Plenary 4: Providing health equity in urban and rural settings – Left-Behind Places, Left-Behind Health

Moderator

Alison Maassen – Programme Manager EuroHealthNet and TBD, a representative from the Basque Department of Public Health

Speakers/Panellists

Pedro Gullón Tosio – Ministry of Health, Spain – General Director of Public Health and Equity

Clare Bambra – Newcastle University – Professor of Public Health

Massimiliano Mascherini – Eurofound – Head of Social Policies Unit

Dorota Tomalak – Representative of the European Committee of the Regions — the EU body most directly representing local and regional authorities

Ada Colau – former Mayor of Barcelona (2015-2023); Chairwoman of the Fundación Sentit Comú (recorded video message)

Background

Climate change poses a serious threat to population health and health systems worldwide. Exposure to rising temperatures and extreme weather events, including heatwaves, floods and droughts, worsens health outcomes. It also increases the risk and prevalence of infectious diseases, such as zoonoses and vector-borne diseases, by extending the range and activity of disease-carrying vectors; this leads to higher vulnerability, particularly among older adults. Climate change also exacerbates chronic diseases through air pollution and other environmental risks, while negatively affecting mental health and accelerating heat-related morbidity and mortality[1]. Accompanying changes in health care demand put enormous pressure on health systems. Health workers are increasingly exposed to occupational risks[2], while health services are disrupted by infrastructure that is unequipped to function under extreme weather conditions. Together, these trends significantly impact care continuity and health systems’ capacity to deliver care, calling for action to adapt and strengthen the resilience of the health sector in the face of climate change.

At the same time, climate change is exacerbated by the health sector’s activities, which account for around 5% of global greenhouse gas emissions.[3] Investing in greener infrastructure and making greener choices in health care can significantly benefit the environment and generate important co-benefits for population health by reducing inappropriate care, strengthening prevention and moving care closer to communities.[4]

Early progress has been recorded in addressing the preparedness and resilience of health systems to climate change, as well as their environmental footprint. Yet, backsliding climate commitments and rising global greenhouse gas emissions risk reversing these gains and accelerating adverse impacts on health and health systems.¹ By showcasing diverse health system adaptation, and resilience initiatives – zooming in from the macro to the local level – this session aims to explore what the health sector can do to adapt and be better prepared to deliver health services under changing climatic conditions, while also reducing its own impact and becoming more environmentally sustainable.

[1] The 2025 Global Report of the Lancet Countdown. Available from: https://lancetcountdown.org/2025-report/

[2] International Labour Organization (2024). Ensuring safety and health at work in a changing climate. Global report. Available from: https://www.ilo.org/publications/ensuring-safety-and-health-work-changing-climate

[3] Pichler, P.-P., Jaccard, I. S., Weisz, U., Weisz, H. (2019): International comparison of health care carbon footprints. – Environmental Research Letters, 14, 6, 064004. https://doi.org/10.1088/1748-9326/ab19e1

[4] Mauer N, Durvy B, Panteli D. How can health care facilities reduce their environmental footprint and contribute to more sustainable health systems? Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe; 2025.