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Background: Instituted under the Paris Agreement, nationally determined contributions (NDCs) outline countries’ plans for mitigating and adapting to climate change. They are the primary policy instrument for protecting people’s health in the face of rising global temperatures. However, evidence on engagement with health in the NDCs is scarce. In this study, we aimed to examine how public health is incorporated in the NDCs, and how different patterns of engagement might be related to broader inequalities and tensions in global climate politics.
Methods: We analysed the NDCs in the UN Framework Convention on Climate Change registry submitted by 185 countries. Using content analysis and natural language processing (NLP) methods, we developed measures of health engagement. Multivariate regression analyses examined whether country-level factors (eg, population size, gross domestic product [GDP], and climate-related exposures) were associated with greater health engagement. Using NLP methods, we compared health engagement with other climate-related challenges (ie, economy, energy, and agriculture) and examined broader differences in the keyword terms used in countries with high and low health engagement in their NDCs.
Findings: Countries that did not mention health in their NDCs were clustered in high-income countries, whereas greater health engagement was concentrated in low-income and middle-income countries. Having a low GDP per capita and being a small island developing state were associated with higher levels of health engagement. In addition, higher levels of population exposure to temperature change and ambient air pollution were associated with more health coverage included in a country’s NDC. Variation in health engagement was greater than for other climate-related issues and reflected wider differences in countries’ approaches to the NDCs.
Interpretation: A focus on health in the NDCs follows broader patterns of global inequalities. Poorer and climate-vulnerable countries that contribute least to climate change are more likely to engage with health in their NDCs, while richer countries focus on non-health sectors in their NDCs, such as energy and the economy.
Objective: To examine country engagement with the health impacts of climate change in (1) annual statements in the UN General Debate (UNGD); and (2) the Nationally Determined Contributions (NDCs) of the Paris Agreement; and to identify what factors drive country engagement.
Methods: First, we measure engagement by the total references to the health and climate change relationship in each text, using a keyword-in-context search with relevant search terms. Second, we use machine learning models, specifically random forest models, to identify the most important country-level predictors of engagement. Our predictors are political and economic factors, health outcomes, climate change-related variables, and membership of political negotiating groups in the UN.
Findings: For both UNGD statements and NDCs, we find that that low- and middle-income countries discuss the health impacts of climate change much more than high-income countries. We find that the most important predictors of country engagement are related health outcomes (infant mortality rates, maternal death risk, life expectancy), countries’ income levels (GDP per capita), and fossil fuel consumption. Membership of political negotiating groups (e.g. G77 and SIDS) is less important predictors.
Conclusion: Our analysis indicates a North-South division in engagement, and hence there is little to suggest that a health framing of climate change overcomes existing geopolitical divisions in climate change negotiations. Countries who carry the heaviest health burdens but lack necessary resources to address the impacts of climate change are shouldering responsibility for reminding the global community of the implications of climate change for people’s health.