Cost-Effective Health Adaptation: Smart Buys to Protect Populations from Climate Risks

Climate change is placing unprecedented strain on global health systems, and the report identifies eight proven, cost-beneficial “Smart Buys” that countries can adopt to protect populations and strengthen resilience. These actions from heat plans and early warning systems to climate-resilient hospitals and drone-based delivery offer some of the strongest evidence-backed returns for climate-health adaptation today.

Climate change is accelerating a profound transformation in global health, a reality documented through the combined research efforts of the World Bank, KfW, the Inter-American Development Bank, the Agence Française de Développement, Harvard T.H. Chan School of Public Health, the Disease Control Priorities (DCP) project, and the Heidelberg Institute of Global Health. Their findings reveal an urgent picture: rising temperatures, intensifying floods, shifting disease patterns, and mounting psychological stress are straining health systems, especially in low- and middle-income countries. By 2050, these regions could face climate-related health losses of up to US$21 trillion, a staggering economic risk that makes one question not only the resilience of global health systems but the soundness of their investment strategies. In response, Smart Buys: High-Value Actions for Health Sector Adaptation sets out a rare commodity in the climate-health landscape: actionable, cost-effective adaptation guidance grounded in robust evidence.

How “Smart Buys” Were Found

The report’s strength lies in its systematic and transparent methodology. Over 7,000 publications, spanning scientific journals and grey literature, were screened using rigorous criteria focused on health and economic outcomes. After multiple review stages, only 15 studies met the standards for full analysis, forming the basis of eight high-value adaptation actions. Each action underwent a detailed value assessment to quantify both its health benefits and economic returns, ensuring that the proposed solutions are not only effective but cost-beneficial. This process mirrors the multi-year evidence-building behind the WHO’s “Best Buys” for noncommunicable diseases, though the authors deliberately refrain from labeling these climate actions as “best buys” to reflect the evolving nature of climate–health evidence.

Heat, Alerts, Hospitals, and Drones: What Works Today

Among the standout strategies are Heat Action Plans (HAPs), structured, cross-sector warning and preparedness systems that save lives by alerting communities before temperatures become deadly. Ahmedabad, India, offers a striking example: its HAP generated a benefit–cost ratio above 100:1, meaning each dollar invested produced over US$100 in avoided mortality. Similarly impressive are early warning and response systems for air quality, such as Hong Kong’s Air Quality Health Index, which delivered a 2.7:1 return by reducing hospitalizations linked to pollution spikes.

The report also champions investment in climate-resilient health infrastructure, spotlighting the Caribbean’s SMART Hospitals initiative. In Jamaica and St. Lucia, upgraded hospitals continued providing essential services throughout climate shocks and yielded extraordinary benefit–cost ratios, 168:1 and 317:1, respectively. These facilities demonstrate how climate adaptation investments can both safeguard life and pay for themselves many times over. Another transformative approach is drone-based medical delivery, which keeps supply chains functioning during floods, storms, and road disruptions. Experience from Rwanda and Ghana shows that drones can reliably transport vaccines, blood, and diagnostics when ground routes fail, offering a low-carbon and highly efficient logistics solution.

Community-Level Interventions and Clinical Preparedness

Beyond large-scale systems, the report highlights targeted interventions that strengthen climate resilience at the frontline. These include community health worker–led education on heat risks and emergency preparedness, text-based mental health support for climate-affected populations, and sustained mosquito vector control for diseases such as dengue. Each of these actions underscores the importance of community trust, local knowledge, and culturally aligned communication. The report further integrates evidence from DCP3 to emphasize that many clinical interventions already recommended for essential health packages, maternal and newborn care, nutrition support, chronic respiratory disease management, and infection control, are inherently climate-relevant. Strengthening these foundational services, it argues, is one of the most immediate ways to enhance climate resilience.

Translating Evidence into Action for a Climate-Resilient Future

The report’s recommendations are closely aligned with the Belém Health Action Plan, the global framework guiding health adaptation efforts ahead of COP30. By mapping each Smart Buy to the plan’s pillars, climate-informed surveillance, evidence-based policy, and capacity building, and climate-resilient infrastructure, the document helps countries translate commitments into implementable strategies. It stresses that no adaptation action is universally optimal; climate hazards, health vulnerabilities, and system capacities differ widely between countries. As such, Smart Buys should be seen as adaptable options rather than prescriptive solutions.

The report calls for continued investment in monitoring, evaluation, and innovation. Many promising adaptation actions, particularly those related to governance, cross-sector planning, and community empowerment, remain unevaluated and require further research. But even as evidence continues to grow, the Smart Buys outlined here offer governments a powerful, practical starting point: a set of actions that save lives, strengthen systems, and deliver exceptional economic value in an era where every climate-health dollar counts.