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Tracking progress on health and climate change: Creating health and climate change indicators for The Lancet Countdown

Author: Steve Pye
Institution: UCL 
Type of case study: Research

About the research

The 2015 Lancet Commission on Health and Climate Change—which assessed responses to climate change with a view to ensuring the highest attainable standards of health for populations worldwide—concluded that “tackling climate change could be the greatest global health opportunity of the 21st century”. The Commission recommended that more accurate national quantification of the health co-benefits and economic impacts of mitigation decisions was essential in promoting a low-carbon transition. Building on these foundations, the Lancet Countdown: tracking progress on health and climate change was formed as an independent research collaboration. The Lancet Countdown is dedicated to tracking progress on the world’s response to climate change, as currently shaped by the Paris Agreement, and the health benefits that result through annual publication of a series of indicators. The Lancet Countdown aims to raise awareness of the connections between climate change and health and to demonstrate how activity to mitigate climate change can also have significant outcomes in addressing global health challenges. The Lancet Commission made ten policy recommendations on which to measure progress:

Recommendation 1: invest in climate change and public health research

Recommendation 2: scale up financing for climate-resilient health systems

Recommendation 3: phase out coal-fired power

Recommendation 4: encourage city-level low-carbon transition to reduce urban pollution

Recommendation 5: establish the framework for a strong and predictable carbon pricing mechanism

Recommendation 6: rapidly expand access to renewable energy, unlocking the substantial economic gains available from this transition

Recommendation 7: support accurate quantification of the avoided burden of disease, reduced health-care costs, and enhanced economic productivity associated with climate change mitigation. 

Recommendation 8: adopt mechanisms to facilitate collaboration between Ministries of Health and other government departments, empowering health professionals and ensuring that health and climate considerations are thoroughly integrated in government-wide strategies. 

Recommendation 9: agree and implement an international treaty that facilitates the transition to a low-carbon economy

Recommendation 10: develop a new, independent collaboration to provide expertise in implementing policies that mitigate climate change and promote public health, and monitor progress over the next 15 years

The Lancet Countdown tracks 41 indicators across five key domains across health and climate change to understand the impact of – and the speed of the transition towards – a decarbonised global economy, a transition that is already underway. It uses the indicators to analyse and demonstrate the health benefits available; provide a global picture of successes of and challenges to the transition; draw out exemplary case-studies for shared learning; and engage with policymakers and the broader health community.  The Lancet Countdown is focused on better communicating the opportunities available in responding to climate change for health.

The partnership comprises 24 academic institutions from every continent, bringing together individuals with a broad range of expertise across disciplines (including climate scientists, ecologists, mathematicians, geographers, engineers, energy, food, and transport experts, economists, social and political scientists, public health professionals, and physicians). The Lancet Countdown will publish an annual ‘health check’up to 2030 on the state of the climate and progress on adapting and mitigating to climate change across forty indicators: 

The partnership covers five thematic working groups under which indicators are organised:

1. Climate Change Impacts, Exposures and Vulnerabilities

2. Adaptation Planning and Resilience for Health

3. Mitigation Actions and Health Co-Benefits

4. Economics and Finance

5. Public and Political Engagement

Research funding and partners

The Wellcome Trust is a strategic partner with the Lancet for the Lancet Countdown, providing financial and technical support for its work. The research is conducted by researchers from Centre Virchow Villermé (France and Germany), European Centre for Environment and Human Health (UK), Imperial College London (UK), International Livestock Research Institute (Kenya), International Institute for Applied Systems Analysis (International), INDEPTH Network (pan African), London School of Hygiene & Tropical Medicine (UK), NHS Sustainable Development Unit (UK), Iranian Fisheries Research Organization (Iran), Tehran University of Medical Sciences (Iran), The Centre for Climate & Security (US), The Grantham Institute (UK), Tsinghua University (China), Universidad Peruana Cayetano Heredia (Peru), Umea University (Sweden), United Nations University (International), University of Birmingham (UK), University of Colorado Boulder (US), University of Geneva (Switzerland), University College London (UK), University of Exeter (UK), University of Sydney (Australia), University of Washington (US), University of York (UK), World Health Organization (International), World Meteorological Organisation (International), World Bank Group (International).


Four of the indicators developed for Working Group 3 (Mitigation actions and health co-benefits) uses International Energy Agency (IEA) data made available by the the IEA via the UK Data Service for use by researchers, learners and teaching staff in UK higher and further education. Additionally, two of the indicators developed for Working Group 4 (Finance and economics) also use IEA data.

The IEA produces market reports and forecasts on energy use and emissions for both OECD member countries and non-OECD member countries. The LancetCountdown Working Group 3 data are derived from country-level estimates of installed capacity, fuel consumption, or power generation. The mix of energy use and emission factors are used to derive estimates of energy-related air pollution. The methodology has been applied in specific geographical locations, with the ambition to expand the work globally. 

Data used from the UK Data Service collection

The indicators developed for Working Group 3: Mitigation Actions and Health Co-Benefits, use International Energy Agency (IEA) data from the UK Data Service made available by the IEA to users in UK higher and further education include: 

3.1. Carbon intensity of the energy system which uses the IEA’s CO2 Emissions From Fuel Combustion data

3.2. Coal phase-out and share of electricity from coal generation which uses the IEA’s World Coal Supply and World Energy Balances data 

3.3. Zero-carbon emission electricity and specific renewable and nuclear generation levels which uses the IEA’s World Energy Balances data, and World Electricity and Heat Supply and Consumption data 

3.6. Clean fuel use for transport which uses the IEA’s World Energy Balances data, as well as World Development Indicators data from the World Bank 

Working Group 4: Economics and Finance, also includes IEA data in its indicators:

4.1. Investments in zero-carbon energy and energy efficiency which uses the IEA’s World Energy Balances data

4.6. Fossil fuel subsidies which uses the IEA’s World Energy Balances data


The Lancet Countdown 2018 report indicators for Working Group 3 (Mitigation actions and health co-benefits) and Working Group 4 (Finance and economics) which use International Energy Agency (IEA) data found that:

  • Indicator 3.1: Globally, the carbon intensity of total primary energy supply (TPES) has remained static since 1990.
  • Indicator 3.2: Since 2013, coal use has declined, resulting largely from reductions in coal consumption in China, enhanced efficiency in coal-fired power generation and continued increase in use of shale gas in the USA. An upturn however, is projected from 2017.

  • Indicator 3.3: In 2017, 157 GW of renewable energy was installed compared to 70 GW (net) of fossil fuel capacity installation.
  • Indicator 3.6: From 2013 to 2015 global transport fuel use increased 2% per capita but was outpaced by growth in non-fossil fuels, which rose by 10%.
  • Indicator 4.1: In 2017, a total of 712 extreme events resulted in $326 billion in overall economic losses, with 99% of losses in low-income countries remaining uninsured. This is almost triple the total economic losses of 2016
  • Indicator 4.6: In 2016, fossil fuel consumption subsidies decreased to $267 billion – a 15% reduction on 2015 levels.

Findings for policy

The 2018 Report of the Lancet Countdown on health and climate change: Shaping the health of nations for centuries to come, shows “the pace of climate change outweighing the urgency of the response. Despite this concerning trend, exciting trends in key areas for health, including the phase-out of coal, the deployment of healthier, cleaner modes of transport, and health system adaptation, give justification for cautious optimism. Promising trends reported via Work Group 3 and 4 showed a continued phase-out of coal-fired power, accelerated deployment of renewable energy, and continued divestment from fossil fuels, which should help to reduce premature mortality from air pollution.”

Launched in parallel with the 2018 Lancet Countdown report are a number of briefings for international policy makers, including for the UK: which focuses on the links between health and climate change, and their implications for the UK’s Government, public sector, businesses, and citizens.


Following the release of the 2018 Lancet Countdown: Tracking Progress on Health and Climate Change report, the Global Climate and Health Alliance called on world leaders to take the actions required to limit global warming to the targets set by the Paris Agreement, making the greenhouse gas reduction commitments between now and 2020 that will limit global warming to 1.5 degrees Celsius: “Air pollution is the number one environmental threat to people’s health, and one of the top five risk factors for chronic disease like heart disease, cancer and asthma,” says Genon K. Jensen, Executive Director of the Health and Environment Alliance. “World leaders walking the talk on tackling climate change would give clean air and disease prevention a major boost worldwide by taking on the Lancet Countdown health recommendations”.

Summaries of the 2018 Lancet Countdown report were translated in to Mandarin, French, and Spanish, and the 11 nationally-focused policy briefs were developed in partnership with national medical associations, for example, a European brief with the European Standing Committee of Doctors; an American brief with the American Public Health Association and a Chinese brief with the Chinese Centres for Disease Control. In response requests were received for private briefings with the Chinese Center for Disease Control and Prevention and the UK Foreign and Commonwealth Office ahead of the United Nations Framework Convention on Climate Changenegotiations. Additionally, 17 Presidents from the UK’s Royal Medical Colleges co-signed a letter that went to Number 10, requesting a meeting to discuss the second phase of the Climate Change Act and a commitment to “net zero”.

1,127 unique media stories, including in the New York Times, the Financial Times, the Daily Mail, the Guardian, the Independentthe Telegraph, The Economist, APAFPReutersCNNForbesthe Hindustan TimesUSA TodayLA Times, and a feature story on BBC World News and BBC Breakfast followed the release of the 2018 report.

A joint meeting organised by Policy Connect and hosted by the All Party Parliamentary Climate Group, the All Party Parliamentary Health Group, the Lancet Countdown and the UK Health Alliance on Climate Change took place following the release of the 2017 Lancet Countdown to consider the impact of climate change on health, mortality and frontline NHS services, demonstrating significant impact through making progress towards the UK administration considering climate change in terms of its effects on public health, meeting a key aim of the Lancet Countdown: summary of the meeting.

The Lancet Countdown 2017 report was discussed in a House of Lords’ debate in December 2017 on climate change and public health.

“The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health” article has been cited 76 times.


The Lancet Countdown 2018 Report

The Lancet Countdown 2017 report

The Lancet Countdown

The Lancet Countdown on health benefits from the UK Climate Change Act: a modelling study for Great Britain