nature medicine

Review article https://doi.org/10.1038/s41591-023-02438-w

Climate change and health: three grand

challenges

Received: 8 May 2023 Diarmid Campbell-Lendrum , Tara Neville, Christian Schweizer &
Maria Neira
Accepted: 5 June 2023

Published online: 18 July 2023

Climate change may be the greatest health threat of the twenty-first
Check for updates century, impacting lives both directly and indirectly, through undermining
the environmental and social determinants of health. Rapid action to
decarbonize economies and build resilience is justified on health, human
rights, environmental and economic grounds. While the necessary health
response is wide ranging, it can largely be encapsulated within three grand
challenges: (i) promote actions that both reduce carbon emissions and
improve health; (ii) build better, more climate-resilient and low-carbon
health systems; and (iii) implement public health measures to protect
from the range of climate risks to health. The health community can
make a unique and powerful contribution, applying its trusted voice to
climate leadership and advocacy, providing evidence for action, taking
responsibility for climate resilience and decarbonization of healthcare
systems, and guiding other sectors whose actions impact substantially on
health, carbon emissions and climate resilience.

The world is warming at a faster rate than at any time in human history, The same development pathways and economic choices that
due mainly to the burning of fossil fuels—with an important additional are driving the climate crisis are also directly causing large health
contribution through land-use changes, mainly for agriculture and impacts. These include polluting energy systems that the World Health
forestry. Unless urgent action is taken to cut carbon emissions, global Organization (WHO) estimates to cause almost 7 million premature
warming will soon exceed the 1.5 °C limit set in the Paris climate agree- deaths from air pollution each year5; environmentally destructive and
ment, and current trends are likely to result in over 3 °C of warming by unhealthy food systems that are contributing to the global increase in
the end of the century1. noncommunicable disease; and urban planning and transport systems
Climate change has been identified as potentially the greatest that result in car dependency—contributing to the burdens of physical
health challenge of the twenty-first century2,3. It is bringing more deadly inactivity and road traffic injuries. The healthcare sector itself is now
extreme heat and wildfires, increasing noncommunicable diseases and also a notable contributor to climate change, responsible for almost
facilitating the emergence and spread of infectious diseases, contrib- 5% of global carbon emissions6,7.
uting to health emergencies. It is impacting the health workforce and The world is not yet responding to the scale of this challenge.
infrastructure, reducing capacity to provide universal health cover- Although the ‘right to health’ is at the core of the United Nations Frame-
age. More fundamentally, climate shocks and growing stresses such work Convention on Climate Change (UNFCCC) and the Paris Agree-
as droughts and rising sea levels are undermining the environmental ment, it is largely absent from its operational mechanisms. Less than
and social determinants of physical and mental health, from clean air 0.5% of international climate finance is currently allocated to health
and water, to sustainable food systems, to livelihoods—and threaten- projects8, and only 30% of nationally determined contributions to the
ing the existence of some nations1. Further delay in action will increase Paris Agreement take account of the large health gains expected from
the risks, undermine decades of improvements in global health and climate change mitigation9. Similarly, while health is routinely identi-
contravene our collective commitments to ensure the human right fied as a top priority for climate action, 70% of countries lack adequate
to health for all4. finance to implement a national adaptation plan (NAP) for health,

Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland. e-mail: [email protected]

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Review article https://doi.org/10.1038/s41591-023-02438-w

and few national or international health actors allocate meaningful Providing a single estimate of the overall health burden of climate
resources to climate action10. change is challenging. The WHO has published conservative projec-
As part of their latest annual health monitoring report for the tions estimating the effect of climate change only on malaria, heat
sustainable development goals11, the WHO have identified key objec- exposure in older people, diarrheal disease in children, undernutrition
tives for the health response to climate change. In line with this, we in children and coastal flood mortality, for the 2030s and 2050s. For
outline the main connections between climate change and health and example, under a medium-to-high emissions scenario, it was estimated
summarize three ‘grand challenges’ to protect and promote health in that climate change would cause approximately 250,000 additional
the face of climate change. In addition, we discuss the specific roles of deaths per year by the 2030s20. While the WHO assessments established
the health community in responding to these challenges and driving that climate change was already having a substantial adverse impact
change within and beyond the health sector. on human health, which was projected to increase into the future,
they recognized the inability of existing models to account for major
Current status of climate change impacts causal pathways for which no reliable quantitative models exist, or that
on health impact a wide range of health outcomes or that may have compounding
The Sixth Assessment Report of the Intergovernmental Panel on Cli- effects with other health risks. Examples include persistent drought,
mate Change estimates that up to 3.6 billion people are living in con- migration pressures and risk of conflict. Further methodological work
ditions that are highly vulnerable to the impacts of climate change12. is needed to either improve quantitative models or develop alternative
Low-income and lower-middle-income countries and Small Island assessment approaches to capture these important risks.
Developing States face the greatest health consequences of climate The fact that poorer communities tend to have relatively lower
change, despite contributing the least to historical global emis- carbon emissions, but higher health vulnerabilities to climate change,
sions8,12. It is estimated that over the past decade, the mortality rate highlights the need for specific consideration of equity in designing
from extreme weather events was 15 times higher for populations in the public health response. A just and equitable response requires
highly vulnerable regions than in regions with the lowest vulnerability12. that those with both the largest responsibility for carbon emissions,
Within-country disparities also exist; those living in poverty, older and the greatest means, should bear the largest part of any costs of
people, women, children, indigenous peoples, outdoor workers, the climate change mitigation and adaptation, and that public measures
socially isolated and individuals with preexisting medical conditions should be explicitly designed to promote health equity, for example,
are typically at highest risk12. by prioritizing particularly vulnerable groups.
The WHO estimates that approximately 2 billion people lack access
to safe drinking water13. Furthermore, there are about 600 million Three grand challenges for health and
global cases of foodborne illnesses each year and children under the climate action
age of 5 years carry 30% of the burden of foodborne deaths (or 125,000 Climate change presents a fundamental threat to human health. It
child deaths every year)14. Extreme weather events and climate-related affects the physical environment as well as all aspects of both natural
environmental stressors degrade water and soil safety, thereby increas- and human systems—including social and economic conditions and
ing the risks of waterborne and foodborne illnesses. the functioning of health systems. It is therefore a ‘threat multiplier’,
In 2020, about 770 million people in the world faced hunger, pri- undermining and potentially reversing decades of health progress.
marily in Africa and Asia—with women and children at particularly high We identify three ‘grand challenges’ to address the threat of cli-
risk15. Higher temperatures, rising sea levels and flooding affect all mate change to health.
aspects of food and nutrition security. Consequently, climate-related
reductions in agricultural and marine productivity, biodiversity loss, Promote actions that both reduce carbon emissions and
volatility in food prices and disruptions in food imports further impact improve health
the quality, quantity and diversity of food consumed, leading to food To stay within the 1.5 °C global warming limit set out in the 2015 Paris
and nutrition crises. Agreement and avoid escalating and intolerable impacts on human
Changing temperature and precipitation patterns also create con- health and well-being, the world will need to drastically reduce carbon
ditions that facilitate the transmission of mosquito-borne, tick-borne emissions.
and rodent-borne diseases in many regions12. If prevention methods While efforts to achieve this goal are often discussed in terms of
are not strengthened, this could lead to an increase in deaths from paying higher economic costs to protect the global climate, evidence
vector-borne diseases (already at over 700,000 each year)16. now shows that the global transformation to clean energy would pay
The health risks of climate change can have both immediate for itself through reduced energy costs in as little as 6 years21. This
and long-term consequences. Extreme weather events can lead to transformation would also bring more and better jobs, and greatly
acute mental health conditions such as anxiety, depression and improve health22. Valuing these societal benefits is estimated to bring
post-traumatic stress. The cumulative effect of loss of livelihood, dis- the payback time to less than 1 year21.
placement, disrupted social cohesion and uncertainty from climate Health has a strong influence on estimates of the benefits of cli-
change can also result in longer-term mental health disorders17. mate action, as the development pathways that are driving climate
Research is ongoing to quantify the current and projected change also have very large negative effects on human health. Nota-
future health effects of climate change. A recent study of 43 coun- bly, the sectors driving greenhouse gas emissions—including energy,
tries estimated that 37% of heat-related deaths are attributable to transport, industry, agriculture and waste—are also sources of harmful
human-induced climate change18, and the 2022 Lancet Countdown air pollutants, which increase mortality from cardiovascular disease,
on Climate Change and Health Report found that heat-related mor- respiratory illnesses and cancer23. The air quality improvements that
tality of people older than 65 years increased by almost 70% over would accompany compliance with the Paris Agreement would there-
the past two decades7. The same report estimates 98 million more fore avoid millions of premature deaths every year by 2050, bringing
people reporting moderate-to-severe food insecurity in 2020 than economic benefits that would equal or exceed the mitigation costs24,25.
the average in 1981–2010, due to climate change7. Advances in the These benefits can also be estimated at the national level, and in
application of detection and attribution studies to health outcomes relation to specific policies. A 2021 WHO study modeled the health
are also providing greater insight and confidence regarding the benefits of adjusting Pakistan’s nationally determined contribution to
magnitude of climate change-related health impacts of extreme the UNFCCC under the Paris Agreement. The study found that under
weather events19. a high-ambition scenario, Pakistan could reduce greenhouse gas

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Review article https://doi.org/10.1038/s41591-023-02438-w

Climate change Secondly, health actors should work to identify and accelerate
UHC index response capacity
90 those climate change mitigation actions that bring the greatest health
High
Low
gains, helping to galvanize political and financial support for accel-
85 erated climate action, and sustainable development overall. These
Medium
NA include a just and inclusive transition to renewable energy, phasing
80
out coal combustion and inefficient fossil fuel subsidies, promoting
75 sustainable and healthy urban transport systems and housing, and
sustainable and healthy food systems and diets4.
70

Build better, more resilient and environmentally sustainable

65
health systems
60 Building climate-resilient and sustainable health systems involves a
Total GHG (t CO2-e/cap) systematic and comprehensive approach to strengthening all core func-
55 tions of a health system so it can respond and adapt to the health risks
0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
of climate change29. This coincides with increased political momentum
Fig. 1 | Global variation in health systems’ performance, carbon emissions to transform the provision of universal health coverage in the face of
and climate resilience. For each country (circle), the graph shows WHO increasing demand and rising costs, with a revitalization of primary
Universal Health Coverage (UHC) Index score (vertical axis), versus estimated healthcare, bringing health services closer to people and communities30.
carbon emissions from healthcare (in annual tonnes of carbon dioxide equivalent
To meet even basic levels of healthcare provision, services includ-
per capita; horizontal axis). Circles are colored by score on an aggregate index of
ing clean energy, water and sanitation, waste management, essential
actions taken to build health system resilience to climate change, as measured by
medical equipment and a trained health workforce are essential. To
the WHO Health and Climate Change Survey Report10. The pattern that emerges
is one of large differences in all dimensions. Some countries with currently very
ensure economic and environmental sustainability, this transforma-
high health sector carbon emissions need to urgently reduce emissions without tion should also support the shift toward a circular economy in health
sacrificing health performance, while others with currently low health sector (and in society generally), through rethinking models of care—includ-
carbon emissions need to focus on increasing their health systems performance ing optimizing the use of telemedicine, minimizing consumption and
in a way that ensures a low-carbon future with health equity45. Figure adapted wastage and making more sustainable purchasing decisions. All of the
from ref. 45. GHG, greenhouse gas; NA, data not available. above can cut operational costs, reduce losses from climate hazards
and increase quality of care—enhancing universal health coverage and
primary healthcare. The overall goal for health systems should be to
emissions by approximately 27.5% by 2030, compared to a reference improve delivery of high-quality health services to all, minimize carbon
case scenario. The accompanying air quality improvements could pre- emissions from healthcare, and enhance resilience of health systems
vent more than 65,000 annual premature air pollution-related deaths to climate and other shocks (Fig. 1).
by the same year, with associated annual economic benefits estimated While the health sector is responsible for almost 5% of global
to be about 9 billion USD26. greenhouse gas emissions, this contribution is as high as 10% in some
Solutions exist to cut carbon emissions across all sectors22 and high-income nations6,7,31. Health systems can decarbonize through
would bring a range of large health gains beyond air quality alone. For measures such as more efficient or renewable energy sources, as well
example, road transport is estimated to account for almost one-fifth as through optimizing the use of resources, sustainable procurement
of global CO2 emissions, while the global food system is responsible for practices and waste reduction—as over 70% of carbon emissions from
between 21% and 37% of greenhouse gas emissions27. Sustainable urban healthcare come from the supply chain. Implementing these measures
planning that promotes a shift toward safe walking and cycling as well can bring multiple health system benefits by contributing to a higher
as access to public transport can lead to health benefits from increased quality of care, greater accessibility, more reliable services, reduced
physical activity, reduced ambient air pollution and lower noise expo- occupational hazards from air pollution and waste and reduced costs31,32.
sure28. In high-income countries, a transition toward plant-based diets, In particular, health systems in all countries can benefit from the
lower red meat consumption and less food waste could help to mitigate transition to renewable energy which, over the medium term to long
climate change while lowering the health burden of diet-related non- term is now cheaper and more reliable than fossil fuel sources and
communicable diseases27. In low-income and middle-income countries, generally well suited to health facilities—especially in remote, off-grid
sustainable agriculture and food production can protect local environ- settings. The greatest opportunities for improvement are likely to be
ments, reduce emissions and promote food and nutrition security15. in poorly served populations. For example, over 50% of health facili-
In support of this, a study of nine countries with high greenhouse ties in some countries in sub-Saharan Africa lack core environmental
gas emissions found that, if these countries followed a sustainable services including energy, water and sanitation, and many lack any safe
pathway scenario consistent with the goals of the Paris Agreement, management of healthcare waste33,34. Investments in these settings
this would be expected to bring a total annual reduction of 1.18 mil- can allow countries to ‘leapfrog’ directly to better, cheaper, and more
lion air pollution-related deaths, 5.86 million diet-related deaths and resilient services.
1.15 million deaths due to physical inactivity by 2040 (ref. 24). In addition, in countries across the entire range of economic devel-
The fact that many actions that would reduce carbon emissions opment, vulnerabilities in infrastructure, management practices and
would also bring large health benefits has two major implications. human resources make health systems vulnerable to climate extremes
Firstly, health should be central to policies in all of these sectors, and in (such as heatwaves, high winds, dust storms and floods) as well as
national and international climate policy. Under the Paris Agreement, longer-term threats ranging from persistent droughts and sea level
countries set out their mitigation commitments and adaptation priori- rise, to the spread of infectious diseases to areas that currently lack
ties through their nationally determined contributions and NAPs. The the public health capacities to address them. This makes it essential
2023 WHO Review of Health in the Nationally Determined Contribu- to improve the ability to detect, prepare for, respond to and recover
tions report found that over 90% of countries reflect health priorities from both short-term shocks and long-term stresses.
in this context9. This ensures that health considerations have at least an Increasing climate resilience and controlling carbon emissions
entry point in national and international climate plans and processes, in health systems should not result in separate, parallel structures.
to be delivered through specific policy measures. Instead, it should seek to reinforce and build on existing functions.

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Climate resilience
long-term climate change35,36. These vary, but typically include three
common features. First, implementation of climate-informed sur-
CLIMATE- veillance and response systems for key risks, such as extreme heat,
FORMATIVE
LE TRANS CL
IM
AB LEADERSHIP & AT infectious disease, and food and nutrition security to improve lead
IN & H E
STA ATE GOVERNANCE WO EA -SM times and accuracy of health early warning systems, and to project
SU LIM ALTH G RK LTH A
C E CIN FO
the longer-term effects of climate variability and change. Second,

RT
H N RC
A
IN integration of climate risk into key ‘vertical’ health programs, target-

E
F
PREPA ENCY D

ing a specific disease or population group35. This includes emergency

E

OF ALTH
AS IMATE
LAT

GEM S
T

HE D GHG
S

SES
EN

preparedness and response, infectious disease control, mental health

CL
NE
E-RE

AN IONS
EM
RED

SME
G

and programs focusing on groups with particular vulnerabilities to

CLIMAT

ISS
EMER

& MANA

RISKS

NTS
climate risks, such as occupational health, maternal, newborn and

AND
child health, climate migrant health and healthy aging. Third, sup-
porting resilience and adaptation in ‘health-determining’ sectors,
CLIMATE

SIONS

LY W ORING,
HEALTH

NG
and within communities35. Approximately 25% of the current global

K M GRATE

ARNI
MIS
burden of disease is attributable to environmental risks—largely

IT
-INF RAM
PRO

ON
RIS I N T E
GE
determined by decisions outside of health systems23. The great-
OR

GH
G

AR
&
ME

est health gains, and protection from climate risks, may therefore

&E
D
S

OF DE
M

N
N AG be achieved through collaboration with other sectors, and some
A

V &
E

TE IRO EME CLIM TH

O R M NM N T
F
ATE-RESILIENT AL TE
HE IMA CH
HNAPs also include integration of climate resilience into water and
HE INA ENTA AND
LOW-CARBON
AL NTS L INFRAS CL EAR sanitation service provision, the built environment, food and nutri-
TH TRUCTURE, RE
S
TECHNO GIES &
LO tion security programs and through supporting community-based
SUPPLY CHAIN
health adaptation.
Low carbon Despite progress on assessment and planning, only a quarter of
countries responding in the WHO global survey (11 out of 46) have
Fig. 2 | Conceptual and operational framework for climate-resilient and reached a ‘high’ or ‘very high’ level of implementation. Insufficient
low-carbon health systems. The health system response to climate change
finance was a main barrier to implementation of national strategies and
should build on the core ‘building blocks’ of health systems: leadership,
plans10 (Fig. 3). In addition to an overall scarcity of resources, action on
workforce, information systems, infrastructure and technologies, service
climate change and health faces an additional financial barrier. While
delivery and finance (inner ring); adding additional functionality and capacity
specifically to build resilience to climate shocks and stresses, while minimizing
most governments and development agencies identify both health
carbon emissions (outer ring)45. Figure adapted from ref. 45. and climate change as top priorities, they generally do so separately,
rather than via integrated and mutually reinforcing goals. Meaningful
progress on implementation will only come with clear mandates and
proportionate resources dedicated specifically to the intersection of
The 2015 WHO Operational Framework for Building Climate Resil- climate change and health.
ient Health Systems29 builds on the six core building blocks of health Ultimately, tackling climate change and protecting health will
systems (leadership, workforce, information systems, technology, require effective monitoring and continuous learning and improve-
service delivery and finance), and describes how specific actions to ment. The interaction between climate change, other environmental
build climate resilience can be added to each of these. The framework and social determinants of health, health interventions and health
is now being updated to include complementary actions to control effects, is constantly evolving. This calls for integrated monitoring
carbon emissions (Fig. 2). systems across these dimensions to improve understanding, track
progress and guide health actions.
Implement public health measures to protect from the range
of climate risks to health The unique role of the health community in
The diverse risks that climate change presents to health, many acting delivering transformative change
through long causal pathways, require action not only within healthcare The climate crisis requires transformative action from across society.
(that is, curative services), but also on public health functions, including However, the health community—including frontline health workers,
on the environmental and social determinants of health. Ministries of Health, intergovernmental and nongovernmental health
The essential first step is to understand the scale and nature organizations and health academics—has a unique role to play.
of health vulnerabilities to climate variability and change, taking We outline three key functions for the health community in
account of important determinants including geography and socio- responding to the climate crisis.
economic condition, and considering differential impacts on sub-
populations—typically in the form of a climate change and health Leadership and advocacy
vulnerability and adaptation assessment. This informs the develop- There is increasingly strong evidence from experimental studies
ment of evidence-based NAPs and interventions, most commonly in from around the world that presenting a positive vision of a health-
the form of a health national adaptation plan (HNAP) aligned with the ier, more environmentally sustainable common future, is effective
whole-of-government NAP. in ensuring public support for climate action, and cutting across
Many countries have made substantial progress on assessment political divides37–40.
and planning in recent years. The 2021 WHO Health and Climate Change Health researchers have assembled a large body of evidence on the
Global Survey found that approximately half of all countries surveyed health benefits of climate action—and the overwhelmingly negative
(48 out of 95) reported having conducted a climate change and health health consequences of inaction. Health is also central to key regula-
vulnerability and adaptation assessment, while 52% (49 out of 95) tions and legislation, from air quality and emissions standards, to food
reported having a national climate change and health strategy in place10. standards, to protection of the right to health under national and inter-
HNAPs generally include intervention measures that are shown national law and conventions41. Health institutions should therefore
to protect against current weather and climate hazards, and that can build not only the applied evidence base, but also their own individual
therefore be expected to provide some level of protection against and institutional capacity to engage more directly in policymaking.

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Review article https://doi.org/10.1038/s41591-023-02438-w

Insufficient finance/budget 70%

Insufficient human resource capacity 54%

COVID-19-related constraints 52%

Insufficient research and evidence 46%

Insufficient technologies, tools and methods 43%

Insufficient prioritization or competing priorities 39%

Insufficient multi-sectoral collaboration 35%

Incomplete or lack of comprehensive plan or strategy 9%

Other 7%

Lack of endorsement by ministry of health 7%

0 10 20 30 40 50 60 70 80 90 100
Percentage of countries (%)

Fig. 3 | Main barriers to implementation of national health and climate change plans. Data from the WHO Climate and Health Country Survey10; 46 country
respondents, multiple responses possible.

At the same time, health professionals are increasingly engaged on

climate change in a range of roles, from actions to reduce carbon emis-
sions in their professional work, to organized expressions of support
Box 1
for stronger international climate action (https://healthyclimateletter.
net/), to a spectrum of public engagement and nonviolent protests to Opportunities for the health
protect their patients from the impacts of climate change and related
threats including air pollution. The large number of health profession- community to influence climate
als, their direct personal connection to individuals and communities,
and their position among the most trusted professions in the world42, and health policy
mean that they have the potential to be among the most powerful
advocates for a healthy future through climate action (Box 1). The most direct point of influence is within healthcare settings.
Health professionals are increasingly engaged in staff-led and
Evidence and monitoring system-wide initiatives to reduce the climate impact of healthcare
Research on climate change and human health is a rapidly growing and extending that role to use their expertise and public trust
field, with the number of articles published each year surging more to advocate for wider societal actions to protect health from
than sixfold over the past decade43. Despite the increase in volume, the climate change.
research itself remains uneven. Most of the currently available stud- National and local government health agencies have an
ies are focused on assessing health impacts of climate change, with a important role in leading public health actions to protect from
particular emphasis on a subset of causal pathways—notably the direct climate risks, providing health assessments of the impacts of
health effects of excessive heat. There is a relative lack of research on policies in key health-determining and carbon-emitting sectors,
other major questions on which health policymakers have expressed such as energy, transport, food systems and urban planning, and
demand44—notably the effectiveness of health adaptation measures, applying relevant health standards and regulations, for example,
the diverse range of potential health co-benefits of both adaptation and on air quality. Health actors should engage fully in relevant national
mitigation measures, the development of decision-support tools and and international climate mechanisms, such as the development
economic assessments of the benefits and costs of climate and health of NAPs, and nationally determined contributions to the Paris
actions. Research output is also highly unevenly distributed across geo- Agreement. They also have a critical and currently neglected role
graphical regions, with many more studies conducted in high-income in accessing climate finance for health, and mainstreaming climate
countries compared to low-income and middle-income countries. mitigation and adaptation across health investments.
Often, data are not available at a level of resolution that corresponds The rapid increase in the number and range of actors now
to decision-makers’ needs—that is, for national or subnational levels, engaging on climate change and health calls for a collective and
or disaggregated by gender, age, ethnicity or socioeconomic status—to coordinated effort. The Alliance for Transformative Action on
assess the differential effects of actions on different population groups. Climate and Health (https://www.who.int/initiatives/alliance-for-
In addition, while much applied research focusses on improving capac- transformative-action-on-climate-and-health/), brings together
ity to protect populations from current climate risks, there is also a over 65 countries that have committed to build climate-resilient
need for research that takes account of the specific characteristics of and low-carbon health systems, together with health practitioners,
long-term climate change, including future projections of changes in development partners and technical experts in an open partnership
various determinants of health, such as aging and urbanizing popula- to accelerate climate and health action.
tions that are particularly vulnerable to extreme heat.
Similar considerations apply in the related fields of monitoring
and progress tracking. There has been rapid progress in recent years further development. These include, among others, standards and indi-
through initiatives such as the triennial WHO Health and Climate cators for climate-resilient health systems and low-carbon healthcare,
Change Global Survey10 and the annual Lancet countdown on health and comprehensive and coherent indicator frameworks that connect
and climate change7. However, as the integrated field of climate change the high-level sustainable development goals on climate change and
and health is a relatively new one, there are a range of issues that require health with exposures, vulnerabilities, health effects and progress in

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Review article https://doi.org/10.1038/s41591-023-02438-w

implementing climate and health interventions. There is also a need for mechanisms for products that harm health (which could potentially
further strengthening of platforms to make emerging evidence more include fossil fuels).
widely accessible and more directly connected to policy, for example, Cutting across all of the implementation functions above is the
through regional and national climate change observatories connected issue of finance. While climate change is now recognized as one of the
to policy institutions. greatest global health threats, there are no dedicated multilateral or
The urgency and existential threat of climate change calls for bilateral funding mechanisms of the kind that exist for some specific
greater investment in climate and health research and demonstration diseases (for example, AIDS, tuberculosis and malaria), health threats
projects, and implies that it should pursue a more demand-driven (for example, pandemics) or population groups (for example mater-
approach to evidence generation, involving decision-makers and nal, newborn and child health). There is therefore an important role
affected populations as directly as possible. Such research should for the health sector in facilitating simpler, faster and greater access
be focused on the need to limit global warming, protect and improve to existing health and climate funding streams, assessing the scale of
health, and ensure universal access to high-quality, climate-resilient, health impacts which cannot now be avoided and therefore should
environmentally sustainable health services. be supported through any ‘loss and damage’ funds, and proposing
improvements in institutional and financial mechanisms for a scale
Implementation up of investment.
Guided by its values and mandates, and informed by the available evi-
dence, the health community can drive the necessary transformation Conclusion
through a range of functions: via direct responsibility for the formal Climate change is already having major negative impacts on public
healthcare sector, more broadly through public health functions into health, and these are increasing rapidly. The societal changes required
the wider community, and also in an advisory role capacity for other to stabilize the global climate will entail initial financial cost, but this
sectors that have a strong influence on health and climate change. is outweighed by the health benefits that are projected to result—even
The most direct effect that health professionals can exert is before considering the rapid economic payback time—and the funda-
through their individual and collective actions within their own work, mental benefit of maintaining the environmental conditions in which
to deliver improved, climate-resilient and low-carbon health systems. humans can survive and thrive.
The early experience in this emerging field indicates that success fac- The range of threats that climate change presents to health is large,
tors include a strong legislative basis (for example, a legally binding diverse and complex, presenting major challenges to health systems,
climate act mandating emissions reductions across sectors), political and to the global health architecture, which is largely supported by
leadership from senior management from within the health system, vertical programs to address individual diseases or health issues. A
investment in analytical and technical support and networking capac- goal-driven approach to (i) promote actions that both reduce carbon
ity and, above all, the positive engagement and commitment of the emissions and improve health, (ii) build better, more resilient and
health workforce. environmentally sustainable health systems, and (iii) implement public
The specific actions to be taken will depend on the professional health measures to protect from the range of climate risks to health, can
role and institutional context, and particularly at this relatively early help to structure and accelerate the health response to climate change.
stage of the development of the field, will depend heavily on learning The scale and scope of the health sector response needs to be com-
from and sharing experience. This is now being supported from the mensurate with the size of the health threat. While much progress has
international level through a range of policy and technical guidance, been made, much more is still needed. The challenges to delivering this
including the WHO’s Conceptual and Operational Framework for Build- transformation are largely political rather than technical, and require
ing Climate Resilient and Low Carbon Health Systems45, guidance on both leadership and public support. The health community has a criti-
developing roadmaps for low-carbon healthcare31,32, as well as tools for cal role to play—directly within the health sector by delivering improved
assessing and managing carbon emissions46–48. It is also supported by services while reducing carbon emissions, as well as through their
new collaborative initiatives, notably the Alliance for Transformative public health functions to safeguard and improve the environmental
Action on Climate and Health (Box 1). and social determinants of health, but also, crucially, through influenc-
Outside healthcare services, public health agencies have a criti- ing other sectors. The most important role, however, is likely to be as
cal role in strengthening and adapting disease prevention to the new leaders and advocates, changing the narrative from the threat of the
challenges presented by climate change. In addition to assessing health climate crisis, to a positive and healthy future through climate action.
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45. World Health Organization. Conceptual and Operational Additional information

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and Health (CLIMAQ-H). https://www.who.int/europe/tools-and- Peer review information Nature Medicine thanks Kristie Ebi, Matthew
toolkits/climate-change-mitigation--air-quality-and-health- Chersich and Sarah Whitmee for their contribution to the peer review
(climaq-h) of this work. Primary Handling Editor: Karen O’Leary, in collaboration
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49. International Association of National Public Health Institutes. regard to jurisdictional claims in published maps and
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and supporting national public health institutes as key climate
actors. https://ianphi.org/news/2021/roadmap-climate- Springer Nature or its licensor (e.g. a society or other partner)
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Acknowledgements self-archiving of the accepted manuscript version of this article is
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Competing interests © World Health Organization, under exclusive licence to Springer

The authors declare no competing interests. Nature America, Inc. 2023

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