HMN 2026: How National climate plans recognize health risks, yet few protect most vulnerable groups

The majority of national climate adaptation plans fail to fully integrate health needs or engage populations most at risk from climate change, an international team of investigators led by Weill Cornell Medicine found.

The study was published in Lancet Planetary Health. Senior author Dr. Ilan Cerna-Turoff, assistant professor of epidemiology in emergency medicine at Weill Cornell Medicine, and his study team reviewed climate adaptation policies from 198 countries and the European Union, finding that while 88% mentioned the health impacts of climate change, important gaps in health integration remain.

Progress on health integration was variable, with several regions of the world falling behind. Some health conditions were nearly absent. Despite the widespread recognition that specific demographic groups were disproportionately affected by the health impacts of climate change, only 12% of the plans engaged these groups in their efforts. Many plans also lacked sufficient budgeting for monitoring and evaluation and health-related climate actions.

“There are many concrete ways that policymakers can more effectively integrate health in climate adaptation plans,” Cerna-Turoff said. “We need more cross-sector coordination and meaningful engagement with disproportionately affected communities.”

Why coordination is lacking

“Very often governments operate in silos,” he said. Ministries of climate or environment are often charged with drafting climate plans, and health ministers are usually not included in these meetings. The latter need to be involved throughout the process in planning, budgeting and establishing metrics for success, he suggested.

Cerna-Turoff noted that many plans currently lack regional subplans or fail to account for distinct community-level needs. For example, national plans often lacked strategies to cope with urban heat island effects or limited health system resources in rural communities. He noted that engaging subnational health leaders is crucial to identifying and closing such gaps.

“Successful implementation requires a decentralized framework,” he said.

Who gets left out

Most of the national climate adaptation plans acknowledge that women, children, adolescents and youth, people with disabilities, low-income individuals and older adults are particularly vulnerable to the impacts of climate change. Yet some heavily affected groups were underrepresented. Only about half acknowledge the impacts on Indigenous people and climate-displaced or migrant populations.

Few plans actively engaged vulnerable groups in the planning process, as recommended by several key guidance documents on climate and health, including the World Health Organization’s Global Action Plan on Climate and Health adopted by the World Health Assembly in 2025.

“Communities need to know what is happening for the plans to be effective,” Cerna-Turoff said. He also noted that community members may have insights into their own needs and potential barriers to accessing care. He highlighted the work of Pacific Island nations in successfully engaging Indigenous community leaders in climate adaptation planning. Additionally, he suggested that plans consider the needs of individuals across the lifespan.

Health threats often overlooked

According to the study, many plans highlighted the potential for climate change to increase the spread of infectious diseases, including those transmitted by insects, such as mosquitoes or ticks, and the potential for increases in chronic conditions.

National plans also frequently highlight harmful climate impacts on food, water supplies and sanitation. However, most policies and discussions fail to mention other key areas of health, namely violence, injuries, mental health, allergies or sexual and reproductive health.

Cerna-Turoff suggested that countries conduct a comprehensive assessment of all relevant health conditions likely to be affected by climate change within their national borders.

Based on current evidence and projections for the future, countries can build comprehensive policies. He suggested cross-country sharing of lessons learned and consulting with climate and health experts to better tailor plans to a complete range of health conditions.

Funding and accountability gaps

One of the largest gaps the team noted was in monitoring and evaluation and budgeting, a central component of effective health systems. Roughly half of countries globally did not outline their targets or structures for measuring progress. Only six countries had outlined complete plans for financing health within their climate adaptation plans.

The report also emphasized the need to adequately budget for climate-related health needs and to set measurable goals to track progress toward implementation.

“We need clear targets and sufficient budgets to adequately address climate impacts on health,” he said.

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