# Rising Incidents, Lax Oversight Ohio Oil and Gas Incidents, Inspections, and Enforcement, 2015–2025 Storage tanks at the Frost well, a Class II injection well site in Athens County, Ohio. Photo: Roxanne Groff, 2024. **Gwen Klenke** FracTracker Alliance, with Buckeye Environmental Network Download the full report ## Overview Ohio’s oil and gas incident records document spills, leaks, equipment failures, and other potentially harmful events.1 These incident reports should help the public understand where these incidents occur, the risks to safety, health, and the environment, and how regulators and operators respond. But FracTracker Alliance’s analysis of Ohio Department of Natural Resources records from 2015 through 2025 found that, even as ODNR has improved some aspects of its data collection, major gaps remain. Incident classifications are often unclear, key details are buried in narrative descriptions, and records do not consistently show whether an event led to inspection, cleanup, enforcement, or corrective action. These gaps are particularly notable amid growing problems with oil and gas wastewater disposal, including releases and oil and gas wastewater migration associated with injection wells. However, one thing is clear: incidents are increasing in frequency on an annual basis. Without an understanding of the severity and complexity of these increasing oil and gas incidents, the public and policymakers may be lulled into a false sense of complacency and may be less likely to address serious problems until they threaten to become a crisis. ### Key Findings * **2,529 oil and gas incidents** were recorded in Ohio from 2015 through 2025. * Incidents are generally increasing, **rising from 103 in 2015 to 268 in 2025** , despite year-to-year variation. * Persistent problems with **poor incident classification and fragmented descriptions** make it difficult to determine what happened, the severity of the incident, and how it was resolved. * Our analysis shows that there is **a lack of consistency in inspections, enforcement, and follow-up** on the part of ODNR when wells have incidents or violations. * ODNR’s inspection capacity appears **insufficient for consistent and meaningful oversight**. Roughly **25 inspectors are responsible for Ohio’s 96,000 wells**. ## Our Previous Analysis This analysis builds on FracTracker’s 2024-2025 series, Data Gaps: A Critical Examination of Oil and Gas Well Incidents in Ohio. That work began after the president of the Ohio Oil and Gas Association stated publicly in 2023 that Ohio had experienced only one or two oil and gas incidents affecting environmental health and public safety during the previous decade. The statement prompted longtime Ohio activist and founder of the Daily Accident Report, Jenny Morgan, to request incident records from the Ohio Department of Natural Resources (ODNR) Division of Oil and Gas Resource Management (DOGRM). The records2 told a very different story. After combining and cleaning ODNR’s annual spreadsheets, FracTracker identified approximately 2,000 incidents from 2015 through 2023. The analysis also found substantial problems with the data itself. Location information was frequently missing or inaccurate, incident classifications often failed to reflect the full nature of an event, and important details were buried in narrative descriptions. Roughly 100 records could not be included in the original map and analysis because their location information was too incomplete. Activist Jenny Morgan continued to dig into this important issue by creating the “Daily Accident Report,” a project documenting Jenny’s deep dives into specific incidents. This updated analysis extends the dataset through 2025 and examines not only how incidents are recorded, but what the records show about the response that follows. ODNR has improved some aspects of its data collection, including location information, event types, and general consistency. But the expanded dataset exposes persistent problems with incident classification and raises broader questions about inspections, remediation, enforcement, and operator accountability. In many cases, the records still do not provide a clear path from the initial report of an incident to its eventual resolution. ## What the Data Now Shows Map of Ohio oil and gas incidents, 2015-2025. Open the full-screen map. ### Number and Types of Incidents One of the most notable trends in the data is an increase in incidents over the years of analysis. Since 2015, the number of incidents has generally gone up (**Figure 1**). Given the number of toxic substances associated with oil and gas wells, these incidents create the potential for communities and environments alike to be harmed. **Figure 1.** Oil and gas incidents by year, 2015-2025 (n = 2,529). Source: Ohio Department of Natural Resources incident records; data cleaned and analyzed by FracTracker. Consistent with our original analysis, the majority of incidents remain as unspecified releases and discharges (**Figure 2**), followed by gas releases. Some examples of such incidents include: ODNR incident record| No. 2017025 ---|--- County**Monroe County**| Incident type**Release/Discharge**| ODNR classification**Major** Level 2 of 5 Discovered**Jan 29, 2017**| Closed**Feb 16, 2017**| Days open**18** Operator**John Burkhart Unregistered well**| Product released**Oil (Crude)**| Quantity reported**40 BBLS** SummaryA release/discharge in Monroe County where a “property owner drained tank into Clear Fork Little Muskingum River on 1/28/17,” releasing 40 barrels of crude oil onto the land, constituting a “major” event classification. ODNR incident record| No. 2025080 ---|--- County**Carroll County**| Incident type**Release/Discharge**| ODNR classification**Minor** Level 4 of 5 Discovered**Mar 29, 2025**| Closed**—**| Days open**Still open** Operator**OWS Acquisitions Co LLC**| Product released**Oil, Refined Sheen on Water FRQ**| Quantity reported**900** SummaryA “minor” release of 1,000 gallons of crude oil mischaracterized in the data as water. Wyatt #1, operated by OWS Acquisition, released crude oil into a ditch which then entered an unnamed tributary to Sandy Creek. OWS attempted to remediate the release by removing the crude oil and contaminated soil. This remediation and a subsequent repair of the well were allowed to occur while parts of production resumed, despite the noted impact to land and water in Carroll County. ODNR incident record| No. 201500102 ---|--- County**Jefferson County**| Incident type**Gas Release**| ODNR classification**Moderate** Level 3 of 5 Discovered**Oct 28, 2015**| Closed**Nov 16, 2015**| Days open**19** Operator**Historic Well**| Product released**Natural Gas**| Quantity reported**Unable to estimate** SummaryDespite being categorized as a moderate gas release, this incident is described as “Report of gas odor” with no estimation of how much gas was released in Jefferson County. Because of the dispersed, short-lived, and difficult-to-capture nature of gas releases, incidents involving the discharge of gas go unquantified in the data reporting, leaving little clarity about the volumes of gas released. Under Ohio’s incident-reporting requirements, a release of any amount of gas is reportable when it results from a blowout, an uncontrolled pop-off valve in an urban area, or otherwise threatens public safety. Authorized controlled flaring and certain other controlled releases are excluded from these reporting requirements. Liquid releases are more likely to have estimated volumes in reports, but those estimates are still often incomplete. Among the 2,373 records in which the “estimated quantity” field was populated, 797 records listed the quantity as “unknown” or “unable to quantify. Other records only provided poor estimates like “>32 barrels”. In addition, some records show a discrepancy between the amount released reported in the “estimated quantity released” field and the “brief description” field, suggesting that the reporting of incidents could still be improved. It is difficult to estimate how many of these records with discrepancies exist due to the sheer number of records. It is important for ODNR to improve reporting systems in order for the public to understand the full extent of these releases because oil and gas-related fluids, particularly oil and gas wastewater,3 could contain toxic PFAS and high levels of radioactivity. **Figure 2.** Oil and Gas incidents by type, 2015-2025 (n = 2,529). Source: Ohio Department of Natural Resources incident records; data cleaned and analyzed by FracTracker. ### Authorized Activity and Classification of Incidents A large majority of incidents occur at “conventional” wells (**Figure 3**), a label that is likely to lead to confusion due to the lack of a definition of the word “conventional” in Ohio’s Oil and Gas code, and competing definitions in other prominent sources. In contrast, Ohio’s code defines a horizontal well as one drilled for oil or gas production in which the wellbore reaches a horizontal or near-horizontal position in the Point Pleasant, Utica, or Marcellus formation and the well is stimulated. “Stimulated” often means that the well has been hydraulically fractured. Hydraulic fracturing, or fracking, is a well-stimulation process in which fluid is injected under pressure to fracture underground rock formations. “Horizontal,” “directional,” and “near horizontal,” describe the path of the wellbore. Horizontal drilling and hydraulic fracturing are commonly used together in shale development, and such wells are commonly called “unconventional.” Taken together, this terminology might suggest that “conventional” wells are any wells that are not “unconventional” or any wells that do not combine horizontal drilling and hydraulic fracturing. However, Ohio’s Oil and Gas code does not make this distinction. The United States Environmental Protection Agency (U.S. EPA), in its 2016 report on fracking and drinking water defined the difference between conventional and unconventional as related to the type of formation rather than to the type of technology used to extract oil or gas. “Conventional oil- and gas-bearing rock formations,” U.S.EPA wrote, “are often described as ‘permeable’ and tend to have many large, well-connected pore spaces that allow fluids to move within the rock formation. Unconventional oil- and gas-bearing rock formations do not exhibit these characteristics.” The U.S. EPA made clear that both conventional and unconventional wells could be fractured and that, in recent years, there had been increased production of oil and gas from unconventional formations (see page 1-3, including footnote 1, and page 3-1). Similarly, one of the world’s leading hydraulic fracturing companies, Schlumberger, notes in its Energy Glossary that the definition of “unconventional” has changed over time, but “[a]t present, the term is used in reference to oil and gas resources whose porosity, permeability, fluid trapping mechanism, or other characteristics differ from conventional sandstone and carbonate reservoirs. Coalbed methane, gas hydrates, shale gas, fractured reservoirs, and tight gas sands are considered unconventional resources.” Like U.S. EPA’s definition, Schlumberger’s characterization focuses on the nature of the formation, not the method of extraction. On the other hand, the U.S. Energy Information Administration (EIA) defines the difference between “conventional” and “unconventional” in part based on the technology used to produce oil and gas. “Conventional production generally means that crude oil and natural gas flow to and up a well under the natural pressure of the earth,” the EIA wrote. “Unconventional production requires techniques and technologies to increase or enable oil and natural gas production beyond what might occur using conventional production techniques.” Because Ohio law does not define “conventional,” it is unclear whether ODNR is applying any of the three definitions listed above or defines “conventional” and “unconventional” in a different way. ### Conventional Does Not Equal Safer As a result, ODNR’s use of the term “conventional well” in this dataset should not be read as a precise description of a well’s age, orientation, depth, or stimulation history. Some wells categorized as conventional may be vertical and older, and some may also have been hydraulically fractured, but are still distinct from horizontal wells. The “well phase” column within the data indicates that some incidents occurring on conventional wells happened during “completion/stimulation,” suggesting that conventional wells in this dataset may reference fracking activities. The dataset also includes “oil and gas production” as one of the categories of activity, or “authorized activity” as it is called in the data. It is unclear how that category differs from the conventional and horizontal well categories or whether it includes incidents associated with well stimulation. ODNR used the category from 2016 through 2022, but it does not appear in the more recent records. Labeling oil and gas wells as “conventional,” without defining the term, may lead some people to inaccurately assume that incidents at these wells pose less of a risk to the public. This assumption may stem, in part, from the fact that most oil and gas production in Ohio and the U.S. now comes from unconventional wells, using the definitions listed above. And it is these unconventional operations that have received most of the attention in recent years regarding pollution impacts. But because Ohio does not define “conventional,” the label does not indicate whether an incident associated with it poses less risk. A separate regulatory distinction may reinforce the perception of the relative safety of “conventional” wells. In 2016, U.S. EPA issued a rule prohibiting water from onshore unconventional oil and gas wells from being disposed of in Publicly Owned Treatment Works (POTWs). POTWs typically collect wastewater from homes and businesses and send it to sewage treatment plants. U.S. EPA defined unconventional oil and gas resources as “crude oil and natural gas produced by a well drilled into a shale and/or tight formation (including, but not limited to, shale gas, shale oil, tight gas, and tight oil).” Wastewater from conventional wells was not covered by the rule. However, in U.S. EPA’s 2016 report on fracking and drinking water, the agency wrote that “[p]roduced water generated from unconventional reservoirs is reported to be similar to produced water from conventional reservoirs in terms of TDS [total dissolved solids], pH, alkalinity, oil and grease, TOC [total organic carbon], and other organics and inorganics.” Produced water, as U.S. EPA defined it in its 2016 report, is wastewater. Therefore, it is unclear whether wastewater from conventional wells is significantly different than wastewater from unconventional wells. And it is possible that incidents at either conventional or unconventional wells involving wastewater could pose pollution risks. These uncertainties and the lack of a definition for conventional wells in Ohio’s Oil and Gas code means that Ohioans should not assume that incidents at “conventional” wells are safer than those at other types of wells. **Figure 3.** Incidents by authorized activity, excluding five records with no authorized activity listed. 2015-2025 (n=2,524). Source: Ohio Department of Natural Resources incident records; data cleaned and analyzed by FracTracker. In addition to qualifying incidents by the authorized activity at a given incident site, ODNR also uses an incident classification matrix to categorize the severity of reported incidents **(Figure 4).** The matrix considers both the reported consequences of an incident and the agency’s assessment of whether the release or hazard is contained or under control. Because those judgments may be made before the full extent of an incident is known, the classification can reflect the initial perception of control and impact rather than the event’s ultimate severity. An incident may therefore be classified as minor when it appears to have been contained quickly or to have caused limited harm, while incidents perceived as uncontrolled or more consequential receive a higher classification. Classification| Incident criteria ---|--- **Information Only** Level 5 incident| Normal conditions. DOGRM involvement only. Controlled and stabilized in less than 4 hours. Follow-up by DOGRM within 24 to 48 hours. Little to no resource needs. Does not exceed reportable quantities with nominal public safety or environmental impact. **Minor** Level 4 incident| Normal conditions. May/may not involve other agencies. Controlled and stabilized in less than 4 hours. Limited deployment within 2 hours. Little to no resource needs. Exceeds reportable quantities with minimal public safety or environmental impact. **Moderate** Level 3 incident| Increased Readiness Conditions. One to three agencies involved due to regulatory authority. Controlled and stabilized in less than 12 hours. Immediate deployment with extended operational phase(s). Additional resources needed. Exceed reportable quantities with considerable public safety or environmental impact. **Major** Level 2 incident| Escalated Response Conditions. Multiple agency involvement and coordination. Uncontrolled impact will take 12 to 24 hours to contain hazard(s). Immediate deployment with extended operational phase(s). Additional resources needed. Exceeds reportable quantities with sizeable public safety or environmental impact. **Severe** Level 1 incident| Emergency Response Conditions. Multiple agency involvement and coordination. Uncontrolled impact will take 24 hours or more to contain hazard(s). Immediate deployment with extended operational phase(s). Additional resources needed. Exceeds reportable quantities with significant public safety or environmental impact. **Figure 4.** The incident classification matrix for Ohio oil and gas incidents. 2025. Source: ODNR Emergency Operations & Response Master Incident Data Tracking (MIDT), Recreated by FracTracker Alliance. Moderate, major, and severe incidents have seemingly decreased over time (**Figure 5**), but descriptions of minor incidents are not convincing as “minor”. Incident 201600072, which occurred in 2016, was classified as minor and described as “Static electricity from overhead power lines caused a conventional well’s tank to explode.” The explosion of the EnerVest-operated tank released 59 barrels4 (2,478 gallons) of crude oil and 5 barrels (210 gallons) of oil and gas wastewater. Because this event was classified as minor, it may indicate that there were few impacts to the environment, or that the incident was contained quickly. However, the records indicate this incident was open for four days, leading to questions about the accuracy of the classification. It is unclear if the incident was “open” due to prolonged discharge or if remediation and follow-up took multiple days, but more information is needed to determine if “minor” was an appropriate classification. As concerning as the incident classification itself is, prior to the incident, the well had not been inspected for 12 years according to Ohio’s Oil and Gas Database, also referred to as RBDMS. After the explosion in 2016, the well was inspected in 2017, 2019, and twice in 2024, suggesting that inspections may increase after incidents, but are generally inconsistent. None of the following inspections made mention of the explosion. Records also indicate that in 2020, EnerVest sold the associated well to OWS Acquisitions, but this change in ownership did not prompt any additional inspections. While Ohio law does not appear to mandate inspections upon every ownership transfer, the absence of one was notable given the well’s incident history. ODNR incident record| No. 201600072 ---|--- County**Columbiana County**| Incident type**Explosion**| ODNR classification**Minor** Level 4 of 5 Discovered**Apr 22, 2016**| Closed**Apr 27, 2016**| Days open**4** Operator**EnerVest Operating LLC**| Product released**Oil (Crude)**| Quantity reported**59 bbl, 5bbls brine** Incident 201600072 is not the only example of potential mischaracterizations of well incidents. Another “minor” incident is incident 2025018, which involved an unknown quantity of oil and gas wastewater released from a well while it was being plugged through an orphan well program. ODNR’s records state that the well had been “flowing overnight with no well control in place” and was located in a 100-year floodplain. Both the duration of the release and potential scale suggest this incident’s severity was misclassified by the agency’s own criteria, especially considering that in the “Estimated Quantity Released” field, the volume listed was “Brine >42 US Gal. in 24 hrs,” a reportable quantity if the oil and gas wastewater was released into the environment. Conflicting information within the data (e.g., both the note of an “unknown quantity” and “Brine >42 US Gal. in 24 hrs” within the same incident record) makes it difficult to understand how much was actually released and if the incident should be considered “minor”. Inspection reports show that after this incident, the well was not inspected until 9 months later, when the orphaned well restoration was complete, meaning the amount of oil and gas wastewater released may still be unknown. These two examples above are not outliers; other records in incident data follow similarly concerning patterns of mischaracterization. **Figure 5.** Declines in moderate, major, and severe incidents, 2015-2025. Source: Ohio Department of Natural Resources incident records; data cleaned and analyzed by FracTracker. ### Events by County Given the pattern of mischaracterized incidents, it’s worth examining where incidents are concentrated. Stark and Noble counties have the highest counts of incidents, with each county recording about 130 incidents (**Figure 6**). These counties both have a moderately high number of wells, but according to FracTracker records, they do not have the largest number of total wells. Incidents in these two counties follow the general trend of the data; releases at conventional wells dominate the incidents within these counties. **Figure 6.** Incidents by county, 2015-2025 (n=2,529). Source: Ohio Department of Natural Resources incident records; data cleaned and analyzed by FracTracker. ### Incident Durations Incident durations may also be cause for concern. In this analysis, FracTracker Alliance defines “duration” as the time, in days, between incident discovery date and closure date as noted in the records. According to the records, many incidents were “closed” or addressed within the same day (**Figure 7**). Closure is not defined in the Ohio Administrative Code that dictates emergency response and tracking, but likely refers to completing any follow-up to an incident, like field response, remediation, documentation, or another administrative milestone. Many of the incidents that were addressed within a day were incidents classified as less severe, that is, those classified as “information only,” “agency assist,” “agency referral,” and “minor” **(Figure 8).** However, despite many less severe incidents being closed within the same day, 486 incidents took over a month to close, and 249 records from as far back as 2018 remain open, or without a closure date today. These open records could be a reflection of the time it takes to fully remediate sites, a gap in documentation and data entry, or the Oil and Gas Management Division’s lax philosophy on addressing violations, where the “Division seeks to return the regulated community to compliance at the lowest level of enforcement possible”. Public confidence in ODNR’s response would be improved by enforcement that is clearly commensurate with the severity of the incident. **Figure 7.** Duration of incidents before closure, 2015-2025 (n=2,529). Source: Ohio Department of Natural Resources incident records; data cleaned and analyzed by FracTracker. **Figure 8.** The average and median durations of closed/addressed incidents, 2015-2025 (n = 2,529). Source: Ohio Department of Natural Resources incident records; data cleaned and analyzed by FracTracker. As with the previous FracTracker analysis on the topic, the “Brief Description” field continues to be the most comprehensive attribute in understanding incidents. The field often describes equipment failure found during routine inspections and maintenance, as well as landowner notification of leaks, spills, and odors. The field also sometimes details the inspector’s actions, follow-up, or communication around an incident. The “Brief Description” field also highlights shortcomings in the dataset’s other categories. It more frequently quantifies volumes of products released than the other data columns, and gives additional context that reveals discrepancies in incident classification. ## Oil and Gas Wastewater Disposal in Injection Wells, Transportation, and Road Spreading ### How injection wells work The waste is not stored in an empty subterranean tank or cavern; it enters the pore spaces of permeable rock within the injection zone. Injected fluids move through pore spaces in the receiving formation. If a well is improperly constructed or operated, if natural fractures already exist, if a high volume of injected fluids creates fractures, if improperly plugged wells are present, or if there is no porous and permeable reservoir, trapping mechanism, or impermeable seal to prevent fluid flow, fluids can migrate outside the permitted injection zone. **A note on terms.** This report uses “oil and gas wastewater” to describe the combination of naturally occurring toxic saltwater and flowback and chemicals incorporated to that water during the fracking process. Oil and gas wastewater is sometimes referred to as “brine” or “produced water,” in different contexts. These are distinct terms with distinct meanings but are often utilized interchangeably. Incident reports related to transportation, disposal, storage, and spreading of oil and gas wastewater also raise significant tracking and response issues. Oil and gas companies inject oil and gas wastewater into underground formations through wells classified as Class II under the Safe Drinking Water Act’s Underground Injection Control program. FracTracker and Buckeye Environmental Network have previously collaborated to map some of Ohio’s more concerning injection wells. Spills, leaks, and other releases of oil and gas wastewater can cause significant damage to the environment. In 2018, in Pickaway County, documented in incident 2018188, a routine inspection found a “brine kill area and leak of brine occurring from a pin hole size leak.” Further inspection notes that over 1 bbl (42 gallons) of oil and gas wastewater was released from the pinhole leak, raising questions about how long the leak continued before detection. Similarly, another incident states, “UIC inspector arrived on site for routine inspection and observed three separate kill area (sic) around the surface brine storage facility indicating a release of brine. Containment dike had approximately 10″ of brine and some oil in it.” Issues involving oil and gas wastewater were not just limited to under-addressed leaks. They were also characterized by descriptions of oil and gas wastewater hauler accidents and potential unreported accidents. Examples include incident 2018220, which states “Tanker accident caused 20bbl of production brine released into a creek. OEPA DNR Wildlife informed. There was no recovery due to fast waters.” and incident 2018187, described as “Former employee reported underreporting of releases to the OneCall alleged release(s) have occurred in containment.” Numerous oil and gas wastewater truck rollovers and releases are described in the data, bringing up questions around the safety of transportation of oil and gas wastewater. Nine incidents directly reference “brine kill” or an area of vegetation that is or has been dying due to oil and gas wastewater releases to that area. The fact that such a phrase is well-documented in the records indicates the seriousness with which incidents involving oil and gas wastewater should be considered. ODNR incident record| No. 2021011 ---|--- County**Washington County**| Incident type**Release/Discharge**| ODNR classification**Minor** Level 4 of 5 Discovered**Jan 20, 2021**| Closed**Apr 2, 2021**| Days open**72** Operator**Deeprock Disposal Solutions LLC**| Product released**Brine >42 US Gal. in 24 hrs**| Quantity reported**23 Barrels** Despite improvements in data collection, such as consistent field usage and better organization since our previous report, it continues to be difficult to properly evaluate the data. Incident 2021011 describes an issue with the Heinrich Unit #2 well owned by DeepRock Disposal Solutions LLC. The incident was described as “Visited site to determine if incident can be closed out. Operator hauled out the contaminated soil and filled in all the trenches. They also put down seed and straw.” There is no description of the incident that created the contaminated soil. It is unclear if this incident’s original description has been overwritten, and no other record in the incident data is attributed to this well’s name or API number, a unique numeric identifier assigned to each oil and gas well. The only other incident associated with DeepRock within the incident data is incident 2024282, which could have created contaminated soil but is attributed to a different well. The description reads as follows: ODNR incident record| No. 2024282 ---|--- County**Washington County**| Incident type**Release/Discharge**| ODNR classification**Minor** Level 4 of 5 Discovered**Dec 22, 2024**| Closed**—**| Days open**Still open** Operator**Deeprock Disposal Solutions LLC**| Product released**Brine >42 US Gal. in 24 hrs**| Quantity reported**unk** ODNR brief description (as recorded)“Dave Casto (DeepRock) reported a brine release occurred at their site on December 22. 2024 at approximately 5:00PM. The brine release is reported to have consisted of between five and eight barrels that resulted from a defect in a check valve on the wellhead of the well named Helen F Hall (SWIW #7) 1-19. A portion of the brine was released outside of secondary containment and impacted land and a nearby intermittent drainage. Deeprock utilized absorbent material in an attempt to prevent migration of brine further into the environment on the evening of December 22, 2024. UIC Inspector Kyle Newbrough was notified of the release and visited on December 23, 2024. On site, Inspector Newbrough worked with Deeprock to construct containment and remediation measures. EOR Coordinator Nathan Lane visited the site to ensure the release was stabilized, leading edge controlled, and remediation is underway.” Another incident involved DeepRock but was not associated with DeepRock in the incident data. In incident 2021015, oil and gas wastewater shot from a production well at 42 gallons a minute **(Figure 9)** in Noble County in 2021. The source of the oil and gas wastewater was nearby wells where DeepRock was injecting oil and gas wastewater, according to a later Chief’s Order by ODNR. However, the incident data assigns the incident to the well at which the blowout occurred, named Ohio Power Gant #17-69, operated by Genesis Resources LLC. This assignment of the incident to Genesis Resources LLC, rather than DeepRock, is not just a difficulty for those exploring the data. While it is reasonable to tag the location of this incident as occurring at the Ohio Power Gant #17-69 well, initially attributing the cause of the incident solely to the operator Genesis Resources may not only make searching for more information on a highly publicized incident difficult, but also may have implications for ensuring proper enforcement and mitigation related to the incident. Prior to the incident, ODNR had ordered Ohio Power Gant #17-69 to be plugged, but Genesis Resources had not done so. DeepRock’s injection wells were suspended, but the state held Genesis Resources responsible for the cost of remediation, an issue that is now the subject of a lawsuit from Genesis Resources’ insurance agency. Additionally, since its suspension, DeepRock has been fighting to reopen the wells and has most recently appealed the Chief’s Order to remain shut down to the Ohio Oil and Gas Commission. Concerningly, the seat of this commission that represents the public is vacant during this appeals process. **Figure 9.** A photo of incident 2021015, 2021. Source: Public records request to ODNR for incident photo log for Ohio Power-Gant #17-69. ## Enforcement The records indicate a few channels through which regulators discover, or are notified of, incidents. Sometimes, inspectors identify incidents during routine inspections. Incidents have also been called in by well operators or emergency services near a given well. Many records indicate that landowners, not well operators, are the ones spotting leaks and flagging when remediation efforts were not completed successfully. Additionally, some incidents are reported through Ohio EPA’s emergency response program. Although Ohio EPA (OEPA) is not the primary regulator of the oil and gas industry, they do assist ODNR when pollutants leave a given well pad, enter waterways, or threaten public drinking water. This shared response can make it difficult to determine responsibility for the follow-up and long-term inter-agency oversight regarding incidents. OEPA notes that a significant portion of the incidents they respond to deal with releases of petroleum products. They also note that the responsible party for many incidents is the operator itself, who is also often responsible for the cost of clean-up. With only around 25 oil and gas inspectors in ODNR and roughly 15 coordinators for Ohio EPA’s Emergency Response program, efforts by the state regulatory agencies to prevent and remediate incidents may be limited in nature by logistical factors such as caseload and time spent with a given case. An analysis conducted by FracTracker for this report found that the 25 inspectors at ODNR are responsible for roughly 96,000 active wells, not including wells that are plugged or abandoned. Using Ohio’s RBDMS system, FracTracker was able to access the duration of inspections and average the amount of time inspectors have spent on inspections in recent years. Reviewing only current inspectors leads us to conclude that it would require, on average, roughly 664 work days per inspector to review all the active wells in the state. This means that it would take inspectors in the state over two-and-a-half work years to return to a given well. While this average is helpful for understanding that ODNR inspectors are overall overburdened, some inspectors are especially overburdened. For example, one inspector is responsible for roughly 1,500 wells, all contained within Harrison County. Another inspector is responsible for all wells in 26 counties, which total around 24,000 wells. This roughly estimated inspector burden does not take into account the responsibility of ODNR inspectors to examine and regulate more inactive well types. Unrealistic inspector workloads have practical consequences for how frequently wells are inspected and how problems are identified. Buckeye Environmental Network has documented many instances in which an inspection was both necessary and not completed. One such example is that of the Kris-Mar 1 oil and gas production well located in Washington County, in Marietta, Ohio. In 2019 and 2020, oil and gas wastewater was suspected to have migrated from a neighboring wastewater injection well and bubbled out of conventional production wells near Kris-Mar 1. Although ODNR had been notified of issues with neighboring production wells, it did not inspect Kris-Mar 1 until 2021, at which point the well had not been in production since 2018. The 2021 inspection cited a violation for failure to post notification, which is the required signage identifying the well name, operator, and emergency contact information, and gave the operator 10 days to remedy it. Nearly a year passed before the next inspection, which found the same posting violation still unresolved and noted “an old release in the area.” By the following inspection in 2023, the well was actively leaking and had destroyed surrounding vegetation, as documented in the inspection reports and in incident 2023100. Each of these earlier visits had been spent revisiting the same unaddressed violation, a pattern that continued to shape ODNR’s response after the fact. What followed the leak was a years-long process of compliance notices and requests to remove contaminated soil, with inspections becoming more frequent but the well still struggling to reach full compliance long after the leak was first observed. This means that inspectors had to spend a significant amount of time attempting to bring this well into compliance, visiting the site a total of 20 times between May 2023 and October 2025. This incident record has not yet been closed. Perhaps at least some of the pollution and the time-consuming regulatory efforts could have been avoided had ODNR’s inspector been able to inspect Kris-Mar 1 sooner and more regularly. An additional question as to why this well was leaking also remains. Wells in this area have been suspected by oil and gas producers and advocates to be leaking due to nearby wastewater injection wells, including DeepRock’s American Growers #1 well, 1,120 feet away from the Kris-Mar 1 well. Cumulative subsurface pressure from injection wells receiving millions of gallons of oil and gas wastewater in Southeast Ohio is possibly resulting in migration of the waste fluids into these conventional wells, leading to increasing pressures at the conventional wells and releases into the environment, such as what has occurred at the Kris-Mar 1. At the time of writing this analysis, these suspicions were made more tangible after ODNR announced the voluntary cessation of operations for four injection wells in Washington County, Ohio. In recent years, disposal zones in Southeastern Ohio have produced “unprecedented migration of brine [wastewater],” according to ODNR. The ODNR should immediately investigate instances when there is suspected migration of oil and gas wastewater, rather than taking a “wait and see” approach. Beyond the thousands of production wells in Ohio, ODNR has sited 232 active or permitted Class II Injection Wells throughout the state. A different set of four inspectors are responsible for the inspection of these wells. These inspectors not only have the major undertaking of being responsible for 50+ wastewater injection wells, but they also cover a vast geographical area. One inspector is reportedly responsible for counties including Holmes, Tuscarawas, Perry, and Washington, a non-contiguous area that spans over 2,000 square miles. This high inspector burden, paired with the potential remediation costs or fines operators may incur for reporting incidents, means the onus of reporting is seemingly left to landowners and residents who may have oil and gas wells on and around their land. The option for citizens to report incidents they see is vital; citizen reporting means more eyes on the incidents and more trust between citizens and the regulators that serve them. However, the current reliance on citizen reporting undermines regulatory accountability, relieving operators of their fundamental obligation to ensure well safety. ODNR’s website describes an escalatory approach for enforcement, ranging from informal to more formal measures, depending on the nature of violations. However, FracTracker separately requested records for “nonappealable Material and Substantial violations from 2000 to 2025,” that is, violations with formal enforceable action through Ohio’s oil and gas code. FracTracker Alliance undertook a small, separate analysis of these violation records since 20195, and found that very few violations have addressed incidents, spills, or pollution events. For example, the widely publicized 2021 DeepRock Disposal incident resulted in Chief’s Order 2023-02 suspending the wells of concern, but did not result in any additional fines, violations, or further enforcement action. As stated earlier in this report, DeepRock Disposal is currently attempting to reopen those injection wells that were problematic. In a similar manner, a report conducted by Buckeye Environmental Network on the Redbird #4 wastewater injection well, whose oil and gas wastewater migration led to the flooding of 28 conventional production wells, documented another case of ODNR’s inability or unwillingness to pursue enforcement. Production well owners who noticed fluid in their wells contacted ODNR directly to report the incident. Inspectors, after waiting half a year and only after being prompted by a state representative-brokered meeting, discovered high pressures and oil and gas wastewater migration as far as five miles away from the wastewater injection well of concern. These concerns were not noted in the incident data, and did not result in a violation. Instead, Redbird Development LLC, the operator of Redbird #4, was allowed to submit voluntary changes to their operations and permits, plug only some of the geologic formation, and resume operations. Rather than violations reflecting on-the-ground safety and pollution-related concerns and liabilities, violations are instead issued for administrative issues, like failing to report production amounts or failing to maintain liability insurance **(Figure 10)**. Other Chiefs’ orders that appeared semi-regularly in the records were revocations of injection and plugging requests, but these records did not strongly indicate that any safety, health, or environmental incidents were considered in these plugging and revocation orders. When violations that could involve civil penalties are not pursued, ODNR forgoes potential revenue for Ohio and weakens financial deterrents against non-compliance that poses a risk to public health and the environment. While these plugging and revocation efforts are steps in the right direction, there is a need to better link incidents with accountability and enforcement. **Figure 10.** An example of a non-appealable material and substantial violation. 2019. Source: Public records request made to ODNR-DOGRM in 2025 by FracTracker. ## Suggestions for Improvement of Incident Tracking and Enforcement In order for the public to evaluate risks to their drinking water and health associated with oil and gas companies operating, or proposing to operate, in their communities, incident data must be more accessible. Accessible data allows residents, reporters, and regulators to quickly determine whether a company has a history of incidents or violations or if multiple violations have been issued regarding a particular type of well, such as wastewater injection wells. However, part of making data accessible includes having shared definitions of terms. If terms like “incident,” “conventional well,” and “closure date” were defined either in Ohio’s oil and gas code or within a separate data dictionary associated with the records, the public understanding of such events would be bolstered. Where Ohio’s definitions differ from definitions used in federal data or by other states, those differences should be made clear. FracTracker commends ODNR for their improvements in data reporting, but there is still a distinct need for better protocols to address issues related to wells. As a starting point, Ohio Revised Code §1509.041 requires non-appealable material and substantial violations to be posted to ODNR’s website. To conduct this analysis, FracTracker Alliance had to submit a public records request to obtain this data, which did not appear on the dedicated webpage. At the time of finalizing this analysis, this information appears on the Orders by the Chief database, which aggregates all legal directives related to oil and gas in Ohio. The Chief’s Orders are not consistently displayed on the website, leading to gaps in regulatory transparency. In addition, records are only available starting in July of 2010. There is a need for distinction between these databases and webpages, consistent updates, and better transparency within these information systems. Additionally, ODNR’s RBDMS database, which contains oil and gas inspections by well in addition to well records on completion, permits, and production, while information-rich, is inaccessible to a majority of residents. It could be made more accessible to the public by having more frequent and timely updates and by linking it to accessible training on how to query and utilize the database. The database currently exists on Microsoft Access, which can be inaccessible due to its difficulty to use and paid licensing requirements. By moving the database to a different format, like SQLite, the public may have an easier time exploring the information available. This shift would also benefit ODNR; Microsoft Access has a 2-gigabyte size limit that the RBDMS system has outgrown, splitting the well history and well tables across two files the state tracks and undermining the purpose of a relational database. Ohio law authorizes civil penalties for oil and gas violations, but ODNR’s DOGRM does not appear to have authority to impose those penalties directly through an administrative order. Instead, the division chief must request that the Ohio attorney general bring a civil action to recover penalties under Ohio Revised Code §1509.33. ODNR can independently use other enforcement tools, including compliance orders, permit suspensions, bond forfeiture, and referrals for injunctive relief. However, the absence of fines may make such notices, particularly the compliance orders, easy to disregard. Relatedly, in 2015, following a citizen’s petition filed by Buckeye Environmental Network and others, the U.S. EPA evaluated ODNR’s Underground Injection Control program. U.S. EPA said that they recommend implementing fines to hold bad actors accountable. To date, we are not aware of any instances of ODNR using the attorney general’s office to issue fines for companies violating Ohio’s injection well laws. This approach to enforcement may have allowed companies to avoid meaningful consequences for repeated violations. FracTracker Alliance and Buckeye Environmental Network also recommend a smaller inspector-to-well ratio, so that wells are inspected with the regularity required to avoid oil and gas pollution events, leaks, and spills, otherwise referred to as “incidents”. Because of the length of time it takes for ODNR to inspect and address potential incidents and violations, more formal enforcement actions should be taken for long-running violations and incidents. In practice, these actions could include fines for any long-standing or unremediated violation or incident. In addition, violations or contamination events should result in an immediate stop-work order until the issue is remediated. This action would once again be bolstered by treatment of incidents as material and substantial violations, addressed with formal enforceable action through Ohio’s oil and gas code, rather than as separate tracking and enforcement measures. * * * ## Appendix A. Oil and Gas Wastewater Glossary “Brine,” “Produced Water,” and “Oil and Gas Wastewater” are often used interchangeably, but come from different industry, legal, and regulatory contexts. To clarify, in this report we use “oil and gas wastewater” to encapsulate many terms that reference the often salty water that is brought above ground during extraction activities. This wastewater may be reused or injected back underground. “Produced water” may be the term that most closely matches our definition of “oil and gas wastewater” but is not used by Ohio regulators or legislators, and may connote a substance that is not harmful. By using “oil and gas wastewater,” we aim to highlight the potential dangers of the fluids involved in extraction. Term| Source / used by| Meaning ---|---|--- **Brine**| Ohio’s Oil and Gas Code Definitions (1509.01-U)| “All saline geological formation water resulting from, obtained from, or produced in connection with exploration, drilling, well stimulation, production of oil or gas, or plugging of a well.” **Produced Water**| U.S. EPA| “The fluid brought up from the hydrocarbon-bearing strata during the extraction of oil and gas, and includes, where present, formation water, injection water, and any chemicals added downhole or during the oil/water separation process.” Produced water is often re-used in oil and gas extraction via practices like Enhanced Oil Recovery. **Oil and Gas Wastewater**| U.S. EPA, Sierra Club, FracTracker Alliance, and Buckeye Environmental Network| Naturally occurring saltwater that is already toxic, combined with flowback (fluids, sands, or hydrocarbons that return to the surface during fracking) and chemicals added during the extraction process. This wastewater may or may not be reused for further extraction, or injected underground. * * * ## Sources and More Information ### FracTracker’s work on this analysis * Ohio oil and gas incidents, 2015–2025 (cleaned dataset) * Ohio Class II injection wells of High Concern (2026) * Ohio Oil and Gas Inspector analysis * Chief’s Orders 2000-2025 * Ohio Oil and Gas Incident Map ### Other sources FracTracker Alliance. (n.d.). _National Oil & Gas Well inventory portal._ FracTracker Wells Portal. https://wells.fractracker.org/ Glabicki, Q. (2026, July 29). _In Ohio, toxic wastewater is bubbling up out of the ground – The New York Times_. The New York Times. https://www.nytimes.com/2026/07/29/climate/ohio-fracking-water-injection-wells.html _How much shale (tight) oil is produced in the United States? – frequently asked questions (FAQs) – U.S. Energy Information Administration (EIA)_. U.S. Energy Information Administration (EIA). (n.d.). https://www.eia.gov/tools/faqs/faq.php?id=847&t=6 _Injection Wells | Ohio Department of Natural Resources_. Ohio Department of Natural Resources. (n.d.). https://ohiodnr.gov/business-and-industry/energy-resources/injection-wells Kington, D. (2026, February 19.). _Lawsuit: Fracking waste company should pay for 2021 disaster._ Athens County Independent. https://athensindependent.com/deeprock-fracking-waste-lawsuit-2/ Kington, D. (2026, September 17). _Operator fights to reopen Injection Wells linked to disaster_. Athens County Independent. https://athensindependent.com/deeprock-appeal-noble-county-injection-wells/ Klenke, G. (2025, January). _Data gaps: A critical examination of oil and gas well incidents in Ohio_. FracTracker Alliance. https://www.fractracker.org/2025/01/data-gaps-a-critical-examination-of-oil-and-gas-well-incidents-in-ohio/ Morgan, J. (n.d.). The Daily Accident Report-Ohio Oil & Gas. Facebook. https://www.facebook.com/profile.php?id=61560490386193&fbclid=IwY2xjawUjtrJleHRuA2FlbQIxMABwZG9mAWJyaWQRMUNaUWh1b0hFandWVlNEOHVzcnRjBmFwcF9pZBAyMjIwMzkxNzg4MjAwODkyAAEeOfiF2H8RYrQ1MtE_3pdzxPiGHKfT7UsUcSbvUiddUnG1hNTn2Qb7zU5wvFw_aem_xrdKMrnCWo8oqLGw-74_DQ Nobel, J. (2025, March 24). _Radioactive Shadow Workers | The treatment of oil and gas field waste is a dirty industry’s dirtiest secret_. Sierra Club. https://www.sierraclub.org/sierra/2025-1-spring/feature/radioactive-oil-gas-shadow-workers Ohio Department of Natural Resources. (2018, September 27). _Incident guide_ (Reprint). https://dam.assets.ohio.gov/image/upload/ohiodnr.gov/documents/oil-gas/resources/IncidentGuide_RePrint%20FINAL%209272018.pdf Ohio Department of Natural Resources – Division of Oil and Gas Resources Management. (2026, January 13). Risk Based Data Management System (RBDMS) inspection records for Kris Mar #1 (API Well No. 341672508400). State of Ohio. https://drive.google.com/file/d/1p2WERwDPnHJIwGKE6pU_0s9YtVHa9Ulb/view?usp=drive_link Ohio Department of Natural Resources – Division of Oil and Gas Resources Management. (2026, July 20). CSI BIA package for “No change” filing for oil and gas definitions, permits, simultaneous operations, prevention of pollution and contamination, and safety rules. https://dam.assets.ohio.gov/image/upload/ohiodnr.gov/documents/oil-gas/rules/CSI_BIA_Package.pdf Ohio Department of Natural Resources, Division of Oil and Gas Resources Management. (2024, October 28). Chief’s Order No. 2024-470: Arrowhead Road Services No. 1 (SWIW #27) Well API #34-167-2-9771-0000. State of Ohio. https://drive.google.com/file/d/1me8JvFj-pwTRJu7egzvhxtsY0I6QnjVv/view Ohio Department of Natural Resources – Division of Oil & Gas Resources Management. (2021, January 25). Incident photograph log: Ohio Power-Gant #17-69 follow-up (Incident No. 2021015, API Well No. 34121232160000). https://drive.google.com/file/d/1j_S8vXkZGLOko5WzzrAkVzGgwCK49QMX/view Ohio Department of Natural Resources — Division of Oil and Gas. _Oil & Gas Commission_.(n.d.). https://ohiodnr.gov/business-and-industry/municipalities-and-public-entities/commissions-and-councils/oil-gas-commission Ohio Department of Natural Resources. (n.d.). _Oil & Gas Inspections and enforcement_. Resources. https://ohiodnr.gov/business-and-industry/energy-resources/required-inspections-and-enforcement/oil-gas-inspections-enforcement Ohio Department of Natural Resources. (n.d.). _Oil & Gas Well database._ https://ohiodnr.gov/business-and-industry/energy-resources/well-information/featured-content-3 Ohio Department of Natural Resources. (n.d.). _Public Database of Non-Appealable orders for Violations._ https://ohiodnr.gov/rules-and-regulations/rules-and-regulations-by-division/oil-and-gas/public-database-of-non-appealable-orders-for-violations Ohio Environmental Protection Agency. (n.d.). _Emergency response_. https://epa.ohio.gov/divisions-and-offices/emergency-response _Oil and Gas Production in Ohio._ Ohio Legislative Service Commission. (2024, October). https://www.lsc.ohio.gov/assets/organizations/legislative-service-commission/files/oil-and-gas-production-in-ohio-october-2024.pdf _Orders by the Chief._ Ohio Department of Natural Resources — Division of Oil and Gas. (n.d.). https://ohiodnr.gov/wps/portal/gov/odnr/discover-and-learn/safety-conservation/about-ODNR/oil-gas/oil-gas-resources Physicians for Social Responsibility. (2022, September). _Fracking with forever chemicals in Ohio_. https://psr.org/wp-content/uploads/2022/09/fracking-with-forever-chemicals-in-ohio.pdf Physicians for Social Responsibility. (2023, October). _Compendium of scientific, medical, and media findings demonstrating risks and harms of fracking_ (9th ed.). https://psr.org/wp-content/uploads/2023/10/fracking-compendium-9.pdf Ramsay, V. (2025, November 26). _A decade of danger: Why ODNR is allowing Deeprock to restart suspended injection wells near Washington County water sources?._ Buckeye Environmental Network. https://benohio.org/a-decade-of-danger-why-odnr-is-allowing-deeprock-to-restart-suspended-injection-wells-near-washington-county-water-sources/ Ramsay, V. (2026, July 14). _Sixteen months of organizing. Four Wells shut down._ Buckeye Environmental Network. https://benohio.org/sixteen-months-of-organizing-four-wells-shut-down/ Reed, B. (2026, July 2). _Ohio Department of Natural Resources investigates leaking injection well, six years later the problem has gotten worse._ Buckeye Environmental Network. https://benohio.org/ohio-department-of-natural-resources-investigates-leaking-injection-well-six-years-later-the-problem-has-gotten-worse/ Schlumberger. (n.d.). _Unconventional resource_. Energy Glossary. https://glossary.slb.com/en/terms/u/unconventional_resource _Section 1509.01: Division of oil and gas resources management – oil and gas definitions._ Section 1509.01 – Ohio Revised Code | Ohio Laws. (n.d.). https://codes.ohio.gov/ohio-revised-code/section-1509.01 _Section 1509.041: Database listing final nonappealable orders issued for violations to be accessible to public._ Section 1509.041 – Ohio Revised Code | Ohio Laws. (n.d.). https://codes.ohio.gov/ohio-revised-code/section-1509.041 _Section 1509.33: Civil penalties._ Section 1509.33 – Ohio Revised Code | Ohio Laws. (n.d.). https://codes.ohio.gov/ohio-revised-code/section-1509.33 State of Ohio. (n.d.). Rule 1501:9-8-01: Definitions. Rule 1501:9-8-01 – Ohio Administrative Code | Ohio Laws. https://codes.ohio.gov/ohio-administrative-code/rule-1501:9-8-01 U.S. energy information administration (EIA). (n.d.). _U.S. shale natural gas production has declined so far in 2024_. Today in Energy. https://www.eia.gov/todayinenergy/detail.php?id=63506 U.S. Environmental Protection Agency. (n.d.-c). Oil and Gas Extraction Effluent Guidelines. https://www.epa.gov/eg/oil-and-gas-extraction-effluent-guidelines U.S. Environmental Protection Agency. (n.d.-c). Unconventional Oil and Gas Extraction Effluent Guidelines. https://www.epa.gov/eg/unconventional-oil-and-gas-extraction-effluent-guidelines U.S. Environmental Protection Agency, Region 5. (2015, September 8). Safe Drinking Water Act underground injection control program periodic program review: Ohio Class II (Final Report). https://drive.google.com/file/d/1ykPsxGbcD77zYM4THg-XhcP39awiRcEv/view U.S. Environmental Protection Agency. (2016) Hydraulic Fracturing for Oil and Gas: Impacts from the Hydraulic Fracturing Water Cycle on Drinking Water Resources in the United States (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-16/236F. https://cfpub.epa.gov/ncea/hfstudy/recordisplay.cfm?deid=332990 U.S. Environmental Protection Agency. (2016, June 28). _Effluent limitations guidelines and standards for the oil and gas extraction point source category_. Federal Register. https://www.federalregister.gov/documents/2016/06/28/2016-14901/effluent-limitations-guidelines-and-standards-for-the-oil-and-gas-extraction-point-source-category U.S. Environmental Protection Agency. (2020, May). _Summary of input on oil and gas extraction wastewater management practices under the Clean Water Act_. U.S. Environmental Protection Agency, Washington, DC, EPA-821-S19-001. https://www.epa.gov/sites/default/files/2020-05/documents/oil-gas-final-report-2020.pdf _Washington County produced water investigation_. Ohio Department of Natural Resources — Division of Oil and Gas. (n.d.-b). https://ohiodnr.gov/discover-and-learn/safety-conservation/about-ODNR/oil-gas/oil-gas-resources/washington-county-investigation WOSU Public Media. (2023, September 20). The state of fracking in Ohio [Radio broadcast]. In All sides with Anna Staver. https://www.wosu.org/show/all-sides-with-ann-fisher/2023-09-20/the-state-of-fracking-in-ohio Zuckerman, J. (2024, May). _Fracking waste wells owned by an Ohio senator are leaking. The state paid $1.3 million to clean it up._ Cleveland.com. https://www.cleveland.com/open/2024/05/fracking-waste-wells-owned-by-an-ohio-senator-are-leaking-the-state-paid-13-million-to-clean-it-up.html ### Notes 1. The term “incident” is undefined by the Ohio Department of Natural Resources and Ohio Oil and Gas Code, but used throughout this report to reflect the records request and associated responsive data. ↩ 2. Data for this analysis was requested and received in three tranches. The first set of data requested, which included incidents from 2014 through early September of 2023 was requested by Jenny Morgan and received in early 2024. The second set of data requested included records from the last part of 2023 through April of 2025, and was requested by Jenny in January of 2025 and received in May of 2025. The final data set included all of 2025 records, and was requested by FracTracker in February of 2026 and received in March of 2026. ↩ 3. This report uses “oil and gas wastewater” to describe the combination of naturally occurring toxic saltwater and flowback and chemicals incorporated to that water during the fracking process. Oil and gas wastewater is sometimes referred to as “brine” or “produced water,” in different contexts. These are distinct terms with distinct meanings but are often utilized interchangeably. For a more extensive description of these terms, see **Appendix A**. ↩ 4. Barrels is abbreviated as “bbls” in the records ↩ 5. While FracTracker received all Chief’s orders records from 2000-2025, Chief’s orders records from before 2019 were not systematically reviewed for the small, separate analysis and may be reviewed for future work. ↩ _Acknowledgments: Special thanks to Anton Krieger, Becca Pollard, Roxanne Groff, and Bev Reed of Buckeye Environmental Network, whose review, on-the-ground knowledge of Ohio’s injection wells, and photographs shaped this report._ Filed underWellsHealth & SafetyWaste RegionsOhio Share this article EmailBlueskyFacebookLinkedIn Stay informedFracTracker Newsletter Support our work FracTracker Alliance helps communicate the risks of oil and gas and petrochemical development to advance just energy alternatives that protect public health, natural resources, and the climate. By contributing to FracTracker, you are helping to make tangible changes, such as decreasing the number of oil and gas wells in the US, protecting the public from toxic and radioactive chemicals, and stopping petrochemical expansion into vulnerable communities. Your donations help fund the sourcing and analysis of new data so that we can keep you informed and continually update our resources. Please donate to FracTracker today as a way to advocate for clean water, clean air, and healthy communities. Donate now ## What You Should Read Next

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_Sign up for The Brief, The Texas Tribune’s daily newsletter that keeps readers up to speed on the most essential Texas news._ Audio recording is automated for accessibility. Humans wrote and edited the story. See our AI policy, and give us feedback. _This article is co-published with_ _El Paso Matters_ _and_ _ProPublica_ _as part of an initiative to report on local control of government._ _Sign up to receive_ _ProPublica’s biggest stories_ _as soon as they’re published._ Last December, New Mexico officials celebrated publication of a plan to address climate change, designed to dramatically reduce the state’s greenhouse gas emissions by 2050. A few months later, just across the state line in Texas, El Paso city officials adopted their own such plan with a similar ambition. Each report cost millions of dollars to draft, but neither one took into account how the construction of data centers could upend climate goals in both places. Work is underway in Doña Ana County in southern New Mexico on one of the largest data center developments in the country: Project Jupiter, built by Austin-based Oracle. Twenty miles away in El Paso, construction is underway on another massive data center, this one built by Meta Platforms. A third, larger data center project is planned less than a 30-minute drive from the Meta site, on the Fort Bliss Army post in east El Paso. The data centers are “going to undo a lot of the very expensive and very meaningful work a lot of people are doing,” New Mexico state climatologist Dave DuBois told El Paso Matters. The sites are among a wave of data centers under construction across the country, driven by the rapidly escalating demand for artificial intelligence services like Claude and ChatGPT. Such projects have drawn intense scrutiny in recent months, as residents and elected officials have questioned their impact on communities’ water supplies, household electric bills and air quality. Texas alone has 596 data centers that are either in operation or planned across Texas as of early September, according to research by The Texas Tribune. But the projects located in this population center of 1.2 million, which encompasses El Paso and parts of southern New Mexico, are particularly notable because of their combined scope. When fully built out, the three data centers, each with its own power plant, will emit millions of tons of greenhouse gas emissions, equivalent to the planet-warming emissions released by more than two million cars in a year. They will also release air pollutants like particulate matter and nitrogen oxides, which directly affect local air quality and human health. The Meta and Project Jupiter data centers are expected to release these kinds of pollutants at relatively low levels, according to paperwork submitted to state regulators. But even a small increase in air pollution can still negatively impact communities close to and downwind of the data center sites, said Shaolei Ren, a professor of electrical and computer engineering at University of California, Riverside. “The health impacts can be significant for local communities,” Ren said. Because Project Jupiter, Meta and the Fort Bliss data centers are in two different states, and because there is no single federal regulation governing climate change or emissions, regulators have largely considered the projects’ impacts separately. “We’ve never had a national climate law passed by Congress,” said Ari Peskoe, director of the Electricity Law Initiative at Harvard Law School. “And so what we’ve had in this country are primarily state and local efforts.” The result is that officials in one state have little say over a project happening minutes away from them. Texas and New Mexico also take different approaches to dealing with climate change. New Mexico has codified greenhouse gas reduction targets into state law; Texas has not. A truck sprays water for dust suppression at the construction site of Project Jupiter in Santa Teresa, New Mexico. New Mexico state Rep. Sarah Silva, a Democrat, represents the community of Chaparral, directly across the state line from Meta’s data center site in northeast El Paso. Her state has the power to regulate air quality and impose noise requirements, but only in New Mexico, not at a Texas construction site, even if it’s only a few hundred yards away. Likewise, residents living in west El Paso across the state line from Project Jupiter have no say in the project despite sharing an aquifer that crosses the state boundary. Emissions do not remain within the state where they originate, Silva said. “This is why we need federal regulation,” said Silva. “How do we knit something together that makes sense for our region when actually this is the job of the federal government?” Though they profess a desire to mitigate the impacts of climate change, local governments in El Paso and Doña Ana counties green-lit these projects in a part of the country seeing rapidly rising temperatures. The counties offered Meta and Project Jupiter tax incentives in exchange for corporate investment in their communities, job creation and, hopefully, the ability to attract more technology companies to the region. State officials have also provided incentives. More than a decade ago, Texas legislators approved a data center sales tax break, which exempts the facilities from paying sales tax on equipment they purchase, a decision that could now cost the state $3.2 billion in revenue over the next two years, according to The Texas Tribune. New Mexico lawmakers declined to advance a bill creating a similar tax break for data centers in 2021. But in 2025, they passed an unrelated law allowing large facilities such as Project Jupiter to generate their own electricity using natural gas. The law exempts these private power systems, known as microgrids, from renewable energy requirements, even as New Mexico requires electric utilities to source 50% of the power they sell from clean energy by 2030. The power plants that keep data centers running typically produce large amounts of emissions like carbon dioxide and methane that drive global climate change over time. Combined, the plants proposed for Project Jupiter and Meta’s data center could emit up to 10 million tons of planet-warming emissions annually. Comparatively, the region spanning El Paso County and neighboring Hudspeth County released 8.4 million tons of greenhouse gases in 2019. (The Army has shared scant information about the Fort Bliss data center, so it’s not clear what level of emissions the facility will produce.) “This does add to our greenhouse gas emissions in a massive way,” said Gunnar Schade, an associate professor of atmospheric sciences at Texas A&M University. “This is a huge source.” Homes in Chaparral, New Mexico, sit adjacent to Meta’s data center, just over the state border in El Paso, Texas. ### An Unprecedented Amount of Energy Silva, the New Mexico representative, was initially supportive of Project Jupiter, in part seeing it as an opportunity to create long-term jobs. Last year, she voted in favor of a bill that included an amendment — tacked on by state Sen. Michael Padilla, a Democrat from Albuquerque — that allows facilities like Project Jupiter, which aren’t connected to the local power grid, a 20-year exemption from clean energy laws, allowing them to generate all their electricity with fossil fuels. “We worked this bill pretty much the entire session, but it did not quite get done. So, we found a piece of legislation that was very similar,” Padilla said in an interview last year. “That’s the legislative process. You have to be very creative to get your work done.” But Silva soon soured on the project out of concern that it won’t employ enough local workers and because it won’t rely on zero-emission renewable energy. Oracle has said the data center will have 750 full-time employees when it’s up and running. The company told Doña Ana County officials in early September that nearly 3,700 people had worked at the site during construction up to that point. Silva and other state lawmakers have said they voted for Padilla’s bill without realizing the broader implications for a data center project in the southern part of the state. “State regulators, state legislators, I think, were so caught off guard at the speed at which these hyperscale data centers showed up in all of our communities almost simultaneously,” Silva said. “I would support a moratorium.” New Mexico state Rep. Sarah Silva was initially supportive of Project Jupiter but has soured on the project over time. The amount of energy Project Jupiter needs is unprecedented in the region: The data center will receive electricity from an on-site power plant made up of fuel cells built by a company called Bloom Energy. Bloom has said the plant will have the ability to produce up to 2.45 gigawatts of electricity — enough to power around 1.5 million homes and more than El Paso Electric has ever supplied to its 465,000 residential and commercial customers at one time, according to the utility’s corporate reports. New Mexico Gov. Michelle Lujan Grisham, a Democrat, has specifically lauded Oracle’s promise to use fuel cells for electricity instead of natural gas turbines, which would have used more water and produced more air pollution. However, an air permit — a state-granted license that authorizes industrial facilities to emit a predetermined amount of pollution — would allow the fuel cells to produce up to 8.8 million tons of greenhouse gas emissions per year. Lujan Grisham didn’t address questions from El Paso Matters about the impact of these additional climate emissions. The Meta power plant in El Paso could release up to 1.3 million tons of climate emissions every year, according to an estimate calculated by El Paso Matters based on El Paso Electric regulatory filings and the Environmental Protection Agency’s emissions factors. Nancy Seidman, a senior adviser with the Regulatory Assistance Project, a nonprofit that advocates for clean energy, also backed up that assessment. “Regulators should weigh all emissions and other impacts like water usage, noise and local air pollution, which can affect public health, when they make decisions about data center projects,” Seidman wrote in an email to El Paso Matters. “This is particularly important when projects are phased over time, so that an accurate account can be made of the total, holistic impacts.” The data center planned for Fort Bliss is expected to use 3 gigawatts of electricity that would likely be supplied by natural gas turbines, according to officials with the Department of Defense, who shared details with reporters during a briefing in April. The Army has issued few other details about the project because it is still in “exclusive negotiations” with the developer, Carlyle Group, a large publicly traded private equity firm. Carlyle Group did not respond to a request for comment. “These are cities in terms of their electricity consumption,” Peskoe, of Harvard Law School, said of AI hyperscale data center campuses such as Oracle’s and Meta’s. The facilities are cropping up so fast that “the pace of this and the scale of this — I think there’s no real parallel, at least for 50, 60, 70 years, but probably ever for the U.S. power industry.” Facilities in New Mexico seeking a state air permit are required by law to disclose estimated amounts of air pollutants and greenhouse gas emissions the project will release. And the state Environment Department has spent months evaluating Project Jupiter’s air permit application, which was submitted in April. A spokesperson for the environmental department didn’t respond to emailed questions. By contrast, the Texas Commission on Environmental Quality only requires project developers to disclose information about pollutants that affect local air quality, and not about greenhouse gas emissions, which are what contribute to climate change. So when El Paso Electric sought an air permit last fall for the Meta data center’s natural gas power plant, the utility didn’t have to share estimated greenhouse gas emissions. The Texas commission approved the permit 20 days after it was filed, following an expedited review. Meta directed questions about its data center’s power plant to El Paso Electric. The electric company declined to share estimates of the plant’s greenhouse gas emissions but said in a statement that the Texas environmental commission had reviewed and authorized the Meta power plant “under a standard permit, which is specifically for projects with limited and well-controlled emissions.” The statement said the facility will “operate in compliance with state and federal standards.” A spokesperson for the agency said, “All Standard Permits have gone through formal notice and comment procedures and have been adopted by the Commission in a public meeting.” These plants will be releasing large amounts of greenhouse gases even as climate change has become increasingly evident in the El Paso metro area, which sits where Texas’ westernmost boundary meets New Mexico and northern Mexico. El Paso’s temperatures have risen faster than those of almost any other city in the U.S. since 1970, according to Climate Central, a nonprofit that quantifies climate shifts throughout the United States. Drought driven by climate change has amplified the impact of wind storms that fill the air in El Paso with hazardous dust in the spring and summertime. This year has been the hottest on record in El Paso through the first nine months of 2026, according to the National Weather Service. Similar records have been set across the state line in New Mexico. “If we started to do these kinds of things — having big data centers with natural-gas-fired turbines — it’s kind of like bringing back a lot of the retired plants that were more dirty, like coal,” said DuBois, the New Mexico state climatologist. Fernando Berjano, El Paso’s climate coordinator, wouldn’t comment specifically on effects resulting from the data centers in the region, but he said the kinds of power plants tied to them produce greenhouse gases that will make it harder for the city to meet its climate goals, as well as produce air pollutants. If emissions increase in the El Paso area, “that has an impact on air quality, that has an impact on pollution,” Berjano said, “which is something that we all know is not good.” Construction at the Project Jupiter data center in Santa Teresa, New Mexico ### The Road Ahead for Data Centers Although construction is already underway on the Project Jupiter and Meta data centers, regulatory hurdles remain for both facilities. The public hearing on the Project Jupiter air permit was scheduled to begin Sept. 14, but the New Mexico Supreme Court delayed it when opponents filed lawsuits challenging the state’s approval process and the facility’s use of groundwater. The state Supreme Court last month lifted the stay. New Mexico more recently appointed an examiner to preside over the hearing that would authorize the facility’s emissions. Other legal challenges are making their way through the court system. In Texas, El Paso Electric is still waiting for the state’s Public Utility Commission to approve construction of the power plant planned next to Meta’s data center, a decision that could come later this year. Officials with both Project Jupiter and Meta have said they are taking steps to help mitigate the climate effects of their projects and plan to develop clean energy projects elsewhere to create new electricity sources and offset the greenhouse gases their data center power plants will release. Oracle also maintains that its emissions will be lower than what it sought in its air permit application and that it plans to get to net zero greenhouse emissions by 2031. “Oracle is committed to building Project Jupiter responsibly and incorporating community feedback into our planning,” the company said in a statement. Protesters rally against the construction of data centers in their region. The road ahead for data centers is unclear. Even once-supportive officials have softened or changed course: Last year, Lujan Grisham, New Mexico’s governor, said Project Jupiter “reaffirms New Mexico’s leadership in global trade, advanced manufacturing, and digital infrastructure.” In Texas, Gov. Greg Abbott at one point called his state “the epicenter of AI development.” Now, amid growing opposition to Project Jupiter, Lujan Grisham recently said she takes seriously residents’ concerns about the data center “and expects any data center operating in New Mexico to meet the state’s rigorous environmental standards and use water responsibly.” This summer, Abbott called on the Texas Public Utility Commission to ensure the projects pay for their own infrastructure and don’t lead to higher electricity costs for residents. He also recommended the state Legislature pass a number of regulations related to data centers next year, many concerning water and electricity usage, and recently told the Texas Water Development Board to penalize data centers that do not report their water usage. Abbott’s new edicts do not address air pollution or climate change, nor the effects that a data center project in one state can have on another. Texas Democratic state Rep. Joe Moody, whose district includes much of west and northeast El Paso, near two of the data center projects, said Abbott’s proposals will likely shape the Texas Legislature’s debate over data-center-related policies next year but called them just a starting point. “In the governor’s directives, we’re not talking about local control and local autonomy to make decisions on these projects,” he said. “And I do think that that’s a whole other lane of conversation that we’re going to get into next session.” _Diego Mendoza-Moyers is a reporter covering energy and the environment at El Paso Matters. He can be reached at_ _diegom@elpasomatters.org_ _._ _Disclosure: Texas A &M University has been a major financial supporter of The Texas Tribune. El Paso Electric Company and Meta have been financial supporters within the past five years. The Texas Tribune is a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in our journalism. Find a complete list of them and more information about our financial and disclosure policies here._ ### Texans need the truth. Help us report it. ## Become a member. Join today. Choose an amount or learn more about membership.

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# 2026 Healthy NDC Scorecard A global assessment of how comprehensively health is integrated into national climate plans (NDCs). See country scores See individual country scorecards See the ranking The 2026 Healthy NDC Scorecards assess the extent to which governments’ national climate commitments recognise and respond to the abundant linkages with health. Nationally Determined Contributions, or NDCs, are climate action plans that countries submit every five years under the Paris Agreement (NDCs are posted on the UNFCCC website here). Using a point-based methodology, 117 NDCs detailing the climate plans of 132 countries have been evaluated based on how frequently, where, and how effectively they include health-related issues across eight key categories: health impacts; air pollution; health sector action; health co-benefits; just transition; integrated governance; economics and finance; and, monitoring and implementation. Full methodology details and summary can be found in the report here**.** ### **How can scorecards be used?** These scorecards help policymakers identify strengths, gaps, and opportunities within climate plans. They also showcase good practices from around the world and enable countries to compare their progress with others. By highlighting where health is being addressed—and where more action is needed —the scorecards support stronger, healthier climate policies. See the report See explainer video Launch event Press release Other NDC work ##### ## The ranking: Who is leading on health, clean air and climate action? All NDCs analysed mention health or air quality considerations to some extent. Top scoring countries include Colombia, with 29/32 points, followed by Nigeria at 25 points and Cambodia with 24. Paraguay and Timor-Leste received 22, completing the top five countries globally for the integration of health considerations. Notably, 19 of the top 20 scores are secured by low- and middle-income countries (LMICs). Nigeria additionally demonstrates extremely high levels of climate ambition, fully in line with its fair share of emissions reductions to deliver the Paris Agreement and to prevent intensifying harms to human health. Nigeria, Paraguay and the Republic of Moldova all have national SCLP plans active or under development. Five countries, Cambodia, Chile, Colombia, Costa Rica, and Paraguay, have targets to reduce black carbon, a major driver of global heating and air pollution, contributing to severe health harms. While Indonesia (11), the EU (12), South Africa (13), Türkiye (14) Canada (16) and the UAE (19) were allocated relatively high health scores, this is not matched by ambitious emissions reductions targets, risking worsening health impacts over time. Other high-emitting countries also fall short of ten points, having failed to commit to their fair share of emissions reductions – namely the Republic of Korea (four points out of 32), Russia (six points), Brazil (seven points), and Australia, China and the UK (nine points). The highest present and historical emitters must mitigate fastest to maximise health co-benefits domestically and prevent escalating health impacts of climate change globally. Developed countries must also provide finance in line with the Paris Agreement to enable developing countries to fully implement their national climate plans to protect their people. Further discussion of the scores can be found in the report. ### Country scorecards can be downloaded in multiple languages here. Please share them on social media, using the hashtag #HealthyNDCs **Click each of the Scorecards below to read a summary report of each country’s score** ### Algeria’s NDC makes numerous mentions of the links between climate change and diseases. According to the NDC, efforts are being made to protect citizens and explore how health policy can be improved. Algeria aims to do this through significant response and preparedness planning. Algeria also specifically mentions mainstream campaigns that highlight the link between health and climate risks. Algeria also has done significant research on climate-sensitive diseases and identification of health impacts. While Algeria has a moderate air pollution mortality rate it is taking steps to monitor air pollution rates and understands the negative effects it can have on its citizens. Download Card Andorra mentions health only in the context of adaptation planning. In its study of climate impacts and vulnerabilities (EVICC), Andorra identifies health as one of four priority sectors alongside energy, tourism, and agriculture. The Pyrenean climate geoportal that Andorra contributes to also includes a dedicated health section. These steps mainly produce indicators and measures that will inform a future National Adaptation Plan. While Andorra mentions climate-related mitigation measures such as free public transport, electric vehicle use, and wind farms, it does not mention a connection to potential health co-benefits like improved air quality, although Andorra’s air pollution mortality rate is relatively low. Download Card Angola strongly recognises the relationship between climate change and health with multiple health impacts and health co-benefits of climate action mentioned, including impacts such as malnutrition, heat related illnesses, food borne illnesses, waterborne disease, vector borne diseases, and negative health impacts of air quality. Health co-benefits described include improved sanitation to reduce disease transmission and improved air quality. However, detail on specific actions in the health sector itself is more limited, with less evidence of specific actions within the health sector. With regards to integrated governance, there is substantive discussion on the public awareness of climate change and its impact on health, health as a key sector, and the right to a clean, healthy, and sustainable environment. There are limited mentions of air pollutants even though the air pollution mortality rate in Angola is relatively high. Download Card Armenia strongly recognises the relationship between climate change and health, with extensive discussion of health impacts including heat-related illnesses, vector-borne diseases, the health impacts of extreme weather, and the disproportionate risks faced by vulnerable populations. Notably, the NDC recognises fossil fuel dependence as a root driver of these issues and additionally refers to the health risks for communities located close to mining sites. Health co-benefits described include improved air quality through active transport, reduced fuel poverty, improved food security, and reduced urban heat. There is also substantive evidence of specific action within the health sector itself, including strengthening climate-resilient healthcare infrastructure, conducting vulnerability assessments of healthcare facilities, improving WASH infrastructure, and climate-proofing healthcare facilities through energy-efficient designs and renewable energy systems. With regard to integrated governance, there is brief reference to public health education campaigns aimed at raising awareness of climate-related health risks among vulnerable groups. The NDC also includes some monitoring and implementation measures, including targets to upgrade healthcare facilities to climate-resilient standards, expand health insurance coverage, and improve epidemiological surveillance of air pollution-related respiratory diseases. Just transition is briefly addressed through references to protecting children’s health and well-being while supporting greener and more resilient economic opportunities for families and youth. In addition, there are several mentions of air pollutants, including HFCs, F-gases and N2O, alongside measures to reduce and monitor HFCs. Given that Armenia’s air pollution mortality is relatively high, a wider scope to address additional air pollutants, and more rapid implementation is needed. Download Card Australia highlights how reductions in indoor and outdoor air pollution can help to reduce the burden of lung and heart diseases, in addition to the broader health and well-being benefits of mitigation actions. Notably, Australia’s air-pollution mortality rate is relatively low. Health impacts and action in the health sector are also acknowledged through discussion of how climate change is jeopardising public health and well-being, how climate-related disasters are impacting infrastructure, and the importance of the resilience of the health system and its net zero transition. There are moderate mentions of air pollutants, with several air pollutants discussed as a requirement of a specific safeguarding mechanism. Integrated governance is addressed through the implementation of Australia’s National Health and Climate Strategy. Download Card Azerbaijan’s NDC refers to public awareness about health impacts from climate and the right to a healthy environment for all citizens. The NDC addresses health impacts clearly through discussions of heat stress and heat-related illnesses as well as waterborne and respiratory diseases. However, adoption measures in the health sector are limited, with only one mention of youth involvement in shaping strategies to reduce emissions from social infrastructure, including schools, hospitals, and sanitation systems. Air pollutants are addressed including through mentions of N2O, SCLP, HFCs, PFCs, SF6, and NF3. Air pollution and air quality are acknowledged to be negative and Azerbaijan is taking initiative for monitoring and improving air quality in urban areas. There are multiple general health benefits of climate policy mentioned. Download Card The Bahamas addresses actions by the health sector in depth in its NDC. Specific actions relate to tools, scientific data, and evidence-based practices to support disaster risk reduction efforts, including a Risk and Vulnerability Assessment (RVA), and mentions of the vulnerabilities of priority sectors such including human health. In addition, national adaptation documents and projects, including the Health National Adaptation Plan (HNAP) are also acknowledged. Health impacts are also strongly addressed through mentions of the hurricanes in 2017 and 2019, which caused significant loss of life, and a large forest fire, with residents reporting extensive smoke and ash exposure. Health co-benefits are alluded to in the NDC through including a mention of safeguarding the broader well-being of society. The Bahamas also recognised air pollutants within its NDC and has a target for 20 percent reduction in HFC use by 2030. Download Card Bahrain does not recognise the relationship between health and climate change beyond a coastal resilience plan in which it anticipates will protect residents. Bahrain has a relatively high air pollution mortality rate, but only refers to the source of one air pollutant, nitrous oxide. Bahrain acknowledges the need to enhance food security and support domestic food production and seeks to invest in agricultural research. Download Card Informed by the outcome of the first global stocktake, Bangladesh recognises the right to health and the right to a clean, healthy sustainable environment in its NDC, and also lists health alongside other considerations playing a vital role in making climate actions viable, effective, and sustainable. Bangladesh notes that strengthening cross-sectoral linkages will ensure that public health outcomes remain central to national climate action. Bangladesh considers the impacts of climate hazards on lives and livelihoods. Health systems are considered to be crucial for both adaptation and mitigation. Actions described for the health sector include those related to climate-resilient health systems, disease outbreak advisory services, climate-proof health centers, as well as healthcare waste management and non-incineration techniques, installation of solar rooftop systems in hospitals, and improving and energy-efficiency of health systems. Bangladesh plans to integrate climate-health training into medical curricula and workforce programs, Bangladesh plans to install rooftop solar systems in 50% of existing government buildings, institutions, schools, and hospitals, and 100% of new government buildings, institutions, schools, and hospitals. Bangladesh has an exceptionally high burden of air pollution mortality, but includes actions which would help to address this. N2O and HFCs are covered in its emissions reductions target, and a target has been identified for HFC reduction supported by a shift to alternative refrigerants. Bangladesh plans to encourage clean air and clean cooking initiatives around health and education facilities to reduce local pollution and improve child respiratory health, and has targets to promote clean cooking. Other health co-benefit actions include those in the transport sector to promote walking and cycling; and in agriculture to promote resilient food systems, safeguard dietary diversity, and strengthen nutritional outcomes; The NDC also notes that decarbonisation of sanitation, solid waste, and water services reduces emissions and also delivers major public health benefits, particularly for children and climate-vulnerable communities, while resilient water and sanitation systems reduce exposure to flooding and waterborne diseases during or after extreme weather events, and reducing exposure to environmental contaminants. Occupational safety is included as a guiding principle for a just transition. Download Card Barbados refers to challenges including an unhealthy planet in crisis, food and water insecurity, and deteriorating physical and mental health. The NDC also acknowledges the vulnerability of the health sector to climate change. Actions by the health sector are also strongly recognised, with specific measures identified, such as installing augmented, disaster-resilient potable water storage capacity in homes to increase resilience. Co-benefits are also discussed in detail, including shifting consumption towards healthier diets. Specifically, drinking water shortages following disasters can be mitigated through improved rainwater harvesting. Air pollutants are also addressed, with specific references to different air pollutants throughout the NDC, and air pollution mortality is relatively low. Integrated governance is addressed through references to frameworks and agendas that underscore the need for effective international agreements to cap and lower global temperatures, limit the spread of pandemics, support nutritional security, reduce poverty and inequality, and encourage energy diversification through renewable energy sources and energy efficiency however, these are discussed in limited detail. Economic and financial mechanisms, as well as monitoring and implementation mechanisms, are also mentioned but receive limited attention. Download Card Belarus’s NDC does not explicitly recognize the relationship between climate change and human health. It briefly addresses public awareness of healthy lifestyles and the prevention of climate-related impacts, but does not discuss specific health impacts or health sector adaptation measures. Although the NDC mentions several pollutants including N₂O, PFCs, HFCs, SF₆, and NF₃, accelerated action on health harming air pollutantsis needed to reduce air-pollution-attributable mortality rate. Download Card Belize’s NDC incorporates a national climate policy aimed at reducing health risks and impacts, strengthening healthcare infrastructure, and improving the capacity of health institutions. The Ministry of Health contributed to the NDC’s development, and SDG 3 (Good Health and Well-Being) is also referenced. The NDC recognizes that extreme weather events increase health risks and emphasizes the importance of resilient infrastructure and healthcare facilities. Health sector adaptation is discussed in depth, including plans to retrofit key hospitals and clinics to withstand extreme weather events and develop an emergency hazard plan for the health sector. Additionally, climate change will be integrated into the Field Epidemiology Training Program (FETP) to strengthen the capacity of community members and leaders to understand climate-related diseases and their impacts on human health. The health sector is a key priority in Belize’s adaptation planning and vulnerability assessments. However, the NDC gives limited attention to air pollution, mentioning only N2O without addressing other air pollutants or their health impacts, while the national air pollution mortality rate remains moderate. Download Card Climate-related health impacts are addressed in considerable detail, covering malaria and other vector- and water-borne diseases, displacement, and cardiovascular and respiratory conditions, alongside the health consequences of air pollution. Air quality is well incorporated, with references to short-lived climate pollutants, nitrous oxide, SOx, NOx, HFCs and black carbon, complemented by measures to strengthen air-pollution monitoring. Integrated governance of climate and health is moderately developed, with the health ministry and sector engaged alongside other sectors, health identified as a key area for climate action, and awareness-raising on climate-health linkages. Health-sector action is extensive, spanning stronger health, water and sanitation services, early-warning systems for climate-sensitive epidemics, capacity-building for the health workforce, vulnerability assessments, solar PV in health facilities, and lower-emission management of biomedical waste. Health co-benefits are embedded across a broad range of measures, including improved nutrition and food security, reduced mortality and malaria transmission, active travel, better air quality and respiratory health, and wider gains in health and wellbeing. Economics and finance are moderately addressed, with costs estimated for health adaptation and dedicated budget allocations for specific health adaptation initiatives. Benin records an air-pollution-attributable mortality rate of 145.3 deaths per 100,000 population. Download Card Bhutan’s NDC integrates health across several dimensions, with a total score of 10. Recognised health impacts of climate change include direct threats to health and wellbeing from climate-related disasters and loss and damage, as well as increasing risks of vector- and water-borne diseases and emerging zoonotic diseases associated with habitat change and biodiversity loss. Air pollutants feature strongly, with references to short-lived climate pollutants and measures for their mitigation. Integrated governance of climate and health receives some attention, including recognition of interlinkages between food, water, energy, climate and health across adaptation priorities, as well as health within non-economic loss and damage. Actions in the health sector include strengthened disease surveillance and control, resilient health facilities, emergency preparedness, and integration of climate-risk management into health-sector planning and capacity development. The health co-benefits of climate action across sectors feature strongly, including protection of food production through climate-resilient agriculture and watershed management, recognition of health co-benefits from mitigation, and simultaneous action on short-lived climate pollutants, which will help to reduce the national air pollution mortality rate. Download Card The health impacts of climate change feature strongly in Bolivia’s NDC, with recognition of general impacts on health, public health and wellbeing, as well as specific risks related to food and nutritional security and the effects of air pollution from forest fires. Air pollutants receive limited coverage, with nitrous oxide identified but without broader consideration of air pollution or air-quality targets and monitoring. Integrated governance of climate and health is addressed moderately, including intersectoral coordination on water management involving sectors such as agriculture and energy, integration of climate and health within education, and alignment with health-related Sustainable Development Goals. Health-sector action features strongly, including the integration of climate-health indicators into sectoral plans and measures to ensure clean and sustainable energy in healthcare facilities. The health co-benefits of climate action across sectors are covered comprehensively, with specific benefits associated with healthy and nutritious food, access to safe drinking water, reduced hydrological risks and improved urban air quality which would help to reduce the national air pollution mortalityt rate, alongside broader benefits for quality of life and public health. Download Card Brazil’s NDC includes safeguarding the health and well-being of populations and promoting sustainable and resilient production and regular access to healthy food among its National Adaptation Objectives, and ​​its recent industrial policy includes health. A planned sectoral or thematic plan for health is mentioned. Notably, a 2023 amendment of Brazil’s Constitution promoted extensive restructuring and simplification of the country’s consumption tax system and provided for a “Selective Tax” on the production, extraction, sale or import of goods and services that are harmful to health or the environment. N2O, SF6, and HFCs are all included in the scope of the NDC’s emissions reductions target. While Brazil acknowledges health, its emissions reduction ambition is highly insufficient to protect health, in line with <4°C of warming. Download Card Brunei’s NDC recognises the link between climate change and wellbeing. Integrated governance of climate and health is reflected through the Ministry of Health’s responsibility for climate actions. Health-sector action is moderately incorporated, with health identified as a priority sector within the National Adaptation Plan. Download Card Burundi considers health impacts extensively in its NDC and identifies specific risks including epidemics, malaria, cholera, measles, malnutrition and respiratory infections. Air pollution is also recognized as a health risk, while disaster victims and health-related measures are included among indicators used to assess climate impacts. Air pollutants mentioned include HFCs, NOx and SOx. Integrated governance of climate and health features strongly, with the Ministry of Health engaged alongside other ministries in adaptation, health identified as a priority sector, awareness-raising on climate-health linkages, and constitutional recognition of the right to a healthy environment. Health-sector action is incorporated comprehensively, including integration of climate-related health impacts into the National Adaptation Plan, solar photovoltaic electrification of health centres, and prioritization of health within adaptation. The health co-benefits of climate action across sectors are incorporated comprehensively, including improved nutrition and reduced hunger, prevention of climate-related diseases, access to clean water and sanitation, improved public health, and health benefits from reduced air pollution. Action to improve air quality would help to reduce Burundi’s air pollution mortality rate. Economics and finance related to climate and health receive some consideration, with the NDC referencing cost calculations for health adaptation. Download Card The health impacts of climate change are considered comprehensively, recognizing impacts on children’s health and public health and identifying specific risks including waterborne, cardiovascular and respiratory diseases. It also links dust-haze episodes to increasing respiratory impacts and includes efforts to study and quantify the health impacts of extreme heat. Air pollutants receive moderate attention, with references to nitrous oxide, HFCs and fluorinated gases. Integrated governance of climate and health receives some attention, with health mainstreamed into climate policy through references to integrating climate and health considerations into policies and raising public awareness of climate-health linkages. Health-sector action features strongly, including early-warning systems, surveillance for vector-borne diseases, climate-resilient healthcare, integration of climate considerations into health adaptation, and mitigation action through improved management of healthcare waste. The health co-benefits of climate action across sectors receive moderate attention, including protection of public health from heatwaves and the urban heat-island effect, planning for cycling and hiking infrastructure, and strengthened food security. Monitoring and implementation of the health dimensions of climate policies receive some attention, through efforts to study and quantify the health co-benefits of greenhouse-gas emissions reductions. Download Card Cambodia’s NDC places health firmly within its climate response, with a total score of 24. The health impacts of climate change are addressed comprehensively, spanning extreme heat, air pollution, climate-related disasters, displacement, nutrition and mental health, with particular attention to children, outdoor workers and other vulnerable groups. The NDC also quantifies several health-related challenges, including seasonal heat stress among workers and growing volumes of medical waste. Air quality and pollutants are integrated extensively, with references to HFCs, black carbon, particulate matter, nitrous oxide, SF₆ and PFCs, alongside measures to expand air-quality monitoring, provide real-time alerts and health advisories, and phase down fluorinated gases. Integrated governance of climate and health is comprehensive, involving the Ministry of Health in consultation, cross-sectoral implementation and monitoring, promoting public awareness of climate-sensitive health risks, and recognizing the human right to a clean, healthy and sustainable environment. Health-sector action is wide-ranging, encompassing a Health National Adaptation Plan, stronger surveillance and early-warning systems, climate-resilient healthcare facilities, solar-powered clinics, and vulnerability assessments to guide adaptation. Health co-benefits are woven throughout action across sectors, including healthier diets, clean cooking, improved air quality, nutrition, public safety and community wellbeing. Monitoring and implementation are well developed, with concrete targets including training 21,000 healthcare workers, upgrading 100 health facilities for climate resilience and maintaining surveillance at 15 sentinel sites. Economics and finance receive some consideration, with estimated costs of US$1.222 billion for human health and WASH and US$53 million for air quality. Health considerations are also well incorporated into just transition, including attention to health, social protection, vulnerable groups and equitable access to the benefits of climate action. Cambodia records an air-pollution-attributable mortality rate of 164.4 deaths per 100,000 population. Download Card Cameroon acknowledges that climate change triggers diseases, food insecurity, and can cause death and further seeks to address this by health adaptation planning and resilience building of infrastructure. Specifically, Cameroon mentions that there are a number of lives saved or economic losses avoided thanks to early warning systems as an indicator for adaptation actions. While Cameroon states that the government dedicates a majority of financial resources to sectors such as health there is no concrete health adaption plan in place. While Cameroon names a few harmful air pollutants there are no targets to reduce air pollution. The consequences of this can be seen in Cameroon’s relatively high air pollution mortality rate. Download Card Canada comprehensively addresses health co-benefits through specific mentions of protecting a healthy environment for all, reducing pollution from the oil and gas sector, links between biodiversity and well-being, and co-benefits that improve the well-being of Canadians. The NDC also strongly addresses health impacts, through mentions of the climate crisis as an emergency, how health is threatened by the climate crisis, and the impact on health and well-being in general. In addition, the threat the climate crisis poses on food security and access to clean water is noted, alongside the emotional and spiritual toll of witnessing the degradation of lands and the threat and danger posed to the survival of Indigenous communities worldwide is also noted. In regards to health sector action, emergency preparedness and enhancing emergency management and climate resiliency is mentioned. Integrated governance is addressed through references to the Healthy Environment and a Healthy Economy policy, alongside other policies that are incorporated into the NDC. In turn, the NDC notes the importance of safeguarding the well-being of at least seven future generations, recognising the interconnected nature of health with other areas on which First Nations depend on, and demonstrating a commitment to ensuring health and well-being. Canada’s NDC mentions few economic and finance commitments. While the NDC discusses health impacts in depth, its emissions reduction ambition is insufficient to protect health, and is instead aligned with a <3°C world. Notably, there is substantive discussion of different air pollutants within the NDC, and Canada has a relatively low air-pollution mortality rate. Download Card The Central African Republic’s NDC does not adequately address integrated governance, mentioning only the integration of climate and health policies. Health impacts are partially recognized through references to climate-related pressures on human health, including heat stress, heat-related illnesses, and emerging diseases. Adaptation is addressed in greater depth, with plans to integrate low-GWP solar solutions into healthcare and agricultural programs and strengthen epidemiological surveillance and early warning systems, particularly for vulnerable communities. Air pollutants are moderately addressed, with references to fluorinated gases (HFCs, PFCs, and SF₆) and N₂O. Health co-benefits are also acknowledged, including access to safe drinking water and reduced morbidity and mortality from climate-related health impacts. Download Card The health impacts of climate change feature strongly, acknowledging general risks to health and wellbeing as well as specific impacts including mental health effects, cardiovascular and respiratory diseases, infectious diseases, cancer and mortality associated with air pollution. Air pollutants are also addressed strongly, with references to black carbon, short-lived climate pollutants and HFCs, alongside air-quality targets. Integrated governance receives limited coverage, with health identified as a priority area and some recognition of the integration of climate and health, but little detail on cross-sectoral coordination or health-sector involvement. Health-sector action is addressed comprehensively, including a sectoral adaptation plan for health, a mitigation plan to reduce health-sector emissions, and a vulnerability assessment intended to inform national health policies. The health co-benefits of climate action across sectors are also covered comprehensively, including benefits associated with safe drinking water, healthy and safe food, reduced mortality and morbidity, improved air quality, and broader improvements in health and wellbeing. Monitoring and implementation of the health dimensions of climate policies is limited, with health indicators included in the measurement of the economic, environmental and social costs and benefits of climate policies. Economics and finance related to climate and health also receive some coverage, including a calculation of health-related costs, but without broader consideration of health-sector budget allocation, the economic costs of health impacts or return on investment. An estimated US$23.68 million is required to implement the measures included in the Health Sector Adaptation Plan, which reflect currently available institutional capacity and fiscal resources but are not guaranteed future budget allocations. At the same time, Chile records an air-pollution-attributable mortality rate of 34.6 deaths per 100,000 population, while its overall climate ambition is assessed being in line with a <2°C pathway. Download Card Air pollutants feature comprehensively in China’s NDC, with references to nitrous oxide, HFCs, ozone and SF6, alongside measures for air pollution control and prevention and the compilation of integrated air pollutant emission inventories. While the NDC does not describe health impacts, it refers to putting people’s lives first in its climate strategy. Health-sector action receives moderate consideration, with reference to the National Action Plan for Health Adaptation to Climate Change. Health co-benefits of climate action across include references to better quality of life, pollution control, low-carbon lifestyles and healthy habits, as well as improved air quality associated with replacing dispersed coal use with clean heating. China has a relatively high air pollution mortality rate, while its overall climate ambition is in line with a <3°C pathway. Download Card Colombia affirms that moving towards carbon neutrality and resilience by 2050 means protecting life, and that its climate action is also a legal and ethical imperative in defense of life. The NDC mentions the right to health and to a healthy environment. With regard to health impacts, Colombia recognises that the climate crisis is not only an environmental challenge, but also a direct threat to life, health, water, food, housing, and the self-determination of peoples. Specific challenges include malnutrition, dengue and leishmaniasis, as well as displacement due to weather disasters such as storms, floods, droughts and forest fires. Climate related illnesses are placing increasing pressure on public health systems. Knowledge of medicinal plants and health practices provides resilience to diseases exacerbated by climate change when access to formal health services are difficult to access, etc. Air pollution is noted to increase health risks, and cardiovascular and respiratory diseases, effects that disproportionately affect women of reproductive age and children in their care. Colombia seeks to increase adaptive capacity and health resilience to reduce climate-sensitive morbidity and mortality through operational capacity of the health system, early surveillance, management of heat and hydrometeorological events, integrated management of vectors and agents, with a focus on vulnerable populations. By 2030, Colombia will implement adaptation actions in disease prevention and health promotion, which contribute to reducing cases of climate-sensitive diseases in 100% of the entities of the health sector at the departmental, district and municipal levels. Digital tools will enable prediction and monitoring of climate-sensitive diseases such as dengue, malaria, and heat stroke. Colombia works with Health Care Without Harm on mitigation in the healthcare sector. Additional budget for the health sector is anticipated through international cooperation, via PAHO, WHO, GCF, and others, as well as specific funds to strengthen health systems in vulnerable municipalities. The scope of Colombia’s emissions reduction target covers N2O, HFCs, PFCs, SF6. SLCPs are also mentioned, with a dedicated target for black carbon. Colombia will reduce black carbon emissions—excluding forest fires—by between 6,130 and 8,873 tonnes by 2035, relative to 2014 levels. The NDC acknowledges the contribution of GHG mitigation measures to reducing this pollutant and the need to identify additional specific actions for its management. Colombia recognizes that mitigating these SLCPs contributes directly to both public health and the achievement of national and global climate goals. Colombia explicitly links SLCP exposure reduction to a just transition including creation of safer and less polluting jobs through technological reconversion and progressively replacing fuels that generate inequalities in health and well-being in vulnerable rural populations. Colombia promotes community participation in the process of adoption and installation of efficient stoves as part of just transitions. It notes the connections between a just energy transition, ecosystem integrity, and the well-being of communities – broadening citizen participation, improving air quality in urban areas, and contributing to positive peace through the creation of green jobs, social cohesion, and shared responsibility in a just energy transition. In terms of co-benefits, the NDC describes links and actions across sectors, including consumption of healthy, sustainable, and culturally appropriate food and decreasing fertilizer use to protect the health and environment for children and adolescents live; and targets for the transport sector regarding vehicle renewal and sustainable mobility and a National Active Mobility Strategy. Active travel is noted to reduce pollutants and associated risks, protecting health and lives. A 5.5% increase in the modal share of active transport is projected compared to the national baseline. The National Program for the Promotion of Bicycle Use and the participation of at least 17 cities in the country, establishes the need to strengthen knowledge regarding the health impact of poor air quality, developing new studies to determine and measure the association between air pollution and health effects. By 2030 Colombia also plans to implement rainwater harvesting programs to increase the availability of water for irrigation and domestic use in order to reduce the impact of drought periods. Download Card The health impacts of climate change are addressed in considerable detail, with recognition of broader impacts on health and the health sector and specific risks including malaria, malnutrition, waterborne and vector-borne diseases, and mental health impacts. It also links deteriorating air quality and air pollution to respiratory health problems. Air pollutants are well integrated, with references to short-lived climate pollutants, nitrous oxide, HFCs, particulate matter and NOx, complemented by air-pollution monitoring and air-quality indicators. Integrated governance of climate and health is moderately developed, with the Ministry of Health involved in NDC consultations and climate-health considerations incorporated into policies and public-awareness activities. Health-sector action covers a broad range of measures, including stronger health infrastructure, disease surveillance, enhanced healthcare capacity, climate-resilient biomedical waste management, and prioritization of health in adaptation. Health co-benefits are clearly reflected across sectoral action, including reduced waterborne diseases and disease-vector risks, improved food security and infant nutrition, sustainable drinking-water access, reduced exposure to indoor smoke, and improved air quality. Monitoring and implementation of the health dimensions of climate policies receive some attention, through specific indicators for tracking health-sector adaptation. Economics and finance related to climate and health are also considered to some extent, with 10% of adaptation investment, equivalent to 0.65 billion, allocated to health. Health considerations within just transition also receive attention, particularly through strengthened occupational health and safety to support safe and healthy working environments. Comoros records an air-pollution-attributable mortality rate of 76.2 deaths per 100,000 population. Download Card The health impacts of climate change receive moderate attention, linking changing weather patterns and climate vulnerability to public health and identifying specific risks including cholera, waterborne diseases, dengue, malaria, displacement and violence. Air pollutants are moderately represented, with nitrous oxide, HFCs, PFCs and SF₆ specifically identified. Integrated governance of climate and health is also moderately developed, with health identified as a key priority, awareness-raising on climate-health linkages, and recognition of citizens’ right to a healthy, satisfactory and sustainable environment. Health-sector action is extensive, including development of a national health adaptation plan, improved management of medical and hospital waste, environmental assessment of the health sector, and vulnerability and adaptation assessments. Health co-benefits are well reflected across climate action, including contributions to food security, clean water and sanitation, protection of public health and safety, and reduced health risks. Economics and finance related to climate and health are moderately addressed, with public-health costs from climate-related diseases projected to reach US$260 million by 2050 and health-sector funding needs estimated at US$41.53 million. The Republic of the Congo records an air-pollution-attributable mortality rate of 162.1 deaths per 100,000 population. Download Card The health impacts of climate change are addressed in considerable detail, including risks to essential health, water and sanitation services, food security and human life. The NDC also quantifies impacts from hydrometeorological events, including deaths associated with landslides, floods and flash floods. Air pollutants are well integrated, with references to nitrous oxide, black carbon and SF₆, alongside quantified measures to reduce black carbon emissions and HFC consumption and transition toward lower-emission technologies. Integrated governance of climate and health is moderately developed, linking climate policy with wellbeing, human rights and social justice and aligning climate action with instruments including the National Health Policy. Health-sector action is extensive, encompassing epidemiological prevention, inclusive healthcare, environmental and population monitoring, climate-resilient essential health services, and adaptation planning, alongside mitigation measures such as energy-efficient cooling in hospitals. Health co-benefits are embedded across mitigation action, particularly in transport, urban planning, biofuels and waste management, with anticipated benefits including reduced pollution, improved health and quality of life, and healthier urban environments. Monitoring and implementation of the health dimensions of climate policies receive moderate attention, including environmental and urban-health monitoring and targets for access to safe drinking water, as well as consideration of physical and mental health within non-economic assessments of disaster impacts. Health considerations within just transition are moderately incorporated, linking decarbonization with collective wellbeing and social inclusion and recognizing health benefits from lower-polluting fuels. Download Card The health impacts of climate change are considered comprehensively, recognizing threats to public health, health infrastructure and sanitation and identifying specific risks including malaria, diarrhoeal diseases, acute respiratory infections and malnutrition. It also links air pollution to health impacts and quantifies several climate-related risks, including deaths from flooding, malaria incidence, childhood stunting and projected population exposure to heatwaves. Air pollutants are incorporated comprehensively, with references to nitrous oxide, HFCs and SF₆, measures addressing air pollution from waste, and targets and monitoring related to HFCs and other emissions. Integrated governance of climate and health receives moderate attention, with the Ministry of Health contributing to the NDC and health incorporated as a cross-cutting priority in climate analysis and national policies. Health-sector action is incorporated comprehensively, including surveillance and prevention of climate-sensitive diseases, occupational health and safety measures addressing heat stress and biological risks, renewable energy in healthcare facilities, climate-resilient health infrastructure, and prioritization of health in adaptation. The health co-benefits of climate action across sectors feature strongly, including improved food security, reduced morbidity and mortality, pollution prevention and improved quality of life. Monitoring and implementation of the health dimensions of climate policies receive some attention, with targets for epidemiological surveillance coverage, equipped health centres, detection of climate-sensitive disease outbreaks, and reductions in associated cases and mortality. Economics and finance related to climate and health receive consideration, with health-sector costs estimated at approximately US$3.125 billion in conditional finance and US$1.79 million in unconditional finance. Côte d’Ivoire records an air-pollution-attributable mortality rate of 146.9 deaths per 100,000 population. Download Card Cuba strongly addressed actions by the health sector within its NDC, through mentions of surveillance and early warning systems for health and vulnerability assessments to guide health actions. Health impacts are acknowledged by mentioning the Constitution of the Republic of Cuba, which was adopted in 2019 and promotes the protection and conservation of the environment and the fight against climate change, which threatens the survival of the human species, and discussion around climate events having direct impacts on water resources, agriculture, human health and other fundamental ecosystems, but in very little detail. Cuba’s NDC doesn’t meaningfully address health co-benefits. In addition, the NDC moderately acknowledges air pollutants through general references and specifically naming N2O, which is a vital part of planning actions. In regards to integrated governance, this is mentioned through discussion on policy that integrates health and quality of life and climate as a guiding policy, but coverage is incomplete. Notably, Cuba acknowledges its vision for a just transition encompasses generating benefits for all of society, with particular attention to gender considerations, children and youth, and including the development of green jobs and the One Health approach, but again in little detail. Download Card The health impacts of climate change are addressed in considerable detail, linking climate trends to health and wellbeing and identifying specific risks including heat stress, vector-borne diseases, mental health impacts and loss of life, alongside institutional monitoring of health and wellbeing impacts. Air pollutants receive moderate attention, with nitrous oxide, HFCs, SOx, NOx and particulate matter specifically identified. Integrated governance of climate and health is well established, with the Ministry of Health consulted on the adaptation component of the NDC, health identified as a priority sector, and constitutional recognition of the right to a healthy and safe environment. Health-sector action is well developed, encompassing measures to strengthen health-system resilience, surveillance and early-warning systems, as well as commitments to update and expand health-sector vulnerability and adaptation assessments. Health co-benefits are embedded across a broad range of climate actions, including active mobility, safe sanitation, reduced gastrointestinal illness and disease-vector risks, improved nutritional security and wellbeing, and health gains from reduced air pollution and improved air quality. Economics and finance related to climate and health receive some consideration, with cost estimates provided for several health-sector actions, including measures to strengthen resilience. The Dominican Republic records an air-pollution-attributable mortality rate of 54.9 deaths per 100,000 population. Download Card Ecuador’s NDC aims to become a mechanism that contributes to the achievement of the 17 Sustainable Development Goals. The Constitution of Ecuador particularly recognizes the importance of protecting the environment and guaranteeing people’s rights to live in a healthy environment. Ecuador acknowledges that climate change presents a multifaceted challenge, primarily affecting agriculture, infrastructure, natural heritage, and public health sectors. Increases in diseases and epidemics have been observed, as well as an expansion in the distribution of disease vectors, which exacerbates pre-existing problems like access to water, sanitation, and nutrition. Ecuador’s adaptation planning and policy has health as a top priority, with plans to guarantee the availability of water resources, to strengthen the health response in situations related to disease, to implement infrastructure to address floods and landslides, and to strengthen food resilience. Air pollution is addressed through mentions of N2O, HFCs, PFCs, SF6, NOx, SO2, VOCs, and CO. Ecuador plans to adopt cross-cutting measures for the mitigation of climate change by limiting greenhouse gas emissions and therefore the greenhouse effect. Download Card El Salvador’s NDC makes limited mentions of health and improving wellbeing as key priorities. Health impacts, such as the health sector facing challenges from climate change, weather impacting health, and diseases (thermal, respiratory, cardiovascular, vector borne) are recognized. The National Plan for Adaptation includes projects aimed at epidemiological surveillance and health risk management. Air pollutants are strongly addressed through mentions of N2O, HFCs, PFCs, SF6 and NF3. Air quality monitoring is mentioned but is not a key focus. Download Card Eswatini’s NDC mentions integrating climate change into national health policies several times. The Ministry of Health (MoH) will be part of the National Climate Change Executive Committee driving NDC implementation. Health impacts are acknowledged but with little detail. There is strong discussion of actions to be implemented in the health sector, such as climate-informed disease surveillance and control programs, capacity building in healthcare, and multiple waste management plans in healthcare systems to reduce emissions. In terms of air pollutants, HFCs, N2O, SCLPs, Black Carbon, PM, VOCs, CO are mentioned but the emissions reduction ambition is insufficient to protect health. Co-benefits are addressed strongly through multiple mentions of how general health benefits of climate actions, specifically improved nutritional security and healthy eating, reduced mortality, and reduced impacts of vector borne diseases or weather events. Download Card The health impacts of climate change are moderately addressed, recognizing growing threats to health from climate-sensitive diseases and identifying malaria, cholera, waterborne diseases and yellow fever among the risks associated with changing climatic conditions. Integrated governance of climate and health is acknowledged, with health and associated benefits identified among the key goals of the NDC. Health-sector action is well developed, encompassing climate-resilient health infrastructure, training for health professionals, strengthened disease surveillance, and the use of clean and renewable energy to provide low-carbon power for healthcare facilities. Health co-benefits are incorporated across adaptation measures, including reduced waterborne and climate-related diseases, active mobility, and improved access to safe drinking water. Monitoring and implementation include measurable health-related targets, notably a 35% reduction in climate-related diseases such as malaria, yellow fever and cholera by 2035, alongside expanded sanitation and climate-resilient water services. Economics and finance are reflected through dedicated adaptation and mitigation budgets for social and health measures, rising from ETB 1.67 billion in 2023/24 to ETB 3.80 billion in 2024/25. Ethiopia also records an air-pollution-attributable mortality rate of 139.9 deaths per 100,000 population. Download Card The European Union NDC recognises the human right to a healthy environment, and commits to engage in discussions advancing this right. The first-ever European Climate Risk Assessment (EUCRA), published in 2024, identified and assessed 36 major climate risks, including to health, and the European Commission’s communication in response notes that poor health heightens vulnerability to climate risks. The EU seeks to address health in its policies, with health included as a sectoral focus in the European Union Green Deal, while the stated aim of the Farm to Fork Strategy is to make food systems fair, healthy and environmentally friendly. Meanwhile, the Industrial Emissions Directive seeks to minimise the impact of pollution on people’s health and the environment by reducing harmful industrial and intensive livestock emissions across the EU. Health opportunities of nature-based solutions are described, and a map has been produced to assess reduction of Urban Heat islands for the 775 urban areas across the EU. The health co-benefits of improved air quality resulting from a predominantly fossil free energy sector well in advance of 2050 are also noted. N2O, HFCs and SF6 are all included in the scope of the emissions reduction target, and the EU F-gases Regulation introduced stricter restrictions for the use of HFCs, with legally binding commitment to fully phase out HFCs by 2050. Unfortunately, the EU’s climate ambition is in line with a <3°C world, making significantly increased health impacts likely. Download Card Fiji addresses health impacts and actions by the health sector in depth, through reflections on its commitment to addressing the climate crisis and its ongoing resolve to build lasting resilience in the face of increasing threats to its way of life. The NDC mentions exposure to rising sea levels, coastal erosion, changing rainfall patterns, and intensified hydrometeorological events, which threaten ecosystems, infrastructure, food security, and human health. Identified impacts include heat exposure; loss of nutritional content due to reduced agricultural and fishing productivity, favourable conditions for mosquito breeding, and water and sanitation issues following disasters and during periods of heavy rainfall and drought. Specific health impacts include water security and safety issues, including an increased incidence of water-borne diseases, health impacts arising from climate-related food insecurity, increased drivers of NCDs, increased risks of vector-borne diseases, increased risks of zoonoses, and an increased burden on under-resourced health systems. Specific actions are outlined through commitments to building a strong, climate-resilient healthcare system and recognising the growing direct and indirect impacts of climate change on human health. These include implementing Fiji’s Health Adaptation Plan (FHAP) and delivering climate-resilient water and sanitation services for all, in line with the objectives of Fiji’s National Development Plan and the Water Authority of Fiji’s Water Sector Strategy 2050. Efforts to build the resilience of health services include objectives to reduce fuel costs, improve energy security, and increase energy efficiency and reliability through the use of renewable energy, as well as building design solutions that support natural airflow and cooling. In addition, health co-benefits are addressed clearly through references to sustainable agriculture, empowering youth and women, enhancing food security, and ensuring that the sector delivers multiple SDG co-benefits, including gender equality, resilient livelihoods, and strengthened community well-being. The NDC also mentions the need to enhance infrastructure resilience by upgrading, repairing, relocating, and constructing public infrastructure through an inclusive, equitable, risk-informed, and ecosystem-sensitive approach. This approach aims to ensure the continuous operation of essential services, safeguard community well-being, and promote environmental sustainability. Fiji recognises air pollutants within its NDC, with references to specific air pollutants however, coverage remains incomplete. Monitoring and implementation mechanisms are strongly recognised through discussions on improving disaster risk management and recovery, as well as increasing the percentage of new or retrofitted schools, health posts, and evacuation centres in rural and maritime areas. In terms of integrated governance, this is moderately acknowledged through references to developing health and climate research. Download Card France’s annex to the EU NDC integrates health to a small extent, with a total score of 3. Air pollutants are explicitly covered, with nitrous oxide, SF₆, HFCs and PFCs specifically identified, while health co-benefits receive some consideration through the promotion of active transport. Download Card The health impacts of climate change receive moderate attention, recognizing growing health risks from heatwaves and specific impacts including increased cardio-respiratory risks and the spread of waterborne and vector-borne diseases associated with flooding. Air pollutants are considered moderately, with references to nitrous oxide, HFCs and SF6. Integrated governance of climate and health features strongly, with the Ministry of Health participating alongside other sectoral ministries in national climate coordination, health mainstreamed into sectoral policies and action plans, and health explicitly integrated into the scope of the NDC. Health-sector action is strongly represented, including the development of a National Action Plan for health and vulnerability and adaptation assessments, with health identified as a key sector for adaptation. The health co-benefits of climate action across sectors are incorporated comprehensively, including improved food security, reductions in air and water pollution, prevention of climate-related diseases, and health benefits associated with action in waste, energy and urban planning, alongside broader benefits for public health and community resilience. Monitoring and implementation of the health dimensions of climate policies receive some attention, through planned health-sector actions including mosquito-net distribution, vector-control measures, rehabilitation and equipping of health centres, and staff training. Economics and finance related to climate and health also receive some consideration, with a specific allocation of 39.55 billion CFA francs for the health sector. Download Card The health impacts of climate change are moderately reflected, with general recognition of climate-related health impacts and reference to research on the climate-health nexus. Air pollutants are moderately represented, with ozone, nitrous oxide, HFCs, PFCs, SF6 and NF3 specifically identified. Integrated governance of climate and health features to some extent, through recognition of the right to a safe and healthy environment within a human-rights-based approach to climate adaptation. Health-sector action features strongly, including measures to enhance health-sector resilience, early-warning, monitoring and risk-management systems for health, and vulnerability assessments of the health system, which is identified as a vulnerable sector. Download Card The health impacts of climate change receive moderate attention, recognizing pressures on health and healthcare and identifying specific risks including malaria, diarrhoea, meningitis and respiratory infections. Air pollutants are moderately represented, with references to nitrous oxide, HFCs and other fluorinated gases, including PFCs, SF₆ and NF₃. Integrated governance of climate and health is moderately developed, with the Ministry of Health involved in the participatory process and interministerial steering of adaptation priorities, alongside public awareness of climate-health linkages and the inclusion of health as a new priority sector in NDC 3.0. Health-sector action is addressed extensively, including refinement of a sectoral health strategy alongside the National Adaptation Plan, climate-vulnerability and risk assessments, and mitigation measures such as energy audits and solar microgrids for healthcare facilities to reduce reliance on fossil fuels. The health co-benefits of climate action are acknowledged to some extent, through general recognition of benefits for health. Guinea also records an air-pollution-attributable mortality rate of 209.2 deaths per 100,000 population. Download Card Guyana mentions cleaner water and sanitation in alignment with Sustainable Development Goal 6. SDG 6 is the United Nations pledge to ensure availability and sustainable management of clean water and sanitation for all by 2030. Guyana understands the importance of access to clean water and sanitation and how this can directly affect health. Although there is no specific action plan, Guyana hopes to phase down hydrofluorocarbons (HFCs), to align with the Kigali Amendment to the Montreal Protocol. Guyana has a moderate rate of air pollution mortality in comparison to other countries, which would benefit from a specific action plan to reduce HFC emissions. Download Card The Holy See’s NDC scores one point, with health considerations confined to the identification of HFCs as an air pollutant and no broader integration of health across the dimensions assessed. Download Card Honduras primarily mentions health through action by the health sector, where health/healthcare is named as one of five strategic pillars of the adaptation component. The NDC includes commitments to updating and approving the Health Sector Climate Change Adaptation Strategy by 2030, including strengthening health infrastructure, training for healthcare workers, and prevention and resopnse planning. It also includes commitments to strengthening the National Health Surveillance System by 2035, including a module on climate-sensitive diseases. Additionally, they recognise health co-benefits such as reduced risk of climate-sensitive diseases, impoved urban air quality, and increased activity through improving public transport, walking, and cycling infrastructure. While the NDC names N2O, VOCs, and specific steps to phase down HFCs, it lacks official air quality targets or monitoring measures. Consequently, it continues to experiences high air pollution mortality rates. Download Card Iceland recognises air pollutants within its NDC, and there is some substantive discussion, including mentions of specific air pollutants such as N2O, SF6, NF3, PFCs, and HFCs, which is good as this is a key part of planning actions. However, coverage remains incomplete. Notably, the NDC does not meaningfully address health impacts, health co-benefits, or action by the health sector. Download Card India’s approach seeks to balance its development priorities with climate resilience, reducing emissions intensity while enhancing adaptive capacity in vulnerable sectors including health. However, Climate Action Tracker assesses India’s NDC as being in line with <3°C warming. India’s NDC seeks to better adapt to climate change by enhancing investment in development programmes in sectors vulnerable to climate change, including health. The National Action Plan on Climate Change (NAPCC) comprises nine focus areas, including human health. In considering technological needs, India highlights health as being especially vulnerable. India promotes “a healthy and sustainable way of living based on traditions and values of conservation and moderation, including through a mass movement ‘Lifestyle for Environment’.” Health impacts and health co-benefits are not meaningfully addressed within the NDC. India’s limited discussion on health is reflected in its emissions reduction ambition, which is insufficient to protect health. The NDC does not mention air pollutants, which is notable given the high air pollution death rate. Download Card Indonesia recognises that climate change has an impact on increasing extreme climate events and natural disasters that lead to loss and damage to priority sectors including health. Health is recognised as a priority sector for adaptation. The NDC describes actions in the health sector such as updated assessments of climate change impacts, vulnerabilities and risks; development of simultaneous climate systematic observation information services; and improving the capacity of stakeholders related to health outcomes, health services, and health systems. The Ministry of Health operates a dedicated tool, “APIK” (Adaptation of Climate Change on Health). The NDC includes N2O and HFCs in the scope of its emissions reduction and outlines sources and actions for their mitigation, but continues to bear a substantial burden of air pollution mortality. Notably, Indonesia has succeeded in removing fossil fuel subsidies to create fiscal space for education, health, and other public goods. A section of Indonesia’s NDC is dedicated to just transition, including enhancing participatory public dialogue to foster high employment rates, adequate social protection, labour standards and wellbeing of workers and their communities. Indonesia recognises the right to enjoy a good and healthy environment and the right to health. Attention to mitigation is also key to ensure that the limits of adaptation are not exceeded, but Indonesia’s emissions reduction target is not compatible with the Paris Agreement, but rather, in line with <4°C of warming, with catastrophic implications for human health. Download Card Iraq recognizes health impacts within its NDC. Specifically, Iraq examines the relationship between various climate disasters and the risks they impose on health. For example, there are numerous mentions of water-borne diseases as well as heat-related illnesses. Iraq further mentions how these challenges pose serious risks to food security, public health, and infrastructure. Iraq hopes to combat these issues by conducting comprehensive and inclusive climate change and health vulnerability and adaptation assessment at the national or subnational level. Including the development and adoption of Health Adaptation Action Plan. Iraq mentions air pollutants a substantial number of times within its NDC, however, there is no further action plan to try to reduce or monitor these pollutants. These policies real-world effect can be seen through its significant air pollution mortality rate. Download Card Jamaica recognises air pollutants within its NDC and there is substantive discussion with specific mentions of different air pollutants including N2O and HFCs, which is a vital part of planning actions. However, health impacts, health co-benefits, and action by the health sector isn’t meaningfully addressed with the NDC. Download Card Japan includes N2O, HFCs and SF6 in the scope of its emissions reduction target, but points were not allocated in any other categories. Unfortunately, according to Climate Action Tracker, Japan’s climate ambition is in line with a <3°C world. Download Card Jordan discusses action by the health sector in depth, including efforts to embed resilience-building into water, energy, and health systems, which have contributed to Jordan becoming a regional leader in climate security. In addition, its NDC acknowledges the national strategy for health-sector adaptation to climate change, embedding climate resilience into service delivery. This includes gender-responsive planning, the expansion of early-warning systems for climate-related health risks, and infrastructure upgrades designed to withstand climate-related events including extreme heat and flooding. Health co-benefits are mentioned through references to the rollout of green infrastructure projects and nature-based solutions, which can mitigate heat-island effects, improve livability, and deliver co-benefits for both mitigation and adaptation, but in very little detail and the health impacts of climate change are not meaningfully addressed at all. Download Card The health impacts of climate change feature strongly, recognizing threats to health, wellbeing, lives and livelihoods and identifying specific impacts associated with floods, drought, extreme heat and water shortages, including psychological distress and risks to vulnerable populations such as children, older people and people with health conditions. The NDC also references quantitative evidence on climate impacts, including population displacement caused by flooding. Air pollutants are strongly represented, with references to black carbon, short-lived climate pollutants, nitrous oxide, particulates, HFCs, PFCs, SF6 and NF3, alongside measures expected to reduce urban air pollution, including electric vehicles, energy efficiency and public transport. Integrated governance of climate and health receives limited attention, with health mainstreamed into climate policy through references to safeguarding people’s wellbeing and the wellbeing of present and future generations, but without further detail on mechanisms for integration. Health-sector action is strongly present, through resilience and preparedness measures including resilient healthcare facilities, early-warning and monitoring systems, epidemiological surveillance, emergency risk reduction planning and cooling centres, as well as vulnerability assessments informing sectoral adaptation planning. The health co-benefits of climate action across sectors are incorporated comprehensively, including public health benefits from transport electrification, public and active mobility, building cooling measures and improved air quality, alongside broader benefits for health and wellbeing. Economics and finance related to climate and health receive some consideration, with costs identified for health adaptation actions and targets. Download Card Kenya strongly addresses health impacts and action by the health sector within its NDC through acknowledgment of heat, droughts, and floods as climate hazards that are negatively impacting lives, livelihoods, and national economic stability, mention of the 2018 floods, which resulted in the loss of human lives, displacement of over 230,000 people, and destruction of infrastructure, and discussion of the impact of extreme drought on women and girls, with some often walking up to 30 kilometers in search of water and firewood, increasing their exposure to gender-based violence. Actions include enhancing climate-resilient health systems by decreasing climate change-induced health threats through improving accessibility and strengthening disease surveillance, prevention, response, and management, as well as providing timely and affordable health services for all. Health co-benefits are recognised, and there is substantive discussion of implementing Climate Smart Agricultural practices to increase productivity and increase sustainable access to adequate nutritional food for all, but in very little detail. In regard to integrated governance, there is some substantive discussion within the NDC, through mentions of Kenya aspiring to be a newly industrialising, middle-income country providing a high quality of life to all its citizens by 2030 in a clean and secure environment. In addition, the NDC acknowledges the Constitution of Kenya (2010), which provides the foundation for implementation of climate change actions through its Bill of Rights provisions, especially the right of all to a clean and healthy environment. Notably, Kenya’s NDC clearly recognises health impacts and action by the health sector, and this is reflected in its emissions reduction ambition, which is almost sufficient to protect health. Download Card Lebanon addresses in depth action required by the health sector. This is evident in its National Adaptation Plan which clearly mentions the health sector. There are also significant mentions of resilience and preparedness planning. Notably, the NDC also discusses reducing GHG emissions through energy efficiency within the health sector. General health co-benefits are also clearly mentioned, with the NDC specifically noting improving public health through air quality. Lebanon strongly recognises the relationship between climate change and health with multiple health impacts mentioned, including heat-related illnesses, waterborne diseases, respiratory diseases. The NDC assesses both population and public health vulnerability to climate change, identifying current health effects and future scenarios. There is moderate discussion on integrated governance. Although air pollutants are recognised, Lebanon has a moderate air pollution mortality rate. Download Card Liberia significantly recognizes the impact of climate change on health. Liberia mentions malaria, cholera, respiratory infections, and heat stress a significant amount as it relates to climate-induced health impacts. They justify these health impacts with research on the relationship between climate and health. Furthermore, Liberia also aims to add a 500,000 budget increase to health-climate nexus research. Liberia also mentions ways to implement this knowledge into health care and climate policy. Specifically, emission free to low carbon healthcare waste management. Liberia has a few mentions of air pollution within its NDC and has a relatively high air pollution mortality rate. The country only mentions installation of a national air quality monitor and air quality sensors as a potential way to combat this issue. Download Card The health impacts of climate change receive moderate attention, recognizing impacts on health systems, increased care burdens and population vulnerability, alongside specific risks including heat stress and threats to food security. Air pollutants are considered moderately, with nitrous oxide and HFCs specifically identified. Integrated governance of climate and health features strongly, with the Ministry of Health contributing to the design of adaptation measures and participating in the NDC approval process, references to cross-sectoral enablers and coordination involving health, and health identified as a priority sector alongside health-related Sustainable Development Goals. Health-sector action receives moderate attention, through measures focused on climate-resilient infrastructure and early-warning systems for health. The health co-benefits of climate action across sectors feature strongly, including specific benefits related to improved quality of life, food security and safer infrastructure, alongside broader benefits for health and the protection of public health. Economics and finance related to climate and health receive some consideration, with cost estimates for adaptation measures, including measures in the health sector. Health considerations within just transition are strongly represented, with the just energy transition explicitly linked to improvements in air quality and health. Download Card Liechtenstein recognises air pollutants within its NDC and there is substantive discussion with specific mentions of different air pollutants including N2O, HFCs, SF6, and NF3, which is a vital part of planning actions. However, health impacts, health co-benefits, and action by the health sector isn’t meaningfully addressed with the NDC. Download Card The health impacts of climate change are addressed in considerable detail, including risks to health and the health sector from malnutrition, maternal mortality, heat stress and heat-related illness, alongside recognition of indoor and outdoor air pollution as contributors to ill health and mortality. Air pollutants are well integrated, with references to short-lived climate pollutants, nitrous oxide, HFCs, black carbon and ozone, as well as recognition of air pollution as a pressing concern. Integrated governance of climate and health is moderately developed, with the Ministry of Health assigned responsibility for multiple adaptation measures and health identified as a key sector. Health-sector action spans a broad range of measures, including early-warning systems, disease surveillance, safer medical-waste management and adaptation measures addressing health-sector vulnerability. Health co-benefits are embedded across climate action, including improved nutritional security, reduced morbidity and mortality, enhanced public health and safety, and health gains from improved air quality. Economics and finance related to climate and health are moderately addressed, with an estimated US$134 million required for health-sector actions, alongside investment in healthcare facilities and climate-change focal points within the health sector. Malawi records an air-pollution-attributable mortality rate of 153.3 deaths per 100,000 population. Download Card The Maldives strongly addresses air pollutants within its NDC, with mentions of specific air pollutants throughout. Action by the health sector is also strongly recognised through mentions of the comprehensive Integrated Vector Management framework and building the capacity of national health institutions to undertake scientific research on local vectors and subsequent vector control efforts, in addition to mentions of the need for climate-proofing of health infrastructure, integrating renewable energy into health facilities, and addressing health emergencies during extreme weather events. There is substantive discussion of the impact of climate change on public health, including changes in rainfall patterns, increased prevalence of water- and vector-borne diseases, and extreme heat events, which cause significant health impacts, and acknowledgement of forecasted increases in extreme weather events having the potential to disrupt access to emergency services, unless anticipatory action plans are put in place to ensure health facilities can remain operational during and after exposure to climate hazards. On the other hand, co-benefits are not meaningfully addressed. In regards to integrated governance, this is mentioned through discussion of the need for urgent support to implement policies which mitigate climate risks and integrate adaptation planning. Notably, the Maldives clearly addresses air pollutants within its NDC, and this is reflected in national air pollution death rates, which are relatively low. Download Card Malaysia strongly recognises health sector action, with specific mentions of measures including improving public health resilience, creating a climate-health early warning system, and conducting climate-health vulnerability assessments. Health impacts and health co-benefits are recognised and there is substantive discussion regarding the risk the climate crisis poses to human health and well-being, heat and food security, and nature-based solutions. There was substantive discussion on air pollutants within the NDC, although Malaysia has a moderate mortality burden attributable to air pollution. Integrated governance is acknowledged through mentioning the way in which health and health-relevant themes are integrated into policy priorities. Download Card Marshall Islands strongly addresses health co-benefits and actions by the health sector in its NDC, through mentions of the need to achieve its climate change targets, greening the electricity sector to improve affordability, energy efficiency, energy security, reliability of service, and quality of life and being fully committed to managing waste from all sources and reforming the waste sector, in order to safeguard the health of the environment and communities and reduce associated greenhouse gas emissions, and mentions of increasing locally produced food to ensure healthier diets for the household and in the long term contribute to decreasing incidence of non-communicable diseases. Detailed actions are documented in its NAP to guide all institutions. Health impacts are recognised through mentions of king tides eating away at the shorelines, storms have destroyed schools and homes, communities have faced drought and food shortages, climate change-related dengue fever outbreaks have strained our healthcare systems and the communities safety, health, culture, way of life, and human rights are at risk. In addition, the NDC acknowledges the full and universal implementation of the Paris Agreement is of utmost importance to the Marshall Island’s security, the health and safety of its people, and humanity’s future. In regards to integrated governance, this is mentioned through discussion of aims to provide a brighter, healthier, more secure future for the country and to be a good global citizen as an exemplar in meeting our international obligations and the promises we have made to others, but coverage is incomplete. Air pollutants are mentioned, but in very little detail. Download Card The health impacts of climate change feature strongly, recognizing risks to human health and the health sector and identifying specific impacts including vector-borne diseases, respiratory illnesses and other climate-related health disorders. Air pollution is also recognized as a health risk, including for schoolchildren and their families. Air pollutants feature strongly, with references to nitrous oxide, NO₂ and SO₂, alongside an air-pollution measurement programme. Integrated governance of climate and health receives moderate attention, including intersectoral coordination between health, nutrition, water and sanitation, as well as integration of health-related Sustainable Development Goals into the NDC and heat-health planning within education. Health-sector action features strongly, including the creation of a national health-sector adaptation programme, prioritization of health within adaptation, and planned vulnerability and adaptation assessments. The health co-benefits of climate action across sectors are strongly represented, including improved food security and nutrition, active transport, safer drinking water, improved public health and quality of life. Monitoring and implementation of the health dimensions of climate policies receive moderate attention, through a monitoring and evaluation framework for health-system resilience and targets to reduce morbidity and mortality associated with specific actions. Economics and finance related to climate and health receive some consideration, with an estimated US$7.39 million required for health-sector adaptation. Mauritania records an air-pollution-attributable mortality rate of 158.3 deaths per 100,000 population. Download Card Mauritius strongly addresses health impacts, health co-benefits, and action by the health sector within its NDC, through mentions of impacts, including heat stress, vector-borne diseases, water-borne diseases, and co-benefits such as walking and cycling to improve well-being. It also references the National Adaptation Plan for the health sector and the greening of the health sector through the installation of solar panels to reduce emissions. Different air pollutants are also clearly specified within the NDC, in addition to mentions of general negative air pollution. However, this isn’t reflected in Mauritius’s air pollution mortality rate which is relatively high. Integrated governance is recognised through mentions of integrating health with climate policy and mentions of a right and dignified environment for all, but coverage inadequate. Download Card The health impacts of climate change are considered comprehensively, recognizing general impacts on public health and the health sector alongside specific risks including increased mortality, gender-based violence, zoonotic diseases and pathogens, mental health impacts, and health risks associated with poor air quality. Air pollution is explicitly identified as a health risk, and the NDC references strengthened research networks examining human health impacts associated with climate change, including air pollutants, food and water security, and environmental determinants of health. Air pollutants feature strongly, with references to black carbon, sulphur oxides, PFCs, HFCs, nitrous oxide, NF3 and SF6, as well as deteriorating air quality and air pollution. Integrated governance of climate and health receives moderate attention, with health considered as an axis of climate policymaking, public dissemination of knowledge on climate and health, and recognition of the human right to a healthy environment. Health-sector action is strongly represented, through resilience and preparedness measures including capacity building, protocols and epidemiological surveillance, as well as measures to strengthen health infrastructure resilience and evaluate medical infrastructure to promote safe, green and resilient spaces. The health co-benefits of climate action across sectors are incorporated comprehensively, including specific benefits from cycling and active transport and from reducing air pollution and black carbon, alongside broader benefits for public health. Monitoring and implementation of the health dimensions of climate policies are not addressed. Economics and finance related to climate and health receive some consideration, through investment in infrastructure reconstruction that meets basic needs, including health. Mexico records an air-pollution-attributable mortality rate of 47.9 deaths per 100,000 population, while its overall climate ambition is assessed as critically insufficient for a pathway above 4°C Download Card Monaco strongly recognises air pollutants within its NDC, with specific mentions of different air pollutants, including N2O, HFCs, SF6, and NF3, which is a vital part of planning actions. This is reflected in Monaco’s air pollution mortality rate, which is relatively low. Both health impacts and health co-benefits are addressed within the NDC through substantive discussion on Chikungunya, which is now being considered a “re-emerging” disease, and climate projections showing an increase in the number of months where conditions are favorable to virus transmission. Co-benefits such as the reduction of kilometers traveled using individual motorised transport, and acknowledgement of many positive impacts, such as quality of life, jobs, and innovation, are also mentioned. The NDC recognises that they must be shared and require a commitment from everyone. Improving the environment and quality of life for residents, the social need for connection to nature, reducing vulnerability to natural risks, and adapting the Monegasque territory to climate change are also mentioned. The NDC doesn’t meaningfully address actions by the health sector. In regard to integrated governance, Monaco pays particular attention to how climate change affects human health and threatens the fundamental right of individuals to live in a healthy, clean, and sustainable environment. Economics and finance mechanisms are mentioned through references to a portion of its international funding going to organisations working to combat the harmful effects of climate change, including the World Health Organization, through its strategic priority B3, and the Climate and Clean Air Coalition. Download Card The health impacts of climate change are addressed comprehensively, connecting extreme weather and changing climate conditions with loss of life and livelihoods, reduced access to healthcare and safe drinking water, cardiovascular disease, mental health impacts, and risks to workers and their productivity. The NDC also draws on data on heatwaves, hot days, mortality and cardiovascular impacts, while recognizing the health implications of worsening urban air pollution. Air pollutants are moderately represented, with nitrous oxide and black carbon specifically identified. Integrated governance of climate and health receives some consideration, including public awareness and recognition of health among sectors requiring climate finance. Health-sector action is moderately incorporated, with health established as a key sector and goal within adaptation planning. Health co-benefits are acknowledged to some extent, particularly through improved access to quality water associated with better urban planning and more sustainable lifestyles. Monitoring and implementation are moderately developed, including expanded data collection and research on climate-related diseases as part of health surveillance. Mongolia records an air-pollution-attributable mortality rate of 124.9 deaths per 100,000 population. Download Card Montenegro recognises air pollutants within its NDC and there is substantive discussion with specific mentions of different air pollutants including N2O, HFCs, SF6, and NF3, which is a vital part of planning actions. This is reflected in Jamaica’s air pollution mortality rate which is relatively low. Integrated governance is acknowledged through mentions of the right to a clean, healthy and sustainable environment being a human right, but in little detail. However, health impacts, health co-benefits, and action by the health sector isn’t meaningfully addressed with the NDC. Download Card The health impacts of climate change are addressed in considerable detail, with general risks to health accompanied by specific concerns around increased vector-borne, waterborne and foodborne diseases, as well as recognition of the health impacts of black carbon emissions. Air pollutants receive moderate attention, with black carbon, nitrous oxide and HFCs specifically identified. Integrated governance of climate and health receives some attention, with health identified as a key sector within the NDC. Health-sector action is moderately developed, including measures to strengthen healthcare capacity and disease surveillance. Health co-benefits are embedded across a broad range of climate actions, including safer drinking water, increased walking and cycling, measures to safeguard public health and protect lives, and improved health through reduced household air pollution. The Federated States of Micronesia records an air-pollution-attributable mortality rate of 148.2 deaths per 100,000 population. Download Card The health impacts of climate change receive some recognition, through acknowledgement that climate change is affecting people’s lives. Air pollutants are well represented, with nitrous oxide, fluorinated gases and SF₆ specifically identified, alongside recognition of the country’s air-quality challenges. Integrated governance of climate and health is reflected to some extent, with health included as a cross-cutting theme in the development of the NDC. Mozambique records an air-pollution-attributable mortality rate of 129.1 deaths per 100,000 population. Download Card The health impacts of climate change feature strongly, recognizing impacts on health services, climate-related illnesses and pressure on healthcare facilities, as well as specific consequences including loss of life, displacement and threats to food security. The NDC also quantifies impacts from hydrometeorological and climate-related disasters, including the numbers of people affected and deaths associated with floods and storms. Air pollutants are strongly represented, with references to short-lived climate pollutants, HFCs, nitrous oxide, NOx, SOx and VOCs, alongside measures to reduce air pollutants from vehicles. Integrated governance of climate and health receives some attention, with health mainstreamed into climate policy through references to multisectoral approaches to health and wellbeing and the integration of health and occupational safety into climate policies. Health-sector action features strongly, with health identified as a priority sector for adaptation and measures aimed at strengthening health-system resilience and preparedness, supporting healthcare provision in vulnerable rural areas, and assessing vulnerability and adaptation needs. The health co-benefits of climate action across sectors are incorporated comprehensively, including benefits for food security, road safety, thermal comfort, air quality and public health, with health benefits linked to measures in areas such as transport, forestry, methane mitigation and urban green spaces. Monitoring and implementation of the health dimensions of climate policies feature strongly, including targets for water quality, sanitation and drinking-water supply, as well as an integrated climate and health system based on the collection of climate and health data. Economics and finance related to climate and health are strongly represented, with quantified economic losses from climate hazards, costs assigned to adaptation measures – including health-system preparedness – and a health adaptation budget of US$8 million in conditional finance and US$9 million in unconditional finance. Health considerations within just transition receive some attention, through investment in health, wellbeing and measures to strengthen citizens’ resilience and adaptive capacity in the context of new economic and environmental realities. Download Card Climate-related health impacts are addressed in substantial detail, including the effects of droughts, heatwaves and floods on lives and livelihoods, with loss of life explicitly documented; for example, floods and landslides in September 2024 resulted in 249 deaths, 178 injuries and the displacement of 11,000 families. Air pollution is well integrated, with references to nitrous oxide, black carbon and short-lived climate pollutants, alongside targets to reduce the disease burden attributable to ambient and household air pollution to 77 per 100,000 by 2030 and 60 per 100,000 by 2035. Integrated governance of climate and health is moderately developed, incorporating health, including climate-sensitive diseases and physical and mental health risks, into loss-and-damage planning and involving the health sector in the transition to electric transport. Health-sector action is extensive, including an updated Health National Adaptation Plan, vulnerability and adaptation assessments, solar energy in healthcare facilities, low-carbon infrastructure and non-burn medical-waste management. Health co-benefits are embedded across mitigation and adaptation measures, spanning walking and cycling, nutrition and food security, water and sanitation, occupational health and safety, and reductions in indoor and outdoor air pollution. Monitoring and implementation are well developed, with concrete targets such as introducing non-burn waste management in 2,800 healthcare facilities and solar energy in 2,800 facilities by 2035, alongside expanded cycling infrastructure. Nepal records an air-pollution-attributable mortality rate of 178.3 deaths per 100,000 population. Download Card New Zealand’s NDC includes HFCs, N20 and SF6 among other gases covered by its emissions reduction target. However, no points were allocated beyond the air pollution category. While Climate Action Tracker has not yet evaluated New Zealand’s most recent NDC, it assessed the 2021 NDC as being in line with a <3°C world. Notably, while measures to reduce agricultural emissions could offer significant benefits for both the climate and people’s health in New Zealand, this connection is not made in the NDC Download Card “Nigeria’s NDC is informed by its national health policy, as well as a special assessment on health and education. The NDC also describes the aim to safeguard health for a just inclusive, and low-emission transition, with a highly health protecting emissions reduction target goal. Nigeria refers to health impacts including water-borne diseases and the health harms of short lived climate pollutants, and also describes the heightened vulnerability of people living with chronic conditions to climate impacts. There is a particular focus on the health burden experienced by women, including increased risks of sexual violence and other forms of exploitation during displacement. It is noted that a recent assessment by the International Office for Migration (IOM) indicates that climate change impacts 94% of the lives and livelihoods of respondents. With regard to actions in the health sector, Nigeria’s NDC covers both adaptation and mitigation related considerations, including to the integration of health and environmental early warning systems; health as a key priority sector in the adaptation plan; an update to the climate and health vulnerability and adaptation assessment before 2030; clean energy access and energy efficiency standards for health facilities; zero burn, safe and low-carbon healthcare waste management. Nigeria’s NDC includes a dedicated section focussed on short lived climate pollutants and its emissions reduction target includes N2O, and HFCs. Nigeria currently has a high rate of air pollution mortality but plans extensive actions to address this. International finance to enable these actions will be vital. The NDC describes the opportunities of mitigating black carbon, methane, tropospheric ozone, and some hydrofluorocarbons to significantly reduce near-term global warming and health impacts. Measures to reduce SLCPs include phasing out of routine flaring and reduction of fugitive emissions in the oil and gas industry, adoption of renewables, reduction of enteric fermentation, improved manure management, reducing biomass burning and improved cookstoves, and improved solid and wastewater treatment. Reduction of HFCs emissions is programmed under Refrigeration and Air Conditioning measures. Modal shifts in the transport sector are anticipated to also reduce overall vehicular traffic and road traffic accidents. A co-benefit assessment using the CLIMAQ-H tool, quantified the health and economic gains from Nigeria’s NDC mitigation actions as having the potential to prevent between 21,000 and 30,000 premature deaths in 2030; avert 1.7 to 2.3 million cases of illness including severe asthma attacks, cardiovascular, and respiratory hospital admissions; and prevent 60.3 million and 82.5 million lost workdays; alongside substantial gains in life years and overall health system efficiency. The corresponding economic benefits are equally significant. The value of avoided mortality alone is estimated at US$ 6.4-9 billion while avoided morbidity and productivity losses amount to US$ 3.8-5.1 billion to US$ 5.1 billion. Nigeria’s latest NDC is just one of two NDCs assessed by Climate Action Tracker as being in line with a <1.5°C world. " Download Card Norway recognises air pollutants within its NDC, with substantive discussion including mentions of specific air pollutants including N2O, PFCs, HFCs, SF6, and NF3, which is a vital part of planning actions. This is reflected in Norway’s air pollution death rate which remains low. In addition, health co-benefits are acknowledged through mentions of their role in global food security in the context of climate change. The NDC highlights the need to adapt to a changing climate, manage and use resources sustainably, and secure food supplies while reducing greenhouse gas emissions however, in very little detail. Health impacts and actions by the health sector are not meaningfully addressed within the NDC. Download Card The health impacts of climate change receive moderate attention, recognizing consequences for public health and anticipating increased risks from food- and water-related, infectious and vector-borne diseases, alongside threats to food security. Air quality is considered to some extent, through roadside air-quality monitoring. Integrated governance of climate and health receives recognition, with health identified as a priority theme and sector. Health-sector action is well developed, including resilient and safe water supplies, strengthened disease surveillance, preparedness for tropical diseases and heat stress, and vulnerability assessments to inform adaptation in the health sector. Health co-benefits are woven throughout action across sectors, including walking and cycling, healthier food, safe water, reduced asbestos exposure, improved air quality, and broader improvements in health and wellbeing. Economics and finance related to climate and health are acknowledged, with the Climate Change and Environmental Protection Fund identified as a source of funding for health-related action. The Republic of Naoero records an air-pollution-attributable mortality rate of 54.3 deaths per 100,000 population. Download Card Oman addresses in depth health co-benefits within its NDC through mentions of improved local air quality with associated public health gains, strengthened energy security and reduced exposure to international fuel-price volatility through greater reliance on domestic renewables, and job creation linked to new industries and supply chains, such as renewable energy, hydrogen, and circular economy services. Actions by the health sector are clearly addressed through discussion of a sector-wide adaptation agenda aimed at enhancing resilience in climate-vulnerable sectors such as water, fisheries, agriculture, infrastructure, and health, particularly through early warning systems, nature-based solutions, and Disaster Risk Reduction (DRR) planning. The NDC also recognises the need to prioritise protective measures for vulnerable groups, including children, the elderly, and individuals with pre-existing health conditions, through heat-health preparedness, risk communication, and strengthened health surveillance and response systems. The 36-month NAP process that strengthens adaptation governance, builds the evidence base for prioritising sector actions, and supports monitoring and finance planning across priority sectors is also mentioned. Health impacts are recognised by acknowledging that rising temperatures, prolonged humidity, and more frequent cyclones, flash floods, droughts, and sea-level rise pose escalating risks to lives, infrastructure, and economic activity. Extreme events, including flooding and intense rainfall, heatwaves, and associated service disruptions, can increase injuries and heat-related illnesses, aggravate respiratory and cardiovascular conditions, and elevate risks linked to vector-borne disease transmission. In regard to integrated governance, this is also acknowledged through mentions of key adaptation measures in the public health sector, but coverage is incomplete. In addition, economic and finance mechanisms are mentioned, but in little detail. Download Card The health impacts of climate change are moderately developed, linking climate change to broader risks to human health as well as heat-related illnesses, vector-borne diseases and fatalities. Air pollutants are explicitly covered, with nitrous oxide and HFCs identified. Integrated governance of climate and health is moderately reflected, with health established as a key sector, climate and health considerations brought together in policy, and the right to a clean and healthy environment recognized as fundamental. Health-sector action is well developed, including cooling centres, stronger disease surveillance, early-warning systems for climate-sensitive diseases, and recognition of health adaptation as a priority. Health co-benefits feature prominently across climate action, with measures supporting walking and cycling, safer drinking water, and broader health gains from mitigation and adaptation. Pakistan records an air-pollution-attributable mortality rate of 176.5 deaths per 100,000 population. Download Card The health impacts of climate change feature strongly, recognizing threats to community wellbeing and survival and identifying specific impacts including sea-level rise, displacement, heat stress, drought and vector-borne diseases. It also includes quantitative information on population vulnerabilities related to mobility, communication and other functional limitations. Air pollutants receive moderate attention, with references to HFCs, NO₂, ozone and NOx, as well as requirements under the Kigali Amendment. Integrated governance of climate and health receives limited attention, with health mainstreamed into climate policy through its inclusion alongside other sectors in the NDC’s overarching priorities, but with little further detail on integration. Health-sector action is strongly represented, through resilience and preparedness measures spanning sanitation, waste disposal, health-sector and emergency-service resilience, and hospitals, alongside vulnerability mapping to inform development planning and updates to the National Disaster Risk Management Framework. The health co-benefits of climate action across sectors are incorporated comprehensively, including benefits related to nutrition and food security, empowerment of vulnerable groups, safer school infrastructure, improved water quality and sanitation, active transport, community resilience, and protection of lives and livelihoods. The NDC also links transport mitigation with reductions in NOx. Monitoring and implementation of the health dimensions of climate policies receive moderate consideration, including implementation of a SCADA system to monitor and control wastewater reticulation and treatment. Download Card The health impacts of climate change are acknowledged, particularly through the effects of droughts and heatwaves on human health and quality of life. Air pollutants are explicitly covered, with short-lived climate pollutants, nitrous oxide and HFCs identified. Integrated governance of climate and health is well developed, bringing together the health and environment ministries, linking public policy with science and communities to support a healthy environment, and recognizing the constitutional right to a healthy environment. Health-sector action features to some extent, with health identified as a priority sector for adaptation. Health co-benefits are clearly incorporated into climate action, including protection of public health through reduced risks from heatwaves and disease, alongside broader health gains associated with mitigation measures. Panama records an air-pollution-attributable mortality rate of 33.7 deaths per 100,000 population. Download Card The health impacts of climate change receive moderate attention, recognizing increasingly severe impacts on public health and healthcare infrastructure and identifying specific risks including deaths, dengue fever, injuries and water stress. Air pollutants are moderately represented, with references to nitrous oxide, HFCs, PFCs, SF₆ and short-lived climate pollutants. Integrated governance of climate and health is moderately developed, with ministries assigned responsibilities for adaptation measures, health established as a priority thematic area, and health considerations integrated into climate policy. Health-sector action is well developed, including measures to strengthen the resilience of healthcare infrastructure, build the capacity of health personnel, enhance surveillance, and advance adaptation within the health thematic area. Health co-benefits are clearly reflected across climate action, including reduced morbidity and mortality, lower risks associated with drinking water and sanitation, protection of livelihoods and improved wellbeing. Economics and finance related to climate and health receive some consideration, with health included among adaptation measures whose total estimated cost amounts to 66.28 billion soles. Peru records an air-pollution-attributable mortality rate of 48.1 deaths per 100,000 population. Download Card Qatar significantly recognizes the link between climate change and health. There are a significant amount of mentions of health and systems being impacted by climate change. This can be specifically seen with the mention of heat stress, heat exhaustion, respiratory diseases, increase in water, and vector borne diseases within the NDC. These illnesses are then quantified via conducting climate-health research on respiratory illnesses. Furthermore, Qatar aims to address the public health sector by creating adaptation and resilience measures. While Qatar has a relatively high air pollution mortality rate it does specifically address air pollution within its NDC with multiple mentions of establishing an air quality monitoring network and establishing targets for air quality. Download Card The Republic of Korea does not detail health impacts in its NDC, and its emissions reduction target is not sufficiently ambitious to protect human health. However, the NDC does refer to actions to heat adaptation measures including installation of tailored climate adaptation infrastructure such as heat-shield coating, cooling shelters and green roofs and walls on buildings. The NDC notes that the Republic of Korea will continue to provide support for climate adaptation among energy-vulnerable households, including assistance for cooling and heating costs and improvements to residential energy facilities. To ensure food security, Korea will expand the rollout of smart production systems in rural and fishing communities, alongside measures such as developing climate-resilient crop varieties, securing domestic and overseas stockpiles, and diversifying supply chains. Pollutants including N2O, HFCs and SF6 are included in the scope of the NDC. While South Korea’s air pollution mortality rate is relatively low, this could be improved with greater efforts to mitigate SLCPs, which would additionally accelerate emissions reductions. Download Card The health impacts of climate change are considered comprehensively, recognizing general impacts on public health and identifying specific risks including vector-borne diseases such as dengue, chikungunya and Zika, as well as cardiovascular, respiratory and gastrointestinal conditions and increased morbidity and mortality associated with extreme weather events. It also explicitly links short-lived climate pollutants to health impacts and quantifies several risks, including a projected 22% increase in mortality from extreme heat by 2050 and an increase of more than 150% in deaths related to fine particulate pollution. Air pollutants feature strongly, with references to nitrous oxide, particulate matter, HFCs and black carbon, alongside measures to reduce and monitor short-lived climate pollutants. Integrated governance of climate and health is incorporated comprehensively, with the Ministry of Public Health and Social Welfare contributing to NDC development, cross-sectoral engagement involving health, integration of climate considerations into health planning through the Technical Committee on Climate and Health and its Institutional Plan on Climate and Health 2025–2030, and recognition of health as a fundamental right. Health-sector action is also comprehensive, including plans for a National Climate Change Adaptation Plan for the Health Sector, a health vulnerability and adaptation assessment, and renewable-energy measures in health facilities. The health co-benefits of climate action across sectors are incorporated comprehensively, spanning food and nutrition security, disease prevention, health-system resilience, wellbeing and improved air quality. Monitoring and implementation of the health dimensions of climate policies feature strongly, including targets for emergency and health-response plans in prioritized health facilities, an Integrated Health-Climate-Environment Data System, and a National Health and Climate Observatory, alongside monitoring related to food security and sustainable production. Paraguay records an air-pollution-attributable mortality rate of 77.7 deaths per 100,000 population. Download Card The health impacts of climate change are considered comprehensively, recognizing impacts on health and healthcare and identifying specific risks including heat stress, heat stroke, heat-related illnesses, stunting and malnutrition. It also directly links air pollution to mortality and calls for improved assessment of climate-related health impacts. Air pollutants are incorporated comprehensively, with references to fluorinated gases, particulate matter and short-lived climate pollutants, recognition of public concern about air pollution, and monitoring of fluorinated gases. Integrated governance of climate and health features strongly, with the Minister of Health involved in the national authority responsible for NDC approval, the Ministry of Health assigned responsibilities related to climate-related public health risks, and health identified as a priority sector. Health-sector action features strongly, including strengthened capacity and infrastructure, early-warning and surveillance systems, and measures to bring hospitals in line with green standards. The health co-benefits of climate action across sectors feature strongly, including safer sanitation and drinking water, broader improvements in public health, and improved health outcomes from reduced air pollution. Monitoring and implementation of the health dimensions of climate policies receive some attention, through indicators and targets addressing climate impacts on public health and health infrastructure. Economics and finance related to climate and health receive moderate attention, including assessment of health costs associated with climate impacts and recovery costs for health infrastructure, as well as development of a financing strategy for investment in public-health adaptation. Health considerations within just transition receive some attention, including measures to strengthen health and safety protections and healthcare services in response to the impacts of climate change and just transition. The Republic of Moldova records an air-pollution-attributable mortality rate of 55.8 deaths per 100,000 population. Download Card The Russian Federation recognises health co-benefits and there is some substantive discussion on ensuring access to water resources and drinking water, food and agricultural production, and the reduction of morbidity and mortality due to climatic factors. However, the Russian Federation’s NDC doesn’t meaningfully address health impacts which is reflected in its emissions reduction ambition, which remains insufficient to protect health. Air pollutants are also acknowledged within the NDC, and there is some substantive discussion, including mentions of specific air pollutants such as N2O, SF6, NF3, PFCs, and HFCs, which is good as this is a key part of planning actions. In regard to integrated governance, this is mentioned through discussion of sectoral plans that have been approved for the most climate-dependent sectors of the economy, such as transport, the fuel and energy sector, construction and housing, agriculture and fisheries, environmental management, health, provision of sanitary and epidemiological welfare of the population, civil defense, protection of the population and territories against emergency situations of natural and anthropogenic origin, industry, technical regulation, and domestic and foreign trade, but in little detail. In addition, economics and finance mechanisms are acknowledged in the context of support for developing countries by allocating financial resources to mitigate and adapt to the negative impacts of climate change, as well as to facilitate the development of energy, education, health, and food security. Download Card The health impacts of climate change are considered comprehensively, recognizing the effects of climate change and extreme weather on health and healthcare and identifying specific risks including vector-borne diseases, gender-based violence, malnutrition, displacement and food insecurity. It also links short-lived climate pollutants and air pollution to adverse public health impacts and uses the annual incidence of malaria as a health indicator. Air pollutants feature strongly, with references to nitrous oxide, short-lived climate pollutants, black carbon, ozone and HFCs, alongside air-quality monitoring systems to track pollutant levels. Integrated governance of climate and health receives moderate attention, with the Ministry of Health engaged alongside the energy sector and health identified as a priority sector. Health-sector action features strongly, including early-warning systems, disease surveillance and measures to strengthen health-workforce capacity, with health prioritized within adaptation. The health co-benefits of climate action across sectors are strongly represented, including access to safe drinking water, resilient food systems, reduced malaria and maternal mortality, lower mortality from non-communicable diseases, and health and air-quality benefits from low-carbon transport. Economics and finance related to climate and health receive some consideration, with US$100 million in financing requirements identified for health adaptation, representing 4% of total financing needs. Rwanda records an air-pollution-attributable mortality rate of 163.3 deaths per 100,000 population. Download Card Saint Lucia’s NDC integrates health across several dimensions, with a total score of 9. Climate-related health impacts are moderately addressed, recognizing threats from extreme weather to health and healthcare facilities and identifying specific risks including vector-borne diseases, heat-related illness and mental health impacts. Air pollutants are well incorporated, with ozone, HFCs and nitrous oxide identified and specific targets established for ozone and HFCs. Integrated governance of climate and health is acknowledged, with health identified as a key sector within climate policy. Health-sector action is moderately developed, notably through the inclusion of health in the National Adaptation Plan and measures to strengthen the resilience of infrastructure such as hospitals. Health co-benefits feature to some extent, particularly through measures supporting access to safe drinking water in the context of agriculture and manure management. Saint Lucia records an air-pollution-attributable mortality rate of 21.4 deaths per 100,000 population. Download Card Samoa recognises air pollutants within its NDC, with substantive discussion including mentions of specific air pollutants, including N2O, CO, SO2, and VO2, which is a vital part of planning actions. However, this isn’t reflected in Samoa’s air pollution mortality rate, which is relatively high. In addition, health impacts are acknowledged through mentions of the physical and mental health of women being disproportionately affected by climate change and climate-related hazards endangering ecosystems, infrastructure, food security, and the livelihoods of people, but in little detail. Notably, health co-benefits and actions by the health sector aren’t meaningfully addressed within the NDC. Economics and finance mechanisms are also mentioned through mentions of budget allocations, including financing both economic and non-economic losses, such as infrastructure rehabilitation, community relocation, agricultural loss; and other pressing needs, such as mental health, and well-being, arising from climatic loss and damage. Download Card The health impacts of climate change feature strongly, recognizing risks to public health and healthcare infrastructure and identifying specific impacts including food insecurity, contaminated and unsafe water, vector-borne diseases, heat stress, heat-related illness, and increased malaria and dengue transmission. It also quantifies health-system vulnerability, noting that damage to the small share of health facilities highly exposed to coastal flooding could affect access to care for up to 45,000 people. Air pollutants receive moderate attention, with nitrous oxide and HFCs specifically identified. Integrated governance of climate and health is incorporated comprehensively, with the Ministry of Health involved in NDC development and cross-sectoral coordination, health included as a focus sector for the first time, and recognition of health as a fundamental right affected by climate change. Health-sector action features strongly, including development and implementation of a Health National Adaptation Plan, prioritization of health in adaptation, and health-sector risk and vulnerability assessment. The health co-benefits of climate action across sectors feature strongly, including improved food and nutrition security, safer sanitation, expanded access to water and sanitation, and protection of lives and quality of life. Monitoring and implementation of the health dimensions of climate policies receive moderate attention, including quantified targets for improved individual and collective sanitation facilities. Economics and finance related to climate and health receive some consideration, with costs identified for adaptation works, equipment and waste-management systems in health facilities and for new health centres, medical equipment and staffing. São Tomé and Príncipe records an air-pollution-attributable mortality rate of 113.7 deaths per 100,000 population. Download Card Saudi Arabia recognises health co-benefits and action within the health sector through mentions of improving quality of life through various actions, advancing public health, and improving nutrition through afforestation. It also discusses early warning systems in relation to food and water security, as well as investments in the healthcare system, but coverage is inadequate. Health impacts are acknowledged through mentions of health concerns mainly related to heat and religious events, but in little detail. While the NDC mentions health impacts, its emissions reduction ambition is insufficient to protect health. In addition, N2O is mentioned as something Saudi Arabia will look at as per IPCC guidelines however, there is limited discussion on air pollutants. Integrated governance is acknowledged with mentions of mainstreaming health in climate policy, but in little detail. Notably, Saudi Arabia has a very high air pollution death rate, but mentions of air pollutants within its NDC is limited, which is a vital part of planning actions. Download Card Serbia recognises health impacts and there is some substantive discussion on the vulnerability of water resources, agriculture, and forestry, including biodiversity and public health, being documented. The NDC also acknowledges the negative impacts of climate change on the energy sector, infrastructure, transport, and the economy. Notably, Serbia’s NDC doesn’t meaningfully address health co-benefits and actions by the health sector. Serbia recognises air pollutants within its NDC, with substantive discussion including mentions of specific air pollutants, including N2O, HFCs, PFCs, SF6, and NF3, which is a vital part of planning actions. However, this isn’t reflected in Serbia’s air pollution mortality rate which is relatively high. Download Card Seychelles recognises air pollutants within its NDC, with substantive discussion including mentions of specific air pollutants, including N2O and HFCs, which is a vital part of planning actions. This is reflected in Seychelles’ air pollution death rate, which is relatively moderate. Health co-benefits are acknowledged through mentions of co-benefits including waste, water, health, tourism, agriculture, forestry, land use, and other sectors, but in little detail. However, health impacts and actions by the health sector aren’t meaningfully addressed within its NDC. In regards to integrated governance, this is mentioned through discussion of a long-term vision being developed, noting that by 2050 Seychelles will be a resilient, responsible, prosperous, low-carbon nation of healthy, educated, and empowered people living together in harmony with nature and engaged with the wider world, with net-zero emissions across its economy. Download Card Singapore recognises specific health co-benefits, such as active travel, walking, and cycling and is implementing actions such as building active mobility infrastructure to make cycling and walking both more convenient and attractive. However, the NDC does not meaningfully address health impacts or actions of the health sector. While there is substantive discussion of specific air pollutants throughout, Singapore’s emissions reduction ambition remains insufficient to adequately address them. Notably, Singapore has a low air pollution death rate compared to global averages. Download Card The health impacts of climate change are addressed comprehensively, covering threats to wellbeing, health services, water and sanitation, food and water security, and changing patterns of infectious diseases such as malaria and dengue. The NDC also quantifies substantial vulnerabilities, including gaps in water, sanitation and hygiene services in schools and health facilities, and recognizes the effects of worsening air quality on children. Integrated governance of climate and health receives some recognition, through coordination between ministries and education and awareness on climate-health linkages. Health-sector action is well developed, including climate-risk assessments for WASH, more resilient health infrastructure, early-warning systems, and prioritization of health within the National Adaptation Plan. Health co-benefits feature prominently across adaptation measures, particularly through safer water, climate-resilient sanitation, healthier households, food security and improved livelihoods. Monitoring and implementation are well established, with indicators tracking resilient water and sanitation services in both schools and health centres. Economics and finance related to climate and health are acknowledged, including estimates of the economic losses and casualties associated with tropical cyclones. Solomon Islands records an extremely high air-pollution-attributable mortality rate of 421.4 deaths per 100,000 population. Download Card The health impacts of climate change are addressed in substantial detail, linking climate change to pressures on health systems, food and water security, displacement and livelihoods, with specific attention to heat, access to reproductive healthcare, gender-based violence and other risks facing vulnerable populations. The NDC also quantifies the human consequences of prolonged drought, including 1.3 million people displaced following five consecutive failed rainy seasons and more than 71,000 people affected by drought, 40% of them children. Air pollutants are explicitly covered, with nitrous oxide and HFCs identified. Integrated governance of climate and health is well established, including constitutional recognition of the right to an environment that does not harm health and wellbeing. Health-sector action is extensive, encompassing stronger early-warning and surveillance systems, preparedness for disease outbreaks and heat stress, improved emergency response and access to essential health services, with public-health resilience prioritized in adaptation planning. Health co-benefits are woven across action on water, food systems, agriculture and clean cooking, supporting better nutrition, household health, livelihoods and wellbeing. Monitoring and implementation include indicators linking cooling access with health and food systems. Economics and finance are moderately developed, with substantial financing identified for climate-responsive health systems, including US$400 million for public health, equivalent to 13% of the adaptation budget. Health also features within just transition considerations, including attention to healthcare systems. Somalia records an air-pollution-attributable mortality rate of 116.6 deaths per 100,000 population. Download Card The health impacts of climate change receive moderate attention, recognizing pressures on health services and health outcomes and identifying specific risks including increased morbidity and mortality, water and sanitation insecurity, food insecurity and malnutrition, and increased vector-borne and diarrhoeal diseases. Health-sector action features strongly, with measures to strengthen disaster-risk management, healthcare and sanitation provision, expand clinical capacity to diagnose and treat water- and vector-borne diseases, and upgrade sanitation in high-risk informal settlements; health is also identified as a priority sector for adaptation and considered in vulnerability assessments. The health co-benefits of climate action receive moderate attention, including recognition that limiting warming can reduce damage to human health and that mitigation can deliver benefits through improved air quality. Monitoring and implementation of the health dimensions of climate policies are incorporated comprehensively, including indicators related to deaths from floods and heatwaves, access to safe spaces, cholera and diarrhoeal disease, and childhood malnutrition; the NDC also cites analysis estimating that full implementation of its adaptation component could save 158,000 lives over ten years. Economics and finance related to climate and health receive some consideration, through quantified costs for adaptation and resilience actions related to health. Health considerations within just transition are incorporated comprehensively, including an emphasis on achieving a better life and high quality of life for all. South Africa records an air-pollution-attributable mortality rate of 68.4 deaths per 100,000 population. Download Card Climate-related health impacts are given substantial attention, with climate change linked to pressures on human health and healthcare systems and to specific risks including climate-sensitive and vector-borne diseases, malnutrition, heat-related illness, non-communicable diseases, injuries, deaths, and mental and social wellbeing impacts. The NDC also quantifies the human consequences of extreme events, including fatalities and displacement, and identifies populations exposed to future climate hotspots. Air pollutants are well represented, with references to nitrous oxide and HFCs, alongside recognition of air pollution associated with transport patterns. Integrated governance of climate and health is moderately developed, including coordination between public health authorities, disaster-management institutions, local authorities and other stakeholders, as well as incorporation of climate-health priorities into national health policy. Health-sector action is addressed across a broad range of measures, encompassing climate-resilient water and sanitation, disease surveillance and early-warning systems, resilient health infrastructure, capacity building, and green and healthy hospitals incorporating renewable energy and improved waste management. Health co-benefits are embedded across action in multiple sectors, spanning food and nutrition security, water, biodiversity and medicinal resources, improved public health, and air-quality benefits from transport and waste-sector mitigation. Monitoring and implementation of the health dimensions of climate policies are well developed, with quantified targets for climate-resilient water and sanitation systems and objectives to reduce morbidity and mortality from extreme weather and other climate-related emergencies. Sri Lanka records an air-pollution-attributable mortality rate of 95.9 deaths per 100,000 population. Download Card The health impacts of climate change are considered comprehensively, recognizing impacts on human health and the health sector and identifying specific risks including malaria, cholera, malnutrition and heat stress. It also links air pollution and vehicle emissions to health risks and includes assessment of climate impacts on health, nutrition services and diets. Air pollutants receive moderate attention, including recognition of pollution associated with transport and medical waste and monitoring of air pollution at healthcare facilities. Integrated governance of climate and health receives moderate attention, with cross-sectoral coordination involving the Ministry of Health, civil society, NGOs and local councils, and health integrated as a priority within climate action. Health-sector action is incorporated comprehensively, including disease surveillance, stronger health infrastructure and access, heat-health planning, vector control, lower-emissions medical waste management and decentralized renewable energy for healthcare. The health co-benefits of climate action across sectors are incorporated comprehensively, including active transport, improved nutrition and food security, protection of public health, and reduced indoor air pollution from cleaner cooking. Monitoring and implementation of the health dimensions of climate policies feature strongly, with indicators and tracking related to occupational health and safety, waste services, air pollution, low-carbon healthcare facilities, early-warning systems for climate-sensitive diseases, health outcomes and adaptation interventions. Economics and finance related to climate and health receive moderate attention, with US$27 million identified for health actions and US$18 million for health-impact schemes, alongside financing for health-related actions through loans, grants and green financing instruments. Sierra Leone records an air-pollution-attributable mortality rate of 208.8 deaths per 100,000 population. Download Card The health impacts of climate change are considered comprehensively, recognizing growing threats to health, wellbeing and the healthcare sector and identifying specific risks including displacement, mental health impacts such as anxiety and stress, non-communicable diseases, infectious diseases and respiratory illnesses. It also links air pollution to health risks and includes climate-health research to assess the impacts of climate change on health. Air pollutants feature strongly, with references to nitrous oxide, HFCs, black carbon and particulate matter, alongside recognition of air quality as a growing concern. Integrated governance of climate and health features strongly, with the Ministry of Health involved in NDC consultations and cross-sectoral coordination, health identified as a priority, public awareness activities on climate-health linkages, and integration of health into climate policy. Health-sector action is incorporated comprehensively, including development of a Health National Adaptation Plan, safer management of medical waste to reduce pollutants, assessment of climate-related burdens and loss and damage in the health sector, and climate-vulnerability assessments of hospitals. The health co-benefits of climate action across sectors are incorporated comprehensively, including disease prevention, strengthened food security, safe water and sanitation, prevention of public-health crises, and improved public health through better air quality. Monitoring and implementation of the health dimensions of climate policies receive moderate attention, including development of an integrated system to monitor progress on mitigation, adaptation and just-transition outcomes associated with health co-benefits. Economics and finance related to climate and health receive some consideration, with part of an identified US$3.375 billion financing requirement allocated to the health sector. Suriname records an air-pollution-attributable mortality rate of 52 deaths per 100,000 population. Download Card The health impacts of climate change receive moderate attention, recognizing threats to health from climate-related natural hazards and identifying specific risks including mortality associated with hotter summers, threats to human life from mountain and rock falls, and impacts on drinking water. Air pollutants are moderately represented, with nitrous oxide and SF6 specifically identified. Download Card Thailand recognises air pollutants within its NDC, and there is moderate discussion with specific mentions of different air pollutants, including N2O, HFCs, PHCs, SF6, and NF3, which is a vital part of planning actions. Integrated governance is mentioned, via acknowledging and assessing its fair share, Thailand emphasises key elements of robust climate action through a balanced approach: maximising national ambition, safeguarding people, ecosystem, nature, lives, and livelihoods, advancing sustainable development objectives, and supporting stronger climate efforts among other developing nations. Notably, health impacts, health co-benefits, and actions by the health sector aren’t meaningfully addressed in its NDC. This is reflected in its emissions reduction ambition, which is insufficient to protect health. Download Card The health impacts of climate change receive moderate attention, recognizing the effects of changing weather patterns on health and public health and identifying specific risks including dengue, malnutrition, gender-based violence, food insecurity and diarrhoeal disease. Air pollutants receive some attention, with HFCs specifically identified. Integrated governance of climate and health receives moderate attention, with the Ministry of Health included as a supporting agency alongside other sectors and health mainstreamed into climate policy through the prioritization of safeguarding communities and livelihoods. Health-sector action receives some attention, through resilience and preparedness measures focused on building climate-resilient sanitation and drinking-water systems and facilities. The health co-benefits of climate action across sectors are incorporated comprehensively, including enhanced nutrition, access to safe drinking water, reduced waterborne diseases, active transport, reduced public health risks and injuries, and improved public health through reductions in urban air pollution. Download Card Trinidad and Tobago recognises air pollutants within its NDC, with substantive discussion and specific mentions of different air pollutants, which is encouraging, as this is a vital part of planning effective actions. This is reflected in Trinidad and Tobago’s air pollution mortality rate which is relatively low. Action by the health sector is mentioned through discussion of decentralising resilience projects, which might be developed across different sectors, including health. However, health impacts and health co-benefits are not meaningfully addressed within the NDC. Download Card The health impacts of climate change feature strongly, with recognition of threats to public health and wellbeing and specific risks including malnutrition, waterborne diseases, food and water insecurity, and loss of life from extreme weather events; it also quantifies impacts from Tropical Cyclone Seroja, including 34 deaths and more than 13,000 people displaced. Air pollutants feature strongly, with references to nitrous oxide, HFCs, NOx, SOx and particulate matter, alongside a commitment to phase down HFCs. Integrated governance of climate and health is incorporated comprehensively, with the Ministry of Health contributing to NDC development and cross-sectoral implementation, health mainstreamed into adaptation planning and resilience-building, and constitutional recognition of the right to health and to a healthy and ecologically balanced environment. Health-sector action features strongly, building on a Health National Adaptation Plan, a health-sector vulnerability and adaptation assessment, and strengthened surveillance and early-warning capacity for climate-sensitive health risks. The health co-benefits of climate action across sectors are incorporated comprehensively, including improved food security and nutrition, cleaner cooking and indoor air quality, pollution reduction, and protection of lives and livelihoods. Monitoring and implementation of the health dimensions of climate policies receive some consideration, including targets related to universal access to healthcare. Economics and finance related to climate and health are moderately represented, with conditional budget allocations proposed for additional health services and infrastructure and recognition of the economic returns from investment in safe water and sanitation. Health considerations within just transition are moderately integrated, including occupational health and safety protections addressing heat and extreme-weather risks and broader attention to health and vulnerable populations within cross-sectoral just-transition measures. Timor-Leste records an air-pollution-attributable mortality rate of 195.5 deaths per 100,000 population. Download Card Tunisia strongly recognises air pollutants within its NDC, and there is moderate discussion with specific mentions of different air pollutants, such as N2O and HFCs, which is a vital part of planning actions. Health co-benefits are also acknowledged and there is some substantive discussion on Tunisia’s aim to significantly reduce climate-induced water shortages and strengthen the climate resilience of strategic sectors against water-related risks, ensuring water supply and sanitation systems are resilient to climate change and providing safe and affordable access to drinking water for all. In addition, actions by the health sector are mentioned with the aim to enhance resilience to health impacts of climate change, strengthen climate-resilient health services and significantly reduce climate-related morbidity and mortality, especially among vulnerable communities. However, health impacts are not meaningfully addressed within the NDC. Economics and finance mechanisms are mentioned, but in very little detail. Download Card The health impacts of climate change receive moderate attention, identifying risks associated with drought, humidity, heat and water stress. Air pollutants feature strongly, with references to SF₆, nitrous oxide and HFCs, alongside a Clean Air Action Subsidizing Framework Program aimed at reducing air pollutants through mitigation action. Integrated governance of climate and health receives some attention, with climate change recognized as a cross-cutting threat to child wellbeing and measures identified to address these risks. Health-sector action receives moderate attention, including consideration of public health in the Climate Change Adaptation Strategy and Action Plan, alongside references to drought and emergency-services planning, health-system resilience and child-sensitive health systems. The health co-benefits of climate action across sectors are incorporated comprehensively, including improved health outcomes for children, benefits for respiratory and neurological development, broader public-health benefits from mitigation, and reductions in air pollution. Health considerations within just transition receive moderate attention, including safeguarding women, children, low-income communities and other groups with specific needs, alongside links between just transition, social welfare and social protection. Türkiye records an air-pollution-attributable mortality rate of 83.6 deaths per 100,000 population, while its overall climate ambition is assessed as highly insufficient for a below-4°C pathway. Download Card The health impacts of climate change receive moderate attention, recognizing that a changing climate brings new health risks and identifying specific impacts including waterborne diseases, malnutrition and heat stress. Air pollutants are considered moderately, with references to carbon monoxide, nitrous oxide, volatile organic compounds, nitrogen oxides and sulphur dioxide. Integrated governance of climate and health is reflected moderately, through mainstreaming health in climate policy, including a link between health, the planet and climate, as well as recognition of the right to a safe and healthy environment. Health-sector action receives moderate consideration, with human health and wellbeing identified as a priority sector within the National Adaptation Plan. The health co-benefits of climate action across sectors also feature moderately, with specific benefits associated with active transport, particularly cycling, and measures to enhance nutrition and food security. Download Card The health impacts of climate change receive general recognition. Air pollutants receive moderate attention, with references to nitrous oxide, HFCs, short-lived climate forcers and perfluorocarbons. Integrated governance of climate and health receives some attention, through references to integrating health considerations into climate policy. Health-sector action receives some attention, including the introduction of climate-resilient water supply in medical facilities. The health co-benefits of climate action across sectors receive moderate attention, including measures supporting safe sanitary and epidemiological conditions. Ukraine records an air-pollution-attributable mortality rate of 65.1 deaths per 100,000 population. Download Card The UAE addresses air pollutants in depth within its NDC. Health co-benefits are strongly recognised through discussion of improved human health, economic diversification, and job creation. Measures include applying best available practices and technologies, controlling fertiliser use, protecting workers from heat-related illness through mandatory breaks for outdoor workers in the summer, and safeguarding children’s health and well-being. Actions by the health sector include the Health and Climate Resilience Programme, support through the Overseas Development and Governance Cooperation (ODGC), and assessment of GHG emissions and carbon footprints across healthcare facilities to develop a sectoral emissions-reduction roadmap and national action plan. The UAE has also strengthened climate adaptation through its National Climate Change Adaptation Programme (2018), 2019 Climate Risk Assessment, and National Adaptation Plan (NAP) Roadmap launched at COP28. Health resilience is also shown through the National Vulnerability and Adaptation Assessment Programme for Health and Climate Change. Planned measures include expanding early warning systems for health-related weather risks and equipping healthcare workers to address climate-related risks, particularly among vulnerable populations. In addition, the NDC clearly identifies the health impacts of climate change, including direct exposure to asthma attacks and other respiratory and cardiovascular conditions, heat stress, morbidity and mortality from heat stroke, and mental health conditions such as anxiety, depression, suicide, and post-traumatic stress disorder. In regards to integrated governance, this is demonstrated through discussion of collaboration between health ministries and other sectors such as housing authorities, as well as between public health and climate authorities. The NDC also mentions frameworks that integrate health into adaptation and other sectors, collaboration with WHO on initiatives, and stakeholder dialogues. Notably, while the NDC discusses health in depth, its emissions reduction ambition is insufficient to protect health. Download Card The UK NDC refers to health among priority policy areas that are crucial to the UK’s overall approach to climate action, and links this to the Preamble of the Paris Agreement. In its opening paragraph, the triple planetary crisis of climate change, biodiversity loss and pollution is noted to pose a critical threat to the UK’s national health interests, though no actions in the health sector are described (notably, the UK submitted separate national adaptation plans). HFCs, N2O and SF6 are all included in the scope of the emissions reduction target, with an established air quality monitoring system mentioned in Gibraltar. Under the Kigali Amendment, the UK is committed to phase down HFC consumption 85% by 2036. The Isle of Man’s air quality monitoring is noted to include NO2 and SO2 at over 60 sites around the Island, with data published monthly. The UK affirms its commitment to delivering a sustainable food system, ensuring that everyone has access to nutritious and healthier food, and Northern Ireland’s Food Strategy Framework is anticipated to improve health and social outcomes for Northern Ireland. The NDC included a strong focus on transport and health links, noting the UK government’s work to decarbonise transport as set out in section 4a(i) will deliver significant reductions in air pollution and improve people’s health, and comparable efforts in Gibraltar and Guernsey. The UK states its intention to introduce a comprehensive Clean Air Strategy, intended to support promotion of the right to health, as referenced in the Paris Agreement, and is working to meet legal limits for NO2 and improve the health of residents. However, the UK’s climate ambition is assessed by Climate Action Tracker to be in line with a <3°C world. Download Card The health impacts of climate change are partially reflected, including the physical and emotional health consequences of displacement and risks to drinking water associated with drought. Air pollutants are moderately represented, with HFCs and nitrous oxide specifically identified. Integrated governance of climate and health is developed to some extent, through the integration of climate plans into national health planning. Health-sector action receives moderate attention, including measures to strengthen health-system capacity to respond to climate impacts, develop environmental and health early-warning systems, and build sanitation capacity. Health co-benefits are moderately incorporated, particularly through active mobility, including walking and cycling, and measures supporting safer living conditions and improved quality of life. Download Card The health impacts of climate change receive moderate attention, recognizing general impacts on health and quality of life and identifying specific risks including heat stress and waterborne diseases. Air pollutants feature strongly, with references to nitrous oxide, HFCs and short-lived climate pollutants, alongside recognition of deteriorating air quality. Health-sector action is incorporated comprehensively, including a sectoral adaptation plan for healthcare, health identified as a sector for adaptation, and mitigation action through infrastructure for processing medical waste. The health co-benefits of climate action across sectors are moderately represented, including improved quality of life, reduced mortality from climate-induced diseases and access to safe drinking water. Economics and finance related to climate and health are moderately addressed, with cost estimates of US$197 million for 2025–2030 and US$379 million for 2025–2035, alongside funding directed toward healthcare actions. Uzbekistan records an air-pollution-attributable mortality rate of 170.2 deaths per 100,000 population. Download Card The health impacts of climate change receive moderate attention, recognizing risks to public health and specific impacts including waterborne and vector-borne diseases, malaria, diabetes, heart disease and other non-communicable diseases. Air pollutants receive some attention, with nitrous oxide specifically identified. Integrated governance of climate and health features strongly, with the Ministry of Health referenced alongside other government and international partners, extensive integration of climate and health across policy and awareness activities, health identified as a priority, and recognition of the right to a healthy environment. Health-sector action is incorporated comprehensively, including plans to develop a National Health Adaptation Plan, solar electrification of health centres, adaptation measures related to biosecurity, and vulnerability and risk assessment for the health sector. The health co-benefits of climate action across sectors feature strongly, including access to safe drinking water, reduced morbidity and mortality, active transport, healthy and sustainable food options, and broader improvements in health and wellbeing. Monitoring and implementation of the health dimensions of climate policies are strongly represented, through national wellbeing indicators across sectors and collection of data on health needs following displacement events. Economics and finance related to climate and health receive moderate attention, with costs calculated for several health adaptation actions and grants and loans partly allocated to the health sector. This is set against a particularly high air-pollution-attributable mortality rate of 234.8 deaths per 100,000 population. Download Card Yemen strongly addresses health impacts and action by the health sector through mentions of general health impacts and specific health impacts including waterborne diseases and vector borne diseases, which are undermining productivity and well-being. Yemen’s NDC also notes that by 2040–2050, waterborne diseases could result in more than 200 additional deaths annually and generate US$120-156 million in excess health costs. And vector borne diseases including malaria and dengue are also expected to increase, adding approximately 1.2 million cases and 8,800 deaths by 2050, with cumulative costs exceeding US$5 billion. In addition, action by the health sector is showcased through discussion of renewable energy expansion and a climate-resilient health sector to protect lives, preserve human capital, and support sustainable recovery and development. While health impacts and health sector action is clearly addressed, the NDC doesn’t meaningfully address health co-benefits. Economics and finance are mentioned however, in little detail. Notably, Yemen has a high air pollution death rate, but they do not meaningfully address air pollutants with the NDC, which is a key part of planning actions. Download Card Zimbabwe comprehensively addresses air pollutants within its NDC, with mentions of specific air pollutants throughout. Health co-benefits and action by the health sector are recognised, and there is some substantive discussion through mentions of co-benefits, including green jobs, improved health and air quality, and better access to energy, and actions including discussion of the National Adaptation Plan, which identifies 18 priority adaptation outputs in seven sectors, including agriculture, water, health, tourism, forest and biodiversity, infrastructure, and human settlements. While health co-benefits and action by the health sector are acknowledged, health impacts are mentioned, mainly regarding drought exposure resulting in dire consequences, especially for communities depending on climate-sensitive natural resources, but in very little detail. Integrated governance and economic and finance mechanisms are also mentioned, with acknowledgment of the Constitution of Zimbabwe, which provides for environmental rights under Section 73, which states that every citizen has a right to a clean, safe, and healthy environment, and mention of the sectoral adaptation priority outputs identified in the National Adaptation Plan through integrating climate change, weather, and climate information into the health surveillance and information system; improving research and response to climate-related diseases, which cost USD 0.5 billion. Notably, Zimbabwe comprehensively addresses air pollutants within its NDC however, this is not reflected in its air pollution death rate, which remains relatively high. Download Card The United States of America in its NDC briefly discusses various schemes such as the Greenhouse Gas Reduction Fund (GGRF), Climate Pollution Reduction Grants (CPRG), and Environmental Justice Block Grants all of which aim to limit health impacts of pollution. The NDC also references tropospheric ozone and black carbon as additional topics to explore. The United States of America’s NDC greatly highlights various health co-benefits, including increased micromobility among citizens through walking and cycling, along with multiple mentions of actions to protect human health, and how cutting air pollution could help in reducing premature deaths, illnesses, and disabilities. Download Card ### **GCHA is grateful toWellcome and the Clean Air Fund for funding the Healthy NDC Scorecards.** Analysis for the 2026 Healthy NDC Scorecard project was led by Dr Nova Tebbe, with project coordination by Jess Beagley. Analysis was completed by Tola Klabough, Rebecca Gilmour, Michele Baker, RoseMary Greeny, Miranda Kramer, Katie Mastorides, Alakshendra Singh, and Emily Wu, with additional support from Milena Sergeeva and Rosie Tasker. GCHA is grateful to Pallavi Pant and Hlina Kiros of the Health Effects Institute for sharing air pollution mortality data from the 2025 State of Global Air Report. Graphic design is by Subhashish Roy. The 2026 Healthy NDC Scorecard was funded by Wellcome (grant #322894/Z/24/Z) and the Clean Air Fund (grant #001594)

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