The converging crises of climate, environment and health are megatrends that present current and future threats to our planet and population. There is a need for multisectoral and interdisciplinary collaboration between countries and actors to unite in political solutions. Joint accelerated efforts to tackle the climate crisis and recover from the COVID-19 pandemic are crucial. Measures taken to address both of these public health crises must be examined carefully, given their strong connection.1

“The pandemic is a reminder of the intimate and delicate relationship between people and planet. Any efforts to make our world safer are doomed to fail unless they address the critical interface between people and pathogens and the existential threat of climate change, that is making our Earth less habitable”.

However, not all actors contribute to these converging crises similarly, and inequality remains a core issue. The top 10% of the emitters generate around 45% of flobal greenhouse gas emissions, while the bottom 50% only generate 13%. According to numbers from 2017, 100 companies are accountable for 71% of the world's total greenhouse gas emissions. Only a handful of transnational companies dominate areas that are significant drivers of environmental change and biodiversity loss, such as agriculture, forestry and fisheries.2,3 Notably, food consumption is the single most significant driver of environmental pressure load accounting for 80% of land conversion and biodiversity loss, contamination of freshwater and coastal ecosystem, 80% of freshwater consumption and contributing 20-30% of global greenhouse emissions.4,5 How can we create rights-based systems of equal distribution that, at the same time, battle the converging crises of climate, environment and health?

The converging crises of climate, environment and health are megatrends that present current and future threats to our planet and population. There is a need for multisectoral and interdisciplinary collaboration between countries and actors to unite in political solutions. Joint accelerated efforts to tackle the climate crisis and recover from the COVID-19 pandemic are crucial. Measures taken to address both of these public health crises must be examined carefully, given their strong connection.


The COVID-19 pandemic has hit the world severely, causing death and suffering to millions of people. And while the world is trying to tackle the pandemic, global warming continues, often interacting with other megatrends6. According to the WMO's State of the Global Climate, 2020 was one of the three warmest years on record, with indicators such as greenhouse gas concentrations, increasing land and ocean temperatures, sea-level rise, melting ice and glacier retreat and extreme weather.7 Climate change affects socio-economic development globally (according to EU numbers, this implies a loss of more than 12bn Euro per year within the Union only), land and marine ecosystems, economy, food, security, trade, migration, health and wellbeing.8 According to the planetary boundaries framework, we have already transgressed at least four boundaries: climate change, land conversion, nitrogen and phosphorous loading, and biodiversity loss. The human population has driven the planet into the Anthropocene: the first geological epoch shaped by human activity.9

It is estimated that an average of 26.4 million people worldwide have been displaced by weather events every year since 2008. There could be as many as 1 billion climate migrants by 2050, thus reinforcing inequalities and complicating access to basic services for a large part of the global population. In addition to this, displacements and migration due to climate change and weather events interact with other issues, often leading to geopolitical tensions, consequently posing threats to international security.10 We know that battling the climate, environment and health crises would reduce the risk of existing and new health threats, such as emerging zoonotic diseases, respiratory diseases and heat exposure, creating a more promising, healthy and equal future for coming generations – not leaving the most vulnerable groups behind.11


As an imminent consequence of the pandemic there is increasing attention and investment on Building Forward Better towards greener, more sustainable, and equal recovery using systematic approaches and holistic perspectives as the world has now to increase its activites to tackle the ongoing climate, biodiversity and environmental crises. The WHO highlights the need for recovery plans protecting nature, investing in essential services, ensuring quick and healthy energy transitions, promoting sustainable food systems, building healthy cities, and stop subsidising air pollution.12 An analysis of COVID-19 related recovery efforts led by Oxford's Economic Recovery Project and the UN Environment Programme (UNEP) illustrates selected green policy areas that could optimise economic recovery with global climate and sustainability commitments after COVID-19: green energy, green transport, green building upgrades and energy sufficiency natural capital, and green research and development. They state: "The choice for policymakers is clear: make use of recovery spending to steer away from the worst impacts of climate change and inequality or reinforce existing carbon-intensive systems and lock in a future that is economically, socially, and environmentally unsustainable."13

Many governments and actors are already leading the way, with leadership focusing on green transitions. However, more action is urgently needed to assure a more promising outlook. During the first half of 2020, the level of carbon dioxide in the air exceeded 410 ppm, the highest level in 3 million years, as pointed out by a new multi-agency report launched in September by UN Secretary-General.14 The recently published Oxford's Economic Recovery Project/UNEP report shows that "USD14.6 tn in announced spending across the world's largest fifty countries in 2020, of which USD1.9tn (13.0%) was directed to long-term 'recovery-type' measures and of that, USD341bn (18.0%) to green recovery initiatives. Considering total spending, only USD368bn (2.5%) was announced for green initiatives ".13 The Global Risks report 2021 states that without systematic solutions, emissions will only continue to increase, risking to miss the window of opportunity the pandemic presents, similar to the scenario of the 2008-2009 financial crisis where emissions quickly bounced back after a temporary decrease due to economies shutdowns.15


The Paris agreement and NDCs

Hamilton et al. state that greater inclusion of health in the Paris Agreement (which is now lacking16) can simultaneously increase health benefits and achieve the "well below 2°C" commitment across various regional and economic contexts.17 There are substantial health co-benefits to be retrieved from these efforts, but they are not enough embraced in climate policies, the authors argue. In a scenario of meeting the goals of the Paris Agreement and the 2030 Agenda, the same study concludes that this pathway would save many millions of lives due to reduced air pollution, improvement of healthier diets and increased physical activity by 2040 in the nine countries of investigation, compared with the current pathway's scenario.15

The newly published UNFCCC NDC Synthesis Report, covering new or updated NDCs by 75 parties, concludes that most of these countries increased their levels of ambition to reduce emissions in the revised NDCs. Yet, the current levels of climate ambition are not on track to meet Paris Agreement goals. In the report, particularly vulnerable areas of concern were mentioned: agriculture and other aspects of food security, water, biodiversity and ecosystems, health systems, infrastructure (particularly energy) and loss of territory, livelihoods and habitats. Many countries highlighted contextual aspirations and priority areas to maximise synergies between climate commitments and human health.18 In addition, the report found that health was identified as an adaptation priority in most of the NDC's adaptation components. While the references to health in the NDCs can strengthen the commitment to climate action at a national and global level, they are made in relation to financial and technological resources/assistance needed from wealthy countries to low-income countries. This makes it evident that the focus on health in the NDCs follows broader patterns of global inequalities.19 While richer (high emitting) countries focus on non-health sectors (i.e., energy and the economy) and make no reference to health (e.g., Australia, EU member countries, the USA), it is the poorest and most climate-vulnerable countries that aim to address health and strengthen their health systems in their NDCs. This brings to the fore the issue of access to climate finance for climate-resilient health systems. According to the WHO Health and Climate Change Survey Report: Tracking Global Progress (2019), the majority of countries reported only moderate or low levels of implementation of their national health and climate change strategies/plans, citing financing as the most common barrier to implementation. Only 9% of the surveyed countries reported having sufficient national health budgets to implement these strategies in full.

Opportunities and frameworks

As pointed out by many, and recently by Bill Gates in his new book20, the only way to reach a healthy planet and healthy people is the path from current to 0 greenhouse gas emissions. Changing energy production from today's 80% dependence on fossil fuel to 100% clean energy is a gigantic task but necessary for people and planet survival. "The countries that build great zero-carbon companies and industries will be the ones that lead the global economy in the coming decades", says Bill Gates. The private sector taking more significant initiatives in green transitions is a crucial aspect, including innovations and technologies for a green and clean recovery, especially regarding energy, food systems and agriculture.

There is a need for policymaking to enable and stimulate these transformations, as well as the willingness to transform systems and traditional economic models from the private sector. It is time for bold political decisions and more efforts of science and innovations for creating a sustainable and healthy planet from a multisectoral and holistic approach. The youth climate movement have been ground-breaking in their requests for bold policies and action for their future on our planet. Essential questions to ask are: How do we increase accountability of all the world's governments, public, private and third sector actors? If the aim to Build Back Better historically has proven to merely build back21, how can we make use of the window of opportunity the pandemic presents to do better regarding the converging crises of climate, environment and health and align our efforts towards the 2030 Agenda?

Positively, some global actors are picking up the pace. The European Green Deal aims to make Europe climate neutral by 205022, with China by 2060 and Japan by 2050. President Biden has proposed a $3 trillion climate plan to phase down fossil fuels by expanding renewable energy capacity while creating jobs, reducing pollution and investing in historically disadvantaged communities.23 The World Bank Group recently launched their new Climate Change Action Plan, including committing to aligning financing flows with the objective of the Paris Agreement and increasing their climate finance with the goal of 35% of World Bank Group financing having climate co-benefits on average over the next five years.24 As described earlier in this concept note, 100 companies are accountable for 71% of the world's total greenhouse gas emissions, but there are at the same time initiatives such as the World Business Council for Sustainable Development with the aim for accelerating the transformation of major economic systems, in line with Sustainable Development Goals, the Paris Climate Agreement and Vision 2050.25

There are multisectoral models and theories developed to improve a more sustainable and healthier planet, to apply at scale. A holistic approach to planetary and human wellbeing is provided by Kate Raworth's "Doughnut Economics" model, combining social and planetary boundaries26, taking a systematic approach for future sustainability for human and planetary health, questioning the need for traditional economic growth to re-focus on more sustainable policies for all.9 Similarly, Tim Jackson argues that "the pursuit of growth at all costs" reinforces inequality, hinders technological innovation and exacerbates financial instability when we instead need to create conditions for an economic system for all, within the planetary boundaries and constraints.27

The syndemic approach is a conceptual framework aiming to improve the understanding of co-occurring risk factors, improving prevention and intervention programmes. Mendenhall et al. state that the term syndemic refers to "synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities"28, considering social, environmental, political and economic factors – understanding that health is largely affected and determined by all of these factors29. The Lancet Commission on the Global Syndemic of Obesity, Undernutrition and Climate Change argues that the three "pandemics" of obesity, undernutrition and climate change represent the global syndemic that affects most people in every country and region worldwide; a synergy of epidemics, interacting with each other, sharing common societal drivers, highlighting the importance of food systems and their unequal distribution and function globally.30 Richard Horton writes: "COVID-19 is not a pandemic. It is a syndemic. The syndemic nature of the threat we face means that a more nuanced approach is needed if we are to protect the health of our communities", highlighting the prevention of Non-Communicable Diseases (NCDs), understanding social inequalities, and virtually all elements playing into the direct and indirect effects of the pandemic.31 The syndemic approach provides an integrated lens of the current pandemic, helping us understand it in a context of a more extensive vision encompassing education, employment, housing, food and environment - a systems view, analysing and understanding how crises and inequalities converge and how to tackle them holistically.

In light of recovering from the pandemic and making investments in green recovery, academia, business, and politicians have a tremendous responsibility to work together to battle these crises, promote health and equality, and prevent disease. The aforementioned Oxford's Economic Recovery Project/UNEP report states: "Despite positive steps towards a sustainable COVID-19 recovery from a few leading nations, the world has so far fallen short of matching aspirations to build back better. But opportunities to spend wisely on recovery are not yet over. Governments can use this moment to secure long-term economic, social, and environmental prosperity."13


The world is in a situation where there is an increased openness for transformation due to the pandemic, where clear goals need to be set, and key activities need to be prioritised. In this, PMAC can be a strong voice addressing the converging global crises and how to take bold actions for humanity and planet – emphasising that human health is dependent on the planet's health.

The objectives for sub-theme 2 are:

  1. Discuss actions to address the converging crises of climate, biodiversity, environment and health.
  2. Mobilise political and private sector support and momentum for action-oriented collaboration between countries and actors to synergise in political solutions and mechanisms. This should also include creating accountability for investing greener in the recovery post-COVID-19 and mobilising resources for "building back better".
  3. Engage youth and vulnerable groups in the converging crises of climate change, environmental degradation and health in these discussions, and create a platform for them to express what they need from today's leaders
  4. Leverage the momentum and impacts from COP26 (before PMAC) and contribute to Stockholm +50 in June 2022 (after PMAC).


  1. Watts et al. (2020) The 2020 report of the Lancet Countdown on health and climate change. Lancet 2021; 397: 129–70.
  2. CPD (2017) CDP Carbon Majors Report 2017.
  3. Folke, C (2019) Transnational Corporations and the Challenge of Biosphere Stewardship. Nature Ecology & Evolution 3, 1396–1403.
  4. The Food and Land Use Coalition (2019) Growing Better: Ten Critical Transitions to Transform Food and Land Use. The Global Consultation Report of the Food and Land Use Coalition, September 2019:
  5. The EAT-Lancet Commission (2019) Food in the Anthropocene: The EAT-Lancet Commission on healthy diets from sustainable food systems. The Lancet, Vol 393, Issue 10170, p. 447-492
  6. During PMAC 2021, subtheme four discussed COVID-19 and the global megatrends. Webinars were: Building back better - maximising co-benefits of addressing climate change, environment and food systems to improve health, in the COVID-19 era; Dealing with disasters fast and slow: Health system resilience for COVID-19 and climate change; The future society – population dynamics following COVID-19; Will the healthcare technologies from COVID-19 lead to a permanent shift in how global healthcare us delivered?; The Lancet-SIGHT Commission on peaceful societies through health and gender equality. In the plenary session, it was presented how COVID-19 is a syndemic and the need to tackle crises of climate change, biodiversity loss, environmental degradation and COVID-19 pandemic.
  7. WMO (2021) State of the Global Climate 2020.
  8. European Comission (2021) Forging a climate-resilient Europe - the new EU Strategy on Adaptation to Climate Change. Retrieved from: (May 3, 2021
  9. Raworth (2017a) Doughnut Economics. Seven Ways to Think Like a 21-st Century Economist. London: Penguin Random House UK.
  10. The Lancet Editorial (2020) Climate migration requires a global response. Vol 395 March 14, 2020.
  11. Nilsson et al. (2020) COVID-19—a rehearsal to build a greener and healthier society. BMJ 2021;372:n127
  12. WHO (2020) WHO Manifesto for a healthy recovery from COVID-19
  13. O’Callaghan and Murdock (2021) Are We Building Back Better? Evidence from 2020 and Pathways for Inclusive Green Recovery Spending.
  14. United in Science (2020)
  15. World Economic Forum (2020) The Global Risks Report 2021.
  16. Stockholm Environment Institute (2019) Connections between the Paris Agreement and the 2030 Agenda. The case for policy coherence.
  17. Hamilton et al. (2021) The public health implications of the Paris Agreement: a modelling study. Lancet Planet Health 2021;5: e74–83
  18. UNFCCC (2021) Nationally determined contributions under the Paris Agreement. Synthesis report by the secretariat.
  19. Dasandi, N., Graham, H., Hudson, D., Mikhaylov, S. J., vanHeerde-Hudson, J., & Watts, N. (2021). How Do Different Frames Affect Public Support for Climate Change Policy: Evidence from a Multi-Country Conjoint Study.
  20. Gates, Bill (2021) How to avoid a climate disaster. New York: Doubleday
  21. Fernandez et al. (2019) “Build back better” approach to disaster recovery: Research trends since 2006. Progress in Disaster Science, Volume 1, 2019.
  22. European Commission: The EU Circular Economy Action Plan:
  23. NY Times (2021) Biden Team Prepares $3 Trillion in New Spending for the Economy. Retrieved from: (March 25, 2021)
  24. World Bank (2021) World Bank Group President’s Statement on Climate Change Action Plan. Retrieved from: (April 28, 2021).
  25. World Business Council for Sustainable Development:
  26. Rockström (2009) Planetary boundaries: Exploring the safe operating space for humanity. Ecology and society, vol.14, Issue 2.
  27. Jackson, Tim (2019) The Post-growth Challenge: Secular Stagnation, Inequality and the Limits to Growth, Ecological Economics, Volume 156, 2019, Pages 236-246.
  28. Mendenhall et el. (2017) Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. The Lancet, Vol. 389, pp. 951-963.
  29. Bukhman et al. (2020) The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion. The Lancet, Vol. 396, No. 10256
  30. Swinburn et al. (2019) The Global Syndemic of Obesity, Undernutrition and Climate Change: The Lancet Commission Report. Lancet 2019; 393: 791–846
  31. Horton (2020) Offline: COVID-19 is not a pandemic. The Lancet: Vol 396, September 2020.