Climate Change and Health Sector Planning: A Mixed-Methods Analysis of National Health Strategies

Abstract Background Climate change poses the greatest threat to global health in the 21st century. National health strategies and plans (NHSPs) guide future health systems but vary in addressing climate-related health risks. This study aimed to (1) examine the extent to which NHSPs consider climate change, and (2) identify country-level factors associated with its inclusion. Methods NHSPs from 101 countries were collected via the WHO country planning repository. Keyword analysis was used to identify references to climate change and health risks. NHSPs were categorized as red (no mention), yellow (mention of climate change), or green (mention plus adaptation strategies). Logistic regression models tested associations between NHSP category and national income, climate risk, and climate-related health vulnerability. Results Of the 101 NHSPs, 73 mentioned climate change, while 38 included adaptation strategies. African and low-income countries addressed climate change more often than high-income ones. Regression results showed a positive association between higher climate risk and inclusion of climate change in NHSPs. No significant association was found for climate-related health risks. Conclusions Only about one-third of NHSPs include adaptation measures. Countries with greater climate risks are more likely to address climate change in planning. Health strategies should systematically integrate adaptation to build climate-resilient health systems and guide effective public health responses. Key messages • Only one-third of NHSPs include climate adaptation strategies. • Greater climate risk predicts stronger climate focus in national health planning.