The need for informed climate-health governance

Brittany Shea (Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA)
Kim Knowlton (Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA) (The Natural Resources Defense Council, New York, New York, USA)
Jeffrey Shaman (Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA)

International Journal of Health Governance

ISSN: 2059-4631

Publication date: 3 September 2018



The purpose of this paper is to discuss the existing opportunity to educate future health professionals on the health impacts of climate change in order to facilitate more informed planning and health governance.


The authors provide context for climate and health education and how it can lead to better-informed health governance, discuss how health can be used to motivate climate action, and provide examples of climate and health governance. In addition, they outline the climate and health educational components needed in health profession curricula and provide an example of an effort currently being implemented to support and coordinate climate and health education at health professions institutions.


Although action to address the health impacts of climate change is taking place, more climate-health policy and informed governance is needed. In addition, climate and health education must be included in the curricula of all health professions institutions to provide critical know-how on this topic.


The authors seek to advance the discussion around the need for climate and health education in schools and programs of public health, medicine, and nursing to better prepare students for their future roles as health practitioners.



Shea, B., Knowlton, K. and Shaman, J. (2018), "The need for informed climate-health governance", International Journal of Health Governance, Vol. 23 No. 3, pp. 196-204.

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Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited


As human health is increasingly impacted by climate change, and with growing recognition that climate solutions have the potential to provide significant benefits for health, the importance of the field of climate and health is gaining recognition globally. Over the last decade, acknowledgment by health professionals of the impact of climate change on human health has grown; indeed, a recent paper found that over 80 percent of health professionals internationally reported climate change is already relevant to direct patient care (Sarfaty et al., 2016). Yet, few health professionals receive training in climate and health. As a result, many may lack the knowledge and tools necessary to provide optimal health solutions or advocate for appropriate climate-health policy action.

The United Nations (UN) Climate Change Conferences and the 2030 sustainable development goals (SDGs) recognize that adapting to the changing climate will require unprecedented international and cross-sectorial collaboration (United Nations, 2017). As health professionals will be among the key collaborators, there is a critical need to educate and train the next generation of health professionals to respond to these climate change-related health effects, to work on the current and future challenges that climate change poses, and to understand how climate and human health relate to overall planetary health. Increasing understanding among health professionals and scientists of the interactions and feedback at the triple intersection of climate change, human health outcomes, and sustainability is crucial, for as awareness of the effects of climate change on human health increases, a greater understanding of our complicity and role in the maintenance and improvement of health can be attained.

Herein, we build upon a previous paper by Hancock et al. (2016), which discusses the health impacts of global ecological changes and the important role of health systems and health care leaders in addressing these issues. We discuss the need for climate and health education in schools and programs of public health, medicine and nursing, which must be provided to better prepare students for their future roles as health practitioners. In this paper, we provide context for climate and health education and how it can lead to better-informed health governance, discuss how health can be used to motivate climate action, and provide examples of climate and health governance. In addition, we outline the climate and health educational components needed in health profession curricula and provide an example of an effort currently being implemented to support and coordinate climate and health education at health professions institutions.

Climate and health research

As summarized by Hancock et al. (2016), the mining and combustion of fossil fuels, along with other anthropogenic activities, are changing the composition of our atmosphere, which in turn is fueling temperature and rainfall extremes, raising sea levels, producing unhealthy air quality and threatening human health. Climate change acts as a stressor on human health, civilization and the natural systems on which civilization depends.

The interaction between climate and health has been long recognized. For example, appreciation that disease is associated with climate is seen as early as the writings of Thucydides (1972). In the present, there is an increasing recognition of the significant impact that climate change is having and will continue to have on health. Some of the most troubling impacts include air pollution-related increases in the severity of chronic respiratory and cardiovascular diseases, increased incidence of respiratory allergies (WHO, 2017a), and injuries due to severe storms, droughts and fires (Balbus et al., 2016). For natural systems, the changes to weather and climate disrupt ocean productivity, ecosystem stability and soil chemistry, which then generate further downstream interactions that threaten food and water security and foment disease emergence (McMichael, 2013).

Although effective communication of the threats due to climate change remains a challenge, framing climate change as a public health issue is important as it may increase public engagement and help drive policy action (Watts et al., 2017; Petrovic et al., 2014). Health outcomes are a touchstone for communities and motivate public and government action. In addition, many health impacts from climate change could be avoided, with appropriate mitigation and adaptation policies (National Institute of Environmental Health Sciences, 2017). Further, health professionals are viewed as trusted communicators on the health impacts of climate change, specifically nurses and primary care doctors, traditional public health agencies (including the Centers for Disease Control and Prevention), and local public health departments (Alliance of Nurses for Healthy Environments, 2017; Maibach et al., 2015). Given this trust, there is great opportunity and agency within this community to increase awareness about the health impacts of climate change and to promote sensible health practices related to this issue.

Another influencing factor in climate change policy is applied research (Campbell-Lendrum et al., 2015). By focusing on the policy implications of research, including risk assessment, scenario modeling and program evaluation, researchers can make their work more applicable to health policy-makers. Such supporting evidence is vital, and continued climate-health research is needed to improve understanding of specific effects and feedbacks. Research on a number of more complex health topics, such as the effects of climate change on mental health, disease outcomes, and nutrition, is needed, as well as integrated assessment of these issues in the context of other ecological, economic and social stressors. For example, projects such as the construction of a dam or a new water filtration plant, in which an analysis of the combined economic, ecological, health, energy costs and benefits in both the short- and long-term, need to be performed in the context of changing climate conditions. Such integrated assessment across multiple dimensions, including health, is needed to inform sensible health governance and project implementation that considers and maximizes health benefits.

Indeed, widespread concern about the health impacts of climate change provides a compelling point of entry for integrating the study of climate and health into health professions education. In addition, health professionals can play an important role in bringing climate change to the forefront of health governance.

Climate-health governance

Climate information must be included in planning and decision-making at all levels of governance, such as by health agencies during development of action plans. Health is already included in many countries’ climate adaptation strategies, as improved health is a recognized co-benefit of many mitigation and adaptation policies, and numerous climate and health recommendations and tools are available (WHO, 2017b). Until recent efforts by the Lancet Countdown and the World Health Organization (WHO), however, only a few studies have tracked national public health adaptation to climate change. In one such study, Austin et al. (2016) found that nations are making strides in public health adaptation and can serve as examples for countries that do not have plans in place, but tracking must be improved in order to interpret how adaptation is happening in practice globally.

The Lancet Countdown is now tracking efforts to deal with the health impacts of climate change through the development of 40 global climate-health indicators. One of their indicator areas is “Adaptation planning and resilience for health,” which includes National Adaptation Plans (NAPs) and climate information services for health (Watts et al., 2018). Their most recent report reveals that 30 out of 40 countries responding to the WHO Climate and Health Country Survey have a “national health adaptation plan or strategy approved by the relevant national health authority,” many of which received support from the WHO (Watts et al., 2018). Importantly, future surveys will gather information on the quality, implementation, review process and funding support for adaptation plans. This information will allow for evaluation of the efficacy of national health adaptation plans and strategies.

The Lancet Countdown also tracks health benefits associated with climate mitigation efforts in the energy, transportation, food and health care sectors, such as improvements in health and reductions in morbidity and mortality from air pollution by transitioning from fossil fuels to renewable energy (Watts et al., 2018). Such co-benefits are highly touted as win-win scenarios that should be actively pursued as a means to improve human well-being.

Climate mitigation and adaptation strategies and policies that address health are being implemented at a variety of scales. Examples include.

Local level: cities are implementing policies to curb air pollution, reduce energy consumption, and improve water quality, which have benefits for both the environment and human health. For example, the C40 network brings together over 90 cities around the world committed to addressing climate change and working together on projects and initiatives (C40 Cities, 2018). The network also helps to create conversations around climate action among city officials. A number of novel efforts have emerged at this local level. For instance, New York City is implementing a $20bn program, called OneNYC, in order to recover from weather events and reduce the impacts of climate change (City of New York, 2018).

State level: states are taking action on climate and health, such as Minnesota, Maine, Arizona, Michigan, New York and California, which have taken steps to adapt to climate change (American Public Health Association, 2015). Actions include pilot programs, toolkits, increasing surveillance, campaigns and plans for health professionals and the public on how to deal with the health impacts of heat emergencies, flooding and wildfires (American Public Health Association, 2015). California is making great strides to reduce emissions, with a cap-and-trade emissions program in effect through 2030 and incentives to greatly increase the usage of clean vehicles (Bloomberg and Brown, 2017). Recently, the state established a program to measure and reduce air pollution in communities most impacted by these health threats, serving as an example of how to protect communities around the country (State of California, 2017).

National level: in the USA, during its second term, the Obama administration implemented the Climate Action Plan to “cut the carbon pollution that causes climate change and affects public health” (Obama White House, 2013). The Plan focused on three main areas: cutting carbon pollution in America via the Clean Power Plan, preparing the USA for the health impacts of climate change, and leading international efforts to combat global climate change and prepare for its impacts (Obama White House, 2013). Important for this discussion, the plan highlighted the improvements that would be made to public health, and specifically “promoting resilience in the health sector” by ensuring that hospitals are equipped to deal with the impacts of climate change, and that public health professions and community leaders are trained to prepare for the health impacts of climate change (Obama White House, 2013). The Obama administration also had several initiatives and executive actions on climate and health, including a White House Climate Change and Health Summit, workshops, toolkits and the climate and health assessment report (Obama White House, 2015). The current Trump administration proposed “An America First Energy Plan,” which commits to “eliminating harmful and unnecessary policies such as the Climate Action Plan and the Waters of the US rule,” while maintaining that protecting air and water will remain a “high priority” (formerly posted on The White House, 2017website).

In the European Union, almost half of the member states in the WHO European region include health in their adaptation strategies (WHO, 2017b). For example, Germany’s adaptation strategy includes human health focused areas on infectious diseases, non-infectious diseases and health consequences, including extreme weather events and allergies, information and health care, and linking health care with other areas (The German Federal Government, 2008). Adopted in 2011, France’s first NAP included 20 thematic areas one of which was health (National Observatory on the Effects of Climate Change, 2016). In the country’s 2015 assessment report of the NAP, health was one of the sectors that had made important progress (National Observatory on the Effects of Climate Change, 2016).

In China, their 13th Five Year Plan from 2016 to 2020 includes 10 targets related to the environment, out of a total of 25, and addresses the health impacts of climate change and pollution (Koleski, 2017). The plan includes measures to increase energy efficiency and reduce emissions, support for green industries, and improvements to air quality, soil and water.

International level: only a small component of international climate financing supports projects related to health (WHO and United Nations Framework Convention on Climate Change, 2015). Collaborative climate efforts at the international level include the 2030 agenda for sustainable development, UNFCCC Paris Agreement, Kyoto Protocol, and the US-China Agreement of 2014 (Watts et al., 2015). The European Union created the European Climate Change Programme to reduce greenhouse gas emissions in 2000, and a roadmap to a 2050 low-carbon economy (European Commission, 2018). International agencies, including the WHO, also help countries create climate and health plans (Watts et al., 2017 citing WHO, 2014, 2016a).

Although progress has been made, an increased and full integration of climate and health issues into governance and policy decision-making is crucial for a more secure, healthy future. Achievement of this goal could be facilitated through inclusion of climate and health education in all health professions schools and programs around the globe.

Educational need

A major barrier to integrating climate and health policies is limited understanding of and training on climate and health. Policies that benefit the environment and human health must be developed by leaders who intimately understand these subjects. In order to facilitate such informed planning and climate-savvy health governance by officials and policy-makers, all health professionals need to be educated at a baseline level on climate and health topics.

For example, health profession students should be educated on climate science, as well as the varied effects of climate on human health. They should have an understanding of the myriad ways that climate might impact health—including through food security, ocean productivity, vector-borne diseases, infectious disease, forced migration, mental health, respiratory and other chronic disease. Effects may manifest at short, weather-related time scales, at longer seasonal, inter-annual or decadal scales in the context of climate variability, or at decades to century scales in the context of climate change. These effects may operate at small spatial scales—the scale of a dam or municipality—or could manifest across continents, such as in changes in food production of global staples.

Health professions students should also learn about climate and health policy, including mitigation and adaptation efforts and improvements in human health that result from such actions. Such curricula would provide the skills needed to design policy and assess its impact, including economic, energy, ecological, health and climate costs and benefits. Health professions students should also be equipped with the tools to analyze and use data and information to understand and evaluate the science of climate and health. Further, they should know how to apply climate and health knowledge to their future roles in the public health and clinical practice, while understanding ethical, legal and professional obligations. Importantly, students should also be trained to communicate about the health impacts of climate change, such as to policy-makers or in clinical practice (Global Consortium on Climate and Health Education, 2018).

By including climate and health topics in health professional school curricula, the next generation of health leaders will be better prepared to respond to, help prevent and mitigate the health impacts of climate change in the various professions they pursue, ranging from roles in clinical practice to departments of health.

The global consortium on climate and health education

The health-related challenges and opportunities produced by climate change necessitate an integration of these topics into existing health education curricula. To effect this integration a number of actions need to be undertaken, including: specification of an agreed upon set of climate and health educational goals and core competencies; development of climate and health-related curricula and resources; and establishment of a network of institutions interested in the communication and sharing of resources on climate and health.

At present, however, not all of these standards and resources exist, and very few programs on climate and health are present among schools of medicine, nursing and public health. As a consequence, there is pressing need to bring the health education community together to share and design climate-health curricula and resources in support of education and training at the professional and graduate levels.

To meet this objective, the Columbia University Mailman School of Public Health (the Mailman School) has initiated a Global Consortium on Climate and Health Education (GCCHE) that builds upon knowledge and experience of the Columbia Climate and Health Program, launched in 2008 as the nation’s first academic program in climate and health. The goal of the GCCHE is to create a global standard that provides health practitioners with the knowledge base from which to address current and future climate-related public health issues. This includes schools and programs of public health, medicine, nursing and other health professional schools. The GCCHE’s vision is that all health professionals be trained to prevent, mitigate and respond to the health impacts of climate change.

The plan to form the GCCHE developed after a meeting during the 21st Conference of Parties to the UN Framework Convention on Climate Change, or COP 21, in 2015. At COP 21, the Mailman School and the US White House co-sponsored a side event dedicated to addressing the need for greater investment in the study of and planning for the health impacts of climate change. At the event, the White House and partners announced a pledge, which was subsequently carried forward by the Mailman School and signed by 115 health professions schools and programs around the world, to educate tomorrow’s leaders on the health impacts of climate change. The GCCHE will help health professions schools around the world implement this pledge.

This global consortium network of health professions institutions aims to:

  • Obtain commitments from health professions schools throughout the world to educate their students on the health impacts of climate change and bring together member institutions to share best scientific and educational practices for doing so.

  • Develop a core global knowledge set on the health impacts of climate change that all graduates of health professions schools should possess, as well as model curricula that member institutions can utilize for this purpose.

  • Build a pipeline of health professionals who focus their work on the health impacts of climate change.

  • Support the development of global academic partnerships to foster mutual learning, particularly in under-resourced countries.

The Consortium recently established a set of core climate and health competencies for all health professions students, and will continue to deliver and develop educational resources and information that can provide the building blocks for institutions to include and advance climate and health education in their own curricula. The GCCHE seeks to connect health professions institutions around climate and health internationally in order to share resources, collaborate and learn about opportunities. This service will be particularly useful at institutions where resources may be limited.

Implications for research, education and public policy

GCCHE members work together at the intersection of a number of UN SDGs: health (SDG 3), education (SDG 4), and climate change (SDG 13). In addition, the work of the GCCHE is consistent with the action items from the “Conference Conclusions and Action Agenda” of the WHO’s July 2016 Second Global Conference on Health and Climate, which states the need to “develop the capacity of the health workforce to address climate risks” through means including “mainstreaming climate change and health topics into medical and public health training” (WHO, 2016b).

The activities of the GCCHE are intended to provide the critical mass, leadership, content, commitments and work needed to construct this curriculum. Through these efforts, we will show a community of health professionals, at the forefront of climate and health education, science, and policy, who can also act in a powerful advisory and advocacy capacity for the improvement of human health and well-being. All of these avenues will establish an ongoing bi-directional dialogue on the ways that health professionals’ research and training can be applied to effectively influence education, policymaking, health governance and business practice.

The Consortium would also like to increase linkages between health professionals and other sectoral climate-health trainings. The work of the GCCHE can potentially be utilized more broadly, such as for business executives, graduate students and governmental officials, because in addition to educating current and future health leaders, we must ensure that other professional fields are educated on the science of climate and health, and the policy challenges posed at this nexus.


Climate change is one of the principal challenges of our time. The health-related challenges posed by climate change also afford an opportunity to improve human health and well-being (Watts et al., 2015). We must act quickly by recognizing and responding to climate-health opportunities and threats, preventing climate change at its source by reducing greenhouse gas emissions, supporting “greener” systems throughout the economy and health sector, learning about and advocating for the health co-benefits of adaptation and mitigation and communicating effectively to leaders and the public about these issues.

Education plays a crucial role in addressing the health impacts of climate change, and training health professional students on this topic will provide the foundation for better-informed health governance. This paper considers the importance of health and research in driving action on climate change, provides an overview of climate-health governance, discusses the role of climate and health education, outlines the education that is recommended for all health professionals, and describes a current initiative that is underway to meet this need.

Through efforts such as the GCCHE, we can fill the knowledge gap that exists among health professionals on climate and health, thereby ensuring that the next generation of global health leaders is equipped with the knowledge and tools needed to create a more secure, equitable and healthy future.


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