Background: As the climate crisis intensifies, national adaptation strategies—including National Adaptation Plans (NAPs), National Adaptation Programmes of Action (NAPAs), and related policy documents—play a critical role in shaping how countries protect public health. These documents are key instruments for defining climate-health priorities, yet little is known about the extent to which they include concrete health interventions or address the ethical imperatives of equity and vulnerability. This study examines how national adaptation strategies globally integrate health-related interventions and ethical considerations. It aims to identify which countries are addressing health comprehensively, which interventions are prioritized or overlooked, and how vulnerable populations are represented (or neglected) in climate adaptation planning.
Methods: A total of 123 national adaptation documents (NAPs, NAPAs, and related strategies) were reviewed. ChatGPT-Pro was used for initial content extraction, followed by manual coding and qualitative synthesis. Documents were assessed for five health-related intervention categories: disaster risk reduction, health workforce training, heat adaptation, mental health, and vaccination. Mentions of vulnerable groups were also analyzed.
Results: Only 10% of countries addressed four or more of the five key health themes. Disaster risk reduction (91%) and health workforce training (81%) were the most commonly included interventions. In contrast, mental health (11%) and vaccination (17%) were severely underrepresented. While vulnerable groups such as women, children, and the elderly were mentioned in many strategies, few included targeted interventions to address their specific needs, highlighting a gap between recognition and action.
Conclusions: Despite growing recognition of climate-health risks, most national adaptation strategies fall short of comprehensive or equity-focused responses. Strengthening the ethical and programmatic integration of health in these strategies is critical to ensure inclusive and just climate adaptation.
