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A 2025 Lancet Countdown policy paper on health and climate change in Africa shows that in 2023, at least 15,000 people died from extreme weather, waterborne diseases increased by 50%, air pollution killed millions and 7 million children under five were malnourished. Despite the evidence, climate is rarely treated as a core health priority.
In an interview, Prof Tafadzwanashe Mabhaudhi, Director of the Lancet Countdown Africa Centre, reflects on why political recognition has lagged behind science. “Climate change is a health emergency. The fact that those in positions of power have not formally declared it as such does not change that reality,” Prof Mabhaudhi says.
He argues that without placing health at the centre of climate responses, preventable health losses will continue to rise across the continent.
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Prof. Tafadzwanashe Mabhaudhi is the Director of the Lancet Countdown Africa Centre. The Africa Centre is part of the global Lancet Countdown initiative and its purpose is to bring a regional focus, enrich contextual understanding, increase the participation of regional scientists and amplify regional voices on global platforms, especially in relation to tracking the impacts of climate change on health.
A recent health policy paper published by the Lancet Group makes a clear case that climate change is a health problem and that health must sit at the centre of climate action. Yet in many countries, climate change remains poorly integrated into health planning. Why is this still the case?
I would say that climate change is present in health planning, but it is not very visible. Health planning still tends to focus on long-standing priorities such as primary care, infrastructure and service delivery.
More broadly, health itself is not very visible within many African economies. Economic priorities often centre on sectors such as agriculture, manufacturing and other areas that are perceived to drive job creation, economic growth and poverty reduction. As a result, health is generally underfunded at the regional level.
Within an already underfunded health system, climate change and its health impacts are not always well understood or clearly articulated. The impacts are not seen as immediate or tangible. That combination of underfunding and limited understanding means that climate-related health risks are not given sufficient priority.
Would it help if climate change is officially declared a health emergency? And why has this not happened?
Climate change is a health emergency. The fact that those in positions of power have not formally declared it as such does not change that reality.
However, declaring something an emergency has legal, budgeting and resource allocation implications. Even at national level, when disasters strike, governments always become hesitant to immediately label them as national disasters because that terminology triggers specific processes and obligations under disaster management frameworks.
There is therefore a political dimension to this issue that needs to be understood. At the same time, from a scientific perspective, the evidence is very clear that climate change constitutes a health emergency.
The 2025 Lancet Countdown report highlights devastating health costs associated with climate inaction. We are seeing unprecedented health harms, increasing risks and impacts, rising mortality and the loss of lives and livelihoods linked to climate change. All of this points clearly to an emergency.
The challenge is that policy and government action often lag behind the evidence. Part of our role as the Lancet Countdown is to bring this evidence to policymakers and support the case for formally recognising climate change as a health emergency.
The report also raises concerns about financing. It is clear that less than 3% of climate adaptation funds flow into health. What does this mean in practical terms, in relation to the disease burden in Africa?
When we talk about the health impacts of climate change, we need to think very broadly. Health encompasses a wide range of issues.
There are direct physical health impacts, such as heat exposure and heat-related illness, as well as air pollution. There are also infectious diseases, including both vector-borne diseases and water-borne diseases such as cholera.
In addition, there are mental health impacts, which are often overlooked. We are seeing increasing levels of anxiety, depression and what is sometimes referred to as eco-anxiety. These are real and growing concerns.
Climate change affects both infectious and non-communicable diseases. Addressing only one category, such as infectious diseases, risks overlooking important pathways, including nutrition and food security, which influence non-communicable diseases, as well as mental health.
What is needed is a holistic approach to climate and health. This is why, through the Lancet Countdown, we track a broad range of indicators that capture physical health, mental health, and the economic and financial dimensions of climate impacts, including the costs of inaction.
Africa is dealing with overlapping climate emergencies like the current floods in Southern Africa. How do these climate emergencies affect the delivery of routine health services?
Adaptation, more broadly, is significantly underfunded. Less than 10% of climate finance is allocated to adaptation, and of that, less than 3% is linked to health.
Even within that small proportion, the figures are not always clear. The less than 3% often includes funding for areas such as agriculture and nutrition, which are assumed to have health benefits. The proportion that actually goes directly into strengthening health systems is extremely small.
This reflects the fact that health is not at the centre of the climate response. Funding allocations follow perceived priorities, which in many African contexts remain focused on socio-economic development sectors.
The core issue is the need to place health at the centre of climate change responses. Evidence from initiatives such as the Lancet Countdown is essential in demonstrating that climate change is fundamentally a health issue, and that human health is one of the most affected areas.
Evidence is important and while there is growing global evidence linking climate change and health, research capacity and output in Africa remain limited. How does this affect the climate and health response on the continent?
Underinvestment in research in Africa leads to gaps in data, or the absence of reliable and robust data. Without this, it is difficult to develop indicators that track climate-related health impacts accurately.
We need to strengthen the evidence base in Africa by improving access to data and promoting data sharing, particularly where governments already collect relevant information. Standardising data collection methods and facilitating data exchange are also essential.
At the same time, we need to build the capacity of researchers across the continent to conduct climate and health research. Connecting researchers across countries and regions helps to create communities of practice, enabling knowledge sharing and strengthening collective capacity.
Based on the available evidence, what changes in disease patterns should we expect in the near future if climate and health responses are not strengthened?
The Lancet Countdown reports track ongoing changes accurately. The data show increasing mortality linked to climate change, particularly from heat exposure. Deaths associated with fossil fuel emissions and air pollution are also rising.
We are seeing changes in the geographical distribution of vector-borne diseases such as malaria and dengue, with these diseases expanding into areas where they were not previously present. This is a serious concern.
The Africa CDC has confirmed that outbreaks of water-borne diseases, including cholera, have increased by nearly 50%. At the same time, health systems are becoming increasingly strained. Primary healthcare networks are weakening, reducing the capacity of health systems to respond effectively.
Recent developments, such as the withdrawal of USAID support in several African countries, have further affected primary care, vaccine access and disease control efforts, including for malaria and cholera. All of this compounds existing vulnerabilities and reflects changes that are already happening.
What key developments should we be watching in the climate and health space in Africa?
The newly established Lancet Countdown Africa Centre will play a central role in leading an African-driven approach to tracking the health impacts of climate change. This includes building partnerships, strengthening research capacity, improving the evidence base and contributing to a coordinated, health-centred climate response.
Beyond the Countdown, there are several promising initiatives being led by institutions across Africa, to address gaps in data, capacity and the translation of evidence into policy. The coming years will be important for consolidating this work and strengthening collaboration across the climate and health community in Africa.