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Review
. 2021 Jan 9;397(10269):129-170.
doi: 10.1016/S0140-6736(20)32290-X. Epub 2020 Dec 2.

The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises

Nick Watts  1 , Markus Amann  2 , Nigel Arnell  3 , Sonja Ayeb-Karlsson  4 , Jessica Beagley  5 , Kristine Belesova  6 , Maxwell Boykoff  7 , Peter Byass  8 , Wenjia Cai  9 , Diarmid Campbell-Lendrum  10 , Stuart Capstick  11 , Jonathan Chambers  12 , Samantha Coleman  5 , Carole Dalin  13 , Meaghan Daly  14 , Niheer Dasandi  15 , Shouro Dasgupta  16 , Michael Davies  17 , Claudia Di Napoli  18 , Paula Dominguez-Salas  19 , Paul Drummond  13 , Robert Dubrow  20 , Kristie L Ebi  21 , Matthew Eckelman  22 , Paul Ekins  13 , Luis E Escobar  23 , Lucien Georgeson  24 , Su Golder  25 , Delia Grace  26 , Hilary Graham  14 , Paul Haggar  11 , Ian Hamilton  27 , Stella Hartinger  28 , Jeremy Hess  29 , Shih-Che Hsu  27 , Nick Hughes  13 , Slava Jankin Mikhaylov  30 , Marcia P Jimenez  31 , Ilan Kelman  5 , Harry Kennard  27 , Gregor Kiesewetter  2 , Patrick L Kinney  32 , Tord Kjellstrom  33 , Dominic Kniveton  34 , Pete Lampard  25 , Bruno Lemke  35 , Yang Liu  36 , Zhao Liu  9 , Melissa Lott  37 , Rachel Lowe  38 , Jaime Martinez-Urtaza  39 , Mark Maslin  40 , Lucy McAllister  41 , Alice McGushin  5 , Celia McMichael  42 , James Milner  43 , Maziar Moradi-Lakeh  44 , Karyn Morrissey  45 , Simon Munzert  30 , Kris A Murray  46 , Tara Neville  10 , Maria Nilsson  8 , Maquins Odhiambo Sewe  47 , Tadj Oreszczyn  27 , Matthias Otto  48 , Fereidoon Owfi  49 , Olivia Pearman  7 , David Pencheon  50 , Ruth Quinn  51 , Mahnaz Rabbaniha  49 , Elizabeth Robinson  18 , Joacim Rocklöv  47 , Marina Romanello  5 , Jan C Semenza  52 , Jodi Sherman  53 , Liuhua Shi  54 , Marco Springmann  24 , Meisam Tabatabaei  55 , Jonathon Taylor  56 , Joaquin Triñanes  57 , Joy Shumake-Guillemot  58 , Bryan Vu  36 , Paul Wilkinson  43 , Matthew Winning  13 , Peng Gong  9 , Hugh Montgomery  59 , Anthony Costello  60
Affiliations
Review

The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises

Nick Watts et al. Lancet. .

Erratum in

  • Department of Error.
    [No authors listed] [No authors listed] Lancet. 2021 Jan 9;397(10269):98. doi: 10.1016/S0140-6736(20)32681-7. Epub 2020 Dec 14. Lancet. 2021. PMID: 33333003 No abstract available.

Abstract

For the Chinese, French, German, and Spanish translations of the abstract see Supplementary Materials section.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests

We declare no competing interests.

Figures

Figure 1
Figure 1. Change in days of heatwave exposure relative to the 1986–2005 baseline in people older than 65 years
The dotted line at 0 represents baseline.
Figure 2
Figure 2. Global heat-related mortality for populations older than 65 years
The error bars were calculated on the basis of the uncertainty range of the exposure-response function, as described by Honda and colleagues.
Figure 3
Figure 3. Annual heat-related mortality in the population older than 65 years averaged from 2014 to 2018
Figure 4
Figure 4. Population-weighted average changes in the number of days of exposure to very high or extremely high risk of wildfire in 2016–19 compared with 2001–04
Large urban areas with a population density of 400 people per km2 or more are excluded. Wildfire risk is based on the Fire Danger Index, which rates risk on a scale from 1 to 6 (1 is very low; 2 is low; 3 is medium; 4 is high; 5 is very high; and 6 is extremely high). The higher the number, the more favourable the meteorological conditions are to trigger a wildfire.
Figure 5
Figure 5. Change in climate suitability for infectious diseases
Solid lines represent the annual change. Dashed lines represent the trend since 1950 (for dengue and malaria) and 1982 (for Vibrio bacteria).
Figure 6
Figure 6. Change in crop growth duration relative to the 1981–2010 global average
The grey line represents the annual global area-weighted change. The blue line represents the running mean over 11 years (5 years forward and 5 years backward). The dashed line represents the 1981–2010 baseline.
Figure 7
Figure 7. Number of people exposed to 1 m and 5 m of global average sea level rise by country
(A) 1 m. (B) 5 m.
Figure 8
Figure 8. Frequency and effects of air conditioning
Global proportion of households with air conditioning (red line), prevented fraction of heatwave-related mortality because of air conditioning (blue line), and CO2 emissions from air conditioning (green line), from 2000 to 2018. CO2=carbon dioxide. GtCO2=gigatonnes of carbon dioxide.
Figure 9
Figure 9. Urban greenness in capital cities with more than 1 million inhabitants in 2019
Levels of urban greenness were quantified on the basis of the mean, population-weighted normalised difference vegetation index, which is a standard, satellite-based measurment to estimate vegetation and is on a scale of –1·0 to 1·0.
Figure 10
Figure 10. Adaptation and resilience to climate change spending by WHO Region
Figure 11
Figure 11. Carbon intensity of the total primary energy supply for selected regions and countries and global CO2 emissions by fuel type, 1971–2019
Carbon intensity trends are shown by a trend line (primary axis) and global CO2 emissions by stacked bars (secondary axis). This carbon intensity metric estimates the tCO2 for each unit of total primary energy supplied (tCO2 per TJ). For reference, the carbon intensity of fuels are as follows: coal, 95–100 tCO2 per TJ; oil, 70–75 tCO2 per TJ; and natural gas, 56 tCO2 per TJ. CO2=carbon dioxide. tCO2=tonnes of carbon dioxide.
Figure 12
Figure 12. Share of electricity generation from coal in selected countries and regions, and global electricity generation from coal
Regional shares of electricity generation from coal are shown by the trend lines (primary axis) and total electricity generation from coal by the bars (secondary axis). The global share of electricity generation from coal is shown with the thick black line. Data series are shown to at least 2017 and are extended to 2018 when data allow.
Figure 13
Figure 13. Household energy usage
(A) Proportion of population with a primary reliance on clean fuels and technology for cooking by WHO region, 2000–18. (B) Proportion of clean energy at the point of consumption in the global residential sector, 2000–16. Proportion is measured as the zero-emission energy consumed (fuels with no emissions at the point of use) over the total energy consumed in the residential sector. Electricity comprised 75% of total clean energy use in 2016.
Figure 14
Figure 14. Estimated net effect of housing design and indoor fuel burning on premature mortality due to air pollution in 2018
PM2·5=fine particulate matter.
Figure 15
Figure 15. Premature deaths attributable to exposure to PM2·5 in 2015 and 2018 by key sources of pollution in WHO regions
The coloured bars represent the attributable deaths if there were a constant 2015 population structure. The diamonds represent the total attributable deaths for 2018 when considering demographic changes. PM2·5=fine particulate matter.
Figure 16
Figure 16. Per-capita fuel use for road transport
(A) All fossil fuels, biofuels, and electricity. (B) Electricity only. Please note the varying scales in the y-axes.
Figure 17
Figure 17. Agricultural production and consumption emissions, 2000–17
(A) Emissions by WHO region. (B) Global agricultural consumption emissions by commodity. Trade data from the Food and Agriculture Organization of the United Nations were used to calculate these numbers. Per-capita production is shown by the solid lines and per-capita consumption by the dotted lines. GtCO2e=gigatonnes of carbon dioxide equivalent. kgCO2e=kilograms of carbon dioxide equivalent.
Figure 18
Figure 18. Deaths attributable to excess red meat consumption in 1990–2017 by WHO region
Figure 19
Figure 19. National per-capita greenhouse gas emissions from the healthcare sector against the Healthcare Access and Quality Index for 2015
kgCO2e=kilograms of carbon dioxide equivalent.
Figure 20
Figure 20. Cost of heat-related mortality represented as the number of people to whose income this value is equivalent, on average, for each WHO region
Figure 21
Figure 21. Annual cost of years of life lost and average months of life lost per person due to anthropogenic PM2·5 exposure
PM2·5=fine particulate matter.
Figure 22
Figure 22. Annual investment in coal-fired capacity, 2006–19
An index score of 100 corresponds to 2006 levels of capacity.
Figure 23
Figure 23. Annual investment in energy supply and efficiency
Figure 24
Figure 24. Cumulative divestment globally and in health-care institutions
Figure 25
Figure 25. Net carbon prices, net carbon revenues, and net carbon revenue as a share of current national health expenditure across 75 countries in 2016 and 2017
(A) Net carbon prices. (B) Net carbon revenues. (C) Net carbon revenue as a share of current national health expenditure. The boxes represent the IQRs, the horizontal lines inside the boxes represent the medians, and the crosses represent the means. The brackets represent the range from minimum to maximum; however, points are represented as outliers beyond this range if their values are 1·5 times the IQR less than the first quartile or more than the third quartile. tC02=tonnes of carbon dioxide.
Figure 26
Figure 26. Average monthly coverage of climate change, and health and climate change combined, in 61 newspapers from 36 countries, 2007–19
The non-linear lines represent the average monthly coverage of climate change and health and climate change only across the 61 newspapers. The linear line represents the linear trend of the average number of climate change articles per month between 2007 and 2019.
Figure 27
Figure 27. Scientific journal articles relating to health and climate change, 2007–19
Figure 28
Figure 28. References to health in NDCs by WHO region
The European region, which consists of 53 countries, is adjusted for the single NDC representing 28 EU countries; treating the EU as one country would increase the regional proportion of NCDs referencing health to 60%. NDCs=Nationally Determined Contributions.
Figure 29
Figure 29. Proportion of health-care sector companies referring to climate change, health, and the intersection of health and climate change in Communication on Progress reports, 2011–19
See this image and copyright information in PMC

Comment in

References

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    1. Field CB, Barros VR, Dokken DJ, et al., editors. Intergovernmental Panel on Climate Change. IPCC 2014: climate change 2014: impacts, adaptation, and vulnerability. Part A: global and sectorial aspects. Contribution of working group II to the fifth assessment report of the Intergovernmental Panel on Climate Change. Cambridge, UK and New York, NY: Cambridge University Press; 2014.
    1. UN. United Nations Framework Convention on Climate Change; Report of the Conference of the Parties on its twenty-first session, held in Paris from 30 November to 13 December 2015; 2016. Jan 29, [accessed April 6, 2020]. http://unfccc.int/resource/docs/2015/cop21/eng/10a01.pdf .
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