Editing IPCC:AR6/WGII/Chapter-7 (section)

==== 7.4.3.3 Financial Constraints ====

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''Financial constraints are the most referenced barrier to health adaptation and so scaling up financial investments remains a key international priority'' ( ''very high confidence'' ) ''( [[#Wheeler--2018|Wheeler and Watts, 2018]] ; [[#UNFCCC--2017a|UNFCCC, 2017a]] )'' . AR5 estimated the costs of adaptation in developing countries at between USD 70 billion and USD 100 billion annually in the year 2050, but these are ''likely'' to be a significant underestimate, particularly in the years 2030 and beyond (UNEP, 2014). National surveys conducted by WHO identified financial constraints as a major barrier to the implementation of health adaptation priorities ( [[#WHO--2019b|WHO, 2019b]] ; [[#Watts--2021|Watts et al., 2021]] ). Novel research drawing on global financial transaction data suggests that in 2019, global financial transactions with the potential to deliver adaptation in the health and healthcare sector reached USD 18.4 billion, driven by transactions in high- and upper middle-income countries, with investment in Africa, Southeast Asia and the eastern Mediterranean mostly stagnant ( [[#Watts--2021|Watts et al., 2021]] ).

There has been limited participation of the health sector in international climate financing mechanisms ( [[#Martinez--2018|Martinez and Berry, 2018]] ). Of 149 projects listed in the Adaptation Fund database in October 2020, a large number were broad-based initiatives that may have considerable indirect benefits for health systems, such as enhanced disaster preparedness and food security, but none were explicitly aimed at strengthening health systems or had directed funds through ministries of health. A review of projects funded by the major multi-lateral climate funds showed that less than 1.5% of dispersed adaptation funding and less than 0.5% of overall funding have been allocated to projects aimed at protecting health ( [[#WHO--2015a|WHO, 2015a]] ). A survey of national public health organisation representatives from a mix of low-, middle- and high-income countries found that a lack of political commitment, insufficient coordination across sectors and inadequate funding for public health-specific adaptation initiatives were common barriers to building climate resilience ( [[#Marcus--2020|Marcus and Hanna, 2020]] ). Under-investment in climate-specific initiatives in health systems coincides with persistent under-investment in healthcare more generally, especially in low- and middle-income countries ( [[#Schaferhoff--2019|Schaferhoff et al., 2019]] ).

Adaptation financing does not often reach places where the climate-sensitivity of the health sector is greatest ( [[#Weiler--2019|Weiler, 2019]] ). Financial constraints in Africa are one of the key reasons for slow implementation of health adaptation measures ( [[#Nhamo--2019|Nhamo and Muchuru, 2019]] ). Strengthening health systems in vulnerable countries has the potential to reduce current and future economic costs related to environmental health risks, thus enabling reinvestment in the health system and sustainable development ( [[#WHO--2020a|WHO, 2020a]] ; [[#WHO--2015a|WHO, 2015a]] ). Robust and comprehensive climate and health financing builds first on core health sector investments ( [[#WHO--2015a|WHO, 2015a]] ). Other potential opportunities for resource mobilisation include health-specific funding mechanisms, climate change funding streams and investments from multi-sectoral actions and actions in health-determining sectors ( [[#WHO--2015a|WHO, 2015a]] ). Incorporating climate change and health considerations into disaster reduction and management strategies could improve funding opportunities and increase potential funding streams ( [[#Aitsi-Selmi--2015|Aitsi-Selmi et al., 2015]] ). Reinforcing cross-sectoral governance mechanisms maximises health co-benefits and economic savings by allowing for multi-sectoral costs and benefits to be comprehensively considered in decision-making ( [[#Belesova--2016|Belesova et al., 2016]] ; [[#WHO--2020a|WHO, 2020a]] ; [[#WHO--2015b|WHO, 2015b]] ). An additional financial need concerns health research, the existing funding for which does not match what is needed to support the implementation of the combined objectives of the UN 2030 Agenda for Sustainable Development, the Sendai Framework for Disaster Risk Reduction and the Paris Agreement ( [[#Green--2014|Green and Minchin, 2014]] ; [[#Ebi--2016|Ebi, 2016]] ; [[#Green--2017|Green et al., 2017]] ).

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