On the day France recorded its hottest temperature on record, a coalition of health ministers, officials and advocates huddled in a sweaty, half-full auditorium in Paris to take stock of a campaign they have spent a decade waging: the fight to put human health at the centre of the world’s response to climate change.

The meeting was a high-level gathering of the Alliance for Transformative Action on Climate and Health (ATACH), the WHO-hosted network of 106 countries launched at COP26 in Glasgow in 2021. 

Convened under France’s G7 presidency, the summit’s task was to look ahead to COP31 in Antalya in Türkiye in November, to gauge what fights the health community should place at the top of its agenda. 

For a movement that began with a handful of officials struggling to be heard, ATACH has grown almost faster than it can handle. “We’ve accidentally been too successful,” said Nick Watts, director of the Centre for Sustainable Medicine at the National University of Singapore, who has tracked the alliance since its creation.

While part of the meeting carried the air of a victory lap, it was also a reckoning with the one thing recognition has not delivered: money.

“Finance is the weakest one, and I think this is a key point for this meeting,” said Elena Villalobos Prats, the WHO official who built much of ATACH’s architecture.

“It’s not just a plea for external support to come to countries,” Prats added. “It’s really about making sure that ministries of health, that now understand what the problem is, have the capacity and the resources to do something about it.”

Winning recognition

ATACH was itself a creation of UN climate talks, among the first concrete health commitments to come out of the climate COP process when it launched in Glasgow in 2021. The milestones – in terms of words on paper, if not finance – have piled up from there.

Dubai’s COP28 produced a health declaration signed by more than 140 countries, unveiled at an event thick with fanfare and celebrity guests like Bill Gates. The following year, in a windowless room in the underground levels of Baku’s football stadium, COP29 created a coalition that committed future presidencies to keep health on the agenda, securing a formal recognition health leaders had sought for decades.  

Then COP30 in Brazil delivered the Belém Health Action Plan, a voluntary framework of 60 measures to ready health systems for climate shocks, and the clearest sign yet that health had secured a permanent place on the UN climate agenda.

“I think we don’t need to tell everyone anymore. I think this is very clear,” said Agnes Soares da Silva of Brazil’s health ministry, who helped write the Belém plan. Real-world action, however, “has not been at the same level”, she added. 

The health community has hailed each declaration and framework as a breakthrough. Yet none is binding, all are voluntary, and none sits inside the formal UN negotiations where targets are set, international legal obligations are made, and money is committed.

And the money required is astronomical. The World Bank estimates climate change could cause up to 15.6 million additional deaths between 2026 and 2050 and inflict $8.6 trillion to $15.4 trillion in health costs by mid-century. WHO calls it “the greatest single risk to humanity.”

“Even if we stop our emissions now, we still need to adapt,” Soares da Silva said. WHO’s director-general had made the same point in reverse. “We must adapt our health systems,” Dr Tedros Adhanom Ghebreyesus said, “but we must also mitigate the cause of climate change by drastically reducing emissions, including from the health sector.”

With the fight for attention successfully won, the hard part begins – getting into the rooms that can fund the response to the worsening climate-health crisis. 

The evidence is settled

The science underpinning the campaign is no longer seriously contested. Diarmid Campbell-Lendrum, who leads WHO’s climate and health work, told the room that extreme heat “kills over half a million people each year,” and that researchers had seen it coming for generations.

“We told you so,” he said, relaying the message of the scientists who first described the greenhouse effect two centuries ago.

That figure comes from the latest Lancet Countdown, which counted around 546,000 heat deaths a year, roughly one a minute, alongside 2.52 million deaths from air pollution caused by burning fossil fuels. Thirteen of its 20 health indicators stood at record highs.

Those effects reach further than hospitals and heatwaves, down to the chemistry of the medicines themselves. Vincent Breton of Unitaid traced the climate exposure of a single product, the HIV treatment taken by 24 million people. In a Kenyan clinic, he said, women were swallowing their pills every day yet still showing high viral loads, because they had been storing the medicine in the kitchen, the hottest room in the house, where it degrades in the heat.

“Climate crisis is a health crisis, not hypothetically in the future, but here and now,” WHO Director-General Tedros Adhanom Ghebreyesus told the meeting by video, kept away by an Ebola outbreak in the Democratic Republic of Congo. 

“Responding to climate change is a key strategic objective for WHO, and ATACH is our most powerful tool to take action against this existential threat.”

There have been over 1,300 excess deaths since the start of the record-breaking heatwave in Europe on 21 June, according to Tedros.

Europe is the fastest-warming continent on Earth, heating at twice the global average. Right now 150 million people are living under extreme heat, hundreds have died, schools are shut, grids are buckling.

Driven by climate change and global warming, the phenomenon of the…

— Tedros Adhanom Ghebreyesus (@DrTedros) June 28, 2026

WHO now ranks climate change as the first of six priorities in its current programme of work, and its officials insist the economics are settled too. “At an absolute minimum, every dollar that you invest gets you $4 back,” Campbell-Lendrum said.

The economics also run the other way. The ingredients of that same HIV treatment trace back to oil, some of it routed through the Strait of Hormuz, leaving the medicine’s price exposed to crude markets and to what Breton called “the current geopolitical context.” 

In a study his team will soon publish, every 10% rise in the oil price translated into a 3% rise in the drug’s price. “How do you avoid being exposed to this risk?” he asked. “Simple answer: decarbonization.”

A movement wide but shallow

ATACH currently counts 106 member countries, more than half the nations that turn up to the climate talks, but membership demands little and delivers less.

Joining requires little more than a statement of intent. Endorsing the Belém plan, the concrete commitment the alliance now wants implemented, takes a signature, and fewer than three dozen countries have so far provided one.

Completing the work the plan describes is rarer still. As of last year, only three members, France, Japan and the United Kingdom, had completed all four assessments that ATACH asks of them. 

There is no penalty for members that do nothing, and, as Health Policy Watch reported from Baku, no mechanism to verify whether commitments translate into action on the ground.

Watts, presenting a new ATACH strategy for 2026 to 2028, was blunt about the habit of the alliance’s members of substituting documents for delivery.

“I have read the same five-page policy brief on climate change and health genuinely, maybe 1000 times,” he said. “They’ve said the same thing for the last two decades. Let’s move on.”

The new strategy leans on regional hubs, a modest catalyst fund and what the alliance calls “implementation clinics,” all meant to drag members from writing plans toward building things.

Another COP, another building block

Türkiye, which holds the COP31 presidency, used the meeting to lay out what it wants from Antalya. Rather than a departure from the pattern, it plans to attach health more firmly to the summit’s action agenda, the voluntary track that runs alongside the negotiations proper.

“We aim to focus on designing the healthcare system we need by adding a new building block to the Belem action plan,” a senior official from Türkiye’s health ministry told the meeting. 

That building block, published as a COP31 priority titled “Dynamic and Resilient Health Systems,” runs to seven goals spanning resilient infrastructure, disease surveillance, early-warning systems, artificial intelligence, a trained workforce, cross-sector coordination and “sustainable financing.” It sets no targets, attaches no figures, fixes no timeline and names no mechanism to deliver any of it.

The priorities largely restate the pillars of the Belém plan, which in turn restated the Baku and Dubai declarations before it. The proposal to build further on Belém also sits uneasily against the plan’s thin support, given that most ATACH members have yet to endorse the document it would extend.

As Türkiye and Australia’s joint presidency angle to strategically side-step the issue of fossil fuels that torpedoed the previous two COPs in Belém and Baku, the COP31 health priority – like the Belém plan it is building on – makes no mention of the role of fossil fuels in the climate crisis. 

“If we don’t have the personnel, and if we don’t have the funds, then it’s just a paper that may be sitting on the shelves,” Zimbabwean Health Minister Douglas Mombeshora, told the meeting. 

Still no money

The French Development Agency puts the cost of adapting the world’s health systems to climate change at $22 billion. The UN climate body’s estimate runs higher, at $26.8 billion to $29.4 billion a year by 2050.

At COP29, wealthy nations agreed to provide $300 billion a year by 2035, against the $1.3 trillion the developing world said it needed. Health receives a fraction of a fraction of that, capturing roughly 2% of adaptation funding and 0.5% of multilateral climate finance, a share that has not moved since Glasgow.

The collapse of aid budgets, led by the United States, has tightened the squeeze. “The world just feels a little bit meaner,” Watts said. “We’re entering into a bit of a rough patch. It’s going to last for a couple of years, and everyone knows what it feels like in their own national context.”

The only fresh money announced at COP30 came from philanthropy, with a $300 million commitment from the Gates Foundation, Wellcome and the Rockefeller Foundation. None has been added since.

“That is a drop in the ocean,” said Aarti Artwell of the Wellcome Trust, an anchor of the funders’ coalition. 

Part of the trouble, she said, is that health falls between two budgets. “We’re either talking about climate finance or we’re talking about health finance, and actually that ambiguity slows everything down.”

Campbell-Lendrum was blunt that the failure is one of will rather than knowledge. “We’re coming up with a plan, we’re still not investing, or not investing enough,” he said. “If anything, it’s got worse; we’re not prioritising this around the world.”

Tamer Samah Rabie of the World Bank located the deeper problem in chronically starved health budgets: “Low- and middle-income countries pay about $8 per person per year on a basic package of services, when in fact they should have been spending about 60 to $80 per person per year.” 

The total cost of carrying on at this level of underinvestment would reach “$21 trillion” by 2050, Rabie said. 

“Let’s stop talking about putting together another report, another plan for how we bring in more sources of finance,” he said. “Let’s be a lot more operational.”

The fund WHO just unlocked

In March, WHO became an accredited entity of the Green Climate Fund, the world’s largest climate fund, having already been approved as an implementing entity of the smaller Adaptation Fund.

The status lets WHO write and manage health funding proposals directly, rather than merely helping countries apply for small preparatory grants. Accreditation is a licence to compete for funding – and so far, health has been virtually absent from the GCF portfolio.

As of COP29, the Green Climate Fund had financed a single health project, in Malawi, and Health Policy Watch reported at the time that the country’s own climate minister did not know it existed.

The fund was designed to let developing-country institutions draw cash down directly, yet the bar has proved too high for most. Of 62 national entities accredited for direct access, 42 have never received any funding from GCF, and only about a fifth of approved projects flow through them. The rest is routed through international bodies such as the World Bank and the UN.

“We absolutely need to simplify access to finance, and for me it remains a major barrier, because the financing landscape still is really complex, really fragmented,” said Camille Perron, deputy head of the Health and Social Protection Division at the French Development Agency. 

Co-financing a single climate and health project through the agency, he added, “sometimes takes from two to sometimes three years to land on the project preparations and be able to commit an investment to our board.”

WHO’s new role does nothing to lower that bar for health ministries, but does add a potential ally in another international middleman, even as WHO contends with an existential budget crisis of its own.

The WHO’s new status will not unlock enough money to shift the needle on the climate crisis, but it can help individual communities. Yet the difficulty of the bureaucracy of the fund means even that may take time. 

An analysis of the fund’s first five years found that projects for the poorest countries took 20 to 22 months on average just to win approval, with the slowest taking nearly five, and that least-developed countries had received less than 9% of the money approved for them after more than five years. 

The Adaptation Fund, with a single-country cap of $25 million and roughly $1.6 billion committed since 2010, deals in sums that electrify a clinic or buy a cold-chain freezer, not money that rebuilds a health system.

“It’s wonderful that WHO are now implementing partners for the GCF. This is what is needed, the technical capacity and expertise,” Wellcome’s Artwell said. “The scale of the challenge isn’t enough for just philanthropy to try and do.”

 

Image Credits: WMO, Felix Sassmannshausen, X/@Cop30noBrasil.