Climate Change Litigation: Guide for Public Health Professionals

By Giovanna Mazzola, WFPHA Environmental Health Working Group

The past several years have seen a significant increase of litigation over actions or inaction related to climate change. The total number of climate change court cases has more than doubled since 2017 and is growing worldwide. While most cases have been brought in the United States (US), Europe, the United Kingdom (UK), and Australia, about 17% of cases are now being reported also in developing countries, including Small Island Developing States. Climate change litigation is thus becoming an integral part of securing climate action and justice, as an effective tool to affect “the outcome and ambition of climate governance”. By using litigation to oblige governments and private sector polluters to address the climate emergency, claimants have been pushing for more ambitious regulations, opposing regulatory steps or new plans and proposed developments, or even requesting compensation measures for human harm. Moreover, climate litigation creates opportunities for public scrutiny and debate, raising awareness around governments’ inaction or harm caused by private sector polluters.

The success of climate litigation mainly relies on compiling a sufficient level of scientific evidence of current and likely future health impacts on populations. Strong cooperation between the legal and scientific communities is thus essential to the successful outcome of climate change litigation when harm to human health is at issue. Yet, public health experts are often unaware of the opportunities offered by litigation and of their crucial role in collecting, securing, and presenting evidence of harm to human health.

To address this gap, the European Public Health Association (EUPHA), the Faculty of Public Health (UK), the Groningen Centre for Health Law, the Aletta Jacobs School of Public Health (Netherlands), and other partners have developed a Guide on climate change litigation for public health professionals. The Guide will be released at the 16th European Public Health Conference in Dublin in November 2023.

With the assistance of the Environmental Health Working Group of the WFPHA, the Guide’s content draws on suggestions made by WFPHA member organizations and public health experts, who were surveyed to ascertain their interest in the proposed Guide and to advise on its content and use. Over 70 completed surveys were received. The survey assessed the level of engagement and interest shared by respondents in climate change issues and their current level of cooperation with local legal expertise. Overall, the results demonstrated that there is a keen interest in the public health community to better understand the importance of climate change litigation in addressing climate-related injustice and the opportunities offered by interdisciplinary collaboration. Yet, while most respondents (79,2%) reported they are already working on issues related to climate change, many of them (57%) declared not to have ready access to legal expertise, either internal or external, for guidance on policy matters.

The Guide will be available from the Faculty of Public Health website, which also contains other useful related resources for public health professionals.

Protecting Healthcare Workers in Low- & Lower-Middle-Income Countries through Vaccination: Barriers, Leverages, & Next Steps

Healthcare workers play a vital role in providing medical care to individuals and communities. Compared to the general public, healthcare workers are at a higher risk of exposure to infectious diseases, including vaccine-preventable ones, due to the nature of their work. The World Health Organization (WHO) recommends healthcare workers be vaccinated against tuberculosis (BCG), hepatitis B, polio, diphtheria, measles, rubella, meningococcal, influenza, varicella, pertussis, and COVID-19; yet, despite clear guidelines, these are not always implemented, especially in less wealthy countries.

Importance of Routine Vaccination of Healthcare Workers

Routine vaccination of healthcare workers not only protects them from contracting infectious diseases but also helps prevent the spread of diseases to their patients, reduce healthcare costs associated with treating infected individuals, and reduce the risk of outbreaks that overburden health systems and increase costs. Moreover, healthcare workers who are protected against vaccine-preventable diseases are less likely to miss work due to illness or infection which can improve confidence and increase overall productivity. This, in turn, is essential for providing quality healthcare and improving the efficiency of the overall healthcare system. Similarly, vaccinated healthcare workers would be more confident in their ability to perform their duties as they are less likely to experience stress and anxiety related to their work.

Despite its importance, the implementation of policies for routine vaccination of healthcare workers in low- and lower-middle-income countries faces several challenges. In a recent article published by the researchers of the WFPHA and its International Immunization Policy Taskforce, they analyzed the barriers and recommendations for policy implementation and the role of partnerships.

Main Barriers to the Implementation of Policies for Routine Vaccination of Healthcare Workers

According to the article, lack of funds, lack of specific schedules for healthcare workers, lack of evidence-based data, hesitancy, beliefs, and low literacy are the main barriers to the implementation of policies for routine vaccination of healthcare workers in low- and lower-middle-income countries.

Recommendations for the Implementation of Policies for Routine Vaccination of Healthcare Workers

Expanding the COVAX initiative to cover healthcare workers, building partnerships with WHO, GAVI, governments, universities, and communities, mandatory insurance for healthcare workers, including vaccination, utilizing COVID vaccination infrastructures to vaccinate healthcare workers, collecting national data focusing on healthcare workers vaccination, increasing awareness and literacy from the university partnering with health-related student organizations, advocacy at different levels, providing specific schedules and funds addressed to healthcare workers (as done for children and pregnant women), and considering healthcare workers vaccination as part of the Occupational Safety Plan are the main recommendations for the implementation of policies for routine vaccination of healthcare workers in low- and lower-middle-income countries.

It is crucial to remember that the primary requirement for implementing the recommendations is the genuine commitment of governments to protect healthcare workers. Regrettably, numerous governments are yet to prioritize the protection of healthcare workers as essential for the well-being and prosperity of their nations. Consequently, this lack of prioritization hinders the successful implementation of the proposed recommendations, despite their potential for positive outcomes.

Global Public Health Policies: Public Health Associations’ Perspectives

Why Public Health Advocacy Matters

The definition of advocacy may vary slightly across disciplines. According to the World Health Organization (WHO), health advocacy is a combination of social actions aimed at securing political commitment, policy support, social acceptance, and systems support for a particular goal or program. Advocacy is identified as one of the core functions of public health and is a key tool for achieving the Sustainable Development Goals (SDGs).

In global public health, advocacy involves engaging diverse stakeholders in decision-making to improve population health. National public health associations and international non-governmental organizations (NGOs) play a vital role in advocating, advising decision-makers, guiding initiatives, and raising citizens’ awareness. Advocacy initiatives and campaigns, joint position statements, resolutions, and internal policies are recognized as the primary tools for influencing public health policy.

As countries continue to address challenges ranging from climate change and emerging infectious diseases to health inequities and workforce shortages, understanding the role of public health associations in shaping policy has become increasingly important. Their advocacy efforts help translate evidence into action and ensure that public health remains a priority within national and international decision-making processes.

Study Overview: Mapping Public Health Advocacy Across 12 Countries

In a recent study by researchers from the World Federation of Public Health Associations (WFPHA), public health advocacy activities conducted by national public health associations between 2018 and 2021 were examined to identify strengths, gaps, and opportunities to strengthen future policy development.

The study included 12 national public health associations representing:

• Ethiopia
• Cameroon
• South Africa
• Nigeria
• Canada
• United States
• Brazil
• Spain
• France
• United Kingdom
• Australia
• New Zealand

A total of 220 officially approved policy documents were analyzed, including position statements, internal policies, white papers, and official submissions to government bodies.

Key Findings on Global Public Health Policies

According to the study, the largest number of policy documents originated from high-income countries and focused primarily on environmental health and communicable diseases, including COVID-19. However, significant regional differences emerged.

Africa: Focus on Health System Strengthening

In the African region, public health advocacy focused primarily on strengthening health systems. This emphasis reflects the importance of building resilient health infrastructure, expanding access to services, and improving population health outcomes.

Women’s and child health also emerged as an important area of advocacy, particularly in Nigeria.

Europe and South America: Pandemic Preparedness and Communicable Diseases

Public health associations in Europe and South America devoted much of their advocacy work to communicable diseases and pandemic management.

The COVID-19 pandemic highlighted the importance of preparedness, surveillance systems, evidence-informed policymaking, and coordinated responses to public health emergencies.

North America and the Western Pacific: Climate and Environmental Health

In North America and the Western Pacific region, climate change and environmental health were dominant advocacy themes.

This reflects growing recognition that environmental determinants—including air quality, extreme weather events, biodiversity loss, and climate-related health risks—have profound implications for population health.

Major Public Health Advocacy Themes Identified

The analysis identified 11 major advocacy themes across all participating public health associations:

Communicable Diseases

Including COVID-19 preparedness, prevention, response, and vaccination policies.

Environmental Health

Including climate change, pollution, sustainability, and planetary health.

Health Equity

Advocating for fair access to health services and addressing social determinants of health.

Health System Strengthening

Supporting stronger healthcare systems, workforce development, financing, and service delivery.

Human Rights and Health

Promoting health as a human right and protecting vulnerable populations.

Mental Health and Substance Use

Addressing growing mental health challenges and substance-related harms.

Non-Communicable Diseases

Including cardiovascular disease, cancer, diabetes, and other chronic conditions.

Women and Child Health

Supporting maternal, newborn, and child health outcomes.

Nutrition

Advocating for healthier food systems and improved nutrition policies.

Injury Prevention and Violence Reduction

Addressing preventable injuries and violence-related health burdens.

International Health

Promoting cross-border collaboration and global health cooperation.

A Critical Gap: Limited Attention to International Health and Human Rights

One of the most important findings of the study was that relatively limited attention was paid to international health and health as a human right across all regions.

Given the interconnected nature of modern public health challenges—including pandemics, climate change, migration, and health inequities—there is a growing need for more internationally focused advocacy efforts.

The study suggests that future advocacy should be more strongly rooted in:

• Health as a human right
• Global solidarity
• International cooperation
• Intersectoral policymaking
• Sustainable Development Goals implementation

Strengthening Public Health Advocacy for the Future

The study revealed that public health associations are active advocates across a broad range of health issues. However, additional efforts are needed to strengthen the effectiveness of advocacy and policy impact.

According to the researchers, several priorities could improve future advocacy efforts:

Better Use of Evidence

Evidence-based policymaking remains essential for designing effective health interventions and demonstrating impact.

Improved Access to Data

Making public health data more accessible to policymakers and decision-makers can support faster and more informed policy responses.

Sustainable Funding Mechanisms

Adequate resources are necessary to maintain advocacy efforts and implement long-term public health strategies.

Increased Public Awareness

Citizen engagement and awareness can help build support for public health policies and strengthen accountability.

Expanding the Public Health Advocacy Coalition

The study also recommends broadening advocacy efforts beyond traditional public health stakeholders.

Future advocacy initiatives could involve:

• Academics
• Journalists
• Media organizations
• Influencers
• Civil society organizations
• Public health professionals

Working together as a unified voice may help strengthen policy influence, increase public awareness, and support the adoption of evidence-informed health policies.

Why Public Health Associations Matter in Global Health Policy

Public health associations serve as a critical bridge between research, policy, and practice. By translating scientific evidence into policy recommendations, they help governments and institutions respond to evolving health challenges.

As the world continues to confront climate change, future pandemics, health inequities, and emerging global threats, strong advocacy from public health associations will remain essential to advancing health equity, strengthening health systems, and ensuring that health is considered across all sectors of society.

Conclusion

This study demonstrates that public health associations play a vital role in shaping global public health policies through advocacy, evidence-informed recommendations, and stakeholder engagement.

While advocacy efforts between 2018 and 2021 focused heavily on environmental health, communicable diseases, and health system strengthening, the findings also highlight opportunities for a more international and intersectoral approach grounded in the recognition of health as a human right and aligned with the Sustainable Development Goals.

Moving forward, stronger collaboration among public health associations, policymakers, researchers, journalists, and civil society will be essential to building healthier, more equitable, and more resilient societies worldwide.

IC2PerMed: Roadmap

Integrating China in the International Consortium for Personalized Medicine (IC2PerMed) project aims to support the European Union (EU)-China collaboration over the developments of personalized medicine research, innovations, and policies through the International Consortium for Personalized Medicine (ICPerMed) initiative, providing people with access to personalized, smart, and inclusive healthcare solutions in the near future.

Over the past 4 years, the IC2PerMed project has developed a roadmap that aims to promote consistent approaches to personalized medicine research, development, innovation, and policies between the People’s Republic of China and the EU.

The roadmap proposes, through the actions listed below, items to deepen and promote alignment and creation of a common ground for European and Chinese collaborations on personalized medicine.

Improving: Empowered and Responsible Citizens

• Health Literacy
• Research
• Public Trust
• Ethical Challenges

Promoting: Trained and Up-to-Date Healthcare Workforce

• Education and Ethics
• Collaborations
• Policies

Fostering: Healthcare Systems’ Sustainability

• Resources
• Ethical, Legal, and Social Implications (ELSI) and Costs
• Evaluation
• Networks

Bringing: Innovation to Market

• Cost Effectiveness
• Needs Assessments
• Principles and Guidelines
• Perspectives

Adopting: Big Data and ICT Solutions

• Data Exchange
• Privacy, Security, and Trust
• Standards

Fostering: Research funding

• Patient Needs
• Value Chain
• Synergies

Translating: Basic Clinical Research and Beyond

• Omics Sciences
• Data and Standards
• Collaborations

The roadmap was presented during the High-Level Symposium on Health Policy and Personalized Medicine for Cancer: Projecting Europe-China Collaboration in the Global Arena, organized by the WFPHA in Geneva, Switzerland, on May 26, 2023.

Promoting Oral Health for Refugees: A Call to Action

Global forced displacement has reached unprecedented levels. As a result of persecution, armed conflict, generalized violence, natural disasters, famine, and economic instability, millions of people have been forced to leave their homes in search of safety and protection.

Among the many health challenges refugees face, access to oral health care remains an often-overlooked issue despite its importance to overall health, well-being, and quality of life.

This policy brief from the FDI World Dental Federation, the Framework Convention on Global Health Alliance, the Sustainable Health Equity Movement, and the World Federation of Public Health Associations (WFPHA) calls for urgent action to ensure that refugees can access essential oral health services as a matter of health equity and human rights.

Why Promoting Oral Health for Refugees Matters

The scale of global forced displacement continues to increase worldwide.

According to international estimates cited in this policy brief, more than 103 million people had been forcibly displaced worldwide by mid-2022, including over 32 million refugees, with more than two in five under the age of 18.

Refugees are among the most vulnerable and marginalized populations globally. They frequently encounter barriers to healthcare caused by:

• Population displacement
• Limited health infrastructure
• Workforce shortages
• Financial constraints
• Language barriers
• Reduced access to preventive services
• Disrupted continuity of care

While these challenges affect many aspects of health, oral health is often overlooked despite being an essential component of overall health and well-being.

Oral Health Is a Human Right

Like all people, refugees are entitled to access health care, including oral health care, as guaranteed by the International Covenant on Economic, Social and Cultural Rights.

This right is reinforced by the 1951 Refugee Convention and its 1967 Protocol, which require countries to provide healthcare without discrimination and on the same basis as nationals.

Access to oral health care should therefore not be viewed as an optional service. It is an important part of fulfilling the right to health and advancing health equity for displaced populations.

The Burden of Oral Disease Among Refugees

Evidence consistently shows that refugees experience higher rates of oral disease while facing greater barriers to care.

Studies referenced in the policy brief indicate that refugees often experience:

• Dental caries (tooth decay)
• Periodontal disease
• Oral soft tissue lesions
• Traumatic dental injuries

At the same time, refugees are less likely to access preventive oral health services and frequently seek care only when experiencing severe pain or emergencies.

Language barriers, limited mobility, financial challenges, unfamiliarity with health systems, and reduced service availability can all delay access to timely and affordable care.

The burden of oral disease among refugee populations represents a significant but often neglected public health challenge that requires urgent attention.

Improving Maternal Oral Health Literacy Among Refugee Communities

Oral health promotion and disease prevention are especially important during pregnancy and early childhood.

Research cited in the policy brief demonstrates that a mother’s:

• Oral health status
• Oral health knowledge
• Oral health literacy
• Health behaviours
• Socioeconomic circumstances

can significantly influence her children’s oral health outcomes.

Why Maternal Oral Health Matters

Maternal oral health is closely linked to childhood oral health outcomes, including the risk of dental caries.

Studies have shown that refugee maternal oral health literacy is associated with children’s oral health outcomes. However, misconceptions about oral health during pregnancy remain common.

Creating supportive systems that empower mothers and caregivers with oral health knowledge can help establish:

• Healthy oral hygiene practices
• Preventive behaviours
• Healthy dietary habits
• Improved oral health outcomes across generations

Women also play a critical role in supporting the health of families and communities, including children, older adults, and medically vulnerable family members.

Investing in maternal oral health literacy is therefore an important strategy for improving community health more broadly.

Ensuring Access to Essential Oral Health Services for Refugees

Refugees are entitled to primary healthcare services, including oral healthcare.

The World Health Organization’s Global Oral Health Action Plan provides important guidance on what constitutes essential oral health care.

Essential Oral Health Care Includes

Urgent and Emergency Care

Services that address:

• Acute orofacial infections
• Severe dental pain
• Dental trauma
• Orofacial trauma
• Abscess management
• Necessary extractions

Preventive and Routine Oral Health Services

Services that support early detection and prevention, including:

• Oral health examinations
• Professional cleanings
• Diagnostic radiographs
• Oral cancer screening
• Preventive interventions
• Access to essential dental medicines

Rehabilitative Care

Comprehensive oral health systems should also consider:

• Permanent restorations
• Periodontal treatment
• Endodontic treatment
• Appropriate referral pathways

Access to these services should be integrated into primary healthcare systems and made available to refugees without discrimination.

Oral Health Equity and the Sustainable Development Goals

Promoting oral health for refugees is not solely a healthcare issue.

It is also a matter of:

• Human rights
• Health equity
• Social justice
• Sustainable development

Ensuring equitable access to oral healthcare supports the core commitment of the United Nations Sustainable Development Goals (SDGs) to “leave no one behind.”

Refugees cannot achieve their full health potential if oral health continues to be excluded from refugee health planning, service delivery, and policy development.

A Call to Action

The FDI World Dental Federation, Framework Convention on Global Health Alliance, Sustainable Health Equity Movement, and World Federation of Public Health Associations recognize that oral health is an integral part of overall health and well-being. Access to oral health care is a fundamental human right.

They urge policymakers, healthcare providers, and international and national organizations to:

1. Include Oral Health in Refugee Health Strategies

Include oral health as part of current and future refugee health priorities, particularly for:

• Pregnant women
• Mothers
• Infants
• Young children

2. Raise Awareness of Refugees’ Oral Health Rights

Promote understanding of oral health and refugee health rights among:

• Healthcare professionals
• Public health practitioners
• Social service providers
• Community organizations
• Non-healthcare staff who work with refugee populations

3. Ensure Equitable Access to Essential Oral Health Services

Ensure access to essential oral health services as an integral component of:

• Primary healthcare
• Maternal healthcare
• Antenatal care
• Community health programs

through partnerships with national and local dental and health organizations.

Advancing Refugee Health Through Oral Health

Refugees face significant barriers to achieving and maintaining good oral health despite clear international commitments to health equity and human rights.

Addressing oral health needs through prevention, education, maternal health initiatives, and equitable access to essential services can improve health outcomes across the life course while strengthening broader refugee health systems.

Promoting oral health for refugees is therefore not only a public health priority but also an essential step toward advancing dignity, equity, and the right to health for all.

View additional FAQs on promoting oral health for refugees below:

What oral health challenges do refugees face?

Refugees commonly experience higher rates of dental caries, periodontal disease, traumatic dental injuries, and barriers to accessing timely oral health services.

Why is oral health important for refugees?

Oral health is an essential part of overall health and well-being, affecting nutrition, communication, quality of life, and broader health outcomes.

Are refugees entitled to oral health care?

Yes. International human rights instruments, including the International Covenant on Economic, Social and Cultural Rights and the 1951 Refugee Convention, support refugees’ right to healthcare without discrimination.

Why is maternal oral health important in refugee populations?

Maternal oral health knowledge and behaviors significantly influence children’s oral health outcomes and can help prevent oral disease across generations.