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