"Countries should be competing to do more": WHO on the Belém Health Action Plan

(Image: Dr Diarmid Campbell-Lendrum in Geneva in 2019)

At COP30, the Belém Health Action Plan became the first international climate adaptation document dedicated specifically to health. Launched by Brazil as part of the Global Climate Action Agenda – a framework designed to translate climate commitments into concrete delivery – the Plan was developed with global health partners, including the World Health Organization (WHO).

So far, the Plan has secured commitments from 30 countries and 50 organisations to climate-proof hospitals and clinics, strengthen disease-surveillance systems, and prepare health workers for rising heat, floods, and changing patterns of infection. It has also unlocked an initial USD $300 million in philanthropic funding.

To understand how the Belém Health Action Plan took shape – and how it will make an impact on the ground – the Climate Champions Team spoke to Dr. Diarmid Campbell-Lendrum, head of the climate change and health unit at the WHO. With more than 20 years of experience in climate and health policy, including research in Brazil on the links between deforestation and the transmission of vector-borne diseases, he shares insights into how to keep health systems functioning in a warming world.

The Action Agenda is being billed as implementation-focused. What makes the Belém Health Action Plan more than just the latest iteration of climate-health commitments?

You’re right, there's been a welcome shift from securing commitments to developing actual implementation plans. COPs are good forums for these discussions, but they represent the most ambitious action that everybody can agree on, which isn't always the most ambitious action possible.

(Image: A nurse in Marsabit County, writes a prescription for a woman visiting a mobile health clinic in Ntiliya village)

The Belém Health Action Plan, [which is part of the Global Climate Action Agenda], is quite specific about the actions and ambition needed. There's sometimes a misperception – particularly in low- and middle-income countries – that they lack the capacity, knowledge and expertise to address climate-resilient health systems. Yet, even in highly vulnerable countries, there's significant expertise in health system strengthening, water and sanitation, food systems – it just hasn't been deployed through a climate lens yet. The Plan addresses this through cross-regional collaboration and peer learning mechanisms, helping countries share expertise and build on existing strengths.

The Plan also addresses surveillance systems, for example, because we've heard from many countries that improving information systems to identify and respond to health risks is a priority. Innovation is crucial too. We can get a long way just by implementing things we already know work but aren't doing everywhere yet.

What happens when a clinic or hospital can’t service its community because of climate impacts, and what changes will doctors see from the new Plan?

We're getting evidence from the field that climate impacts are much greater than we previously appreciated. During the Pakistan floods, many lives were lost immediately, healthcare facilities were washed away and transport networks disrupted. We saw upticks in both malaria and tuberculosis cases. Recent science shows that 10 to 100 times more lives are lost in the months after flooding due to health system disruption than in the immediate event itself.

(Image: Imaad, a resident of Shabara village in Charsadda district in Pakistan, wades through floodwaters to bring food to his cattle on 31 August 2022)

It's one thing to tell people to be concerned, but the other is to ask what we can do about it. WHO/PAHO's Smart Hospitals approach in the Caribbean retrofitted facilities with higher design standards to withstand hurricanes and flooding. When these extreme events hit, those upgraded facilities kept functioning and providing health services. This approach saves money, as you're not rebuilding hospitals and saves lives, both immediately and long-term.

The Belém Health Action Plan tackles this by training health workers and hospital managers to prepare for climate impacts – from gradual changes like rising temperatures to sudden disasters like floods. The training uses real-world case studies and simulations so medical teams know what to expect and how to respond. We're also building climate lessons into medical education from the start, and creating programs that bring together different disciplines and incorporate knowledge from Indigenous communities.

The initial USD $300 million pledged by countries and organisations is significant. What happens next?

What we expect and want to happen is that the countries actually take ownership of their own agendas. We’d like countries to use the Belém Health Action Plan as an orientation, helping them identify actions and include these in their health adaptation plans or overall national adaptation plans. And the WHO can support. We have a broad public health mandate through the World Health Assembly and are present in almost every country around the world.

The USD $300 million philanthropic funding is really important, but it’s a very small proportion of what the world spends on healthcare – given that the total global spending [as of 2020] has reached about 10% of global GDP, somewhere around USD $8 trillion. That funding has to be catalytic. It can orientate the big investments needed, for example, from multilateral development banks that are huge funders of health systems, particularly in low and middle income countries. This funding can orientate private finance as well, telling them their healthcare investments need to be climate-resilient, innovative, and low-carbon.

We shouldn't have a lot of patience with the argument that there's not enough money. The evidence is very clear: we have effective interventions that are highly cost-beneficial, and there is money there, but it's not necessarily spent on the right things. Our initial conservative economic assessment, according to a new analysis that the WHO hopes to publish shortly, indicates that for every dollar you spend, you get about USD $4 back in health gains. Additionally, if we scaled up interventions around extreme heat, early warning systems and facilities’ renewable energy, we could save about 2 million lives every year.

(Image: Hospital in Mecufi, northern Mozambique was damaged by Cyclone Chido)

The other part of the economic equation is that aid budgets are decreasing, but even in a resource-constrained environment, the world currently spends hundreds of billions each year subsidizing fossil fuels: the very thing that's taking lives and causing the climate crisis.

How does a 'just transition' apply to health and which solutions can scale fastest?

I think we have to be adaptable even in the solutions that we choose. An example of rapid uptake is improved information systems. We have started using weather and health information for better early warning systems, and we have every reason to believe this will scale rapidly because the technology is advancing quickly. Also solutions like renewable energy for health facilities will move fast because it’s the cheapest energy technology available. There shouldn't be a barrier to replacing expensive coal driven grids or diesel generators. It reduces local air pollution and carbon emissions. And a third characteristic of innovations connecting directly to daily life, like wearable devices to provide personalized heat risk information and tailored medical advice. These will gain rapid uptake because people immediately see how they improve their lives.

About the Belém Health Action Plan

The Belém Health Action Plan was developed with global health partners and serves as the health sector's principal contribution to COP30 Objective 16 on resilient health systems under the Global Climate Action Agenda. Aligned with WHO's Global Action Plan on Climate Change and Health and multiple World Health Assembly resolutions, it supports the Paris Agreement's Global Goal on Adaptation. By COP33 (2028), endorsing Parties are expected to report on implementation through the UNFCCC's Global Stocktake, creating accountability mechanisms that align health adaptation with broader national planning processes.