Big Pledges Won’t Solve Our Climate and Health Crisis If Those Who Need the Money Can’t Access It

Last month in Dubai, leaders at COP28 took the first critical steps to strengthen the global health response to climate change. Later this month in Davos at the World Economic Forum, leaders will gather in attempts to galvanize action along similar themes. But none of the billions of dollars committed so far will matter if those who need them most can't access them — and philanthropic leaders can help.

The climate crisis is a health crisis. A new report from the BMJ predicts more than 5 million excess deaths from air pollution annually, with 61% of those deaths directly attributable to fossil fuels. As a wide array of damning data shows, the health impacts of climate change are now without doubt and undermine every sector in which we seek progress for countries and communities, including education, economic growth, security and more.

While climate change may be killing us, it is smart financing that is needed to save us. We must unlock more flexible, accessible and accelerated financing — especially through philanthropy — and we must do this quickly if we hope to turn the tide and address the very real, very urgent health challenges exacerbated by this global crisis.

COP28 highlighted several new funding initiatives for the health space: attempts to close the massive funding gap needed to address the mitigation, adaptation and resilience challenges we face today. The first-ever Health Day at COP was headlined by an announcement of $1 billion in funding dedicated to the climate and health nexus. The Global Fund led with a $512 million commitment. Over $100 million was committed by the Wellcome Trust, along with $100 million from the Rockefeller Foundation — and the list continues.

However, these funding pledges — while welcomed and greatly needed — are often challenging for two reasons.

First, much of this funding is not new, flexible or uncommitted. While they are dedicated to meeting some of the health challenges from climate change, over half of the funding commitments announced as part of that $1 billion have already been earmarked for expenditure or are dedicated to specific projects or narrow, disease-focused (rather than systems-focused) interventions. There is a significant risk now in the global philanthropic community that funds will be perceived as sizable and available, driving complacency around raising the money that is actually needed to ensure we close gaps.

Second, these philanthropic leaders are going to need a lot more company to put a dent in the problem. The UN Environment Programme just released a report outlining the need for $387 billion annually to help vulnerable countries and communities adapt to the climate and health impacts they already feel. This amount dwarfs the Health Day pledge as well as $450 million pledged toward the new loss and damage fund also announced in Dubai last month.

For global health, the funding environment is stark. Over 90% of countries include health priorities in their Nationally Determined Contributions, a key progress measurement used at COP. Yet, of the $28 billion being spent on climate adaptation funding, only 5% is allocated to projects that explicitly address human health. Multilateral institutions provide only 0.5% of that total funding. This lack of absolute dollars dedicated to health ignores the important economic impact of health.

Studies show the economic return of every dollar invested in health is at least $4. Focusing on prevention and the adoption of known healthcare interventions could increase the GDPs of lower-income countries by $4.4 trillion by 2040. As these investments lead to better health, they grow economies, create jobs, and foster social inclusion and gender equity, especially as women comprise around 70% of the health workforce.

Prime Minister Mia Mottley of Barbados often cites that every dollar spent on adaptation now would save $7 in loss and damages. Based on current numbers, one year of missed adaptation could lead to almost $3 trillion in loss and damages.

Further, we have seen how our approaches to funding vulnerable health systems have not worked. While health leaders have been trying to build stronger, more climate-resilient and responsive health systems, too many donors have been focused on short-term wins and easy evaluation metrics. During the COVID-19 pandemic, we saw years of progress reversed and a near collapse of health systems around the globe, leading to increased deaths from preventable causes, as well as trillions in GDP losses and a surge in poverty. To most efficiently and meaningfully meet the health challenges communities are facing today, we need to examine how we fund health systems.

First, we can no longer afford to take a vertical focus in designating funding. For too long, project-based or disease-based approaches have chopped up health delivery systems, have complicated national plans as countries try to piece together whole health responses, and have created administrative headaches and costs. We must support the development of holistic national plans that recognize the acute threat of climate change and rising demands on health systems.

Second, we must avoid creating a series of new funds or organizationally dictated funding mechanisms, which create a series of competing monies to which countries and communities must respond. Every fund brings its own application and reporting processes; it becomes a minefield of paperwork to access the funds and apply them. Perhaps the worst offense is the sheer time it takes to stand up these new mechanisms. In our battle against accelerating rates of climate change, lost time means lost lives: Countries cannot afford to wait years to wade through bureaucratic hoops and technical applications. For communities whose survival quite literally rests on building resilience — something wealthier, more climate-secure communities may take for granted — leveraging existing mechanisms will be more efficient and effective.

There are existing mechanisms that can be leveraged to ensure funding is mobilized quickly and effectively to the communities that need it most. Yet the communities most at risk from the impacts of climate change cannot access or influence the financial resources and expertise they need: Just 10% of global climate funds were dedicated to local-level activities in 2016. While new approaches to funding must be embraced, one example that could serve as a quick and established model is the Global Fund’s country coordinating mechanisms (CCMs). CCMs determine priorities, move funds and administer grants. The mechanism was flexed during the COVID19 pandemic, moving $4.7 billion quickly to respond to the emergency.

Finally, we must acknowledge the power of philanthropic funding to seed and attract larger investments and funding. For instance, climate-related damages can cost small island nations more than 20% of their annual gross domestic product. Such costs, which are already often insurmountable, can increase still further if countries cannot afford to take action in the immediate aftermath of a disaster. Philanthropic funding can play a critical role to fill this gap, acting as a bridge to multilateral or other large-scale funding mechanisms. In this context, philanthropic funding can address immediate needs in the short term and inform, through innovation and implementation science, the way forward for when larger, catalytic sources of funding arrive.

As we act to counter one of the greatest and most existential challenges of our time — the health impacts of climate change — we must remember not only to rise to the moment in terms of the number of dollars at the table. We must also keep in mind to whom and how we are making those dollars available and accessible.

Dr. Vanessa Kerry is CEO and Co-Founder of Seed Global Health.

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