NCD patients face disproportionate climate risks from various vulnerabilities. Extreme heat exacerbates cardiovascular and respiratory conditions: deaths from heatstroke in Japan increased fivefold from 1995 to 2023, with 83.3% among those aged over 65. Power outages threaten refrigerated medications and medical devices. Extreme weather disrupts routine care precisely when health systems are facing maximum stress. Air pollution causes approximately 48,000 deaths annually in France,77 with the most deprived areas facing tenfold higher exposure risk.78 Adaptation frameworks are emerging, but implementation is incomplete. Italy’s Heat Health Watch Warning Systems enable 72-hour forecasts, while Japan combines “Heatstroke Alerts” with housing insulation subsidies. Spain’s Health and Environment Strategic Plan addresses air quality and urban health impacts. Yet translation into NCD- specific protocols remains limited: heat warnings rarely trigger modified care protocols, despite cardiovascular medications requiring dosage adjustment during heatwaves. France’s experience illustrates the challenge: despite implementing heat warnings after the deadly 2003 heatwave, heat-related deaths increased 60% between 2000 and 2022. Healthcare systems simultaneously contribute significantly to the climate crisis. Healthcare accounts for 3.8–7.6% of national carbon emissions, with per capita emissions varying more than twofold from 172 kg CO2 equivalent in Poland to 996 kg in Japan.79 Higher emissions intensity correlates with technology-intensive, hospital-centred care models, while community-based approaches achieve lower environmental impact. Yet most countries lack comprehensive emissions measurement systems.Current landscapeBetter prevention and care pathways simultaneously reduce emissions and improve outcomes for climate-vulnerable NCD patients. Relationship between the healthcare system, climate change and sustainability strategies and interventions80FIGURE 6 Source: Adapted from: Or, Z. and Seppänen, A. V. (2024). The role of the health sector in tackling climate change: A narrative review. Health Policy, 1433.5 Environmental sustainability and climate adaptation System-level mitigation strategies System-level mitigation strategies Provider-level green interventions Supply-side policies – Shifting care to less polluting settings – Minimizing low-value care, overdiagnosis and treatment – Regulation and incentives for greener medical products – Primary prevention – Patient education – Public information – Effective disease management – Minimizing avoidable demand – Recycling, reuse and waste management – Better energy use and green care protocols Health outcomes Climate change direct and indirect emissions Demand-side policies Health system Acting Early on Non-Communicable Diseases: A Framework for Health System Transformation 21

Acting Early on Non-Communicable Diseases 2026