Are national climate commitments enough to protect our health?

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 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.

Now in its second edition, the Healthy NDCs Scorecard ranks 67 Nationally Determined Contributions (NDCs) covering 93 countries (including the joint NDC submitted by the 27 countries of the European Union). 

NDCs were assessed based on their attention to five health categories: health impacts, health in adaptation measures, health co-benefits, economics and finance, and bonus points available for overall prominence and integration of health. Three points were available for each category, with a total possible ‘health score’ of 15. 

In addition, where available, the scorecard also includes information on governments’ overall climate ambition, reflecting the most recent analysis of Climate Action Tracker. These ratings take into account domestic targets, policies and action, fair share of emissions reductions, climate mitigation finance, and land use and forestry. Overall climate ambition is the factor which will have the greatest ultimate bearing on health. 

NDCs are posted on the UNFCCC website, and a full summary of the methods is available here

The content of NDCs provides an overall snapshot of governments’ priorities relating to climate change, and this analysis serves as a barometer for the extent to which the intrinsic links between health and climate change are recognised and being addressed. 

The ‘health score’ calculated by GCHA is based solely on analysis of each country’s NDC, and not other wider policies. It is important to note that rather than including adaptation measures in their NDCs, many more economically developed countries have separate adaptation strategies, and were hence awarded a lower score for adaptation than would otherwise be the case. Nevertheless, it is notable that despite the very limited resources of many nations in the Global South, low and middle income countries secured the top scores. These countries have contributed least to the emissions responsible for climate change, and are already experiencing the most severe health impacts.

Countries responsible for half of global emissions have yet to publicly update their national climate commitments ahead of COP26. There is therefore a massive opportunity for governments to build in ambitious emissions reductions targets, reap the health benefits of well-considered climate action, and bolster their economies. 

For countries which have already submitted an NDC, placing health at the centre of policies implemented across the energy, food and agriculture and transport sectors to achieve specified emissions reductions will yield both health and economic returns thanks to improved air quality, healthy diets and physical activity.

By their nature, NDCs primarily refer to future plans and targets. While commitment is a prerequisite for ambitious action, health will only benefit if these commitments are delivered. 

GCHA is very grateful to the following individuals for their work and guidance to make the Scorecard initiative possible: Iris Martine Blom, Omnia El Omrani, Laura Jung, Juliette Mattijsen, Blanca Paniello Castillo, Kim Robin van Daalen, and Arthur Wyns. If you have any questions about this work, please contact Jess Beagley at


“Costa Rica recognizes that climate change will impact people’s health and that we need to take urgent action. Fortunately, we have the tools to address this issue. The investments needed to tackle climate change will improve air quality, take pressure off our healthcare systems, and improve our well-being. The recognition of Costa Rica’s climate policies in this ranking shows once again that the country is a world leader in the fight against climate change and that these actions are within reach of countries of all sizes.”

Andrea Meza, Minister of Environment and Energy for Costa Rica.

*The analysis for South Africa is based on its draft NDC. The analysis for the Republic of the Marshall Islands is based on its submission dated 22 November 2018. Zambia was included in the July edition of the scorecard, but is not included in the September edition because a final NDC has since been released by Zambia – the score will be updated in the next edition of the scorecard. A correction was made to Colombia’s score on 16th July 2021, with additional points awarded.

The Ranking

Cambodia, Cape Verde and Moldova received the joint highest score of all countries analysed, with14 points out of an available 15. Costa Rica follows closely with a score of 13 points. All NDCs which received over 10 points were submitted by low and middle income countries, which bear the greatest burden of the health impacts of climate change. By contrast, four of the seven countries with a score of zero are high-income countries. In other cases, a mismatch between recognition of health impacts and overall ambition is notable – the level of ambition in the NDCs submitted by Thailand, Colombia, Argentina, Vietnam and Indonesia does not reflect the links between health and climate change contained in their NDC. Low scores were consistently received for economics and finance, which are essential considerations if commitments are to become reality. In low and middle income countries, international financing will be crucial for delivering measures to protect health.

Countries seeking to improve their scores can look to others for example. Notably, Cambodia’s NDC includes appendices which detail financial costs and returns of mitigation and adaptation measures, with health impacts among those considered. These appendices also detail which actions can unconditionally be completed using existing national resources, and which are conditional on financing from donor countries. Cape Verde’s NDC includes health from the very outset, with a 2025 commitment to build a monitoring system for tracing climate change related risk, and to build health and integrate climate change resilience targets into the national One Health policy framework as one of its flagship contributions. Meanwhile, Moldova seeks to undertake integrated assessments of the environmental, economic and health impacts of climate change, underscoring the interdependence of these development priorities for all countries.

Aside from these countries which received the top total scores, several excelled in individual categories. Nineteen countries scored full marks for consideration of health impacts. Both Laos and Papua New Guinea include dedicated annexed components on health in adaptation in their NDC. Countries which were awarded the third point available in the co-benefits category included Chile and Mexico for their goals on black carbon reduction in the context of health; Costa Rica which notes Sustainable Development Goal 3 (SDG3) co-benefits for a series of timebound mitigation targets to be achieved by 2030; the UK for identifying air pollution as the leading environmental risk to health; and the USA for mention of the tens of thousands of lives which can be saved by 2030 through improved air quality. Cape Verde was the only country to score three points for economics and finance. Only five countries of those analysed by Climate Action Tracker were aligned with the Paris Agreement, namely Costa Rica, Kenya, Morocco, Nepal, and the UK, all of which aligned with the Paris Agreement target of limiting warming to 2C, though not the more ambitious target in the agreement of 1.5C.

Country scorecards can be downloaded here. Please share them on social media, using the hashtag #HealthyNDCs

Argentina recognises multiple health impacts in its NDC, including heat and cold-waves, vector-borne disease and flooding. With regard to adaptation, the NDC includes reference to a dedicated health and climate change action plan, the Plan de Acción Nacional de Salud y Cambio Climático (PANSyCC). Argentina was the first country to include healthcare sector mitigation measures in its NDC, and also includes health as a “guiding axis” underpinning much of the content of its NDC. Acknowledgement is also made of financing needed for mitigation in the health sector. Health and the effect of climate change on humanity is mentioned at the very outset of the NDC, which also refers to the inclusion of the right to a healthy environment in the 1994 National Constitution. The NDC also makes several references to equality, in terms of intergenerational equity, vulnerable populations and participation in decision-making processes. Despite prioritisation of health and equity, Argentina’s level of climate ambition is not aligned with the Paris Agreement, but rather with 4C temperature rise.
Australia’s NDC makes no mention of health-related considerations, and fails to align with the Paris Agreement. Despite claiming to be “on track to meet and beat its 2030 target” set out in its 2016 NDC, and experiencing devastating annual wildfires, Australia opted to not increase this insufficiently ambitious target to reduce greenhouse gas emissions, jeopardising the health of the national population and of people worldwide. This contributes to Australia’s overall climate ambition score, which is in line with 4C of warming.
Brazil’s NDC did not receive points in any of the five health categories considered. Despite mentioning that its NDC “is among the most ambitious in the world”, Brazil’s level of ambition is both insufficient and has actually decreased, being aligned with a 4C rise according to Climate Action Tracker. These failures to consider health and to bring Brazil’s emissions into line with the Paris Agreement jeopardises the wellbeing of Brazilians and populations around the world.
Cambodia’s NDC includes mention of a multitude of health impacts, including vector borne diseases such as malaria, water borne diseases, heat-related disease and undernutrition. The level of detail on adaptation in the health sector is exceptional, with actions set out in both the body of the NDC and an annex. Cambodia commits to air quality monitoring and to making the information easily accessible to the public, as well as recognising health benefits related to interventions in the transport and agriculture sectors. The economic impacts of reduced labour productivity due to heat stress are mentioned, along with investment in and returns on investment for adaptation interventions. In addition to multiple paragraphs which include substantial health mentions and detailed policies, health also features in the title of a subsection of the NDC. Cambodia’s NDC includes numerous mentions of gender equality. Cambodia’s level of climate ambition is not assessed by Climate Action Tracker.
While Canada’s NDC does not acknowledge the health impacts of climate change in the general population it does refer to the “incalculable costs” to Inuit of the loss of ice, snow and permafrost in northern Canada and to the dependence of the Métis on healthy ecosystems for survival. In terms of co-benefits, reference is made to health gains arising from nature-based solutions, active transportation in the context of a healthy environment, and to health co-benefits from reduced air pollution, for which projections have also been produced. Financial allocations for pandemic recovery are also mentioned in the context of health. Bonus points were allocated for the dedicated section on a healthy environment and healthy economy. Canada refers to equality and equity throughout its NDC, particularly with regards to indigenous peoples. Despite inclusion of health in several aspects of its NDC, Canada’s level of climate ambition is in line with 4C temperature rise, a level catastrophic for human health, putting at risk both its own population and people around the world.
The Chilean NDC includes substantial detail on adaptation measures for health and water. Chile mentions air pollution, the benefits of forests and water quality for mental health and quality of life respectively. The NDC includes a specific goal on black carbon reduction, relating this to respiratory health and acknowledging associated costs. 2 bonus points were allocated in recognition of multiple paragraphs having prominent mentions of health and the integration of health throughout the NDC. Mentions of equality and equity mainly refer to gender. Though Chile’s NDC notes the health impacts of warming beyond 1.5C, its ambition is aligned with 3C of warming. 


Costa Rica received full marks in all health categories except economics and finance. Its NDC is also aligned with the Paris Agreement. Costa Rica highlights the links between climate change and vector-borne disease, zoonoses, and food security and nutrition and commits to monitoring such impacts. Adaptation considerations for health are referred to in detail in the NDC. In terms of co-benefits, Costa Rica notes the benefit of specific and timebound mitigation targets in the transport and energy sectors for health. Health also features in the financing section of the NDC. In addition to a dedicated section on health, Costa Rica was awarded a third bonus point for the consistent integration of health throughout the entire NDC.
The EU NDC makes only one reference to health, in relation to the co-benefits of nature-based solutions. Given the extensive monitoring of health and climate links by the European Climate and Health Observatory, hosted by the European Environment Agency, the absence of such recognition in the NDC is notable. Equality is mentioned throughout the NDC. According to Climate Action Tracker, EU ambition is in line with 3C of warming. 



Prime Minister Bainimarama of Fiji requested WHO to prepare a report on health and climate change to be delivered at COP24, following Fiji’s COP23 Presidency. Fiji’s 2020 NDC acknowledges the health impacts of climate change including vector-borne and water-borne diseases, and the vulnerability of people living with noncommunicable diseases to increasing heat. Reference to the national guidelines for climate-resilient and environmentally sustainable health care facilities secured points in both the adaptation and co-benefits categories. Health co-benefits of nature-based solutions and interventions relating to oceans are also referred to. More widely, Fiji makes mention of the need for equity and gender-responsive interventions throughout its NDC. 


Indonesia’s NDC refers to health and social impacts of climate change, including noting the impacts of drought, floods and other disasters on access to food and water for the most vulnerable populations. It also notes health as a sector of focus in its adaptation planning and describes key actions. A general reference is made to the concept of health benefits arising from emissions reductions. The NDC notes that removing fossil fuel subsidies has created fiscal space for other priorities including health. Bonus points were scored for language on the right to health and a healthy environment, and for the inclusion of paragraphs with detailed heath content. Indonesia refers to gender and intergenerational equity in its NDC. Despite these mentions of health, Indonesia’s climate ambition is assessed as being in line with 4C of warming.


Kenya’s NDC makes mention of general vulnerability to health, loss of life due to flooding, and also refers to famine. It mentions the number of people left without food and water during a period of drought from 2014-2018, and includes a target to measure the incidence of malaria and other vector-borne diseases. The health sector and also water and sanitation feature in the adaptation section of the NDC, together with drought and flood management which are mentioned earlier in the NDC as being related to health. Kenya’s climate ambition is aligned with the Paris Agreement. Additional international financing may increase the feasibility of co-benefit interventions for health.


Morocco lists health impacts including heatwaves, malaria, and diarrhoea in its NDC. These risks are regularly assessed. A National Strategy for Adapting the Health Sector to Climate Change is being developed. Morocco plans to strengthen monitoring of air quality and its impacts on health. Health is included as part of wider budgeting for adaptation, but a specific allocation for health is not mentioned. A bonus point was received for depth of focus on health in one section. Morocco’s climate ambition is in line with 2C of warming, within the boundaries set by the Paris Agreement.
Nepal’s climate ambition is aligned with the Paris Agreement, which in itself offers protection for public health. Specific mentions of health in Nepal’s NDC are less prominent. Health, drinking water and sanitation are noted as being included in the national adaptation plan. Nepal also seeks to reduce emissions from the healthcare sector by prohibiting the burning of healthcare waste, instead putting in place requirements for proper waste management. Nepal states the importance of leaving no one behind, and also plans to develop an action plan for integrating gender equality and social inclusion into the achievement of NDC targets, thus helping to address the social determinants of health.
There is no content in New Zealand’s updated NDC that makes any reference to health. This was also the case for New Zealand’s 2016 submission. It also falls short of the level of ambition required to meet the Paris Agreement. Notably, New Zealand’s updated submission was the shortest of any country analysed, at just slightly over one page. As a country which is often perceived to have an especially progressive government, these results are striking. New Zealand was at the forefront of the response to the COVID-19 pandemic, but fails to acknowledge the health threats of climate change in its NDC, which pose an even greater risk. Advice provided in June by the national Climate Change Commission outlines how to reduce long-lived climate pollutants such as carbon dioxide by 63% between 2019 and 2035. New Zealand now has an opportunity in advance of COP26 to update its NDC with increased ambition and due attention to public health. 


Norway makes no mention of health anywhere in its NDC. While the country has been a leader in international discussions on improving air quality for the sake of health, and it also supports such work in developing countries, these objectives are not reflected in the NDC. Norway’s Climate Action Tracker assesses Norway’s climate ambition to be in line with 3C of warming. 
Russia’s NDC refers to the negative impacts of climate change on health and living conditions. Healthcare is also covered in the National Action Plan for the first stage of adaptation to climate change. However, its overall climate ambition is aligned to >4C of warming, with the most disastrous implications for health. 
Singapore refers to an increase in the population of mosquitos in the context of health in its NDC. It also briefly refers to adaptation measures to control this and to provision of heat information systems. Health is included in the title of a paragraph, but its health content is limited and only one bonus point was allocated. Singapore’s climate ambition is aligned to >4C temperature rise, which would overwhelm capacity to respond to these identified threats and many others.
South Africa’s draft NDC includes mention of heatwaves, as well as recognising health as one of the sectors most vulnerable to climate change, and noting its inclusion in the National Climate Change Adaptation Strategy (NCCAS). Air quality is highlighted as a co-benefit of transitioning to renewable energy. Required financing for the NCCAS overall is mentioned to be USD 3 – 4 billion (although it is not clear precisely how much is allocated for health adaptation investments). A bonus point was allocated for reference to the right to a safe and healthy environment. The NDC includes integrated mentions of equality and equity. South Africa’s climate ambition is in line with 3C temperature rise.
South Korea ranks poorly both in terms of attention to health and its overall ambition, which is aligned with a 4C temperature rise, catastrophic for human health. Vulnerability of the health sector is mentioned, but only as part of a broader assessment, and health is not highlighted as a sector in adaptation planning, so only one point was allocated. Green remodelling of hospitals and investment to support this were also mentioned. There is hope that South Korea may submit an update to its NDC before COP, with increased ambition. This would directly benefit the people of South Korea through health co-benefits of climate solutions, while meeting its responsibilities under the Paris Agreement. Submitting an updated NDC would also provide an opportunity to increase the attention to health throughout its NDC. 
The UAE NDC mentions both heat (specifically heat stress, heat stroke and heat exhaustion) and general health impacts of climate change in its NDC. As well as individual measures to improve adaptation to health impacts, the UAE will develop a policy and action plan on health and climate change. The UAE NDC also mentions the monitoring of air pollutants and includes a dedicated section on public health. Despite experiencing severe health impacts of climate change, the UAE is more focussed on adaptation measures, which have only finite potential to protect health, than on addressing its high emissions. According to Climate Action Tracker, the NDC is aligned with 4C of warming, deemed “highly insufficient”. As a high income country, feeling significant climate impacts, UAE could be expected to have both the motive and the means to set far more ambitious emissions reduction targets, and thereby also fulfil its international obligations.
The UK NDC alludes to the impact of climate change on hunger due to food insecurity. The UK did not receive any points in the adaptation category, but the UK, and indeed many other developed economies focus on mitigation in the NDC and submit a separate Adaptation Communication to the UNFCCC. The UK would otherwise have been awarded 2 points for health in adaptation. The UK NDC refers to health co-benefits that can be reaped through more sustainable food and transport systems, and cites air pollution as the top environmental risk to health in the UK. Bonus points were awarded for the paragraph dedicated to health and air pollution, as well as the specificity of policies to deliver health co-benefits. The UK makes several mentions of equality and equity in it’s NDC. The UK’s climate ambition is in line with the Paris Agreement. 
The United States NDC recognises climate change as an “existential threat” which demands bold action, alluding to the health impacts of climate change. Adaptive measures in the buildings sector are described as protecting health. Health co-benefits are referred to in sections of the NDC dedicated to energy and transport, and quantified in terms of the number of lives which could be saved through improved air quality. A point was also awarded in the economics and finance category for the statement that “the cost of inaction far outweighs the cost of action in economic and humanitarian terms”. More broadly, the NDC makes several mentions of equity. The climate ambition of the US is in line with 3C of warming.


The Vietnamese NDC includes reference to heatwaves, access to clean water and a myriad of infectious diseases as health impacts of climate change, and cites the particular vulnerability of people with pre-existing conditions, the elderly, women and children. It also quantifies other risks, such as the number of people at risk of water-borne disease and malnutrition. Some of these human impacts were also linked to a financial sum of the cost of climate impacts. Adaptation measures relating to health and access to clean and hygienic water are also briefly included. In terms of co-benefits, the need to reduce energy consumption in hospitals and community health centres is mentioned, with a brief mention of the need for investment to achieve this. Vietnam includes a dedicated section on public health, gender equality, and child protection in its NDC. In spite of all this, Vietnam’s ambition is aligned with 4C temperature rise. Climate mitigation often offers substantial near-term, local co-benefits to health, with health savings that could offset some of the costs of climate action. Together with international financing, this may increase the feasibility of measures to reduce emissions, and offer great benefit to the people of Vietnam.

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