The Climate-Health Divide: How Climate Change Will Rewire Health Care Across High-, Middle-, and Low-Income Settings

Climate change is increasingly recognised not only as an environmental emergency but also as a structural determinant of health and health-system performance. Its clinical consequences will not be distributed evenly: high-income countries face rising heat mortality, infrastructure fragility, ageing-related vulnerability, and the need to decarbonise technologically intensive care; middle- and low-income countries face heterogeneous but often more compressed combinations of heat, infectious disease, food insecurity, water stress, displacement, conflict-related fragility, and limited fiscal capacity. Objective: This structured narrative review proposes a comparative framework for understanding how climate change will transform health care across high-, middle-, and low-income settings and identifies adaptation priorities that are resilient, equitable, and low-carbon