Africa’s health in a warming world – Evidence, urgency and what to do next

Climate change is increasingly destabilising the planetary systems and environmental conditions on which human health and life depend. The recently published 2025 Lancet Countdown on Health and Climate Change report shows that increasing global temperatures and the growing size of vulnerable populations – infants younger than one year and adults older than 65 years – have led to a 63% increase in heat-related deaths since the 1990s. Between 2012 and 2021, heat-related fatalities reached an average of 546 000 deaths a year, most of which occurred in Africa.

This is the reality for millions who live and work in the hottest regions on the continent. The indicators in the report tell the story of a growing danger in households, workplaces and broader communities. The data shows that heat exposure is eroding people’s ability to work outdoors, exercise safely and sleep well at night. These disruptions affect both physical and mental health, affecting livelihoods that are already fragile.

For African communities, where subsistence agriculture and outdoor labour are central to income and survival, the exposure is unavoidable. Long days in the sun, limited access to water and sanitation, and poor housing conditions converge to amplify heat-related harm. The combined pressures of poverty, unemployment and inequality increase that vulnerability.

More concerning is the impact on children. Extreme heat can slow down cognitive development and weaken concentration, affecting early childhood development. The cost of this will reverberate for generations, creating vicious cycles of generational poverty as children’s futures hang in the balance during early development.

The economic consequences are just as alarming. The report shows that heat exposure resulted in a record-high of 639 billion potential work hours being lost in 2024 alone. This resulted in probable losses of more than $1 trillion, close to 1% of global domestic product. On a continent where many households rely on manual labour and informal work, this loss is a direct blow to food security, household stability and community resilience, and threatens to undo decades of developmental efforts in Africa.

Why health and climate action go hand in hand with development goals

The continent is entering a cycle where rising temperatures, worsening droughts and more frequent extreme weather events reinforce one another. On average, Africa is warming up at twice the global average. We’ve reached record levels of climate-linked hazards, where extreme weather conditions threaten water quality and food production, creating fertile ground for water- and vector-borne disease outbreaks. Parts of Africa are already experiencing a 50% increase in the incidence of water-borne diseases, overwhelming the capacity of health systems.

The interaction of hazards, exposure and socio-economic vulnerability places African populations at the sharpest end of the crisis, with real and direct implications for health systems. Clinics in rural areas lose power during extreme weather, labour wards operate without reliable electricity, and diarrhoeal disease outbreaks spread faster through water contamination after floods.

In addition to these dynamics weakening already strained health systems, studies conducted across Africa, Asia and Latin America link droughts – especially during crop-growing seasons – to higher risks of riots, communal violence and insurgency.

The report shows that public spending continues to exacerbate the risks that African populations face. The slow transition away from fossil fuels has also come at a major financial cost. After Russia’s invasion of Ukraine triggered a global spike in fuel prices, most countries, still heavily dependent on fossil energy, turned to subsidies to keep power affordable and prevent rising energy poverty.

Of the 87 countries reviewed, 73, representing 93% of global greenhouse gas emissions, provided fossil fuel subsidies in 2023. Together, they allocated a net total of $956 billion. Fifteen of these countries directed more money to net fossil fuel subsidies than to their entire national health budgets.

In addition, because Africa is a developing continent, national agendas tend to focus on infrastructure, such as roads, bridges and industrial capacity. These are seen as the engines of development and transformation, and dominate planning and spending.

Health infrastructure rarely receives the same attention. When countries consider energy, they often focus on cities, industry and large users, rather than on whether rural healthcare facilities are electrified. They don’t think about whether people can reach quality care without travelling long, unsafe stretches. These everyday conditions are often overlooked, even though they have a significant impact on people’s ability to maintain sufficient health to participate in the economy.

This is the contradiction at the heart of current spending patterns. Countries pursue development goals while overlooking the fact that these goals require a healthy, active population. If people are weakened by extreme heat and unable to work outdoors, lose income because of unsafe conditions, have to travel long distances for basic care, and if children’s early childhood development is hindered, development cannot succeed and will be undermined for future generations.

The rallying call for African climate and health leadership

The findings from the Lancet Countdown report highlight the devastating costs of inaction on climate change. Without urgent action, we could breach the limits of adaptation, with significant impacts on health, lives and livelihoods, all of which could undo Africa’s development.

Africa, the least contributor to climate change but the most affected, is at a crossroads – now is the time for bold leadership that prioritises climate and health, catalysing a unified continental response and transforming vulnerability into impact. The challenge is urgent: Africa must seize this moment to drive action, elevate its voice and translate global climate commitments into meaningful local interventions that safeguard lives and livelihoods.

The Lancet Countdown Africa Regional Centre, based at the University of Pretoria’s Future Africa platform, is the engine for Africa-centric evidence and policy guidance. Its work closes the gap between global data and African reality, translating climate science into tailored, actionable intelligence for the continent – by Africans, for Africans. The centre drives the collaboration and partnerships needed for rapid gains in clean energy, sustainable transportation and healthy food systems – making science work for policy and communities.

African leadership must be unified, assertive and visionary – not as a plea, but as a strategic imperative. Our climate-health future depends on the continent actively shaping decisions that affect its people.

By Prof Tafadzwa Mabhaudhi is the Director of the Lancet Countdown Africa Centre hosted at Future Africa at the University of Pretoria (UP); professor of climate change, food systems and health at the London School of Hygiene and Tropical Medicine; and extraordinary professor in the Faculty of Natural and Agricultural Sciences at UP