COP27 Climate Change Conference: Urgent action needed for Africa and the world.

Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present, and future impacts of climate change. The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction, and climate hazards such as heatwaves and floods. These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement— as 231 health journals argued together in 2021—that the rise in global temperature must be limited to less than 1·5C compared with pre-industrial levels. Although the Paris Agreement of 2015 outlines a global action framework that incorporates providing climate finance to developing countries, this support has yet to materialise. COP27 is the fifth Conference of the Parties (COP) to the United Nations Framework Convention on Climate Change to be organised in Africa since its inception in 1995. Ahead of this meeting, we—as health journal editors from across the continent—call for urgent action to ensure it is the COP that finally delivers climate justice for Africa and vulnerable countries. This is essential not just for the health of those countries, but also for the health of the whole world. Africa has suffered disproportionately from the climate crisis, although it has done little to cause the crisis. The climate crisis has had an impact on the environmental and social determinants of health across Africa, leading to devastating health effects. Impacts on health can result directly from environmental shocks and indirectly through socially mediated effects. Climatechange-related risks in Africa include flooding, drought, heatwaves, reduced food production, and reduced labour productivity. Droughts in sub-Saharan Africa have tripled between 1970–79 and 2010–19. In 2018, devastating cyclones impacted 2·2 million people in Malawi, Mozambique, and Zimbabwe. In west and central Africa, severe flooding resulted in mortality and forced migration from loss of shelter, cultivated land, and livestock. Changes in vector ecology brought about by floods and damage to environmental hygiene has led to increases in diseases across sub-Saharan Africa, with rises in malaria, dengue fever, Lassa fever, Rift Valley fever, Lyme disease, Ebola virus disease, West Nile virus, and other infections. Rising sea levels reduce water quality, leading to waterborne diseases, including diarrhoeal diseases, a leading cause of mortality in Africa. Extreme weather damages water and food supply, increasing food insecurity and malnutrition, which causes 1·7 million deaths annually in Africa. According to the Food and Agriculture Organization of the United Nations, malnutrition has increased by almost 50% since 2012, owing to the central role agriculture has in African economies. Environmental shocks and their knock-on effects also cause severe harm to mental health. In all, it is estimated that the climate crisis has destroyed a fifth of the gross domestic product of the countries most vulnerable to climate shocks. The damage to Africa should be of supreme concern to all nations. This is partly for moral reasons. It is highly unjust that the most impacted nations have contributed the least to global cumulative emissions, which are driving the climate crisis and its increasingly severe effects. North America and Europe have contributed 62% of carbon dioxide emissions since the Industrial Revolution, whereas Africa has contributed only 3%. Yet it is not just for moral reasons that all nations should be concerned for Africa. The fight against the climate crisis needs all hands on deck. The acute and chronic impacts of the climate crisis create problems such as poverty, infectious disease, forced migration, and conflict that spread through globalised systems. These knock-on impacts affect all nations. COVID-19 served as a wake-up call to these global dynamics and it is no coincidence that health professionals have been active in identifying and responding to the consequences of growing systemic risks to health. But the lessons of the COVID-19 pandemic should not be limited to pandemic risk. Instead, it is imperative that the suffering of front-line nations, including those in Africa, be the core consideration at COP27; in an interconnected world, leaving countries to the mercy of environmental shocks creates instability that has severe consequences for all nations. Lancet Digit Health 2022