Global health. The current scenario and future perspectives

131 By 2005, the Organization for Economic Cooperation and Development (OECD) recognized the importance of the relationship between Chile and other OECD members by highlighting the country’s economic and social growth and urging it to protect the environment and its natural resources through 52 recommendations. These emphasized greater environmental institutionality, the improvement of information systems, laws to protect biodiversity, proactive climate responses, etc. (OECD, 2005). Considering this analysis and other policy concerns, the Chilean government worked to meet OECD standards and was invited to become a member of the institution in 2009 and signed the agreement in January 2010 (OECD, 2010). Since then, the environmental institutional framework has been strengthened, with new obligations established in different areas, including environmental protection. Thus, in 2010, the Ministry of the Environment, the Council of Ministers for Sustainability, the Environmental Assessment Service and the Superintendence of the Environment were created (Government of Chile. Ministry General Secretariat of the Presidency, 2010); however, serious problems still exist in terms of oversight, regulations, cooperation between institutions and institutional jurisdiction. Chile is a member of the UNFCCC and has ratified both the Kyoto Protocol and the Paris Agreement, in addition to submitting its NDCs in 2015 and 2020. However, climate commitments and actions are still limited and weak, especially in terms of health and climate change: national GHG emissions have been increasing steadily. The latest measurement in 2013 revealed a total of 70,054 gigatons of CO 2 equivalent emissions, considering land use, land-use change and deforestation (Government of Chile. Ministry of the Environment, 2018b). Strategies include the National Climate Change Action Plan 2017- 2022, an integrating instrument of climate-change policy that includes actions from different ministries and services. This plan considers four pillars of action: 1) adaptation, 2) mitigation, 3) means of implementation and 4) regional and local climate change management. It also provides an operational structure for the development and implementation of nine sectoral plans: agriculture and forestry, biodiversity, fishery and aquaculture, health, infrastructure, cities, energy, water resources and tourism (Government of Chile. Ministry of Health and Government of Chile. Ministry of Environment, 2017). In 2018, the Fourth State of the Environment Report established that the main challenges are related to environmental institutional framework, air quality, biodiversity, circular economy, waste management and climate change. It emphasized the importance of achievements in policies and