Strengthening key health measures in national climate plans

The majority of national climate adaptation plans fail to fully integrate health needs or engage populations most at risk from climate change, found an international team of investigators led by Weill Cornell Medicine.

Their study was published on June 10 in Lancet Planetary Health.

Senior author Ilan Cerna-Turoff, assistant professor of epidemiology in emergency medicine at Weill Cornell Medicine, and his study team reviewed climate adaptation policies from 198 countries and the European Union, finding that while 88% mentioned the health impacts of climate change, important gaps in health integration remain. Progress on health integration was variable, with several regions of the world falling behind. Some health conditions were nearly absent.

Despite the widespread recognition that specific demographic groups were disproportionately affected by the health impacts of climate change, only 12% of the plans engaged these groups in their efforts. Many plans also lacked sufficient budgeting for monitoring and evaluation and health-related climate actions.

"There are many concrete ways that policy makers can more effectively integrate health in climate adaptation plans," Cerna-Turoff said. "We need more cross-sector coordination and meaningful engagement with disproportionately affected communities. Very often, governments operate in silos."

Ministries of climate or environment are often charged with drafting climate plans, and health ministers are usually not included in these meetings. The latter need to be involved throughout the process in planning, budgeting and establishing metrics for success, Cerna-Turoff said, noting that many plans currently lack regional subplans or fail to account for distinct community-level needs.

For example, the national plans often lacked strategies for urban heat island effects or for limited health system resources in rural communities. He said engaging subnational health leaders is crucial to identifying and closing such gaps.

"Successful implementation requires a decentralized framework," he said.

Most of the national climate adaptation plans acknowledge that women, children, people with disabilities, low-income individuals and older adults are particularly vulnerable to the impacts of climate change. Yet some heavily affected groups were underrepresented. Only about half of plans acknowledge the impacts on Indigenous people and climate-displaced or migrant populations.

Few plans actively engaged vulnerable groups in the planning process, as recommended by several key guidance documents on climate and health, including the World Health Organization's Global Action Plan on Climate and Health, adopted last year by the World Health Assembly, the decision-making body of the World Health Organization.

"Communities need to know what is happening for the plans to be effective," Cerna-Turoff said, noting that community members may have insights into their own needs and potential barriers to accessing care. He highlighted the work of Pacific Island nations in successfully engaging Indigenous community leaders in climate adaptation planning. Additionally, he suggested that plans consider the needs of individuals across the lifespan.

According to the study, many plans highlighted the potential for climate change to increase the spread of infectious diseases, including those transmitted by insects, such as mosquitoes or ticks, and the potential for increases in chronic conditions. National plans also frequently highlight harmful climate impacts on food, water supplies and sanitation. However, most efforts fail to mention other key areas of health, such as violence, injuries, mental health, allergies, or sexual and reproductive health.

Cerna-Turoff suggested that countries conduct a comprehensive assessment of all relevant health conditions that are likely to be affected by climate change within their national borders. Based on current evidence and projections for the future, countries can build comprehensive policies. He suggested sharing of lessons learned between nations, and consulting with climate and health experts on plans tailored to a complete range of health conditions.

One of the largest gaps the team noted was in monitoring, evaluation and budgeting, a central component of effective health systems. Roughly half of countries did not outline their targets or structures for measuring progress. Only six countries had outlined complete plans for financing health within their climate adaptation plans.

The report also emphasized the need to adequately budget for climate-related health needs and set measurable goals to track progress toward implementation.

Said Cerna-Turoff: "We need clear targets and sufficient budgets to adequately address climate impacts on health."

Bridget Kuehn is a freelance writer for Weill Cornell Medicine.