The health sector and fiscal policies of fossil fuels: an essential alignment for the health and climate change agenda

The WHO declared in 2018 that ‘climate change is the greatest challenge of the 21st century, threatening human health and development’.1 The relationship between climate change and adverse health impacts has been described in detail2 and is driven by increasing greenhouse gas emissions (especially CO2, black carbon, methane and nitrous oxides) principally from the combustion of fossil fuels.3 The relationship between climate change and health has focused on the three notions of (1) mitigation, or reducing the climate footprint of the health sector itself, (2) health sector adaptation or improving the resilience of the health sector in the face of climate-related hazards and (3) the multitude of direct and indirect impacts of climate change on the global disease burden. [...]the current triangular framing of ‘mitigation’, ‘adaptation’ and the newly endorsed momentum towards rectifying ‘loss and damage’ does not recognise or prioritise the cobenefits of moving from fossil fuel subsidy to fossil fuel taxation.16 Cobenefits entail the notion of offset; improved air quality alone could realise health benefits that easily offset the global costs of emissions reductions.17 This would also include reduced consumption, with its associated health benefits. [...]the WHO Framework Convention on Tobacco Control limits engagement with the tobacco industry (Article 5.3), aided by surveillance tools such as the Global Tobacco Industry Interference Index.20 The normative and systemic protection of policy-making from interference by industry actors with clear vested interests is in its infancy, judging by the perpetuation of subsidies themselves as well as the overbearing presence of a reported 636 industry representatives in the COP27 deliberations.21 The health sector and its civil society allies would be well placed to initiate witnessing processes and interference indices that enable a better systemic understanding of the nature and extent of fossil fuel industry interference in the ecosystem of policy, legislative and financing process directly connected, but not limited to, UNFCCC instruments. [...]direct support to the fossil fuel subsidy reform (FFSR) agenda at multiple levels is required.