 Okay, I think we will start now. So welcome everyone to this second day of this zero emissions solutions conference 2021. This virtual side event of the COP26 in Glasgow today on the Pathfinder initiative, finding pathways to a healthy zero carbon future. This is a really significant session which is focusing in on one of the fundamental and perhaps most promising leverage points to accelerate and scale the transformation towards a safe and equitable zero carbon future for humanity by exploring the evidence between the links of mitigation pathways and healthy outcomes. So in that sense, this is really one of the content sessions on how to enable us to give a chance of a safe landing at well below two and aim towards 1.5. The Pathfinder initiative is an international collaboration led from the London School of Health and Tropical Medicine in London, so we have experts very strongly engaged in science and leadership in this area from the London School and it's a privilege to to be moderating this session with you. My name is John Rockstrom. I'm a Professor of Systems Science and then heading the Potsdam Institute for Climate Impact Research working very closely with Andy Haynes and colleagues on the Pathfinder initiative. So it's not to lose any time because we should jump right into the content. This conference is really about, you know, getting scientists, business governments together with the Academia Civil Society on exploring and understanding much better how mitigation pathways give synergies or have tradeoffs with health outcomes for humanity. And we would very much like to encourage you in this one and a half hour session to also come with your questions and your ideas. What are your experiences on opportunities, pathways and health co-benefits or concerns with regards to how mitigation pathways towards zero carbon have implications for health. And this may seem straightforward, but remember that we have basically 150 years of conventional thinking that the fossil fuel driven modern industrial development has been the key towards positive health outcomes while recognizing increasingly all the tradeoffs we have with air pollutants and fossil fuel energy provision as being one of the major, you know, threats towards human life expectancy. And now we are in this massive trend transformation point to phase away from this, you know, over a century journey into the next step in human future on planet Earth. So this is decisive and looking forward to all the inputs will then have an open discussion. Please put your questions, ideas in the chat, we'll be seeing them through and picking them up so we have an open discussion in the second half. And with that, I'll just jump right into the presentations and we'll kind of the presenters will will introduce themselves as we go along. So with that, I'd like to hand over to you and the and the hands will be giving the the first presentation. And please floors your and the. Well, thank you so much, your hand for the introduction, let me just check that everyone can see my screen. Yeah, looks good. Great. So thanks for introduction. My name is Andy Haynes. I'm Professor of Environmental Change and Human Health at London School of Hygiene Tropical Medicine. I'm going to be focusing really on some introductory remarks about setting the scene which you already of course begun to do. So I think we're increasingly aware that climate change has a range of different impacts on human health. So it's one of the really overriding concerns as we move into the next decades. And so the implications of climate change for human health are really worrying. But what I'm going to talk about today is the other side of the coin. And that is that as we mitigate as we cut greenhouse gas emissions, we can also produce near term benefits to human health as well as reducing the risks of dangerous climate change. And that's what we're going to focus on this afternoon, the kind of opportunity story, if you like, from decarbonizing the world economy and improving human health. And this slide really summarizes some of the key issues. It reminds us that our transport systems are inefficient. They're polluting. They also encourage physical inactivity, sedentarism, which is a major risk factor for real health increases the risk of a whole range of non-communicable diseases like diabetes, heart disease, stroke and so on. Energy systems likewise largely driven by fossil fuels, domestic energy in some countries also from burning solid biomass, which is very damaging to health. Our food system responsible for perhaps 30% of greenhouse gas emissions, of course, as well as driving many of the other changes that are eroding our planetary boundaries, water pollution and fresh water use, indeed contributing to air pollution as well. So there's a lot that we can do in moving towards more sustainable energy transport and food systems to reduce the emissions of greenhouse gases, but also improve human health. And we'll be talking about some of those impacts as we move forward. So looking at the destiny to outdoor and household air pollution, WHO estimates around 7 million people dying prematurely every year from air pollution, both household, household often coming from burning of solid fuels, as I say, sometimes coal, but often wood and other sources of biomass. And we know that air pollution causes about a substantial number of deaths, a proportion of deaths from ischemic heart disease, from stroke, from pneumonia, which is a major killer of children, of course, from chronic obstructive pulmonary disease. That's where people have long term difficulty breathing because of damage to their lungs and also contributes to lung cancer as well. So air pollution is a major driver of ill health, and in moving towards a cleaner and more sustainable economy, we can benefit health in the near term. This is a study of a couple of years ago showing the contribution of fossil fuel burning to air pollution. And the map shows you where the premature deaths are particularly experienced. You can see that many of them are over China, Southeast Asia, including Indonesia, India, of course, much of Europe and North America. Less so over Africa, because people currently burn more fossil fuels. But if Africa develops a longer fossil fuel intensive pathway, then of course, those fossil fuel related air pollution deaths will increase. So that reminds us really that there are big benefits to reducing greenhouse gas emissions, fossil fuel in particular, but other sources as well. But those will differ according to the country. And so this slide just summarizes the different sources of air pollution. The US on the left, you can see that power and traffic are major contributors, agriculture as well. And then on the right is rather a contrast. You can see in the case of India that residential energy is a really important contributor. Other sectors as well, but residential energy is an important contributor to air pollution. So air pollution strategies will need to vary according to the country, according to the sources of air pollution. And that will have implications for the policy choices that different countries make. We also know that much of our burning of fossil fuels is driven by the fact that we don't pay the full economic cost of fossil fuel burning. So if we take the IMF definition of fossil fuel subsidies, that gap between existing and efficient prices and those prices should include the cost of health and environmental damage, then these subsidies are mounted to about $5.9 trillion in 2020, equivalent to about 6.8% of GDP. The explicit subsidies account for only about 8% of those. And the implicit subsidies, in other words, those externalities, the failure to pay the full economic costs account for about 90% something of that order. An assessment has suggested that efficient fuel pricing in the next four or five years could reduce global CO2 emissions to a level compatible with a 1.5 degree future, about 36% below baseline levels, and would also raise revenues substantially and prevent nearly a million local air pollution deaths. So that just gives you an example of what we could be doing to put ourselves on a healthier, more sustainable trajectory. So we know that cities are an important drive as a greenhouse gas emissions, because cities are responsible for around about 70 to 75% something of that order. Economic activities based on fossil fuels and on other human activities that contribute to climate change and air pollution. And a number of cities are taking the lead in moving towards a much more sustainable local economies. This is just the city of Evascular, I hope I'm pronouncing that correctly, in Finland, which has this long-term development plan, which emphasizes six components, all of which are really relevant to human health, using renewable energy, sustainable transport, or walking, cycling, public transport, using waste as a resource rather than burning it or discarding it, healthy, more sustainable food, valuable water, recycling water, using fresh water much more efficiently, and creating more sustainable healthy communities that are better for mental and for physical health. And in that, in those ways, they aim to move towards a one planet ecological footprint within planetary boundaries and sustaining and enhancing the health of their population. The C40 and the network of cities is also very committed, many of those mayors and civic leaders very committed to decarbonizing their economy and improving, promoting and improving health. And a study done a couple of years ago through CDP showed that some of those cities that were implementing climate actions, climate mitigation actors, actions, those that publicly reported on and communicated the co-benefits were more likely to have greater ambition in their co-benefits. And a minority, a substantial minority of cities were not reporting the co-benefits of their actions, co-benefits being the ancillary benefits of action. So there's a wasted opportunity there. We also know that, as I've said, improving sustainable transport systems can benefit health, both through reduced air pollution, but also through increased physical activity. This is a study we did a few years ago. It was a kind of thought experiment, if you like, looking at the implications of the urban population of England and Wales, if they could be persuaded to walk and cycle like the population of Copenhagen, which we know has very high levels of walking and cycling. And we estimated that over a period of 20 years, there would be quite substantial savings to our health system with something like 25 billion euros equivalent, something of that order over a 20 year period, due to reductions in diabetes, dementia, other conditions which place a heavy burden on the health care system. We also know that exposing populations to green spaces can help to improve physical and mental health. And I think Penny will be talking about that in just a moment. This is the example of the super blocks in Barcelona, where they've amalgamated city blocks, nine city blocks into one large block reduced through traffic, planted more trees and vegetation, encouraging more walking and cycling and reducing air pollution. And they've estimated that if they could scale that to the whole city, it would have substantial health benefits. So access to green space can improve both physical and mental health. And the evidence is stronger in adults, but there's also emerging evidence in children as well. Our houses, houses can be made much healthier and more efficient. This is just a study we did some time ago in the UK, looking at the benefits of retrofitting much of the UK's obsolete housing stock with more energy efficiency, double glazed windows, inner wall insulation and so on. And we estimated about 5,000 premature deaths could be averted. 55 million tons of CO2 could be saved as a result of those modifications. But there is an issue here that it's very important when you're retrofitting houses, you have to ensure good ventilation, because if you just seal them up, you can actually have unintended adverse consequences by increasing household air pollution. So these policies need to be thought through in an integrative way. And food, of course, is a crucial sector. And Johan himself's been very much involved in the Lancet Commission. He may have time to say a few words about that later, perhaps in the discussion period. But we do know that the food system is a major driver of climate change, as I mentioned. Some of that's obviously contributed by livestock, which produces methane, of course, powerful greenhouse gas, also rice paddies as well. And we know that more plant-based diets have a much lower environmental footprint than those that are very meat intensive, particularly those with a lot of red meat. So big benefits to health and to the environment from moving towards predominantly plant-based diets. And then finally, in conclusion, the health care system itself, we are now recognising the health care system, despite its commitment to improving human health, also contributes to pollution and to greenhouse gas emissions and thus to climate change. Probably between four and five percent of emissions overall around the world, in some countries more than that, like the US, for example. And if the global health care sector was a country, it would be the fifth largest emitter on the planet, according to this work done by health care without harm. A number of health care systems now are committing themselves to net zero emissions, for example, the National Health Service in England, by 2045, even for indirect emissions. And it's the indirect emissions through supply chains, which account for about 70 percent of emissions in many countries. So you need to work not just with your energy suppliers, but also with a pharmaceutical medical equipment industry. So finally then, the Pathfinder Initiative, where does that fit into all this? Well, the Pathfinder Initiative is really about capitalising on these co-benefits, moving beyond some of the important modelling exercises that have been done to document what happens when you put in place zero carbon, net zero carbon decarbonisation strategies. It aims to accelerate the net zero transition by showing how well designed policies and technologies can yield multiple benefits for people and the planet. And it aims to document the impact of implemented actions. It summarised here the partners, including C4, TSTSN itself, OECD, CDP and the Alliance for Health Policy and Systems Research, 16 commissioners from a wide range of disciplines and a network of champions to create a dedicated advocacy effort. Co-chaired by Helen Clark, Joy from Afia and myself, and funded by the Wellcome Trust with support from the OECD Foundation. And we invite you to submit your case studies using this link, because we're very keen to learn from examples around the world. So I'll stop there. That's the Pathfinder Initiative. It aims to bring together, grade and prioritise existing evidence of what, of the beneficial effects of decarbonisation, collect these series of case studies to exemplify the issues that, both the positive and negative issues and the challenges and the barriers, and how these can be overcome. And to synthesise guidance from shared learning, with the outcomes of course being improved health, net zero targets and hopefully flourishing societies as well. I'll stop there, Johan, and I will hand over to the next speaker, Christine Pelasova. Thank you so much Andy. I lost you for a little moment, I'm not sure if it was on my side, but thanks for this incredibly comprehensive overview of where we are on on the science and the evidence. I think it's quite a, you know, quite mind-boggling, not only the 5.9 trillion US dollars annually in direct and indirect subsidies that we are accepting from fossil fuel burning, but also cycle like Dane in Copenhagen and we can save 25 billion euros over 20 years in a major UK city setting. So I think we're talking of big leverage points here with regards to this transition. With that we dig ourselves deeper into this topic with Christine Pelasova also at the London School of Hygiene and topical medicine over to you Christine. Hi everyone, thank you very much for the introduction. I'll speak in more detail about the pathways to improve public health and reach net zero target in cities. So as Andy already mentioned cities are responsible for over 70% of energy right at CO2 emissions and in this graph you can see the consumption side emission estimates for 13,000 cities. What you notice from this graph quite quickly is that the emissions across different cities are distributed very unevenly and the highest emitting 100 cities account for around 18% of the global carbon footprint. So it appears that a decisive action by a very limited number of local governments can help make notable progress towards meeting climate change mitigation goals. To limit the average temperature increase to well below two degrees, CO2 and short-lived climate pollutant emissions would need to be reduced to net zero within the next 50 years. Some suggest that cities have to achieve this much earlier and in this graph you can see the suggestion from C40 cities climbed leadership group which is a group of 97 cities around the world representing one quarter of the global economy and they have estimated that to stay on the aspirational one and a half degree trajectory C40 cities would need to achieve net zero emissions by 2030 unless we start using negative emission technologies and that is in just nine years from now. So to reduce the emissions we need to examine what are their sources. Emissions originate from most urban sectors including transport, water supply, food energy and buildings and these sectors are designed for urban dwellers convenience and well-being but depending on how they're designed they often also exert pressures in the local and the global environment and sometimes pose risks to human health but of course we can take actions that can reduce carbon emissions within and across these sectors and at the same time help improve human health locally and globally. So what are some of these actions? Let's take the transport sector as an example a recent scoping review looked for peer reviewed and great literature on initiatives promoting low emission mobility and they identified 108 initiatives globally. In the diagram you can see the typology that they developed based on their results and this typology is broadly classifying actions into sanctions that are more regulatory and incentives which are softer more motivational actions. Quite importantly this literature review found that there is very little evaluation of the initiatives. In fact changes in emissions as a result of the initiatives were evaluated only in only 31% of the studies that they identified and these evaluations substantially differ in their quality. So for example studies on sanctions such as congestion charges and restrictions are more likely to be evaluated in peer reviewed analysis than incentives the software initiatives. So similarly in other sectors good quality evaluation studies of actions that are aiming to reduce emissions and improve health are quite limited. Green urban infrastructure is a good example of solutions that help contribute to both climate change mitigation and health and in this graph you can see how different green infrastructure approaches can help reduce heat island effect producing benefits at multiple scales and of course other benefits of green infrastructure include noise absorption mental health benefits space for physical exercise and social interaction as well as environments that are conducive for children's cognitive development. But there are also negative impacts on health for example increased levels of allergies from certain tree species and potential safety concerns depending on how the green space is designed for example a dark and quite intimidating park at night. So an important question is not only what actions to take but how do we design them in a manner that maximizes both climate change mitigation and health benefits in a holistic and synergistic manner. So one set of actions is unlikely to be sufficient to reach climate change mitigation targets and therefore we really need to think about package interventions and when we think of those it is important to consider what are their effects and how they will how the effects of different actions within the package will interact. Some actions have synergistic benefits so for example improved physical accessibility to amenities can help people access services for health and well-being more easily but at the same time also reduce the need for travel therefore saving energy but there can also be trade-offs so for example compact urban development can come in conflict with the availability of space for urban parks opportunities for passive dwelling design and for renewable energy production. So when we're talking about package interventions we have to ask the question what has been attempted at the city scale so far and you may have had the visionary ideas of eco-city is. Mazda city is an example of such a vision. It had the vision to become the world's first zero carbon zero base city with 30,000 residents and 50,000 commuters. Its buildings would be subjected to very stringent sustainability standards aiming to reduce the embodied carbon and achieve high energy and water efficiency. In 2006 the Abu Dhabi government announced that it will spend 22 billion US dollars to build the city by 2016. To date only 10% of the city has been developed and the completion date has been pushed back to 2030 with further funding reductions down to only 10 billion US dollars. So it is quite unclear how a city like Mazda will function in practice and of course it's not only about building new cities for most city cities the challenge is to transform their current infrastructure and social makeup to meet the net zero targets. So one of the best performing cities at the moment is Copenhagen. From 2005 to 2018 Copenhagen has reduced its CO2 emissions by more than 40% and it has the goal to become a CO2 neutral by 2025 but it hasn't always been a smooth road for Copenhagen. They had a number of emission reduction targets set for example for 2010 and 2015. The 2010 target wasn't achieved, the 2015 target was on the contrary overachieved. So Copenhagen in total has planned and implemented over 165 initiatives. The city has very high overall implementation performance both in terms of the changes in the energy supply and the emission reductions and it is really moving at an impressive pace towards its climate neutrality target for 2025. If we zoom out of just one example of Copenhagen we can see that actually over 100 cities are now reporting that at least 70% of their electricity is coming from renewables. Over 40 cities are currently operating on 100% renewable electricity but that is just one aspect to the emissions from the energy supply and there are many other sources of emissions that cities have to tackle and with many emissions we are really depending on our own consumption patterns. So how can cities transform to meet the net zero target? Colleagues and I developed a framework for achieving urban transformation for health and sustainability which you can see on the slide. The framework is emphasizing the importance of close collaboration between the city government, the private sector and people living in the city and the key mechanisms for transformation are governance, urban planning and infrastructure, technological and social change, scientific evidence and its co-production as well as the behavior change. So one of the most dramatic reductions in greenhouse gas emissions and air pollution that we have seen so far was in 2020 as many countries went into lockdown in response to the COVID-19. People have drastically changed their lifestyles in response to the virus and when habits are temporarily disrupted people are much more sensitive to new information and they may adapt to mindset that is more conducive to behavior change. The agency of having to make these changes in response to the pandemic has helped us overcome some of the barriers that we used to have against active travel and against reducing the consumption of non-essential goods and perhaps traveling less internationally and this could provide a momentum to lock in the behavior changes that benefit health and the environment and might catalyse a shift from a consumerist culture to a much more sustainable economy. So translating these temporary behavior changes into permanent culture change could be supported through the development of new infrastructure such as converting roads into pedestrian and cycle lanes new policies including incentivizing more flexible working from home virtual meetings, medical consultations and less long-distance travel. City governments in Mexico City Bogota New York Milan Paris Berlin and London have implemented such measures and although some cities only use the policies and the infrastructure during the response to COVID-19 and unfortunately these measures were temporary in other cities these measures remained permanent for example in Paris and Milan and many more cities should really follow their example. Thank you very much. Thank you so much Christine I think this was an incredibly rich overview of scalable solutions at city level I think the C40 initiative reaching a net zero point already in nine years time is just pointing the direction of how cities can be leveraged points for this transition towards healthy zero carbon future development and as you point out there's so much evidence here that we have I mean if there's any space where we have really significant co-benefits it's it's in the urban settings for for urban dwellers. Thanks for that so with that we jump on to nature-based solutions with Penny Mirage and over to you Penny. Thank you very much could I confirm everyone can hear me and see my screen? Yes we see looks good. Thank you very much for the introduction Johan so I'll be talking about my work on nature-based solutions within the Pathfinder initiative and really try to showcase how nature-based solution can help us achieve multiple societal benefits including carbon mitigation their carbon mitigation potential. So I'll start off with a brief definition of what NBS approaches are and this is coming from the International Union of Conservation for Nature and NBS really are actions that protect or sustainably manage nature or restore our natural ecosystems and the whole idea here is that they enhance nature but at the same time address multiple societal challenges and not just on in health but also economic challenges challenges including livelihood challenges and also environmental challenges and typically when we think of NBS we think of three broad but interrelated categories as you can see at the bottom of that screen there. So type one approaches are typically approaches where we leave the natural environment intact but continue to generate ecosystem services benefits from those. You can see at the bottom of the screen there an example is when we leave wetlands or mangroves forest intact and the second one really is where there's a little bit more intervention or human engineering and a good example of this is where we are agroforestry techniques where we intentionally integrate trees and vegetation in croplands and grazing lands. It's very popular in Africa in Asia and I'll be telling you a little bit more about that. And the type three is really the generation of new ecosystem and a really good example here is when we we create a new ecosystem such as green roofs in urban areas. I think it's really good to cover the ground of what NBS are and what they are not. And I you see and I have come up with eight principles that define NBS approaches. I'll only discuss four today the things that the four key ones and also because of the time limit. So the first one is that all NBS approaches should respect cultural and ecological rights and this and what I mean by that is that is respecting the cultural rights of particularly from indigenous communities or native communities. And when that's not respected there's a little bit of a pushback from indigenous groups who feel that their natural environment is being used to address challenges that they never contributed to in the first place. As you can see on the top part of the screen there is a little bit of a pushback from several indigenous communities who think that their nature is not part of our solution. The second one is that they should be fair or implemented in a fair and equitable way that promotes transparency and broad participation. So no one is left behind essentially. And the third one is and which is really core to all NBS approaches is that they should maintain biological and cultural diversity. This is the idea of about enhancing biodiversity and the ability of ecosystems to evolve over time. And the fourth one is that they need to be applied at large scale. At the bottom of the screen they have given an example of what NBS are not or what does not cover NBS approaches. So interventions that include monoculture, single-sport species including plantations such as palm oil plantations. They might have carbon mitigation benefits but they don't fall under the umbrella of NBS because they're not good for biodiversity and they have other harmful effects. So in this slide I just want to showcase how NBS have been increasing in popularity and these are examples of papers and reports have been imaged over the last few years. And in the following slide I'll try and summarize why I think NBS have gained so much popularity in the last few decades or a few years. The first one is that they're very low-cost. This is an example on the picture on the left-hand side there shows an example of unnatural flood mitigation solutions buses and engineered solutions and you can see why we consider them low-cost. And that image there on the top shows an example of mangrove forest I think it's in Indonesia. So they have multiple benefits such as flood protection and also act as storm barriers. And the second thing is that they support fisheries which safeguards food and nutritional security. A lot of coastal population rely on fish as a source of protein. In fact probably the only source of protein so it's important that we ensure that they have food and nutritional security. And the third one is that they generate income and income is generated from fisheries but also from sales of timber products generated from the mangroves. And the third one is that they enhance biodiversity. And just quickly showing you another example of NBS. One of the things that's highlighted from NBS approaches is that they help us achieve multiple sustainable development goals. And I like using this example here of agroforestry techniques popularized particularly in Africa and in Asia. And this is where farmers in particular intentionally integrate trees, vegetation and shrubs in agricultural landscapes. There are numerous benefits in terms of health, economic, but also the environmental benefits including the reduction in soil erosion, improvement in soil fertility. And some of the social economic benefits include higher crop yields so increased agricultural productivity which is really good for maintaining food and nutritional security. And as you can imagine, better water catchment which has associated health benefits such as improved water and sanitation benefits. Trees are also really good for in terms of income generation and farmers then have a little bit of a surplus when they sell their food. They also improve enhanced micro climates which supports or improves the environment of the outdoor agricultural workers by providing shading for instance. And also several biodiversity benefits. And just to highlight another example this one coming from cities is that NBS are increasingly used to promote climate resilience, particularly in cities. You've heard this from the previous speakers. In particular NBS are increasingly used as for flood mitigation and also in terms of cooling urban cities where they mitigate against the effect of urban heat islands. Improved air quality again associated with NBS in trees and vegetation. And the one I wanted to highlight is the reduction in energy cost. And this is some figures coming from the Chicago green roof that was implemented in the beginning of 2000 I think. And some estimates of how much that particular building the running cost has declined. The estimates are between 3000 to 5000 annually. And this is just from the implementing green roofs of the Chicago green hall. And the other one that you've heard from my previous speakers is increase in physical activities. So the image on the top there shows an example of a green corridor and when these are implemented in urban areas citizens then can use those spaces for running or cycling or walking which has demonstrated health impacts. And not just physical health but also mental health impacts. And the last one I want to highlight is the NBS potential in terms of carbon mitigation. This is a little bit of a busy slide about trying to talk you through it. So the graph there comes from a seminal report that came from Griscombe and colleagues back in 2017. And what they did is they came up with 20 distinct NBS or what they called NCS, natural climate solutions that can help mitigate CO2 from the atmosphere. And so that's the green part. So the green part is how NBS can help us mitigate. And the gray part there is how we can mitigate carbon emissions through decarbonization. And so some of the things I wanted to highlight is that NBS have the potential of mitigating between 30 to 37 percent of carbon emissions. Some of the approaches that I mentioned earlier such as trees and croplands have been shown to be very effective. And also coastal wetland restoration in terms of creating blue carbon reservoirs. But really to highlight the fact that NBS cannot replace decarbonization. So we need both. And just to conclude maybe with a word of caution about when NBS are wrongly implemented they can lead to some unintended consequences and indeed some damage. And this is a quote from that that I was really recently saying that the wrong tree in the wrong place can do a lot of damage. And an example of some of that damage includes depleting water tables. And on the right hand side you can see an example of invasive species that have been introduced in South Africa that have led to drying up riverbeds. So it's just to caution that NBS are good, that they are exciting and they present a lot of opportunities. But they need to be properly implemented. I think I'll stop there. Thank you. Yeah, thank you. Thank you so much Panina. This was adding a very, very essential dimension in the whole health climate transition. And I think it's so important you're sharing your experience on the fact that we need to define nature-based solutions and to do that in a very robust, strict way because as you point out it's a very popular term. It is picked up by businesses and cities and big institutions like the International Energy Agency and beyond. And then we need to distinguish between biodiversity-rich Indigenous community anchored NBS solutions versus initiatives that cannot be qualified as NBS like, for example, as you refer to big monoculture systems, for example, which may be sequestering carbon but are not at all delivering on the other key criteria that are required. I look forward to coming back to this in terms of also the health, the health-go benefits of nature-based solutions. That might be a part of our conversation. With that, the final talk before opening up for a broader discussion. So over to you, Serene Hassan. I should also say that Serene is also involved in the Pathfinder Initiative like all the previous speakers as well. So we're here kind of covering the rich content of all the knowledge generation that are being delivered into the Pathfinder Initiative and I know that you have some exciting case studies as well. So over to you. Thank you, Johan. So I work on this part of the Pathfinder Initiative which focuses on actions that have been implemented in the real world and have demonstrated benefits for both mitigation and health. So in the past six months we've been searching published as well as great literature and we also had a call for evidence supported by our partner organizations. And so far we identified about 20 studies that span energy, urban infrastructure, diets, and agriculture. Not all were large scale. Some were implemented nationally and had large impacts while others were only local interventions. So I'm going to give you now a few examples of what we found. So in this example Milstein and colleagues aim to quantify the benefits from solar and wind power generation which replaced coal and natural gas plants in the US. And as you can see the generation from these sources increased considerably between 2007 to 2015 which resulted in economic benefits in the range of about 30 to more than 100 billion US dollars. Mostly from about 3,000 to almost 13,000 avoided premature deaths from improved air quality as well as 147 million tons of avoided carbon dioxide emissions. And 58 percent of all of this non-hydroelectric renewable electricity capacity built in the US in the last 20 years was used to meet state renewable portfolio standards. And this means that these standards require electricity load serving entities or electric companies in other words to meet a growing portion of their load with eligible forms of renewable electricity. And these standards exist in 29 US states as well as Washington DC. So in another paper the authors looked at the impact of complying to this standard for one of the years during this time period which was 2013. And they quantified other health benefits as well such as emergency department and hospital admissions for respiratory and cardiovascular diseases. And as you can see here the greatest benefits occurred to the eastern half of the country and that's because there were higher emitting fossil plants there that were displaced and population densities are also higher. So another example comes from China where two cities in the Habai province Baoding and Longfeng are now coal free. They're approximately more than one million wall mounted natural gas stoves that have been installed for rural families in those cities to replace coal use. And these were just typical low pressure boilers and the natural gas supply that was supplied by the local gas companies had to meet requirements for Chinese national standard which included needing to be less than 1% of carbon monoxide and less than 2% of carbon dioxide content. And as you can see here in this graph there was an almost 100% reduction in particular matter levels which resulted in a total of 6,000 avoided premature deaths in the two cities. There were also about 35 to 55% reduction in carbon dioxide and 70 to 80% of methane emissions and that's just in one winter heating season. One gap in the study is that as you can see here there's a difference in these outcomes between the two cities but the study focused on reporting impact and doesn't explore these variations. Another example I wanted to show is this intervention that was done in Indonesia and here clinic discounts or vouchers were given to villages based on community wide reductions and illegal logging activity which were using and illegal logging was used the funds from that were used to meet healthcare costs so the the purpose of this intervention was to offset these healthcare costs from illegal activity. So there were also conservation and education programs as well as alternate livelihood training and this took place in around 73 villages around a large 900 kilometer square national park, 13% of which was already lost to illegal logging activity between 92 and 2004. So the intervention led to increased healthcare access of more than 28,000 patients with the highest frequency occurring in participating communities. There were also declines in disease in some diseases such as malaria, TB, childhood diseases and diabetes and there was a 70% reduction in annual forest loss in that 10 year where the study took place compared to a synthetic control and that and 590 kilotons of carbon dioxide emissions were averted due to the averted loss of 27 kilometer square forest. What nice about the study is that it described how the intervention was designed which was through extensive engagement with the local community to understand their needs. So the NGO that was behind this intervention undertook about 400 hours of focus groups with 500 members and leaders in the community to understand why illegal logging was happening in the first place. The one gap however is that it doesn't provide insight into the implementation of the intervention for example what went well what didn't go as planned or what adaptations were necessary. So I wanted to also talk about this intervention which was occurred on city level and it was New Zealand's model community program and this was mainly an investment from both local as well as central government in infrastructure to improve active travel networks and education as well as promotion campaigns. So a quasi experimental study over the years of 2011 to 2013 was conducted to evaluate whether this intervention was successful in moving away from motorized modes and the study found 30% increase in active trips which equated to 5% decrease in motorized trips and that translates to a reduction of about 1,000 tons of CO2 emissions and 34 avoided disability adjusted life years as well as two avoided deaths and a disability adjusted life here or a dally is a measure of the burden of disease so which is basically the sum of the years of life lost due to premature mortality as well as the years lived with a disability. So one dally represents the loss of the equivalent of one year of full health and just as a thought exercise if we took the total population of New Zealand which is 5 million and we focused on the population that is between 15 to 65 years of age 87% of which live in urban areas we have around 2.6 million people that would be the target of this intervention and if it was scaled up to all of New Zealand targeting this population we would have a reduction of 20 kilotons of carbon dioxide and as you can see here this is a very small amount in comparison to other actions that have potential for much larger reductions such as the example we saw in the two cities in China but the benefit cost ratio of this intervention as estimated by a cost benefit analysis that was done by the authors was due to its health gains and injury reduction as well as emission reduction so this could be even higher as well if you take into account other benefits such as congestion or noise reductions. Finally I wanted to talk about this local small scale example just to show you a contrast of something that is happening on a local level and this intervention aimed to reduce the carbon footprint of school meals while retaining the same food supply and recommended nutritional value of the meals. This took place in only three or four schools in Sweden and it was only over a four week period so as you can see there was a reduction in 28 to 40% of carbon dioxide equivalents depending on the baseline meal and just a small another small exercise just to see what these benefits might be it was scaled up to 1 million children that live in Sweden that are between four to 14 years of age and about 200 days in the school year so if we were to assume this reduction across ultra children throughout the entire academic year we are looking at about 14 million to 66 million kilograms of carbon dioxide equivalents per year and just to as just one last thing to highlight is the National Health Service in England which was successful in reducing carbon dioxide emissions from healthcare between 1919 2019 so there was a reduction of 26% and a major contribution of contributing to this reduction is from the energy system and with a reduction of about 64% just from building energy alone during this period the population of England actually increased by 17% and the provision of care doubled with health spending more than tripled and as you can see here the reduction in total emissions was not consistent throughout over these years but the carbon intensity of the NHS reduced by 37% of carbon equivalents per capita and 64% per inpatient finished admission episode which is defined as a single inpatient admission in the year so just to close with some final messages as we saw in the range of examples I've presented here the magnitude of the benefits will depend on the type as well as the scale of the intervention and in order to address this climate change crisis and also realize their health benefits the health benefits of these interventions we need actions that are transformative and also for those that are happening on a small scale to really have an impact they need to be scaled up and this may sound obvious of course but the point here is that we need better evaluations the evidence that we found so far is limited in two ways first the evaluations of implemented real-world actions usually measure either mitigation benefits or health benefits but often not both and second those that we have found in this case were focusing on measuring impact only there were missed opportunities to understand the process side of things which includes implementation and contextual factors that interfere or help in realizing these benefits and therefore can help in the scale up or the transfer of these actions into other contexts and the last point I want to make is that often what we see in the published or even the grey literature are examples of successful interventions or actions there's a lot of value and knowledge in those that were not successful but unfortunately we don't have access to these experiences because they're either not written up in sufficient detail or not made publicly available so perhaps there needs to be a drive to encourage publications of lessons learned from unsuccessful interventions as well thank you thank you so much Serene and thanks everyone for these talks I think your your final action oriented overview here Serene was really important for us and it just I mean I think you you put you know your your head right right on the on you nailed it finally reminding us that one of the key entry points for the Pathfinder initiative is this conclusion that we have a lot of studies on mitigation we have a lot of started on health impacts but we have so limited studies that are looking at the combined interactions between climate mitigation and health outcomes both positive and negative and this is what we need to really map out in a much more prominent way and I think just just your Chinese example here with going to low pressure boilers with with with LG gas how that both gives co-benefits for mitigation but also over 6000 reduction of 6000 premature deaths and I think these are you know really fundamentals and and as a Swede you you quickly pass through this children's school example but just just to remind everyone who's on this call that 40 to 60 million carbon dioxide equivalents reduction as a thought experiment if every child in Sweden would be eating a healthy diet in school that is actually equivalent to all the reported domestic emissions from Sweden to the United Nations Framework Convention here in Glasgow which is roughly 50 million so we're talking about big you know big cumulative outcomes if you start taking local success on climate health and scaling it up to the city or to the national level so we're I mean it's small at the local level but it really adds up to big big impacts at the larger scale with that we have ample time actually half an hour for a joint discussion across you know all these topics and I'd really encourage everyone who's participating to come in with questions comments ideas concerns pointing at the directions forward I'd like to to start with I see that there are two questions kind of hanging here from from the start and if I could take those and I and I see that you actually help also hear Sarah and then please join in on on this and I'll just throw this question out to anyone in the panel so Amanda Quintana asking what what are the panelists thoughts about how we can go about assessing revamping existing national local health adaptation plans to incorporate mitigation and adaptation actions and I think it's quite an interesting question because our experience as you remember Andy is that you know we have we have dietary guidelines in many countries but those dietary guidelines are only about health they have nothing to do with sustainability at all and and and what are your thoughts anyone on the panel on on you know how do we develop guidelines or do you have example of national guidelines that that integrate health and climate or is this is this a gap a global gap and that if that is the case then we have quite some work to do anyone would like to pick that up Andy well shall I start then my colleagues can jump in yeah I think it's a great question I think there issues here well a number of issues one is about adaptation and mitigation and we tend to think of those in kind of separate silos so the adaptation community often doesn't talk to the mitigation community and so on I think increasingly we need to integrate adaptation and mitigation it isn't you know in order to avoid unintended adverse consequences in order to capitalize on potential synergies let me give an example I mean we can adapt to some extent to extreme heat exposure by installing a lot more air conditioners that will have big implications for energy use for fossil fuel burning for local air pollution it will increase the urban heat island effect because you've got to pump the air the hot air somewhere and so just facing an adaptation initiative or strategy on increased air conditioning is going to have all sorts of adverse consequences and so it means that we need to think about ways of reducing heat exposure that don't require a large amount of energy that would be passive cooling for example of buildings cool roofs shutters shading of buildings and so on and passive ventilation so that's just one example of the need to integrate mitigation and adaptation the second point is about guidelines and these are important you know in clinical medicine when I was a clinical practicing doctor you know we increasingly in a complex world one relies on state of the science guidelines you don't just you know it traditionally doctors who just practice the way they thought it was fit but now in a complex world you need the synthesis of the best available evidence to inform your clinical practice and it's the same with climate change and planetary health we do need guidance about how to implement actions around adaptation mitigation best based on the best available scientific evidence which currently of course is often suboptimal but the way to increase the quality of the evidence of course is to increase the demand for evidence and then of course people start to improve the quality of it in a sort of semi-continuous way we do have some examples there are a few examples of national dietary guidelines which incorporates sustainability but they're relatively few and it's not quite clear to what extent they're being implemented but I think the question is absolutely right we need to develop a better guidelines better evidence to inform those guidelines and very importantly we need to have an implementation strategy for the guidelines you can have guidelines that sit on a shelf and are never implemented so you need to really build implementation in right from the outset but let me ask pass over to my colleagues to see what they've got me additional comments yeah so please jump in anyone who feels I see Peninja are you um yeah yeah it was just a really brief addition and just to say I don't have any examples of national guidelines but I think nature-based solutions have the potential to meet both adaptation and mitigation benefits I think I highlighted that on my talk so where trees and vegetation and and also they form really good vital carbon sinks but at the same times deliver adaptation benefits particularly for rural farmers or rural households that are really really connected with the land so it's a it's a I think it's an opportunity that we need to drop on a little bit more you know I fully agree yes Christine I'd like to just add that we definitely have to think about adaptation in terms of the upstream actions that we can take a lot of adaptation considerations have been um in the health sector at least around how do we ensure sufficient hospital capacity under changing climate etc but it's way much more about how do we actually prevent people from getting into the hospital because of climate change in the first place how do we ensure that they have resilient livelihoods how do we ensure that they don't get infected but increasing prevalence of infectious diseases how do we tackle the transmission factors how do we improve lifestyles and I think a lot of that can be definitely tied to the mitigation actions where we definitely have to understand what are the impact pathways of the actions that we're implementing of the strategies and policies more widely so there's lots and lots to be done about the complex um understanding of the impacts and and the complex pathways of impact yeah no no thanks and I fully agree and just to say also that I think it fits very well and in this session as well your point Andy and I think it's really supported by by your statement here Christine that we are beyond the point where we can deal with climate and health separately but we're certainly also beyond the point where we can deal with mitigation and adaptation separately I mean I increasingly talk of um zero carbon adaptive management meaning that we have to you know invest in and building resilience having adaptive capacity is yes but it has to be done in ways that give multiple outcomes for zero carbon development for health for pinning us point about nature-based solutions that give multiple benefits I mean as you say both adaptive management resilience mitigation and and scoring on both health and basic basic livelihood outcomes and I think that's we we're we haven't been good enough in really mapping these properly um I mean I I'm kind of keen to ask you Andy actually that is almost unfair in a session like this because it perhaps is more kind of a bilateral thing but but to be honest I I mean you you raised the numbers so you triggered me here that you know I find it I'm I mean I'm not a health professional so what I'm stating now is really coming as a nurses and sciences might even be unethically put so please correct me here if if you feel I'm I'm walking into some deep corner here but but you point out that seven million people die prematurely each year because of air pollution caused by unsustainable fossil fuel burning well COVID-19 a disaster is also a premature death up till today roughly four million people I mean it's a complete disaster but it's also premature death I mean it's people dying too early compared to their normal life expectancy I mean looking at it coldly I would say these are completely comparable I mean the seven million versus four it's it's the equivalent scale of a of unacceptable outcome how can it be that we accept that every year we have a COVID-19 equivalent disaster just occurring under the radar year after year after year or am I somehow pulling this too far no it's a very important point you're making Johan I just to clarify though the seven million deaths that WHO that the estimate WHO uses is a combination of ambient air pollution much of which is possible that's right of course and also household air pollution now household air pollution is partly it used to be cold because a lot of people are burning coal in homes in China that's less so now but also a biomass you know wood dung and so on other solid fuel so it's a combination of different sources but overall it is a big burden and it is unacceptable the point is it's a rather silent burden isn't it we don't sort of see it in such an obvious way we don't see intensive care units full of people suffering from air pollution they're having from heart attacks that stroke pneumonias and so on so the label air pollution is not necessarily on them so the public's not always and indeed the health professionals are not always aware that air pollution is an important risk factor in these cases but I think that awareness is growing rapidly so I do think on the positive side of what you're saying is that because we can now say there are big benefits in the near term to moving towards a zero carbon economy that can make policy change and implementation more attractive that to to the public and that's what we have to capitalize on not just air pollution though but also healthier diets increased physical activity and some of the benefits of green space exposure as well so it's the whole argument as you were pointing out the argument of multiple benefits from policies that increasingly I think has to be a kind of guiding star for public policies we should be looking for multiple benefits from the policies that we're implementing and in that way we can help to scale up and get much more public support and hopefully also shift the decision makers towards making the right decisions in a timely fashion and and and while we are on the kind of COVID track Taskinul Huda Sakweb has come in with a question goes as follows regarding the marginalized people like refugee camps small island communities etc how we could successfully implement revived revived health policies especially for those especially those adopted after COVID breakout and if anyone of you have any thoughts on on what actions will be required in the most vulnerable settings in the world any thoughts there I don't know if any of my colleagues want to jump in but shall I have a quick go and then make a jump just go ahead um so yeah I mean this is a really crucial issue I mean it's something which is obviously made worse by climate change but climate change is not the only factor many other factors are causing marginalization of populations including you know conflict and a range of other factors so it's partly about improving the kind of delivery of healthcare to these marginalized populations and I think that more resilient health systems can play a very important role in that so health systems that are based on primary care which is was my sort of background so very much working in the community to deliver resilient healthcare systems that don't necessarily depend on on high technology but can deliver a lot of the vital interventions that are required for population health so strengthening primary care is is going to be really important for addressing these marginalized populations but also of course climate change mitigation adaptation are crucial because we know that if we don't act quickly that there will be more marginalized populations we know that people will be displaced by floods droughts increasingly difficult to work because of extreme heat so there are important interlinkages between these marginalized populations the increased risk to these marginalized populations and climate change adaptation and mitigation so certainly we need these climate resilient net zero emission health systems can help to address some of these interlinked challenges yeah thanks any other yeah just a quick one on on covid i think one of the benefits of covid if i can call it a benefit is that that the fact that it's unified many many different perspective and many people combined effort to work together so and and mobilize international responses so it's really how we can capitalize on the momentum created by covid in solving some of the other issues a really good example is how quickly we are able to generate vaccines and just remember that there are so many other diseases areas particularly neglected tropical diseases that require similar global efforts and i think covid shows that that we can do it and maybe we should continue doing that yeah thanks so here comes a big and complex question from from denise caro and and backed up by by chip pits so very interesting presentations if i may how do you change people's behaviors and the focus on consumption driven economics and and and chip kind of fills this in by adding the whole dimension of misinformation that that pollutes very much of efforts of trying to really share so i mean you pointed out andy that only a fraction of countries have even even national dietary guidelines or any health guidelines well that's one challenge that we don't even have the information systems in place but then even if we have them we have difficulties in in reaching out with with with the kind of the science as as we understand it what what are your reflections on how do we address this how do we accelerate understanding of health climate interactions andy well it's it's a very big question that's been posed and we can have several conferences just trying to answer those really important and complex questions let me just quickly address behavior change well it's impossible to do it quickly but at least touch upon it so i think what the behavior change researchers tell us is that many of the decisions and behaviors that we have are in a sense almost automatic we get up and we're cued by certain automatic cues to have performed certain behaviors we we act according to our routines and so on and so one of the challenges is how to make the right that the climate neutral the carbon mitigation decisions the easy decisions and of course there's various ways we can do that one of course is by pricing policies so you know if we have adequate carbon taxes as long as they're not regressive as long as they're pro-poor they have to be recycled to ensure that they're progressive then that could help to make some of these choices easier but as we know there are major political barriers to implementing carbon pricing for all sorts of reasons so the other is by infrastructural changes you know it's difficult to walk and cycle it's difficult to use public transport if the infrastructure is not there so making sure that we make that infrastructure accessible it is a really important component of behavior change and then there are the more individual approaches to behavior change I mean there's some nice experiments been done for example in canteens in cafeterias we've actually done it a bit that under the school although we haven't evaluated it very much but we for example pre-COVID we our catering manager implemented the planetary pick so every day you could choose a dish which had a low environmental footprint and was healthy and if you put that forward if you make it very easy for people to access it then you find increasing numbers of people eat that kind of food and enjoy it so there are all sorts of things that can be done at the kind of micro level as well and the example that serene showed of the swedish schools it was very interesting these are primary school children and they implemented these quite radical dietary changes and they had no increase in food waste they had no increase in criticism of the food at all so it was well accepted so if you implement it in a way that's sensitive to people's you know beliefs and attitudes and that example she gave serene you might want to emphasize this yourself but that nice example of the work in Indonesia which showed that if you really listen to people listen to communities and understand why they're being forced to often act unsustainably then you can develop solutions with them rather than imposing them on them solutions have to be co-designed and co-impermented they cannot be just imposed from outside they will be resisted yes I would like to just add serene yes is the point that I concluded with at the end is about evaluations as well and I'm trying to understand the reasons why things work or don't work in order for us to learn these lessons and implement things better next time and that's where there's a lack right now in the evidence because these kinds of evaluations there's a lot of focus on impact but not on process not on implementation not on what people think of what's happening so that you know exactly what it is that you need to address so um yeah I think I think we need to to find the evidence and strengthen the evidence as well and just to add to what serene and Andy were saying as Andy really started his point we're locked in in in our behavior patterns in our kind of daily routines and as behavioral scientists often say the best opportunity for us to change some of these patterns is that when our own routines are changing for some other reason for example when we're moving house when people are getting married they already somehow have to essentially change their routines and that's a great opportunity to do something more sustainable at an individual level but the same logic can be applied to the societal level so for example when we all started working from home that's a whole completely different routine so how do we now pick out from these changes the best patterns for our own behaviors at a larger scale at a societal scale that we can continue to be more sustainable and to also live in a more healthy way and how can we use it as a leverage for transformation much wider bigger transformation so even when we think about large-scale development projects and the cities how can we use them as an opportunity not only just as a change in structure but also as an opportunity to change behaviors of the populations that are impacted by the new developments etc so we really have to think in this systems manner in terms of the leverage points and how can we transform the way how we behave Yeah thanks Christine really important reflection there and I think this is something that all of us have been you know hoping for and I think we should still not give up but you know that we what are the lessons that we learn from the pandemic that we can use in support of this transition that we're now facing in terms of sustainability and I'm a little bit concerned there that we're just bouncing back to the pre-COVID unsustainable and in many ways irresponsible lifestyles or behaviors but but let's see I mean that's the the jury is still out there we have 10 more minutes and we are at COP we're in the midst of the most important COP meeting since Paris so I'd like to really push you all of you on the panel with one question if we could take around having the reflections from each one of you on the same question namely so in my mind we've had one and a half hours soon of the most important topic that connects closest to individuals in every culture every geography around the world how climate change is threatening the health and quality of life of fellow citizens in the world I do not see anything of that in the negotiating corridors in the blue zone here in Glasgow so my question to you is what would you like to see as any evidence of a positive outcome in Glasgow in terms of the topics that we've been discussing on integrating health with climate change what would you be when you see the final statements coming out of Glasgow what would you be looking for to check whether we're making any progress on the topic that we have been discussing since three o'clock or two o'clock this afternoon if I may so Peninja would you like to start you're on your closest to me on the on the screen here yeah it's a really good question Johan so what would I like to see I think any mention of health would be really good but not just health on its own but how health integrates in the economic sphere in the environmental sphere and in the business sphere so not just health in isolation because health doesn't work in isolation so it's therefore integrated approach with health embedded across all the different perspectives thanks and then I have Andy and after Andy it's Christine so if you want to be able to pre-warn so Andy please yeah so it's a fascinating question I do think one would like to see a really explicit statement about the importance of protecting human health from climate change and would like to see the metric of human health trying to assess the impact of climate change on human health has really brought out as one of the ways in which we can monitor the success or otherwise of these discussions and you know we are because of scientific advances we now are in a much better position to be able to attribute health outcomes to climate change so for example we used to just be able to say well you know heat will kill people of course that's true but we can now say that particular heat wave or heat event that caused a certain number of deaths and that the intensity and the frequency of those events has been increased by a certain amount as a result of climate change so we now in a much better position to put numbers in the future on the health impacts and climate change I'd like to see that built into the monitoring if you like of the impact of these discussions the second point is about the issue we've been discussing just now the benefits of moving towards a zero carbon economy so I'd like to see every country including health co-benefits in their nationally determined contributions when they file them under the Paris Agreement they should be saying well these are the ways in which we aim to improve health as well as reducing greenhouse gas emissions we commit to reducing our fossil fuel age air pollution by X promoting healthy diets and increasing capacity potential for physical activity particularly in our cities so we could build in these metrics in into the into the NDCs and then finally I'd like to see more funding specifically to protect and promote health in climate adaptation and mitigation funding at the moment the institutions that fund adaptation and mitigation are largely unaware they choose to be unaware of the health implications of what they're doing and I would like to see that much more given a much higher profile in the kind of menu of activities that these big funding organizations undertake so that should be explicitly built in climate and health yeah thanks a lot of a lot of really policy relevant inputs there thanks a lot Christine well what I would really like to see from this cop is action so once the cop is over are we actually going to do what we are promising to do and what we're discussing and as Andy already touched on there should definitely be monitoring and evaluation mechanisms for the actions that are taking place and careful consideration about how do we maximize the health benefits of all climate change mitigation actions that we are implementing so a transparent system for for tracking what gets implemented how it is implemented and a very careful cross-sectoral consideration of all health related concerns of actions that are taking place but of course also very collaborative interdisciplinary transdisciplinary action so that we all work together to maximize all possible benefits for health for the society and for the environment in the best way we can No wonderful and I think everyone is really screaming for action here here in Glasgow that that's absolutely clear I think that's one of the key insights where I think the health climate agenda can also rise very rapidly in prominence that we recognize we are at this action moment that this is the transformative point this is the decade when we have to go from incrementality to exponential change which has to be equitable and which has to be science-based so I think the kind of action action question will be coming up almost by the hour here Serene Yeah so I would like to see as I think Andy already touched a bit is a specific very specific commitment it's not just large statements but things on what these governments are going to do for example to promote more plant and make available and accessible more plant-based diets and what are they going to do to change the infrastructure of cities to improve to reduce motorized travel and and also engagement of local communities I think that is that is really important people know what they're doing and why they're doing it and and these stories and these people need to be heard so that we can come up with things that work for everybody you can't have only top-down approaches you need to have bottom-up approaches as well Yeah thanks Serene I think that was a really good point to to kind of round this incredibly rich dialogue up that we also need to anchor this with the social, cultural, local realities at community level at the local scale and I think that is a good place to to round this off also because we are here in Glasgow setting the top-down framing we have so far failed in delivering on that framing but here's the moment to update all the pledges all the promises all the indices and as Andy pointed out one proof point will be to what extent integrated health metrics are pointed at present within the nationally determined contributions I think that's a really good measuring point for Glasgow I also think that we've covered so much evidence that this is a scientific field but we also have already so much evidence on the ground not least the phenomenal steps taken in the city's sphere that you shared, Christine with regards to all the co-benefits from mitigation climate mitigation for health outcomes with that we're coming to the end of this session I'd like to thank all of you I'd like to thank all the participants for all your contributions there's a very rich chat and a Q&A we'll be logging all of those and feeding them right into the Pathfinder initiative project so thanks for that this is not only kind of a session in general it's actually almost like part of a research project because just your inputs here are really valuable into the mapping led by the team on the panel on the Pathfinder initiative so with that I'd like to thank you all thanks for hosting this for the sustainable development solutions network and of course the great champions and experts at the London School of Hygiene and Tropical Medicine thanks a lot and yeah keep up the great work and for those of you who are in Glasgow let's go out and make climate and health an integral part of the policy outcomes thanks a lot goodbye there thank you