Structural inequities and loss

Climate-related health risks are not evenly distributed. Poverty, racism, gender inequality, colonial legacies, and political marginalization shape who is most exposed, who is most vulnerable, and who has the least access to protection [3]. Without confronting these root drivers, climate-health strategies risk reproducing the very inequities they seek to reduce. Equity must be embedded in research design, funding allocation, and implementation research and evaluations.

Infrastructure destruction, livelihood erosion, population displacement, strain on fragile health systems, and profound mental health consequences are unfolding in real time [3]. Yet we still lack robust research methods to understand how systems can withstand cumulative shocks and sustain resilience. This is both a technical and moral challenge - requiring improved methods to measure, anticipate, and respond to compounding risks, while also demanding ethical commitments to justice, accountability, and meaningful support for communities who have contributed least to climate change but bear its greatest burdens.

Systems capacity: Finance, translation, and delivery

Beyond questions of justice, institutional capacity will determine whether solutions can be implemented at scale. For example, climate and health ambitions cannot be realized without fair, predictable, and accessible funding. Without financial integrity, commitments remain aspirational. Furthermore, mechanisms governing how resources are mobilized, who controls allocation decisions, and whether financing mechanisms reach the most affected populations are often not transparent. A clearly outlined health-centred lens integrated into these mechanisms can evaluate not only funding volume, but effectiveness, transparency, and equity. Translating climate data into actionable public health tools also remains underdeveloped. Climate services for health require investment, research and partnerships between weather services and the health sector, with the aim of achieving integrated, climate-informed decision-support systems usable by frontline practitioners and planners [12]. Bridging meteorological expertise, climate modelling tools and public health implementation requires sustained institutional investment and long-term partnerships.

Implementation science is equally critical to closing the persistent ‘know - do’ gap [13]. While evidence on effective interventions for managing heat risks continues to grow, there are still research gaps with regard to efficacy of many climate adaptation and mitigation measures, particularly in health systems. At the same time, we have to think about how to scale promising measures across diverse cultural, geographic, and economic contexts. Acting under uncertainty remains a challenge, in a field where rapid action is needed. Research must therefore generate knowledge about efficacy and at the same time move towards delivery, examining delivery systems, contextual adaptation, workforce capacity, and real-world constraints, particularly in low-resource settings. In transformative research the scientist takes on the role of supporting a transformative change in society, for instance with regard to decreasing inequalities or fostering environmentally sustainable changes. Transformative research can support the closure of the implementation gap by involving stakeholders in the research process. This will only be possible if incentive structures foster transdisciplinary research and reward interdisciplinary collaboration.

Education, knowledge justice, and capacity building

Long-term resilience depends on education at all levels. Climate and health training is increasingly being included in public health education, but other methods are fragmented and often reliant on time-limited, unstable funding [14]. Future professionals working on adaptation require competencies in risk assessment, climate communication, implementation science, systems thinking, sustainable practice, and ethical leadership. Embedding climate literacy not only across health curricula but across primary, secondary and tertiary education more broadly is vital for societal resilience. At the same time, broadening whose knowledge counts is essential. Indigenous and local knowledge systems, community-led research, and lived experience provide insights that are often marginalized in dominant paradigms. Pluralistic approaches strengthen legitimacy, relevance, and the range of viable solutions. This also means diversifying the types of publications to include practice-based scholarship, lessons learned, commentaries on emerging issues, and, perhaps most critically, generative thought leadership, beyond a narrow, formulaic approach to climate-health scholarship. Such contributions can surface implementation insights from the field, elevate underrepresented perspectives, and catalyze new frameworks, research questions, and policy directions that more traditional study designs alone may not capture. Scientific rigor and epistemic humility are mutually reinforcing.

Health co-benefits and the mitigation-adaptation nexus

While much of the climate–health agenda focuses on preventing harm, it is equally important to articulate what can be gained. When individuals seek medical care, they often ask a fundamental question: can this be treated and will I recover? Climate mitigation can be framed in similarly human terms. Cleaner air reduces respiratory and cardiovascular disease. A pollution-free environment mitigates contaminant transfer pathways. Active transport improves physical and mental health. Sustainable food systems have lower emissions while strengthening nutrition security. Climate action, viewed through a health lens, is not a sacrifice that contributes to cost of living but an investment in longer, healthier lives of current and future generations. These co-benefits should be systematically quantified and integrated into economic modelling and policy appraisal to strengthen the case for ambitious decarbonization.

Greater attention must also be paid to the mitigation–adaptation nexus. Integrated strategies, such as urban greening, climate-resilient health facilities powered by renewable energy, and climate-smart food systems, can simultaneously reduce emissions, improve adaptive capacity and health outcomes [15]. Identifying and scaling such ‘triple-win’ solutions is both efficient, because they maximize co-benefits and avoid duplicative investments across sectors, and transformative, because they reshape systems in ways that align climate action with healthier, more resilient communities. Health systems themselves must also confront their environmental footprint, advancing the decarbonization of healthcare delivery while maintaining equitable access and quality of care.

Political economy, trust, and communication

Climate action unfolds within political and economic systems shaped by governance structures, accountability mechanisms, corporate interests, and power asymmetries [15]. Research must therefore examine not only technical interventions but the power structures and decision-making processes that enable or obstruct climate action at political and community levels. Climate–health projections and the economic costs of inaction remain underdeveloped in many regions, particularly in low- and middle-income countries [16]. Robust modelling that integrates health impacts, macroeconomic consequences, and distributional effects can clarify the true cost of delay and inform equitable decision-making. This is particularly important as healthcare systems globally are already facing an unsustainable rise in the cost of healthcare delivery whilst needing to grapple with the expanding healthcare burden associated with climate change. Extreme heat, increased frequency, duration, and intensity of natural hazard disasters, shifting infectious disease patterns, air and water pollution, food insecurity, and population displacement are increasing service demand. Health systems must prepare for chronic, compounding pressures as well as acute shocks [17]. General health system strengthening and maximising efforts towards universal health coverage is one viable way to reach health system resilience.

Climate action also depends on policy makers and communities’ trust in science and its communicators. Even the strongest evidence can fail to catalyse change [18]. Misinformation and disinformation, sorely exacerbated by generative artificial intelligence (AI), threaten effective responses [19]. At the same time, AI systems are increasingly shaping climate–health modelling, policy simulations, and public communication. Research is needed to examine how AI-driven tools influence decision-making, resource allocation, and equity, including risks of algorithmic bias and unequal access across regions. Understanding both the risks and opportunities of AI is essential to ensure that emerging technologies strengthen rather than undermine trust, transparency, and evidence-based climate action. Furthermore, research on science communication, trust-building, and countering false narratives is essential to safeguard democratic decision-making and evidence-based policy. This needs to be a part of designing solutions that are equitable, implementable, and politically informed. Communicating the health impacts of climate change and the health benefits of climate actions is inherently a powerful climate solution. It requires novel research dissemination approaches that go beyond traditional journal publications, such as publicly available dashboards, story maps, podcasts, townhalls, and op-eds in regional newspapers.