Why Health Remains Underfunded in Global Climate Finance
Climate change has far-reaching consequences for population health, and the World Health Organization has identified it as the biggest threat of the twenty-first century. At COP28, the UAE Declaration on Climate and Health was adopted for the first time, alongside delegates convening for the first-ever ‘Health Day’. An initial tranche of US$1 billion was announced. An initial tranche of US$1 billion was announced through a range of multilateral and philanthropic commitments. According to the World Health Organization (WHO), the healthcare sector accounts for nearly 5 percent of global greenhouse gas emissions, which include carbon dioxide, methane, ozone, and others.
According to the 2019 report ‘Health Care Climate Footprint’, the healthcare sector in the United States is the largest emitter of carbon emissions globally, responsible for 27 percent of all healthcare-related emissions worldwide. China follows, contributing 17 percent of global healthcare emissions, reflecting its extensive healthcare infrastructure and large population. In contrast, India, South Korea, and Australia together account for just 2 percent of global healthcare emissions. Additionally, India has the lowest per capita healthcare emissions among all countries included in the study.
While carbon emissions from the healthcare system are lower than those from the energy, transport, and construction sectors in many countries, the sector remains an important contributor to the climate crisis. This is because the healthcare system acts as the first responder to many climate-related crises that humanity may face, from air pollution and waterborne disease, to heat stress and vector-borne disease. The energy sector is responsible for 76.7 percent of greenhouse gas emissions, which include electricity and heat production, transportation, manufacturing, construction, and buildings.
Yet negligible multilateral climate finance goes towards improving health systems; it appears that the health sector has not been a focus area of climate change negotiations over the years. According to WHO estimates, just 2 percent of adaptation funding, and only 0.5 percent of multilateral climate funding overall, goes to health — leaving the sector with the greatest unmet need.
In exploring climate-related funds operating at the global level, the Adaptation Fund has allocated US$1.6 billion to climate adaptation activities, supporting 226 projects. According to the Adaptation Fund investment infographics, health has not been listed as a separate category in these project sector overviews; instead, work related to food security, agriculture, disaster risk reduction, and early warning systems has dominated.
By comparison, according to the Alliance for Transformative Action on Climate and Health (ATACH), a technical partner of the Green Climate Fund (GCF), 13 health-related projects have been approved under its Health, Food and Water Security thematic area — out of a total of 206 projects approved under that theme.
For instance, in Malawi, the Climate Resilient Health and Well-Being Project (FP244) has been initiated to bolster healthcare access in rural communities particularly vulnerable to climate-related shocks. Similarly, in Togo, the National Health System Resilience Project (FP305) has been approved to modernise medical infrastructure. In contrast, most of the projects received by India do not incorporate health resilience. However, projects such as the e-mobility financing programme may offer indirect health benefits by helping to reduce air pollution. NABARD (National Bank for Agriculture and Rural Development) and SIDBI (the Small Industries Development Bank of India) are both accredited entities, responsible for managing programmes aimed at agricultural and rural development, as well as the growth of small industries.
The Fund for Responding to Loss and Damage was established at COP 27 to support developing countries vulnerable to climate change impacts. This fund aims to address the significant loss and damage these nations face, which can include severe weather events, rising sea levels, and other climate-related challenges. As of 15 March 2026, US$ 631.12 million has been collected, out of a pledged US$ 822.06 million, from 25 partners to support those impacted by climate change. While health care isn’t a standalone funding window, it falls under the broader loss and damage mandate, which aims to complement humanitarian responses after extreme weather events and address specific priority gaps.
The Structural Bias in Climate Finance
The primary reason healthcare has been overlooked in large climate funds is how these funds are designed. Multilateral climate funds prioritise time-bound projects with measurable outputs, such as infrastructure and renewable energy, which align well with blended finance instruments. In contrast, enhancing health system resilience requires ongoing operational costs — such as disease surveillance and community health worker capacity — that yield long-term, diffuse benefits.
The primary reason healthcare has been overlooked in large climate funds is how these funds are designed.
Tracing cause and effect in health systems can also be challenging: health outcomes are often complex, depending heavily on socioeconomic factors, diet, genetics, baseline infrastructure, and other variables, many of which require long-term investment to address.
The Green Climate Fund accredited the WHO as an implementing entity in March 2026, expanding the pathways through which health-related finance can flow from global climate funds. Additionally, non-health-sector projects with notable health and well-being co-benefits have already been launched, including electric and active mobility projects and the promotion of climate-friendly cooking in Kenya and Senegal — all of which help reduce respiratory diseases associated with poor air quality.
India’s Climate-Health Financing Gap
One possible constraint on countries like India receiving health-related financial support from climate change funds is the absence of a fully costed, finance-ready Health National Adaptation Plan (HNAP). Such a plan would assess climate health vulnerability and the resilience interventions needed to address it, helping determine how much funding is required and from what sources.
Coordination challenges between the Ministry of Health and Family Welfare (MoHFW) and the Ministry of Environment, Forest and Climate Change (MoEFCC) may have contributed to this gap. In 2018, the MoHFW approved the ‘National Action Plan for Climate Change and Human Health’ (NAPCCHH). Simultaneously, the ‘National Programme on Climate Change and Human Health’ was launched in 2019. A separate division, the Centre for Environmental and Occupational Health, Climate Change and Health (CEOH-CCH), has since been established to help implement this agenda.
At the implementation level, the health ministries at national and state levels often have inadequate capacity to assess climate risk vulnerability and translate it into actionable plans.
However, there is limited evidence of dedicated international climate-finance mobilisation for these efforts, suggesting that much of the financing is domestically funded. Given India’s own low health spending, the country has sought external collaboration to address climate-related factors within the health sector. The National Health Policy (NHP) 2017 set a goal of raising government health expenditure from its then level of 1.15 percent of GDP to 2.5 percent of GDP by 2025, under the earlier GDP series. However, government health expenditure stood at 1.43 percent of GDP in 2022-23, underscoring the continued need for financing to help the health sector absorb the impacts of climate change.
At the implementation level, the health ministries at national and state levels often have inadequate capacity to assess climate risk vulnerability and translate it into actionable plans. This may be compounded by the absence of dedicated climate departments and by mismatches in procurement and fiduciary standards.
Building a Climate-Resilient Health System
Health adaptation finance is better understood as a differentiated obligation, rather than an act of charity. It builds on the principle of Common But Differentiated Responsibilities and Respective Capabilities (CBDR-RC), which has been a foundational aspect of international climate negotiations for the past two to three decades. Framing health finance in this way offers a useful basis for encouraging countries to treat their commitments to global health equity as shared responsibilities, rather than as discretionary gestures.
Health adaptation finance is better understood as a differentiated obligation, rather than an act of charity.
There is a strong need to create a health-funding window within the Green Climate Fund and other global funds. This funding window should focus on ongoing operational costs, rather than one-off projects. Priority areas for support include staffing to maintain health services, cold chain management for safe vaccine storage, and surveillance systems to monitor health threats worsened by climate change.
Further, it is crucial to advocate at the national level for the development of mechanisms that effectively link health-related climate change interventions with Nationally Determined Contributions (NDCs). Integrating these health interventions into NDCs not only reinforces the importance of health within the climate agenda, but also fosters a sustained commitment to addressing climate change.
At the operational level, interventions targeting on-site generation of renewable energy and heating in hospitals (for example, installing solar power), energy monitoring, and building upgrades (including new lighting, cooling, and heating systems) can be prioritised as measures towards a net-zero health system.
Integrating these health interventions into NDCs not only reinforces the importance of health within the climate agenda, but also fosters a sustained commitment to addressing climate change.
Overall, it is vital for climate finance to establish a dedicated health finance window, rather than treating it merely as a footnote or a co-benefit. This should be complemented by the formulation of a separate Health National Adaptation Plan (HNAP) that delineates specific expenditure allocations, alongside a distinct decarbonisation roadmap, each with its own implementation approach.
Rajeev Kumar Jha is a development practitioner with 18+ years of experience in disaster risk reduction, climate adaptation, and community resilience across South Asia.
The author acknowledges the use of Google Gemini for editing and language refinement.
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