Newsletter Edition #361 [The Files In-Depth]
Readers,
Urgent and intersecting crises demand different ways of engagement. Do climate negotiations have lessons for global health? Our edition today might have some indications.
Here, we bring you two pieces related to climate negotiations. One on the different levels of efforts being made in the realm of climate and health diplomacy, and the second, looks back at the significance of the Brazilian COP in late 2025.
My colleagues Anjan Rosario and Bianca Carvalho, bring these thoughtful analyses for you. Write to us with your feedback.
Also, we are having a small online event next week, sharing our editorial strategies, how we making decisions and the likes. We'd also like to hear back from our readers on what is working and what it isn't. Join us for a chat? (We intend to do this more often, than not. Talking to our readers helps us align our objectives, both editorial and business.)
Geneva Health Files offers value to our readers who are experts in global health. Tracking global health policy-making in Geneva is tough and expensive, without institutional support. For six years, we have provided you with the information and tools that directly contribute to your work in the field. We rely on our readers who value news they can use.
By becoming a paying subscriber you make our work possible. Our subscribers contribute towards greater accountability in global health.
Priti
Priti Patnaik, Founder & Publisher, Geneva Health Files
Feel free to write to us: genevahealthfiles@gmail.com ; Find us on BlueSky, Instagram and Linkedin.
I. HEALTH & CLIMATE UPDATE
Two-Speed Multilateralism and the Climate-Health Agenda: Can Parallel Processes Accelerate Action?
By Anjan Rosario
Rosario is a Philippine-qualified lawyer, Joint LL.M. candidate in Global Health Law and Governance at Georgetown Law and the Geneva Graduate Institute, and Geneva Health Files Fellow focused on WHO governance, pandemic law, global health security, regulatory policy, and international institutional processes. anjan.rosario@graduateinstitute.ch
Can smaller coalitions and parallel initiatives move the climate-health agenda faster than the formal multilateral system alone? This question was tackled at an event held at the Geneva Graduate Institute a few weeks ago, by a panel of policymakers, researchers, and health. (The event was organized by the Global Health Center of the Institute.)
The discussion framed climate change from the outset, as both an environmental emergency and a public health crisis. Speakers pointed to heat, air pollution, vector-borne disease, food insecurity, mental health pressures, and mounting strain on health systems as evidence that the climate-health nexus can no longer be treated as peripheral. That broader framing helped explain why health is gaining traction in climate politics, including in the lead-up to COP31.
COP30 was described as an important, if incomplete, step in that direction. Panelists stressed that health is no longer being discussed only as one vulnerable sector among many, but increasingly as a human lens through which climate risks and policy choices can be understood. Margarita Gutiérrez, policy advisor at Friends of Climate and Health at the International Institute for Sustainable Development (IISD), said the climate-health agenda has advanced because health is increasingly being understood “not only from the adaptation side,” but also as “the human side of climate change.” Adaptation debates, measurement frameworks, and non-state actor engagement all reflected that shift.
That set up the panel’s central question: when universal multilateral processes move too slowly, can smaller, faster-moving coalitions accelerate progress without eroding the legitimacy of the broader system?
What “two-speed multilateralism” means
Several panelists described “two-speed multilateralism” as the growing tendency of states and institutions to supplement formal, consensus-based negotiations with smaller bilateral, minilateral, or plurilateral initiatives. The concept reflects frustration with the pace of universal climate processes, which, while legitimate and inclusive, often move too slowly on urgent issues. In the climate-health space, that matters because the harms are already here, while the machinery of negotiation still struggles to convert political recognition into operational results.
In her opening remarks, Suerie Moon, co-director of the Global Health Centre at the Geneva Graduate Institute, located the issue in the widening gap between scientific urgency and political response. Referring to recent climate reporting, she warned that the world is edging dangerously close to the 1.5°C threshold and that current governance systems are not mobilizing action quickly enough. If the formal multilateral process cannot keep pace, the discussion suggested, alternative forms of cooperation will continue to proliferate.
Even so, the panel did not frame these efforts as a clean alternative to the UN system. Rather, they were presented as a response to blockage within it. As Miguel Ruiz Botero of the Permanent Mission of Colombia to the United Nations in Geneva put it, the more constructive model is not exclusionary club diplomacy but a coalition of the willing, one in which those prepared to move faster do so without allowing unwilling parties to freeze the entire process.
The main debate
That distinction led directly to the panel’s central tension. For supporters, smaller coalitions offer a practical path forward when consensus-based negotiations stall. For critics, they risk weakening the coherence, legitimacy, and equal voice that make multilateral institutions valuable in the first place. The question, then, was not simply whether these initiatives move faster, but whether they remain politically connected to the broader system they are meant to support.
Diarmid Campbell-Lendrum, head of unit for climate change, energy, and air quality at the World Health Organization, framed the issue institutionally. He noted that climate and health still operate largely as separate governance tracks, each with its own forums, incentives, and decision-makers. The problem is therefore not only speed but coordination: public health evidence on climate harms has existed for years, but institutions have struggled to bring climate and health actors into the same operational frame.
From that perspective, newer plans and political declarations matter because they help bridge those tracks. He also noted, however, that international institutions tend to perform better when dealing with discrete sectoral problems than with cross-cutting ones. Climate change does not fit neatly into a single silo. It is simultaneously a health, rights, development, and economic issue, which is precisely why more flexible platforms have gained appeal.
Still, the panel was careful not to romanticize speed for its own sake. Several interventions returned to the importance of universality, especially for states and communities that rely on inclusive multilateral processes to ensure they are not sidelined by more powerful actors. In that sense, the case for two-speed multilateralism was presented less as a replacement for the formal system than as a pressure mechanism, one that can unlock movement, generate practical pathways, and feed momentum back into broader negotiations.
Santa Marta as an example
The clearest illustration of that logic came in the discussion of the planned Santa Marta conference, convened by Colombia and the Netherlands on transitioning away from fossil fuels. Botero described it as a response to the limited pace of progress within formal climate negotiations. He said the idea is to create a space where willing governments and other actors can advance urgent questions without being trapped in procedural deadlock.
Santa Marta therefore emerged as a test case for coalition-based climate diplomacy. It is not intended to replace the COP process, but to create political room where the COP process has struggled to produce stronger outcomes, especially on fossil fuels. The aim is to move from broad principle to more concrete pathways on transition, mitigation, and adaptation.
Although health may not appear as a stand-alone track in every such initiative, panelists repeatedly argued that the link is intrinsic. Climate change is already weakening the conditions that support health, especially in vulnerable countries with fragile systems and limited fiscal space. At the same time, health systems themselves are energy-intensive and will have to adapt and decarbonize, making the transition away from fossil fuels inseparable from the future of public health.
COP31 and implementation
If COP30 helped raise the profile of health, COP31 was framed as a test of whether that recognition can be translated into implementation. Representatives linked to the incoming presidency — Ömer Öztürk, head of the department of adaptation to climate change and local policies at the Directorate of Climate Change under the Ministry of Environment, Urbanization and Climate Change of the Republic of Türkiye, and Gül Mersinlioğlu Serin, health expert at the Ministry of Health of the Republic of Türkiye — emphasized action, delivery, dialogue, and consensus. In that framing, health was not treated as a side issue but as a cross-cutting one linked to adaptation, resilience, cities, food systems, and human development.
That emphasis reflected a wider shift in the panel’s tone. The question is no longer simply whether health belongs in climate politics. It now clearly does. The harder task is to translate that recognition into budgets, projects, indicators, and institutional arrangements that can change outcomes on the ground.
Panelists pointed in particular to adaptation planning and to the growing effort to develop common indicators for measuring progress. Such frameworks are imperfect, but they matter because they create a shared basis for reporting, comparison, and accountability. In the climate-health context, they may also help keep health visible not only in speeches and side events, but in the technical architecture of implementation.
The incoming COP31 process was also presented as an opportunity to build continuity across presidencies. The Turkish representatives pointed to efforts to keep climate and health on the agenda through dedicated programming and coordination with other actors. Margot Morris, counsellor for health at the Permanent Mission of Australia to the United Nations in Geneva, likewise stressed the importance of grounding upcoming discussions in Pacific realities, where climate change is already affecting well-being, health systems, and community resilience in immediate ways.
Why this matters in real life
One of the strongest interventions came from the audience, when a participant reflecting on work in Zanzibar urged the room to keep sight of what these debates mean in practical terms. In places already experiencing heat stress, salinized groundwater, environmental disruption, and fragile public services, climate change is not a future scenario. It is part of daily life. The challenge for governance is to make those realities visible to decision-makers and to ensure that indicators, diplomacy, and institutional reform actually produce protection for people living with those pressures now.
That intervention helped anchor the discussion. For all the focus on negotiation architecture, political pathways, and conference diplomacy, the underlying measure of success remains simple: climate governance will be judged by whether it reduces harm. The value of any institutional innovation, whether a universal forum or a coalition of the willing, depends on whether it improves conditions for people whose health is already on the line.
By the end of the discussion, there was broad agreement that health occupies a stronger place in climate politics today than it did even a few years ago. The harder question is how to use that momentum well. If smaller, faster-moving initiatives can generate practical progress while reinforcing broader multilateral legitimacy, they may help push the climate-health agenda forward at a pace closer to what the crisis demands. If they drift too far from the wider system, however, they risk adding fragmentation to an already crowded field. The challenge ahead is not to choose between speed and multilateralism, but to make them work together.
II. GHF ANALYSIS
COP30 and Health: Negotiation Outcomes and the Belém Health Action Plan
By Bianca Carvalho
Carvalho is a fellow at Fiocruz, a public health research institution in Rio de Janeiro, Brazil. She is also a writer for Geneva Health Files and a representative of the WHO Youth Council. Carvalho attended COP 30 in Belém.
In November 2025 the eyes of the world turned to COP 30 in Belém, Brazil, as governments and civil society awaited the outcomes of high-stakes climate negotiations. For the first time in history, a climate COP took place in the heart of the Amazon rainforest. Framed as the “people’s COP”, COP30 also marked the highest Indigenous participation ever recorded at a climate conference, with approximately five thousand Indigenous representatives from across the world. The United States did not send a delegation to COP30, reflecting Donald Trump's politics on multilateralism.
At COP 30, health was consolidated as a central pillar of climate negotiations, moving beyond its traditional framing as a secondary co-benefit of climate action. The World Health Organization (WHO), the Brazilian Ministry of Health and international organizations such as Drugs for Neglected Diseases Initiative (DNDi) and Médecins Sans Frontières (MSF) consistently emphasized that “the climate crisis is a health crisis.” Health was no longer presented as a distant or indirect outcome, but as an immediate and lived reality for millions of people.
