Developing a National Health and Climate Strategy for Japan

Climate change is the single most important public health challenge of the 21st century. The term “climate change” refers to the long-term changes in temperature and weather patterns that are the clear result of greenhouse gas (GHG) emissions associated with human activities. By 2023, there was an observed increase in annual mean temperature of more than 1.5°C above pre-industrial levels. Effects associated with this change to the earth’s environment including increased frequency of droughts, biodiversity loss, ocean acidification, and food shortages have severe impacts on all life on Earth. Actions for climate change have been the subject of active global-level discussions in recent years at forums including the United Nations Framework Convention on Climate Change and the G7, but if even further efforts to reduce GHG emissions are not taken, then by the end of this century, a wide range of natural ecosystems including those in terrestrial, freshwater, and coastal and open ocean areas will be placed at very high risk of serious and irreversible and impacts on a global scale.

Climate change is also a threat to human health. In addition to greater damage to infrastructure and other assets due to increased frequency and intensity of climate disasters such as heat waves, torrential rains, droughts, and tropical cyclones, around the world, climate change will cause or is expected to cause worsening sanitary conditions and food insecurity due to difficulties in securing water for domestic use while reducing crop yields and increasing water, food, and arthropod-borne diseases. Climate change may also aggravate mental health conditions and force more people to become climate refugees. In addition to approximately 250,000 additional deaths per year, there are also concerns that climate change will lead to political instability and violent armed internal conflicts. Health hazards are likely to be particularly severe in the Global South. Japan may experience a number of effects, as well. Greater heat stress from rising temperatures is likely to increase the risk of various diseases, starting with heat stroke and other heat-related illnesses. Rising temperatures may also change endemic regions and patterns of spread for arthropod-borne diseases, while changes in ambient temperatures may alter prevalence patterns for water- and food-borne diseases and infectious diseases such as influenza. It has been pointed out that these health threats are likely to disproportionately affect elderly people, people living with chronic diseases, and other vulnerable groups.

However, the healthcare sector is a major GHG emitter that accounts for 5% of all CO2 emissions. Factors like global population aging, growing prevalence of chronic non-communicable diseases, and urbanization all contribute to increased healthcare demand, so it is unrealistic to expect the amount of GHG emitted by the health sector to decrease on its own. To strongly promote efforts to address climate change though GHG reductions, it will be essential to set the clear goal of establishing a health system that is net-zero GHG emissions through the supply chain and to provide a roadmap to carbon neutrality by 2050.

Active discussions on transitioning to green health systems are currently being held at the global level. Ongoing initiatives such as the Alliance for Transformative Action on Climate and Health (ATACH) from the United Nations and the World Health Organization (WHO) aim to create climate resilient, low carbon, sustainable health systems and to address the environmental impacts of supply chains. The Government of Japan expressed interest in ATACH at the WHO Executive Board meeting in January 2024, but has not yet formally joined. Of the G7 members, only Japan and Italy have yet to join ATACH. As CO2 emissions from Japan’s health system are high by global standards, it may be safe to say that in the transition to green health systems, Japan is being left behind.

In light of these circumstances, the purpose of these recommendations is to help Japan formulate a national health and climate strategy for a more climate resilient, decarbonized, and sustainable health system. In addition to efforts from the Ministry of Health, Labour and Welfare (MHLW) and the entire Government, meeting this challenge will require that we cooperate and collaborate with related organizations and other countries to share scientific expertise and develop international standards. Building a climate-resilient, decarbonized, and sustainable health system will protect the health and improve the well-being of the people of Japan, and decarbonization will allow us to seek substantial solutions to the problem of climate change.

We have sorted the necessary actions into adaptation actions, which reduce negative impacts by adjusting ecological, social, and economic systems, and mitigation actions, which focus on reducing GHG emissions. Addressing climate change will require parallel progress in both adaptation and mitigation, so for each, we conducted a critical appraisal of existing measures, identified issues, and compiled discussion points. These recommendations then identify measures that should be implemented based on five principles: the concept of planetary health, in which the health of the planet and the health of people or human society are considered to be interrelated; the perspective that emphasizes protecting populations; evidence-based policymaking (EBPM); ensuring opportunities for good health; and harmonizing with the traditional view of nature in Japanese culture. Adaptation measures include evaluating climate vulnerability, establishing an integrated surveillance system that is linked to climate information, and reinforcing disaster preparedness with an increase in climate disasters in mind. Mitigation measures include establishing methods to measure the carbon footprint of the health system, identifying specific emission sources and formulating mitigation measures, and raising awareness among stakeholders. We then present three essential elements for strong progress on these policies: all of government leadership and governance, providing education and capacity building to healthcare professionals, and promoting research activities.