India has performed poorly in integrating health into national climate change action plan, according to a new global scorecard. The finding is significant given the country’s vulnerability to climate-related illness and premature death.
The report, “Healthy NDC Scorecard”, published by the Global Climate and Health Alliance, assessed how well countries incorporate health considerations into their Nationally Determined Contributions (NDCs). These are national climate action plans submitted under the Paris Agreement, setting out commitments to reduce greenhouse gas emissions and adapt to climate change.
Of the 132 countries assessed, Colombia scored highest for integrating into its climate plan, followed by Nigeria and Cambodia. Climate commitments of several high emitting economies, by contrast, do not adequately account for health, states the report. It is third in the series, following earlier assessments in 2021 and 2023.
The Global Climate and Health Alliance is a consortium of more than 300 health professionals and civil society organisations and networks from around the world working at the intersections of climate change and health.
The findings are particularly relevant for India, which ranked ninth in the Climate Risk Index 2026, covering the period from 1995 to 2024. The index was released around the COP30 climate summit in Belém, Brazil.
Health is also expected to feature prominently at COP31, scheduled to take place in Antalya, Turkey, in November 2026. Discussions at the UN climate negotiations in Bonn in June has set the agenda for advancing health, equity and resilience in the global climate response at COP31.
Air pollution and climate action remain disconnected
The climate commitments of Japan, New Zealand and India fail to adequately account for health, the report states. Other major emitters, including the EU, China, Brazil and Britain, refer to health in their national climate plans but have not matched those commitments with the emissions cuts needed to protect public health.
Many countries are missing opportunities to improve air quality, protect public health and tackle climate change simultaneously. Only five—Cambodia, Chile, Colombia, Costa Rica and Paraguay—have set targets to reduce black carbon, a pollutant that contributes to global warming and air pollution, with serious consequences for human health, the report notes.
India is particularly affected by air pollution, making the omission significant.
India scores just 2 out of 32
The report gives India a score of just 2 out of 32 for the extent to which its latest NDC, submitted in April, prioritises health in climate policy. That puts India joint-bottom with Japan and New Zealand.
The scorecard assesses eight indicators: health impacts, air pollution, action in the health sector, health co-benefits, a just transition, integrated governance, economics and finance and monitoring and evaluation. Each carries a maximum score of four. India scored zero on six indicators and just one each for action in the health sector and integrated governance.
The report estimates that India records 186.2 deaths per 100,000 people from air pollution and warns that the country is on course for a rise in global temperatures of more than 2°C above pre-industrial levels.
“India additionally carries a high burden of air pollution mortality; but is among the countries which do not refer to air pollution considerations in their NDCs,” the report states.
A heavy health burden but little policy action
Speaking to Down To Earth (DTE), Anumita Roychowdhury, executive director of research and advocacy at the Centre for Science and Environment, Delhi, said, “It is inexplicable that, while air pollution claims roughly 2m lives annually in India, the country’s NDC makes no mention of air pollution or the health benefits of climate action.” Climate change cannot be tackled effectively without integrating air pollution and energy policies. India’s NDC overlooks both air pollution and potent short-lived climate pollutants, such as black carbon, produced by incomplete combustion. These pollutants trap heat and damage public health. The omission persists despite India’s endorsement of the COP28 Declaration on Climate and Health, which recognises the links between climate change, public health and air pollution, Roychowdhury added. “Addressing these links is essential to maximise the benefits of public investment.”
“Governments must grasp that air-quality action is a vital part of effective climate action, and that people’s health and lives are at stake with both,” said Jeni Miller, executive director of the Global Climate and Health Alliance.
Anjal Prakash, a professor of public policy at FLAME University in Pune and an author of reports by the Intergovernmental Panel on Climate Change (IPCC), said to DTE, “Climate policy cannot be divorced from public health; there are lives behind every tonne of emissions avoided and every clean-air intervention.” Prakash suggests that India’s next NDC must include health indicators, assess the impact of climate change on vulnerable populations, strengthen the resilience of health infrastructure and introduce measures to tackle worsening air quality. A health-centred climate policy is essential to protecting the gains from development and safeguarding citizens’ right to a safe and liveable future.
Global climate plans fall short on health
The scorecard assesses NDCs of 132 countries which submitted their 2035 climate plans to the United Nations Framework Convention on Climate Change (UNFCCC).
Colombia topped the rankings with 29 out of a possible 32 points, followed by Nigeria with 25 and Cambodia with 24. Paraguay and Timor-Leste rounded out the top five, with 22 points each. Nineteen of the 20 highest-scoring countries were low- and middle-income economies.
The report finds that the emissions-reduction targets in the NDCs of India and Japan are not aligned with the Paris agreement, putting public health at risk and leaving gaps in plans to protect populations from climate-related harms.
Other major emitters also scored poorly. South Korea received four points out of 32, Russia six, Brazil seven, and Australia, China and Britain nine each. These countries have failed to commit to what the report considers their fair share of emissions reductions, it says.
Indonesia received 11 points, the EU 12, South Africa 13, Turkey 14, Canada 16 and the United Arab Emirates 19. The report warns that inadequate emissions cuts could undermine these countries’ health-related commitments over time.
Among the major emitters assessed, the EU’s NDC is the only one to set a specific target for reducing air pollution, according to the report. It commits to phasing out hydrofluorocarbons (HFCs) by 2050.
The US, whose NDC was not considered active following its withdrawal from the Paris agreement, received a score of just seven.
Integrated action guarantees triple win
“The ‘Healthy NDC Scorecard’ enables us to evaluate how governments are considering health in their climate planning, whether this is matched by their emissions reductions ambition, and to compare intended health and climate action to actual national air pollution mortality,” said Nova Tebbe, a postdoctoral researcher at the Global Climate and Health Alliance and the study’s research lead.
Tebbe said that rapid action to curb short-lived climate pollutants, including black carbon, methane, hydrofluorocarbons (HFCs) and tropospheric ozone, “offers a triple win: slowing global heating and future health threats, delivering immediate health benefits, and generating significant cost savings even within a political term”.
“Clearly, such action must be taken immediately and implemented rapidly. The health impacts of climate change are intensifying, with further escalation likely because of El Niño conditions,” Tebbe added.
Jess Beagley, policy lead at the Global Climate and Health Alliance, said that developing countries would need financial support from richer nations to implement their climate plans. “In developing countries a significant proportion of the finance for NDC implementation needs to come from developed countries … Such funding is quite literally a lifeline,” she said.
Beagley also stressed that countries responsible for a large share of historical and current emissions had a duty to cut them most rapidly.