Ten years of the Paris Agreement: WHO finds health central to climate plans, but implementation lags
Image credit: WHO The World Health Organization has published Ten years of the Paris Agreement: a global review of health in nationally determined contributions. The report frames climate change as "a present and escalating public health emergency" reshaping the determinants of health, with disproportionate impacts on children, women, Indigenous Peoples and persons with disabilities.
NDCs are country-specific national climate plans setting targets for reducing greenhouse gas (GHG) emissions and increasing adaptation and resilience - the main instruments for implementing the Paris Agreement. NDCs 3.0 were due in 2025, setting out actions to 2035. The review assesses 114 NDC documents representing 140 Parties, structured around WHO's six quality criteria: leadership and enabling environment; national circumstances; mitigation; adaptation; loss and damage; and finance.
Key findings from the report:
91% (128) of Parties mention health, matching the 2023 review.
59% (82) identify health co-benefits of mitigation - up from 30% in 2023 - but only 5% (4) quantify or monitor them.
22% (31) include air pollution/SLCP targets or measures, up from 10% in 2020 and 16% in 2023.
11% (15) include health-sector emissions reduction targets or measures, despite health systems contributing an estimated 5% of global GHG emissions.
55% (77) include health-specific adaptation actions or targets; 59% (82) refer to climate-sensitive health risks (CSHRs).
29% (41) reference health in loss and damage - up from 11% in 2023 - yet financial implications are quantified in just three NDCs.
23% (32) estimate resources needed for health actions, but only 7% (10) specify any unconditional climate-health finance.
The report findings are structured around WHO’s Quality criteria for integrating health in Nationally Determined Contributions (NDCs) with country examples to outline the actions or strategies included in NDCs.
Leadership and National Circumstances
Only 15% (21) of Parties specify that the ministry of health led the health contribution, and 17% (24) specify an ongoing role - though the 2025 WHO global survey found 60% of countries reported ministry of health involvement in practice. 24% (34) link their NDC to the SDGs in the context of health.
36% (51) of Parties refer to an evidence-based assessment of CSHRs. Among the 82 identifying risks, vector-borne diseases (66%), waterborne diseases (55%), extreme weather injury and mortality (52%), and malnutrition and foodborne diseases (52%) are most cited. Lebanon's NDC describes a health system struggling with heat-related mortality, water- and vector-borne diseases, and power outages disrupting services; Moldova notes 14% of public health facilities are at risk of flooding.
Mitigation
Among the 82 Parties identifying co-benefits, energy (60%), waste management (34%) and transport (21%) are most cited. Nigeria estimates cleaner air will prevent over 21,000 deaths and deliver US$ 7.2 billion annually.
Chile's NDC sets black carbon reduction targets of 25% by 2030 and 30% by 2035 (vs 2016), plus PM2.5 concentrations of 18 µg/Nm³ or less by 2035. A UNDP/Clean Air Fund analysis found 20 countries mention black carbon, with five setting explicit targets—Chile, Colombia (40% reduction by 2035 vs 2014), Costa Rica, Mexico and Micronesia. Cambodia, Mongolia, Nepal and Zambia referenced black carbon for the first time.
Only 15 Parties include health-sector mitigation. Nepal plans to upgrade 140 health facilities by 2030 and 280 by 2035 to be low-carbon and climate-resilient, develop a low-carbon health system action plan by 2030, and replace 75% of traditional anaesthetic gases by 2035.
Adaptation, Loss and Damage
51% (71) link health adaptation to national planning processes such as National Adaptation Plans, and a further 7% (10) refer to a separate Health National Adaptation Plan. Eswatini targets 80% of health facilities remaining operational during climate disasters by 2035 and a 50% reduction in climate-related mortality. 38% (53) include health adaptation in other sectors, and 20% (28) identify mitigation-adaptation synergies.
On loss and damage, 34% of the 41 Parties referencing health L&D include interventions - such as Bangladesh's integration of mental health and psychosocial support into disaster response, and Belize's emergency health response plans and climate-resilient medical supply reserves.
Finance
Only 7% (10) of Parties specify any unconditional funding for health measures. Vanuatu estimates health and nutrition commitments at US62million,nearlyUS62million,nearlyUS 52 million conditional; Angola estimates US$ 21 million for health adaptation by 2035.
While health is now a priority in most NDCs, this report finds that there is a clear opportunity to strengthen depth, specificity and financial support. The next NDC round in 2030 - which will be informed by the 2028 Global Stocktake - offers a window to elevate health as a core pillar of climate ambition.
An ATACH Technical Meeting on NDC 3.0 was held on 21 October in 2 sessions to outlining the report findings and provided country examples from ATACH Members.
Click here to see the Technical Meeting agenda and view the event recording.