding, integrated programme design, and further research on gender, climate and security linkages. Inclusive approaches recognise that much of the vulnerability that drives conflict risk is generated by existing inequality and marginalisation of large proportions of the population—for example women and youth—and that peace cannot be achieved without their needs being taken into account and without their participation in peace processes ( [[#Mosello--2021|Mosello et al., 2021]] ). Diverse and inclusive partnerships also require ways to better engage local-level participation, and improve understanding of how to build consensus through human rights-based approaches that recognize non-violent conflict and protest to be potentially positive and constructive elements of transformational approaches to building resilience ( [[#Nursey-Bray--2017|Nursey-Bray, 2017]] ; [[#Ensor--2018|Ensor et al., 2018]] ; [[#Schipper--2021|Schipper et al., 2021]] ). Addressing the lack of participation of researchers and experts from countries most at risk of conflict in many climate-related conflict and peacebuilding assessments and initiatives could also support this objective. There is an increasing focus on the role of environmental defenders in highlighting violations and gaps in state obligations through non-violent protest ( [[#Butt--2019|Butt et al., 2019]] ; [[#Scheidel--2020|Scheidel et al., 2020]] ).

CRDPs for sustainable peace also require different ways of gathering intelligence and informing conflict risk. Dynamics that affect such risks exist across scales from the local to the regional, and require response in a transboundary manner. There is increasing emphasis on engaging local stakeholders and diverse partnerships to inform context appropriate measures and better policy coordination ( [[#Bremberg--2019|Bremberg et al., 2019]] ; [[#Tshimanga--2021|Tshimanga et al., 2021]] ; [[#Abrahams--2020|Abrahams, 2020]] ). The UN’s Climate Security Mechanism, working across three UN departments, takes an integrated approach to analyse and support timely and appropriate responses to conflict risk, focusing on risk assessments and early warning systems to aid conflict prevention, climate-informed peace and security activities and conflict-sensitive development, and to promote inter-sectoral cooperation, partnership and information sharing (DPPA et al., 2020). There is already acknowledgement that adaptation needs to be effectively monitored so that maladaptation can be avoided ( [[#Eriksen--2021|Eriksen et al., 2021]] ). Here, academic research, which until now has predominantly focused on understanding the causal relationship between conflict and climate, could contribute to advancing the monitoring and evaluation of climate-resilient peacebuilding initiatives ( [[#Mach--2020|Mach et al., 2020]] ; [[#Gilmore--2018|Gilmore et al., 2018]] ).

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'''Cross-Chapter Box HEALTH | Co-benefits of Climate Actions for Human Health, Well-Being and Equity'''
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Authors: Cristina Tirado (USA/Spain, Chapter 7); Robbert Biesbroek (Netherlands, Chapter 13); Mark Pelling (United Kingdom, Chapter 6); Jeremy Hess (USA, Chapter 7); Felix Creutzig (Germany, WGIII); Rachel Bezner Kerr (Canada/USA, Chapter 5); Siri Eriksen (Norway, Chapter 18); Diarmid Campbell-Lendrum (United Kingdom, Chapter 7); Elisabeth Gilmore (USA/Canada, Chapter 14); Maria Figueroa (Denmark/Venezuela, WGIII); Nathalie Hilmi (Monaco, Chapter 18); Peter Newman (Australia, WGIII); Sebastian Mirasgedis (Greece, WGIII); Sharma Rohit (India); Yamina Saheb (France/Algeria, WGIII); Gerardo Sanchez Martinez (Spain); Peter Smith (United Kingdom, WGIII); Adrian Leip (Italy, WGIII); Dhar Subash (Denmark/India, WGIII); Chris Trisos (South Africa, Chapter 9); Mercedes Bustamante (Brazil, WGIII); Luisa Cabeza (Spain, WGIII); Diana Urge-Vorsatz (Hungary, WGIII)

''Achieving the Paris Agreement and SDGs can result in low-carbon, healthy, resilient and equitable societies with high well-being for all (very high confidence) ( [[#Alfredsson--2018|Alfredsson et al., 2018]] ; [[#O’Neill--2018|O’Neill et al., 2018]] )'' . Given the overlap in sources of greenhouse gases (GHGs) and co-pollutants in energy systems, strategies that pursue GHG emission reductions and improvements in energy efficiency hold significant potential health co-benefits through air pollution emission reductions ( ''high confidence'' ) ( [[#Gao--2018|Gao et al., 2018]] ). Air quality improvements alone can substantially offset, or most likely exceed, mitigation costs at the societal level ( [[#Schucht--2015|Schucht et al., 2015]] ; [[#Chang--2017|Chang et al., 2017]] ; [[#Markandya--2018|Markandya et al., 2018]] ; [[#Vandyck--2018|Vandyck et al., 2018]] ; [[#Peng--2017|Peng et al., 2017]] ; [[#Woodward--2019|Woodward et al., 2019]] ; [[#Sampedro--2020|Sampedro et al., 2020]] ; [[#Xie--2018|Xie et al., 2018]] ). Pursuit of a mitigation pathway compatible with warming of +1.5°C with associated cleaner air, avoided extreme events and improved food security and nutrition could result in 152 ± 43 million fewer premature deaths worldwide between 2020 and 2100 compared with a business-as-usual scenario ( [[#Shindell--2018|Shindell et al., 2018]] ). Reaching the Paris Agreement could result in an annual reduction of 1.18 million air pollution-related deaths, 5.86 million diet-related deaths and 1.15 million deaths due to physical inactivity across nine major economies by 2040 ( [[#Hamilton--2021|Hamilton et al., 2021]] ). In Europe, a mitigation scenario compatible with RCP2.6 could reduce total pollution costs, mostly from PM2.5, by 84%, with human health benefits equal to more than Euro 1 trillion over five years ( [[#Scasny--2015|Scasny et al., 2015]] ). In the EU, ambitious climate mitigation policies could reduce years of lost life due to fine particulate matter (PM) from over 4.6 million in 2005 to 1 million in 2050, reduce ozone-related premature deaths from 48,000 to 7,000 and generate health benefits of Euro 62 billion yr –1 in 2050 ( [[#Schucht--2015|Schucht et al., 2015]] ).

However, there may be significant trade-offs between mitigation and other societal goals ( [[#Dong--2019|Dong et al., 2019]] ; [[#Gao--2018|Gao et al., 2018]] ). In some scenarios, mitigation policies consistent with the NDCs may slow poverty reduction efforts ( [[#Campagnolo--2019|Campagnolo and Davide, 2019]] ) with implications for health. A framework of ‘co-impacts’ that assumes neither a general beneficial nature of all implications from mitigation policy nor a hierarchy between climate and other types of benefits, may be more appropriate ( [[#Ürge-Vorsatz--2014|Ürge-Vorsatz et al., 2014]] ; [[#Cohen--2017|Cohen et al., 2017]] ).

''Transitioning to affordable clean energy sources for all presents opportunities for substantial well-being, health, and equity co-benefits (high confidence) ( [[#Gibon--2017|Gibon et al., 2017]] ; [[#Lacey--2017|Lacey et al., 2017]] ; [[#Peng--2018|Peng et al., 2018]] ; [[#Vandyck--2018|Vandyck et al., 2018]] ; [[#Williams--2018|Williams et al., 2018]] )'' . Residential solid fuel use affects health and degrades indoor air quality for up to 3.1 billion people in low- and middle-income countries ( [[#WHO--2016b|WHO, 2016b]] ; [[#Wang--2017a|]] [[#Wang--2017|Wang et al., 2017]] a ). Adherence to planned emission reductions from the Paris Agreement related to renewables could subsequently improve air quality and prevent 71,000–99,000 premature deaths annually by 2030 ( [[#Vandyck--2018|Vandyck et al., 2018]] ). This effect increases with a 2°C pathway, with 0.7–1.5 million premature deaths avoided annually by 2050 ( [[#Vandyck--2018|Vandyck et al., 2018]] ). Co-benefits are also observed at national and regional levels. For instance, China could expect 55,000–69,000 averted deaths in 2030 if it transitioned to a half-decarbonised power supply for its residential and vehicle sectors ( [[#Peng--2018|Peng et al., 2018]] ).

''Investing in universal basic infrastructure, including sanitation, clean drinking water, drainage, electricity, and land-rights, can transform development opportunities, increase adaptive capacity, and reduce vulnerability to climate-related risks (high agreement, high evidence)'' .Transformative approaches that reduce climate-related risks and deliver enhanced social inclusion and development opportunities for the urban poor are most likely where local governments act in partnership with local communities and other civil society actors ( ''high confidence'' ) (Chapter 6, sections 6.1, 6.3, 6.4).

''Rapid urbanisation offers a time-limited opportunity to work at scale towards transformational adaptation and climate resilient development ('' ''medium evidence, high agreement).'' Multi-level leadership, institutional capacity and financial resources to support inclusive adaptation in the context of multiple pressures and inter-connected risks can help ensure that the additional 2.5 billion people projected to live in urban areas by 2050 are less exposed to climate-related hazards and contribute less to global warming ( ''high confidence'' ) (Chapter 6, sections 6.1, 6.3, 6.4). Integrating low-carbon, inclusive adaptation into infrastructure investment driven by rapid urban population growth and COVID-19 recovery can accelerate co-benefits (Chapter 6).

''Urban planning that combines clean, affordable public transportation, shared clean vehicles and accessible active transportation modes can improve air quality and contribute to healthy, equitable societies and higher well-being for all.'' Stimulating active mobility (walking and bicycling) can bring physical and mental health benefits ( ''high confidence'' ) (Chapter 6; [[#Rojas-Rueda--2016|Rojas-Rueda et al., 2016]] ; [[#Avila-Palencia--2018|Avila-Palencia et al., 2018]] ; [[#Gascon--2019|Gascon et al., 2019]] ; [[#Hamilton--2021|Hamilton et al., 2021]] ). The health gains from active mobility outweigh traffic-related injuries due to a decreased incidence of chronic diseases ( [[#Ahmad--2017|Ahmad et al., 2017]] ; [[#Maizlish--2017|Maizlish et al., 2017]] ; [[#Tainio--2017|Tainio et al., 2017]] ; [[#Woodcock--2018|Woodcock et al., 2018]] ).

''Urban green and blue spaces contribute to climate change adaptation and mitigation and improve physical and mental health and well-being (high confidence) (Hansen 2017; EC, 2018; WHO, 2018a; Rojas-Rueda et al. 2019;'' 13.7.3, WGII; 6. WGII; 8.4 WGIII). Urban green infrastructure including urban gardens, can bring benefits to social cohesion, mental health and well-being and reduce the health impacts of heatwaves by decreasing temperatures, thus reducing inequities in exposure to heat stress for low income, marginalised groups ( [[#Hoffman--2020|Hoffman et al., 2020]] ; [[#Hoffmann--2020|Hoffmann et al., 2020]] ; [[IPCC:Wg2:Chapter:Chapter-5|Chapter 5]] section 5.12.5; Chapter 6; [https://www.ipcc.ch/report/ar6/wg2/chapter/chapter-7 Chapter 7] section 7.4; [[IPCC:Wg2:Chapter:Chapter-13|Chapter 13]] section 13.7). The trade-offs of increasing urban green and blue spaces include potential public health risks related to increased vectors or hosts for infectious diseases, toxic algal blooms, drowning and aeroallergens ( [[#Choi--2021|Choi et al., 2021]] ; [[#Stewart-Sinclair--2020|Stewart-Sinclair et al., 2020]] ; Chapter 6).

''Climate adaptation and mitigation policies in the building sector offer multiple well-being and health co-benefits (high confidence)'' ( [[#Diaz-Mendez--2018|Diaz-Mendez et al., 2018]] ; [[#Macnaughton--2018|Macnaughton et al., 2018]] ; Chpater 3 section 3.6.2). Leadership in Energy and Environmental Design (LEED) certified buildings in the USA, Brazil, China, India, Germany and Turkey saved an estimated USD 7.5 billion in energy costs and averted 33 Mt of CO 2 from 2000–2016 ( [[#Macnaughton--2018|Macnaughton et al., 2018]] ). These measures can increase health benefits through better indoor air quality, reduction of the heat island effect, improved social well-being through energy poverty alleviation, creation of new jobs, increased productive time and income, increased thermal comfort and lighting indoors and reduced noise impact ( [[#Smith--2016|Smith et al., 2016]] ; [[#McCollum--2018|McCollum et al., 2018]] ; [[#Thema--2017|Thema et al., 2017]] ; [[#Mirasgedis--2014|Mirasgedis et al., 2014]] ; [[#Alawneh--2019|Alawneh et al., 2019]] ; [[#Diaz-Mendez--2018|Diaz-Mendez et al., 2018]] ). The value of these multiple co-benefits associated with climate actions in buildings is equal to or greater than the costs of energy savings ( [[#Ürge-Vorsatz--2016|Ürge-Vorsatz et al., 2016]] ; [[#Payne--2015|Payne et al., 2015]] ; [[IPCC:Wg2:Chapter:Chapter-14|Chapter 14]] section 14.4.5).

''Shifting to sustainable food systems that provide affordable, diverse and plant-rich diets with moderate quantities of GHG-intensive animal protein can bring health co-benefits and substantially reduce GHG emissions, especially in high income countries and where ill health related to overconsumption of animal-based products is prevalent (very high confidence) ( [[IPCC:Wg2:Chapter:Chapter-5|Chapter 5]] section 5.12.6; [https://www.ipcc.ch/report/ar6/wg2/chapter/chapter-7 Chapter 7] section 7.4, [[IPCC:Wg2:Chapter:Chapter-13|Chapter 13]] section 13.5; [[#Springmann--2018c|Springmann et al., 2018c]] ; [[#IPCC--2019b|IPCC, 2019b]] ; [[#Clark--2017|Clark and Tilman, 2017]] ; [[#Poore--2018|Poore and Nemecek, 2018]] ; [[#Hayek--2021|Hayek et al., 2021]] )'' . Transforming the food system by limiting the demand for GHG-intensive animal foods, reducing food over-consumption and transitioning to nutritious, plant-rich diets can have significant co-benefits to health ( ''high confidence'' ) ( [[#Hedenus--2014|Hedenus et al., 2014]] ; [[#Ripple--2014|Ripple et al., 2014]] ; [[#Tirado--2017|Tirado, 2017]] ; [[#Springmann--2018c|Springmann et al., 2018c]] ; IPCC, 2018; [[#IPCC--2019a|IPCC, 2019a]] ; [[#IPCC--2019b|IPCC, 2019b]] ; [[#Nelson--2016|Nelson et al., 2016]] ; [[#Willett--2019|Willett et al., 2019]] ; [[#Tilman--2014|Tilman and Clark, 2014]] ; [[#Green--2015|Green et al., 2015]] ; [[#Springmann--2016b|Springmann et al., 2016b]] ; [[#Springmann--2018b|Springmann et al., 2018b]] ; [[#Springmann--2018a|Springmann et al., 2018a]] ; [[#Springmann--2018c|Springmann et al., 2018c]] ; [[#Milner--2015|Milner et al., 2015]] ; [[#Milner--2017|Milner et al., 2017]] ; [[#Farchi--2017|Farchi et al., 2017]] ; [[#Song--2017|Song et al., 2017]] ; [[#Willett--2019|Willett et al., 2019]] ). Reduction of red meat consumption reduces the risk of cardiovascular disease (CVD) and colorectal cancer; the consumption of more fruits and vegetables can reduce the risk of CVD, type II diabetes, cancer and all causes of mortality ( [[#Tilman--2014|Tilman and Clark, 2014]] ; [[#Sabate--2014|Sabate and Soret, 2014]] ; [[#Willett--2019|Willett et al., 2019]] ; [https://www.ipcc.ch/report/ar6/wg2/chapter/chapter-7 Chapter 7] section 7.4; [[IPCC:Wg2:Chapter:Chapter-5|Chapter 5]] section 5.12.5). Globally, it is estimated that transitioning to more plant-based diets—in line with World Health Organization (WHO) recommendations on healthy eating—could reduce global mortality by 6 ‒ 10% and food-related GHG emissions by 29 ‒ 70% by 2050 ( [[#Springmann--2016b|Springmann et al., 2016b]] ). There are limitations in accessibility of affordable of healthy and diverse diets for all ( [[#Springmann--2020|Springmann et al., 2020]] ) and trade-offs such as the potential increase of GHG emissions from producing healthy and diverse diets in low- and medium-income countries (Semba et al., 2020). Agroecological approaches have mitigation and adaptation potential and deliver ecosystem services, biodiversity, livelihoods and benefits to nutrition, health and equity ( [[#Rosenstock--2019|Rosenstock et al., 2019]] ; [[#Bezner%20Kerr--2021|Bezner Kerr et al., 2021]] ; [[IPCC:Wg2:Chapter:Chapter-5|Chapter 5]] sections 5.4.4, 5.14.1; [[IPCC:Wg2:Chapter:Chapter-13|Chapter 13]] section 13.5; [[IPCC:Wg2:Chapter:Chapter-14|Chapter 14]] section 14.4.4).

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