COP30's health plan lands in Belém with a number attached: 1 in 12 hospitals at risk

The Belém Health Action Plan, a flagship initiative of Brazil's COP30 presidency, was unveiled on the summit's dedicated Health Day, 13 November [s1]. A day later the World Health Organization, the Government of Brazil and the Brazilian Ministry of Health jointly released a special report intended to tell governments what to do with it [s1].

Health has been a peripheral item at climate negotiations for most of their history. What is different about this one is that the report attaches specific, quantified vulnerability figures to health infrastructure — the buildings and services that are supposed to absorb climate shocks rather than be broken by them.

The numbers in the report

The report states that more than 540,000 people die from extreme heat each year, and that one in twelve hospitals worldwide is at risk of climate-related shutdown [s1]. Health facilities face a 41% higher risk of damage from extreme weather-related impacts than they did in 1990, and without rapid decarbonization the number of facilities at risk could double by mid-century [s1].

It also puts 3.3 to 3.6 billion people in areas highly vulnerable to climate change, with global temperatures now exceeding 1.5°C above pre-industrial levels [s1]. And it turns the lens back on the sector: health care itself contributes around 5% of global greenhouse gas emissions [s1].

The gaps the report identifies are as specific as the risks. Only 54% of national health adaptation plans assess risks to health facilities at all [s1]. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities [s1]. In other words, most countries planning for climate and health are not yet planning for who inside their populations will actually be exposed.

What the plan is structured around

The Belém Health Action Plan rests on two cross-cutting principles — health equity and "climate justice", and leadership and governance on climate and health with social participation — and three lines of action for climate-resilient health systems [s1]. Those are surveillance and monitoring, meaning climate-informed health surveillance; evidence-based policies, strategies and capacity-building at national and local level; and innovation, production and digital health, covering research and access to technologies [s1].

The special report's recommendations to governments are correspondingly concrete: integrate health objectives into Nationally Determined Contributions and National Adaptation Plans; use the financial savings from decarbonization to fund health adaptation and workforce capacity; invest in resilient infrastructure, prioritising health facilities and essential services; and empower communities and local knowledge systems to shape responses [s1].

Professor Nick Watts, who chaired the report's Expert Advisory Group and directs the NUS Centre for Sustainable Medicine, framed the financing ask as a share rather than a sum: allocating just 7% of adaptation finance to health would, in his words, safeguard billions of people and keep essential services running during climate shocks [s1].

What is already working

The report is not purely a warning document. It draws on more than 70 case studies and identifies interventions already producing results — early warning systems, green hospital design, climate-informed health planning, sustainable financing [s1].

One measurable gain: between 2015 and 2023 the number of countries with national Multi-Hazard Early Warning Systems doubled to 101, now covering roughly two-thirds of the global population [s1]. The coverage is uneven where it matters most, though — only 46% of Least Developed Countries and 39% of Small Island Developing States have effective systems in place [s1].

Brazil released a companion report of its own, focused on social participation, governance and community engagement, arguing that adaptation fails without the active involvement of the communities it is meant to protect in designing, implementing and monitoring health policies [s1]. Brazil's health minister, Dr Alexandre Padilha, described COP30 as "the COP of Truth" and said the report gives countries the tools to turn evidence into action [s1].

The complication nobody at Belém can wish away

The plan asks countries to spend more on health infrastructure at a moment when many of them are spending less. Ten days before the Health Day, WHO published separate guidance on what it called a health financing emergency, projecting external health aid to fall by 30% to 40% in 2025 compared with 2023 [s2]. Survey data WHO collected from 108 low- and middle-income countries in March 2025 found funding cuts had reduced critical services — including maternal care, vaccination, emergency preparedness and disease surveillance — by up to 70% in some countries [s2].

A 7% earmark of adaptation finance for health is a plausible ask precisely because it is a share of a different pot of money than national health budgets. Whether it materialises is a negotiation outcome, not a scientific one, and nothing in the special report determines it.

The report's own central claim is narrower and harder to argue with: that the evidence base is now sufficient to act, and that cost-effective, high-impact interventions exist for every component of the plan [s1]. Its accompanying caution is that adaptation strategies will fail anyway unless they address the root causes of health inequity — inside health systems and across the societies they serve [s1].

Sources

• [s1] WHO and Brazil urge swift action on Belém Health Action Plan at COP30, World Health Organization, 14 November 2025. https://www.who.int/news/item/14-11-2025-who-and-brazil-urge-swift-action-on-bel-m-health-action-plan-at-cop30
• [s2] WHO issues guidance to address drastic global health financing cuts, World Health Organization, 3 November 2025. https://www.who.int/news/item/03-11-2025-who-issues-guidance-to-address-drastic-global-health-financing-cuts