Outside the UN's multilateral organizations, the world's leading summit institutions, led by the G8, have governed both health and climate in an increasingly integrated way. The G8 has done so across several dimensions of global governance (Kirton, 2013). The first dimension is its public deliberation in the conclusion documents issued collectively in the leaders' names. The words appearing there carry the full authority and agreement of the world's most powerful leaders and are the subject of much hard negotiation among themselves and their personal representatives (Hajnal, 1989). The second dimension is direction setting by approving principles, defined classically as “beliefs of fact, causation, and rectitude” (Krasner, 1983, p. 2). G8 leaders have long struggled over a public and collective consensus that global warning is a fact; that it has human causes; and that it is right, proper, and just to control climate change. These consensus-principled directions, as well as the collective deliberations, have a larger impact and importance, as constructive scholars of international relations have highlighted (Haas, 2002; Pettenger, 2007). The third dimension is decision making, through the future-oriented collective commitments with sufficient precision and obligation that the leaders make (Abbott, Keohane, Moravcsik, Slaughter, & Snidal, 2000). These can be ambitious and significant, setting numerical targets and timetables, and mobilizing new money to meet them. The fourth dimension is delivery of these decisions through members' compliance and implementing behavior after the summit. This compliant behavior, shows the autonomous impact of the international institution on the otherwise constrained action of sovereign states (Kirton, 2006; Kirton, Roudev, & Sunderland, 2007; Kokotsis, 1999).
Deliberation and Direction Setting
The G8 has addressed both health and climate change in parallel since 1979 (Kirton and Guebert, 2009b, 2009c). In 1997, when the Kyoto Protocol paid no attention to the link, the G7/8 connected the two issues for the first time (see Appendix A). It appeared again with a single reference in 2003, three references in 2005, and then continuously with one or two references each year from 2007 to 2012.
At the start of this sequence, at their U.S.-hosted Denver Summit in 1997, G8 leaders declared:
Overwhelming scientific evidence links the build-up of greenhouse gasses in the atmosphere to changes in the global climate system. If current trends continue into the next century, unacceptable impacts on human health and the global environment are likely. Reversing these trends will require a sustained global effort over several decades, with the involvement of all our citizens, and changes in our patterns of consumption and production. (G8, 1997)
The leaders thus established the foundation of the G8's climate–health regime by declaring that climate change was a major challenge, one that affected human health, did so in unacceptable and harmful ways, and required an immediate response.
After an absence of several years the G8's attention returned in 2003 (G8, 2003). It recognized the potential of technologies and research to improve public health by cutting pollution and reducing greenhouse gases. While missing from the 2004 American-hosted Sea Island Summit, the link came back at the British-hosted G8 Gleneagles Summit in 2005 (G8, 2005a, 2005b). Here the G8 identified the specific impacts of climate change on respiratory disease and health-care costs. In doing so it forged, for the first time, the trilateral climate–health–economy link. The issue was absent from the Russian-hosted St. Petersburg Summit in 2006, although health was one of that summit's priority themes.
From 2007 to 2012, however, G8 leaders continuously forged the link (see Appendix A). In 2008 they focused on climate change adaptation and how “minimizing the impacts of extreme hydrological variability are critical to protecting human health” (G8, 2008). In 2009 they were “deeply concerned about the consequences of climate change on … health and sanitation, particularly for LDCs [least developed countries] and SIDS, but also for the poor and most vulnerable in all countries” (G8, 2009). In 2010, food security was an urgent global challenge exacerbated by climate change, and was enhanced by reducing malnutrition as a contribution to “improved maternal and child health” (G8, 2010). In 2011, innovation was presented as crucial for “climate change, poverty eradication and public health,” while a low carbon economy generated significant benefits for health (G8, 2011). In 2012, “short-lived climate pollutants” were recognized as having an impact on “on near-term climate change … and human health” (G8, 2012).
The G8 thus has increasingly acknowledged the link, especially on a continuous basis from 2007 to 2012. Its attention has been strongest when its summits have had climate change as a priority, as in 1997, 2003, 2005, 2007, 2008, and 2009, in contrast to health, which was a priority only in 2006 and 2010. It has also been stronger when the summits have been more closely and directly connected to Africa, and thus to the acute health challenges there (Cooper, Kirton, & Schrecker, 2007; Kirton, Cooper, Lisk, & Besada, 2014).
G8 statements of fact have presented both climate change and health as a reality. Statements of causation have been entirely on how climate change harms human health, even as the context of climate change and health—and the causal pathways between the two—have expanded significantly to cumulatively produce a more complex causal map. Statements of rectitude have referred to an array of international institutional agreements. Yet after 2005 none came from UN summits apart from a reference to the Copenhagen agreement in 2009. They came increasingly from the G8 summit itself.
These statements on the link also suggest the key underlying causes. Science was specifically referenced at the start—boldly with “overwhelming scientific evidence” in 1997 and again amidst “uncertainties” in 2005, but not in subsequent years (G8, 1997, 2005a). Shock-activated vulnerability, defined as instances with a high level of surprise and high threat to national values that can come as an assault with no precedents or warning and also as one installment along a cumulative causal chain, was another factor (Kirton, 2013). The closest reference to such vulnerability came in the 2012 statement that short-lived climate pollutants caused “over thirty percent of near-term global warming as well as 2 million premature deaths a year” (G8, 2012). Summitry was increasingly featured as a cause. This cadence started with references in 2003 to the UN's 2002 World Summit on Sustainable Development (Rio+10), in 2005 to the UN Millennium Summit of 2000, and after 2005, G8 summitry itself as a self-referential and self-sustaining summit institution. One anomaly was the declaration from the summit of the Major Economies Meeting on Energy Security and Climate Change (MEM) at the G8 summit in 2008. The MEM's (2008) single paragraph on the climate-health connection noted the UNFCCC as “the global forum for climate negotiations.”
An assessment of the G8's climate-health–related commitments made from 1975 to 2012 shows six central trends (see Appendix B). First, G8 deliberation on this issue has not been translated into a significant number of decisions. Since 1975 members have made only seven commitments that recognized the relationship between general environmental degradation on the one hand and human health on the other. The only commitment to reference climate change specifically came in 2012. Second, the number of climate-health commitments has not increased, despite the growth of scientific research and consensus. Indeed, no environment-health commitments were made between 2003 and 2012. Third, there is a bulge between 1996 and 1997 when three commitments were made, almost half of the total overall. Fourth, the development influence is apparent, as two of the three commitments made in 1996 and 1997 have a strong development focus, with references to official development assistance and assistance for African countries. Fifth, the biotechnology driver appears in 2000 and 2003, as these two commitments emphasized the use of biotechnologies and research when addressing the impact of environmental challenges on human health. Sixth, there is little congruence between what G8 summits committed to and what the relevant UN summits promised. Particularly surprising is the lack of congruence between the G8's 2012 Camp David Summit and the 2012 Rio+20 Summit, despite the fact that they occurred within 1 month.
In delivering its environment-health commitments in the following year until the subsequent summit is held, G8 performance is also weak. Compliance is classically measured on a scientific scale from +1.00 for full compliance, 0 for partial compliance or work in progress, and −1.00 for no compliance or action that is antithetical to the commitment (Kokotsis, 1999). (The score is converted to a percentage by adding 1 and dividing by 2.)
The extensive compliance data base developed by the G8 Research Group since 1996 shows that G8 members' compliance with both their separate health and the climate commitments has been considerable. The 56 assessed health commitments from 1983 to 2012 have an average compliance score of 76% (+0.51) (Kirton, Roudev, Sunderland, Kunz, & Guebert, 2010).2 The 60 assessed climate change commitments from 1985 to 2010 have a nearly identical average compliance score of 75% (+0.49) (Kirton, Guebert, & Bracht, 2011).
The one specific connected climate-health commitment, which was on short-lived pollutants in 2012, had a compliance score of only 56%, compared to that summit's average of 79%. Compliance with the climate-health commitments was complete for Canada, Germany, and the European Union; partial for France, Japan, the United Kingdom, and United States; and non-existent for Italy and Russia.