Introduction

Climate change is among the most significant threats to global public health, driving rising temperatures, worsening air pollution, increasing spread of vector-borne diseases, escalating food insecurity, and growing mental distress. Meanwhile, systemic drivers of climate change, including fossil fuel dependence, car-centric cities, and unsustainable agricultural practices, further harm population health through chronic pollution, poor nutrition, and inadequate physical activity [1].

Nevertheless, many Nationally Determined Contributions (countries’ plans to deliver the goals of the Paris Agreement, NDCs) still consider health merely a co-benefit rather than a fundamental driver of climate ambition. This year, as countries prepare their third-generation NDCs outlining their planned climate actions until 2035 (“NDC3.0”), there is a unique opportunity for integrating health into NDCs. It is a scientific, economic, and political imperative, and a practical strategy to protect populations, mobilize public support, and ensure sustainable and equitable climate action [2]. As of July 2025, 27 countries, responsible for 21% of global emissions, had submitted an updated NDC [3]. Here, we discuss examples of good practice for embedding health considerations in NDCs, for consideration by policymakers and other stakeholders engaging in NDC development in the coming months.

Why health belongs in NDCs

The case for health-inclusive NDCs is grounded in both evidence and principle.

• Scientific imperative: The IPCC Sixth Assessment Report states that “every increment of global warming will intensify multiple and concurrent hazards” [4]. From a human health perspective, higher temperatures lead to increased mortality, particularly among vulnerable populations [5].
• Policy alignment: The Paris Agreement recognizes the right to health, and both the COP28 UAE Declaration on Climate and Health and the World Health Organization Global Action Plan on Climate Change and Health explicitly encourage countries to integrate health into NDCs [6].
• Economic rationale: Climate-sensitive health risks could cost developing countries $11.1 billion annually in adaptation needs alone by 2030 [7]. Preventive climate action, such as promoting clean air and resilient health systems, is more cost-effective than disaster response [8].
• Public and political capital: Health resonates with voters. It cuts across sectors and demographics and is often ranked as a top public concern.

How to include health in NDCs

Health can be protected and promoted in NDCs through several meaningful ways:

• Commitment to ambitious and equitable emissions reduction targets aligned with the Paris Agreement and with a focus on the reduction of short-lived climate pollutants, offering short-term gains for both emissions reductions and air quality
• Inclusion of actions on health system adaptation (e.g., resilient infrastructure, early warning systems)
• Identifying co-benefits of mitigation and adaptation action, such as clean air, active mobility, healthy diets, and safe water across health-determining sectors like agriculture, energy, sanitation, and transport
• Strengthened governance and coordination, including contributions by health ministries to NDC development, implementation, and monitoring
• Budget allocations and monitoring frameworks to support and track implementation.

Here, we consider the integration of such health considerations in NDCs of the UK and Kenya. A more detailed evaluation of existing good practice can be found in the Global Climate and Health Alliance’s Healthy NDCs 3.0: Embedding Health in National Climate Plans for 2035 [9].

Country case studies: UK and Kenya

Recommendations: Towards comprehensive health integration

To elevate health to a core component of global climate action, several steps are critical:

1. Adopt measurable public health targets in future NDCs, following the guidelines developed jointly by the UNFCCC and WHO, setting standards for clear, measurable health outcomes [12].
2. Strengthen guidance for health and health-related projects within global climate financing mechanisms, supporting targeted health adaptations and interventions.
3. Institutionalize collaboration: Require health ministries’ active involvement in developing and implementing NDCs to ensure policy coherence across sectors [13].
4. Undertake national vulnerability assessments, including detailed evaluations of climate-sensitive health risks and health system readiness.
5. Leverage WHO technical resources such as the HEAT [14] (https://www.who.int/tools/heat-for-walking-and-cycling) and CLIMAQ-H [15] (https://www.who.int/europe/tools-and-toolkits/climate-change-mitigation--air-quality-and-health-(climaq-h)) tools, to quantify and maximize health co-benefits of climate action.
6. Ensure accountability: Include health indicators in national MRV (Monitoring, Reporting, Verification) and MEL (Monitoring, Evaluation, Learning) systems and global processes like the UNFCCC Global Stocktake [12].

Conclusion: Embedding health at the heart of climate action

The next generation of NDCs (NDC 3.0) in 2025 represents a pivotal opportunity to redefine climate ambition through a health lens. Current approaches, treating health as peripheral, are scientifically insufficient and politically shortsighted. Placing health as a core consideration in NDC development and implementation provides a robust rationale for ambitious climate action, with the potential to garner public support and ensure tangible, immediate benefits for populations worldwide.

Future NDCs must reflect this dual commitment: ambitious climate action as a proactive public health strategy. Climate ambition is incomplete unless it explicitly protects and promotes health, making health foundational rather than an optional “co-benefit”.

The third generation of NDCs can, and must, be the turning point where health becomes integral to climate ambition, safeguarding populations, securing broad-based support, and translating the urgency of climate science into immediate and sustained health benefits for all.