2023 Healthy NDC Scorecard
Nationally Determined Contributions (NDCs) are country commitments to deliver the goal of the Paris Agreement, limiting global temperature rise to well below 2C, and preferably to 1.5C. The 2023 edition of the Healthy NDC Scorecard assesses the consideration of health in the 58 NDCs submitted between 1st October 2021 and 23rd September 2022. Details of the 2021 edition of the Healthy NDC Scorecard can be found here.
The GCHA Healthy NDCs Scorecard assesses the extent to which governments’ national climate commitments recognise and respond to the abundant linkages with health. Ensuring the integration of health into climate policy protects populations, maximises economic benefits, and builds public backing for ambitious climate policies which are so urgently needed. Failure to include health in NDCs is a missed opportunity for people, the public purse, and political support.
NDCs were assessed based on their attention to six health categories: integrated governance, health impacts, health sector action, health co-benefits, economics and finance, and monitoring and implementation. Three points were available for each category, with a total possible ‘health score’ of 18. In addition, where available, the scorecard also includes information on governments’ overall climate ambition, reflecting the most recent analysis of Climate Action Tracker. Full details of the methodology can be in the 2023 report, including on updates since the 2021 analysis, are accessible here.
Read the press release here: Healthy NDC Scorecard: As ‘Health COP’ Approaches, Analysis Shows Big Emitting Nations Doing Too Little to Protect Health from Climate Change
GCHA is extremely grateful to Iris Blom, Emaline Laney, Juliette Mattijsen, and Blanca Paniello Castillo for their collaboration in developing the methodology and for carrying out the analysis for this project. If you have any questions about this work, please contact Jess Beagley at [email protected].
Ranking and Implications for UNFCCC Policymaking
The vast majority of NDCs analysed (90%) refer to health and climate linkages to some extent. Leading health scores were secured by Burundi (17 points) and Côte d’Ivoire (15 points), closely followed by the Democratic Republic of the Congo, Dominica, State of Palestine, and Venezuela (all with 14 points). Notably, out of the 16 countries scoring 11/18 or above for inclusion of health, all were low- and middle- income countries. Meanwhile, Australia, Japan, and New Zealand were among the countries which scored zero for inclusion of health.
Of all UNFCCC Regions, the highest average scores were achieved by Parties from the United Nations Latin America and Caribbean Region (10.2 points), followed by Parties from the Africa region (9.4 points), Asia-Pacific (6.3 points), Eastern Europe (2.3 points), and Western Europe and Others Group (1.2 points).
There is a mismatch between the focus on health in NDCs and the climate ambition of many Parties: increased recognition of health does not necessarily translate to increased climate action. Notably, G20 countries Indonesia, Saudi Arabia, Turkey, outgoing COP Presidency Egypt and incoming COP Presidency the UAE, were assessed by Climate Action Tracker as having emissions reductions targets in line with >4°C temperature rise – a level of warming which would far exceed the limits of adaptation, and be catastrophic for human health. This is inconsistent with the mentions of health and climate links made in the NDCs of Egypt and the UAE, which secured health scores of 8 and 10 points respectively.
With regards to UNFCCC policymaking, the recommendations of the Global Stocktake, which will inform the development of the next round of NDCs, should include guidance for integrating health into NDCs to maximize benefits for people and the planet. The widespread recognition of the health impacts of climate change by countries make the case for the need for health to be elevated within UNFCCC discussions on loss and damage. Similarly, the elaboration of adaptation actions in the health sector, as well as reference to the recognition of health co-benefits of adaptation in other sectors, show the relevance of greater consideration of health and wellbeing within discussions on the Global Goal on Adaptation. The mismatch between recognition of health and climate linkages but low levels of mitigation ambition could be improved by embedding health in the UNFCCC Mitigation Work Programme. Finance is essential for action to be taken, but both climate change finance and health finance are stretched thin. Integrated health and climate projects may help to make the best use of available funds by maximising co-benefits.
Further discussion of the scores can be found in the report.
Country scorecards can be downloaded in multiple languages here. Please share them on social media, using the hashtag #HealthyNDCs
A wide variety of health threats are identified in Albania’s NDC, including water-borne and vector-borne diseases, mental health impacts, respiratory and cardiovascular diseases due to deteriorating air quality, deaths from heatwaves and injuries from floods and other extreme weather events, wildfires, and damage to healthcare infrastructure. The number of people affected by different hazards are quantified. With regard to health sector action, a vulnerability and adaptation assessment has been drafted, and actions planned by the health sector include research and monitoring of vector-borne diseases and capacity building to address health impacts, “climate proofing” of health facilities, and limiting incineration of clinical waste.
Argentina’s 2021 submission states clearly that the purpose of the document is to update the emissions target, and that the 2020 NDC is otherwise unchanged. As such, the 2020 NDC was analysed to give the health score, and the CAT assessment of the 2021 NDC was used for the climate score. The 2020 NDC takes an integrated approach to health in its NDC, taking health as one of 15 principles guiding the design, implementation, and monitoring of all national adaptation and mitigation actions, and recognises that “the pandemic has forced us to reflect on the importance of human health and its interrelation with the health of the planet”. Health impacts include the between climate change and zoonotic and vector-borne diseases, and contamination of drinking water. According to the NDC, in terms of health sector action, impact scenarios have been assessed, and by 2030, policies, measures, and actions will have been implemented to provide a timely response to the new emerging epidemiological profiles of environmental and climatic changes, while guaranteeing the operation of the health system. Early Warning Systems will have been strengthened for events that have an impact on health, and climate-sensitive diseases that expand their geographical border will be addressed. Greenhouse gas emissions generated by healthcare establishments will be reduced. A dedicated health and climate action plan, the Plan de Acción Nacional de Salud y Cambio Climático (PANSyCC), was published in 2019. Beyond the health sector, the NDC includes the health of workers when defining a just transition, and health co-benefits of action relating to agriculture, energy, gender, nature-based solutions, transport and water are mentioned. Despite its improved emissions reduction target, Argentina’s 2021 NDC is in line with up to 4°C global temperature rise, which would be catastrophic for human health.
Australia’s 2022 NDC includes no mention of health and climate linkages, but its updated emissions target will contribute to the protection of human health, although it is assessed by CAT as being in line with up to 3°C of warming and is thus not yet compliant with the Paris Agreement. The 2022 NDC was submitted shortly after the start of the Albanese government. The updated emissions target was an urgent priority, but can be further strengthened. In the next NDC, recognition of the health and climate links, which will be addressed in Australia’s national climate and health strategy currently under development, could be integrated into the NDC to embed health across national climate action.
Bahrain makes no mention of health and climate linkages anywhere in its NDC.
Belarus makes no mention of health and climate linkages anywhere in its NDC.
Benin refers to the reduction of drinking water supply, both due to the levels of increased evaporation and to saline intrusion on account of sea-level rise. Benin seeks to improve health and well-being of all by increasing resilience to climate change, and refers to a National Health Development Plan, National Community Health Policy, and Cholera Containment Plan. Solar power and solar water heating will be installed in health centres. Benin notes the health co-benefits of air quality improvement through mitigation measures which reduce SLCPs, as well as referring to the health co-benefits of climate action in the agriculture, energy, transport and other sectors. Budget for health sector actions are listed in Annexe 2, and target reductions of different air pollutants are included in table 4.
Bolivia notes in its NDC that in order for the National Healthcare System in Bolivia to anticipate, prepare, prevent, respond and recover quickly from the risks associated with the consequences of climate change, the sector must seek to maximize the health benefits of intersectoral climate action. Health risks of climate change include hunger and malnutrition, and vector-borne disease. Within the health sector, Bolivia will organise observatories to generate data to inform early warning systems for climate-related diseases, emergencies and disasters, prepare health vulnerability assessments and a national health sector adaptation plan, reduce greenhouse gas emissions, and increase the resilience of health infrastructure and services. Actions in the agriculture, waste, and water sector are linked to SDG3, with accompanying targets.
While Brazil’s NDC makes several mentions of health, the only reference to a link between health and climate (rather than a background mention of health unrelated to climate change) is the need for the government to improve sanitation conditions as part of the NDC.
The NDC of Burkina Faso describes the establishment of a Coordination Unit that will include representatives from eight ministries, including the ministry of health. Within the health sector, action will be taken to improve the medical technical platform, strengthen the capacities of healthcare personnel, and construct health infrastructures. Solar power will be installed in medical centres, with associated budget. Health co-benefits of actions in the agriculture, transport and water sectors are included, with targets for water and sanitation.
In many respects, the NDC of Burundi is exemplary. With regard to integrated governance, the health sector is specifically named as having contributed to the development of the NDC, as well as being involved in the implementation of specific actions. Health was a consideration in the prioritisation of actions. In terms of health impacts, the NDC refers to the links between risks including the spread of vector-borne disease, and records the many deaths due to flooding. For health sector action, actions were identified following a vulnerability analysis, and centre on raising awareness and capacity building in communities. In addition, the NDC refers to plans to electrify 455 health centres with solar energy, which would support mitigation efforts in the longer term, as well as improving reliable energy access in the shorter term. While Burundi secured points on three different criteria in the health sector action category, additional planning for actions to support resilience, beyond awareness raising, would be crucial to protect the population. Health co-benefits of action across other sectors are well recognised in the NDC, including agriculture, energy, transport and water. Budget for awareness raising activities includes estimates for both unconditional and conditional actions. Finally, with regard to monitoring and implementation, indicators and timelines are described for several actions in the health sector, and other health determining actions.
The NDC of Cameroon notes that drought is an amplifier of diseases to which 3,000,000 people are exposed. It is estimated that five droughts per decade will occur, causing a death toll of at least 500 per event in the Sudano-Sahelian Zone. Food and water insecurity are described in the context of necessary health investments. General reference is made to the need to strengthen adaptive capacity of the health sector. Health co-benefits of climate action in the agriculture and water sectors are recognised. An estimate for the human costs of climate inaction is provided, as well as budget for actions in the health sector.
In its NDC, the Central African Republic notes that conditions remain favorable to epidemics linked to diseases such as meningitis, typhoid, respiratory infections, diarrheal diseases, and malaria. Vulnerability assessments for public health will be completed by 2025. Surveillance systems will be developed for malaria, cholera, meningitis, and other sensitive diseases, and basic hygiene and sanitation will be promoted. Health co-benefits are referred to for water and waste. A total estimated cost for public health actions is provided. Targets or indicators are provided for the health sector actions described, and for availability of drinking water.
With regard to integrated governance, within the government of Chad, the Directorate of Environmental Education and the Fight against Climate Change (DEELCC) provides a coordination function for climate action with sectors including the Ministry of Health, and health is deemed to be a relevant consideration across the actions described in the NDC. Health is impacted by drought (malnutrition, sanitation), high temperatures (malnutrition, potable security, loss of life, sanitation), floods (diseases, loss of life, sanitation), violent winds (eye conditions). The numbers of deaths due to former droughts are recorded. Reference is made to health co-benefits of action in agriculture, energy, nature-based solutions, waste, and water.
The NDC of China refers to widespread impacts of climate change on health, including casualties and deaths from forest fires. China notes the need to respond to air pollution and environmental health emergencies in natural disasters, epidemics, and diseases in flood-stricken areas. Research projects related to health risk assessment and adaptation to climate change have been carried out and technical guidelines have been formulated for health risk assessment of climate change. The health sector is included in China’s National Strategy on Climate Change Adaptation, with actions also detailed in the NDC to respond to specific health risks. Action to conserve energy and reduce emissions is being taken across public institutions, including hospitals, and a carbon emissions trading scheme is being piloted for medicine. Co-benefits of adaptation in coastal zones and the water sector for health are noted. Despite this integration of health throughout the NDC, the emissions reductions target of China’s NDC is assessed by CAT as being in line with up to 4°C of warming.
Comoros identifies the health sector as being highly vulnerable to climate change. Specific reference is made to malaria. An early warning and intervention system for new diseases is being developed to be effective throughout the territory, and strategies are being developed for malaria and emerging diseases. The importance of gender action for realising the right to health is described.
Côte d’Ivoire seeks to reinforce intersectoral coordination for health adaptation, and counts health as a cross-cutting aspect of the NDC which can generate significant co-benefits. Côte d’Ivoire notes that, according to the World Health Organization, more than 34,000 premature deaths per year are associated with exposure to air pollution nationally. Other health threats include increased temperatures, coupled with drought and dust (sand, pollen, etc.), which can lead to respiratory (asthma) and cardiovascular diseases, and intense effects on pregnant women and women in the menopausal phase; while variations in rainfall could amplify the risks of vector-borne diseases (malaria, dengue fever), and water-borne and diarrheal diseases (cholera). Risk to life due to sea-level rise is also noted. Actions in the health sector include strengthening surveillance of sensitive diseases linked to climate change; strengthening technical capacities to deal with a resurgence of diseases linked to climate change; and strengthening institutional capacities. Due to the simultaneous reduction of SLCPs and
air pollutants in addition to GHGs as Côte d’Ivoire implements its NDC, the effects of improving
indoor and outdoor air quality have been estimated at about 7,000 premature deaths averted per year in 2030, thus considerably improving public health. Health co-benefits in the energy, transport, and waste sectors are mentioned, with specified targets. Health sector action is included in the adaptation budget.
air pollutants in addition to GHGs as Côte d’Ivoire implements its NDC, the effects of improving
indoor and outdoor air quality have been estimated at about 7,000 premature deaths averted per year in 2030, thus considerably improving public health. Health co-benefits in the energy, transport, and waste sectors are mentioned, with specified targets. Health sector action is included in the adaptation budget.
The Democratic Republic of the Congo mentions the number of deaths caused by floods, droughts, coastal erosion, and heatwaves. The NDC makes reference to assessing health vulnerability and strengthening the preparedness of health systems to face the disease burden of climate-sensitive diseases. The Democratic Republic of Congo seeks to “improve access to public health services for poor populations vulnerable to climate change” by improving, building, rehabilitating and maintaining health infrastructure and equipment; and improving people’s access to basic health services in order to reduce risks. The Ministry of Health will stimulate and increase the exchange of good practices, experience data and technical skills with a view to strengthening health, improving health monitoring and protecting the environment. Health links with climate action across agriculture, gender, nature-based solutions and water are recognised. Budget is included for health sector actions, and indicators are recorded for both health sector action and for forestry, agriculture, coastal zone and water resource actions linked to health.
With respect to integrated governance, the Ministry of Health, Wellness and New Health Investment collaborated with other agencies to address climate actions for health as part of a national consultation on the Global Framework for Climate Services. Dominica refers to the devastating multitude of impacts on lives and livelihoods, as well as the impacts of climate-related land degradation on health and nutrition. The NDC notes the health impacts of Tropical Storm Erika in 2015, which caused the deaths of 30 people across the island in the nation’s worst disaster since Hurricane David. Also in 2015, The Ministry of Health, Wellness and New Health Investment conducted a Vulnerability and Adaptation Assessment for climate change and health. Training for all district health care workers on the impacts of climate change on health was conducted by the Ministry of Health, and a national media campaign was conducted to highlight the health impact of climate change. According to the NDC, climate change was previously mostly regarded as an environmental phenomenon. Health co-benefits are referred to in the agriculture, energy, gender, nature-based solutions, transport, water and waste sectors. A budget is included for Health, Wellness and New Health Investment. With regard to monitoring and implementation, Dominica seeks to have 80% community health service functional within ~1-2 hours of a major event by 2025, and zero climate-related fatalities and 100% Smart Health Centres by 2030.
As the Presidency of COP27, Egypt recognises in its NDC that severe storms and other extreme weather events that have increased significantly in Egypt over the last ten years, inducing casualties and economic losses, as well as heat stress presenting challenges within cities. Egypt seeks to develop weather forecast and early warning systems to provide citizens with information for time-sensitive actions to reduce injury, sickness, and deaths, and to raise the efficiency of the health care sector to deal with climate change and increase awareness on pro-active health measures to limit risks and confronting crises and disasters on both political and community levels. Health co-benefits are alluded to from climate action in the infrastructure, nature-based solutions, and water sectors. In order to meet demands for drinking water, Egypt targets a total design capacity of 4 million m3 daily for water desalination. Despite securing 8 points for health, Egypt’s NDC is in line with >4°C of warming.
In El Salvador, the Ministry of Health participated in the process to develop the NDC. Support provided by the Pan American Health Organization sought to strengthen the coordination of seven institutions that work in the health sector and civil society organizations through the Intersectoral Commission on Health (CISALUD) as an intersectoral working group. Under this commission, the issue of climate change was examined from various angles: environmental health, epidemiological surveillance, first level of care, etc. Although CISALUD no longer exists as a structure, the Social Plan maintains the mandate to work on the issue of climate change from an intersectoral perspective. The NDC includes recognition of health threats including heat
waves, changes in intra- and inter-annual precipitation patterns, including rainfall variability, and the incidence of extreme wet and dry hydrometeorological events, influencing the spread of insect disease vectors. El Salvador plans to improve epidemiological surveillance of climate-sensitive diseases, (especially arbovirosis), and to develop a model for nutrition surveillance for populations affected or at risk of climate-related threats. The NDC refers to identification of technological changes in hospitals that allow significant reductions in energy consumption and mitigation of greenhouse gases.The NDC notes links between SDG3 and action in across the agriculture, buildings, city, energy, transport, waste and water sectors. A budget is included to address epidemics. Monitoring is planned for health related water and sanitation measures.
waves, changes in intra- and inter-annual precipitation patterns, including rainfall variability, and the incidence of extreme wet and dry hydrometeorological events, influencing the spread of insect disease vectors. El Salvador plans to improve epidemiological surveillance of climate-sensitive diseases, (especially arbovirosis), and to develop a model for nutrition surveillance for populations affected or at risk of climate-related threats. The NDC refers to identification of technological changes in hospitals that allow significant reductions in energy consumption and mitigation of greenhouse gases.The NDC notes links between SDG3 and action in across the agriculture, buildings, city, energy, transport, waste and water sectors. A budget is included to address epidemics. Monitoring is planned for health related water and sanitation measures.
Eswatini refers to epidemics and mortality due to climate change in its NDC. An adaptation assessment of the health sector was conducted. In terms of action in the health sector, Eswatini plans firstly enhance legal, policy and institutional frameworks for health sector through mainstreaming climate change into the national health policy and other strategic documents; strengthening climate-informed disease control programs and surveillance systems; integrating the health management information system with other systems from relevant sectors; and strengthening the preparedness and resilience of the health sector to respond to climate related emergencies and illnesses. Second, Eswatini seeks to build capacity in the health sector through strengthening capacity of healthcare workers, and educating and informing the public of the needed measures to protect health from the adverse impacts of climate change. Third, the government plans to leverage the use of technologies to help health sector adapt to climate change through adopting sustainable climate smart technologies to enhance the resilience of communities to the adverse effects of climate change and establishing a multi-hazard early warning system. Fourth, the NDC refers to enhancement of the adaptive capacity in the health sector through financing health actions to address inequities and climate related vulnerabilities; promoting capacity building through research and development, education and awareness, and training in climate change related issues; and mainstreaming gender responsive climate policies and emphasize special efforts to support vulnerable groups. Health co-benefits of climate action are recognised across the agriculture, energy, gender, water and waste sectors.
Gabon refers to the links between climate change and emerging diseases in its NDC, as well as the threat of elephant conflicts (due to reduced fruiting of rainforest plants) to the wellbeing of rural populations, and seeks to address these threats through adaptation actions in the health sector. Health co-benefits are alluded to from the nature-based solutions and water sectors.
Ghana mentions the need to manage climate-induced health risks in its NDC but does not provide further details. In terms of action in the health sector, it refers to the automation and the use of renewable energy to back the deployment of a disease surveillance system and climate early warning systems. Measures including improved cookstoves and electric vehicles, are expected to reduce black carbon emissions for better public health outcomes. Through the actions in its NDC, Ghana expects to avoid at least 2,900 premature deaths per year from improved air quality. A budget is included for managing gender-related and climate-induced health risks. Projections for the reduction of various air pollutants are included, and improved management of climate-induced and gender-related health risks are expected to benefit 31,500,000 people.
The Ministry of Public Health and Social Assistance of Guatemala was involved in the update of its NDC, and is tasked with monitoring of water basins. The importance of coordination between health and other sectors is emphasized. Climate change is recognised to be one of the main threats facing humanity. The NDC states that “since to date there is no information or history of sectoral linkage [between the health sector] with the issue of climate change that would allow the establishment of goals and responsible parties”, there are no defined goals for the health sector, but rather a general roadmap, including improvement of internal coordination of the health ministry, improving inter-institutional coordination, establishing financing sources, and strengthening of research and technical capacities. Health co-benefits of mitigation and adaptation are recognised and considered across sectors, and specifically in the agriculture and waste sectors. The NDC includes target dates for interim actions in the health sector, and also aims to reduce the prevalence of chronic malnutrition in children under five years by 1.75% per year.
The NDC of Guinea-Bissau is considered to be aligned to SDG3. Human health is identified to be without adequate funding for adaptation and “should be prioritized through new programs and initiatives”. Availability of drinking water is jeopardised by rising temperatures and decreased precipitation, as well as increased salinity due to sea-level rise. Health co-benefits of measures in the agriculture and water sectors are alluded to.
In its NDC, Haiti refers to health losses and damages, and the threat of climate change to sanitation. Actions for the health sector include reinforcement of prevention systems and treatment of climate-related diseases, provision of adequate equipment in health facilities, establishment of education programme on environmental and health, and capacity building of staff. Health co-benefits are alluded to across agriculture, infrastructure, waste and water. Budget is specified for multiple actions by the health sector, along with indicators within the health sector and for health adjacent sectors.
India’s 2022 NDC is intended as an update to its existing 2016 NDC. In its cover letter, the government of India confirms that the 2016 NDC should be considered to remain in force, with the 2022 submission updating the emissions reduction target and providing some additional content. Both iterations of the NDC describe the aim of propagating a healthy and sustainable way of living based on traditions and values of conservation and moderation. The 2016 NDC notes that climate change will increase health related stress from extreme weather-related disasters such as wider spread of vector-borne diseases as malaria and dengue and increasing frequency of heat and cold waves, and that with changing climate, islands are highly susceptible to frequent and more intense tropical cyclones and associated storm surge, droughts, tsunamis and volcanic eruptions, which will have adverse impact on economy of these islands and health of their inhabitants. India’s 2016 NDC refers to the formulation of a health ‘’Health Mission’ under the National Adaptation Plan which analyses epidemiological data, and increases knowledge and awareness. In the 2016 NDC, India sets out the aim to eliminate malaria by 2030. India’s NDC emissions reduction target is assessed by CAT as being in line with up to 3°C.
In Indonesia, the removal of fossil fuel subsidies was used to create fiscal space for health services and other social assistance. Its NDC refers both to the right to health, and the right to enjoy a good and healthy environment. A general mention is made of the health threats of climate change, and health is included in the NDC Adaptation Roadmap. Indonesia’s emissions reduction target is assessed by CAT as being in line with global temperature rise of >4°C.
Iraq refers to the general impacts of climate change on human health, and more specifically also to dust and dust storms which caused an increase in the number of asthma cases in Iraqi society, and the spread of diseases and cancers. Iraq is planning to develop an Atlas of deaths due to climate change. Iraq seeks to enhance the resilience of the health sector by preventing diseases caused by climate change; to rehabilitating health-fragile and poor communities exposed to health risks and restoring their ability to withstand and adapt to the negative effects of climate change; to raise health awareness among communities vulnerable to diseases related to climate change and support the family and health program, and to fight endemic and epidemic diseases caused by climate change. Health co-benefits of actions in the energy and waste sector are mentioned. Iraq is preparing an application to the Green Climate Fund, including health actions, which is assumed to require a specific budget.
Japan makes no mention of health and climate linkages anywhere in its NDC. The emissions reductions target in its NDC is assessed by Climate Action Tracker as being aligned to global temperature rises of up to 3°C.
With regard to integrated governance, the health sector is tasked with introducing new indicators that are useful for protecting health, such as Air Quality Index and UV index, in cooperation with the relevant institutions. Described health impacts include lack of availability of drinking water, deaths due to flooding, air-borne and respiratory diseases, water and food-borne diseases, vector-borne diseases, nutrition, heat waves, occupational health, and asthma. In terms of adaptation action in the health sector, the NDC states the intention to update the climate change and health vulnerability and adaptation assessment that was conducted in 2012. Proposed measures include mapping of all critical habitats that include the presence of species that could act as vectors for zoonotic viral diseases; educating and informing the public; developing climate-informed disease control programs; developing new methods and tools for preparing for, coping with, and recovering from outbreaks of climate-sensitive diseases; and building the capacity of public health and health care professionals to monitor, diagnose, and treat cases of climate-sensitive health outcomes, even when they change their incidence, seasonality, and geographic range. Jordan has a national Climate Change and Health Adaptation Strategy and Action Plan. Health sector mitigation actions include a baseline assessment of greenhouse gas emissions of the health system, including supply chains; developing an action plan to achieve this, and reducing emissions under direct control of the health sector to reach net zero. Health co-benefits of actions in the water and waste sectors are described. A budget is included for strengthening surveillance.
With regard to integrated governance, in Kuwait, the health sector works with the Meteoritical Public Administration on the Common Alerting Protocol. The links between environmental protection and human health are embedded in the Environmental Protection Act of 2014. The NDC touches on the health effects of climate change from rising temperatures, scarce rainfall, rising sea levels, limited water sources, increasing intensity of dust storms. The only action in the health sector is linked to the Common Alerting Protocol.
In Kyrgyzstan, the recognised health impacts of climate change include increase in morbidity and mortality from noncommunicable diseases, infectious, vector-borne and parasitic diseases; poor nutritional status, injuries, and damage or destruction of health infrastructure due to climatic events. Within the health sector, Kyrgyzstan plans to improve the evidence base on the impact of climate change on the health of the population; develop a health system development policy; improve the clinical regulatory framework for climate change adaptation of the healthcare system; improve climate resilience of health infrastructure; reduce vulnerability of the population to identified conditions. Improvements in climate resilience of health infrastructure are stated to offer “co-benefits to GHG emission reduction”. Health co-benefits of actions in other sectors include those in the agriculture, cities, nature-based solutions, and water sectors. Budget is included for action in the health sector.
The NDC of Mali refers to the negative impacts of black carbon on human health, and of PM2.5 on cardiovascular and respiratory systems. The NDC includes an estimate of premature deaths avoided due to improvements in air quality by 2030 on account of actions across multiple sectors, and also refers to health co-benefits of measures in the water sector. The NDC includes target levels of different air pollutants, and a target number of rural homes for which access to potable water should be improved.
In its NDC, Mauritania lists health risks including more frequent and severe droughts, disruption of the rainy season, temperature increase, more severe rains, winds, smoke and dust, heatwaves, waterborne diseases, and malnutrition. Particular climate-related risks to women and young people include epidemics, epizootics, and health risks in general, with 626 deaths recorded per 100,000 births. Mauritania refers to the establishment of a program to combat diseases with common risk factors, and of a monitoring network to strengthen climate/health/food security early warning systems, as well as establishment of community health mutuals for the benefit of women. Health co-benefits of climate action in agriculture and water are alluded to. A budget is included for health sector measures.
Health risks identified by Mauritius in its NDC include cyclones and associated hazards such as torrential rains and flash floods, which account for 32.7% of nationally reported losses in terms of mortality between 1990 and 2014. Other climate related health threats include vector-borne diseases. Health is included in the National Climate Change Adaptation Policy Framework (NCCAPF) of Mauritius. Mauritius plans to mainstream of climate change adaptation in the health sector, develop and implement a communication, education and awareness strategy with respect to climate change risks and impacts on human health, improve surveillance of diseases associated with climate change and develop and implement a decentralized alert and rapid response mechanism, and enhancing strategic frameworks to address policy gaps and improve expertise in the health sector. In other sectors, the NDC includes mention of measures to increase access to potable water. Two NAPs are being formulated to enhance resilience to climate, of which one is focussed on health for a total of USD 425,000 from the GCF.
The implementation of the NDC of Mozambique is said to prioritize human health alongside environmental integrity and the creation of green jobs. Health impacts recognised in the NDC include epidemics, floods (which cause direct loss of life and the outbreak of diseases such as malaria, cholera and diarrhea), and impacts on sanitation and access to potable water. Injuries, deaths and affected health units during rainy seasons are recorded in the NDC. The World Health Organization is supporting the Ministry of Health and the National Institute of Health to strengthen the National Health System to the Impacts of Climate Change and in drafting a Health Sector Adaptation Plan; the Plan for Adaptation of the Health Sector to Climate Change. A climate sensitive disease monitoring dashboard is already in place. The importance of preserving the water supply to maintain public health is mentioned. The economic costs of climate related impacts are noted.
The overriding priority of the Government of Nauru is to eradicate poverty and to improve the safety, security, and quality of life of its citizens, ensuring healthy and productive people, and a healthy environment. The health impacts of climate change include tropical diseases, heat stress, dehydration, changes in the incidence of vector-borne and other infectious diseases, and decreased access to healthy foods, and damage to critical health infrastructure. Food supplies are primarily imported resulting in high costs, and are limited in supply and variety. The lack of access to fresh and healthy foods results in poor diets and associated health consequences, including a high rate of non-communicable diseases. Nauru plans to conduct an assessment of national public health implications of climate change. Health sector adaptation actions include increased preparedness and resilience of public health care infrastructure. In partnership with the World Health Organization, the national assessment and its recommendations will inform the development of a national strategy to prepare the nation for the public health implications of climate change. In terms of health co-benefits of climate action, links with SDG3 are made to measures implemented in agrirulture, costal zones, safe housing, waste and water. With regards to budget, Nauru will also seek financial support from the GCF to fully fund work with the World Health Organization under its Special Initiative “Climate Change and Health in Small Island Developing States”.
New Zealand makes no mention of health and climate linkages anywhere in its NDC. The emissions reductions target in its NDC is assessed by Climate Action Tracker as being aligned to global temperature increases of up to 3°C.
Niger mentions the intensification of climate-sensitive diseases in its NDC, as well as persistence of epidemics such as meningitis and cholera, and increased nutrition insecurity. Solar PV for health centres is mentioned. Health co-benefits of climate action in the agriculture sector is described. Niger has started a process of developing concept notes and pre-feasibility/feasibility and cost-benefit studies for projects and programs including on health.
Pakistan seeks to establish mechanisms to facilitate collaboration between health and other sectors, including climate and energy. Pakistan recognises climate change as an increasing existential threat globally and lists specific health impacts such as vector-borne disease and nutrition insecurity, and hopes to contribute research on these issues. Concerning actions in the health sector, Pakistan plans to increase monitoring of climate-sensitive diseases and introduce forecasting systems to increase effective planning prior to pandemic and disease outbreaks, and Geographic Information System (GIS) mapping to identify climate change/ health impacts hotspots and implement specified health adaptation prevention and control programs. The government plans to develop standardized emergency procedures and stockpiling of essential medicines in advance, and to take measures to improve the access of women to medical services. With regards to health co-benefits of action in other sectors, Pakistan plans to adopt a Health in All Policies (HiAP) approach to energy policy and to manage targeted training of women in livestock management and agricultural practices under a OneHealth program. The NDC also refers to health gains of action across gender, nature-based solutions, water and waste. Targets and indicators are included for both health and other sectors.
Regarding integrated governance, the NDC Partnership plan of the State of Palestine identifies that the health sector will play a leading role in assessing the impact of the COVID-19 pandemic on climate adaptation and mitigation efforts in Palestine. Future climate scenarios for Palestine are expected to impact health through reproduction rates of vectors of diseases; contamination of soil and water bodies after floods making water unsafe for human consumption, increasing water-borne and food-borne diseases; challenges in preserving food products, increasing the chances of food-borne diseases; heat stress and dehydration, due to high temperatures and decreased precipitation. Air pollution from road transport is noted to damage people’s health, leading to respiratory problems. Actions to be taken by the health sector include raising awareness and capacities for disease prevention among both healthcare professionals and women; and developing safety and monitoring systems for water, food and sanitation. Additional co-benefits of climate action are identified in the gender, transport and waste sectors. Costs for health sector actions are outlined, and targets are set for action in the health sector and health adjacent sectors.
The Republic of Korea makes broad reference to the health impacts of climate change in its NDC. In July 2020, the Republic of Korea published a comprehensive Climate Change Assessment Report, including an assessment of the health sector alongside other sectors. The NDC includes a general reference to health adaptation plans. Beyond the health sector, cooling shelters for heatwaves will be installed and green spaces will be created for densely populated vulnerable groups.
Saint Kitts and Nevis includes general mention of the impacts of climate change on health in its NDC, and also records the numbers of deaths due to Hurricanes Hugo and Georges. St Kitts and Nevis adopted guidelines and vulnerability assessment templates for assessing the health sector. The health sector is included in the National Climate Change Adaptation Strategy. Specific adaptation measures include development of a national program to address mental health issues in the aftermath of disasters; revising the National Multi-Hazard Health Disaster Management Plan; training exercises and undertaking health facilities assessment utilizing the PAHO Green Checklist and the Safe Hospital Checklist assessments tools; and the development of health sector disaster and emergency plans. Health co-benefits are identified in agriculture, cities, nature based solutions, and water. A budget is included for climate change and disease prevention.
In terms of action in the health sector, Saudi Arabia plans to retrofit 2,500 hospitals and clinics (along with other public facilities) to improve energy efficiency. In other sectors, health co-benefits in transport and water are mentioned. However, the NDC of Saudi Arabia is far off track from the Paris Agreement, being assessed by CAT as in line with >4°C.
Serbia makes one mention of a health and climate link in its NDC, referring only to the vulnerability of health to climate change.
Sudan was afflicted with devastating flooding in July-September of 2020 that led to at least 100 fatalities. Water- and vector-borne diseases are also mentioned as health impacts of climate change, alongside unmanaged waste disposal sites where open burning causes local air pollution and public health impacts. A national vulnerability assessment for the health sector has been conducted. Within the health sector, Sudan seeks to introduce early diagnosis and treatment programmes; raise awareness of communities in vulnerable areas to climate change related diseases in order to increase their adaptive capacities; control endemic and epidemic diseases; improve medical services including capacities of diagnoses and treatment. Sudan also plans to incorporate solar for health to provide basic services to communities in remote areas without access to electricity services. For health co-benefits in other sectors, the potential of adaptation measures to save lives is well noted, and some detail is offered on drinking water. Budget for action in the health sector is included.
Switzerland’s NDC refers to two health impacts of climate change, namely risk falls due to melting glaciers, and mortality due to extreme heat. CAT deems Switzerland’s emissions reduction target to be in line with up to 3°C of warming.
Tajikistan describes the vulnerability of its agricultural system to climate change, jeopardizing nutrition security. Health is identified as a cross cutting sector in adaptation. Health co-benefits are alluded to for agriculture, transport and water.
Togo’s NDC touches on health impacts including nutritional insecurity, infectious disease spread, damage to healthcare facilities, lack of drinking water, and loss of human life due to flooding. Adaptation actions in the health sector include (but are not limited to) supporting the prevention and fight against vector-borne diseases; strengthening the regulatory framework concerning health and the environment; and providing rural areas with adequate health infrastructure. Mitigation action in the health sector include solar electrification of 314 health centers and equipping 122 health centers with solar water heaters. Health co-benefits of actions in other sectors span agriculture, energy, nature based solutions, transport, waste and water. Budget lines are included for emergency medical services and development and implementation of a health monitoring plan.
With regards to integrated governance, Tunisia’s NDC seeks to strengthen the role of health in leadership and intersectoral collaboration. The NDC is said to align with SDG3, and the right to a healthy environment is recognised in the national constitution. The main health impacts due to climate change include vector-borne, water-borne and food-borne diseases; the aggravation of diseases related to air pollution and the increase in the frequency and intensification of the health effects of floods. Actions within the health sector comprise strengthening the surveillance of climate-sensitive diseases; developing the capacity for early detection and early warning of phenomena; developing and empowering the health system to address climate change-related health risks. Actions in agriculture, gender, waste and water are noted as offering health co-benefits. A budget is included for increasing health resilience.
Turkey submitted an updated NDC on 13th April 2023, after analysis for the 2023 NDC Scorecard was completed using the 2021 NDC. The updated NDC also receives the worst possible rating by CAT for climate ambition, being in line with >4°C of warming. However, the latest NDC includes a section on public health, which would lead to a higher health score for Turkey. It is vital that updated NDCs protect both people and planet.
The health sector was consulted in the development of Uganda’s NDC. General impacts of climate change on human health are referred to. Within the health sector, a health vulnerability rating has been quantified. Actions include development of resilient and “fit for future” health systems; integration of climate considerations into national health plans and strategies; development of district climate health profiles developed; improvement of early warning; and development of a surveillance and response system for climate sensitive health hazards. A health national adaptation plan is referred to. Health co-benefits of energy, waste and water sector actions are deemed to offer health co-benefits.
The UAE NDC refers to health impacts including direct exposure to extreme weather events and indirectly impacts of climate change on air quality and water supply. According to the national climate risk assessment undertaken by the UAE, reduced productivity of outdoor workers due to heat stress is a high-magnitude and highly likely impact that the country will face. A climate risk assessment of the health sector was carried out. The NDC mentions surveillance of infectious diseases and their link to climate- and environment-related factors amidst the COVID-19 pandemic. The Abu Dhabi government has also rolled out a ‘Safety in Heat’ program that aims to limit heat exposure in the workplace. The UAE National Framework for Action on Climate Change and Health 2019-2021 sets out the country’s strategic response to public health challenges posed by climate change. Health co-benefits are described for actions in the agriculture, energy, transport and water sectors, including the health benefits of improved air quality. The NDC includes targets for increased clean power capacity, and availability of potable water. Nevertheless, the emissions reduction target of the NDC is assessed by CAT as being in line with >4°C warming.
In its NDC, the UK recognises that air pollution is the top environmental risk to human health. Health benefits of air quality improvements are reflected in the UK and Scottish clean air strategies. Additional co-benefits are described in food systems, in terms of access to nutritious and healthier food, and transport systems in terms of promoting wellbeing.
Uzbekistan notes the emergence and exacerbation of diseases due to climate change. Actions discussed for the health sector include strengthened statistical database and priority adaptation planning and budgeting options and preventing the emergence and exacerbation of diseases caused by climate change. Health co-benefits are described in the agriculture, waste and water sectors.
In its NDC, Vanuatu notes that it is vulnerable to climate change natural disasters which create public health emergencies, such as water and food contamination and other emerging diseases. Health losses and damages are referref to. Climate change related events will continue to threaten Vanuatu with the potential to impact on health service planning and delivery. In terms of actions in the health sector, Vanuatu commits to implement programmes that create, promote and protect a better environment and hygienic conditions to improve health, climate resilience, and wellbeing of the people of Vanuatu. Vanuatu commits to establish an Environmental Health Authority; to develop and refine public health emergency procedures; provide continuing support for life-saving and essential health care to affected populations, including rapid measures to repair and/or rebuild damaged health facilities; and erect temporary health facilities with particular attention on restoring WASH infrastructure. In terms of health co-benefits in other sectors, Vanuatu refers to health gains of actions in the disaster risk reduction, agriculture and water sectors. Budget for health actions, and estimated costs of health losses and damages, are included. Targets are described for drinking water.
The health threats of climate change described by Venezuela in its NDC include the appearance of vectors, parasites or viruses. Health sector actions include surveillance of vectors and strengthening capacity of responses. Regarding mitigation in the health sector, a cooling mechanism for hospitals was described in 2015. A wide variety of sectors are described as having health co-benefits, including agriculture, household energy, nature-based solutions, transport, waste and water. Targets are included for health related actions in shipping / transport and for sanitation.
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