Adopting policies that are consistent with achieving the Paris Agreement and prioritise health, could save 6.4 million lives due to better diet, 1.6 million lives due to cleaner air, and 2.1 million lives due to increased exercise, per year, across nine countries.
New research from The Lancet Countdown on Health and Climate Change published in a special issue of The Lancet Planetary Health journal highlights the benefits to health if countries adopt climate plans - Nationally Determined Contributions (NDCs) - that are consistent with the Paris Agreement aim of limiting warming to "well below 2°C". [1,2]
The countries considered in the study represent 50% of the world's population and 70% of the world's emissions - Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK and the US.
Paris signatories are updating and revising their NDCs ahead of COP26 this year, which were due to be submitted before the end of last year, and remain to be announced in the majority of countries (including six out of the nine countries included in the study).  Currently, NDCs globally are not strong enough to achieve the Paris agreement (risking a global temperature rise of greater than 3°C), and the authors emphasise that the lives saved through better diet, cleaner air and increased exercise, provide yet another rationale for strengthening commitments.
Lead author Ian Hamilton, Executive Director of The Lancet Countdown on Health and Climate Change, said: "Our report focuses on a crucial but often overlooked incentive for tackling climate change. Unlike the direct benefits of carbon mitigation which are ultimately long-term and understood in terms of damage limitation, the health co-benefits of ambitious climate policies have an immediate positive impact. The message is stark. Not only does delivering on Paris prevent millions dying prematurely each year, the quality of life for millions more will be improved through better health. We have an opportunity now to place health in the forefront of climate change policies to save even more lives." 
For each nation, emissions generated from energy, agriculture and transport sectors, and annual deaths due to air pollution, diet-related risk factors and physical inactivity, were estimated for the year 2040 for three different NDC scenarios. The baseline scenario looked at current NDC policies, the second scenario (sustainable pathways scenario) at NDC policies in line with the Paris Agreement and Sustainable Development Goals, and a third scenario (health in all climate policies scenario) looking at the additional benefit from embedding explicit health objectives within the sustainable pathways scenario. 
Across all nine countries, the Paris Agreement-compliant scenario, could save 5.8 million lives due to better diet, 1.2 million lives due to cleaner air, and 1.2 million lives due to increased exercise. Adopting the more ambitious pathway, with explicit health objectives within the NDCs, could result in a further reduction of 462,000, 572,000, and 943,000 annual deaths attributable to air pollution, diet and physical inactivity, respectively. [Country-level data is available at the bottom of the press release].
The authors note that number of deaths averted through air pollution, diet and physical activity were modelled separately, so they cannot be added together, as they cannot account for crossover in potential deaths averted due to air pollution, better diet, and increased exercise. As the modelling study projects into future possible scenarios, they also note that the estimates relied on various assumptions of future demographic and socio-economic trends.
The health benefits of strengthened NDC commitments are generated through both direct climate change mitigation as well as supporting actions to reduce exposure to harmful pollutants, improve diets and enable safe physical activity.
All countries benefit most from improvements to diet
While the impact of each of the three-health metrics varies from country to country, all the countries benefit most from dietary improvements under the Paris Agreement-compliant scenario. These reflect the modelled widespread adoption of flexitarian diet, aided by greater access to fruit and vegetables. While the shift sees reductions in red meat and processed food there remains a moderate consumption of food sourced from animals.
Those countries benefitting most from dietary improvements in proportional terms, are Germany with 188 deaths avoided per 100,000 of population annually, followed by the US with 171 per 100,000 and China with 167 per 100,000.
It is worth noting that deficiency in fruit, vegetables, legumes and nuts taken together is a greater health problem overall than the risk associated with eating excess red meat, according to the findings. The former accounts for 30% of deaths avoided, while the latter contributes 22%.
Future Policy Ambition
Dr Alastair Brown, Editor-in-Chief of The Lancet Planetary Health, says: "As countries are being asked to increase their level of ambition ahead of COP 26 in Glasgow, the coming months represent a key moment in the fight against climate change and an opportunity to improve global health. If there is a need for a deadline to motivate action, we have it and it's November, 2021."
The authors note that some countries have strengthened their efforts since the analysis was done, with the UK and EU submitting stronger NDC targets, and China announcing its commitment to achieving carbon neutrality before the year 2060. The Joe Biden and Kamala Harris administration have promised to commit to net zero emissions by the year 2050. 
Even with these new announcements, the world is not yet on track to meet the goals of the Paris Agreement and would still face 2.5°C of warming by the end of the century. 
Writing in Comment article also published in The Lancet Planetary Health special issue, Margaret Chan, Former Director-General of the World Health Organisation, says: "The report findings therefore provide an important further incentive not only for the world's leaders to make good on their climate commitments in new NDCs but also to align environmental and health objectives in Covid-19 recovery plans. After all, healthier populations will prove more resilient to future health shocks.
She continues: "It's also important to recognise the billions in cost-savings resulting improved health on this scale, which could help offset the up-front costs of mitigation.
Peer-reviewed / Modelling / People
NOTES TO EDITORS
This study was funded by Wellcome Trust and Engineering and Physical Sciences Research Council. It was conducted by researchers from University College London, UK, International Institute for Applied Systems Analysis, Austria, Columbia University, USA, London School of Hygiene & Tropical Medicine, UK, University of Cambridge, UK, University of Oxford, UK.
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.
 The Lancet Countdown: Tracking Progress on Health and Climate Change is an international research collaboration providing a global overview of the relationship between public health and climate change. A collaboration of over 120 leading experts from academic institutions and UN agencies across the globe, it brings together climate scientists, engineers, energy specialists, economists, political scientists, public health professionals and doctors. Each year their annual report is published in The Lancet journal ahead of the UN climate change negotiations.
 The article is being published in a special issue of The Lancet Planetary Health journal alongside two other papers looking at the inclusion of health in the NDCs and the calculation of the carbon footprint of NHS England, as an exemplar for other health systems. The special issue will also include commentary pieces from Margaret Chan, former Director-General of WHO, Dagur Eggertsson, Mayor of Reykjavik, Collin Tukuitonga, Associate Dean Pacific of the Faculty of Medical and Health Sciences, University of Auckland, and Paula Vivili, Director of the Public Health Division at the Secretariat of the Pacific Community and Andrea MacNeill, Department of Surgery, University of British Columbia
 Only 40 countries (39 countries plus the EU27), have submitted revised NDCs, including three nations included in this study - the UK, Germany and Brazil [Latest update here: https:/
 Quote direct from author and cannot be found in the text of the Article.
 For further details on the different scenarios modelled, please see Panel: Scenarios used for climate and health modelling, p. 3.
Deaths avoided in 2040 by scenario (relative to baseline scenario) and country (total number of deaths avoided and number of deaths avoided per 100,000 population).
Sustainable Pathways Scenario (SPS): Estimating for the year 2040, this scenario was designed to be aligned with the commitments of the Paris Agreement to limit the increase in global temperature to well below 2°C within the century and also to meet SDG2 (zero hunger), SDG3 (good health and wellbeing), SDG7 (affordable and clean energy), and SDG13 (climate action).
Health in all climate Policies Scenario (HPS): Estimating for the year 2040, the health in all climate policies approach seeks to systematically take into account the health implications of policy decisions, seeking synergies and avoiding harms to maximise population good health and wellbeing. This scenario includes measures that are in line with the Paris Agreement and SDGs but seeks to maximise ancillary health benefits.
Deaths avoided Deaths avoided per 100,000 population
Country Scenario Air pollution Diet Active Travel Air pollution Diet Active Travel
Brazil SPS 21,069 328,040 56,224 9 143 24
HPS 24,456 336,270 102,386 11 147 45
China SPS 503,467 2,409,640 440,757 36 167 31
HPS 855,807 2,810,400 809,324 60 195 56
Germany SPS 8,770 143,770 2,856 11 188 4
HPS 15,614 143,710 5,631 19 188 7
India SPS 433,549 1,741,860 364,948 27 111 23
HPS 491,756 1,869,300 670,230 31 119 43
Indonesia SPS 130,541 301,970 37,759 42 97 12
HPS 159,129 321,630 71,762 51 103 23
Nigeria SPS 43,839 88,490 29,376 13 25 8
HPS 46,915 91,550 55,094 14 26 16
South Africa SPS 8,409 97,160 19,341 12 159 32
HPS 9,457 98,900 35,011 14 162 57
United Kingdom SPS 3,458 98,420 21,486 5 139 30
HPS 5,771 100,100 38,441 8 141 54
United States of America SPS 30,560 654,580 172,618 8 171 45
HPS 36,371 664,050 300,419 10 173 78
All countries considered SPS 1,183,662 5,863,930 1,145,365 26 130 25
HPS 1,645,276 6,435,910 2,088,298 37 143 46