- The Lancet Countdown’s sixth annual report tracks 44 indicators of health impacts that are directly linked to climate change – and shows key trends are getting worse and exacerbating already existing health and social inequities.
- Global leaders have the opportunity to put actions and policies in place that will address these stark inequities, improve health, and deliver economic and environmentally sustainable COVID-19 recovery plans.
- Countries must commit to more ambitious climate plans that incorporate health equity and societal support to ensure a more suitable future for all.
- Many current COVID-19 recovery plans are not compatible with the Paris Agreement and will therefore have long-term health implications.
- Despite the detrimental climate effects, the world continues to subsidise fossil fuels. In 2018, 65 out of the 84 countries analysed by Lancet Countdown researchers had net-negative carbon prices equivalent to an overall subsidising of fossil fuels. The median value of the subsidy was US$1 billion, with some countries providing net subsidies to fossil fuels in the tens of billions of dollars each year. The 84 countries surveyed are responsible for around 92% of global CO2 emissions.
- In 2020, adults over 65 were affected by 3.1 billion more days of heatwave exposure than in the 1986–2005 baseline average. Chinese, Indian, American, Japanese, and Indonesian senior citizens were the most affected.
- Climate change and its drivers are creating ideal conditions for infectious disease transmission, potentially undoing decades of progress to control diseases such as dengue fever, chikungunya, Zika, malaria, and cholera.
- Healthcare systems are ill-prepared for current and future climate-induced health shocks. Only 45 (49%) of 91 countries in 2021 reported having carried out a climate change and health vulnerability and adaptation assessment.
The COVID-19 pandemic has demonstrated the need for increased international co-operation in the face of global crises. Politicians must show leadership by moving beyond rhetoric and take action at the upcoming UN Climate Change Conference (COP26), which will start on Sunday 31 October 2021 in Glasgow, Scotland. Carbon emissions must be rapidly reduced to improve health and to provide a more equitable, sustainable future.
As countries commit trillions of dollars to restart their economies in the midst of the COVID-19 pandemic, the report urges political leaders and policy makers to use this public spending to reduce inequities. Promoting a green recovery by creating new and green jobs, and safeguarding health, will build healthier populations now and in the future.
A fossil-fuel driven recovery – which includes large subsidies for oil, gas and coal and limited financial support for clean energy – could potentially meet narrow and near-term economic targets, but may then push the world irrevocably off course and make it impossible to meet the maximum 1.5C of warming as outlined in the Paris Agreement. This has a toll on human health, hardest hitting to those people living in low income countries, whose populations have made the smallest relative contribution to climate change. As governments turn from emergency spending to long term post-pandemic recovery it is vital that more of these funds are spent in ways that reduce climate change, such as promoting jobs in zero-carbon energy, where investment lags behind what is necessary to keep within 1.5C of warming.
The Lancet Countdown report shows that many countries are under-prepared for the health effects of climate change. In a 2021 World Health Organisation survey of health and climate change, only 45 of 91 countries surveyed (49%) say they have a national health and climate change plan or strategy. Only 8 out of those 45 countries in the analysis reported that their assessments of the effects of climate change on their citizens’ health had influenced the allocation of human and financial resources. The survey found 69% of countries in this analysis reported insufficient financing was a barrier to implementing these plans.
“Climate change is here and we’re already seeing it damaging human health across the world,” said Prof Anthony Costello, Executive Director of the Lancet Countdown.
“As the COVID-19 crisis continues, every country is facing some aspect of the climate crisis too. The 2021 report shows that populations of 134 countries have experienced an increase in exposure to wildfires. Millions of farmers and construction workers could have lost income because on some days it’s just too hot for them to work. Drought is more widespread than ever before. The Lancet Countdown’s report has over 40 indicators and far too many of them are flashing red.
“But the good news is that the huge efforts countries are making to kick-start their economies after the pandemic can be orientated towards responding to climate change and COVID-19 simultaneously. We have a choice. The recovery from COVID-19 can be a green recovery that puts us on the path of improving human health and reducing inequities, or it can be a business-as-usual recovery that puts us all at risk.” 
The Lancet Countdown report represents the consensus of leading researchers from 38 academic institutions and UN agencies. The 44 indicators in the 2021 report expose an unabated rise in the health impacts of climate change:
- The potential for outbreaks of dengue, chikungunya and Zika is increasing most rapidly in countries with a very high human development index, including European countries. Suitability for malaria infections is increasing in cooler highland areas of countries with a low human development index. Coasts around northern Europe and the US are becoming more conducive to bacteria which produce gastroenteritis, severe wound infections, and sepsis. In resource-limited countries the same dynamic is putting decades of progress towards controlling or eliminating these diseases at risk.
- There are 569.6 million people living less than five metres above current sea levels, who could face rising risks of increased flooding, more intense storms, and soil and water salinification. Many of these people could be forced to permanently leave these areas and migrate further inland.
Maria Romanello, lead author of the Lancet Countdown report, said:
“This is our sixth report tracking progress on health and climate change and unfortunately we are still not seeing the accelerated change we need. At best the trends in emissions, renewable energy and tackling pollution have improved only very slightly. This year we saw people suffering intense heatwaves, deadly floods and wildfires. These are grim warnings that for every day that we delay our response to climate change, the situation gets more critical.
“Governments are spending trillions of dollars on the recovery from the COVID-19 pandemic. This gives us an opportunity to take a safer, healthier, low carbon path, but we have yet to do so. Less than one dollar in five being spent on the COVID-19 recovery is expected to reduce greenhouse gas emissions and the overall impact is likely to be negative. We are recovering from a health crisis in a way that’s putting our health at risk.
“It’s time to realise that no one is safe from the effects of climate change. As we recover from COVID-19 we still have the time to take a different path and create a healthier future for us all.” 
A Lancet Editorial adds, “The world is watching COP26—widely perceived as the last and best opportunity to reset the path to global net zero carbon emissions by 2050—and public interest in climate change is higher than ever, in part due to global youth activism and engagement…This year’s indicators give a bleak outlook: global inequities are increasing, and the direction of travel is worsening all health outcomes. Health services in low-income and middle-income countries are in particularly urgent need of strengthening…However, the future is not necessarily hopeless…Succumbing to the climate emergency is not inevitable.”
Key report findings
Just as the world is failing to deliver an equitable supply of COVID-19 vaccines, the data in this report exposes similar inequities in the global response to climate change. In general, it is the countries lowest on the human development index that are often least responsible for rising greenhouse gas emissions and are lagging behind in climate change adaptation and mitigation efforts and in realising the associated health benefits of accelerated decarbonisation.
- In 2020, up to of 19% of the global land surface was affected by extreme drought in any given month, a value that had not exceeded 13% between 1950 and 1999.
- Climate change is driving an increase in the frequency, intensity, and duration of drought events, threatening water security, sanitation, and food productivity, and increasing the risk of wildfires and exposure to pollutants. The five years with the most areas affected by extreme drought have all occurred since 2015. The Horn of Africa, a region impacted by recurrent extreme droughts and food insecurity, was one of the most affected areas in 2020.
- Climate change threatens to accelerate food insecurity, which affected 2 billion people in 2019. Rising temperatures shorten the time in which plants reach maturity, meaning smaller yields and an increased strain on our food systems. Maize has seen a 6% decrease in crop yield potential, wheat a 3% decrease and rice a 1.8% decrease, compared to 1981 – 2010 levels.
- Average sea surface temperature has increased in the territorial waters of nearly 70% (95 out of 136) of coastal countries analysed, compared to 2003-2005. This reflects an increasing threat to their marine food security. Worldwide 3.3 billion people depend on marine food.
- In 2021 the World Health Organisation found just over half of countries that answered to the Health and Climate Change Global Survey (37 out of 70) had a national health and climate change strategy in place, a similar proportion to 2018. Nearly three-quarters of countries surveyed said finances prevented them developing such a strategy, with others citing a lack of skilled people, being restricted by COVID-19 and lacking research and evidence.
- Globally, climate change adaptation funding directed at health systems represents just 0.3% of total climate change adaptation funding.