Health integration in national climate adaptation policies from 198 countries: a global policy analysis

Background

Health is an essential component of climate adaptation and should be integrated into national policies to build resilient and effective systems. We aimed to review national climate adaptation policies to assess health integration globally, regionally, nationally, and sub-nationally.

Methods

In this global policy analysis, we systematically identified national climate adaptation policies for 198 countries in English and 14 other languages. We reviewed Health National Adaptation Plans (HNAPs), National Adaptation Plans (NAPs) or National Adaptation Programmes of Action (NAPAs) when NAPs did not exist, Nationally Determined Contributions (NDCs), and National Communications (NCs). We created a Python application to increase the accuracy of identification of health-related text and applied a standardised scoring metric that assessed five domains—health analysis, health-related actions, planned institutional leads, dedicated budgets and funding mechanisms, and measurement indicators for monitoring and evaluation (M&E)—to compare health integration across documents and countries.

Findings

197 countries, all except Libya, were found to have national climate adaptation policies (36 HNAPs, 123 NAPs or NAPAs, 200 NDCs, and 223 NCs). Across these policies, 458 (88% of 522 policies) mentioned health. 159 (81% of 197 countries) further referenced other national health policies. 191 (97%) identified populations disproportionately affected by climate change, whereas only 24 (12%) involved such populations in decision making. Six (3%) countries outlined budgets for health-related actions. Insufficient budgeting and fiscal planning emerged as the weakest aspects of health integration, and sexual and reproductive health and rights, allergies, injuries, violence, and mental health were found to be under-represented in policies.

Interpretation

Climate adaptation policies should be comprehensive and outline clear structures to translate plans into action. We need evidence-based inclusion of diseases and health conditions linked to concrete strategies, national and sub-national measurement to track progress, and designated leads to spearhead coordination. Involvement of disproportionately affected groups further bolsters policy relevance and equity, and adequate financing is central to ensuring implementation.