The path towards a healthy climate will be a rocky one in the coming year. December's global negotiations in Paris are a crucial crossroads for choosing between bold new routes to health through well-designed climate action or continuing to threaten human survival and wellbeing. Meanwhile, the Trans-Pacific Partnership (TPP) agreement is about to add another giant obstacle to progress.

As the Lancet, one of the world's leading medical journals, described recently, humanity is on the cusp of choosing to use climate action as our greatest health opportunity or committing to "unacceptably high and potentially catastrophic risk to human health".

For New Zealand, climate-friendly transport, housing, energy and food policies offer us new routes to addressing the biggest causes cutting our adult lives short and making our kids sick. These include heart disease, obesity, cancer, asthma and road traffic injury. On the other hand, health risks of unabated climate change come from storms, droughts, financial uncertainty, changing infections and rising food prices, leading to a wide variety of injuries, diseases and mental illness.

There are plenty of stumbling blocks on the international path to opportunity. One of the most challenging is the need to leave almost all the known reserves of coal, oil and even gas in the ground - un-sold and un-burnt. This scientific reality is an unavoidable threat to the business model of many of the world's most powerful corporations and requires an adaptation of the world's economy.

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Unbelievably, New Zealand and 11 other countries, representing at least a third of the global economy, have just quietly dropped a massive boulder in the path to health-protecting climate action by agreeing to the TPP investment deal.

The text of the proposed agreement was finally made public recently. As suspected, the TPP will allow international companies to sue governments for making decisions that threaten their profits through Investor State Dispute Settlement (ISDS) provisions. Similar provisions are already being used elsewhere to reverse, slow down or prevent laws designed to protect health from industrial pollution. In other words, governments are successfully being forced to put the profits of the world's richest few ahead of their own people's health.

Companies who profit from climate pollution are responsible for a disproportionate number of ISDS cases. In recent examples, the German government has been sued for placing restrictions on coal burning, while the Canadian government in Quebec is also being sued for placing a temporary ban on injecting undisclosed chemicals into the ground to extract natural gas. Both of these bans were as much about protecting people's health from air and water pollution now as they were about longer-term protection from climate change.

In response to these cases, and with their own version of the TPP looming, the European Parliament has adopted a resolution to protect the forthcoming Paris negotiations from existing and future trade agreements. This is a powerful statement by one of the world's largest economic blocs that climate action must not be derailed by the vested interests of fossil fuel companies.

New Zealand needs to insist on a similar climate 'carve out' from trade agreements that we're involved in, including the TPP.

But let's be perfectly clear: such a carve out would only be aiming to make a bad deal for health just a little less bad. The requirement for such an exemption indicates that the TPP is deeply flawed; if the agreement included protection of government sovereignty to make laws, no such 'carve outs' would be needed.

We have a brief window right now between agreeing to the TPP in principle and cementing it into law. New Zealanders from all walks of life have been demonstrating their concern about the TPP and need to continue to voice their resistance to its passage into law as an assault on our democracy and our health.

In the meantime, a contingency for the climate is also needed in the TPP. In the face of New Zealand's irrational reluctance to walk away from a bad deal, a climate 'carve out' may be our best chance for a healthy climate future.

Climate change is a medical emergency that will affect the health and wellbeing of everyone in the world including New Zealanders. We still have time to choose the path of opportunity rather than the path of catastrophe - but not if we hand the reins of climate governance to fossil fuel companies.

Dr Alexandra Macmillan is a public health medicine specialist and senior lecturer in environmental health at the University of Otago.
Dr Rhys Jones (Ngāti Kahungunu) is a public health medicine specialist and senior lecturer in Māori health at the University of Auckland.
They are co-convenors of OraTaiao: The New Zealand Climate and Health Council.