Daniel Hunt is a postgraduate research student (PhD) at the University of Bath's Centre for 21st Century Public Health.
In a world of fitful geopolitics, one thing is constant: climate change continues to rip, unabating, at the seams of public policy.
The politics of climate change are intimately those of public health. The World Health Organization (WHO) has described climate change as the ‘single biggest health threat facing humanity’. The physical and mental health and health equity impacts of the triple planetary crisis of climate change, biodiversity loss and pollution are well-established.
The case for action is growing all the time. Just last month, the 2025 Lancet Countdown on Health and Climate Change described the health threats of climate change as ‘unprecedented’, and found that 12 of their 20 annual indicators performed the worst since records began.
Why ‘green hospitals’ won’t cut it – seeking a fresh approach to governing health and climate policies
Over the past five years, many of the political agreements linking health and climate change have grappled with trying to reduce emissions, and increase resilience to climate shocks. Year after year, diplomats have gathered at climate COPs in Scotland, Egypt and Azerbaijan. Handshakes, photocalls, and pledges for ‘net-zero’ health services resulted. Indeed, as diplomats departed and the giant river otters returned, Brazil presented us with more of the same: a COP30 Belém Health Action Plan, focused squarely on ‘health care sector adaptation’.
We should certainly protect health services from the perils of a warming planet, and spaces of medical care should not exacerbate the diseases they treat. However, there is a real risk that in celebrating ‘health care sector adaptation’, we trap the climate and health policy agenda into the walls of clinics and hospitals. This does an enormous disservice to doctors and nurses, who become burdened with both more, and more complex, cases of disease, many of which could have been prevented. While health care is responsible for around 5% of global greenhouse gas emissions, for the other 95%, it is not.
Yet health is not only the domain of the hospital. Health is profoundly shaped by the social, economic and political norms that govern society. This is ‘public’ health: that which is determined, not only cured. And specifically, when commercial actors, their activities and enabling economic systems and wider norms contribute to climate change, they affect health: they become ‘commercial determinants of health’.
While much study of the commercial determinants of health has emerged from investigating how a small set of industries – tobacco, alcoholic beverages, ultra-processed foods and beverages and gambling – affect noncommunicable diseases (NCDs) and mental health, the thinking is highly relevant to a climate context. And indeed, not only to the fossil fuel or extractive industries: commercial actors readily cause ecological destruction to service their business models, such as deforestation for intensive agriculture or pollution from private vehicles.
Many industrial products that harm health, such as alcoholic beverages or ultra-processed foods, are highly resource intensive. It can take around 870 litres of water to produce one litre of wine. What’s more, local populations must live with the consequences of industrial disasters that intersect with climate change. And governments have faced sophisticated industry lobbying to deny, delay and obstruct climate policies. The might of the vested interest is huge: in 2023, 15 countries allocated more funds to net fossil fuel subsidies than to national health budgets.
In seeking new ways to grapple with norm in health and climate policymaking, and to understand how thinking about commercial determinants of health might help to shed new light on climate and health policy thinking, our paper has explored two questions: how does climate change have intermediary destabilising impacts on systems of governance necessary for health and health equity? And as a result, how might commercial actors misaligned with health cause, worsen or exploit these destabilised conditions of governance?
Climate change might wreck governance for health, playing into the hands of health-harming industries
First, the doomsday alert. Climate change is destabilising the foundations of our politics, economics, social togetherness and use of technology, that govern our health. This is likely to have widespread and unpredictable consequences for health and health equity. This destabilisation is being caused, worsened and exploited by many industries to harm health for private gain.
By placing demands on public services and population health needs, climate change is destabilising the political fabric of all governments. The longer insufficient political action continues, the greater the likelihood and impact of diverting public sector resources away from health policy activities, towards mopping up the impacts of climate change. Weak governance becomes ripe for corporate capture – when corporations influence and take control of policy decisions. Alternatively, a weaponisation of social media might exploit declining trust in politicians to push people to types of politics less known for evidence-based health policymaking. When we experience climate-related health emergencies, reduced political governance capacities might entrench a reliance on market-driven approaches to providing medical care.
Next, health and the economy are inseparable. In the workplace, we benefit from safety and protection from physical and mental harm. At home, our lives and livelihoods are affected by the economic security of our jobs. As societies, how much money is taken in taxes, from incomes and businesses, affects how much governments can spend on health, or what we can spend on our own care. Yet, the economic impacts of climate change on health are highly unpredictable, and potentially seismic. Core indicators of macroeconomic performance, such as GDP, employment rates, job security, inflation and resource scarcity, are all likely to be undermined by climate change.
Socially, climate change not only worsens disease transmission, but also civil unrest, conflict, violence and forced human migration. These are all public health issues but are not always understood as such. In inflamed social contexts, commercial actors misaligned with health can weaponise discontent and subjugate vulnerable populations. Operations include the proliferation of private security, drug smuggling and human trafficking, or the privatisation of state functions such as border security and migrant services. Again, the shadow of social media looms large.
Lastly, climate change undermines the technologies we rely on to protect health. It might make it harder to find and grow the organic compounds we need for new drugs. It might mean less reliable power and computer systems in hospitals, or across medical supply chains. Or it might be more existential: who gets to use resources in a trade-off between human livelihood and economic growth, or gets to co-opt Indigenous technologies for private gain, disenfranchising communities from ownership of their own knowledge.
All is not lost, and change is inevitable
The toxic interplay of climate change and industries misaligned with health is a cautionary tale for health policy and governance. In affecting the foundational conditions that determine how governments can operate, it is a legitimate influence on how ‘good governance’ can occur.
While the way ahead may seem bleak, we propose four plausible paths.
First, governments can place more attention on the determinants of health in both health and climate policies and plans.
Second, governments can prioritise commercial activities as determinants of climate change and health in policies and plans.
Third, governments and international finance institutions can pause and reflect: their past approaches have accelerated the climate changes that now existentially threaten economic norms, and are no longer fit for purpose.
And last, governments and civil society have untapped policies that can simultaneously prioritise resilient economies, sustainable development, human health and planetary flourishing.
A fundamental reimagining of ‘governance for health’
By bringing together climate change and the commercial determinants of health as serious threats to political functioning, we highlight that governments might need to fundamentally reimagine what they understand as ‘governance for health’.
In months and years to come, the question is not if climate change will continue to damage health – it will – but how we must think about climate change, and its commercial drivers, when politicians govern for health. Expanding our horizons might lead to new fixes.
Will governance be proactive, open-minded and transformative? Or will it be chaotic, reactive and unable to grasp the structural reforms so desperately needed? The answer will have profound consequences for public policy. Finding out is the urgent work of our time.
Read the full paper by Daniel Hunt and Britta Matthes, Safeguarding governance and advancing policy at the nexus of climate and health: a commercial determinants of health perspective.
All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath.
