World leaders must urgently redirect the trillions invested annually in fossil fuels to safeguard human health and survival against the devastating impacts of global heating, urge the authors of the latest Lancet Countdown report.

In the eighth annual Countdown on health and climate change—an independent evaluation of progress toward the goals of the 2015 Paris climate agreement—the report authors write that prioritizing global health risks is essential to achieve a sustainable, equitable, zero-emissions future. “Repurposing” the vast subsidies currently propping up the fossil fuel industry can fund this critical transition, the authors say.

Since 2015, the Countdown has been released annually just before the United Nations Conference of the Parties (COP) to catch the attention of world leaders with a timely call to action. It is produced in collaboration with the World Health Organization, the World Meteorological Organization, and myriad academic institutions.

Record-Breaking Health Threats in 2023

“The year 2023 was the hottest on record, with persistent droughts, deadly heatwaves, and devastating forest fires, storms and floods, and disastrous impacts on the health, lives and livelihoods of people worldwide,” Lancet said in a release.

Hotter days and far more of them in 2023—50 days more than average—proved deadly, with heat-related deaths in people aged over 65 increasing by “a record-breaking 167% above deaths in the 1990s.” In comparison, if global temperatures had remained the same, demographic changes would have meant a 65% increase in heat-related mortality over 1990 levels.

Increasing temperatures have also led to a record 512 billion potential hours of labour lost globally in 2023—a 49% increase on the 1990-1999 average—with potential income losses equivalent to US$835 billion.

Such labour losses owe partly to restless nights, as outdoor and factory workers around the world lost 6% more hours of sleep than the 1986-2005 average due to high nighttime temperatures.

The higher temperatures also meant more hunger. More heatwaves and droughts in 2023 were associated with 151 million more people experiencing moderate or severe food insecurity than annually between 1981 and 2010. Last year’s Countdown—which urged COP28 convenors to push for a fossil phaseout (COP negotiators agreed, but oil and gas exploration is still surging)—put the number of people facing food insecurity at 127 million.

And yet, Lancet finds “persistent delays in adaptation.” As of December 2023, only 61% of countries that committed to boosting their health systems’ resilience to climate change had completed vulnerability and adaptation assessments, and only 52% had developed health adaptation plans.

Fossil Fuels Driving Climate Risk

Meanwhile, oil and gas companies are strategizing to expand production and reinforce the global dependence on fossil fuels, “pushing the world further off track” from the goals set in Paris, and “threatening people’s health and survival,” the authors write.

The Countdown echoes other analysis concluding that global energy-related carbon dioxide emissions reached an all-time high in 2023. By March 2024, the 114 largest oil and gas companies were on track to exceed emissions compatible with a 1.5°C increase by 189% by 2040, up from 173% the previous year.

This trajectory is fueled by public funding, with fossil fuel subsidies totalling $1.4 trillion in 2022. “While climate action is limited by the lack of funding, fossil fuel investment still attracted 36.6% of global energy investment in 2023.” Many governments also increased explicit fossil fuel subsidies when energy prices soared after Russia’s invasion of Ukraine.

Financial resources continue to be invested in “the very things that undermine our health,” Lancet Countdown Executive Director Marina Romanello said in the release. “Repurposing the trillions of dollars being invested in, or subsidizing, the fossil fuel industry every year would provide the opportunity to deliver a fair, equitable transition to clean energy and energy efficiency, and a healthier future, ultimately benefiting the global economy.”

However, the connection between health and climate change is fading from public discourse. Mentions of health and climate in UN General Debate statements fell significantly from 2022 to 2023, and just 47% of updated Nationally Determined Contributions (NDCs) as of February, 2024, referenced health.

Media attention, too, is waning: “The proportion of newspaper climate change articles mentioning health fell 10% between 2022 and 2023.”

Fund Health, Not Fossil Fuels

Amid this dreary outlook, there are signs of progress, Air-pollution deaths declined almost 7%, from 2.25 million in 2016 to 2.09 million in 2021, with 59% of the drop attributed to reduced pollution from burning coal. That gain demonstrated the “life-saving potential of coal phaseout,” the authors say.

Global clean energy capacity is growing with increasing investments, and employment in the renewables sector hit a record high of 13.7 million in 2022—a 35% increase since 2016.

“Progress towards an equitable and healthy future requires a global transformation of financial systems, shifting resources away from the fossil fuel-based economy towards a zero-emissions future,” said Anthony Costello, co-author and co-chair of the Lancet Countdown.