If we’re really lucky, some sort of progress will be made - if our politicians and negotiators are sufficiently clear-eyed and understand that, as United Nations Secretary-General António Guterres said in June, we have already tipped into an era of global boiling. And that we are here because of our insatiable appetite for fossil fuels.

But perhaps the most significant event at COP28 will not be played out in the wranglings of the negotiating hall – we’re all just a bit too cynical now to believe that transformation will come from there. For me the confirmation that COP28 will dedicate an entire day to discussions on health is already a modest win.

Oil makes us ill. Coal makes us wheeze. Plastics are clogging our rivers and oceans and breaking down into bite-sized pieces and worse still microplastics that we are all ingesting. The connection between the climate crisis and human health has never been clearer. And yet, like any other addiction, kicking the fossil fuel habit is proving very difficult.

Climate change is no longer an isolated environmental issue; it has far-reaching implications for human health. Our region – already the most disaster-exposed on the planet – is increasingly susceptible to extreme weather events, which means that we are increasingly experiencing this connection. Rising temperatures, changing rainfall patterns, and more frequent heatwaves are already exacerbating existing health challenges, such as heat-related and respiratory illnesses, and the spread of vector-borne diseases.

And with the current El Niño predicted to last well into next year we are set for a challenging period ahead.  So, I welcome the fact that the decision to devote a day at COP28 to climate and health issues underscores the critical connection between climate change and public health.

But it’s also easily wasted. When we look at the climate-health connection we’re actually recognizing that everything is joined up.

In my home country, Malaysia, we have taken this to heart, and are developing a National Planetary Health Action Plan. The plan, which will help to focus our policymakers on the connections between their decisions and the impact those decisions have on the health of the population of our country and the ecosystems that support life, will be open source and available to other countries to duplicate.

But beyond demonstrating to the world what science, policy and popular action can do together, it will also be important that the discussions in Dubai accelerate international agreement on several issues.   

Firstly, there is the development of climate-resilient healthcare systems. As the world gets hotter, we need to make sure that our medical facilities are prepared to handle climate-related health challenges, such as heatwaves and disease outbreaks. Investment in infrastructure, medical equipment, and training for healthcare professionals is needed to bolster the capacity to respond effectively to health crises exacerbated by climate change. So too is rapidly reducing the carbon footprint of global healthcare which, if it was a country, would be the fifth largest emitter in the world.

Second, we all know that the planet faces significant air quality issues, including from factors that don’t have immediately visible connections to air pollution, like the acceleration in urbanization and how we grow food. Focusing on how we can develop common and collective air quality management strategies at COP28 should bring us closer to the development of transboundary regulations and policies that reduce air pollution and improve respiratory health. The current spotty and nationally focused laws and regulations don’t consider that air pollution travels between countries.

Third, we are seeing a rise in vector-borne diseases like dengue and Zika due to warmer temperatures and changing rainfall patterns. As the planet warms, we should expect to see more of this, and so cooperating across the planet to manage vector-borne diseases has a clear resonance with the COP28 Health Day agenda.

And finally, we need an urgent focus on public awareness and education; trying to understand why it’s so difficult to communicate about the health implications of climate change. At COP28, the health community needs to work with global leaders to crack this nut.

An outcome of Health Day should be agreement on developing and overseeing a far more effective global public relations and public information campaign rather than relying on scientists to publish reports that, frankly, have limited resonance with the end-users of fossil fuels.

As the health community across Southeast Asia gets ready for COP28’s Health Day discussions, we need to be brave, to exercise leadership which is perhaps outside our comfort zone. The links between climate and health are as clear as the light of day and the time for dancing around the issue is over.

We must be grateful to the United Arab Emirates for getting health onto the agenda. But Dubai’s bad air quality reminds us that the UAE and other governments need to walk the walk as well as talk the talk. Making sure something meaningful emerges at COP28 will be a significant challenge but one that we must meet. The links between the health of people and health of the planet are clear.

The opportunity to institutionalize that understanding as a central contribution to action on the broader climate agenda is here. We can lead. The question – for those of us from the health fraternity in Southeast Asia who will be at COP28 – is will we?

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The writer is a physician and experienced crisis leader, the executive director of the Sunway Centre for Planetary Health at Sunway University, Malaysia, and the recipient of the ASEAN Prize 2019.