In November of 2025 the 30th session of the Conference of Parties (COP30) took place in Belem, Brazil.While the COP has been the central platform for environmental policy for decades, and a touchpoint on current attitudes towards the climate crisis, health has surprisingly not played a very central role in the past. It appears this is – at last – changing. Starting withCOP29 and in the run-up to COP30 we have seen the topic of health be inserted into the action agenda as objective Nr. 16: “Promoting resilient health systems. In fact, in 2024 The World Health Organization (WHO) framed health as the compelling argument for climate action, pointing out how overlapping environmental and climate crises have extremely detrimental effects on people’s health (ibid.). This special report on climate change and health also pointed out that these effects are unequal, having most negative impact on women, children, the elderly as well as racialized and marginalized populations. The way forward, they write, is through prioritizing “equity, human rights, and a just transition to ensure everyone benefits from climate action”. In this article I will argue that health should also be central to climate adaptation.
Adaptation and mitigation are not, as some think, exclusive categories. By focusing on adaptation strategies we may, in fact, also contribute to more sustainable and effective mitigation strategies. With the challenges we see coming, both are – unfortunately – important. Which is why some researchers are advocating for a two-pronged approach in which mitigation policies are complemented by efforts to adapt to climate change.
Perhaps health is starting to become a central topic at COPs because first the short- and long term effects of the climate crisis on health are becoming more obvious, as for example the Lancet countdown shows, and second because as the hope for effective mitigation strategies dwindles, the call for robust adaptation strategies grows.
Health and adaptation
So what’s the current state of affairs in terms of adaptation?
Adaptation strategies are being developed at local, regional and national levels and seek to integrate multiple challenges and themes such as education, gender, and social protection to name just a few. However, as important as they are, adaptation plans have certain blind spots. Studies have shown that National and Local Adaptation plans (NAP and LAP) overwhelmingly focus on infrastructure (cooling centers, flood defenses, water systems) within cities, and are “scattered and underfunded”. And within these adaptation plans, health only plays a marginal role. In a study of National Adaption Plans in 327 European Cities, for example, Reckien et. al. found that while some health risks were covered, large scale risks like water-borne diseases, extreme-weather injuries, cardiopulmonary conditions, malnutrition, and mental health were largely neglected. In addition, National Adaptation Policies were far removed from the realities of day-to-day health-care delivery and emergency response. There was a gap, so to say, in what is seen as being politically relevant for climate adaptation and what is actually practiced “on the ground” in health care. Finally, additional research has shown that in many policies health is rarely treated as a core objective of climate adaptation policy, instead appearing as an indirect co-benefit of actions in other sectors, leaving many health risks insufficiently addressed.
These findings coincide with findings in the latest (2025) global review by WHO, „Health at the heart of national adaptation planning: a global review of national adaptation plans and health national adaptation plans”. In addition to advocating for integrating “health” into NAPs, WHO also pushes Ministries of Health to develop a climate specific health adaptation plan – aka a “health national adaptation plan (HNAP)” – with the objective of prioritizing health interventions in the face of the climate crisis. This is perhaps an important step in thinking about health as part of the critical infrastructure of climate resilient systems. However, stand-alone HNSPs parallel to NAPs run the risk of fragmenting the conversation around health and climate even more, reproducing and strengthening the silos practitioners often encounter when dealing with health and climate change and slowing implementation efforts.
A need for integrating health into climate adaptation strategies from the start
The Global NAP Network has identified the lack of implementation as the main challenge to moving forward in adaptation strategies. While national policies and legal frameworks are crucial to adaptation, equitable action at a local and regional level is more important than ever in the face of growing skepticism towards the realities of climate change. Researchers and practitioners who aim to bridge the climate and health divide must move from planning to implementation, integrating relevant (health) actors into climate adaptation strategies from the start. And health adaptation plans must draw on climate expertise in all areas of health systems – from capacity building of health professionals to delivery of health services and monitoring and treatment of disease to name just a few areas. Finally, intersectional, participatory approaches to understanding lived adaptation practices are more valuable than ever as people everywhere adapt to changing climate conditions with or without national strategies. Acknowledging these efforts and integrating local expertise into regional and national plans is crucial for future oriented approach to the challenges we face.