Mapping Global Climate and Health Governance: Exploring India’s Role

Executive Summary

Climate change has both direct and indirect effects on human health, disproportionately affecting vulnerable populations. Climate induced disruptions in healthcare due to extreme weather events, vector-borne diseases and food and water insecurity underscore the urgency of integrating health into climate policies. The World Health Organization (WHO) estimates that climate change will contribute to an additional 250,000 deaths annually between 2030 and 2050 due to malnutrition, disease, and heat-related illnesses globally. As climate change accelerates, these health risks are becoming a critical global concern, necessitating the integration of health within climate policy frameworks.

India becomes a vital country to analyse in the context of global climate and health governance. Its large population and geographic vulnerabilities, means that the country will face a large burden of mortality, disease, and economic losses from climate change. Hence, this discussion paper examines the increasing prominence of health in global climate discourse and goes on to analyse India’s role in this context.

Growing Prominence of Health in the Climate Agenda

This paper systematically documents the evolution of health from being relatively marginal in the climate agenda to becoming an integral part of negotiations in forums such as the United Nations Framework Convention on Climate Change (UNFCCC), Conference of Parties (COPs), as well as other multilateral forums, including the G20 and G7. It begins with the 2015 Paris Agreement, which laid the groundwork for recognising health as an integral aspect of climate action. If continues with subsequent COPs that introduced health-specific climate commitments and mechanisms to support countries in achieving Climate Resilient Health Systems (CRHS) and Sustainable Low-Carbon Health Systems (SLCHS). Simultaneously, this paper notes that international development actors have recognised the shortfall in available climate financing for health related adaptation and have begun work to remedy the situation. The “Guiding Principles for Financing Climate and Health Solutions,” created by a consortium of multilateral development banks (MDBs), funders, countries, and philanthropies, provides a roadmap for synergistic and focused attention towards supporting equitable, inclusive, and holistic climate and health solutions.

Mitigating Systemic Challenges by Integrating Climate and Health

The current climate governance system is mired in several weaknesses that have impeded accelerated progress on climate change.

• Political will for climate action is diminishing worldwide with the rise of nationalist leaders, influenced by entrenched interests and poor public engagement with climate issues. The recent decision by the Trump administration to withdraw from the Paris Agreement exemplifies this trend. Persistent shortfalls in fulfilling climate financing commitments from the Global North further raise concerns about the credibility of these commitments and the feasibility of equitable climate solutions.
• There is growing recognition that a polycentric, multi-stakeholder approach which looks beyond the UNFCCC process is required for climate action. However, current global climate governance system has not been very successful in integrating non-state and subnational voices into decision-making processes, despite their critical role in translating international and national commitments into practical action
  on the ground.
• Shaped by an agenda spearheaded by the Global North, there has been an emphasis on mitigation actions focused on emissions reductions, despite nations in the Global South advocating for a greater focus on adaptation. The global community has acknowledged the need to look at climate change through the lens of development. However, in practice, creating the linkages between developmental goals and climate action have remained weak.

The paper posits that adopting a health perspective through proactive engagement by emerging powers of the Global South, such as India, may offer potential alternative strategies to advance climate action in the face of existing challenges. Historically, India has been effective in amplifying the voice of the Global South in international negotiations by building coalitions, as seen with the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement and, more recently, with the Pandemic Fund. Raising developmental concerns related to climate change, particularly regarding health, across multilateral and regional forums has also proved to be an influential strategy for groupings like the Small Island Developing States (SIDS) and Least Developed Countries (LDCs) to gain resources and influence discourse.

• Using a health framing in the climate change debate has been a useful policy strategy to overcome interest groups, such as those in the fossil fuel industry, by fostering public engagement. Highlighting the health impacts of climate change in global, regional, and sub-regional forums can help maintain momentum despite diminishing political will for climate action in traditional climate forums like the COP.
• Global health presents a powerful model for translating global consensus into accelerated action at local levels through cross-country exchanges of knowledge and resources. Mechanisms like the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Alliance for Vaccines and Immunisation (GAVI), and, more recently, the COVID-19 Vaccines Global Access (COVAX) initiative potentially offer useful lessons for undertaking climate action.
• Demonstrated interest in supporting action on sustainability and health across stakeholders, including the private sector, as well as greater alignment with the sustainable development agenda, can help synergise finance and reduce reliance on public finance transfers from the Global North.
• Global networks of sub-national actors working on developmental issues such as health can make progress even when vertical processes of climate policy and planning prove ineffective. Strategic integration and intersectoral coordination with public health professionals, civil society, and private sector actors across diplomatic and policy channels can help push for greater accountability and alignment with the sustainable development agenda.

India’s Approach to International Climate-Health Engagement

Recognising the growing convergence of climate and health interests globally, we examine India’s approach to international engagement. We find that the country has been cautious and tentative – acknowledging the significance of the climate and health agenda while being reluctant to sign on to global frameworks, such as the WHO Alliance for Transformative Action on Climate Change and Health (ATACH). India has started to make nascent efforts through its interventions and diplomacy, including engaging with multilateral development banks (MDBs), developmental organisations, bilaterally and trilaterally. Key Indian initiatives include the Lifestyle for Environment (LiFE) movement that reframes climate policy as a broader sustainability issue, as well as leadership in multilateral institutions such as the International Solar Alliance (ISA) and the Coalition for Disaster Resilient Infrastructure (CDRI). However, these actions are so far limited and the paper makes a case for India to engage more proactively. The paper identifies the benefits available to India through such a strategic approach.

1. Meeting Gaps in Financing: Currently, government expenditure on health is only 1.4% of Gross Domestic Product (GDP), significantly lower than comparable economies, reflecting substantial underfunding and neglect. The pathway towards climate resilience will inevitably require greater resources for overall health system strengthening. The increasing availability of international climate-health financing initiatives can provide access to additional investments for India to support its climate-health programmes as well as broader health system strengthening efforts.
2. Strengthening Domestic Institutional Capacity and Preparedness: Beyond financing, India faces structural challenges in implementing an integrated climate-health strategy. Its current climate and health policies remain fragmented, with poor accountability and institutional inefficiencies. International experience, such as the Dutch Global Health Strategy (2023–2030) and Australia’s Climate and Health Alliance, provides valuable insights that India can adapt to its unique context.
3. Knowledge Exchange Platforms of Best Practices: Platforms like ATACH, and the Global Heat Health Information Network (GHHIN), provide opportunities for a diverse range of actions including sub-national governments and non-state actors to leverage global collaboration on climate-health best practices. For instance, the forthcoming Climate and Health Hub, supported by the ADB, is an avenue for regional knowledge exchange on innovative climate change mitigation and adaptation best practices in health, from government, civil society, and the private sector.
4. Positioning India as a Climate-Health Innovation Hub: India’s geographic and population diversity, technological expertise, low-cost healthcare solutions, and strategic partnerships position it as a leader in climate-health adaptation, benefiting both domestic and Global South nations. Through its international engagements, India can move closer towards becoming a credible development partner and replicate successful domestic health and climate initiatives in other developing countries.
5. Championing Inclusive Global Governance: Health has historically been an important avenue for India to advocate for the collective needs of the Global South at international forums. India can continue to strengthen its South-South cooperation by using its health diplomacy to build coalitions and bridge the gap between Global North funding and the needs of vulnerable nations.

Conclusion and Future Directions

The integration of health into global climate governance presents an opportunity for India to simultaneously strengthen its healthcare resilience and enhance its geopolitical standing. However, achieving these goals requires:

• A clearly defined national strategy integrating climate and health policies.
• Enhanced institutional coordination to prevent fragmented implementation.
• Expanded global engagement to leverage international funding opportunities.
• Scaling up research and knowledge-sharing to develop scalable, transferable solutions.
• Fostering South-South cooperation in climate-health policy and technology transfer.

This discussion paper calls for further research into India’s policy effectiveness, financing strategies, and governance mechanisms, ensuring that its climate-health initiatives are both impactful and sustainable. India must act strategically and proactively to maximise the benefits of climate-health convergence while advancing its domestic and global interests.