The Rockefeller Foundation identifies critical gaps in city responses to climate-induced health threats

During New York City Climate Week, The Rockefeller Foundation released a three-step roadmap to help cities around the world more effectively plan for, and respond to the global health emergency caused by climate change. With more than half of the world's population living in urban areas, Urban Climate-Health Action: A New Approach to Protecting Health in the Era of Climate Change, identifies the critical gaps in city-level responses to climate-induced health threats. The Rockefeller Foundation announced today that it will invest more than $1 million to support the plan's implementation through grants, including to C40 Cities and Resilient Cities Network.

"From New York to Nairobi, Bogotá to Bangalore, cities worldwide are facing rising health risks and increased stress from climate change," said Elizabeth Yee, Executive Vice President of Programs at The Rockefeller Foundation. "This report highlights immediate, actionable steps mayors, health officials, and residents can take to protect lives and improve well-being."

While the health implications of climate change are global, cities, which are home to an estimated 5 billion people, are already bearing the brunt of the crisis. By 2050, nearly 70% of the world's population is expected to live in a city, each facing unique health risks caused by climate change. The features that define cities-dense populations, concrete landscapes, limited greenspace, and proximity to water- intensify heat, increase pollution, and spread disease. Cities like New Delhi and Ouagadougou, Burkina Faso are experiencing unprecedented heatwaves, while Dhaka, Miami, and Dubai face more frequent and severe flooding. Rio de Janeiro and Ho Chi Minh City have seen increased cases of dengue fever due to expanding mosquito habitats.

The Urban Climate-Health Action report was informed by data from the Urban Pulse: Identifying Resilience Solutions at the Intersection of Climate, Health and Equity survey that was also released today. Conducted by Yale School of Public Health and the Resilient Cities Network, with support from The Rockefeller Foundation, the survey reveals that of nearly 200 city leaders in 118 cities in 52 countries, 70% of city leaders recognize these climate-related health threats, and over 90% report economic losses from such events. Despite this, few cities have emergency response plans that use reliable climate data, and only 20% have strong inter-departmental coordination.

In response, The Rockefeller Foundation outlines its three-step action plan for cities:

• Connect health and meteorological agencies to translate climate risks into forecasts that show the impact on the health of vulnerable populations.
• Build multisectoral teams that include leaders and experts across climate, health, urban planning, transportation, education, and civil society who will use climate insights to develop local prevention and response plans.
• Budget for future climate-related health threats by positioning resources where they are needed most and ensuring timely, effective communications reach those most at risk.

The Foundation's roadmap for cities also includes seven case studies demonstrating successful programs across three continents, including:

• Rio de Janeiro, Brazil, a multidisciplinary team including Rio's Municipal Health Secretariat under the Health Surveillance Superintendence, set up the Dengue Emergency Operations Center to forecast dengue hotspots and predict spikes in early 2024. By bringing together the Operations and Resilience Center and other local partners to predict a spike two months earlier than forecasted by traditional epidemiological models, Rio improved timely notifications and deployment of resources enough to ensure the lowest death rate among the last four dengue epidemics.
• Dhaka, Bangladesh, the Red Crescent Society engaged a multisectoral team to develop an Early Action Protocol to minimize health risks during intense heatwaves. By using heat forecasting and street-by-street vulnerability data, response partners in Dhaka have alerted a million people of their increased risk and deployed live-saving resources like safe drinking water and umbrellas at critical locations. If scaled to 57 countries, this sort of warning system could save almost 100,000 lives a year, according to the World Health Organization and World Meteorological Organization.
• Lusaka, Zambia, the El Niño climate phenomenon has led to severe drought and water insecurity, increasing the incidence and severity of cholera outbreaks. A risk communication and community engagement response led by the Collective Service has improved localized understanding of health-seeking behaviors and key concerns, propelling a 100% uptake of the cholera vaccine and increased uptake of oral rehydration salts, stemming the outbreak and preventing deaths.

As these cases make clear, city-led action can save lives. If the action plan championed by this report were implemented for just one heatwave in Dhaka, preliminary estimates by Mathematica, a leading policy research firm, commissioned for this report, finds a $1 to $7 return on investment in terms of lives saved among the most vulnerable - illustrating the tremendous economic value at stake.

"Cities are flying blind to the impact climate change is having on human health, and people are needlessly suffering as a result," said Dr. Naveen Rao, Senior Vice President of Health at The Rockefeller Foundation. "Integration across sectors is vital to respond to the unfolding climate-health crises."

To put this roadmap into action, The Rockefeller Foundation is supporting C40 Cities and Resilient Cities Network in separate grants to implement recommendations laid out in this report. A grant to the Resilient Cities Network, made up of over 100 cities advancing urban resilience globally, will support the Urban Pulse: Climate, Health, and Equity in Action program by creating a city-led Community of Practice and integrating health priorities into climate adaptation and mitigation efforts. Another grant to C40 Cities, a network of nearly 100 mayors of the world's leading cities working to confront the climate crisis, will support heat-health pilot initiatives to assist city officials and other stakeholders to better respond to health impacts on vulnerable communities during extreme heat events. These investments are part of the Foundation's $100 million commitment to test and scale climate and health solutions, announced at the inaugural COP28 Health Day in December 2023.

Statements of support

• Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization: "As the effects of climate change intensify, the world is coming increasingly to the realization that the climate crisis is a health crisis. Health is one of the most compelling reasons for climate action, demanding collaboration between health, meteorology, and other sectors to deliver effective solutions to promote and protect the health of people and the planet on which all life depends."
• Professor Celeste Saulo, Secretary-General of the World Meteorological Organization said: "Widespread, intense and extended heatwaves have hit communities and cities on every continent. At least ten countries have recorded temperatures of more than 50° C in more than one location this year. Many dozens of locations have seen daytime maximum temperatures of more than 40°C and dangerously high minimum overnight temperatures. The so-called urban heat island effect means that people in cities are particularly vulnerable. Integration across sectors is key to ensuring that city leaders have the right information at the right time to respond effectively to the unfolding climate-health crises."
• Sadiq Khan, Mayor of London and Co-Chair of C40 Cities said: "London is at the forefront of addressing climate health challenges. From expanding our Clean Air Zone, now the largest in the world, to deploying zero-emission buses and installing more electric vehicle chargers than the rest of the UK combined, we've significantly improved air quality. Given London's progress in tackling issues like cleaning up our air, it's clear that there is an opportunity for global discussions, like those at the Summit of the Future, to place greater emphasis on the vital link between climate action and public health. I look forward to working with global leaders to further the conversation on building resilient, healthy cities for the future. Together we can build a greener, safer and healthier world for all."
• Yvonne Aki-Sawyerr, OBE, Mayor of Freetown, Sierra Leone and Co-Chair of C40 Cities: "The climate crisis disproportionately impacts our most vulnerable populations, including women, who often face heightened risks due to entrenched gender inequalities. In Freetown we're working to combat these threats and reduce inequalities through initiatives like #FreetowntheTreetown, where we've planted over a million trees to mitigate heat and prevent flooding. While we recognize these measures as major steps, the reality is that we must drive more robust, comprehensive actions to address these issues. It is therefore essential for global leaders to unite and develop strategies that truly protect all communities and build resilient, equitable cities for the future."
• Lauren Sorkin, Executive Director of the Resilient Cities Network: "Cities are acutely aware that climate change poses serious health risks, which disproportionately affect populations that face vulnerabilities. The R-Cities network of Chief Resilience Officers is at the forefront of addressing these challenges, driving cross-sector collaboration to pilot and scale equitable, innovative solutions. This Urban Pulse report, produced in partnership with Yale University, captures both the scale of the challenge and pioneering actions already underway in cities. We look forward to supporting more cities in the next phase of the Urban Pulse program to advance climate, health, and equity solutions where they are needed most."
• Mark Watts, Executive Director of C40 Cities: "The Rockefeller Foundation's new roadmap underscores the critical need for visionary leadership and cross-sector collaboration to tackle the climate emergency. From New York to Nairobi cities are not just sites of climate change impact but also arenas of innovative solutions. This $1 million commitment will make a tangible impact for the cities confronting the escalating health impacts of climate change. Addressing these threats requires united action and forward-thinking strategies. United, we can turn the tide and safeguard the health and resilience of our urban communities."
• Jeannette Ickovics, Professor at the Yale School of Public Health and lead author of the 2024 Urban Pulse Survey: "Our Urban Pulse report highlights that city leaders recognize the impact of climate change on residents' health and mental health, though resources, infrastructure, and collaboration to address these profound threats have been limited. We call on the global community to put health at the heart of the urban climate change agenda, to amplify and scale-up evidence-based solutions, and to invest in new financing models that prioritize rapid disbursement to cities so that they can build and sustain resilience. We must leverage this research to unite in a vision of urban resilience - harnessing our collective wisdom and strength to build a healthier, more equitable and sustainable urban environment for all."