Climate-resilient health systems are a moral imperative

The climate emergency worsens global health conditions and weakens healthcare infrastructure. Health systems must be fortified to withstand these disruptions to ensure health equity and continuity of care.

Achieving universal health coverage (UHC) is one of the most ambitious goals outlined in the 2030 Sustainable Development Agenda. At its heart, UHC promises to ensure that everyone, everywhere, can access the health services they need—when and where they need them—without financial hardship. Yet, despite its transformative potential, the path to UHC is uneven, and for many countries in Africa, the goal feels increasingly out of reach. 

Here is the stark reality: Fragile health systems across the continent are under tremendous strain. The covid-19 pandemic, the Mpox outbreak, and the resurgence of Marburg and other diseases disrupted services and exposed deep inequities. At the same time, climate change emerged strongly as a silent yet devastating force, threatening to undo decades of progress. Its fingerprints are everywhere—rising temperatures, more frequent droughts, unrelenting floods—and its impact is felt most acutely by the poorest and most vulnerable communities. 

In Africa, climate change is not just an environmental challenge but a public health emergency. Diseases like malaria and dengue fever, already endemic in many regions, are spreading to new areas including previously unaffected colder regions as temperatures rise. Access to clean water, safe food, and adequate shelter—basic determinants of health—is becoming increasingly precarious. For marginalised communities, these challenges are overwhelming. Women and children walk long distances in search of water, exposing themselves to risks of sexual violence. Children face malnutrition as crops fail, and entire communities are displaced by floods, losing their homes, livelihoods, and becoming cut off from access to care. 

Health systems in Africa, already stretched to their limits, are buckling under the weight of intersecting crises. Clinics are often flooded or damaged during extreme weather events, while health workers grapple with impossible choices amid dwindling resources. The World Health Organization (WHO) highlights that over half of public health emergencies in Africa over the past two decades were climate-related.

Yet, despite this glaring evidence, health remains alarmingly underrepresented in global climate priorities. To make matters worse, the US$300 billion per year climate finance commitment made in Baku—already far below the US$1.3 trillion annually required to reduce emissions and build resilience in vulnerable countries—is not only inadequate but also shortsighted and disconnected from the lived realities in developing nations. This failure to act decisively is a profound betrayal by high-income countries and the world’s largest carbon emitters, who continue to claim they take climate change seriously while leaving the most vulnerable populations to bear the brunt of its impact. 

The economic toll of inaction is staggering, particularly for Africa. Some African nations spend a meagre US$40 per capita on health. This stark disparity underscores the chronic underfunding of health systems across the continent—a situation that will only worsen as climate impacts intensify.

The 2023 State of Climate in Africa Report notes that the continent has been warming at a faster rate than the global average and that climate-driven disasters are getting worse, inflicting the most suffering on those who did least to cause them. The report further highlights that the climate crisis is an economic sinkhole, sucking the momentum out of economic growth, costing many African nations between 5%–9% of GDP. By 2050, the economic cost of the health impacts of climate change is projected to reach between US$11–20.8 trillion in low- and middle-income countries (LMICs), according to the World Bank.  

Labour productivity losses across agriculture and other vital sectors could cost Africa an estimated US$30–50 billion annually by 2030. The human toll is equally staggering, as rising cases of heat-related illnesses, respiratory diseases, and malnutrition erode the continent’s human capital. Families lose breadwinners, communities lose economic contributors, and entire societies face stalled development. Sub-Saharan Africa bears the brunt of this crisis, accounting for 71% of cases and nearly half of all projected deaths, with the economic impact reaching up to 3.7% of GDP. Every year of inaction amplifies these losses, forcing African nations to shoulder an avoidable burden that grows heavier with each passing season. 

 

Solutions designed without the input of those they aim to serve often miss the mark. Photo: Hansel Ohihoma/Wikimedia

For families, the stakes could not be higher. When health services are unavailable or unaffordable, the consequences are devastating. Parents are often forced to sell assets or borrow money, plunging their families deeper into poverty. Children drop out of school to support household income, tightening the grip of generational deprivation. This is not a distant future—it is the harsh reality faced by millions of Africans today. 

Scaling up climate and health action is essential not only to prevent future economic losses, which could amount to trillions of dollars due to the health consequences of climate change, but also to accelerate the attainment of UHC. To break the cycle, African governments must rethink their health systems through the lens of resilience and equity. Health systems need to be fortified to withstand the shocks of extreme weather, ensuring continuity of care even during crises. Disease surveillance, especially community-led systems, must be enhanced to detect and respond swiftly to outbreaks of climate-sensitive diseases.  

Investments in primary healthcare are particularly critical. When primary care is robust, communities have a safety net that provides not only essential services but also a lifeline during emergencies. Strengthening primary healthcare builds resilience and also lays the foundation for equitable and sustainable health systems capable of supporting populations in the face of climate and health challenges.  

At the same time, the financial burden of healthcare must be lifted from the shoulders of low-income communities. Expanding publicly funded health insurance schemes is critical to ensuring that healthcare costs do not drive families into poverty. These schemes must also evolve to address the growing risks posed by climate change, including heat-related illnesses and waterborne diseases.

Achieving this will require substantial financial support from the international community. High-income countries have both a moral and a practical obligation to honor their commitments under the Paris Agreement by scaling up public funding to help developing nations build resilience against climate impacts.

It is therefore deeply unjust and unacceptable that the new US$300 billion climate finance goal is not only insufficient but also shifts the responsibility of developed countries from directly providing financial resources to merely mobilising them. This undermines the spirit of the climate convention, which obligates developed nations to provide financial support in recognition of their historical and ongoing contributions to the climate crisis. 

Communities must also be at the center of the response. Solutions designed without the input of those they aim to serve often miss the mark. Engaging local leaders, women, community health workers and youth to co-create primary healthcare-based interventions can ensure that services are tailored to the evolving needs of populations. These partnerships can also foster greater trust, resilience, and ownership, empowering communities to address the root causes of health inequities. 

Ultimately, achieving UHC in the face of the climate crisis will require unprecedented levels of collaboration, innovation, and political will. Health systems must be reimagined not as passive responders but as proactive agents of resilience, capable of mitigating the impacts of climate change while protecting the most vulnerable. The cost of inaction is far too high—for individuals, for nations, and for the world. Investing in climate-resilient health systems is not just an economic imperative; it is a moral one. 

Article first published on https://www.re-solveglobalhealth.com/post/climate-resilient-health-systems-are-both-an-economic-and-a-moral-imperative