Climate and health: COPs, NDCs and plans

ATACH: the network that delivers the COP26 health commitments

ATACH — the Alliance for Transformative Action on Climate and Health — is a voluntary network of countries, areas and partners working to build climate-resilient, sustainable and low-carbon health systems. It was established in 2022 to deliver the COP26 Health Commitments on climate-resilient and low-carbon health systems, which health ministers from over 75 countries had asked WHO to support.

In October 2025, Tuvalu became the 100th country to join, and the Alliance then had 100 countries and areas committed, plus over 95 partners (WHO, 16 October 2025). Members share knowledge, case studies and country documents through the Alliance, and can commit to making their health systems climate-resilient and low-carbon in line with the COP26 agreement. ATACH is the delivery vehicle for much of what follows in this guide — including the Belém plan and the COP31 Antalya Initiative.

COP28: the Declaration and the first Health Day

The COP28 UAE Declaration on Climate and Health was announced on 2 December 2023 at the World Climate Action Summit in Dubai. It was signed by 123 countries at launch (148 had signed by May 2026, according to WHO) — the first time governments had collectively acknowledged the need to protect communities and prepare health systems for climate-related health impacts, including extreme heat, air pollution and infectious disease. Its commitments cover building climate-resilient health systems, working across sectors to cut emissions and maximise the health benefits of climate action, and increasing finance for climate and health.

Alongside the Declaration, partners collectively committed US$1 billion to climate and health, including a US$300 million commitment from the Global Fund announced at the launch, US$100 million from the Rockefeller Foundation and £100 million from the Wellcome Trust.

The day after the Declaration, 3 December 2023, COP28 held the first-ever Health Day at a COP, including the first climate-health ministerial. No earlier COP had a dedicated health day or health ministerial, which is why COP28 is described as the first.

NDCs: how health appears in national climate plans

A Nationally Determined Contribution (NDC) is a country’s national climate plan under the Paris Agreement. Health can appear in an NDC in several ways: the plan mentions health, identifies the health co-benefits of cutting emissions, includes health-specific adaptation actions or targets, and — rarely — costs or funds them.

WHO’s review of the third generation of NDCs, published 19 October 2026, examined 114 NDC documents representing 140 Parties. It found that 91% of Parties mention health, 59% identify health co-benefits of mitigation actions, and 55% include health-specific adaptation actions or targets. But only 11% include emissions-reduction measures or targets for the health sector, and only 23% estimate the resources required for health-related climate actions. The review’s conclusion is that commitments need to be more specific, better evidenced and adequately financed, with more quantification of health benefits. The previous WHO review, in 2023, found 91% of available NDCs included health considerations, up from 70% in 2019 — the share mentioning health has stayed high while the depth of the commitments still lags.

Figures: WHO review of the third generation of NDCs, 19 October 2026 (114 NDC documents, 140 Parties).

Health National Adaptation Plans (H-NAPs)

A Health National Adaptation Plan (H-NAP) is a plan developed by a country’s Ministry of Health as part of the National Adaptation Plan process. WHO defines it as the health sector’s plan for building climate-resilient health systems that can anticipate, absorb and transform in a changing climate — setting out actions to protect population health while improving the management of other health threats.

One example is Lao PDR’s H-NAP 2025–2030, developed by the Ministry of Health with WHO support, which prioritises climate-sensitive health outcomes including extreme weather, water- and vector-borne diseases, food insecurity and heat. In February 2026, Lao PDR held a national consultation to put the plan into practice alongside the health component of its NDC 3.0. H-NAPs are where the global frameworks in this guide become a country’s own health-sector plan.

The Global Goal on Adaptation and its health target

The Global Goal on Adaptation (GGA) comes from Article 7 of the Paris Agreement. COP28 gave it an operational framework — the UAE Framework for Global Climate Resilience (Decision 2/CMA.5, December 2023) — with targets for 2030 across seven systems, including health. The health target is to attain, by 2030, “resilience against climate change related health impacts, promoting climate-resilient health services, and significantly reducing climate-related morbidity and mortality, particularly in the most vulnerable communities”.

COP30 then agreed how progress would be tracked: 59 adaptation indicators were formally adopted, including eight on health, after a two-year technical process that started from some 10,000 potential indicators. At the same conference, countries agreed to at least triple adaptation finance to US$120 billion a year by 2035 — building on the COP26 target of doubling it to US$40 billion a year by 2025, a target that was likely to be missed. The scale of the gap is shown by the UN Environment Programme’s Adaptation Gap Report 2025, which found international public adaptation finance to developing countries was US$26 billion in 2023. As of 30 September 2025, 144 countries were engaged in national adaptation planning and 67 developing countries had formally submitted adaptation plans to the UNFCCC.

The eight health indicators adopted at COP30

The eight health indicators are the ones adopted under target 9(c) of the UAE Framework for Global Climate Resilience — the health target quoted above. They are listed in paragraph 5 of the annex to the COP30 decision on the Global Goal on Adaptation (Decision -/CMA.7) and reproduced in the panel of The Lancet Planetary Health’s COP30 report; the two wordings agree verbatim:

1. Rate of mortality associated with climate impacts compared with counterfactual rates, including as an outcome of adaptation actions or coverage of early warning systems where applicable
2. Level of incidence of climate-sensitive infectious diseases, including as an outcome of adaptation actions where applicable
3. Rate of morbidity associated with climate impacts compared with counterfactual rates, including as an outcome of adaptation actions where applicable
4. Proportion of the population vulnerable to climate change with access to mental health and psychosocial support
5. Extent to which climate health services have remained at full capacity during and following climate-related events relative to pre-event service capacity
6. Percentage of health facilities that are resilient to climate-related hazards under different warming scenarios, as appropriate for regions and contexts, including as an outcome of adaptation actions where applicable
7. Coverage of essential health services that are supported by adaptation measures to ensure continuity during and following climate-related events
8. Proportion of health practitioners who have received capacity-building support pertaining to climate change adaptation and health

The decision stresses that these indicators are voluntary, non-prescriptive and facilitative — meant to complement, not replace, national monitoring systems — and that they create no new financial obligations or reporting burdens. The list itself is contested, and the contest is part of the record: the same Lancet report notes that some indicators were reformulated in the final hours of the negotiations, that the decision was gavelled through in the closing plenary without allowing country interventions, and that several countries and regions opposed it; one commentary (CCCLLC Substack) argues that only one of the technical experts’ original ten health indicators survived intact, with four dropped and five altered. The eight above are the adopted list — the official yardstick countries are now expected to use — not the experts’ recommendation.

Short labels for the eight adopted indicators listed above; the full wording is the adopted list.

Making health systems low-carbon

Health systems are both vulnerable to climate change and a contributor to it: the health sector is responsible for almost 5% of global greenhouse-gas emissions (WHO, 9 November 2023). WHO’s Operational framework for building climate-resilient and low-carbon health systems, released in November 2023, gives countries a roadmap for both halves of that problem — withstanding climate shocks while cutting their own carbon footprint. It sets out different pathways depending on a health system’s overall performance, its emissions and its climate-and-health capacity, including systems in low-income countries that need to increase energy access and health service provision to deliver universal health coverage. ATACH and the COP26 Health Commitments are the delivery vehicle for the framework.

COP30: the Belém Health Action Plan

The Belém Health Action Plan (BHAP) was launched at COP30 in Belém on 13 November 2025 — the conference’s Health Day — and is the first international climate-adaptation document dedicated to health. It is a voluntary framework, with no legally binding requirements or targets, organised around three lines of action: surveillance and monitoring; evidence-based policies, strategies and capacity building; and innovation, production and digital health. Two cross-cutting principles run through it: health equity and climate justice, and leadership and governance on climate and health with social participation. It contains 60 action items, and endorsing countries report progress through the Paris Agreement’s second Global Stocktake, at COP33 in 2028. WHO serves as the plan’s secretariat, and implementation is measured through ATACH.

By May 2026, the plan was endorsed by 33 countries and supported by 50 organisations (WHO, 20 May 2026). On finance, the launch came with no new financial commitments from endorsing governments. The sole funding announcement was an initial US$300 million pledge from the Climate and Health Funders Coalition — a group of philanthropies including the Gates Foundation, Wellcome Trust and Rockefeller Foundation — to support implementation. There is no separate Belém financing framework with its own launch date; the US$300 million coalition pledge at the COP30 launch is the answerable fact.

COP30 also decided more than the Belém plan: beyond it, the conference adopted the 59 GGA indicators described above and agreed the adaptation-finance tripling to US$120 billion a year by 2035.

The WHO Global Action Plan on Climate Change and Health, 2025–2028

On 27 May 2025, the Seventy-eighth World Health Assembly adopted the first-ever Global Action Plan on Climate Change and Health, covering 2025–2028 (decision EB156(40)). It is a strategic framework to guide Member States, the WHO Secretariat and other stakeholders in developing climate-resilient, low-carbon health systems; enhancing surveillance and early-warning systems; protecting vulnerable populations; and integrating health into climate policy and financing. The Assembly affirmed that climate action is not only an environmental priority but a strategic health priority, while noting that some Member States wanted more time and dialogue on certain principles and language in the plan.

Which countries include health best in their climate plans?

The Global Climate and Health Alliance (GCHA) — a consortium of more than 300 health-professional and civil-society organisations — published its 2026 Healthy NDC Scorecard on 14 October 2026. It assesses the 2035 NDCs of 132 countries, scoring each out of 32 across eight categories: whether the plan recognises the links between climate change, air quality and health, and whether it sets out plans to act.

Colombia scores highest, with 29 out of 32, followed by Nigeria (25) and Cambodia (24); Paraguay and Timor-Leste score 22 each. At the other end, India, Japan and New Zealand score 2 each. Larger emitters sit in the middle on health while falling short on emissions ambition: the EU scores 12, Canada 16 and Türkiye 14. Nineteen of the top 20 scores are held by low- and middle-income countries. The scorecard is the Alliance’s assessment of what governments put in their submitted plans — not a UNFCCC ranking — and the scores describe plans, not implementation: a high score does not mean the policies have been carried out or that health outcomes have already improved.

Tracking extreme heat for pregnant women and newborns

On 21 October 2026, WHO, the World Meteorological Organization, UNICEF and the UN Population Fund launched the first set of priority indicators to help countries track the health impacts of heat on pregnant women, newborns and children. The framework, Priority indicators to monitor the impact of heat exposure on maternal, newborn and child health, is designed to connect routine health data with heat-exposure data so that health authorities can spot emerging problems, prepare services and respond sooner.

Countries are recommended to monitor preterm births, stillbirths, low birthweight, pregnancy hypertension, child deaths and health-facility visits during extreme heat; monitoring school attendance can also show how heat disrupts children’s lives. The evidence behind it: exposure to extreme heat is associated with a 26% increase in the odds of preterm birth; babies under one year of age experienced 389% more heatwave days in 2024 than during the 1986–2005 baseline; and an estimated 1.5 billion children are exposed to heatwaves that are becoming more frequent, longer or more severe. The indicators track associations to investigate — they do not by themselves prove that a particular heatwave caused a particular outcome.

Frequently asked questions

What is ATACH?

The Alliance for Transformative Action on Climate and Health — a voluntary network of countries and partners, established in 2022 to deliver the COP26 health commitments. It had 100 countries and areas and over 95 partners as of October 2025.

Who tracks whether countries keep their climate-health promises?

No single body does. The Belém Health Action Plan is reported through the Paris Agreement's Global Stocktake (next at COP33 in 2028), the Global Goal on Adaptation has 59 agreed indicators, and WHO measures Belém implementation through ATACH.

Is there a separate financing framework for the Belém Health Action Plan?

No. No separate Belém financing framework with its own launch was announced. The financing at the COP30 launch was an initial US$300 million pledge from the Climate and Health Funders Coalition, a group of philanthropies; endorsing governments announced no new finance.

Which countries include health best in their climate plans?

According to the Global Climate and Health Alliance's 2026 Healthy NDC Scorecard, Colombia scores highest (29 out of 32), followed by Nigeria (25) and Cambodia (24). It is the Alliance's assessment of what the plans contain, not a UN ranking, and it does not measure implementation.