Health features widely in national climate adaptation policy, yet many plans still lack the mechanisms needed to convert recognition into action. A global policy analysis published in The Lancet Planetary Health assessed health integration across policies from 198 countries, including Health National Adaptation Plans, National Adaptation Plans or National Adaptation Programmes of Action, Nationally Determined Contributions and National Communications. The assessment applied a standardised scoring metric covering health analysis, health-related actions, institutional leads, budgets and monitoring and evaluation indicators. National climate adaptation policies were identified for 197 countries, all except Libya. Across 522 policies, 458 mentioned health, but gaps remained in financing, metrics, equity and implementation structures.
Health Is Commonly Mentioned, but Coverage Is Uneven
National climate adaptation policies frequently include general references to disease and health. Disease appears in 397 of 522 policies and health appears in 458, often without specific health conditions. Vector-borne diseases, infectious diseases and non-communicable diseases are among the most frequent disease categories. Health-care related terms also appear commonly. Water, sanitation and hygiene and nutrition are the main drivers of disease covered in the policies.
Several health areas receive less attention. Mental health appears in 217 policies, sexual and reproductive health and rights in 206, injuries in 178 and allergies in 107. Violence appears as a health term in 87 policies. The interface between climate change, human health and humanitarian settings also receives limited coverage, including climate-induced displacement in 156 policies and conflict in 62.
The average number of health terms per policy increases over time, but the distribution remains uneven across health topics. All searched health terms appear at least once, except crush as an injury type, quality-adjusted life-years and syndemic. General health language is therefore widespread, while several specific conditions and risk pathways remain under-represented. The gap is not simply one of health visibility, but of how precisely health needs are named across policies.
Equity Principles Remain Weak in Decision-Making
Most countries recognise groups disproportionately affected by climate change. Such groups appear in policies from 191 of 197 countries. Children, adolescents, young people and women are commonly referenced, followed by older adults, low-income populations and people with disabilities. Around half of countries mention migrant or displaced populations or Indigenous groups.
Gender-responsive health plans are also frequent, appearing in 161 countries. Sub-Saharan Africa has the highest prevalence of gender-responsive policies, with 46 of 48 countries including such strategies. Age-specific health strategies are much less developed. Age-specific considerations remain limited in 176 countries, despite frequent references to children, young people and older adults as affected groups.
Participation in climate and health decision-making remains narrow. Only 24 countries involve women and other directly affected groups in decision-making. Similar patterns appear across regions, with little meaningful involvement of disproportionately affected groups. Across UNFCCC negotiating groups, two groups do not outline plans for involving disproportionately affected groups in decision-making. Several negotiating groups also lack age-responsive strategies, including the Bolivarian Alliance for the Peoples of Our America, Environmental Integrity Group and Mountain Group. The result is a gap between recognising affected populations and including them in policy creation, implementation and evaluation.
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Financing and Monitoring Limit Implementation
Health system structures show partial development across national climate adaptation policies. Policy coherence is relatively common, with 159 of 197 countries referencing other national health standards. Approximately half of countries include sub-national health planning, implementation or reporting. Fewer than a quarter tailor health responses to urban areas, rural areas or both. Policy coverage also varies, as 123 countries have UNFCCC-reported policies, while only 33 have a Health National Adaptation Plan.
Monitoring and evaluation are present but remain uneven. National Communications from 131 countries include monitoring and evaluation mechanisms for health. The quality score for health integration averages 9.4 out of 15 across all 198 countries and the EU region. Monitoring and evaluation average 1.5 out of three, while financing averages 1.2 out of three. These are the weakest domains in the scoring framework.
Budgetary planning is the clearest structural gap. Only six countries allocate funds for health-related actions. Latin America and the Caribbean and Northern Africa and Western Asia have notably weak financing scores, with insufficient budgets and identified funding sources. Central and Southern Asia, Eastern and South-Eastern Asia, Australia and New Zealand and Oceania have no countries outlining health-related budgets or financing mechanisms in National Communications. Health National Adaptation Plans are also uncommon, with fewer than 30% of countries in each Sustainable Development Goal region having one.
Health now appears widely in national climate adaptation policy, but broad recognition does not consistently translate into specific conditions, equitable participation, local planning, monitoring or financing. The main gaps concern under-represented health areas, limited involvement of disproportionately affected groups, weak age-specific strategies and insufficient budgetary structures. Stronger health integration depends on clearer disease coverage, defined implementation structures, measurable indicators and dedicated funding. These elements connect policy recognition with practical health system readiness. Without them, climate adaptation policy remains less equipped to support health systems and populations facing climate-related risks.
Source: The Lancet Planetary Health
Image Credit: iStock
References:
Morneau C, Philippon-Dulac D, Hu X et al. (2026) Health integration in national climate adaptation policies from 198 countries: a global policy analysis. The Lancet Planetary Health: Online first.
