Countries need to establish structures to turn climate–health goals into impact

Most national climate adaptation plans talk about health – but there are gaps in structures and investment to achieve this crucial strand of climate policy. However, examples exist of countries that are building comprehensive policies and acting upon them – Colombia and New Zealand among them. Clare Morneau and Ilan Cerna-Turoff report on the findings of a study of 198 countries plus the EU to explain what’s at stake.

Health has been a component of international climate change discussions since their inception and was incorporated into the 1992 United Nations Framework Convention on Climate Change (UNFCCC). Yet, the first dedicated Health Day at a meeting of the Conference of the Parties (COP) to the UNFCCC took place as recently as 2023, at COP28 in Dubai. Last year, COP30 offered a hopeful signal that health would be given greater attention, with the adoption of the Belém Health Action Plan – the first health-specific climate adaptation framework – to guide governments towards health action between COP summits. But more still needs to be done.

Why is it so important to integrate health into climate adaptation policy?

Unlike climate change mitigation, which seeks to reduce greenhouse gas emissions at source, climate adaptation concerns how societies prepare for and respond to changes that are already occurring. Climate change is spurring increases in heat-related illness, vector-borne diseases, cardiovascular and respiratory conditions, and other disease burdens. Health is one of the most critical systems that policy must protect and strengthen as part of climate change adaptation, which requires meaningful inclusion in climate policy on both the global and national scales. But to what extent is this happening?

Our recent policy analysis, published in the Lancet Planetary Health in June, sought to analyse the extent to which health is currently integrated into National Adaptation Plans (NAPs), National Adaptation Programmes of Action (NAPAs), Health National Adaptation Policies (HNAPs), Nationally Determined Contributions (NDCs), and National Communications (NCs) in 198 countries and the European Union. The headline finding is a familiar paradox of climate governance. Health appears in almost every national climate adaptation policy, but few policies outline a plan for monitoring and evaluation, or a budget to achieve health goals. Countries are making commitments – but the accountability and implementation structures to follow through on commitments are largely absent.

Health is widely named as a priority but rarely funded

Across the 522 national policies in our review, 88% mention health in some form. Almost all countries – 97% – identify groups disproportionately affected by climate change. While positive, the figures obscure differences in priorities across regions and key blocs in climate negotiations. While all UNFCCC negotiating groups outline monitoring and evaluation (M&E) structures in their National Communications, this incorporation ranges from 25% in the BASIC bloc – Brazil, South Africa, India, and China – to 100% of countries in the EU. Only six countries, representing 3% of those reviewed, outline a budget for health-related climate action. Dedicated financing, as well as M&E – the mechanism that enables governments and citizens to track whether commitments are being met – are notably absent for most countries.

National climate adaptation policies will only lead to effective action if they are accompanied by sufficient budgets and strong indicators to measure progress. This is not insurmountable. Countries have examples of high-quality policies to emulate. One such example is New Zealand’s national climate adaptation policies, which detail institutional responsibilities with deadlines, financing requirements and measurable indicators within a monitoring plan.

Recognising affected groups is not the same as involving them

The pattern repeats with regard to equity. While 97% of countries identified populations disproportionately affected by climate change, such as women, children, people with disabilities and older adults, and 82% of countries include gender-responsive planning, only 12% actually involve these populations in climate and health decision-making. This gap represents a clear departure from principles outlined in the Belém Health Action Plan and the WHO Global Action Plan on Climate and Health, which state that disproportionately affected groups should be involved in all stages of policy creation and implementation.

Involvement of affected populations can produce better outcomes, not just more equitable ones. For instance, recruitment of traditional leaders to implement community-led climate adaptation for health has proven both effective and equitable in Pacific Island nations.

Colombia shows what sustained commitment and national leadership can look like

Colombia provides a strong example of regional and global leadership. In April this year, following COP30, Colombia and the Netherlands co-hosted the ‘coalition of the willing’, with the intent to advance the global transition away from fossil fuels. While setting a strong example of dedication to climate commitments to other countries in South America and globally, Colombia is equally taking steps to drive climate and health integration at home. The Ministry of Health has partnered with Health Care Without Harm to estimate the carbon footprint of the Colombian health sector – the first country in the region to do so.

This is consistent with Colombia’s emphasis on evidence as a foundation for action. Colombia’s revised Nationally Determined Contribution under the Paris Agreement was the result of an eight-year partnership between the Ministry of Environment and the Stockholm Environment Institute. It began with black carbon modelling in 2013, which led to the development of a national black carbon emissions inventory in 2016 and 2017 and a published strategy on Short-Lived Climate Pollutants in 2018. That groundwork gave Colombia the evidence base to commit to cutting black carbon emissions by 40% by 2030, a target with direct and significant benefits for respiratory and cardiovascular health.

Colombia’s ambition extends beyond emissions targets. Its HNAP takes an intersectional approach, examining how overlapping social and demographic factors shape climate-health risks across different populations and adopts a gender-responsive framework to address the disproportionate health impacts of climate change on women and ensure their meaningful participation in adaptation decisions.

The ‘coalition of the willing’ raises an important consideration: there is a need for increased national leadership. Colombia presents a model in building a credible evidence base, setting ambitious targets and translating policies into global action.

Greater linkages are needed within and across borders

Two concrete actions that create longevity in policies involve embedding health-related climate commitments across all segments of government and society and mandating dedicated proportions of public budgets. This requires cross-sectoral coordination and, in particular, the meaningful integration of health ministries into forums that address environmental and climate issues. Currently, environmental and climate ministries tend to draft climate policies, with health ministries playing a secondary role or, at times, not having the opportunity to input into climate documents at all.

Regional partnerships are equally important. We increasingly live in an interconnected world, where the health effects of climate change affect populations near and far. Regional partnerships promote shared ownership of climate and health initiatives and enable tailoring of cross-border issues. They create structures to increase accountability and action.

Plans do not guarantee action

While it is encouraging that health is named in national climate adaptation policies, it is not the final step. Policy needs to be translated into action. We need governments to ratify binding climate policy and set up mechanisms to fund, measure and sustain health indicators over time. This requires considerable financial investment and political capital. As countries revise their climate commitments in the coming years, the test will be whether the policies improve health indicators and stand the test of a changing political landscape.

Read the underlying research paper: Health integration in national climate adaptation policies from 198 countries: a global policy analysis, The Lancet Planetary Health 10(5). Clare Morneau is a PhD Candidate in Environmental Policy and Development in the Department of Geography and Environment at LSE. Ilan Cerna-Turoff is Assistant Professor of Epidemiology in Emergency Medicine (primary) and Assistant Professor of Population Health Science (secondary) at Cornell University. Both are co-authors of the paper.

The views in this commentary are those of the authors and do not necessarily represent those of the Grantham Research Institute.