Air pollution worsens a range of serious mental health disorders, according to the latest research.

Breathing in air with high levels of pollution worsens a range of serious mental health conditions, such as schizophrenia, depression, and anxiety disorders, according to emerging research.

A 2026 study, published in the journal Environmental Research, reviewed 25 existing studies on air pollution’s impact on anxiety disorders and found that while long-term exposure is the most dangerous, even short-term exposures worsen anxiety disorders.

The finer the air pollutants, the higher the danger, according to a 2023 study published in Environment International involving over 1.7 million people in Rome, Italy.

“Long-term exposure to ambient air pollution, especially fine and ultra-fine particles, was associated with increased risks of schizophrenia spectrum disorder, depression, and anxiety disorders,” the 2023 study found.

Currently, nearly 99% of the world’s population breathes in air exceeding the World Health Organization’s (WHO) clean air guidelines.

While air pollution’s impact on depression is reasonably well known, more is being understood about its impact on other mental health disorders. Research on a link between air pollution and bipolar disorder has currently produced mixed results.

“A growing evidence base links exposure to air pollution to a variety of mental health disorders, including anxiety, depression, and schizophrenia, as well as risk for suicide. Evidence also points towards the risk being higher for more disadvantaged communities,” said Pallavi Pant, an environmental health scientist at Health Effects Institute (HEI).

Pant cautioned that this area of research is currently limited but very active.

Also read: More Evidence That Air Pollution is Linked to Higher Risk of Dementia

Air pollution’s role in worsening mental health disorders

Air pollution has been linked to a large number of dementia deaths in research.

Air pollution kills an estimated 8.1 million people every year, according to the State of Global Air Report 2024, which is brought out annually by HEI in collaboration with the Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project.

The links between high levels of air pollution and higher rates of dementia and other cognitive impairment, post-partum depression, and even schizophrenia relapse were established by a study in World Psychiatry published in 2024.

“Higher levels of specific air pollutants were associated with a higher risk of dementia or cognitive impairment, cognitive disorders, post-partum depression (class II), and schizophrenia relapse,” according to the 2024 study, which looked at 32 existing global studies on air pollution and mental health disorders.

Higher temperatures also affect mental health. “Temperature increase was associated with an increase in suicidal behaviour, suicide or mental disorders-related mortality; and hospital access due to suicidal behaviour or mental disorders, or mental disorders only,” the 2024 study noted.

“What happens when high temperatures and poor air quality intersect? That is an area that remains understudied, Pant said.

The biological mechanisms of how air pollution affects mental health disorders are still not well understood, “but evidence points towards inflammation playing an active role,” Pant explained.

“Some studies also indicate greater risks for children and adolescents- exposure during critical windows of development, including development of the brain, can increase the risk of psychiatric disorders,” she added.

Also read: Air Pollution ‘Kills a Child Every Minute’

Disadvantaged communities hit hardest

Most of the air pollution deaths are in low- and middle-income countries.

A report released last year by the US non-profit advocacy group, Physicians for Social Responsibility Pennsylvania, looked at the role physicians can play in low-income neighbourhoods where air pollution levels tend to be worse, and the mental and emotional toll on communities is high.

“Physicians can work as advocates for their patients’ health. They can use their influence as trusted professionals to promote policies that will decrease air pollution and increase access to mental health resources,” said Laura Dagley, a nurse who wrote the report.

“We have learned from research that air pollution itself has physiological impacts on the brain and other organs in the body, but what I learned from my time working with these communities is the mental health implications from the erosion of their sense of place and home,” Dagley added.

 “Many felt they were living in sacrifice zones, or that their lives were not considered important enough by industry or politicians to care about the health impacts.”

Such communities often also tend to have poorer access to resources.

Limited research from the global south

Nearly 99% of the world breathes in polluted air. World’s most polluted countries are in Africa and Asia.

The world’s most polluted countries are in the developing world, particularly in Asia and Africa, but evidence about the health impact is sparse from these regions.

Most studies are from high-income countries in North America, Western Europe, and increasingly, from China and other Asian countries. Studies from Africa and South Asia are still relatively scarce, Pant said.

Dagley said that physicians can also play a role in filling this data gap: “A lot of the research we have showing mental health impacts has come from medical records, combined with air pollution data.”

Image Credits: Unsplash, State of the Global Air report 2025, IQAir.

Thousands of people claim that exposure to Roundup has given them cancer.

Monsanto has reached a provisional $7.25 billion settlement with US law firms representing clients who claim that exposure to its pesticide, Roundup, caused them to develop non-Hodgkin lymphoma (NHL).

The settlement was filed in the St Louis Circuit Court in Missouri on Tuesday and still needs court approval, according to an announcement from Bayer, which bought Monsanto in 2018.

It covers plaintiffs who allege exposure to Roundup before 17 February and currently have a medical diagnosis of NHL, or who receive a medical diagnosis within 16 years following the final approval of the agreement.

“Monsanto is taking the Roundup-related actions solely to contain the litigation, and the settlement agreements do not contain any admission of liability or wrongdoing,” according to the company statement.

“Indeed, leading regulators worldwide, including the US EPA [Environmental Protection Agency] and EU regulatory bodies, continue to conclude based on an extensive body of science, that glyphosate-based herbicides – critical tools that farmers rely on to produce affordable food and feed the world – can be used safely and are not carcinogenic.”

However, the World Health Organization’s International Agency for Research on Cancer (IARC) classified glyphosate as “probably carcinogenic to humans” back in 2015.

IARC made its decision based on “limited evidence of carcinogenicity in humans for non-Hodgkin lymphoma. The evidence in humans is from studies of exposures, mostly agricultural, in the USA, Canada, and Sweden published since 2001. In addition, there is convincing evidence that glyphosate also can cause cancer in laboratory animals.”

Right to appeal

The Roundup settlement proposal comes as Bayer is preparing to appeal against $1.25 million awarded by ​​the Missouri Circuit Court to NHL patient John Durnell, who sued the company for its failure to warn customers that Roundup could cause cancer.

The company stated in court papers in the Durnell case in April last year that it faced claims from “more than 100,000 plaintiffs across the country that … seek to hold Monsanto liable for not warning users that glyphosate, the active ingredient in Roundup, causes cancer”. 

It has settled around 130,000 claims but still faces around 67,000 active claims, many of which are based on state requirements about cancer warning labels.

Bayer argues that the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) is responsible for issuing cancer warnings and that this is a federal decision that should  supercede state law warning claims.

“For decades, EPA has exercised its authority under FIFRA to find that Monsanto’s Roundup product line and its active ingredient, glyphosate, do not cause cancer in humans,” Bayer states in the court papers.

“Consistent with that understanding, EPA has repeatedly approved Roundup’s label without a cancer warning. FIFRA prohibits Monsanto from making any substantive change to an EPA-approved label unless it first obtains EPA’s permission.”

Trump support

Bayer, which donated $1 million to Donald Trump’s presidential inauguration, successfully lobbied the Trump administration for support to ensure that the Supreme Court would hear its appeal against the Durnell award.

Last year, Solicitor General D. John Sauer filed a brief with the Supreme Court, supporting Monsanto’s argument that federal law was responsible for cancer warnings, and urged the Supreme Court to review the company’s case.

“A positive ruling on the question before the Supreme Court should largely foreclose present and future claims based on state label-based warning theories – including the pending appeals, as well as opt-outs from the class,” said Bayer, which noted that “a favorable ruling by the Supreme Court would provide essential regulatory clarity.”

However, the Trump administration’s intervention has angered “Make America Healthy Again” (MAHA) supporters.

“President Trump specifically promised to address the harms from pesticides. This move to support the Supreme Court in hearing Bayer’s case for federal preemption of state laws that protect our safety could not stray further from that promise he made to American citizens,”  said Kelly Ryerson, co-executive director of American Regeneration and a MAHA leader.

Manipulation of science

Meanwhile, a scientific paper written 25 years ago, claiming that glyphosate posed little risk to people, has finally been withdrawn after it was found that the authors relied solely on Monsanto studies and did not acknowledge that Monsanto staff had assisted in writing the paper.

The study by Gary Williams, Robert Kroes and Ian Munro was published in 2000 in the journal, Regulatory Toxicology and Pharmacology, but only retracted last December.

Making the announcement, journal co-editor Martin van den Berg cited several problems, including the “authorship of this paper, validity of the research findings in the context of misrepresentation of the contributions by the authors and the study sponsor and potential conflicts of interest of the authors”.

Image Credits: Pesticide Action Network.

During winter, snow renders roads in Kashmir impassable.

In the high Himalayas of  Kashmir, winter does not arrive quietly. It rolls in across mountain ridges in dense sheets of snow, swallowing roads, sealing off valleys and transforming steep passes into walls of white. 

Entire communities become temporarily cut off from the outside world. In some villages, the only link to the nearest hospital disappears for weeks.

For most residents, winter is a season of endurance. But for pregnant women, it can become a countdown measured not in weeks, but in weather forecasts.

Officially, the region of Jammu and Kashmir records one of India’s lowest maternal mortality ratios: 47 deaths per 100,000 live births, nearly half the national average. 

Public health indicators suggest improvement over the past decade, with institutional deliveries increasing and antenatal coverage expanding. But statistics do not climb mountains.

Across remote districts near the Line of Control, the de facto border dividing India and Pakistan, childbirth is shaped as much by geography as by policy. Villages sit at high altitudes. Roads are narrow and vulnerable to landslides. Within hours, snowfall can block the only route linking a community to a district hospital.

When that happens, ambulances stop running. Helicopter evacuations depend on clear skies and administrative clearance. Primary health centres, already short of specialists and equipment, become the only point of care.

Every autumn, families in snowbound belts quietly begin preparing for a decision that has become routine: relocate pregnant women to lower-altitude towns before the snow closes in or remain behind and hope there are no complications.

For those who can afford to move, childbirth becomes an economic burden. For those who cannot, it remains a medical gamble.

Leaving before the snow seals the valley

Pregnant Kashmiri women living in isolated areas often need to move closer to health facilities when their due date looms as winter snowstorms can make it impossible to get maternal health services.

In Machil, a remote Himalayan border village in north Kashmir, the nearest district hospital lies more than 60 kilometres away in Kupwara.

In summer, the drive can take several hours along winding mountain roads carved into steep slopes. In winter, heavy snowfall can render the route impassable for days and sometimes weeks. 

For 67-year-old Abida Khan, winter no longer brings beauty: “I have seen women suffer because they couldn’t reach a hospital in time,” she told Health Policy Watch.

Her daughters and daughters-in-law now leave the village weeks before their due dates. The family arranges temporary accommodation in Kupwara or Srinagar, absorbing the costs as best they can.

“If complications happen at night during heavy snowfall, what can we do?” she asked. 

In previous winters, residents say they waited days for helicopter evacuations that were delayed due to poor visibility. In such conditions, childbirth becomes dependent on timing and luck rather than medical preparedness. 

Local health workers say they routinely advise families to shift pregnant women out of Machil before peak winter. But relocation requires savings, something many households that are reliant on small-scale farming or daily wages struggle to accumulate.

Migration for childbirth

Nearly 200 kilometres away, in Kangan market in central Kashmir’s Ganderbal district, Faqir Mohammad stands outside an electrical shop, weighing whether to buy a room heater he cannot afford. 

The heater is intended for a rented room where his pregnant wife, Rasheeda Begum, now lives with their two children, far from their home in Buglinder village in the remote Tulail Valley of Gurez. 

Tulail lies in a high-altitude belt that remains snowbound for months. Once heavy snowfall begins, roads close and air evacuations become uncertain.

“We have no choice,” Rasheeda told Health Policy Watch from the cramped rented room. “Every winter, doctors tell our husbands to shift the pregnant women out of Gurez. It is out of compulsion, not comfort.”

She is expecting her third child. Her first two deliveries, both at home, were uncomplicated. But this time, early snowfall warnings pushed the family to leave in November.

 “Our monthly expense is nearly ₹20,000 [$220],” Faqir said. “The rent alone is ₹4,000 [$40]. I don’t earn that much.” 

To manage costs, he borrowed ₹1 lakh [$1,100] from his brother-in-law, a sum that will take months, perhaps years, to repay.

“I am mentally disturbed with all this financial burden and the harsh cold,” said a woman twho asked not to be named. “But staying back would be more dangerous.”

She recalled a tragedy in her village nearly a decade ago when a woman died because the helicopter couldn’t travel for three days during a snowstorm. 

“They kept her in the medical room until she lost her breath. That memory scares all of us.”

Structural gaps in care

Even outside winter, maternal healthcare in remote belts faces systemic constraints.

There is no ultrasound facility in the entire Gurez–Tulail region.  Rasheeda must travel around 120km for a single scan, and pay about ₹1,000 [$10]  excluding transport.

“We don’t have specialists, tests, transport, nothing,” she told Health Policy Watch.

Such limitations reflect wider staffing shortages. Reporting by Kashmir Times found that hundreds of consultant posts are vacant across Jammu and Kashmir’s health department, leaving tertiary hospitals overstretched and peripheral centres understaffed.

Previous coverage by Health Policy Watch reported that dozens of primary health centres and hundreds of sub-centres in the region lack reliable electricity, a critical requirement for conducting safe deliveries and emergency procedures.

A doctor in north Kashmir, speaking on condition of anonymity, said terrain magnifies existing shortages: “There are areas we simply cannot reach in winter. Even in summer, these terrains are difficult. During snowfall, ambulances get stuck. If a woman develops complications at night, response time becomes critical.”

He added that while referral systems exist on paper, implementation falters when roads close or communication lines fail.

Some families incur large debts while renting rooms near hospitals if a woman is due to give birth during winter.

Conflict and climate pressures

In frontier towns near the Line of Control, residents say periodic cross-border shelling adds another layer of unpredictability to maternal care.

In villages near Uri, families described how an escalation in shelling has forced temporary evacuations in the past. Pregnant women were shifted to safer areas with limited facilities, disrupting routine check-ups and antenatal monitoring.

“When there is firing or roads close, where do we go?” asked Nadeem from Buzgaow. “We cannot abandon our homes for months. But we cannot reach hospitals either.”

Weather patterns, too, have grown less predictable. Residents report sudden heavy snowfall arriving earlier in the season, complicating planning. In high-altitude regions already vulnerable to isolation, even minor shifts in snowfall timing can determine whether a woman delivers near a fully equipped hospital or in a basic facility without specialist support.

Choice between debt and danger

For women in Kashmir’s snowbound valleys, childbirth often becomes a negotiation between financial survival and physical safety. Temporary migration means rent, heating, food and transport costs in unfamiliar towns. Many families depend on livestock or seasonal agricultural income. Months away from home disrupt livelihoods.

“We left our home, borrowed money and separated our family just to survive childbirth,” Shazada Akhter from Kupwara told Health Policy Watch. “What else can a mother do?”

Back in Machil, as the first snow settles across the mountains, Abida Khan watches the road disappear beneath fresh drifts.

“We pray the winter passes without emergency,” she said.

The region’s maternal mortality statistics suggest progress. But in villages perched along fragile mountain routes, safe delivery still depends on clear skies, open roads and borrowed funds.

For pregnant women in Kashmir’s high Himalayas, winter remains the single most decisive factor in whether childbirth is routine or perilous.

Image Credits: Rutpratheep Nilpechr/ Unsplash, Welt Hunder Hilfe, Safina Nabi.

Fatioma, 30, a pregnant refugee who fled conflict in Sudan, sits with her daughter in front of their shelter in a camp in Adre, Chad.

Over 60% of maternal deaths in 2023 took place in countries and territories experiencing conflict or institutional and social fragility, according to a World Health Organization (WHO) technical brief published on Tuesday.

“In 2023, an estimated 260,000 women died from causes related to pregnancy and childbirth. Around 160,000 of those deaths occurred in settings experiencing conflict or institutional fragility,” Jenny Cresswell, WHO sexual and reproductive health scientist, told a media briefing in Geneva on Tuesday.

“The majority of women dying in pregnancy today are not dying because we lack medical solutions. They are dying because of structural weaknesses in health systems, often rooted in conflict, crisis and instability,” Cresswell added.

The maternal mortality ratio in conflict-affected countries was 504 maternal deaths per 100,000 live births in 2023, according to the report.

In fragile settings, it was 368 deaths per 100,000 and countries not affected by these challenges, it was 99 per 100,000. 

The cost of disrupted services

“The overwhelming majority of these deaths can be prevented,” Cresswell stressed. “That gap is not a coincidence. It is the cost of disrupted services, damaged hospitals, health workers fleeing violence, interrupted supply chains, and women unable to reach quality care safely or quickly enough at the time that this is needed. 

“This means that women are dying from preventable maternal causes in conflict settings, such as haemorrhage or excessive bleeding relating to childbirth, hypertensive disorders such as pre-eclampsia, infections and complications relating to unsafe abortion.”

A 15-year-old girl living in a country or territory affected by conflict in 2023 had a 1 in 51 lifetime risk of eventually dying from a maternal cause, in comparison to a 1 in 593 risk for  a 15-year-old girl living in a country not affected by conflict or institutional and social fragility.

Around 10% of women of reproductive age lived in the 17 countries and territories classified as experiencing conflict by the World Bank, where 21% of all live births, and 55% of all maternal deaths occurred. 

The 20 countries and territories classified as experiencing institutional and social fragility were home to just 2% of all women of reproductive age, 4% of all live births and 7% of all maternal deaths.

Progress is possible

But progress is possible, as the report shows.

The MMR in Ethiopia decreased from 267 to 195 maternal deaths per 100 000 live births between 2020 and 2023.  But pregnant women in the areas affected by conflict, drought and displacement – particularly the Tigray, Amhara, Afar and Oromia regions – faced “significant challenges” to get essential maternal health services.

These included a lack of ambulances, restrictions on vehicle movements at night, and health workers fleeing from conflict-affected areas. 

In response, the WHO, United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA), with funding support from the Bill & Melinda Gates Foundation, launched the Service Delivery Innovations in Conflict-Affected Areas (SDI) project in Amhara, Oromia and Afar, in collaboration with Ethiopia’s Ministry of Health and Regional Health Bureaus.

This resulted in three ambulances and six mobile health service teams being deployed to underserved and remote communities. Twenty-four maternity waiting homes, six neonatal intensive care units and four maternity wards were renovated, and 24 midwives were trained and deployed.

“Since the SDI project began in 2022, the number of deliveries attended by skilled health workers increased from 12,790 to 17,620 in 2024,” according to the report.

“The number of women and girls receiving at least four antenatal care visits rose from 15,636 in 2022 to 23,228 in 2024”, while the number of women receiving postnatal care visits within seven days of delivery increased from 17,611 in 2022 to 21,730 in 2024”.

Off track

“The world is committed to reducing maternal mortality globally to fewer than 70 deaths per 100,000 live births by the year 2030, but at current rates, we are off track,” said Cresswell.

“We must protect maternal health in fragile settings. That means investing in primary health care, protecting health workers and facilities, ensuring emergency obstetric services remain functional during crisis,” she added. “No woman should lose her life, giving life.”

The WHO report also recommends “improving data collection on maternal and newborn mortality at the subnational level, particularly in settings where humanitarian access is restricted, can help identify and address inequities and track progress towards ending preventable maternal deaths.”

Additional reporting by Elaine Fletcher.

Image Credits: Nicolò Filippo Rosso/ WHO.

A doctor at a diistrict hospital in Ifakara, Tanzania treating a malaria patient.

Every $1 invested in the Medicines for Malaria Venture (MMV) between 2000 and 2023 yielded $13 in monetised health benefits, according to a study published in The Lancet Global Health this week.

MMV is a not-for-profit product development partnership (PDP) that works with public and private sector partners to discover, develop and deliver accessible and affordable medicines to treat, prevent and eliminate malaria. 

Since its launch in 1999, it has brought 19 malaria medicines to the market that have treated or protected more than 1.3 billion people worldwide. 

The total investment received by MMV was $2.3 billion over the 23-year study period, and the antimalarial drugs developed and launched with the support of MMV averted an estimated 1.6 million deaths and 87 million disability-adjusted life-years (DALYs). The cost of delivery is estimated to be $785 million. 

“This analysis demonstrates that funds invested in MMV are working extraordinarily hard,” said Dr Lesong Conteh, from the London School of Economics and Political Science (LSE), the study’s corresponding author.

“Every dollar produces outsized and sustained benefits for malaria-affected regions. In a constrained funding environment, identifying investments that consistently deliver is critical.” This evidence also underscores the vital role that investing in the PDP model plays in generating global health returns beyond any single organisation. “

The study was conducted by experts from the LSE and Imperial College London, in collaboration with Cambridge Economic Policy Associates. 

Malaria kills almost 600,000 people annually (2023 figures), 95% in Africa. Among the most affected are newborns and pregnant women.

A new Novartis anti-malarial drug designed for newborns and babies under 5kg, which was developed with MMV, was launched late last year in Ghana. 

Meanwhile, new treatments for pregnant women have just entered Phase 3 trials.

However, progress against the parasite is stalling, in part because a lack of resources and the parasite’s ability to mutate to develop resistance to antimalarial drugs. 

Growing resistance to artemisinin, the standard drug of care, is a huge challenge that highlights the need for new products.

The WHO forecasts an additional 78 million cases of malaria over the next five years in the absence of new treatments, which could result in 80,000 more deaths each year.

Climate-driven extreme weather events and conflict are also increasing the risk of malaria.

Image Credits: Peter Mgongo.

Social connection and healthy foods are key ingredients of Blue Zone Communities.

It’s a cold winter morning in Davos, but the pictures on the screen are aglow with warmth  – a 100-year-old man cuddling an infant; ancient women with faces wrinkled in laughter; aged men sharing a flask of local red wine;  and an extended family gathered around a Mediterranean meal of chickpeas, cheeses, salads and seafood. 

These are everyday scenes from the world’s best known “Blue Zone” communities – far-flung regions of the world with huge cultural, economic and geographic differences that share something deeply in common. 

In these Blue Zone communities, longevity is common and chronic disease is less prevalent, explained Dan Buettner Jr, executive vice president of the Blue Zones Initiative, at a session of the Davos Alzheimer’s Collaborative during the 2026 World Economic Forum (WEF). 

What are blue zones?

Centenarian women in Okinawa, Japan which has the longest healthy life expectancy in the world.

The term Blue Zones refers to “geographically demographically defined places of longevity,” explained Buettner, at the session in the DAC “Brain House”, which hosted a series of WEF side events  that zeroed in on the growing relevance of brain health to global health and economic policy. 

“These are longevity hotspots, places even at 10 times the rating we get in the United States.”

People in Blue Zone communities maintain the “longest disability free life expectancy in the world, seven good years longer than most Americans,” alongside “one-fifth the rate of dementia and a sixth the rate of cardiovascular disease,” he said.

Perhaps most striking is that wealth is not the driver: “Four out of five of these places are places that are at or below the poverty line, so they don’t have big pharmacies, billion-dollar health systems, big health plans, and yet they’re getting what we’re talking about right here.”

Dan Buettner maps out some of the world’s outstanding Blue Zones.

Flipping through scenes as diverse as Okinawa, Japan; Sardinia, Italy; Ikaria, Greece; Costa Rica and Loma Linda, a community of Seventh Day Adventists in Southern California, Buettner talked about their differences – but also what they still have in common. 

Sardinia, noted for its high number of centenarians, largely relies on a plant-based diet and strong social fabric.  Loma Linda, a tightly-woven community of Seventh-Day Adventists, emphasises a diet straight from the Bible, leading to a longer, healthier life. People in the Nicoya Peninsula in Costa Rica and Ikaria in Greece, a relatively poor Aegean Sea island, also have a high likelihood of reaching age 100, with a focus on natural movement, community connection, and celebrating life.

“Take Nicoya Peninsula, Costa Rica,” said Buettner.  There is abject poverty, and yet, according to the World Health Organization, if you can reach age 50 here, you have the highest likelihood of making it to 100 anywhere else on planet Earth. 

“And again, we see communities that are well connected, families that are nearby, people who are engaged in a purpose and a mostly vegetarian diet with lots of beans, beans, beans. So this idea that you have to be elite in order to afford good, whole food that’s healthy for you, is a myth.”

Even more revealing is the mindset of the people who live in the Blue Zones. Of the hundreds of centenarians in diverse communities surveyed, “not a single one pursued health, not a single one pursued fellowship or purpose or love for all of them, ensued as a byproduct of where they lived, that’s environment, and who they lived with, the culture, the rituals, the lifestyle,” Buettner observed. 

Those insights flip conventional wellness culture on its head. Longevity is less about individual discipline and more about the visible architecture of communities – the spaces where people move, as well as the foods most available for people to consume – and the invisible architecture of social connectivity.

Lessons from longevity hotspots

People in Blue zones consume healthy homemade foods, generally mostly vegetarian.

Across diverse regions of the world, patterns repeat with surprising consistency. Their lifestyles are not extreme; they are embedded.

“They all lived in environments and had hobbies, were they able to move a little bit every day, as opposed to the sedentary life that we have,” Buettner said. Social rituals matter just as much: “It is about the ritual of a glass of red wine over a healthy meal with friends… and of course, it all sits on a bedrock of connection.”

Purpose also plays a measurable role. “Purpose is good for four to six years of added life expectancy.”

The takeaway is clear: health is not pursued. It emerges from what Buettner calls the “Power Nine” best practices of Blue Zones, including: moving naturally, managing stress, eating a plant-heavy diet, living in a well-networked community with social rituals, and having a sense of purpose.

“None of these people was pursuing health or longevity or long life,” Buettner observed. “Ït ensued as a byproduct of where they lived, the culture that they belong to.”

Asked what people truly need in life, one 98-year-old grandmother offered a simple formula, Buettner recalled: “We all need four things: someone to love, something to do, some way to give back, and something to look forward to.”

He believes communities that deliver those essentials can transform public health. “If we can give that to people… they will do the transformation for us.”

Designing communities for brain health

Left to right: Jochem Reiser, UTMB, Dan Buettner, Blue Zones Project; Amy Dittmar, Rice University

“For decades, Blue Zones have shown real-world evidence that everyday environments supporting movement, connection, purpose and lifelong learning can prevent cognitive decline, dementia and preserve independence,” said Rice University’s Provost, Amy Dittmar, who moderated the discussion at the DAC Brain House in Davos. 

But after years of studying natural Blue Zones, researchers have begun asking a harder question: can such conditions be recreated in places where they haven’t emerged organically?

If Blue Zone communities could also be engineered, then the implications for healthier minds and dementia prevention could be enormous.

“Healthy neighborhoods lead to healthy neurons,” added Buettner, summing it all up.

Buettner believes they can, but only by shifting the focus away from the individuals and to the community settings. 

“Individual discipline is a muscle, and muscles always fatigue,” he said. “It’s hard to always make the right choice.”

Instead, success depends on structural change. “You don’t rely solely on individual discipline. You have to set people up for success. You empower them… with the invisible hand that nudges all of us all day long around food systems, tobacco and the built environment.”

When these elements align, Buettner argues, “you can literally engineer the effect of living in a Blue Zone anywhere in the world.”

To test out his theories, Buettner’s initiative has already linked up some 90 communities around the United States in a network of Blue Zone project communities. 

Communities in the network engage to promote healthier foods, more physical activity and ‘natural’ mobility via walking paths and bicycle lanes, as well as fora for social connectivity. 

Taken together the strategies mean that “when you step out of your door for your life mindlessly, you’re being inundated with a few more choices that are the healthy choices and they’re the easy choice,” as Buettner describes it.

Landmark collaboration 

New UTMB- Galveston partnership with the nationwide netework of Blue Zone projects.

But if Blue Zone communities can be engineered, can their health benefits also be measured more conclusively by researchers?  That question is now driving a landmark collaboration between Buettner and the University of Texas Medical Branch (UTMB) at Galveston, Texas.

UTMB is now partnering with the City of Galveston as well as Buettner’s Blue Zone network of some 90 US cities, to study the physical and human ecology of Blue Zones, and how they can improve help, said Jochem Reiser, President of UTMB at the session.  

“One of the biggest pushbacks we have got… is, where is the scientific evidence?” said Reiser. “Everybody believes it, but what’s the evidence?”

“We are going to create a research institute that studies the biological and the genetic underpinnings of Blue Zone,” Reiser explained. The effort aims to “define biomarkers and spark innovation as well as extending research beyond laboratories to “have impact in the communities.”   

Rice is also a part of the action, Dittmar observed, noting that the two universities are also collaborating in the context of the Rice Brain Institute – an interdisciplinary hub uniting experts in engineering, natural sciences and social sciences to advance brain health.   

Mapping longevity in Galveston

The new UMTB partnership is focusing first on the city of Galveston, Texas, a diverse coastal community seen as an ideal testing ground.

Buettner described the project’s ambition: “What we’re looking to do is to take a deeper clinical  dive into how environment and lifestyle can be expressed in the human body, whether it’s biometrics, whether it’s epigenetics.”

The approach breaks new ground. “What if we baseline people not with a program, a lifestyle program, but with an environment, and then had them just live their lives in that environment and then show that their lifestyle shifted?” Buettner asked.

Reiser sees Galveston as a microcosm. “We have a mix of people from all kinds of backgrounds… We also have centenarians, and we have people who die early. So we will study all of that.”

The UMTB collaboration also includes what Buettner called a “brain trust” compact with UTMB that will link their research and science powerhouse… with the Blue Zone Project’s international network of longevity experts and community experts to further advance the science of implementing lessons of the Blue Zones.”

Ultimately, the work aims to scale the insights “for everyone, whether they live in a Blue Zone project city or not.”

The added value of prevention

While the innate appeal of the Blue Zones is longer, healthier and happier lives, a stark financial reality is also a driver. 

“We spend seven times more on health care than any other nation, arguably not getting a very good return on investment,” Buettner warned. 

“Of that $4 trillion a year, which represents 20% of the American GDP, the predominance of it is spent on chronic disease, preventable chronic disease, and a fraction is spent on prevention. 

“And that [prevention part] is typically spent on diets, supplements, exercise, medication – short term wins, long term failures. Why is that? It’s because individual discipline is a muscle, and muscles always fatigue.

“The puck is moving,” Buettner said. With rising labor costs, inflation, and growing disease burden, the current system is “utterly unsustainable.”

“You’re a single mother, you’re a firefighter, you’re a nurse. Crap happens. It’s hard to always make the right choice. 

“But if you can get to a tipping point of people, places and policy, you can make the healthy choice, the easy choice, you can literally engineer the effect of living in a Blue Zone anywhere in the world.” 

Image Credits: Health Policy Watch .

African Union leaders sign an agreement with Rwanda’s Ministry of Health to establish the African Medicines Agency’s first headquarters in the capital, Kigali, in June 2023.

The African Medicines Agency (AMA) called on the 24 African member states that are yet to ratify the AMA Treaty to “act without delay” at a meeting on the sidelines of last week’s African Union assembly in Addis Ababa.

AMA aims to improve African countries’ capacity to regulate medical products, which will improve access to quality, safe and efficacious medical products on the continent. It will do so by harmonising regulatory requirements and practices across the national medicines authorities (NMRAs) of the AU member states. 

However, since the AMA Treaty was signed in 2019, it has only been ratified by 31 of the 55 AU member states, which is “leaving gaps in protection against substandard and falsified medical products and limiting the benefits of a unified African regulatory system”, according to a media release from the agency on Monday.

Ratification by 15 states enabled AMA to be established, with headquarters in Kigali, and in June last year, Ghana’s Dr Delese Mimi Darko was appointed AMA Director General.

Darko briefed the meeting last week, stressing that AMA wants to be universally ratified,  achieve WHO Listed Authority status and be financially self-reliant by 2030. 

“Over the past five years, we have moved from a treaty on paper to a living institution,” said Darko, who stressed that AMA is “already working hand‑in‑hand with member states that have ratified to strengthen regulatory systems, streamline joint assessments and increase reliance on shared expertise.”

Boost from Seychelles

At the meeting, Sebastien Pillay, Vice President of Seychelles, reaffirmed his country’s political support and committed $200,000 to AMA, doubling the seed fund contribution of $100,000 required of state parties. 

Tunisian Health Minister Dr Mustapha Ferjani reinforced the foundational importance of regulation, highlighting that “today, a single truth imposes itself: Africa’s health sovereignty depends on regulatory sovereignty. 

“Let us all ratify, and equip AMA with the capacity to act—with resources, skills, clear procedures, and effective governance. Our people deserve it, our health security demands it, and our sovereignty depends on it.” 

Ambassador Amma Twum‑Amoah, AU Commissioner for Health, Humanitarian Affairs and Social Development, described AMA as “a shared continental asset integral to delivering on the African Health Strategy 2030 and Agenda 2063, and the commitments our Member States have made to protect the health and wellbeing of their people.”

She affirmed that the Commission “firmly believes that universal ratification, full implementation and sustainable financing of the African Medicines Agency are achievable within this political cycle.”

 

Image Credits: Rwanda Ministry of Health.

Adapting to a much hotter world will include changing the design of buildings, moving away from glass high-rises.

Extreme heat will rise rapidly as the 1.5°C threshold is crossed, potentially causing half the world’s population to live in extreme heat by 2050, 

Shiny, glass-facade buildings are a symbol of modernisation and growth, but such buildings are dangerously vulnerable in a rapidly warming world, as they trap solar heat and will face much greater heat stress over their lifetime than expected, according to a new study from Oxford University. 

This disconnect between modern aesthetics and thermal reality is emblematic of a wider adaptation gap. While glass towers lock in high energy demand, the report’s findings focus on the more urgent scale of human exposure, tracking how billions in the most vulnerable communities will be forced to navigate a world of unprecedented heat.

Almost half the world’s population, almost four billion people, will be living with extreme heat by 2050 if the world reaches 2°C of global warming above pre-industrial times, according to the report, a global gridded dataset published in Nature Sustainability.

By population exposure, six countries – India, Nigeria, Indonesia, Bangladesh, Pakistan and the Philippines – will have the largest populations affected by the extremes. 

As absolute heat intensity surges, 20 countries, primarily in Africa, South America, and Southeast Asia, are estimated to see the greatest absolute change in heat intensity. The hottest countries are predicted to be Central African Republic, Nigeria, South Sudan, Laos, and Brazil.

Paradoxically, colder climates will see the largest relative change. Compared to the 2006–2016 period, a 2.0°C rise would more than double “uncomfortably hot days” in Canada and Austria, with Ireland seeing a staggering 230% increase.

The hottest 20 countries.

What are CDDs and HDDs?

The study’s results are measured in ‘cooling degree days’ and ‘heating degree days’ metrics commonly used in climate research and weather forecasting to estimate whether cooling or heating is needed to keep people within safe temperatures. 

Cooling Degree Days (CDDs) and Heating Degree Days (HDDs) are simple measures of how much heating or cooling buildings need. They compare outdoor temperatures to a reference temperature (often around 18°C). For example, a day with a mean outdoor temperature of 30 °C has 12 CDDs. Adding up all such days over a year gives the annual CDD value. A value of 3,000 CDD means that, over the year, temperatures are persistently high enough to create very large heat exposure. 

“In practical terms, 3,000 CDD signals that cooling is no longer optional or occasional — it becomes a central issue for building design, energy use, and health,” Jesus Lizana, one of the report’s authors, told Health Policy Watch. 

While the 18°C reference point helps policymakers and engineers to improve standards, ‘safety’ for the average citizen in the Global South is a far more complex equation. For a street vendor in Kolkata or the construction worker in Lagos, extreme heat isn’t just a matter of energy demand, but it’s a biological limit. 

Crossing the 1.5°C threshold means setting new public safety standards, for instance, based on wet-bulb temperatures, where humidity and heat combine to make outdoor labour life-threatening. These new standards need to ensure that adaptation strategies protect those without the luxury of living in glass buildings and air conditioning. 

The danger is 2030 not 2050 

The report’s most urgent finding is that the threat is not decades away. The most significant shifts in adaptation requirements occur in the early stages of warming, as we cross the 1.5° warming threshold.

“If we pass 1.5° around 2030 – which is likely – India will have an average CDD of 3,078. By 2050, it will have an (annual) average CDD of 3,248,” Radhika Khosla, of the Smith School of Enterprise and the Environment and an author of the report, told HPW. 

In comparison, a decade ago, between 2006 and 2016, when the world had warmed by 1 degree, India already had 2,864 CDDs annually. 

“Our study shows that India will continue to have the largest affected population globally, and that the number of extremely hot days it faces will rise exponentially as we pass 1.5°,” Khosla says. 

Global South: Hot, hotter 

The Central African Republic is predicted to see the greatest increase in heat intensity.

Countries in South Asia and Africa are more used to extreme heat, and 18°C days are usually a rarity in the countries mentioned in South and Southeast Asia, Africa and South America. But Khosla says that doesn’t mean its impacts will be any less acute, particularly when we are talking about a significant increase in the number of “dangerously hot days”.

In the authors’ assessment, while some Indian cities already have heat action plans to improve responses when temperatures rise, implementation needs accountability as the impacts of heat intersect across development priorities, such as healthcare, energy access, productivity, and education. 

In Africa, the Central African Republic and Nigeria face an even steeper challenge, the authors point out. They will need to adapt to ever more extreme heat while building reliable energy grids, all while dealing with life-threatening heat. 

“It is worth remembering that these countries are responsible for only a fraction of the emissions that have caused climate change, raising important questions of climate justice and adaptation finance,” Khosla adds.

What should policymakers do?

The warning is clear that the adaptation to higher temperatures needs to be sped up. Most increases in CDDs occur before reaching the 1.5° threshold across the top 20 countries, indicating that the most significant shifts in adaptation requirements occur in the early stages of warming – before 2030, rather than in a steady progression. 

This dataset provides a basis for incorporating new climate data into sustainability planning and development policy. For buildings, CDD is a useful metric to estimate and design the increased demand for cooling while ensuring it is sustainable – for instance, how to deliver more air conditioning but with lower emissions and power consumption. 

“This research adds to the body of evidence that heat exposure in vulnerable communities is accelerating, in some cases faster than many have predicted,” says Luke Parsons of The Nature Conservancy. 

Low-income nations with relatively higher social vulnerability are usually the least equipped to face some of the largest increases in extreme heat. 

“Unless we move to rapidly limit global warming, we are on track to see major impacts in the short and long term,” he says.

Rethink glass high-rises

Policy-makers need to rethink architecture, such as these glass buildings that characterise Dubai, to prepare for heat.

More visibly, this means that the glass high-rise buildings designed today will face much greater heat stress than expected. Building standards need to be updated to avoid locking in high energy use, overheating risks and costly retrofits later. 

“This is especially relevant for glass-facade high-rises, which have become symbols of growth but often perform poorly in hot conditions. Large glass areas trap solar heat, increasing cooling demand and vulnerability during heatwaves,” Jesus Lizana told HPW. 

Inclusive adaptation requires looking past the shiny skyscrapers to the neighbourhoods where most people actually live. In dense, low-income urban areas, the ‘Urban Heat Island’ effect can make local temperatures several degrees hotter than official weather station readings. 

Real adaptation, for the majority, looks like ‘cool roofs’ for informal housing, greater urban tree canopies to provide natural shade, and improving the energy grid to prevent the power outages that turn modest homes into ovens. The Oxford data shows that the most vulnerable communities are already on the clock.

The glass high-rise is emblematic of a larger disconnect: a modernisation strategy that prioritises aesthetics over global warming reality. For the billions living in informal housing or working outdoors, adaptation cannot be a luxury. 

The message for the Global South is clear. Policy choices made today must be built for the 1.5°C reality of 2030, not the cooler world of the past.

Image Credits: Erika Plepyte/ Unsplash, Shashi Yadav/ Unsplash.

WHO Director General Dr Tedros Adhanom Ghebreyesus addressing the 158th session of WHO’s Executive Board in Geneva in 2026. His term ends in August 2027.

As the mandate of Dr Tedros Adhanom Ghebreyesus approaches its expiration in August 2027, the high-stakes manoeuvring for the next Director-General (DG) of the World Health Organization (WHO) has intensified in the halls of Geneva and capital cities worldwide. While the official call for nominations is expected in April 2026 and no candidate has formally declared, the global health “rumour mill” is already hard at work – floating the names of at least 12 candidates from Jakarta to Berlin.

Whoever makes the final list will have to deal with an existential convergence of crises facing the WHO.

Externally, the geopolitical earthquake of the United States withdrawal under the Trump administration has left the organization with a funding gap which stood at $1 billion in November 2025. This has since been reduced to approximately $640 million – or 15% of the 2026-2027 biennium budget – per the Director-General’s report at the February Executive Board meeting. And the US still owes over $260 million in dues.

Internally, the organization is struggling with a 25% cut in staff following the loss of United States support, leading to a low in staff morale. The layoffs, a lack of transparency, sexual abuse scandals and a fear of retaliation among staff who have raised claims of harassment and damaged trust in the organization’s leadership.

While American re-engagement may seem “imponderable” right now in the words of one diplomatic source, choosing a candidate with strong credentials as a technocrat and  “reformer” could eventually help unlock a path to Washington’s return – not to mention helping to right the tempest-wracked agency internally and regain public confidence. 

A ‘unicorn’ to navigate a convergence of crises

Lowering the stars and stripes from WHO headquarters under a grey Geneva sky on 22 January 2026, after the United States’ withdrawal became official.

In the face of these immense diplomatic, economic and internal challenges, the ideal profile for the next WHO Director-General has been described as a “unicorn”: someone with the political skill to navigate a fractured world but the technical discipline to focus the agency’s ambitious mandate. They have to enforce long overdue fiscal reforms and fundamental changes in leadership.

Member states may also face pressure to find a candidate viewed as an outsider, rather than someone who is too cosy with the current “Tedros shop” – which the US rightly or wrongly blames for delaying key policy decisions in the initial stages of the COVID pandemic.

The emerging line-up researched by Health Policy Watch presents a complex set of choices: including competent insiders who nonetheless carry the legacy of the current administration, versus external reformers offering a clean break.

Here’s the brief candidate check, with some of the most talked about contenders lined up at the top – although this is still very early days.

Indonesia’s ‘CEO’ potential

Indonesia’s Minister of Health, Budi Gunadi Sadikin is described as a strong candidate for the next WHO Director-General.
Indonesia’s Minister of Health, Budi Gunadi Sadikin is described as a strong candidate for the next WHO Director-General.

Budi Gunadi Sadikin, Indonesia’s Minister of Health, is emerging as a strong contender for the post of WHO Director-General, described by a senior insider close to the matter as “the real one” with a viable chance of leading the WHO through these turbulent times.

  • Sadikin fits the emerging requirement for fiscal stewardship: a former banker with senior leadership roles in state-owned enterprises, he brings a financial rigour that the WHO desperately needs.
  • While lacking medical training, his tenure as Minister has been marked by large-scale system reform following COVID-19, credited with modernising Indonesia’s digital health infrastructure. However, some of his reforms to medical education also sparked criticism, e.g. from the Indonesian Medical Association.
  • According to European sources we spoke with, Sadikin enjoys support from key Asian powers, including Japan and India; other senior observers state that European candidates could be tough right now, “because of pushes against neocolonialism”.
  • Sadikin is considered a potentially suitable candidate to bridge the gap between the Global South and Europeans pushing for fiscal reform and transparency, with keeping hopes of the US returning to the table alive.
  • A point of contention mentioned is that, historically, WHO leadership rotates by region. With the tenure of Margaret Chan (China) still in recent memory, an Asian candidate might theoretically be an issue. However, sources indicate that this rotation is “no longer an issue”.

Scientific heavyweight from the United Kingdom

Jeremy Farrar, the World Health Organization’s Chief Scientist and former Director of the Wellcome Trust, is viewed as a high-potential candidate for the Director-General post.
Jeremy Farrar, the World Health Organization’s Chief Scientist and former Director of the Wellcome Trust, is viewed as a high-potential candidate for the Director-General post.

The UK’s Jeremy Farrar is another potential candidate with high chances of success to become the next WHO Director-General.

  • As the former Director of the Wellcome Trust, Farrar managed a massive global research portfolio with a strong financial governance record. 
  • A UK national, who was born in Singapore and grew up in New Zealand, Cyprus, and Libya, his training and research experience straddles Asia and Europe, and the Global North and South.
  • His research track record commands deep respect: in 2004, he and his Vietnamese colleague Tran Tinh Hien identified the re-emergence of the deadly bird flu, or H5N1, in humans.
  • Nonetheless, Farrar faces significant headwinds as a member of Tedros’ senior leadership team, and thus by association with Tedros’ own record.
  • Additionally, Farrar has been a target of various attacks by proponents of the SARS-CoV2 lab leak theories – who disliked his positions favouring theories of a natural origin for the virus.
  • While the jury is still out on that charged debate, with many reputable scientists lined up on either side, in a political climate where the U.S. administration is hostile to the WHO, Farrar’s proximity to these early positions is considered a possible “deal-breaker” for Washington, potentially alienating the very donor the WHO is eager to woo back.

A geopolitical ‘master stroke’ from Saudi Arabia?

Dr. Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean (EMRO), is increasingly viewed as a "master stroke of diplomacy".
Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean (EMRO), is increasingly viewed as a “master stroke of diplomacy”.

While initially viewed as a regional candidate, Hanan Balkhy is increasingly being discussed as a strategic solution to the US as one of the WHO’s most pressing problems.

  • Balkhy could be positioned as a “master stroke of diplomacy” to the Trump administration. While she’s serving in WHO as a Saudi national, she spent part of her childhood in the United States and later returned there to do her paediatric residency as well as post-doc stints.
  • Balkhy currently leads the WHO Eastern Mediterranean Region (EMRO), a bloc that has never held the Director-General post.
  • As an elected Regional Director rather than a direct appointee of Tedros, some analysts argue her association with the current “Tedros shop” is overstated, giving her enough distance to frame herself as a fresh start.
  • According to sources, her unique profile allows her to stand as a representative of the Global South and an emerging power (Saudi Arabia), while simultaneously being sold to the White House as a “unifying candidate” capable of replacing the current WHO Director-General.
  • Despite her administrative role and being a medical doctor by training, her primary weakness is tenure: having served as Regional Director for just over two years, critics argue she lacks the seasoned track record of a long-term administrator managing a huge agency like WHO’s.
  • Finally, her candidacy would inevitably invite pushback from member states critical of Saudi Arabia’s domestic human rights record, as well as its policy positions on controversial issues such as sexual and reproductive health rights.

Does Germany have a ‘ticket free’ to the top?

As a major donor country to both the UN and WHO, Germany has explicitly signalled a desire to occupy more top leadership posts, in alignment with the level of its financial contributions. Following the failure to secure the UNHCR post for a German candidate, Berlin may believe it has “a ticket free” to mount a successful campaign for the WHO’s top post, with two names being floated in German media.

From the Bundestag in Berlin, Germany’s former Minister of Health, Karl Lauterbach, could seem like a perfect blend of competent technician and politician.

While Karl Lauterbach checks many boxes for leadership due to his experience with fiscal reform, his candidacy faces distinct hurdles.
While Karl Lauterbach checks many boxes for leadership due to his experience with fiscal reform, his candidacy faces distinct hurdles.
  • He has an outstanding medical background as a trained physician and a long list of extensive academic achievements in public health and epidemiology. 
  • As a former Minister with experience in fiscal reform, he checks all those boxes.
  • However, sources we spoke with in Geneva suggested he has “little chance” due to his public praise of WHO and Tedros’ performance during the pandemic period.
  • As a member of the centre-left Social Democratic Party (SPD) in the German Parliament, he could not only be contested by the conservative party to his right (CDU), led by Chancellor Friedrich Merz, Lauterbach also represents a political faction that is highly disliked by the current US administration.
  • Finally, he has a somewhat polarising domestic reputation, linked (in part or largely) to the “mess on vaccines” –  related to Germany’s anxious over-procurement during the pandemic.

The second, lesser-known, but also less-charged candidate on the German wish list for WHO Director-General is Paul Zubeil.

German global health expert Paul Zubeil is currently serving as Deputy Director-General at the German Federal Ministry of Health.
German global health expert Paul Zubeil is currently serving as Deputy Director-General at the German Federal Ministry of Health.
  • As Deputy Director-General for European and International Health Politics at the German Federal Ministry of Health, Zubeil is considered a “respected technocrat” responsible for coordinating German health financing to the WHO and UNAIDS.
  • He also leads engagements with the G7 and G20 and possesses a reputation for fiscal discipline and institutional turnaround, backed by over a decade of experience with the UNFPA.
  • Zubeil has strong ties to the conservative party in power (CDU), having been appointed by former Health Minister Jens Spahn, suggesting he could be well-positioned to navigate relations with the Trump administration.
  • However, insiders warn that having experience “as a bureaucrat is not enough”. Unlike competitors who are former Ministers or prestigious scientists, Zubeil lacks the global public profile and “personal branding” typically required for the top job.

And, notably, both German candidates face distinct challenges from member states in the Global South, and particularly in Africa, where Germany is often perceived as a “champion of defending industry interest” over equity, when it comes to technology transfer and access to health products.

A ‘safe pair of hands’ from Brazil?

Jarbas Barbosa is the Director of the Pan American Health Organization (PAHO) and WHO Regional Director for the Americas.
Jarbas Barbosa is the Director of the Pan American Health Organization (PAHO) and WHO Regional Director for the Americas.

While currently serving as the WHO Regional Director for the Americas, Jarbas Barbosa is increasingly being discussed as a technocratic solution to the WHO’s credibility crisis.

  • According to PAHO sources, Barbosa is a pragmatist with skills that might help him navigate the “Americas problem”, where the US has exited the WHO but remains a member of the Pan American Health Organization (PAHO). He could offer a path to cooperation with the US without requiring an overt political endorsement from the Trump administration.
  • As an elected Regional Director rather than a direct appointee of Tedros, he possesses the necessary distance to frame himself as a “fresh start”.
  • His background in health surveillance and ANVISA regulation is said to signal competence in “boring-but-decisive” institutional delivery, potentially appealing to donors seeking a “post-COVID repair” agenda.
  • Sources tell us, his profile allows him to stand as a representative of the Global South who is a “technocrat” rather than a “firebrand,” making him marketable to a coalition of Latin American, EU, and Asian states.
  • However, while Barbosa is a trained physician and epidemiologist, he has never served as a Minister of Health and his primary weakness is timing: having only started his term in February 2023, running in 2027 would mean leaving PAHO mid-mandate.
  • Finally, his candidacy faces a unique financial hurdle: with PAHO heavily exposed to US arrears and funding pressure, opponents may argue that if he cannot stabilize the finances of his own regional house, he may struggle to manage the wider WHO in a post-US environment.

French ministers and diplomats

While sources indicate Paris may ultimately sit this election out, three distinct profiles have emerged in the conversation, representing the spectrum from political heavyweight to technical negotiator.

Agnès Buzyn, mentioned by informed circles as a possible candidate, theoretically ticks every box.

Former French Health Minister and WHO Academy Executive Director Agnès Buzyn is a highly experienced clinical practitioner and researcher,
Former French Health Minister and WHO Academy Executive Director Agnès Buzyn is a highly experienced clinical practitioner and researcher,
  • Buzyn is a prestigious scientist as professor of haematology and former French Health Minister (2017-2020).
  • Her portfolio includes leading high-stakes national agencies like the French National Cancer Institute (INCa) and the High Authority for Health (HAS), followed by recent internal WHO roles as the Director-General’s Envoy for Multilateral Affairs and Executive Director of the WHO Academy, positioning her as an insider with external political value.
  • However, her domestic political baggage is heavy, as her resignation from the Ministry at the dawn of the pandemic in February 2020 to run for Mayor of Paris was widely criticized as abandonment.

With 48 years of age, Anne-Claire Amprou would be the youngest candidate to run for election.

Anne-Claire Amprou, France’s Ambassador for Global Health, is a key architect of the historic 2025 WHO Pandemic Agreement.
Anne-Claire Amprou, France’s Ambassador for Global Health, is a key architect of the historic 2025 WHO Pandemic Agreement.
  • Her primary asset is her technical knowledge of the WHO’s current reform architecture as France’s Ambassador for Global Health.
  • As a chief negotiator and co-chair of the WHO Pandemic Agreement, she has demonstrated credibility in navigating complex multilateral texts.
  • However, insider assessments are blunt: confidential sources state she stands little chance, as her experience in global health is too recent with the primary concern being her shortfall of political weight: Amprou has never been a minister and lacks the medical credentials of a prestigious scientist, as she is not a doctor.

Marisol Touraine, too, is a strong candidate as an experienced political operator.

Marisol Touraine, former French Minister of Social Affairs and Health (2012–2017) and current Chair of the Executive Board of Unitaid.
Marisol Touraine, former French Minister of Social Affairs and Health (2012–2017) and current Chair of the Executive Board of Unitaid.
  • She served a full five-year term as Minister of Social Affairs and Health.
  • Sources claim she offers the “ministerial weight” and legislative toughness that is required to force through WHO reforms, having passed significant legislation, including plain packaging for tobacco.
  • Her strong point is her current leadership role in global health governance as President of Unitaid.
  • However, she represents a more traditional political profile, which sources suggest may not perform well in the current UN climate.

Longer shots from Belgium, Norway, and Pakistan? 

Word is that the Regional Director for Europe and trained physician, Hans Kluge (Belgium), would be eager to step up as WHO Director-General.

Hans Kluge, WHO Regional Director for Europe, has led the European region through the COVID-19 pandemic, the war in Ukraine, and massive refugee health challenges.
Hans Kluge, WHO Regional Director for Europe, has led the European region through the COVID-19 pandemic, the war in Ukraine, and massive refugee health challenges.
  • Kluge offers a leadership profile defined by “permanent crisis management”, having navigated a fractured region through the COVID-19 pandemic, the war in Ukraine, and significant refugee health challenges.
  • While technically an internal candidate, sources note that Kluge “openly disagreed” with Director-General Tedros during the pandemic and pursued distinct regional policies, allowing him to potentially market himself as a “reformist insider” capable of independent leadership despite never holding the rank of Minister.
  • Still, he faces a unique geopolitical hurdle: with the former Belgian Prime Minister Alexander De Croo recently appointed as UNDP Administrator, it is diplomatically improbable for the country to hold two top UN spots simultaneously.
  • Additionally, Kluge’s current mandate as Regional Director for Europe runs through 2029. While this is not a formal hurdle, there is an expectation among member states that he fulfil the term he was elected to serve, rather than pivoting to a campaign to become WHO’s Director-General.

Just this week, Norway’s Cathrine Lofthus was also mentioned in the Swiss media outlet NZZ as a possible candidate.

Head buried in draft texts, Lofthus, led a compromise agreement with Islamic states over the renewal of WHO collaborations with five reproductive health NGOs at last week’s Executive Board meeting.
  • Lofhus, a tough and ambitious and outspoken Director-General of Health, stood out during the recent WHO Executive Board debates on sexual and reproductive health rights, when she brokered a deal with the Organization of Islamic states, led by Egypt, to abstain from opposing the renewal of WHO relations with a number of reproductive health NGOs. A compromise text emphasized the  “sovereign” right of member states to choose their own engagements with non-state actors.
  • Norway has led the WHO successfully in the past, under the guidance of former Norwegian Prime Minister and WHO Director General Gro Harlem Brundtland (1998-2003). Brundtland gained international recognition for her management of the 2002-2003 SARS outbreak, as well as overseeing the adoption of the WHO Framework Convention on Tobacco Control, and redefining the connection between poverty, health, and development.
  • As a progressive European nation with a large donor portfolio and strong positions supporting climate, environment, and health equity in the Global South, a Norwegian candidate could potentially appeal to low and middle income countries – although not necessarily to social conservatives or the United States.

And finally, Sania Nishtar (Pakistan), CEO of Gavi, has also been mentioned as a potential candidate, who possesses the “stage presence skills” and consequent appeal. She ran against Tedros for WHO Director-General in 2017, as one of three short-listed scientists to succeed outgoing DG Margaret Chan. But precisely for that reason, her candidacy ten years later might not be perceived as the ‘fresh blood’ the organization needs now. 

A cardiologist by training, Sania Nishtar is a seasoned global health leader who previously served as a finalist for the WHO Director-General post in 2017.
A cardiologist by training, Sania Nishtar is a seasoned global health leader who previously served as a finalist for the WHO Director-General post in 2017.
  • As a former Federal Minister who oversaw Pakistan’s massive social safety net, Nishtar combines the “technical discipline” of a cardiologist and researcher with the “executive weight” of a cabinet member.
  • However, according to informed circles, her bid faces significant internal and external obstacles.
  • Observers say, she could have difficulty securing support from her government, and the regional conflict between Pakistan and India complicates coalition-building.
  • As a nominee from Pakistan would likely also be supported by China, this alignment renders her candidacy unlikely given the current geopolitical ruptures and the critical need to secure American re-entry.

Fierce competition on an arduous path

For any of the candidates entering the race, the election process will be arduous. According to WHO rules and previous election protocols, expect the cycle to formally begin in April 2026 when the current WHO Director-General issues the first call for candidate proposals, closing in October. In late January or early February 2027, the WHO Executive Board will then screen the candidates and nominate up to three finalists. The World Health Assembly casts the decisive vote in May 2027, with the new Director-General assuming office in August.

Winning will require more than just staying power, it means satisfying a contradictory set of demands: the successful candidate must straddle the divide between the Global South demanding equity and European countries like France, the UK and Germany, insisting on fiscal accountability. The new DG will have to negotiate deep geopolitical divides while preparing the organization for future pandemics or other global health crises. And this, while also managing the daunting post-COVID challenge of reaching at least some of the targets for the 2030 Sustainable Development Goal 3, Good Health and Wellbeing, including critical indicators of infectious and chronic disease in which the world lags far behind. Not to mention Universal Health Coverage. 

And, if the winds blow more favourably in Washington DC, trying to get the US back onboard.

Editor’s note: We extend our sincere gratitude to the experts and former WHO staff members whose dedicated research and perspectives were instrumental in the development of this analysis. This story has been updated on 23 February to reflect the most recent budget figures released by the WHO.

Image Credits: WHO/X, Anonymous/HPW, Kementerian Kesehatan, John Sears, Hannan Balkhy, Steffen Prößdorf, Germanhealth100, PAHO/WHO, Amélie Tsaag Valren, EU/Julien Nizet, EU, WHO, John Sears.

Climate change EPA

Hailed as the “single largest deregulatory action in US history,” the Environmental Protection Agency repealed a 2009 scientific decision that gave the agency the authority to regulate climate change pollutants, also known as the Endangerment Finding.

The US Environmental Protection Agency (EPA) has eliminated the scientific finding that determined planet warming gases also harm human health. 

For the last 15 years, that finding has served as the legal basis for EPA’s regulation of greenhouse gas emissions by power plants, vehicles, and other sources. 

Reversal of the finding effectively pulls the legs out from the framework that underpins virtually all of the climate rules enacted since by the EPA – whose mandate is to regulate pollutants once it’s found that they damage public health and the environment. 

In a White House announcement, EPA administrator Lee Zeldin derided the Endangerment Finding as the “‘Holy Grail’ of the ‘climate change religion.’

Critics in the US and worldwide slammed the US reversal as a politically-charged policy decision that would lead to more ill health as well as putting “millions” of lives at risk in the US and worldwide, if the new finding survives the court challenges that are expected to follow, in the words of former EPA administrator Gina McCarthy. 

EPA following ‘letter of the law’

EPA trump Zeldin Climate change
EPA Administrator Lee Zeldin at a White House press conference, announcing the repeal of the Endangerment Finding, alongside President Trump.

“The Trump EPA is strictly following the letter of the law, returning common sense to policy, delivering consumer choice to Americans and advancing the American Dream,” Zeldin countered at a press conference at the White House on Thursday. He was joined by President Trump, who called the rule the legal foundation for the “Green New Scam.”

The 2009 finding issued after a technical assessment by EPA staff scientists determined that current and projected concentrations of six key greenhouse gases, including methane, carbon dioxide, and hydrofluorocarbons, threaten public health in current and future generations. 

The ruling, which directly connected greenhouse gases to human health impacts for the first time, followed a 2007 Supreme Court decision that greenhouse gases are also air pollutants covered by the 1970 Clean Air Act. But the Court also ordered the EPA to determine “whether or not emissions of greenhouse gases from new motor vehicles cause or contribute to air pollution that may reasonably be anticipated to endanger public health or welfare, or whether the science is too uncertain to make a reasoned decision.”

The White House announcement marked the culmination of years of backstage work by climate skeptics and conservatives aligned with President Donald Trump to undo the finding following his election to a second term. 

Speaking at a press conference alongside Zeldin yesterday at the White House, the President blamed the rule for costing “trillions of dollars in regulation” and for “driving up the cost of vehicles for American families and small businesses.” 

No longer a matter of debate 

The Administration statements also attacked the scientists who issued the findings for taking “novel mental leaps” and being part of an “ideological crusade” to connect greenhouse gases to human health harms, also describing the  2009 ruling as “legal fiction.”

Yet the evidence linking climate change and health is “no longer a matter of debate,” said Maria Neira, former World Health Organization Director of the Department of Climate, Environment and Health, told Health Policy Watch. 

“Evidence has grown exponentially since 2009. Today, it is no longer a matter of debate; it is a matter of record,” Neira said. “Research shows that heat extremes, air pollution, the spread of infectious diseases, and food insecurity driven by climate change are intensifying — and already costing millions of lives each year worldwide.”  

Furthermore, the Finding has led to changes in vehicle design that have reduced other harmful tailpipe pollution emissions, as well as making them more fuel efficient. So while the Administration claims that the repeal will save Americans $2400 per vehicle, critics pointed to the millions of dollars in long-term climate and pollution-related health costs that the reversal will entail – if tailpipe and power plant emissions indeed rise once more. And that’s regardless of new tariff policies that have also raised vehicle costs by thousands of dollars.

Tentative evidence is now resolved 

“Much of the understanding of climate change that was uncertain or tentative in 2009 is now resolved – and new threats have been identified,” said the National Academy of Sciences, Engineering, and Medicine in a 2025 report.

The EPA’s repeal of the endangerment finding “disregards decades of unequivocal scientific evidence on the severe health threats posed by climate change and fossil fuel–related emissions, and on the associated harms to the broader economy,” said Dr Marina Romanello, executive director of the Lancet Countdown on Climate and Health, in a statement to Health Policy Watch. “It is a direct attack on the health and survival of people in the US and beyond,” she said. 

Her group recently published the first estimates of heat-related deaths – over half a million in the past decade – or one heat-related death per minute.

“Together with the promotion of coal burning, it shows the US administration is prioritizing the economic interests of a wealthy few to the detriment of people’s health and wellbeing. 

“As the US loses its scientific leadership, other countries have the opportunity to lead the way forward, ensuring a safe environment, and reaping the major benefits that the transition away from dirty fuels can deliver.”

Win for industry, deregulatory champions

In this latest finding, the Administration argued that the 1970 Clean Air Act applies only to localized pollutants like smog and particulate matter – and not to the greenhouse gases, which disperse across the globe. 

That ignores, however, the fact that other polluting gases and particles also travel tens or hundreds of miles – and across borders, wreaking health damage on neighboring cities, rural areas, and countries. 

Other conservatives have argued that Congress should pass a new law to regulate greenhouse gases if it wishes to do so, instead of relying on the Clean Air Act. 

The debate over the economic cost of cleaner air regulations played a central part in the repeal, despite evidence that such regulations save millions in healthcare and disaster-related costs. 

“The final rule will save Americans over $1.3 trillion by removing the regulatory requirements to measure, report, certify, and comply with federal GHG emission standards for motor vehicles, and repeals associated compliance programs, credit provisions, and reporting obligations that exist solely to support the vehicle GHG regulatory regime,” said the EPA statement. “Americans will have certainty, flexibility and regulatory relief, allowing companies to plan appropriately, and empowering American families.”

Yet many emissions savings that followed the Endangerment Finding, such as start-stop ignitions in idling cars, also saved drivers some 7-26% in fuel economy savings. 

Wildfires and extreme weather 

Drought, wildfire, and other extreme weather events have and are expected to increase in frequency and intensity.

While Administration officials touted the immediate economic benefits around the ruling, they were silent about the costs of extreme weather – even though there is increasing recognition in American communities that climate is one of the drivers. 

“Repealing the Endangerment Finding will shape our clinical reality for years to come,” argued Lisa Patel, a pediatric hospitalist and executive director of the Medical Society Consortium on Climate and Health, in an opinion piece.

“Clinically, the implications are straightforward. Increased greenhouse gas emissions mean more days of unhealthy air, higher concentrations of ground-level ozone, and more frequent and intense wildfires,” Patel explained. “For pediatricians, this translates into more asthma exacerbations, more emergency department visits, and more hospitalizations. 

“For obstetricians and neonatologists, it means higher risks of preterm birth, low birthweight, and hypertensive disorders of pregnancy. For internists and cardiologists, it means higher rates of myocardial infarction, stroke, and heart failure exacerbations during heat waves and pollution events,” she said.

Heatwaves and natural disasters costing more 

EPA climate change cost
Cost of extreme weather-related events over the past several decades.

Already, the intensity of heatwaves and natural disasters is costing mounting damage, according to the University of Chicago’s Energy Policy Institute, which stated in a recent policy brief: 

“The average American experiences 20 percent more extremely hot days than they did two decades ago, and the last decade was the warmest on record. 

“Hurricanes of all intensity categories have become more frequent, and the most extreme, Category 5, have doubled in frequency. 

“If planet-warming emissions continue to rise at the same rate they have over the last few decades, by the end of this century there may be seven times more extremely hot days compared to today. 

“In that scenario, nearly half of U.S. states could experience summer temperatures hotter than today’s summers in India or Egypt,” the Institute stated. “Going forward, the combined effects on labor productivity, health, and energy systems “could cost roughly 0.7 percent of GDP for every 1°F increase in temperature on average.” 

Environmental groups gear up for court fights

“The repeal will likely face strong legal challenges,” said Arthur Wyns, Assistant Director of the Australia’s Center for Disease Control, in a social media post. 

Several US environmental groups have already vowed to challenge the Administration’s decision.

These groups still do have the 2007 Supreme Court ruling, determining that climate pollutants  can potentially harm health, although a more conservative bench may be sympathetic to the Administration’s arguments that short of new Congressional Legislation, the 2009 Endangerment Finding represented overreach of the EPA’s authority under the Clean Air Act.  

“This move is part of a growing pattern of hostility toward the American public: stripping protections and making people less safe, all while billionaires profit,” said Natural Resource Defense Council CEO Manish Bapna.

“NRDC will not let this stand. We will see them in court — and we will win.”

The Environmental Defense Fund echoed this sentiment. “This decision is now endangering all of it — and all of us.

“We need to know the truth about the challenges we face, not fake science. We need investment in our communities to promote health, support families, lower costs and power the economy. EDF will challenge this decision in court, where evidence matters, and keep working with everyone who wants to build a better, safer and more prosperous future.”

Looking at the opportunity – rather than costs 

Adds Neira: “This is not abstract science. It reflects Americans’ lived reality. Anyone who has fallen ill during a heatwave, struggled to breathe through wildfire smoke, or faced the aftermath of a devastating hurricane understands that climate change is not a distant environmental issue — it is an immediate and escalating threat to human health.

“But that is only half the story,” she added.

“When governments act to reduce the drivers of climate change, they also address some of the most pressing health challenges of our time. Cleaner vehicles and cleaner sources of electricity mean cleaner air — and fewer deaths from heart and lung disease. Designing cities around safe sidewalks and protected bike lanes encourages walking and cycling, increasing physical activity and lowering the risk of chronic illness.

“The benefits multiply across sectors. Climate action is not a sacrifice; it is a public health opportunity. By confronting climate change, we do not just protect the planet — we advance healthier, longer, and more equitable lives.”

Image Credits: White House, Matt Howard/ Unslash, WMO, Enel North America.