Tag: Lancet Countdown

Development is adaptation: Bill Gates’s shift is actually about linking climate change and health
Bill Gates’ latest public memo marks a significant shift in how the world’s most influential philanthropist frames the challenge of climate change. He sees a future in which responding to climate threats and promoting well-being become two sides of the same mission, declaring, “development is adaptation.”

Gates argues that the principal metric for climate action should not be global temperature or near-term emission reductions alone, but measured improvement in the lives of the world’s most vulnerable populations.

He argues that the focus of climate action should be on the “greatest possible impact for the most vulnerable people.”

The suffering of poor communities must take priority, since, in his view, “climate change, disease, and poverty are all major problems. We should deal with them in proportion to the suffering they cause.”

Climate change is about the health of the most vulnerable

This position resonates with a core message that has emerged across global health over the past several years: climate change is about health.

New data from the 2025 Lancet Countdown draw a stark picture:
- Heat-related mortality has risen 63 percent since the 1990s.
- Deaths from wildfire smoke and air pollution caused by fossil fuels continue to climb.
- Food insecurity, driven by erratic weather, is destabilizing health and economies at once.
- Thirteen out of twenty key health indicators linked to climate impacts now signal urgent action is needed.
Health professionals, policy coalitions, scientists, and patient advocates have succeeded in bringing this nexus between climate and health squarely to the global agenda, culminating in recent summits where health finally shared the main stage with energy and economics.

Yet just as the science and advocacy align, political attention risks fragmenting.

Despite sweeping reports, evidence, and high-level declarations, momentum can ebb.

There is now a risk that the transformative potential embedded in the climate-health linkage may not be fully realized.

Here, Gates’s pivot could actually be the inflection point that the field needs.

The case for health workforce-centered adaptation

For nearly a decade, The Geneva Learning Foundation (TGLF) has been advocating and demonstrating that meeting complex humanitarian, health, and development challenges requires strengthening not just technical capacities or disease programs, but the underlying connective tissue of the health system: its workforce.

TGLF’s digital peer-learning platform now connects over 70,000 health workers across more than 130 countries.

These practitioners – mostly in government service, often in low-resource or crisis-affected settings – are the first to observe, and often the first to respond to, the local impacts of climate change on health.

Their reports show that health impacts are immediate and multi-faceted: rising malnutrition from crop failures, increases in waterborne diseases following floods, new burdens from air pollution and heat, and psychological distress from repeated disasters.

What sets this approach apart is its systemic focus.

Climate change is not a threat that can be “verticalized”.

It demands responses that are adaptive, distributed, and coordinated across all levels of the health system.

TGLF’s innovation lies in harnessing a distributed network to surface and scale locally-grounded solutions:
- Peer learning accelerates uptake of proven local adaptations – health workers share and adapt practices in near real time.
- Digital networks enable early warning and rapid, cost-effective dissemination of context-appropriate strategies, even in remote settings.
- The workforce is not merely the channel for external solutions but is positioned as a community of problem-solvers and trusted communicators, leaders in building and sustaining resilience.
Data from these initiatives demonstrate that such networked learning delivers results at scale, often with return on investment superior to parallel vertical programs, and increases system resilience and flexibility.

Development is adaptation: the need for human capital investment

The urgency and logic of these approaches are reinforced by ongoing policy developments ahead of COP30:
- WHO’s Global Action Plan on Climate Change and Health, adopted at the World Health Assembly in May 2025, recognizes that without context-sensitive system strengthening, existing approaches are insufficient, and positions knowledge and workforce mobilization as strategic imperatives.
- The COP30 Belem Health Action Plan establishes adaptation of the health sector to climate change as an international priority, calling for holistic, cross-sectoral strategies, and “community engagement and participation as foundational to implementation.”
Without empowered and connected health workers, no global action plan will reach those most at risk or maintain public trust.

A strategic investment imperative: why the next breakthrough must be human-centered

The philanthropic search for cost-effective, scalable, and measurable impact has built immense legacies in reducing child mortality and combating infectious disease.

Gates’ own approach of pioneering “vertical” innovations, optimizing delivery through metrics, and prioritizing technical solutions has been transformative, especially at the intersection of science and delivery.

However, emerging science show the limits of technical “magic bullets” absent robust, interconnected local systems.

Trust, legitimacy, and action flow from the relationships health workers build in – and with – their communities.

If development is adaptation, what does this mean for the next phase in climate-health philanthropy?

If the measure of climate action’s value is the scale and speed at which lives are improved and disasters averted, investing in the human infrastructure of the health system is the most evidence-based, cost-effective, and legacy-ensuring play available.
1. Investing in the health workforce is itself a breakthrough technology: It increases the absorptive capacity of low-resource health systems, making innovations stick and catalyzing uptake well beyond single-disease silos or narrow infrastructure projects.
2. Long-term, system-wide resilience is built by equipping health workers – not simply with technology or training from above, but with platforms for peer learning, rapid response, and locally-driven adaptation coordinated through agile networks.
3. The network effect is real: A million motivated and networked health practitioners is likely to surface, refine, and implement interventions at a scale and pace that outstrips most top-down models. Digitally-enabled peer learning, tested by TGLF, could link to AI systems to provide distributed AI-human intelligence that supports effective action.
Without these bridges, even the best technology or policies will fail to gain a durable footprint at community level, especially as climate impacts deepen.

Health is where climate change action matters most

The world is waking to the reality that technical solutions alone cannot future-proof health against climate risks.

We need to focus on the highest-value levers.

This starts with a distributed, networked workforce at the coalface of the crisis, empowered to adapt, share, and lead.

In a world of accelerating climate shocks and retreating political will, the boldest, most rational bet for sustained global impact is to go “horizontal” – to invest in the people and the systems that connect them.

By helping build adaptive, digitally connected networks of health professionals, philanthropy can reinforce the foundation upon which all high-impact innovation rests.

This is not a departure from the pursuit of technology-driven change, but rather the necessary evolution to ensure every breakthrough finds its mark – and that trust in science and public health stays strong under pressure.

If ever there was a time for rigorous, data-driven engagement that bridges technology, health, and community resilience, this is it.

Every indicator – scientific, economic, social – suggests that communities will confront more climate disruptions in the coming years.

Investing in the people who translate science into health, who stand with their communities in crisis, is the most robust, scalable, and sustainable bet that any philanthropist or society can make.

By focusing on these vital human connections, the world can ensure that innovation works where it matters most – and that the next chapter of climate action measures true success by the health, security, and opportunity it delivers for all.

History will honor those whose support creates not only tools and policies, but the living networks of trust and craft upon which community resilience depends.

That is the climate breakthrough waiting to happen.

References
1. COP30 Belém Action Plan. (2025). The Belém Health Action Plan for the Adaptation of the Health Sector to Climate Change. https://www.who.int/teams/environment-climate-change-and-health/climate-change-and-health/advocacy-partnerships/talks/health-at-cop30
2. Ebi, K.L., et al. (2025). The attribution of human health outcomes to climate change: transdisciplinary practical guidance. Climatic Change, 178, 143. https://doi.org/10.1007/s10584-025-03976-7
3. Ebi, K.L., Haines, A. (2019). The imperative for climate action to protect health. The New England Journal of Medicine, 380, 263–273. https://doi.org/10.1056/NEJMra1807873
4. Jacobson, J., Brooks, A., Mbuh, C., Sadki, R. (2023). Learning from frontline health workers in the climate change era. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7316466
5. Jones, I., Mbuh, C., Sadki, R., Steed, I. (2024). Climate change and health: Health workers on climate, community, and the urgent need for action (Version 1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.11194918
6. Romanello, M., et al. (2025). The 2025 report of the Lancet Countdown on health and climate change. The Lancet S0140673625019191. https://doi.org/10.1016/S0140-6736(25)01919-1
7. Sadki, R. (2024). Health at COP29: Workforce crisis meets climate crisis. The Geneva Learning Foundation. https://doi.org/10.59350/sdmgt-ptt98
8. Sadki, R. (2024). Strengthening primary health care in a changing climate. The Geneva Learning Foundation. https://doi.org/10.59350/5s2zf-s6879
9. Sadki, R. (2024). The cost of inaction: Quantifying the impact of climate change on health. The Geneva Learning Foundation. https://doi.org/10.59350/gn95w-jpt34
10. Sanchez, J.J., et al. (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
11. Storeng, K. T. (2014). The GAVI Alliance and the Gates approach to health system strengthening. Global Public Health, 9(8), 865–879. https://doi.org/10.1080/17441692.2014.940362
12. World Health Organization. (2025). Draft Global Action Plan on Climate Change and Health. Seventy-eighth World Health Assembly. https://apps.who.int/gb/ebwha/pdf_files/WHA78/A78_4Add2-en.pdf
October 30, 2025
How the Lancet Countdown illuminates a new path to climate-resilient health systems
The 2025 Lancet Countdown report has begun to acknowledge a critical, often-overlooked source of intelligence to build climate-resilient health systems: the health worker. By including testimonials from health workers alongside formal quantitative evidence, the Lancet cracks open a door, hinting at a world beyond globally standardized datasets. This is a necessary first step. However, the report’s framework for action remains a traditional, top-down model. It primarily frames the health workforce as passive recipients of knowledge—a group that must be “educated and trained” because they are “unprepared”, rather than build on existing evidence that points to health workers as leaders for climate-health resilience.

The 2025 report confirms that climate change’s assault on human health has reached alarming new levels.
- Thirteen of 20 indicators tracking health threats are flashing red at record highs.
- Heat-related mortality, now estimated at 546,000 deaths annually in the 2012-21 period, has climbed 63% since the 1990s.
- Deaths linked to wildfire smoke pollution hit a new peak in 2024, while fossil fuel combustion overall remained responsible for 2.52 million deaths in 2022 alone.
- Extreme weather increasingly drives food insecurity.
- This accelerating health crisis unfolds against a backdrop of faltering political will.
- The report documents governmental retreats from climate commitments.
Yet, within this sobering assessment lies a quiet but potentially pivotal shift.

For the first time, the Countdown’s country profiles integrate direct testimonials from frontline health workers, explicitly acknowledging their “lived experiences as valuable evidence”.

It is a crucial opening, recognizing that globally standardized data alone cannot capture the full picture or tell the story.

The Countdown’s inclusion of health worker voices in its country profiles is laudable.

It hints at bridging what philosopher Donald Schön called the divide between the “high, hard ground” of research-based theory and the “swampy lowlands” of messy, real-world practice.

Schön argued that the problems of greatest human concern often lie in that swamp, requiring practitioners to rely on experience and intuition – what he termed “knowing-in-action”.

This promising step creates new possibilities.

When the reference global report on climate change and health sees the frontline, this illuminates the path to recognize those working there as agents and leaders capable of forging solutions.

However, the report’s dominant framework still positions the health workforce primarily on the receiving end of knowledge transfer.

Indicator 2.2.5 meticulously documents gaps in climate and health education, concluding that professionals are left “unprepared”.

The resulting recommendation?

Health systems must “[e]ducat[e] and train[…] the health workforce”.

This framing, while highlighting a genuine need, implicitly casts health workers as passive vessels needing to be filled, rather than as active knowers and problem-solvers.

This perspective misses an important dimension, one vividly apparent from our direct work at The Geneva Learning Foundation with tens of thousands of health practitioners globally.

Frontline health workers are already responding – adapting vaccination schedules during heatwaves, managing cholera outbreaks after floods, counseling communities on new health risks – because they must.

Their daily observations is distinct from “lived experience”, because of their formal health education.

The patterns that emerge could form a vital, real-time early warning system, detecting subtle shifts in disease patterns or community vulnerabilities even before formal surveillance systems register them.

To dismiss this deep experiential knowledge as merely “anecdotal” is to ignore critical intelligence in a rapidly escalating crisis.

Worse, it reflects an “epistemological injustice” where practical wisdom is systematically devalued.

Here lies the crucial disconnect.

The Lancet Countdown rightly presents evidence for “community-led action,” showcasing powerful examples in Panel 6 where farmers or local groups have driven substantial environmental and health gains.

Yet, it fails to connect this potential explicitly to the health workers embedded within those very communities.

What does empowering the health workforce truly mean?

It cannot be limited to providing didactic training, such as webinar lectures about climate science.

Drawing on our research and practice, it involves concrete actions:
1. Recognizing health professionals as knowledge creators: Systematically capturing, validating, and integrating their “knowing-in-action” into the evidence base.
2. Connecting them through peer learning networks: Enabling practitioners facing similar “swampy” problems across diverse contexts to share hyperlocal solutions and build collective intelligence.
3. Supporting locally-led implementation: Equipping them to design and execute adaptation projects tailored to community needs, often leveraging existing local resources, as demonstrated in TGLF initiatives where the vast majority of participants reported sustaining action without external funding.
4. Creating feedback loops to policy: Establishing mechanisms for this ground-level knowledge to flow upwards, informing district, national, and even global strategies.
This approach offers concrete pathways for the academic research community.

These networks function as distributed, real-world laboratories.

They generate rich qualitative and quantitative data on context-specific climate impacts, the practicalities of implementing adaptation strategies, barriers encountered, and observed outcomes.

They offer fertile ground for implementation science, participatory action research, and validating citizen science methodologies at scale.

Rigorous study of these networks themselves – how knowledge flows, how solutions spread, how collective capacity builds – can advance our understanding of learning and adaptation in complex systems.

This vision of an empowered, networked health workforce directly supports emerging global policy.

WHO’s Global Plan of Action on Climate Change and Health, and the Belém Health Action Plan (BHAP) under development for COP30, both stress social participation, capacity building, and the integration of local knowledge.

Peer learning networks provide a practical, field-tested engine to translate these principles into action, connecting the ambitions of Belém with the realities faced by a nurse in Bangladesh, a community health worker in Kenya, or a community health doctor in India.

Furthermore, this approach may represent one of the most effective investments available.

Preliminary analysis by The Geneva Learning Foundation suggests that supporting local action health workers through networked peer learning could yield substantial health gains.

With a critical mass of one million health workers connected to learn from and support each other, the potential is to save seven million lives, at a cost lower than that of immunization.

This is not just about doing good.

It is about smart investment in resilience.

The 2025 Lancet Countdown acknowledges the view from the ground.

The challenge now is to fully integrate that perspective into research and policy, by supporting and amplifying existing, community-led local action.

We must move beyond framing health workers as recipients of knowledge or vulnerable populations needing protection, and recognize their indispensable role as knowledgeable, capable leaders.

Harnessing their “knowing-in-action” through structured, networked peer support is not merely an alternative approach.

It is essential for building the adaptive, equitable, and effective health responses this escalating climate crisis demands.

The wisdom needed to navigate the swamp often resides within it.

References
1. Romanello M, Walawender M, Hsu S-C, et al. The 2025 report of the Lancet Countdown on health and climate change. Lancet 2025; published online Oct 29. https://doi.org/10.1016/S0140-6736(25)01919-1.
2. Sadki, R., 2025a. Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries. https://doi.org/10.59350/redasadki.21339
3. Sadki, R., 2025b. WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action. https://doi.org/10.59350/redasadki.21322
4. Sadki, R., 2024a. Critical evidence gaps in the Lancet Countdown on health and climate change. https://doi.org/10.59350/nv6f2-svp12
5. Sadki, R., 2024b. Health at COP29: Workforce crisis meets climate crisis. https://doi.org/10.59350/sdmgt-ptt98
6. Sadki, R., 2024c. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
7. Sadki, R., 2024d. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
8. Sadki, R., 2024e. Why guidelines fail: on consequences of the false dichotomy between global and local knowledge in health systems. https://stories.learning.foundation/2024/11/26/why-guidelines-fail-on-consequences-of-the-false-dichotomy-between-global-and-local-knowledge-in-health-systems/
9. Sadki, R., 2024f. Anecdote or lived experience: reimagining knowledge for climate-resilient health systems. https://stories.learning.foundation/2024/11/11/anecdote-or-lived-experience-reimagining-knowledge-for-climate-resilient-health-systems/
10. Sadki, R., 2024g. Knowing-in-action: Bridging the theory-practice divide in global health. https://stories.learning.foundation/2024/12/14/knowing-in-action-bridging-the-theory-practice-divide-in-global-health/
11. Sadki, R., 2023a. Investing in the health workforce is vital to tackle climate change: A new report shares insights from over 1,200 on the frontline. https://doi.org/10.59350/3kkfc-9rb27
12. Sadki, R., 2023b. Climate change is a threat to the health of the communities we serve: health workers speak out at COP28. https://stories.learning.foundation/2023/12/11/climate-and-health-health-workers-trust/
13. 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 13, e199–e200. https://doi.org/10.1016/s2214-109x(25)00003-8
14. Schön, D.A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34. https://doi.org/10.1080/00091383.1995.10544673
15. The Geneva Learning Foundation, 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.10204660
Image: The Geneva Learning Foundation Collection © 2025
October 29, 2025
Climate change and health: what the Lancet Countdown says about the value and significance of local knowledge and action
Here is everything that the new Lancet Countdown says about the value and significance of indigenous and other forms of local knowledge, as well as their value for community-led action to respond to the impacts of climate change on health.

Why does this matter? Read our article: How the Lancet Countdown illuminates a new path to climate-resilient health systems

On the value of community-led action and the significance of local knowledge

Defining community-led action by its local context and empowerment

“Community-led actions are those spearheaded by self-organised individuals within a community, working together for a common goal. Rooted in local societal, cultural, and economic contexts, they can promote equity, empower local actors, and strengthen climate resilience.”

Community-led action as a driver of meaningful progress

“Individual, community-led, and civil society actions can drive meaningful progress with substantial health benefits.”

Grassroots activities growing into formal organizations

“These grassroots activities can grow into formal organisations with national or international influence.”

The dependence of community-led initiatives on local actors

“Despite their capacity to enact change, community-led initiatives depend on the willingness and possibilities of local actors.”

The advantages of community-led actions over top-down interventions

“Tailored to local needs, community-led actions are more likely than top-down interventions to maximise health benefits, bypass the limitations of implementing top-down solutions, and can help avoid unintended harms such as gentrification or increased inequalities.”

The co-benefits of community-led action on mental health and awareness

“Community-led actions can also foster agency, increase attachment to the local environment, and promote social interactions, all of which help reduce the mental health impacts of climate change and increase awareness.”

Recommendation for individuals and civil society: Engage in community-led action

“Engaging in community-led action on health and climate change, supporting equitable inclusion of marginalised communities.”

Recommendation for individuals and civil society: Create community platforms for collective resilience

“Creating community platforms on climate change and health, including citizen groups, to safely exchange ideas and concerns, build collective resilience and adaptive capacity, and enable engagement with decision makers.”

Value of local knowledge: We need more examples of community-led action

Example of local community and indigenous peoples’ forest management

“In Nepal, community forests user groups have grown into a state-sponsored and legally mandated initiative, under which local communities, including Indigenous Peoples, manage 37-7% of national forests—augmenting carbon sinks, enhancing food access, and improving livelihoods.”

Example of farmer-led interventions improving health outcomes

“Across the Sahel, farmers have implemented Farmer Managed Natural Regeneration… These farmer-led interventions resulted in increased tree coverage, crop yields, drought resistance, and access to traditional medicines, contributing to improved health outcome and poverty reduction.”

Environmental defenders need protection

The disproportionate killing of indigenous and minoritized environmental defenders

“A Global Witness report found that 196 activists were killed in 2023 (57% in Latin America), with minoritised and Indigenous groups disproportionately affected.”

Protecting environmental defenders to enable community-led interventions

“Protecting environmental defenders in line with international conventions is critical to enabling community-led interventions, and providing a fertile ground for grassroots initiatives to deliver life-saving progress on health and climate change.”

On the need for community-led action amid waning political engagement

The role of health framing in driving community-led action

“This [health framings of climate change] can be a crucial driver for individual-led and community-led action, especially amid waning engagement from political leaders.”

Community and individual action as essential when national engagement wanes

“When national government engagement wanes (indicator 5.4.1), action by subnational governments, corporations, civil society organisations, communities, and individuals can contribute to keeping the planet within inhabitable limits.”

Recommendation for funders on the significance of local knowledge:

Recommendation for funders: Support community initiatives to scale action

“…supporting governmental bodies, civil society organisations, and community initiatives to scale-up health-promoting and inclusive climate change action.”

On the value of indigenous knowledge

Respecting indigenous knowledge in global health action

“To support global health, these actions need to be delivered in ways that are gender-responsive, reduce health inequities, respect and promote the rights and knowledge of Indigenous People, and account for the protection of vulnerable and underserved communities.”

Recommendation for national governments: Integrate community and indigenous perspectives in policy design

“Including community perspectives in the design of climate and health policies, with particular focus on the most vulnerable communities and Indigenous people.”

Recommendation for city governments: Prioritize indigenous knowledge and community-led initiatives

“Reducing inequities and avoiding unintended harms by integrating community perspectives in all climate change actions and supporting community-led initiatives, with particular focus on vulnerable communities and the priorities and knowledge of Indigenous people.”

On the need to refocus the apparatus of science on the most vulnerable people and communities

Scientific evidence generation is concentrated in high-HDI countries, not where impacts are highest

“Scientific evidence generation is still concentrated in higher HDI countries rather than those most exposed to the health impacts of climate change.”

Data gaps obscuring the impacts on indigenous people

“This lack of disaggregated data makes it difficult to capture the disproportionate impacts of climate change on Indigenous people, such as those living in the circumpolar region, which is heating nearly four times faster than the global average.”

Conflict analysis must be shaped by local dynamics

“This relationship [between climate change and conflict] is now widely recognised as a complex, multicausal phenomenon shaped by local social and cultural dynamics, economic fluctuations, and geopolitical forces at both the domestic and international levels.”

On ensuring the relevance of science to support local action

Harnessing local knowledge for regional stakeholders

“…harnessing local knowledge and translating findings to meet the needs of local stakeholders.”

Advancing the local generation of evidence

“…to advance the local generation of evidence to inform action in one of the world’s most vulnerable regions.”

Informing action at the local level

“…make their findings available to inform action at the national and local levels.”

References
1. Romanello, M., et al., 2025. The 2025 report of the Lancet Countdown on health and climate change. The Lancet S0140673625019191. https://doi.org/10.1016/S0140-6736(25)01919-1
2. Sadki, R., 2024. Critical evidence gaps in the Lancet Countdown on health and climate change. https://doi.org/10.59350/nv6f2-svp12
Image: The Geneva Learning Foundation Collection © 2025
October 29, 2025