Alan S. Miller
5 min readJan 23, 2024

Responding to the health risks of climate change

What needs to happen now!

Source: The Lancet Countdown on Health and Climate Change: 2020 Report

Climate change is killing millions globally every year from soaring temperatures, declining food production, and spreading diseases — and it’s only going to get worse as temperatures continue to rise. In a previous blog, I provided an overview of the health impacts of climate change. The public health and health policy communities including medical schools are increasingly aware of the seriousness of the health risks of climate change as reflected in attention to these issues at COP28. A comprehensive response requires much greater effort across many fronts.

The essential elements of an effective response to the health risks of climate change

Scientific publications now increasingly feature articles about the impact of extreme heat and other climate changes on human health, most focused on scientific research and new understandings. Much less has been said about what needs to happen. Five distinct actions are required:

1. Research

A lot is known about the effect of extreme heat on the human body — for details check out the recent book by Jeff Goodell, The Heat Will Kill You First. However, many risks are emerging with climate change and thus are only now being investigated. These include changes in mosquito habitats that vary by population with important implications for the likely spread of vector borne diseases; (illnesses spread by mosquitos, ticks, and fleas). Between 2004 and 2018, illnesses in the U.S. from insect bites more than doubled as mild winters, early springs, and warmer temperatures created more favorable conditions for insects to expand their habitats. In response, researchers have developed new vaccinations for malaria, dengue, and other diseases likely to be more prevalent and to maintain food production are working on development of more climate resilient crop varieties.

2. Methods to anticipate and identify new risks

As the climate changes, the past is no longer prologue and public health agencies will need to anticipate and identify new risks. Weather agencies in developed countries have steadily improved forecasting through technologies like low-flying satellites with equipment able to observe below cloud cover. Weather apps have also been steadily improving to provide more accurate and timely warnings of extreme weather events, critical for enabling the pubic to take effective action. However, climate data and forecasts are not always publicly available when paid for by private companies, a growing concern.

Meanwhile, many developing countries, especially in Africa, people die from the absence of basic systems for early warning of extreme weather events. The problem is more poor governance than lack of technical solutions, a problem I worked on with a UN project 10 years ago and that has recently become a priority for the World Meteorological Organization. Better technology is being used in some developing countries, e.g., researchers in Peru have been hauling drones and sensors into remote communities and using the weather data obtained with AI systems to predict the likelihood of disease outbreaks.

3. Public health programs

Some of the most effective measures to address climate risks are at the local and community level. Many cities in the U.S. and around the world including Atlanta, Berlin, Durban, Hanoi, and Mumbai have or are developing climate action plans and several NGOs now provide support for such efforts. Multiple cities have a chief heat officer responsible for preparing and helping implement a heat action plan. Some cities such as Ahmedabad in India have community cooling centers to provide temporary shelter for those without access to water or electricity during extreme heat events. India and many other developing countries are preparing cooling action plans in recognition that heat extremes are a serious danger that requires public action. The India plan includes measures to improve the energy efficiency of cooling and to certify thousands of technicians with the skills necessary to maintain cooling equipment.

An NGO, the Arsht-Rock Resilience Center, promotes categorizing and naming heat waves comparable to hurricanes to increase public awareness and responsiveness; Seville, Spain, and Athens, Greece are among the first to do so. Another NGO, the Smart Surfaces Coalition, is promoting ways cities can cool urban heat islands through measures like green roofs, reflective pavement, and planting trees.

4. Stronger regulation to protect outdoor workers from extreme heat

Adopting up-to-date building codes is the starting point for protecting people and property from heat extremes and other climate disasters. Unfortunately, 65% of counties, cities, and towns across the U.S. today still have not done so according to the Federal Emergency Management Agency (FEMA), despite expected savings of over $30 billion over the next two decades.

Regulation is also critical for protecting low-paid farm and construction workers exposed to extreme temperatures because they work outdoors in the summer. There is currently no federal regulation to protect such workers. The Occupational Safety and Health Administration (OSHA) initiated a rulemaking to address the issue in September 2021 and has yet to announce a final rule. There is a general requirement for employers to provide a safe and healthy work environment, but heat is not mentioned. Meanwhile Texas passed legislation 2023 that prohibits local governments from mandating water and rest breaks. Some European countries are more progressive, although there is no common EU standard or regulations.

5. Support for innovative technologies

The creative use of drones, sensors, and AI to identify climate health risks was noted above. New more climate resilient crop varieties are another. There are many additional needs for improving technologies to address climate health risks. One is more efficient, sustainable, and affordable cooling technologies, the subject of a major UN report, Keeping it Chill, released at COP28. Others include measures to improve the heat resistance of mobile homes, a frequent choice for low-income households, and techniques for reducing the heat buildup in urban areas.

Enabling conditions

In support of the five initiatives, strong institutional leadership and more funding will be essential. Regarding the former, health ministries and public health agencies are increasingly recognizing and promoting awareness of health risks from climate change. The World Health Organization (WHO) has made climate action a high priority and through the Alliance for Transformative Action on Climate and Health works to create an effective advocate for action at the national and international level. Multiple NGOs and academic institutions, including the aforementioned Arsht-Rock Resilience Center and University of Colorado Medical School, are also making significant contributions.

With respect to funding, currently only a very small fraction of climate finance goes to health-related issues, much less than the importance of the risks would justify. However, there are a growing number of initiatives especially from philanthropies and donor funded climate finance programs

As should be evident, people have a limited range of options for responding to the health risks of climate change, and even less power as individuals to make the risks less likely. There is no simple solution to the health risks associated with climate change — other than to avoid it as much as possible! However, given that it is already happening and expected to increase in coming years, aggressive measures to protect public health are essential to avoid enormous increases in human suffering and mortality.

Alan S. Miller

Alan S. Miller is co-author of “Cut Super Climate Pollutants Now!”. His full bio and links to writing are available at