Health in nationally determined contributions: a policy analysis of 191 countries.

BACKGROUND: Nationally Determined Contributions (NDCs) describe the commitments made by each country to reduce its greenhouse gas emissions. Assessing how health is considered in NDCs is critical to understand how countries plan to protect their populations' health from climate change. METHODS: This policy analysis investigated how health was considered by NDCs for 191 countries across seven domains: health co-benefits, health adaptation, health impacts, sustainable healthcare, health inequalities, women, and other. It included quantitative analysis, which summarised the score for each domain, and qualitative analysis using content analysis to identify common themes (i.e., recurring patterns/concepts). RESULTS: The mean of the total score was 4.7 (SD 3.5) points for the first submission, with median of 5 [range 0-12] points. For the second submission, the mean of the total score was 3.2 (SD 3.7) points, with median of 2 [range 0-12] points. The mean of the total score for the third submission was 7.3 (SD 3.2) points, with median of 9 [range 0-13] points. Latin American and Caribbean States achieved the highest scores. Content analysis identified important themes, such as the direct and indirect impacts of climate change on health, the need to adopt bold policies to protect the population with early warning systems and other health protection interventions, the need to build resilient health systems, the co-benefits of transitioning to renewable energy sources, the unequal impact of climate change, and the importance of gender equality and women's vulnerability. CONCLUSIONS: Although health is considered by the NDCs of most countries, this is often superficial and does not capture the entirety of the health impacts and co-benefits. There is a need to consider health across all domains of climate mitigation and adaptation to prevent climate change from widening health inequalities and to inform planning to mitigate negative impacts on population health. Full consideration of health impacts and co-benefits is likely to strengthen the moral and economic cases for nations to prioritise action on climate change and to prevent ideology-based minimisation of the need for action.