After the World Health Assembly’s adoption of ambitious global plan of action for climate and health, global and country stakeholders are meeting in Brasilia for the Global Conference on Climate and Health, ahead of COP30. Three critical observations emerged that illuminate why conventional global health approaches may be structurally inadequate for the challenges resulting from climate change impacts on health.
These observations carry particular significance for global health leaders who now possess a WHA-approved strategy and action plan, but lack proven mechanisms for rapid, community-led implementation in the face of an unprecedented set of challenges. They also matter for major funders whose substantial investments in policy and research have yet to be matched by commensurate support for the communities and health workers who will be the ones to translate better science and policy into action.
Signal 1: When funding disappears and demand explodes
Seventy percent of global health funding vanished, virtually overnight. This collapse comes precisely when the World Health Organization projects a shortage of 10 million health workers by 2030—six million in climate-vulnerable sub-Saharan Africa.
The World Bank calculates that climate change will generate 4.1-5.2 billion disease cases and cost $8.6-20.8 trillion by 2050 in low- and middle-income countries alone. Health systems must simultaneously manage unprecedented demand with drastically reduced resources.
Traditional technical assistance—flying experts to conduct workshops, cascade training through hierarchies—is more difficult to resource. By comparison, peer learning networks can reduce costs by 86 percent while achieving implementation rates seven times higher than conventional methods. Furthermore, 82 percent of participants in such networks continue independently after formal interventions end. Peer learning is especially well-suited to include health workers in conflict zones, refugee settings, and remote areas where climate vulnerability peaks—precisely the locations where traditional expert-led capacity building proves most difficult and expensive.
The funding crisis makes it more of an imperative than ever before to examine which approaches can scale effectively when resources contract. Organizations that recognize this shift early could achieve breakthrough results as traditional approaches become unaffordable.
Signal 2: Global expertise meets local reality
The World Health Assembly continues producing comprehensive action plans backed by thousands of expert hours. The climate and health action plan represents the pinnacle of this approach—technically excellent, evidence-based, globally applicable.
Yet the persistent implementation gap reflects deeper challenges about how knowledge flows between institutions and communities. Current theories of change assume that technical expertise, properly communicated, will lead to improved outcomes. Local knowledge gets framed as “barriers to implementation”, rather than recognized as essential intelligence for adaptation.
This creates a paradox. The WHO recognizes that “community-led initiatives that harness local knowledge and practices” are “fundamental for creating interventions that are both culturally appropriate and effective.” Health workers possess sophisticated understanding of how global frameworks must adapt to local realities. But systematic mechanisms for capturing and integrating knowledge and action remain underdeveloped.
Climate change manifests differently in each community—shifting disease patterns in Kenya differ from changing agricultural cycles in Bangladesh, which differ from altered water availability in Morocco. Health workers witness these changes daily, developing contextual responses that often remain invisible to global institutions. The question becomes whether global frameworks can evolve to recognize and systematically integrate this distributed intelligence rather than treating it as anecdotal evidence.
Signal 3: The policy-people gap widens if field-building ignores communities and is disconnected from local action
Substantial philanthropic funding is flowing toward climate and health policy and evidence generation. Some funders call this “field-building”. Research institutions develop sophisticated models. Policy frameworks become more comprehensive. Scientific understanding advances rapidly. These investments are producing genuinely better science and more effective policies—essential progress that must continue.
Yet investment in communities and health workers—the people who must implement policies and apply evidence—remains disproportionately small. This disparity creates concerning dynamics where knowledge advances faster than the capacity to apply it meaningfully in communities.
The risk extends beyond implementation gaps. When sophisticated policies and evidence develop without commensurate investment in community relationships, communities may reject even superior science and policies—not because they are irrational or too ignorant to recognize the benefits, but because the effort to accompany communities through change has been insufficient. Health workers, as trusted advisors within their communities, are uniquely positioned to bridge this gap by helping communities make sense of new evidence and adapt policies to local realities.
Health workers serve as trusted advisors within communities facing climate impacts. When investment patterns overlook this relationship, sophisticated policies risk becoming irrelevant to the people they aim to help. The trust networks essential for translating evidence into community action – and ensuring that evidence is relevant and useful – receive less attention than the evidence itself.
The pathway forward: Health workers as knowledge creators and leaders of change
These three signals point toward a fundamental misalignment between how global institutions approach climate and health challenges and how communities experience them. The funding crisis makes traditional expert-led approaches unsustainable. Implementation gaps persist because local knowledge remains systematically undervalued. Investment patterns favor sophisticated frameworks over the human relationships needed to apply them effectively.
When a community health worker in Nigeria notices malaria cases appearing earlier each season, or a nurse in Bangladesh observes heat-related illness patterns in specific neighborhoods, they are detecting signals that epidemiological studies might take years to document formally. This represents a form of “early warning system” that current approaches tend to overlook.
Recent innovations demonstrate different possibilities. Networks connecting health practitioners across countries through digital platforms treat health workers as knowledge creators rather than knowledge recipients. Such approaches have achieved, in other fields, implementation rates seven times higher than conventional technical assistance while reducing costs by 86 percent. There is no reason why applying these approaches would not result in similar results.
For the World Health Organization, such approaches could offer pathways to operationalize the Global Plan of Action through the very health workers the organization recognizes as “uniquely positioned” to champion climate action while building essential community trust.
For major funders, these models represent opportunities to complement policy and research investments with approaches that strengthen community capacity to apply sophisticated knowledge to local realities.
The evidence suggests that failure to bridge these gaps could prove more costly than the investment required to close them. But the returns—measured in communities reached, knowledge applied, and trust maintained—justify treating health worker networks as essential infrastructure for climate and health response rather than optional additions.
Three questions for leaders
As leaders prepare for the Global Climate Change and Health conference in Brasilia and begin work to implement climate and health commitments, three questions emerge from the World Health Assembly observations:
- For institutions with comprehensive plans: How will technical excellence translate into community-level implementation when traditional capacity building approaches have become economically unsustainable?
- For funders investing in research and policy: How can sophisticated evidence and frameworks reach the health workers and communities who must apply them to local realities?
- For all climate and health leaders: What happens when policies advance faster than the trust relationships and implementation capacity needed to apply them effectively?
The signals from the World Health Assembly suggest that conventional approaches face structural constraints that incremental improvements cannot address. The funding crisis, implementation gaps, and investment disparities require responses that recognize health workers as partners in creating climate and health solutions rather than merely implementing plans created elsewhere.
The choice is not whether to transform approaches—resource constraints and community realities make transformation inevitable. The choice is whether leaders will direct that transformation toward approaches that strengthen both global knowledge and local capacity, or risk watching sophisticated frameworks fail for lack of community connection and trust.
References
Miller, J., Howard, C., Alqodmani, L., 2024. Advocating for a Healthy Response to Climate Change — COP28 and the Health Community. N Engl J Med 390, 1354–1356. https://doi.org/10.1056/NEJMp2314835
Sanchez, J.J., Gitau, E., Sadki, R., Mbuh, C., Silver, K., Berry, P., Bhutta, Z., Bogard, K., Collman, G., Dey, S., Dinku, T., Dwipayanti, N.M.U., Ebi, K., Felts La Roca Soares, M., Gudoshava, M., Hashizume, M., Lichtveld, M., Lowe, R., Mateen, B., Muchangi, M., Ndiaye, O., Omay, P., Pinheiro Dos Santos, W., Ruiz-Carrascal, D., Shumake-Guillemot, J., Stewart-Ibarra, A., Tiwari, S., 2025. The climate crisis and human health: identifying grand challenges through participatory research. The Lancet Global Health. https://doi.org/10.1016/S2214-109X(25)00003-8
Sadki, R., 2024. Health at COP29: Workforce crisis meets climate crisis. https://doi.org/10.59350/sdmgt-ptt98
Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
Sadki, R., 2024. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
Image: The Geneva Learning Foundation Collection © 2025
