Review

. 2019 Nov 16;394(10211):1836-1878.

doi: 10.1016/S0140-6736(19)32596-6.

The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate

Nick Watts¹, Markus Amann², Nigel Arnell³, Sonja Ayeb-Karlsson⁴, Kristine Belesova⁵, Maxwell Boykoff⁶, Peter Byass⁷, Wenjia Cai⁸, Diarmid Campbell-Lendrum⁹, Stuart Capstick¹⁰, Jonathan Chambers¹¹, Carole Dalin¹², Meaghan Daly¹³, Niheer Dasandi¹⁴, Michael Davies¹⁵, Paul Drummond¹², Robert Dubrow¹⁶, Kristie L Ebi¹⁷, Matthew Eckelman¹⁸, Paul Ekins¹², Luis E Escobar¹⁹, Lucia Fernandez Montoya²⁰, Lucien Georgeson²¹, Hilary Graham²², Paul Haggar¹⁰, Ian Hamilton²³, Stella Hartinger²⁴, Jeremy Hess²⁵, Ilan Kelman²⁶, Gregor Kiesewetter², Tord Kjellstrom²⁷, Dominic Kniveton²⁸, Bruno Lemke²⁹, Yang Liu³⁰, Melissa Lott³¹, Rachel Lowe⁵, Maquins Odhiambo Sewe³², Jaime Martinez-Urtaza³³, Mark Maslin²¹, Lucy McAllister³⁴, Alice McGushin²⁶, Slava Jankin Mikhaylov³⁵, James Milner³⁶, Maziar Moradi-Lakeh³⁷, Karyn Morrissey³⁸, Kris Murray³⁹, Simon Munzert³⁵, Maria Nilsson⁷, Tara Neville⁹, Tadj Oreszczyn²³, Fereidoon Owfi⁴⁰, Olivia Pearman⁴¹, David Pencheon⁴², Dung Phung⁴³, Steve Pye²³, Ruth Quinn⁴⁴, Mahnaz Rabbaniha⁴⁰, Elizabeth Robinson⁴⁵, Joacim Rocklöv³², Jan C Semenza⁴⁶, Jodi Sherman⁴⁷, Joy Shumake-Guillemot⁴⁸, Meisam Tabatabaei⁴⁹, Jonathon Taylor¹⁵, Joaquin Trinanes⁵⁰, Paul Wilkinson³⁶, Anthony Costello⁵¹, Peng Gong⁸, Hugh Montgomery⁵²

Affiliations

¹ Institute for Global Health, University College London, London, UK. Electronic address: nicholas.watts@ucl.ac.uk.
² Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria.
³ Department of Meteorology, University of Reading, Reading, UK.
⁴ Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
⁵ Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.
⁶ Cooperative Institute for Research in Environmental Sciences and Environmental Studies, University of Colorado Boulder, Boulder, CO, USA.
⁷ Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
⁸ Department of Earth System Science, Tsinghua University, Beijing, China.
⁹ Department of Public Health and the Environment, WHO, Geneva, Switzerland.
¹⁰ School of Psychology, Cardiff University, Cardiff, UK.
¹¹ Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland.
¹² Institute for Sustainable Resources, University College London, London, UK.
¹³ Department of Environmental Studies, University of New England, Biddeford, ME, USA.
¹⁴ School of Government, University of Birmingham, Birmingham, UK.
¹⁵ Institute for Environmental Design and Engineering, University College London, London, UK.
¹⁶ Yale Climate Change and Health Initiative, Yale University, New Haven, CT, USA.
¹⁷ Department of Global Health, University of Washington, Washington, DC, USA.
¹⁸ Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA.
¹⁹ Department of Fish and Wildlife Conservation, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
²⁰ Global Malaria Programme, WHO, Geneva, Switzerland.
²¹ Department of Geography, University College London, London, UK.
²² Department of Health Sciences, University of York, York, UK.
²³ Energy Institute, University College London, London, UK.
²⁴ The Integrated Development, Health and Environment Unit, Universidad Peruana Cayetano Heredia, Lima, Peru.
²⁵ Centre for Health and the Global Environment, University of Washington, Washington, DC, USA.
²⁶ Institute for Global Health, University College London, London, UK.
²⁷ Health and Environment International Trust, Nelson, New Zealand.
²⁸ School of Global Studies, University of Sussex, Brighton, UK.
²⁹ Nelson Marlborough Institute of Technology, Nelson, New Zealand.
³⁰ Rollins School of Public Health, Emory University, Atlanta, GA, USA.
³¹ Center on Global Energy Policy School of International and Public Affairs, Columbia University, New York City, NY, USA.
³² Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
³³ The Centre for Environment, Fisheries and Aquaculture Science, Dorset, UK.
³⁴ History and Society Division, Babson College, Wellesley, MA, USA.
³⁵ Data Science Lab, Hertie School, Berlin, Germany.
³⁶ Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK.
³⁷ Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
³⁸ European Centre for Environment and Human Health, University of Exeter, Exeter, UK.
³⁹ Faculty of Medicine, School of Public Health, Imperial College London, London, UK.
⁴⁰ Iranian Fisheries Science Research Institute, Agricultural Research, Education, and Extension Organisation, Tehran, Iran.
⁴¹ Center for Science and Technology Policy Research, University of Colorado Boulder, Boulder, CO, USA.
⁴² Medical School, University of Exeter, Exeter, UK.
⁴³ School of Medicine, Griffith University, Brisbane, QLD, Australia.
⁴⁴ School of Biological Sciences, University of Aberdeen, Aberdeen, UK.
⁴⁵ School of Agriculture, Policy, and Development, University of Reading, Reading, UK.
⁴⁶ Scientific Assessment Section, European Centre for Disease Prevention and Control, Solna, Sweden.
⁴⁷ Department of Anesthesiology, Yale University, New Haven, CT, USA.
⁴⁸ WHO-WMO Joint Climate and Health Office, Geneva, Switzerland.
⁴⁹ Faculty of Plantation and Agrotechnology, Universiti Teknologi MARA, Shah Alam, Malaysia.
⁵⁰ Physical Oceanography Division, Atlantic Oceanographic and Meteorological Laboratory, National Oceanic and Atmospheric Administration, Miami, FL, USA.
⁵¹ Office of the Vice Provost for Research, University College London, London, UK.
⁵² Institute for Human Health and Performance, University College London, London, UK.

PMID: 31733928
PMCID: PMC7616843
DOI: 10.1016/S0140-6736(19)32596-6

Review

The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate

Nick Watts et al. Lancet. 2019.

. 2019 Nov 16;394(10211):1836-1878.

doi: 10.1016/S0140-6736(19)32596-6.

Authors

Affiliations

¹ Institute for Global Health, University College London, London, UK. Electronic address: nicholas.watts@ucl.ac.uk.
² Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria.
³ Department of Meteorology, University of Reading, Reading, UK.
⁴ Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
⁵ Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.
⁶ Cooperative Institute for Research in Environmental Sciences and Environmental Studies, University of Colorado Boulder, Boulder, CO, USA.
⁷ Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
⁸ Department of Earth System Science, Tsinghua University, Beijing, China.
⁹ Department of Public Health and the Environment, WHO, Geneva, Switzerland.
¹⁰ School of Psychology, Cardiff University, Cardiff, UK.
¹¹ Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland.
¹² Institute for Sustainable Resources, University College London, London, UK.
¹³ Department of Environmental Studies, University of New England, Biddeford, ME, USA.
¹⁴ School of Government, University of Birmingham, Birmingham, UK.
¹⁵ Institute for Environmental Design and Engineering, University College London, London, UK.
¹⁶ Yale Climate Change and Health Initiative, Yale University, New Haven, CT, USA.
¹⁷ Department of Global Health, University of Washington, Washington, DC, USA.
¹⁸ Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA.
¹⁹ Department of Fish and Wildlife Conservation, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
²⁰ Global Malaria Programme, WHO, Geneva, Switzerland.
²¹ Department of Geography, University College London, London, UK.
²² Department of Health Sciences, University of York, York, UK.
²³ Energy Institute, University College London, London, UK.
²⁴ The Integrated Development, Health and Environment Unit, Universidad Peruana Cayetano Heredia, Lima, Peru.
²⁵ Centre for Health and the Global Environment, University of Washington, Washington, DC, USA.
²⁶ Institute for Global Health, University College London, London, UK.
²⁷ Health and Environment International Trust, Nelson, New Zealand.
²⁸ School of Global Studies, University of Sussex, Brighton, UK.
²⁹ Nelson Marlborough Institute of Technology, Nelson, New Zealand.
³⁰ Rollins School of Public Health, Emory University, Atlanta, GA, USA.
³¹ Center on Global Energy Policy School of International and Public Affairs, Columbia University, New York City, NY, USA.
³² Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
³³ The Centre for Environment, Fisheries and Aquaculture Science, Dorset, UK.
³⁴ History and Society Division, Babson College, Wellesley, MA, USA.
³⁵ Data Science Lab, Hertie School, Berlin, Germany.
³⁶ Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK.
³⁷ Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
³⁸ European Centre for Environment and Human Health, University of Exeter, Exeter, UK.
³⁹ Faculty of Medicine, School of Public Health, Imperial College London, London, UK.
⁴⁰ Iranian Fisheries Science Research Institute, Agricultural Research, Education, and Extension Organisation, Tehran, Iran.
⁴¹ Center for Science and Technology Policy Research, University of Colorado Boulder, Boulder, CO, USA.
⁴² Medical School, University of Exeter, Exeter, UK.
⁴³ School of Medicine, Griffith University, Brisbane, QLD, Australia.
⁴⁴ School of Biological Sciences, University of Aberdeen, Aberdeen, UK.
⁴⁵ School of Agriculture, Policy, and Development, University of Reading, Reading, UK.
⁴⁶ Scientific Assessment Section, European Centre for Disease Prevention and Control, Solna, Sweden.
⁴⁷ Department of Anesthesiology, Yale University, New Haven, CT, USA.
⁴⁸ WHO-WMO Joint Climate and Health Office, Geneva, Switzerland.
⁴⁹ Faculty of Plantation and Agrotechnology, Universiti Teknologi MARA, Shah Alam, Malaysia.
⁵⁰ Physical Oceanography Division, Atlantic Oceanographic and Meteorological Laboratory, National Oceanic and Atmospheric Administration, Miami, FL, USA.
⁵¹ Office of the Vice Provost for Research, University College London, London, UK.
⁵² Institute for Human Health and Performance, University College London, London, UK.

PMID: 31733928
PMCID: PMC7616843
DOI: 10.1016/S0140-6736(19)32596-6

Abstract

The Lancet Countdown is an international, multidisciplinary collaboration, dedicated to monitoring the evolving health profile of climate change, and providing an independent assessment of the delivery of commitments made by governments worldwide under the Paris Agreement.

The 2019 report presents an annual update of 41 indicators across five key domains: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. The report represents the findings and consensus of 35 leading academic institutions and UN agencies from every continent. Each year, the methods and data that underpin the Lancet Countdown’s indicators are further developed and improved, with updates described at each stage of this report. The collaboration draws on the world-class expertise of climate scientists; ecologists; mathematicians; engineers; energy, food, and transport experts; economists; social and political scientists; public health professionals; and doctors, to generate the quality and diversity of data required.

The science of climate change describes a range of possible futures, which are largely dependent on the degree of action or inaction in the face of a warming world. The policies implemented will have far-reaching effects in determining these eventualities, with the indicators tracked here monitoring both the present-day effects of climate change, as well as the worldwide response. Understanding these decisions as a choice between one of two pathways—one that continues with the business as usual response and one that redirects to a future that remains “well below 2°C”—helps to bring the importance of recognising the effects of climate change and the necessary response to the forefront.

Evidence provided by the Intergovernmental Panel on Climate Change, the International Energy Agency, and the US National Aeronautics and Space Administration clarifies the degree and magnitude of climate change experienced today and contextualises these two pathways.

The impacts of climate change on human health: The world has observed a 1°C temperature rise above pre-industrial levels, with feedback cycles and polar amplification resulting in a rise as high as 3°C in north western Canada.^, Eight of the ten hottest years on record have occurred in the past decade. Such rapid change is primarily driven by the combustion of fossil fuels, consumed at a rate of 171 000 kg of coal, 116 000 000 L of gas, and 186 000 L of oil per s.^– Progress in mitigating this threat is intermittent at best, with carbon dioxide emissions continuing to rise in 2018. Importantly, many of the indicators contained in this report suggest the world is following this “business as usual” pathway.

The carbon intensity of the energy system has remained unchanged since 1990 (indicator 3.1.1), and from 2016 to 2018, total primary energy supply from coal increased by 1·7%, reversing a previously recorded downward trend (indicator 3.1.2). Correspondingly, the health-care sector is responsible for about 4·6% of global emissions, a value which is steadily rising across most major economies (indicator 3.6). Global fossil fuel consumption subsidies increased by 50% over the past 3 years, reaching a peak of almost US$430 billion in 2018 (indicator 4.4.1).

A child born today will experience a world that is more than four degrees warmer than the pre-industrial average, with climate change impacting human health from infancy and adolescence to adulthood and old age. Across the world, children are among the worst affected by climate change. Downward trends in global yield potential for all major crops tracked since 1960 threaten food production and food security, with infants often the worst affected by the potentially permanent effects of undernutrition (indicator 1.5.1). Children are among the most susceptible to diarrhoeal disease and experience the most severe effects of dengue fever. Trends in climate suitability for disease transmission are particularly concerning, with nine of the ten most suitable years for the transmission of dengue fever on record occurring since 2000 (indicator 1.4.1). Similarly, since an early 1980s baseline, the number of days suitable for Vibrio (a pathogen responsible for part of the burden of diarrhoeal disease) has doubled, and global suitability for coastal Vibrio cholerae has increased by 9·9% indicator 1.4.1).

Through adolescence and beyond, air pollution—principally driven by fossil fuels, and exacerbated by climate change—damages the heart, lungs, and every other vital organ. These effects accumulate over time, and into adulthood, with global deaths attributable to ambient fine particulate matter (PM_2·5) remaining at 2·9 million in 2016 (indicator 3.3.2) and total global air pollution deaths reaching 7 million.

Later in life, families and livelihoods are put at risk from increases in the frequency and severity of extreme weather conditions, with women among the most vulnerable across a range of social and cultural contexts. Globally, 77% of countries experienced an increase in daily population exposure to wildfires from 2001–14 to 2015–18 (indicator 1.2.1). India and China sustained the largest increases, with an increase of over 21 million exposures in India and 17 million exposures in China over this time period. In low-income countries, almost all economic losses from extreme weather events are uninsured, placing a particularly high burden on individuals and households (indicator 4.1). Temperature rise and heatwaves are increasingly limiting the labour capacity of various populations. In 2018, 133·6 billion potential work hours were lost globally, 45 billion more than the 2000 baseline, and southern areas of the USA lost 15–20% of potential daylight work hours during the hottest month of 2018 (indicator 1.1.4).

Populations aged 65 years and older are particularly vulnerable to the health effects of climate change, and especially to extremes of heat. From 1990 to 2018, populations in every region have become more vulnerable to heat and heatwaves, with Europe and the Eastern Mediterranean remaining the most vulnerable (indicator 1.1.1). In 2018, these vulnerable populations experienced 220 million heatwave exposures globally, breaking the previous record of 209 million set in 2015 (indicator 1.1.3). Already faced with the challenge of an ageing population, Japan had 32 million heatwave exposures affecting people aged 65 years and older in 2018, the equivalent of almost every person in this age group experiencing a heatwave. Finally, although difficult to quantify, the downstream risks of climate change, such as migration, poverty exacerbation, violent conflict, and mental illness, affect people of all ages and all nationalities.

A business as usual trajectory will result in a fundamentally altered world, with the indicators described providing a glimpse of the implications of this pathway. The life of every child born today will be profoundly affected by climate change. Without accelerated intervention, this new era will come to define the health of people at every stage of their lives.

Responding to climate change for health: The Paris Agreement has set a target of “holding the increase in the global average temperature to well below 2°C above pre-industrial levels and pursuing efforts to limit the temperature increase to 1·5°C.” In a world that matches this ambition, a child born today would see the phase-out of all coal in the UK and Canada by their sixth and 11th birthday; they would see France ban the sale of petrol and diesel cars by their 21st birthday; and they would be 31 years old by the time the world reaches net-zero in 2050, with the UK’s recent commitment to reach this goal one of many to come. The changes seen in this alternate pathway could result in cleaner air, safer cities, and more nutritious food, coupled with renewed investment in health systems and vital infrastructure. This second path—which limits the global average temperature rise to “well below 2°C”—is possible, and would transform the health of a child born today for the better, right the way through their life.

Considering the evidence available in the 2019 indicators, such a transition could be beginning to unfold. Despite a small increase in coal use in 2018, in key countries such as China, it continued to decrease as a share of electricity generation (indicator 3.1.2). Correspondingly, renewables accounted for 45% of global growth in power generation capacity that year, and low-carbon electricity reached a high of 32% of global electricity in 2016 (indicator 3.1.3). Global per capita use of electric vehicles increased by 20·6% between 2015 and 2016, and now represents 1·8% of China’s total transportation fuel use (indicator 3.4). Improvements in air pollution seen in Europe from 2015 to 2016, could result in a reduction of Years of Life Lost (YLL) worth €5·2 billion annually, if this reduction remained constant across a lifetime (indicator 4.2). In several cases, the economic savings from a healthier and more productive workforce, with fewer health-care expenses, will cover the initial investment costs of these interventions. Similarly, cities and health systems are becoming more resilient to the effects of climate change; about 50% of countries and 69% of cities surveyed reported efforts to conduct national health adaptation plans or climate change risk assessments (indicators 2.1.1, 2.1.2, and 2.1.3). These plans are now being implemented, with the number of countries providing climate services to the health sector increasing from 55 in 2018 to 70 in 2019 (indicator 2.2) and 109 countries reporting medium to high implementation of a national health emergency framework (indicator 2.3.1). Growing demand is coupled with a steady increase in health adaptation spending, which represents 5% (£13 billion) of total adaptation funding in 2018 and has increased by 11·8% over the past 12 months (indicator 2.4). This increase is in part funded by growing revenues from carbon pricing mechanisms, with a 30% increase to US$43 billion in funds raised between 2017 and 2018 (indicator 4.4.3).

However, current progress is inadequate, and despite the beginnings of the transition described, the indicators published in the Lancet Countdown’s 2019 report are suggestive of a world struggling to cope with warming that is occurring faster than governments are able, or willing to respond. Opportunities are being missed, with the Green Climate Fund yet to receive projects specifically focused on improving climate-related public health, despite the fact that in other forums, leaders of small island developing states are recognising the links between health and climate change (indicator 5.3). In response, the generation that will be most affected by climate change has led a wave of school strikes across the world.

Bold new approaches to policy making, research, and business are needed in order to change course. An unprecedented challenge demands an unprecedented response, and it will take the work of the 7·5 billion people currently alive to ensure that the health of a child born today is not defined by a changing climate.

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Conflict of interest statement

Declaration of interests

The Lancet Countdown’s work is supported by an unrestricted grant from the Wellcome Trust (209734/Z/17/Z). The Lancet Countdown covered travel costs for meetings related to the development of the paper. Ten of the authors were compensated for their time while working on the drafting and development of the Lancet Countdown’s report (NW, AM, MB, JC, MD, PD, GK, LM, OP, and RQ). The work of MB was supported by the Cooperative Institute for Research in Environmental Sciences, University of Colorado Boulder. The work of CD was supported by the Natural Environment Research Council, and the input of CD and RQ contributes to the Sustainable and Healthy Food Systems programme supported by the Wellcome Trust’s Our Planet, Our Health programme. The work of MD and JT was supported by the Wellcome Trust Complex Urban Systems for Sustainability and Health project. RD would like to acknowledge funding from the Overlook International Foundation. HG would like to acknowledge funding from C & JB Morrell Trust Priming Fund. IH and TO would like to acknowledge funding from the Engineering and Physical Sciences Research Council Centre for Research in Energy Demand Solutions grant. The work of YL was supported by the NASA Applied Sciences Program. The work of HM is partially funded by the National Institute for Health Research’s Biomedical Research Centre at University College London Hospitals NHS Trust. DP would like to acknowledge funding from the 2018 Australian Endeavour Research Fellowship. JT would like to acknowledge funding from the National Oceanic and Atmospheric Administration’s OceanWatch and Atlantic Oceanographic and Meteorological Laboratory, and the support of Universidade de Santiago de Compostela Instituto de Investigaciones Tecnoloxicas and University of Miami Cooperative Institute for Marine and Atmospheric Studies.

Figures

**Figure 1. Change in the number of heatwave exposure events in people aged 65 years and older, compared with the historical 1986–2005 average number of events**

**Figure 2. Potential global work hours lost per sector due to heat, 2000–18**

**Figure 3. Potential full-time annual work lost in the shade (A) or in the sun (B) based on the percentage of people working in agriculture (400 W), industry (300 W), and services (200 W)**
W=Watts.

**Figure 4. Map showing the average annual number of days people were exposed to wildfires in 2018**

**Figure 5. Global trends in all-cause mortality and mortality from selected causes as estimated by the Global Burden of Disease 2017 study for the 1990–2017 period, by WHO region**

**Figure 6. Changes in global vectorial capacity for the dengue virus vectors *Aedes aegypti* and *Aedes albopictus* since 1950**

**Figure 7. Change in suitability for pathogenic *Vibrio* outbreaks as a result of changing sea surface salinity and sea surface temperatures**

**Figure 8. Change in global crop growth duration as a proxy for crop yield**
Dashed line=the average change in crop duration of the 1981–2010 baseline. Grey line=annual global area-weighted change. Blue line=running mean over 11 years (5 years forward, 5 years backward).

**Figure 9. Number of countries with a national health and climate change plan or strategy**
Data from 101 country respondents of the 2018 WHO Health and Climate Change Country Survey, by permission of the World Health Organization.

Figure 10. Global proportion of households with air conditioning (red line), prevented fraction of heatwave-related mortality due to air conditioning (blue line), and CO2 emissions from air conditioning (green line) 2000–16
CO₂=carbon dioxide.

**Figure 11. Spending on adaptation for health and health-related activities in WHO-specified regions.**
Graphs show Adaptation to Resilience and Climate Change spending (A) and spending per capita (B).

**Figure 12. Carbon intensity of TPES for selected regions and countries, and global energy-related CO₂ emissions**
Carbon intensity is shown by lines (primary axis) and global emissions by stacked bars (secondary axis). CO₂=carbon dioxide. tCO₂/TJ=total CO₂ per terajoule of energy. TPES=Total Primary Energy Supply.

**Figure 13. TPES coal in selected countries and regions, and global TPES coal**
Regional primary energy supply of coal is shown by the trend lines (primary axis) and total global supply by the bars (secondary axis). EJ=exajoule. TPES=Total Primary Energy Supply.

**Figure 14. Renewable and low-carbon emission electricity generation**
(A) Electricity generated from low-carbon sources. (B) Share of electricity generated from low-carbon sources. (C) Electricity generated from renewable sources (excluding hydropower). (D) Share of electricity generated from renewable sources (excluding hydropower). TWh=terawatt hours.

**Figure 15. Graph showing proportion of households cooking with clean fuels in World Bank grouped low-income and middle-income countries**

**Figure 16. Premature deaths attributable to exposure to ambient fine particulate matter (PM_2·5) in 2015 and 2016, by key sources of pollution in WHO-specified regions**
PM_2·5=atmospheric particulate matter with a diameter of less than 2·5 μm.

**Figure 17. Per-capita fuel use by type (TJ per capita) for road transport**
(A) Global per-capita fuel consumption for road transport using all types of fuels. (B) Global per-capita fuel consumption for road transport using biofuels and electricity.

**Figure 18. Gigaton CO₂e emissions from 2000 to 2016**
(A) CO₂e emissions from livestock. (B) CO₂e emissions from crop production. CO₂e=carbon dioxide equivalent.

**Figure 19. Variations in per capita health-care sector emissions as a function of time, per capita GDP, and the proportion of national spending on health care**
(A) Health-care sector emissions as a function of GDP per capita (bubble widths indicate the proportion of national spending on health care). (B) Health-care sector emissions as a function of time. Graphs created using multiregional input-output EXIOBASE model. CO₂e=carbon dioxide equivalent. GDP=gross domestic product. AU=Australia. BR=Brazil. CA=Canada. CN=China. DE=Germany. GR=Greece. IN=India. JP=Japan. KR=South Korea. MX=Mexico. RU=Russia. SE=Sweden. TR=Turkey. ZA=South Africa.

**Figure 20. Economic losses from climate-related events relative to GDP**
GDP=gross domestic product. US$2018=based on the value of the US dollar in 2018.

**Figure 21. Annual investment in coal-fired capacity from 2006 to 2018**

**Figure 22. Annual investment in the global energy system**
US$ 2018=based on the value of the US dollar in 2018.

**Figure 23. Employment in renewable energy and fossil-fuel extraction sectors**
Data from IBISWorld ^, and IRENA.

**Figure 24. Global fossil-fuel and electricity consumption subsidies in 2008–18**
US$ 2018=based on the value of the US dollar in 2018.

**Figure 25. Summary map of regional, national, and sub-national carbon pricing initiatives implemented, scheduled for implementation, and under consideration (ETS and carbon tax)**
Adapted from State and Trends of Carbon Pricing 2019, by permission of World Bank Group. The large circles represent cooperation initiatives on carbon pricing between sub-national jurisdictions. The small circles represent carbon pricing initiatives in cities. Carbon pricing initiatives are considered to be scheduled for implementation when they have been formally adopted through legislation and have an official, planned start date. Carbon pricing initiatives are considered to be under consideration if the government has announced its intention to work towards the implementation of a carbon pricing initiative and this has been formally confirmed by official government sources. The carbon pricing initiatives have been classified in ETSs and carbon taxes according to how they operate technically. ETS not only refers to cap-and-trade systems, but also to baseline-and-credit systems as seen in British Columbia. Australia had a carbon tax implemeneted in 2012, which was then removed in 2014. ETS=Emissions Trading Scheme.

**Figure 26. Coverage of climate change and health and climate change in *People’s Daily* between 2008 and 2018**

**Figure 27. Connectivity graph of Wikipedia articles on health (blue) and climate change (red) visited in 2018**
Popularity of articles is indicated by node size; lines represent co-visits in clickstream data.

**Figure 28. Proportion of countries referring to climate change, health, or the linkage between health and climate change in UN General debates between 1970 and 2018**

See this image and copyright information in PMC

Comment in

Health and climate change: making the link matter.
The Lancet. The Lancet. Lancet. 2019 Nov 16;394(10211):1780. doi: 10.1016/S0140-6736(19)32756-4. Lancet. 2019. PMID: 31733927 No abstract available.
The health-care sector's role in climate stabilisation.
Bugaj TJ, Cranz A, Nikendei C. Bugaj TJ, et al. Lancet. 2020 Jul 11;396(10244):91-92. doi: 10.1016/S0140-6736(20)30808-4. Lancet. 2020. PMID: 32653061 No abstract available.
The health-care sector's role in climate stabilisation.
Weisz H, Pichler PP, Weisz U, Jaccard I. Weisz H, et al. Lancet. 2020 Jul 11;396(10244):92. doi: 10.1016/S0140-6736(20)30809-6. Lancet. 2020. PMID: 32653062 No abstract available.

References

1. Haustein K, Allen MR, Forster PM, et al. A real-time global warming index. Sci Rep. 2017;7:15417. doi: 10.1038/s41598-017-14828-5. - DOI - PMC - PubMed
1. IPCC. Global warming of 1·5°C An IPCC Special Report on the impacts of global warming of 1·5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change. Geneva, Switzerland: World Meteorological Organization; 2018.
1. NASA, NOAA. 2018 fourth warmest year in continued warming trend, according to NASA, NOAA. 2019. [accessed Sept 23, 2019]. https://climate.nasa.gov/news/2841/2018-fourth-warmestyear-in-continued-...
1. Cooper A, Johnson C. Now near 100 million bpd, when will oil demand peak? 2018. [accessed Sept 23, 2019]. https://www.reuters.com/article/us-oil-demand-peak/now-near-100-millionb... .
1. IEA. Market Report Series: gas 2017. Paris, France: International Energy Agency; 2018.

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The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate

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The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate

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