February 20, 2025

Twin crises: why rich countries must pay up for climate and health

topic:	Health and Sanitation
tags:	#climate change, #climate finance
located:	Tanzania
by:	Cameron Boyle

"Last year during the rainy season, the rain flooded our house and we had to leave. I have fungus on my toes and this area gets full of mosquitoes because of the stagnant water. Malaria is a real problem."

Hawa's life was upended by a crisis she did not cause. When climate-induced floods devastated her family's home in Dar Es Salaam, Tanzania, the toilet overflowed with faeces, leaving them exposed to myriad health risks.

Hawa is not alone. In Bhetkhali, a village in the southwestern coastal region of Bangladesh, flash floods have destroyed water salinity, yet during intense heatwaves, Shyamoli and her family have no choice but to bathe in the dirty, salty ponds:  

"The water I bathe in causes my skin to get very dry and I often get blisters. The blisters sometimes get so dry that they bleed."

Around the world, millions of people – the vast majority in low- and middle-income countries (LMICs) – face the same fate as Hawa and Shyamoli; forced to suffer the impacts of a crisis created by wealthy countries. As both situations show, these impacts take a heavy toll on public as well as planetary health. 

From cyclones causing cholera outbreaks, to air pollution causing respiratory and cardiovascular hospitalisations, the climate crisis is fuelling its own health emergency. 

Yet who is bearing the brunt? Those least responsible. High-income countries (HICs) account for 43 per cent of cumulative greenhouse gas emissions. Low-income countries (LICs) account for just 3 per cent. Yet LICs also have the lowest climate readiness scores, and already face profound health inequities. Inevitably, then, they face the most adverse health outcomes due to climate change.

International Climate Finance: Broken Promises and Hidden Cuts

It is a profound injustice. But are those responsible paying up? The numbers speak for themselves. Rather than rising steadily to meet a target of £11.6bn over five years, UK climate spending overseas has fallen for two years in a row.

Alongside these overt failures are some more covert ones, like the UK changing how it accounts for its international climate finance (ICF) contributions. The £11.6bn target was set in addition to, not instead of, other forms of assistance - such as Official Development Assistance (ODA). But when ODA was cut from 0.7 per cent to 0.5 per cent of GNI, the UK could no longer continue this arrangement. It therefore moved the goalposts, drawing at least £1.6bn from sources meant to be ring-fenced - essentially aid cuts by stealth. 

Between 2017 and 2021, the UK's bilateral ODA to climate adaptation decreased by 81 per cent. What’s more, a mere fraction is used to ease health burdens. In 2022, just 2 per cent (£48.7 million) of UK climate ODA was allocated to health-specific programmes, compared to a Development Assistance Committee average of 6 per cent. So, despite an abundance of rhetoric regarding climate and health action, recent years have seen a backwards trajectory – all while the warning signs have grown starker. 

According to the latest assessment report from the Intergovernmental Panel on Climate Change (IPCC), carbon emissions must be reduced by 48 per cent by 2030 to have any real chance of limiting global warming to 1.5°C. Even with all the pledged action, we are currently on track for 2.7°C by 2100.

All the while, this negligence intensifies the health burden on those least responsible. A 2024 World Economic Forum report states that climate change could result in an additional 14.5 million deaths, $12.5 trillion in economic losses and $1.1 trillion in extra costs to healthcare systems by 2050. If these figures don't act as a wake-up call, what will?

Last year’s COP29 in Baku, Azerbaijan, consolidated this rejection of reality. Far from finally cleaning up their mess, high-income countries stumped up just $300bn (£238bn) a year – well short of the $1.3tr developing countries were pushing for.

Jess Beagley, Policy Lead at The Global Climate and Health Alliance, was in attendance. She said:

"The financial commitment of USD 300bn by 2035 for climate action falls far short of what is needed to protect health and lives. A roadmap by COP30 in Belém to adequate climate finance will be essential to protect and promote health through climate action across sectors - including building robust healthcare facilities, nourishing food systems, resilient water and sanitation infrastructure and access to reliable, safe and affordable energy."

Addressing funding gaps is the only way to arrest the current trajectory and ensure a just transition to a healthier future. To quote James Tibenderana, Chief Executive of Malaria Consortium: 

"It is imperative that new investments are secured - through global climate leaders like the UK and others - to help us better understand the unknowns, so that we are in a position to anticipate, predict and respond to these impacts."

Voices from the Frontlines

Listening to civil society actors such as the above is critical. But even more crucial is listening to those in the eye of the storm – people like Hawa and Shyamoli. For too long, these voices have been sidelined. 

As we look towards the future, the blueprint is evident. High-income countries must pay what countries on the frontlines stipulate – not what suits their economic interests best. Moreover, the voices of affected communities must play a central role in shaping programmatic and policy interventions. After all, who is better placed to inform solutions than those bearing the brunt of the problem?

In the words of Peter Waddup, CEO of The Leprosy Mission, "It is a never-ending fight." But it is one which, through concerted effort and equitable action, progress can be attained, and the existential threat of the climate emergency - and its associated health crises - can be mitigated.

A major reset is needed. One rooted in equity and justice. One that ensures fair financial contributions from those most responsible and that places communities on the frontlines at the centre of the response. Then, and only then, can we build a future where everyone lives with dignity and in harmony with our planet. 

Cameron Boyle is Senior Digital Campaigns and Media Advisor at Action for Global Health.

Image by Water Aid/ Sam Vox.