Health Indicators for the Global Goal on Adaptation Have Been Adopted

It’s time to open the package of adopted Global Goal on Adaptation Indicators for Human Health that just arrived from the 30^th Conference of Parties climate negotiations in Belém!

Let me loosen the tape, undo the ribbon, and …. Oh Dear!! The contents appear to have been damaged in shipping!!

In my last blog on the indicators from before COP30, I suggested that if fully implemented, the proposed set would provide a “concise yet comprehensive framework for assessing national progress on health adaptation to climate change”.

I was hoping that even if some did not get selected or were changed, most might survive intact.

Of the original 10, only one has survived intact. Four are completely gone. The other five have been altered in ways that make them hard to understand and consequently much harder to implement.

Completely gone are indicators for occupational heat mortality, level of operationalization of early warning systems, level of implementation of national plans, and proportion of responsible ministry staff who have been trained in climate and health. These were important content, process, and accountability indicators and their loss leaves big holes in the framework.

Operationalization of early warning systems has been wedged into the indicator for mortality from “climate impacts”, apparently as an effect modifier. Going from heat-related mortality to mortality from all climate impacts makes this indicator much harder to define and implement.

The indicators for facility resilience are now less measurable. “Percentage of retrofitted or newly built to standard facilities” is now “percentage of resilient facilities”, followed by qualifiers that are vague and hard to follow: “under different scenarios, as appropriate for regions and contexts, including as an outcome of adaptation actions where applicable”. It will require further negotiation to define those phrases, and the term “resilient” itself, and make them implementable. Number of facilities destroyed or damaged has become “extent to which climate health services have remained at full capacity”. While the number of facilities damaged or destroyed is not always easy to obtain, the new indicator will be harder to quantify.

The proposed indicator for Universal Health Coverage related to essential health services was unlikely to be adopted from the start because of political concerns. The replacement indicator, though, is very hard to interpret: “Coverage of essential health services that are supported by adaptation measures that ensure continuity during and following…events”. Again, this is unlikely to be implemented without considerable negotiations to clarify meaning and measurement.

The proposed indicator for implementation of Mental Health and Psychosocial Support preparedness and response was modified to “Proportion of the population vulnerable to climate change with access to mental health and psychosocial support”. The proposed indicator would have been challenging to measure; the modified indicator introduces a restriction of measurement to an undefined vulnerable population. Given the widespread nature of the mental health impacts of climate change, it will be very challenging to have a consensus definition of a vulnerable population for this indicator.

As mentioned, the proposed indicator for heat-related mortality was broadened to mortality from an undetermined number of climate impacts. In the adopted modifications, this has been paired with an indicator for the “rate of morbidity associated with climate impacts”. This is also an attributable burden estimate, as it is “compared with counterfactual rates”. And it includes the inscrutable qualifier “including as an outcome of adaptation actions where applicable”. But for some reason, it does not include the qualifier of the relation to “coverage of early warning systems”. This will also take a very long time to sort out and attempt to come to consensus on definitions and measurement techniques.

The sole survivor? Incidence of climate-sensitive infectious diseases. Though not without some collateral damage: this indicator is also qualified by the unclear phrase about it being an outcome of adaptation actions.

How did this happen?

How did a reasonable, well-honed set of proposed indicators, the result of many hours of expert deliberation, get adopted as a confusing morass of language?

Was there a heated debate between the experts and the country negotiators and this was the best they could manage? Or an open discussion amongst the country negotiators without the experts?

No and no. It appears this was the result of a closed-door rewrite of the indicators by the Brazilian Presidency. And a last minute, rushed vote left few options for countries other than to adopt them for now.

What comes next?

There will need to be extensive additional discussion by technical experts to clarify definitions, bound scopes, and agree on specific methods for these adopted indicators. Will the working group that developed the proposed indicators be asked to provide that ongoing service? Will they agree? That remains to be seen.

What is clear is that rather than marching off to implement the first consensus set of indicators and start tracking progress on climate adaptation for health, countries will need to wait at least a year, maybe two. Efforts will likely be fragmented, with some countries moving forward with indicators systems of their own design, others standing still. Perhaps in developing their own systems, countries will draw heavily from the language and details of the original proposed indicator set. That might allow easier harmonization down the road.

This disappointment around indicators is just one of many letdowns from COP30. Like so many challenges this year, we need to acknowledge and grieve for this. And then move on. Like kintsugi pottery, the package of GGA health indicators can and should be repaired and made fit for purpose.