A New Handbook for Global Health: Natural Infrastructure. By Vera Seisjo, Senior Scientist, One Health/Asian Infrastructure Bank (AIIB)

Vera Siesjö, Senior Scientist, One Health, Economics Department,Asian Infrastructure Bank (AIIB)

Focusing investments on the nexus of health, climate change, and nature could unlock billions of dollars in additional funding from health and climate funding agencies, climate-affected countries, philanthropic organizations, and the private sector.

The world is facing converging crises: climate change, nature degradation, and public health instability. These crises are inextricably linked, amplifying each other, and undermining progress toward sustainable development.

Today, more than 3.3 billion people already face increased health risks due to climate change, and the World Health Organization estimates that overall morbidity and mortality from climate-intensified natural disasters will result in an additional 15 million deaths by 2050. Vulnerable populations in low- and middle-income countries (LMICs), often underinvested in climate and health infrastructure, are most at risk.

Despite this, global financing mechanisms currently address these issues in isolation. Climate funds overlook health benefits. Health infrastructure ignores environmental risk. Investments in nature are rarely linked to human health outcomes.

Fragmented financing and ignored environmental risk

Financing models often neglect the fundamental environmental determinants of health: clean air, clean water, and functioning ecosystems. For example, the risks of nature and biodiversity loss are insufficiently considered in existing solvency and debt sustainability assessments. However, the impact of nature and biodiversity loss on GDP, sovereign credit ratings, debt distress risks, and interest costs is significant, especially for vulnerable developing countries.

Health investments rarely consider climate risk or ecosystem degradation, and climate or nature finance often ignores public health outcomes. This fragmentation limits the scale and effectiveness of infrastructure interventions.

Furthermore, the cost of inaction is alarming. A recent study found that the total annual cost of antimicrobial resistance (AMR) through 2050 could reach $20 billion in Brazil, $85.4 billion in China, $13 billion in Indonesia, and $82.2 billion in India. In these cases, water, sanitation, and hygiene (WASH) and hygiene interventions were found to have a significant impact on reducing health and economic burdens, highlighting the need for a global multisectoral approach.

Early investment as a catalyst

With macroeconomic pressures driving disinvestment in global health and the unlikely decline in demand for health infrastructure in later stages, climate and adaptation finance could be key to boosting investment in early-stage health.

Thus, in 2023, multilateral development banks financed climate projects worth $125 billion, more than double the amount in 2019. However, previous studies revealed that only 2% of adaptation finance and 0.5% of multilateral climate finance is allocated to projects explicitly focused on protecting or improving human health.

By considering the health benefits of investing in climate and nature, we could unlock billions of dollars in additional financing, not only from multilateral development banks, but also from climate finance agencies, climate-affected countries, philanthropic organizations, and the private sector.

Air pollution, an example

Take air pollution, for example. Exposure to fine particulate matter is a leading cause of respiratory and cardiovascular disease. Projects that replace coal-fired energy with renewables or improve public transportation not only reduce emissions but also improve health outcomes and ease the burden on healthcare systems.

Similarly, heat-mitigating infrastructure, such as urban forests, not only cools cities and absorbs carbon, but also reduces hospitalizations during heat waves and improves mental well-being.

That's why nature is one of our most vital health resources. Forty percent of modern pharmaceuticals come from natural sources; pollinators sustain approximately one-third of our global food supply; ecosystems provide natural water filtration; and biodiversity helps protect us from zoonotic diseases. These benefits are not only currently threatened due to the climate crisis, but are also too often overlooked as determinants of better global health.

Natural infrastructure as an ally for health

Natural infrastructure, such as mangroves, wetlands, and forests, plays a critical role in protecting and enhancing life. Mangroves, for example, provide flood protection, filter water, store carbon, and contribute to food security and livelihoods.

Furthermore, they provide immense economic value, estimated by UNEP at between US$33,000 and US$57,000 per hectare per year. However, natural systems like these are disappearing at an alarming rate: between 1980 and 2000, approximately 25% of mangrove areas worldwide were lost, and their decline has continued ever since, and proactive funding to reverse this situation remains negligible.

A shift in mindset is long overdue, and this World Conservation Day is an opportune moment to reflect on how we develop and conserve the planet's natural resources and biodiversity. By investing in infrastructure that considers the co-benefits for health, climate, and nature, we can free up billions of dollars in underutilized funds, improve long-term health outcomes, and reduce the financial burden on health systems. These investments are evidence-based, cost-effective, and increasingly urgent.

Vera Seisjo Senior Scientist, One Health, Economics Department,Asian Infrastructure Bank (AIIB)

She has over 15 years of international experience in global health, planetary health, One Health, and health systems development. Prior to joining the AIIB, she worked in various organizations, including as an advisor to the Swedish Development Agency, a senior program officer at the Alliance to Defeat NCDs at UNOPS (Geneva), a health systems consultant for the Asian Development Bank, and Country Director of ACCESS Health International in the Philippines and Indonesia. At these organizations, she led work on health financing, healthcare quality and process improvement, climate and health, digital health, people-centered healthcare, and health policy and systems research. Siesjö also served on the management of the Center for Health Market Innovation and was one of the first managers of the Joint Learning Network for Universal Health Coverage. She also co-founded E-Pharma and advised several healthcare startups.

Vera was one of the authors of the MDB's flagship report, Infrastructure for Planetary Health , and was part of the team that developed the AIIB's previous report, "Nature as Infrastructure : Infrastructure for Planetary Health," which explores the significant co-benefits for health, climate, and nature of sustainable infrastructure development.

Focusing investments on the nexus between health, climate change and nature could unlock billions of dollars in additional funding from health and climate financing agencies, climate-affected countries, philanthropies and the private sector.

The world is facing converging crises – climate change, nature degradation, and public health instability. They are inextricably linked, amplifying one another and undermining sustainable development progress. Today, over 3.3 billion people are already facing heightened health risks due to climate change, with the World Health Organization Council estimating that overall morbidity and mortality from climate-intensified natural disasters will result in 15 million more deaths by 2050.[1] Vulnerable populations in low- and middle-income countries (LMICs), often with scant investment in climate and health-related infrastructure, are at greatest risk.

Despite this, global financing mechanisms currently approach these issues in silos. Climate funds overlook health benefits. Health infrastructure ignores environmental risk. Investments in nature are rarely tied to human health outcomes.

Environmental Determinants and Funding Gaps

Funding models often neglect the root environmental determinants of health – clean air, safe water, functioning ecosystems. For example, nature and biodiversity loss risks are not sufficiently factored into existing creditworthiness and debt sustainability assessments. However, the impact of nature and biodiversity loss on GDP, sovereign credit ratings, debt distress risks and interest costs are significant, particularly for vulnerable developing countries.

Healthcare investments also rarely consider climate risk or ecosystem degradation, and climate or nature financing often omits public health outcomes. This fragmentation limits the scale and effectiveness of infrastructure interventions.

Furthermore, the cost of inaction is staggering. In a recent study, we found the total cost of antimicrobial resistance (AMR) per year up to 2050 could reach USD 20.0 billion in Brazil, USD 85.4 billion in China, USD 13.0 billion in Indonesia USD 82.2 billion in India.[2] In these instances, WASH and hygiene interventions were found to have a significant impact in reducing both the health and economic burdens, highlighting the need for a multi-sector planetary approach.

Climate Finance as a Health Catalyst

With the macroeconomic pressures driving global health divestment and the demand for downstream health infrastructure unlikely to ease soon, climate and adaptation funding could hold the key to unlock upstream health investment. In 2023, multilateral development banks financed USD 125 billion worth of climate projects – more than double the figure for 2019.[3]

Yet previous studies found only 2 percent of adaptation funding and 0.5 percent of multilateral climate funding is allocated to projects explicitly focused on protecting or improving human health.[4] By considering the health benefits of climate and nature investment, we could unlock billions in additional funding – not just from multilateral development banks, but also climate financing agencies, climate-affected countries, philanthropies, and the private sector.

Take air pollution as an example. Exposure to fine particulate matter is a leading driver of respiratory and cardiovascular diseases. Projects that replace coal-fired power with renewables or improve public transportation don't just reduce emissions – they improve health outcomes and ease the burden on healthcare systems. Similarly, heat-mitigating infrastructure, such urban forests, not only cool cities and absorb carbon, but reduce hospitalizations during heatwaves and improve mental well-being.

Nature is one of our most vital health assets. 40 percent of modern pharmaceuticals are derived from natural sources; pollinators support about one-third of our global food supply; ecosystems provide natural water filtration; and biodiversity helps protect us against zoonotic diseases. Not only are these benefits currently under threat due to the climate crisis, but they are also too frequently overlooked as a determinant of improved global health.

The Role of Nature-Based Infrastructure

Nature-based infrastructure – such as mangroves, wetlands and forests – plays a critical role in protecting and improving lives. Mangroves, for instance, provide flood protection, filter water, store carbon, and support food security and livelihoods. They also provide immense economic value – estimated by the UNEP to be USD 33,000 to USD 57,000 per hectare per year.[5] However, natural systems like these are disappearing at an alarming rate – since 1980 and 2000, approximately 25 percent of mangrove areas were lost globally, with continued decline since – and proactive financing to reverse this remains negligible.[6]

A shift in mindset is long overdue, and this World Nature Conservation Day is an opportune moment to consider how we develop and conserve the planet's natural resources and biodiversity. By investing in infrastructure that considers the co-benefits across health, climate, and nature, we can unlock billions in underutilized funds, improve long-term health outcomes and reduce financial burdens on healthcare systems. These investments are evidence-based, cost-effective, and increasingly urgent.

Vera Siesjö, Senior One Health Scientist Economics Department, Asian Infrastructure Investment Bank (AIIB)

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