Health SDGs are at risk from climate change: Evidence from India

PLOS One | https://doi.org/10.1371/journal.pone.0335529 November 26, 2025 12 / 17 establishes the extent to which climate risks can explain some of the persisting disparities in health outcomes. These risks need to be considered in health sector assessments health sector preparedness in line with the WHO call to action for protecting maternal and child health [92]. Cost-effective investment decisions need to consider the differentials in climate vulnerability across sub-national regions in health sector decision-making for effective implementation [93]. Tackling climatic vulnerability is essential for progressing on the SDG targets [94], and ignoring these can lead to delays and setbacks, most of which are avoidable. Effective climate resilient practices include communities in implementation and planning, empower local governance [95] and strengthen self-help groups [96] to enhance adaptive capacity. Since the current study uses data from a cross- sectional household survey it can provide inferences on the association between climate conditions and child health outcomes. Cohort studies can be designed specifically to overcome the limitations of such cross-section datasets, such as the presence of potentially unobservable factors that may be masked in a single large scale dataset. Further, in-depth studies are required to establish locally relevant and regionally disaggregated results, which could strengthen the evi- dence base on how local climatic conditions undermine SDG outcomes. Localized district level assessments can be

particularly important for areas highly vulnerable to climatic extremes such as cyclones, droughts, floods and heatwaves. On the operational side, national level assessments can incorporate some of the climatic vulnerability related indicators. 5. Conclusion The study provides quantitative evidence to establish the existence of a significant climate impact and its potential to dis- rupt sustainable SDG achievements. As such it establishes the unequivocal need for adaptation and for building a climate resilient healthcare system at sub-national levels to ensure that the benefits of investments made in achieving good health and well-being can be fully realized. Differentials in climate vulnerability need to be mainstreamed into plans and strate- gies for the health sector such as through the District Action Plans and the National Health Mission. State Action Plans on Climate Change, National Adaptation Plans and State Action Plans on Climate Change and Health are in the process of being drafted and revised by different states in India and the evidence provided in this study could be a timely input. Tracking climate disaster impacts and integrating these with health outcomes will lead to better health system pre- paredness, including surveillance, flood and heat resilient health infrastructure, stocking up on medicines and essential supplies according to vulnerability profiles, and training of personnel to respond in a sustained manner, including para- medics and community health workers. Closer co-ordination between health departments and other departments such

as state disaster management authorities and nodal agencies for implementation of climate change action plans can be facilitated through incorporation in the National Health Mission as well as the National Indicator Framework to track the progress on SDGs. Similar studies for other LMICs would be useful in planning effective strategies for climate action to support develop- ment, including awareness creation and raising resources. Advancing good health is linked to advancing on several of the non-health SDGs, including poverty alleviation (SDG1), promoting inclusive societies (SDG16), settlements (SDG11), sustainable use of ecosystems (SDG15), learning opportunities (SDG4), and productive employment (SDG8). It is import- ant therefore that health and non-health sector actors are made aware of the evidence on the impacts of climate change on health in order to eliminate disparities and progress on all the SDGs. Supporting information S1 Fig. Distribution of very high and highly vulnerable districts across India. (DOCX) S1 Table. Distribution of observations by level of climatic vulnerability. (DOCX)