AT Pre-COP, public health doctor Remco van de Pas says Pacific climate action must count illness, care work and community trauma and put people at the centre of the transition to COP31.

When climate policy is measured in seawalls, damaged hospitals, and land loss, the costs carried in people’s bodies and communities can disappear from view. In the Pacific, public health doctor van de Pas says this blind spot leaves illness, heat stress, unpaid care, and trauma at the edge of a debate that should be as much about people as projects.

“People should be at the centre of this transition that we’re in,” said Remco, public health doctor and Research Lead for Climate Justice and Determinants of Health at the United Nations University’s International Institute for Global Health (UNU-IIGH) based in Kuala Lumpur.

Remco, who was also in Fiji, collaborated with Public Services International, the Fiji Nursing Association, and the Pacific Council for Education during the Pre-COP said climate policy needed to protect the right to health.

The consequences extend beyond the damage visible after a storm. Remco pointed to infectious diseases, including malaria and other vector-borne illnesses, water- and food-borne diseases, extreme weather and food insecurity through malnutrition. Together, he said, they can leave people living with disease or contribute to premature death.

“The World Health Organization (WHO) estimates that climate change will cause approximately 250,000 additional deaths per year between 2030 and 2050,” he said, adding that it was difficult to separate the impacts into precise figures.

Heat, too, has consequences that reach into work and pregnancy. Remco said extreme heat affected workers, including farmers, and could affect the time a child stays in the womb, raising the possibility of premature delivery.

Costs that do not show up on a seawall

When illness keeps people from working, the effect moves beyond the individual. “If people have to deal with disease and if they’re ill, they can’t contribute to the labour market,” Remco said. Care needs then carry economic implications, while mental health effects can remain hidden.

He said heat stress could affect mood, with more aggression and depression, while displacement and repeated disasters could produce distress that is too easily framed as an individual problem. Counselling and medical treatment may have a role, he said, but they do not address the communal nature of the trauma.

“At the core, it’s a social communal trauma that we’re going through,” he said. Responses should include community mourning and collective coping, as well as individual psychological support.

Remco also argued that climate policy should make room for social care, community nurses, social workers, art and culture.

“Climate policy is not only a technical discussion where it’s about renewable energy,” he said, adding that the social, mental, and cultural dimensions are central too.

Care work and climate finance

Remco said climate finance remained focused on technical innovation and energy infrastructure, while the care economy received too little attention. That includes formal jobs and unpaid work in communities, much of it done by women. He said about 70 per cent of care jobs were done by women and that this work was not recognised.

He said climate finance could include support for care work, including financial support and better working conditions. But such schemes were not currently eligible and could “fall between the cracks,” even though community care was central to resilience.

“If we invest in enabling people to be healthy despite the climate crisis,” Remco said, including in the care work required, “it might be two or three times economic gain if we did not do it.” He described inaction as having a cost visible in population health.

For Pacific countries, the question also extends to the health workforce. Remco said labour mobility was real, and that people had the right to choose destinations that worked for their families. But when publicly trained professionals left because of unemployment or low pay, for example in Fiji, he said, the result could amount to a subsidy from Fiji’s public finances to the rest of the world.

A fairer arrangement, he said, would preserve the benefits of mobility while returning part of the investment to the country of origin through public services or education. Pension, tax, and social-protection entitlements built up abroad should also be portable so they can support workers and communities back in Fiji.

What COP31 should put on the table?

Remco said health costs should be part of loss-and-damage discussions, including disability and years spent ill.

He said such costs could be calculated, but the wider imbalance in available loss-and-damage finance was large. For him, the case was also a moral claim rooted in historical responsibility and financial solidarity with Pacific islands.

He said health workers should have a voice in those discussions, alongside legal and government representatives. He said their evidence and testimony could also contribute to legal debate and litigation.

When asked what COP31 should deliver, Remco called for health and education, and the public provision of those services, to be included in just-transition schemes and made eligible for climate-finance grants. He also called for consultations on climate policy to include health and education workers.

He said health workers can give the crisis “a human face” and help show what can be done. But they may not be found on conference stages.

“You need to go down to the villages to get their message out.”