 Ian Nayra, Director of the Department of Environment, Climate Change and Health at the World Health Organization. She's been generous enough to take time out of her schedule to speak to us. Dr. Nayra will speak for about 20 minutes and then we will go to questions and answers with you, our audience. You'll be able to join the discussion using the Q&A function on Zoom, which you should be able to see at the bottom of your screen. And please feel free to send in any questions you have throughout the session as they occur to you and we'll come to them as soon as Dr. Nayra has finished her presentation. And just a reminder that today's presentation and the Q&A are both on the record. Please feel free also to join the discussion on Twitter using the handle at IIEA. And we're also live streaming this afternoon, so you are very welcome if you're watching on YouTube. So it is now my pleasure and privilege to introduce Dr. Maria Nayra, who's the director of the Department of Environment, Climate Change and Health at the WHO based in Geneva. Dr. Nayra is a medical doctor by training and she specialized in endocrinology and metabolic diseases at university in Paris. Amongst many distinctions, she's been awarded the Medaille de l'Ordre Nationale du Mérite by the government of France and she also received an extraordinary woman award by Her Majesty, Queen Laetitia of Spain. And in 2019, she was nominated among the top 100 policy influencers in health and climate change. So we are deeply privileged to have you with us today, Dr. Nayra. But before we hear from Dr. Nayra, I'd like to hand the floor to His Excellency Michael Gaffey, Director-General of Irish Aid to deliver some opening remarks. Thank you very much, Quiva, and good afternoon, everybody. It is a real pleasure for me to open this latest session of the IIEA Development Matters series, which is, as Quiva said, supported by Irish Aid. And it's particularly, I'm particularly pleased to be doing this as one of the first public events that I have taken on since taking on this role of Director-General of Irish Aid about just five weeks ago. Now, it has been a very busy five weeks and I just want to say that last week was the budget in Ireland and I'm very pleased that as part of the budget we received, there has been a 17% increase in the International Development Programme, the ODA of Ireland for 2023. So this helps us address the growing and significant and interlocking problems that we need to face as a development programme. And that's relevant very much to what we're here to discuss today, which is future proofing of the climate health nexus. This is unquestionably an issue of growing global importance and urgency. I think the links between health and climate change should be very obvious, but sometimes really do need to be reasserted. Climate change and environmental degradation threaten our ability to maintain good health. It's a very obvious, clear, simple statement, but one that does need to be underlined. And I think we're therefore really honoured to have someone as distinguished as Dr. Maria Nera with us here today to address that. It is clear that we need strong global health architecture and that it be equipped to deal with the effects of climate change. And the pillars of this architecture are multilateral health institutions with the WHO at its heart. And Ireland continues to be a strong supporter of the organisation. I spent the last five years as our ambassador in Geneva, so I am very well aware of the importance of the WHO, but also not just in the traditional standard health areas, but right across the areas which need to be addressed in order to achieve the sustainable development goals. We are very encouraged by the growing body of work that WHO is doing on the links between climate health, climate and health systems. And at COP26 last year, Ireland was proud to join the WHO-led Alliance for Transformative Action on Climate and Health, which aims to build climate resilient and sustainable health systems. And I was very happy to learn that our own national health service, the Health Service Executive, is currently working on its own climate strategy for our health systems. At the international level, Ireland is very active across the area of health and climate action, both in our diplomacy and through our international development programming. And we have committed to over 100 million per year to global health since 2020, focusing on equitable health system strengthening in low-income contexts. It's just the week before last that I was with Minister Kovni in New York, and he announced Ireland's new pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria of 65 million for the next three years, and increase of 30% on our last pledge. This reflects our deep awareness of the importance of adopting a one-health approach, which highlights the centrality of climate-proofing for preventing future pandemics. The impact of climate change on human behavior and health was perhaps most clearly demonstrated during the Ebola outbreak in West Africa in 2014, but it also had clear implications for the cause of the COVID-19 pandemic. Earlier this year, Ireland published its international climate finance roadmap, which sets out a plan for reaching the target set by our T-shirt, our Prime Minister, last year to provide at least 225 million in climate finance per year by 2025. And the budget last week started the process of increasing our climate finance quite significantly. In the roadmap, we maintain a focus on climate change adaptation and resilience as a priority for our funding. This includes climate adaptation in key sectors, such as health, nutrition and food systems. And we are really keen to learn more about how health systems, services and infrastructure can build resilience on the impacts of climate change while also positively contributing to climate action. It's a very, very rich and detailed area. And honestly, I don't think we could, if anyone more qualified or better than Dr. Marie Inera, to speak to us on it today. So Dr. Inera, thank you again for joining us. I'm going to hand you the floor and look forward to a really good, detailed discussion. Thank you. Thank you. Thank you so much, Director-General, Ambassador. And thank you as well, the presenter. Thanks for the pressure you're putting in me as well, saying that I am a person for providing the good overview of this. I hope I will not disappoint you. Let me first of all say that I love what you put it on your slogan on sharing ideas and shaping policy. This is most of the time what we are trying to do. I think that today, as you rightly say, we have a very strong evidence about what climate change is doing to our heads. Of course, we still need more research. We still need to shape our interventions to make sure that we will put our money, our efforts, our energy where we will have as much impact as possible. But we cannot say, we will never be able to say we didn't do more on climate change because we didn't have enough evidence. We have very strong evidence. Many scientific papers demonstrating that climate change will have a negative impact on our health. And part of that negative, the harmful impact in our health will come from the fact that the causes of climate change are as well overlapping on a big proportion with the causes of air pollution. And let me start with one of those already negative, terrible figures that we need to put on the table at one point. The seven million premature deaths. That's something which is absolutely unacceptable, but we are accepting it every day. We have every year seven million premature deaths caused by exposure to air pollution. Means caused by the bad quality of the air we are breathing. And it's air that we must breathe. We cannot stop breathing. And we have to breathe in Dublin. We have to breathe in Madrid. We have to breathe in Namibia. And we have to breathe in Mexico City. So this actual, totally unacceptable fact of our air quality or lack of our air quality causing this damage to our health I think is the first barrier that we need to analyze. Why is it still there? Why we are not reacting at the level of ambition that the magnitude of the problem represent? Not only we are causing seven million deaths every year air pollution, but air pollution is making sure that our hospitals are full, that our hospitals are treating diseases that are representing as well chronic diseases that are costing a lot to our health system. So the health system is already investing a lot on coping with the consequences of inaction on climate change and air pollution. So when someone at the international level on the different negotiation and conference, when we use this argument that is very expensive to do mitigation of climate change, please make sure that you tell the economist of those who are preparing that document that they need to include the cost that the health systems are already paying and is, believe me, very, very high. We have several studies as well demonstrating that the fact that we need to treat chronic diseases, diseases that will require long-term hospitalization and that represent not only obviously a terrible human suffering, but in addition to that, our health system is already responding and paying for the climate change. Not only our big and sophisticated hospitals, when you go to Africa or to developing countries, you see that those healthcare facilities, even in very isolated places, they are already somehow paying the price of climate change. Of course, they will be treating more diseases of the so-called climate-sensitive diseases they are having more cases of dengue or more cases of malaria because the global warming will facilitate certain diseases that are already occurring, that there will be exacerbated. So my first point that I wanted to share with you and to hopefully provoke a little bit for the discussion later on is no excuses. I mean, we have the scientific evidence, as I say, we can always develop more. There is never enough on science, but we know that this is already occurring. There are not only the disease burden, but as well a terrible cost for society and a terrible cost for our economies. So that element needs to be considered and not accepted as an excuse when decisions are not taken. But let me now pass on something a little bit more positive. Let's look at the opportunities we have here. You know that the health professionals, the medical and health community forever has been talking about prevention and we have even prevention is better than cure. This is a fantastic sentence that even on your daily life, you can incorporate. But unfortunately, we do not incorporate it on our daily life when we plan on this global health architecture, because in fact, climate change adaptation on our own terminology, on the health professionals terminology means secondary prevention. So we invented that already many years ago and mitigation of climate change on our own terminology means primary prevention. So this is the positive part. Look at what will require to tackle the causes of climate change. It will require first and most importantly, changing the sources of energy we are using at the moment. I mean, we need to accelerate this transition to a healthy, renewable, clean source of energy we can't afford from a public health point of view. And now I'm exclusively talking about public health point of view. We can't afford to keep combusting fossil fuels. And we can't afford it, not because we are activists of the environment, we are eco-friendly people, we are lefties, very green peace friends or we are from a party that has a very environmental ecosystems agenda. We can't afford it because this is dramatically affecting our health. We need to stop combusting fossil fuels because not only those fossil fuels are contributing to the climate change, the global warming but they are contributing dramatically to this pollution of the air that we need and we need to breathe the 10,000 approximately liters of air that we need every day. Imagine that air that we need every day coming into our lungs, damaging already our respiratory system. We know the diseases that can cause from lung cancer to asthma. I think asthma is one of the most visible linkages now between air pollution and health of the people because people connected very well, the exposure to when the days are very polluted the asthmatic people will feel it that they will immediately feel at risk so they connect very well. But as I say, the polluted air we breathe not only will stay in our lungs in our respiratory system it will go to the bloodstream and from there it can reach any of our organs and now we are accumulating more and more evidence about the damage to our brain as well. So imagine that we are putting at risk our IQ which is the thing that will help us to survive as a society, as humans and because we are breathing and we are exposed to pollutants that are very damaging for our health. Let's go back to the positive. As I was saying, we have plenty of opportunities and we cannot miss any of them on our massive primary prevention strategy. Everybody's these days after the pandemic and with the different crisis we are facing in the middle of a horrible humanitarian situation conflict and lack of biodiversity everybody's talking about the crisis we are facing. Well, health professionals sometimes are very pragmatic we used to be very pragmatic and we can easily make a diagnosis and then make some prescriptions and our prescriptions will be the following. One, please accelerate the transition to clean, healthy, renewable sources of energy. That's fundamental for our health and not only will benefit our health it will decrease the cost of the health system therefore benefiting as well economically it will contribute as well to a more sustainable economy. $1 invested on a job generated by the fossil fuels will generate the renewable energy investment will generate four times more jobs than the dollar invested on the fossil fuels. So again, another argument of common sense that the health community can put forward and hopefully promote those fantastic opportunities. So first prescription transition to healthy sources of energy. Second prescription, accelerate a healthy urban planning our cities today they are celebrating the International Architectural Day and they have decided that the thing will be the signing for health. And it's very clear that the way we design our cities will have a positive or negative influence on our health depending of course what decisions we are taking and those decisions are fundamental because they will impact not only they will reduce their pollution if you have a healthy urban planning you will reduce injuries and accidents you will have buildings that are more and better and for energy efficiency you will be able to walk and therefore reduce your sedentary lifestyle and all the diseases that are associated with that and if we are smart enough on the way we plan our cities we will make sure that people will have access to healthy food and cheap food and then we can reduce the obesity isn't the fantastic plus we will contribute to mental health and reducing inequities in cities. That's one of the most fantastic challenges that we have in front of us but again we can use the funds to tackle the causes of climate change to mitigate climate change and this might result on healthy urban healthy urban and therefore our health will the health benefits the health outcomes will be enormous. Next prescription about sustainable food systems we need to change the way we produce food we consume food we manage the waste of the food we are generating we are producing enough food for everyone but unfortunately one third of the food we produce is finishing into waste we need to reshape as well of consuming and again that's something positive it's something that we can use the health argument to further motivate action on climate change. So if you look at the agenda of climate change and you look at one by one to all the interventions and you take a manual of public health you can confront to the two and you will realize that they overlap. All of the interventions promoted under climate change mitigation and adaptation are public health pure and pure and basic interventions because we want to breathe better air we want to have clean water we want to have food and now with the natural disasters we are facing with the destruction of the ecosystems that are breaking as well this barrier between human health and animal health and therefore destroying this concept of one health which again is something so public health and so primary prevention approach that we need to retrieve it again. And as I say the benefits for our population will be so good that we can use that to further motivate and anytime you put in place an intervention you can quantify the benefits for that. So this is the positive agenda and the prescriptions. Another prescription please make sure you involve mayors. Mayors are fundamental in implementing our health agenda because those are the ones that needs to look at the sustainable transport system for the citizens in the cities. They are the ones that can influence the way the buildings are organized and whether there is efficiency or not in our use of energy. They will look at whether we create some climate refuse in our cities which looks that it will be very much needed. I was in London this summer when the temperature reached at 41 and it was clearly the big cities in Europe we are not prepared to cope with the heat waves and well I'm sure we need to start to think about that as well. Another prescription and then we can discuss is how the health system can lead by example. And Director General mentioned it already that last year at COP26 one of the health commitments was and I'm very happy about that was on reducing our own carbon footprint. Obviously for middle and high income countries because low income countries they are not only not generating any carbon footprint they need to gain access to the electricity for uses as a healthcare facility. So leading by example, decarbonizing our own health system and this is very rewarding that the health professionals we are joining with a lot of entusiasmen I'm sure that the voices of those health professionals can help us to further motivate others and engage using the health argument for more climate action is something that we are very, very much promoting. I think we have all of those opportunities we need as well to use more the positive language. These days people is terrified by the bad news that we are hearing all the time and that generates sometimes a kind of paralysis or this apocalypse is now approach that we are using might generate a paralysis by the population while if we put it in positive if you reduce your carbon footprint if you take a bicycle instead of your car if you take a bus instead of your private car if you recycle, if you switch off the light if you put pressure on your politicians you can generate enormous health benefits. For me, the mantra here is influence, influence, influence and I'm not talking about the influencers on social media I'm talking about influencing ministers of energy influencing ministers of economy influencing ministers of environment influencing layers, influencing the big responsible for academic institutions government institutions, citizens all the associations we can put in place and then create this very powerful network on a positive movement for using health arguments for climate action. Another example mentioned it before the support that has been given to the global fund to tackle malaria TV and HIV AIDS. Well, if the global fund will put solar panels for their refrigerators when they distribute their vaccines, for instance what we are saying is that don't put a solar panel that will cover only the needs of electricity for your refrigerator, the refrigerator of Gabby or the refrigerator of the global fund. Please upgrade the panels on an initiative that WHO is putting in place now upgrade those panels and then you will have electricity for the whole healthcare facility. That's a way as well to be pragmatic action oriented jumping on opportunities reducing the cost and still obtaining a lot of health advantages. I think I will stop here. I can talk about this for ages but definitely I hope to see you all at COP 27 putting pressure where you can do it and making sure that the health argument will be very strongly positioned because it's the common sense one and it's the one that will generate finally more action and more ambition on this climate change agenda. Thank you very much. Thank you. Dr. Maria, thank you so much for that excellent input. I think it's quite staggering that seven million people per annum die as a result of air pollution. I think that figure alone should make us all sit up pay attention and take greater action. And I think also it's clear from your input that health and bringing to light making people more aware of the impact on our health everywhere across the world already of climate change is not just hugely damaging to us as individuals and to our societies but it's hugely costly. So I think that's very important. So please by all means everybody who is listening please put your questions into the Q&A. I'm going to come to a couple of questions now, Dr. Neira. So maybe the first question I will ask you comes from Leanne Digny, who's a researcher at the IEA. And Leanne says that the UN General Assembly recently passed a resolution recognizing the right to a clean, healthy and sustainable environment as a human right. And the question is what meaningful actions should member states take as a priority to ensure that this resolution will serve as a catalyst for systemic and transformative change. And if I could add to that, Dr. Neira, I wonder if you could in your answer comment on the different proportionate responsibility of governments such as the government of Ireland, governments in the European Union and governments of low income countries. So if the question is what are the meaningful actions that member states should take as a priority, then if you could comment a little bit about we've got very different resource environments in different parts of the world, I think would be helpful for the audience to hear and understand your perspective on what those priority investments should be. Thank you. Thank you. Thank you very much. And let me start by this second part of your question about differentiated responsibilities. You know that one of the focus of the COP 27 this year will be the so-called loss and damage. It was very interesting because last week I participated in one meeting where they were discussing about loss and damage. And of course they are looking at the loss of land or the loss of resources, the damage on the ecosystems and which is already a huge agenda and hope countries need to commit to support those who have contributed the less to the climate change now to COP with the loss and damage. And just to put yet another strong piece there is that obviously the loss and damage in terms of health is not considered. I mean, the agenda is already in terms of loss and damage so big that when I ask it, then are you considering health? They say, no, unfortunately, no, because there is not even yet a full commitment by countries on how to support. As you know, Denmark has announced recently, I think it was Denmark to a strong contribution to that in discussing seriously about the differentiated responsibilities. But I don't think we need to keep and in many countries like Fiji who are extremely vulnerable to climate change these days and their voices are always very strong. And they always say, we don't want to be evicted only, we don't want you to be the ones receiving it. We are raising our voice because what you are doing is nonsense but we will put ourselves as well some solutions. And so I think developing countries, of course they need to start to move into renewable sources of energy. I think they need to learn from our mistakes and not only, of course they need to make sure that they help mobilize those resources that the rich countries, the developed countries need to share with them or put in place new technologies but not committing the same mistakes, opening coal mining or opening. Now, again, why we don't have solar panels in the whole continent in Africa, for instance, we need to invest on solutions where the countries not only they receive support from something to repair something that they didn't do but as well they are equipped with the technology that will respond to the challenges we have today. So differentiated responsibility, if you look at health, it's terrible because you see that the countries that are contributing the most are the countries that will be less affected in terms of health and the countries that contribute in the less, like in Africa, there will be the countries most affected in terms of health consequences as well. So it's quite dramatic but this will not exclude that the developing countries they need to put in place lessons learned and not going to our path of development because it was wrong, our path of development. Now, in terms of the resolution of healthy environments, this is beautiful that finally this resolution was approved and recognized as a human right. At the same time, I think as a society, we need to ask ourselves how can it be possible that we need that resolution to recognize that I have the right to breathe clean air or have a clean water, but this is where we are. So this resolution was very important and I know that the commission is now very much committed to move this agenda. We are joining forces and hopefully this will result on legislation as well, why not? And taking countries to the court or this is happening as well. There are groups that are taking their own countries to court because they are not taking actions to protect their own citizens. I think the case of Ella Kisidebra, I think is a very important one that will change legislation on this little girl who passed away with horrible asthma, but anytime she was cured at the hospital, she was sent back home where she was exposed to those horribly high levels of pollution in London. So I think more and more legislation will play a role as well. So it's not just a recognition of a human right, but using that resolution, hopefully action will come as well and legislation might be one of those actions that we would put in place. Excellent, thank you so much, Dr. Nera. And it's shocking to hear that story of that little girl who ultimately tragically lost her life as a result of air pollution. And I think you're absolutely correct that legislation measures are increasingly being used by citizens who are considering that their governments are not taking climate change sufficiently seriously. I'm going to come to a question from Kirsten Hadfield and Kirsten is an assistant professor in global health at Trinity College Dublin. And Kirsten says that here in Ireland, there's a lot of reticence from the public and from the government to reducing road space for cars and for reallocating it to pedestrians and cyclists in public transport. And it is true that even minor changes to our transport systems are fought very hard. So we feel we're very behind, therefore, in reducing our transit emissions and other emissions. And Kirsten's question is, do you have any suggestions for how we as citizens can try to push these changes forward with the goal of promoting health and reducing climate impacts? Thank you. Thank you, and Kristian, I fully agree with you. There are a lot of reluctance, unfortunately, in many places, even the citizens, sometimes they have reluctant to have solar panels, sometimes they have reluctant to have wind turbines, sometimes they are reluctant to reduce road space, and sometimes they are reluctant to stop smoking. Or even to use the safety belt for road safety purposes. But I think it's up to us, public health authorities and governments to have a look at the public health. I mean, the public health means looking at the collectivity and then protecting the rights of individuals, but at the same time looking at how public health can be the outcome of this type of intervention. What we know is that we have created what we call the Breathe Life Campaign. We are doing this with UNEP and the Climate and Cleaner Coalition and other organizations now. And the idea is exactly that. This is great a platform where experiences about changing cities and putting in place some interventions like promoting a very efficient, sustainable transport system, collecting all of those samples and experiences. How can this be useful for other cities? And I will, Christian, invite you to have a look at this Breathe Life catalog and initiatives because this is the way where mayors are exchanging experiences and ideas and of course frustrations as well. In some cases and some cities in France, for instance, the mayors have a lot of opposition by the citizens because they say, well, if you reduce space, you will then reduce maybe the shops will reduce their income and they will not be of interest of citizens. So I think we need to obviously be very good on the narrative on explaining to citizens what will be the advantages for health, for economic purposes and as well using the samples of other cities where at the beginning the citizens were very much opposed but then now they don't want to go back. And this is an experience that we have everywhere. Even if at the beginning it was a bigger position and the mayor insisted and then they went ahead. At the beginning it was resistance but then the citizens never wanted to go back. When you think that even in Rome, the Coliseum, around the Coliseum, it was until few years ago a place where cars could go. It was such a dense traffic there, the Coliseum, imagine our Patrimon. So yes, we need to move. So tell your citizens to look at other experiences, have a good argument about how health will be beneficial and be conscious as well that sometimes the economic arguments needs to be considered as well and explain properly to the citizens because they cannot buy only the environmental or health arguments if they think that there will be suffering on their economies because that's the daily maybe urgency for many of them is that. Just a last example, in Mexico City, which is very, very polluted, the mayor decided to reduce pollution and then using the health arguments so we were very much behind but unfortunately the decision that was taking was to ban all the cars that were more than, I don't know, five or six years old. You know, if you don't have a good solution in terms of sustainable transport, what you are doing is you are penalizing the vulnerable part of your population because the rich people will never have a car which is old. I mean, it's the modest people, the people with low economy, the ones that will have very old car, very old pollutant car. So you need to have a look as well at maybe subsidies, maybe a good sustainable transport. You need to have a holistic approach to all of those measures. You cannot have it in vertical because maybe you fix something and you create an inequity or a problem somewhere else. Excellent, thank you very much. And I think you're right. I think we can all recognize, even from our own experience here in Ireland, how people might resist a positive behavioral change but once it's embedded, then not only welcome us but sometimes congratulate ourselves loudly for having been one of the first introducers such as the plastic bike tax and the city bikes of course, which are now hugely popular here. But maybe if I just go to another issue which comes in from Leanne Digny again, researcher at the IIEA. And this is sometimes used in discourse when we're talking about changing behavior and there's a sort of a what about response. So Leanne's question is around the impact of countries such as China and India. So of course, air pollution is a huge problem of public health, particularly for lower income countries. And countries such as China and India and we could probably add a few more are currently economically dependent on pollution heavy manufacturing industries. And these governments therefore have few incentives to abate air pollution. The question is what can the international community do to address this? But if I could also add in a secondary question which is how can we short circuit the argument that China and India are much bigger problems and therefore we don't need to change, they do. That's the question because I think at the cops, this is an argument that has been used very often unfortunately the fact that, well, those are the most polluters. If you are the US and China and India, the rest of us we can relax because we are small contributors. Well, again, we need to look at the individuals. So independently where you are, you need to look at how this is affecting my lands, my health. And then if we use that, there is never enough level of ambition to go for more. Keeping in mind that we need to protect the economy but this is feasible. Look at the Scandinavians. The Scandinavians are among the most environmentally friendly for their own people, maybe. But for their own people, and they are a very important economy. So it's feasible. Now, India and China is very interesting because definitely India is unfortunately one of the country where the respect for double-edged quality guidelines is unfortunately going beyond our standards and many, many times. And the reasons for that pollution are many. But ironically, at the end of Glasgow COP26 India refused on accepting some of the agreements that the COP26 wanted to take. And the day after the COP, business was closed in New Delhi. Schools were closed. All the outside construction and buildings were closed because the levels of pollution were such that it was impossible to see. So it was impossible to work outside and impossible to take children to school. And that has an economic cost. And what has an economic cost in China is that they realize that international organizations or industries or big multinationals, they don't want to live there. I mean, they are concerned about the health of their families and it's becoming a very challenging duty station for many professionals. And they realize that there are many things related to that pollution that is bad for their economy as well. So interestingly in China, although there are still among the biggest polluters, no doubt, but the trend is starting to get stable or probably going down. So they realize that this is not good for business at all. So they are taking some measures and we hope that now that the energy crisis will not revert to those measures, but the trend is going there. In India, it's more challenging because the sources of pollution are many and they might take in some states, I mean, the structure of the whole country as well that the bureaucracy might create some difficulties, but definitely this is something that sooner or later India will wake up. So this association of if you want to develop, you need to pollute is a nonsense because you can learn from those who polluted to be developed and then avoid the wrong decisions and use the new technology and those resources that will be allocated for intelligent and unhealthy solutions instead of repeating the same mistakes on a very polluting development that will give you then a level of business very low because if your rivers are polluted in India or in China, you might make some business in few months, but in few years you will be out of business. Thanks very much, Dr. Nair. I think that's really interesting and also encouraging and it's very stark when you say that by direct comparison with the reluctance of a government maybe to give concessions around climate emissions, then if you have direct evidence that actually their economy as well as their people are suffering as a result of poor air quality, maybe that might force a change. There's a question here again in the whole area of innovative solutions and thinking outside the box. Colin O'Hare has a question. He was inspired by your example of the solar panels, not just for vaccine installations, but for the wider health system. And he says that the possibilities of thinking outside the box could be far reaching. So Ireland, for example, is supporting a health perspective in work by the EU on building design. And his question is, are there any other examples where health or climate considerations need to feature in broader actions? Well, interesting question. Definitely we are thinking and every day to make sure that we are not missing any of those. But when you look at the emergency operations, okay, and you look at the humanitarian community, which is huge at large. I mean, every government will have a humanitarian branch and international support for emergency situations. We are still sending diesel or through our emergency operations to operate the diesel generators in many healthcare facilities. So this is already a kind of shocking or until very recently in our emergency operations, we were still sending for construction purposes asbestos for pipes and things like that. But let's focus on the opportunities. Yes, I see one which is this on not sending diesel for diesel generators at the healthcare facilities. Please, it's extremely costly to transport. Second is clearly not environmentally friendly. And third, we have a much better solution, which is having solar panel at that facility. And electrifying our healthcare facilities with solar panel is one of our key projects. And we want to put an effort on that and create some coherence and common sense approach is a network of institutions that are now with the best of the intention sending one refrigerator with one solar panel because the purpose is to keep my vaccine for which I have the responsibility. That cannot be. The other one in terms of opportunities and this is huge as well is that any international organization that is building healthcare facilities and there are many that they build healthcare facilities or hospitals, please don't call it healthcare facility if you don't provide sanitation and water and electricity services. Call it something else. Call it a building or call it a piece of brick as you wish. But I mean, it's the minimum if you open something which is called healthcare facility, please make sure as a basic, basic recommendation and again an opportunity that the provision for hygiene, sanitation and come on electricity are there. And at least the water and sanitation, I don't even, I mean, it will be a dream to have electricity, but come on. I mean, we are in the, in the, on a pandemic where the main recommendation was wash your hands for almost half of the population around the world washing your hands is a challenge. You don't have soap in the healthcare facilities in Africa, you don't have water and how do you want to provide. So please, when you build facilities, basic standards, you can reduce maybe the size but make sure that there is water and sanitation or other ways don't call it healthcare facility. Thank you, Dr. Neda. And I know from your own work that there's a shocking number and percentage of healthcare facilities globally that don't meet those global standards. I think if I'm right, about 50% of healthcare facilities don't have either hand washing facilities in the bathrooms or adequate sanitation stations within the hospital operating infrastructure itself. So I think if we're asking you what the priorities are, they're becoming very clear. And this may well be our last question but we do have a question here around, oh sorry, I've got a question here around biomass fuels and I've got one other question on priorities. So maybe we'll just take these two. So question from Emily Binshee at the IIEA who says that today, the investing in health for all high level event organized by the WHO and the European Investment Bank is taking place. What outcomes do you hope to see from that event? And then the second question, and I leave you with both of these, is from Keelan O'Sullivan at the IIEA also who says that approximately 2.4 billion people depend on biomass fuels as their main source of energy for cooking. So what practical changes can be made to move away from burning biomass fuels in low income countries? Fascinating questions. Thank you very much. Regarding the investment case, very simple. If you look at them, my dream, it doesn't mean that it's this cause at the moment on the investment case but my dream will be 25% of the global burden of diseases is linked to modifiable environmental risk factors. So one quarter of the whole mortality and morbidity globally is linked to environmental risk factors that you can modify. As we were saying, access to safe water, sanitation, occupational health standards, chemicals that we use, climate change and air pollution. So this is the 25%. It can be reduced every year very easily. So those factors can be modifiable. It's not something that is happening and there is nothing you can do about it. No, you can modify it. So when you look at the investment that we are doing on Keel, 97% of the resources are going for care and 3% is going to prevention. So please, that will be my call and my dream about this investment increase a little bit. I'm not saying to 25%, which will be kind of balance because I don't want to reduce investment on care but maybe if we increase the investment on prevention, that investment might come as well from the Ministry of Energy or the Ministry of Environment or the Ministry of Economy or the Ministry of Urban Planning because all of those interventions will help us with this agenda. But at least please increase the investment on environmental health because now we are less than 1% and this is, if you allow me to say, ridiculous. Regarding the biomass fuels, again, another thing that is absolutely unacceptable, almost half of the world population is cooking like in the Stone Age. So not like in the last century. No, the Stone Age. I mean, you do an open fire and you put inside whatever you can find, you know, vegetable coal or wood or whatever is around. And then you put girls to do that for hours and then they need to first collect it, then they need to cook and then they need to inhale it. The moms, the girls and the babies in the back of those moms. If somebody thinks that this is a good society, if somebody thinks that this is a good investment, it's not. But in addition to that, from a health point of view, this is almost criminal. So we need to accelerate access to clean household fuels for heating, lightening and cooking. And this is an agenda very, very much neglected, but we are doing our best, accelerating that and we have created a high level panel for action convening Ministers of Health and Ministers of Energy. And on the 7th of October, so this week we are having the second meeting of those energy ministers and health ministers looking at whether we can accelerate and convince Ministers of Energy of the importance of discussing with Ministers of Health on healthcare facilities access to electricity and household clean fuels at household level. Excellent. Thank you very much. We're working in the sector that indoor air pollution is a huge driver of illness and ill health in many of the countries that we work in. So thank you for that. And I think you're absolutely right to link it also to gender inequality and the fact that it's women and girls that are leaning over the fire, breathing in the particulate matter with sometimes a baby in the wild. And I think it's a great opportunity to have this kind of knowledge in the long term. Dr. Nera, we're drawing very close to the end of this session. Is there any final message that you would like to give to your audience this afternoon? Just to say that thank you very much for the opportunity, the privilege and of course please keep with passion interest, don't give up. We can change this and I think the health will be used health as a strong motivation. Thank you Dr. Nera. I think that's an excellent message and especially as we approach COP 27 it gives a bit of a freshness maybe to some of the discourse. So I'd like to thank you very, very warmly for giving your time to us this afternoon for giving us such a positive outlook as well on what are all of the solutions that in fact the solutions are very much in our hands and it is a matter of us taking action and doing that with a greater degree of urgency than we have done here before. So thank you.