Climate change is no longer a distant threat but an active force dismantling decades of progress in global health, intensifying disease burdens, and deepening public health inequities worldwide.¹ Despite mounting scientific evidence, climate adaptation efforts remain fragmented and mostly reactive. The decision to operationalize the Global Goal on Adaptation (GGA) at COP28 was therefore a landmark achievement for the integration of health and climate action, introducing a critical framework to measure collective adaptation progress. Yet significant challenges persist—including in the thematic target on climate and health under this framework.² As COP30 approaches, the stakes are high: Parties are expected to adopt this critical framework with a robust and comprehensible set of indicators and ensure that adaptation is grounded in equity and transparency.

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Context and background

The 2025 Lancet Countdown on Climate and Health³—the largest annual analysis of its kind—reveals that millions of people die each year as a result of insufficient climate action. Every country is now experiencing some combination of extreme heat, water scarcity, food insecurity, and changing patterns of infectious disease. For example, nearly half of hospitals and schools in European cities are now located in areas affected by strong urban heat island effects, putting patients, staff, and students at risk.⁴ Meanwhile, mosquitoes have been detected in Iceland for the first time,⁵ illustrating how climatic change is redrawing vector disease maps. In many developing countries, the situation is even more severe; for example, Small Island Developing States as well as countries across Africa and Asia have experienced the greatest increases in heatwave exposure due to climate change in recent years.⁶

While the immediate impacts—disruption, injury, displacement, and reduced access to care—may be similar worldwide, the compounding crisis and ability to recover differs sharply across countries. Official development assistance has declined significantly, while 3.4 billion people now live in nations spending more on servicing debt than on health or education.⁷ Much of this debt is linked to the costs of climate-related disasters.⁸ At the same time, governments continue to invest heavily in fossil fuel subsidies, spending US$956 billion in 2023—more than three times the amount pledged to support climate adaptation in vulnerable countries. Some nations spend more subsidizing fossil fuels than on their entire national health budgets.⁹

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The health target under the GGA

Established under the Paris Agreement in 2015, the GGA reached a turning point at COP28 with the adoption of the UAE Framework for Global Climate Resilience, which articulated seven thematic and four dimensional targets to guide adaptation action. A cornerstone of this process is the development of a set of global indicators. In 2024-2025, Parties and technical experts undertook an ambitious exercise, reviewing over 9,500 proposals submitted by Parties and other stakeholders. Through a rigorous refinement process, this list was reduced to 490, and ultimately to 100 indicator options.¹⁰

Among the seven thematic targets, the health target (Target 9c) focuses on strengthening resilience against climate-related health impacts, promoting climate-resilient health systems, and reducing climate-related morbidity and mortality, particularly in vulnerable communities. The process of developing health indicators illustrates both the ambition and the complexity of the GGA. From an initial pool of around 900 health-related submissions—reduced to 747 after removing duplicates—experts narrowed the list to 62 by June 2025 and to just 10 by September 2025. The final proposal consists of ten dedicated health indicators along with numerous cross-cutting ones embedded in other thematic areas and the policy cycle framework. The main objective was to identify metrics that can meaningfully capture adaptation efforts in reductions in adverse health outcomes directly attributable to climate change rather than merely measure exposure to climate sensitive health burdens. However, the complex and multifactorial nature of climate-health relationships complicates attribution. For example, universal health coverage is a critical measure of climate adaptation effectiveness, but it needs to be adjusted to reflect climate vulnerability and adaptation readiness.

Mortality indicators currently focus on extreme heat and climate-sensitive infectious diseases. For the latter, countries will be able to select the diseases most relevant to their national context, allowing flexibility without requiring reporting on irrelevant pathogens. The indicators on extreme heat exposure and occupational injuries seek to capture the effects of pro-active adaptation measures, though some Parties see such metrics belonging under loss and damage. 

Integrating health and water indicators is particularly important. Diarrheal diseases have been proposed as proxies for waterborne infections, providing evidence that indirect deaths from natural disasters like storms and floods—through contaminated water and outbreaks of cholera or rotavirus —now exceed direct fatalities from natural disasters (attributed to mostly better warning systems and more-resilient buildings) and are especially deadly for children.¹¹

Experts further propose an indicator monitoring preparedness of mental health and psychosocial support during climate induced events exposing people to potentially traumatic events and increasing the risk of depression, substance misuse, or post-traumatic stress disorder. Some studies also indicate that people living with certain mental health conditions are at higher risk of dying during heatwaves.¹²

Because of the strong interlinkages between health, water, food, biodiversity, infrastructure, and poverty and livelihoods target, the integrity of the full set of 100 indicators is essential. Removing one may weaken coherence across others. While most process-related health indicators were moved to the policy cycle targets, one key metric—capacity building among the health workforce (Indicator 9c10)—was retained. Strengthening the capacity of health professionals to identify, manage, and respond to climate-related hazards is fundamental to building climate-resilient health systems. The profound importance of such preparedness is demonstrated by evidence from early warning systems, which shows that countries with comprehensive early warning systems have six to eight times lower mortality during disasters.¹³

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Expectations for COP30

At COP30 in Belém, expectations for progress in operationalizing the GGA framework are high, but several key questions and challenges remain unresolved:

• A common reporting framework may unintentionally deepen inequities, as countries differ widely in their data infrastructure and analytical capacity. For the GGA to be successful, developing countries must receive adequate financial and technical support to meet reporting expectations and to implement effective adaptation actions. In this regard, COP30 could contribute to rebalancing global climate governance, giving developing countries a stronger voice and better access to resources.
• Measuring the specific impact of adaptation on the health and wellbeing of vulnerable populations must remain at the centre of the framework, which could be ensured through disaggregation modalities for all indicators aiming to ensure inclusion.
• Greater synergies are needed between global climate and health institutions and funding sources to increase the effectiveness of the limited resources. Given that the health sector accounts for roughly ten percent of the global economy and is one of the world’s largest employers, climate-proofing this sector is essential. Aligning the GGA and the forthcoming Belém Health Action Plan for Adaptation of the Health Sector to Climate Change with the WHO Climate and Health Frameworks under the Alliance for Action on Climate Change and Health (ATACH) will be vital to ensure coherence across institutions.¹⁴
• Beyond the question of how much adaptation finance will be mobilized, attention must also turn to the nature of that finance. Access to new and additional finance and macroeconomic stability tools for developing countries, particularly grant-based finance, and effective modalities for local access are essential tools to ensure developing countries can invest in adaptation without exacerbating debt burdens. Support for building national and subnational reporting systems is equally important, ensuring that local actors are meaningfully engaged in monitoring and decision-making.
• COP29 affirmed that the GGA would remain as a standing agenda item beyond COP30—an important institutional development that could help consolidate adaptation discussions under a single, coherent framework. The Baku Adaptation Roadmap and the High-Level Dialogue on Adaptation scheduled to launch at COP30 will be critical in maintaining this momentum.

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Conclusion

Health provides a compelling entry point for political commitments and action: it is politically non-contentious, highly visible, and closely tied to economic stability. COP30 could be a defining moment for connecting the global climate and health agendas. The operationalization of the GGA with credible, equitable, and health-sensitive indicators offers an unprecedented opportunity to institutionalize adaptation under the UNFCCC and make human health a measurable, central outcome of global climate policy. Successful implementation will depend on the capacity of Parties to deliver equitable means of implementation—finance, technical support, and capacity building—essential for countries most exposed to climate risks.