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With the global average temperature having risen to 1·2°C more than that in preindustrial times, the indicators contained in the 2020 report provide insights into the health impacts of climate change today and in the future. Extremes of heat affect vulnerable populations the most, with some 296 000 deaths occurring as a result of high temperatures in 2018 (indicator 1.1.3) according to The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises.

The climate suitability for the transmission of a range of infectious diseases—dengue fever, malaria, and those caused by Vibrio bacteria—has risen across the world (indicator 1.3.1). At the same time, crop yield potential has fallen for each of the major crops tracked, with dire consequences anticipated for food-insecure populations (indicator 1.4.1).

And yet, the global response has remained muted. The carbon intensity of the global energy system has been stable during the past three decades, and global coal use for energy increased by 74% during the same period (indicators 3.1.1 and 3.1.2). This rise has resulted in approximately 390 000 deaths from PM2·5 generated by coal-fired power, with total global mortality for all ambient sources exceeding 3·01 million deaths, in 2018 (indicator 3.3). In the agricultural sector, emissions from livestock grew by 16% from 2000 to 2017, with some 990 000 deaths occurring globally from excess red meat consumption in 2017 (indicators 3.5.1 and 3.5.2).

In the face of these problems, the response from the health profession continues to gain momentum. Spending on health system adaptation continued to increase, rising by 12·7% in 2019 to $18·4 billion (indicator 2.4). In just more than 10 years, original research on health and climate change has increased by a factor of eight, and, in half that time, health institutions with total assets of $42 billion have divested their holdings from fossil fuel industries (indicators 5.3 and 4.2.3). Led by low-income countries, more governments are linking health and climate change in their annual speeches at the UN General Debate and their NDCs under the Paris Agreement.

The public health and financial effects of COVID-19 will be felt for years to come, and efforts to protect and rebuild local communities and national economies will need to be robust and sustained. Despite concerning indicators across each section of this report, the 2021 UN Climate Change Conference presents an opportunity for course correction and revitalised NDCs. The window of opportunity is narrow, and, if the response to COVID-19 is not fully and directly aligned with national climate change strategies, the world will be unable to meet its commitments under the Paris Agreement, damaging health and health systems today, and in the future.

Integrative Journal of Global Health is a peer reviewed journal that focuses on providing insights into various aspects of health care, public health and health education research and practice, that is intended towards improvement of health standards of people across the globe.

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