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THECOSTOFINACTION
QuantifyingtheImpact
ofClimateChangeonHealth
inLow-andMiddle-IncomeCountries
F
CLIMATE
INVESTMENT
FUNDS
WORLDBANKGROUP
©2024InternationalBankforReconstructionandDevelopment/TheWorldBank
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Pleasecitetheworkasfollows:WorldBank.2024.TheCostofInaction:QuantifyingtheImpactofClimateChangeonHealthinLow-andMiddle-IncomeCountries.Washington,DC:WorldBank.
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Contents
Foreword
AcknowledgmentsAbbreviations
UnitsofMeasurementSummary
1.Introduction
2.Methods
2.1|SelectionofCountries
2.2|SelectionofClimateScenarios
2.3|ModelingandAnalyticalApproach
2.4|Data
3.ImpactsofClimateChangeonHealth
andtheEconomicCostofInaction
3.1|impactsofClimateChangeonHealth
3.2|EconomicCostofinaction
4.Discussion
4.1|SummaryofKeyFindings
4.2|ComparisonofFindingswithKeyLiterature
4.3|StudyCaveats
4.4|PolicyimplicationsandFutureDirections
Annexes
viviiviiiviii ix
1
4
5
5
8
13
14
15
16
19
20
21
23
25
26
iv
Annex1
|
CountriesincludedintheAnalysis
26
Annex2
|
SSPsandRCPs
29
Annex3
|
EstimatingtheimpactsofClimateChangeonMorbidityandMortality
33
Annex4
|
ModelingFatalityRates
38
Annex5
|
EstimatingYLLfromClimateChange
42
Annex6
|
EstimatingtheEconomicCostofClimate-RelatedHealthimpacts
45
Annex7
|
CumulativeEstimatesoftheimpactsofClimateChange
onMorbidityandMortalityintheShortTermandLongTerm
65
Annex8
|
EconomicCostoftheHealthimpactsofClimateChangeintheShortTermandLongTerm
67
References68
v
FIGURES
1SSPsandRCPs7
2DistributionoftheEconomicCostoftheHealthimpactsofClimateChange18
AcrossRegions:2026-2050
A.1PopulationGrowthunderSSPs29
A.2EconomicGrowthunderSSPs29
TABLES
1SharedSocioeconomicPathways6
2ComparativeAnalysisofApproaches:WHO(2014)andthisReport8
3CumulativeNumberofCasesAttributabletoClimateChange:2026-205015
4CumulativeNumberofDeathsAttributabletoClimateChange:2026-205016
5CumulativeEconomicCostoftheHealthimpactsofClimateChange:2026-205017
A.1LMiCsincludedintheAnalysis26
A.2TotalProjectedRegionalPopulation30
A.3TotalProjectedRegionalGDP(trillionUSD)30
A.4ModelingMalaria’sFatalityRate40
A.5EstimatingLifeExpectancies42
A.6AgeDistributionofDeathsfromMalariainNigeriain202043
A.7AgeDistributionofDeathsfromMalariainCameroonin202044
A.8EstimatedCountry-SpecificvaluesforvSL(USD)–SSP346
A.9EstimatedCountry-SpecificvaluesforvSL(USD)–SSP248
A.10EstimatedCountry-SpecificvaluesforCOiDengue(USD)–SSP351
A.11EstimatedCountry-SpecificvaluesforCOiDengue(USD)–SSP253
A.12EstimatedCountry-SpecificvaluesforCOiMalaria(USD)–SSP355
A.13EstimatedCountry-SpecificvaluesforCOiMalaria(USD)–SSP257
A.14EstimatedCountry-SpecificvaluesforCOiDiarrhea(USD)–SSP359
A.15EstimatedCountry-SpecificvaluesforCOiDiarrhea(USD)–SSP261
A.16CumulativeNumberofCasesAttributabletoClimateChange:2026-203065
A.17CumulativeNumberofDeathsAttributabletoClimateChange:2026-203065
A.18CumulativeNumberofCasesAttributabletoClimateChange:2026-210066
A.19CumulativeNumberofDeathsAttributabletoClimateChange:2026-210066
A.20EconomicCostoftheHealthimpactsofClimateChange:2026-203067
A.21EconomicCostoftheHealthimpactsofClimateChange:2026-210067
Foreword
vi
Climatechangehasprofoundandextensiveadverseimpactsonhealth,andtheseareexpectedtointensifyinthecomingdecades.Ascasualtiesandfatalitiesincrease,theclimate-relatedhealthcrisisrisksoverwhelminghealthcarefacilitiesandsystems,particularlyinlow-andmiddle-incomecountries.Asaresult,thehealthimpactsofawarmingplanetcouldpushmillionsofpeopleintoextremepoverty.
Avitalfirststeptowardaddressingthehealthemergencyarisingfromclimatechangeinvolvesidentifyingthemultiplehealthimpactsandestimatingthecostofinaction.BuildingonanearliereffortbytheWorldHealthOrganization,thisWorldBankreportquantifiestheimpactsandcostsofprojectedclimatechangeonhealthinlow-andmiddle-incomecountries.
Thestudyrevealsthatclimatechange-relatedhealthimpactswillbesevere,evenintheshortterm,andcertainregionslikeSub-SaharanAfricaandSouthAsiawillbearadisproportionateshareoftheglobalburden.Thecostofinactionisexpectedtobefarhigherthanprojectedinthereport,whichdidnotcoverallofthehealthriskslinkedtoclimatechange.
Theseprojectionsshouldgalvanizedecision-makersandspururgent,transformativeaction.Countriesmustadoptboldmeasurestolimittheimpactsofclimatechangeandsignificantlyboosttheresilienceoftheirhealthcaresys-tems.Thiscannotbeaboutaddressingtheimpactonspecificdiseasesalone.Instead,wemustfocusonstrengthe-ninghealthsystemssotheycanadaptandmitigatethebroaderimpactsofclimatechangeonhealthconditions.
TheWorldBankaimstoreach1.5billionpeoplewithqualityhealthservicesby2030.Thisgoalwillnotbereached,withoutexpandingourinvestmentsinclimateandhealthtohelpcountriesbuildhigh-quality,climate-resilient,andlow-carbonhealthsystems.Thesearenotjustwords.Infact,lastyearclimateinvestmentsinhealthprojectsamountedtoathirdoftheBank’stotalfinancingforhealth.
Furtherwearefocusingonassessingcountry-specificclimate-healthvulnerabilitiestoinformthedesignoftailo-redsolutionstoguideourinvestmentstobuildresilient,low-carbonhealthsystems;aswellasdeepeningpart-nershipsattheglobal,regional,andcountrylevelstosupporttheseefforts.Lookingahead,theWorldBankisdevelopingafullrangeoffinancinginstrumentsforbothadaptationandmitigationactivities,whichwillenableustoincreaseoursupporttohelplow-andmiddle-incomecountriestackleclimate-healthchallenges.
Climatechangeisaglobalcrisis–wemustjoinforcesnowtoaddressitsdirectandindirectimpactsonhealthandlimitthehighhumanandeconomiccosts.Thisisawake-upcallforallofustoactdecisivelyandurgentlyto
safeguardourfuture.
JuanPabloUribe
GlobalDirector,Health,NutritionandPopulationTheWorldBank
Acknowledgments
vii
ThisreportwasproducedbytheClimateandHealthProgramintheHealth,Nutrition,andPopulationGlobalPracticeoftheWorldBank.
ThereportisauthoredbyLorieRufo(SeniorClimateChangeSpecialist,WorldBank);BenoitLaplante(EconomicsConsultant,WorldBank);StevenCegliaSmith(DataAnalystConsultant,WorldBank);andDavidAlexanderClary(EconomicsConsultant,WorldBank).ThereportreceivedoverallguidancefromTamerSamahRabie(GlobalProgramLead,ClimateandHealth,WorldBank).
Thereportgreatlybenefitedfromthevaluablecontributionsofthefollowingpeerreviewers:PatrickHoang-VuEozenou(SeniorEconomist,WorldBank);JedFriedman,(LeadEconomist,WorldBank);XianFuLu(ClimateChangeConsultant,ClimateInvestmentFunds);andUrvashiNarain(ProgramLeader,WorldBank).
Theauthorswouldalsoliketothankthefollowingexternalpeerreviewersofthereportfortheirinsightfulcom-ments:EnisBaris(Director,GlobalHealthPolicy,InstituteforHealthMetricsandEvaluation);DiarmidCampbell-Lendrum(Head,ClimateChangeandHealthUnit,WorldHealthOrganization);SariKovats(AssociateProfessor,LondonSchoolofHygieneandTropicalMedicine);ChristopherMurray(FoundingDirector,InstituteforHealthMetricsandEvaluation);FrankPega(TechnicalOfficer,Environment,ClimateChangeandHealth,WorldHealthOrganization);andAlexanderPreker(AdjunctAssociateProfessor,ColumbiaUniversity).
TheauthorssincerelyappreciatethevaluablecontributionsprovidedbyAletheaCook(HealthConsultant,WorldBank);StephenDorey(SeniorHealthSpecialist,WorldBank);ToniJoeLebbos(Economist,WorldBank);YunaNakayasu(HealthConsultant,WorldBank);WameqAzfarRaza(SeniorHealthSpecialist,WorldBank);JyotirmoySaha(HealthConsultant,WorldBank);ZaraShubber(SeniorHealthSpecialist,WorldBank);andPennyWilliams(Manager,PeopleVice-Presidency,WorldBank).
SincerethanksarealsoextendedtotheWorldBankClimateChangeKnowledgePortalteamwhoprovidedgui-danceontheappropriateuseofthemostrecentclimatedataavailableontheportal.FurtherthankstoKahYingChoowhodiligentlyperformedthecopyeditingofthereport.
TheauthorswouldliketoexpresstheirgratitudetoJuanPabloUribe(GlobalDirector,Health,Nutrition,andPopulation,WorldBank)andMoniqueVledder(PracticeManager,Health,Nutrition,andPopulation,WorldBank)fortheirunwaveringsupport.
Finally,theauthorsarethankfultotheClimateInvestmentFundsforitsfinancialsupport.
viii
ABBREVIATIONS
AR6
SixthAssessmentReport(oftheIPCC)
CCKP
ClimateChangeKnowledgePortal
CMIP6
SixthPhaseoftheCoupledModelIntercomparisonProject
CO2
CarbonDioxide
COI
CostofIllness
COP
ConferenceoftheParties(totheUNFCCC)
COP26
26thConferenceoftheParties
EAP
EastAsiaandPacific
ECA
EuropeandCentralAsia
GDP
GrossDomesticProduct
IAM
IntegratedAssessmentModel
ILO
InternationalLabourOrganization
IPCC
IntergovernmentalPanelonClimateChange
LAC
LatinAmericaandtheCaribbean
LMICs
Low-andMiddle-IncomeCountries
MENA
MiddleEastandNorthAfrica
OECD
OrganisationforEconomicCo-operationandDevelopment
RCP
RepresentativeConcentrationPathway
SA
SouthAsia
SIDS
SmallIslandDevelopingStates
SRES
SpecialReportonEmissionsScenarios
SSA
Sub-SaharanAfrica
SSP
SharedSocioeconomicPathway
UN
UnitedNations
UNEP
UnitedNationsEnvironmentProgramme
UNFCCC
UnitedNationsFrameworkConventiononClimateChange
US
UnitedStates
USD
UnitedStatesDollar
VSL
ValueofStatisticalLife
WEF
WorldEconomicForum
WHO
WorldHealthOrganization
YLL
YearsofLifeLost
UNITSOFMEASUREMENT
°C
DegreeCelsius
Gt/yr
GigatonsPerYear
W/m2
WattPerSquareMeter
ix
Summary
Climatechangeisimpactinghumanhealthinmyriadways,includingbyincreasingthefrequencyofextremeweatherevents,theemergenceandspreadofinfectiousdiseases,anddisruptionstofoodsystems.Theimpactsofclimatechangeonhealth—alreadyprofound—areonlyexpectedtoworsenovertime.Notonlywillthenumberofdiseasesanddeathsfromclimate-sensitivehealthrisksincrease,butsotoowillthegeographicalrangeofthesediseases.Low-andmiddle-incomecountries(LMICs)areexpectedtofaceadisproportionateburdenoftheseimpactsduetotheirhigherlevelsofpovertyandincomeinequality,andweakhealthcaresystems.Withgrowingrecog-nitionthattheclimatecrisisisahealthcrisis,theinternationalcommunityhasexpressedurgentcallsforactiononclimateandhealth.
Theresponseofthehealthcommunityandresearchershasbeenlargelyfocusedonstudyingthelinkbetweenclimatechangeandhealth.Alimitednumberofstudieshaveestablishedempiricallinksbetweenclimateconditionsandthevariabilityinthenumberofdifferentdiseasesinspecificnational(orsubnational)contexts,particularlyfocusingonvector-borneandwaterbornedisea-ses.Inaddition,fewstudieshaveaimedtoassesstheeconomiccostassociatedwiththehealthimpactsofprojectedclimatechange.
Thisreportaimstoaddresstheexistingknowledgegapandprovideadeeperunderstandingoftheinterconnectionbetweenclimateandhealth,intermsoftheriskstohumanhealthandtheeconomicburdenoftheserisks.Specifically,itprovidesaquantitativeassessmentofthepotentialimpactsofclimatechangebasedonthenumberofcasesandthenumberofdeathsresultingfromselectedvector-andwater-bornediseases,stunting,andextremeheat.Anassessmentoftheeconomiccostofclimatechangeonhealth(intermsofbothmorbidityandmortality)isalsoprovided.
Theanalysiscovers69low-incomeandmiddle-incomecountrieswithnationalpopulationsexcee-ding10millionpeopleinthebaseyear2020.These69countriescomprise96percentofthetotalpopulationofallLMICs.
Estimatesoftheimpactsofclimatechangeonhealthareprovidedfordifferenttimeperiodsin-cluding2026-2030,2026-2050,and2026-2100inthecontextoftwosocioeconomicdevelopmentscenariosfeaturedintheSixthAssessmentReport(AR6)oftheIntergovernmentalPanelonClimateChange(IPCC)—namely,SSP3-7.0andSSP2-4.5(referredtohereafterasSSP3andSSP2).Thesetwoscenariosrepresentmiddle-of-the-roaddevelopmentpathsbetweentheworst-case(RCP8.5)andtheincreasinglyunlikelybest-casescenarios(RCP2.6andRCP1.9).SSP3representsacha-llengingpathway,assuminghighpopulationgrowth,limitedeconomicdevelopment,andreduced
x
investmentsinhealthandeducation,whereasSSP2presentsmoderatechallenges,characterized
bysteadypopulationandeconomicgrowth.Themainfindingsofthisreportareasfollows:
1.Theimpactsofclimatechangeonhealtharesignificantandcallforimmediateac-tionattheglobalandcountrylevels.Between2026and2050,climatechangeisprojec-tedtocausebetween4.1billion(SSP2)and5.2billion(SSP3)casesacrossLMICs.Theimpactofclimatechangeonmortalitywillbeequallystark.By2050,thenumberofdeathscausedbyclimatechangecouldreachbetween14.5million(SSP2)and15.6million(SSP3).Immediate,decisiveactionisneededtoavertthesedevastatingimpactsonhealthacrossLMICs.
2.Scalingclimate-healthactionisneededtoaverttrillionsofdollarsineconomiccostsarisingfromtheseselectedhealthimpactsofclimatechangeinthecomingdeca-des.By2050,theeconomiccostofthehealthimpactsofclimatechangeisprojectedtoreachbetweenUSD8.6-15.4trillionunderSSP3.Thesecoststranslatetobetween0.7percentand
1.2percentofthegrossdomesticproduct(GDP)ofLMICs.TheseestimatesarehigherunderSSP2,reachingbetweenUSD11.0-20.8trilliontranslatingto0.7percentand1.3percentofGDPinLMICs.
3.Sub-SaharanAfrica(SSA)andSouthAsia(SA)willbearthebruntofthehealthim-pactsofclimatechange.TheseimpactswillbeparticularlysevereinSSA,whichisprojectedtoexperienceapproximately71percentofallcasesandnearlyone-halfofalldeathscausedbyclimatechangebetween2026and2050underbothsocioeconomicdevelopmentscena-rios.SAisprojectedtoexperienceapproximately18percentofallcasesandone-quarterofalldeathsunderbothscenarios.Inthesetworegionscombined,thenumberofdeathscausedbyclimatechangeisprojectedtoreachbetween10.5million(SSP2)and11.7million(SSP3)by2050.TheeconomiccostwillbesignificantlyhigherforSSAthanforanyotherre-gion—by2050,thiscostwillamounttobetween2.7percentand3.6percentoftheregion’sGDPunderbothscenarios.
4.Thehealthimpactsofclimatechangepresentedinthisreportaresignificantbutli-kelytobejustthetipoftheiceberg.Theanalysispresentedinthisreportincludesthepo-tentialimpactsofclimatechangeonalimitednumberofhealthrisks.Thepotentialimpactsofclimatechangeonotherhealthrisks,suchasnon-communicablediseasesandmentalhealth,arenotincludedinthisreport.Moreover,theanalysisofthesehealthriskshasnotconside-redthechangeintheirgeographicaltrajectorybecausefactors,suchasmigrationandwaterstress,canonlybecapturedthroughadynamicmodel.Asaresult,theresultspresentedhere
xi
shouldbeunderstoodasanotableunderestimateofthescaleoftherealimpactsofclimatechangeonhealthinLMICs.
ThefindingsofthisreportconfirmtheAR6’sprojectionofasignificantincreaseincasesanddeathsduetoclimatechangeandtheunevengeographicaldistributionofthisfutureburden,withSSAand,toalesserextent,SAbearingthebruntoftheprojectedincrease.Furthermore,byestimatingtheassociatedeconomiccostsofthesehealthimpacts,thisreportarguesforintensifyingandacceleratingeffortstoreducegreenhousegasemissionsaswellasforLMICstoprioritizeinvest-mentsinhealthsystems.Theseinvestmentsareneededtobuildresilientandsustainablehealthsystemsthatcanweathertheadverseimpactsofclimatechangeonhealth.Itmustbeclearlysta-tedthatthisreportdoesnotadvocateforaverticalapproachtothehealthrisksincludedintheanalysis.Ahealthsystemsapproachisneededtotackletheprojectedimpactsofclimatechangeonhealtheffectivelyandefficiently.
THECOSTOFINACTION
QuantifyingtheimpactofClimateChangeonHealthinLow-andMiddle-incomeCountries
1.Introduction
1.Introduction
2
Climatechangehasbeenimpactinghumanhealthatanacceleratedpaceoverthepastdecade.Thisincludesincreasesinheat-relatedillnesses,waterborneandvector-bornediseases(includingoutbreaks),andmalnutritionfromreducedcropproductivity,amongnumerousothers.Theseeffectsareexpectedtoworsenovertime,withchangesnotonlyinthenumberofdiseasesanddeathsfromclimate-sensitivehealthrisksbutalsointheirgeographicalrange(Georgeetal.2024).Inadditiontoimpactinghealthoutcomes,climatechangeisprojectedtoadverselyimpacthealthsystems.Asaresultofpoverty,incomeinequality,andweakhealthcaresystems,low-andmidd-le-incomecountries(LMICs)areexpectedtofacedisproportionateincreasesinmorbidity,aswellasincreasinglossesanddamagestohealthfacilities.Urgentcallsforactionhavebeenexpressedbytheglobalcommunity(Fielding2023;IntergovernmentalPanelonClimateChange[IPCC]2023;Romanelloetal.2023;UnitedNationsEnvironmentProgramme[UNEP]2023).Over200healthjournalshaverecentlycalledontheUnitedNations(UN),politicalleaders,andhealthprofessionalstotreattheongoingclimateandnaturecrisesasoneglobalhealthemergency(Abbasietal.2023).
Despitethescaleofthiscrisis,evidencequantifyingtheimpactofclimatechangeonhealthre-mainslimited.Theunderlyingphysiologicalfactorslinkingclimatechangeandtheincidenceofvector-borneandwaterbornediseaseshavebeendiscussedbynumerousexperts(Georgeetal.2024;Semenzaetal.2023;Thomsonetal.2022;Wong2023).However,theextentoftheriskofclimatechangeonhealthremainspoorlyquantified(Moraetal.2022).Onlyalimitednumberofpapershaveaimedtotransformthisknowledgeintoquantifiedassessmentsofthepotentialimpactsofclimatechangeonspecifichealthrisks.1Giventhescarcityofpublicresources,futurepolicyresponsesontheirallocationsrequiregoingbeyondunderstandingtheunderlyingnatureofclimatechangeandhealthlinkstoquantifytheextentofthelinkagesintermsoffutureinci-dences,mortality,andeconomiccosts(Ebi2022,2024).Thislackofcomprehensivequantificationmaypartiallyexplainwhyhealth-specificclimateactionsrepresentonly6percentoftotaladapta-tionfunding(WorldHealthOrganization[WHO]2023).IthasbeenestimatedthatLMICsrequireatleastUSD11billioninfundingperyearthisdecadetoadapttoclimateandhealthimpactsandincreasetheresilienceoftheirhealthsystems(UNEP2023).
Toaddresstheevidencegap,thisreportprovidesestimatesoftheeconomiccostofinactiononselectedhealthriskslinkedtoclimatechange.Itprovidesaquantitativeassessmentofthe
1Alimitednumberofstudieshaveestablishedandestimatedempiricallinksbetweenclimateconditions,variability,andthe
incidenceofdiseasesinspecificnational(orsubnational)contexts.ExamplesincludeBrazil(Barcellosetal.2014);China(Xiangetal.2018;Zhengetal.2017);Colombia(Quinterro-Herreraetal.2015);Iran(Salahi-Moghaddametal.2017);Philippines(Su2008);SierraLeone(Georgeetal.2023);Singapore(Struchineretal.2015);Tanzania(Kulkarnietal.2016);Uganda(Boyceetal.2016);Vietnam(Xuanetal.2014);andZambia(Bennettetal.2016).
1.Introduction
3
potentialimpactsofclimatechangeon(1)thenumberofcasesanddeathsresultingfromselectedhealthrisks:extremeheat,waterbornediseases(diarrhea),stunting,andvector-bornediseases(dengueandmalaria);(2)thenumberofyearsoflifelost(YLL)fromdeathsarisingfromthesehealthrisksattributabletoclimatechange;and(3)theeconomiccostoftheincrementalnumberofcasesanddeathsattributabletoclimatechange.Theseimpactsareestimatedfor69LMICswhosepopulationexceeds10millionpeopleinthebaseyear2020.Estimatesoftheimpactsaregeneratedfortheshortterm(2026–2030),mediumterm(2026–2050),andlongterm(2026–2100)basedontwo(ofthefive)climatescenariosformingthebasisoftheSixthAssessmentReport(AR6)oftheIntergovernmentalPanelonClimateChange(IPCC)—SSP2andSSP3.
Thisreportbuildsonpreviousworkandleveragesnewanalysistofurtherdeepentheunders-tandingofthehealthimpactsofclimatechange.ItexpandsonanassessmentconductedbytheWorldHealthOrganization(WHO2014)ontheimpactsofclimatechangeonmorbidityandmor-talityresultingfromdengue,diarrhea,extremeheat,malaria,andstuntingfortheyears2030and2050.2ThisreportadoptsthesamemethodologicalapproachasastartingpointbutextendstheanalysisinnumerousdirectionsasexplainedinSection2below.
2WHO(2014)alsoincludedananalysisoftheimpactsofclimatechangeondeathsresultingfromfloods.Floodsarenotincludedinthecurrentanalysis:thenatureofthemodelingrequireddifferssignificantlyfromthemodelingoftheimpactsofclimate
changeondiseases.
THECOSTOFINACTION
QuantifyingtheimpactofClimateChangeonHealthinLow-andMiddle-incomeCountries
2.Methods
5
2.Methods
2.1SelectionofCountries
TheanalysispresentedinthisreportfocusesontheLMICsofthesixregionsbasedontheWorldBankGroup’sclassification.3Atotalof69countrieswithanationalpopulationexceeding10millioninthebaselineyear2020areincluded.ThelistofcountriesincludedintheanalysisisprovidedinAnnex1.These69countriesrepresent96.2percentofthetotalp
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