Rockefeller Foundation: Resourcing Climate and Health Priorities

The Climate-Health Crisis: A $15.4 Trillion Threat Demanding Urgent Investment

Climate change is no longer a distant environmental concern — it is an active, escalating global health emergency. The Rockefeller Foundation’s landmark report, Resourcing Climate and Health Priorities, published in January 2025, delivers the most comprehensive mapping of climate-health finance ever undertaken. The findings are both encouraging and deeply sobering: while funding has surged tenfold since 2018, it remains a fraction of what is needed to protect the 3.3 billion people already facing heightened health risks from a warming planet.

This analysis unpacks the report’s key data, explores the funding landscape across bilateral donors, multilateral institutions, and philanthropies, and examines the strategic priorities that will shape climate-health policy for the next decade. For professionals tracking the intersection of global development, public health, and climate finance, understanding these dynamics is essential.

“The health impacts of climate change could cost between US$8.6 and US$15.4 trillion by 2050, with 14.5 to 15.6 million projected deaths between 2026 and 2050.” — Rockefeller Foundation, Resourcing Climate and Health Priorities (2025)

Funding Landscape: From $1 Billion to $7.1 Billion in Four Years

The headline figure from the report is striking: total climate and health finance commitments reached US$7.1 billion in 2022, up from less than US$1 billion in 2018. This tenfold increase signals a major shift in how the international community perceives the climate-health nexus. Preliminary 2023 estimates push the total to approximately US$7.84 billion.

However, context matters. Low- and middle-income countries require at least US$11 billion per year this decade simply to adapt to health impacts from malaria, dengue, diarrheal diseases, heat-related mortality, disease surveillance, water and sanitation, and health infrastructure. The current funding level, while growing, covers barely 70% of this conservative estimate — and only 28% of countries receive any international funding for climate-health activities at all.

The distribution reveals a critical imbalance: bilateral donors shoulder nearly 68% of the burden, while multilateral climate funds — ostensibly purpose-built for this challenge — contribute a mere 0.3%. Only 0.5% of all multilateral climate funding is allocated to health, and only 6% of total adaptation funding reaches health sector projects. These gaps represent both a failure of institutional design and an opportunity for reform.

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Bilateral Donors: Japan, the US, and Europe Lead — But Questions Remain

DAC bilateral donors provided US$4.8 billion in climate-health finance in 2022, with the share of development assistance for health targeting climate-related interventions rising from 3% in 2018 to 19% in 2022. Three donors — Japan, the United States, and EU institutions — accounted for 79% of all DAC climate-health funding between 2018 and 2022.

Japan’s dominance deserves scrutiny. While it leads in total volume, 77% of Japan’s ODA was climate-tagged in 2022 compared to the DAC average of 29%, and 71% of its climate-health finance came as loans rather than grants. The report notes that 99% of health projects tagged as climate-relevant were classified as “climate significant” (secondary objective) rather than “climate principal” (primary objective). If a standard 50% discount is applied to secondary-objective projects, the real DAC contribution drops from US$4.8 billion to approximately US$2.4 billion — cutting the headline figure in half.

This tagging methodology raises fundamental questions about how much of this funding truly represents new, additional investment in climate-health versus relabeling of existing health programs. The report urges donors to develop more rigorous climate-health markers that go beyond the current OECD Rio marker system.

Where the Money Goes: Priority Areas and Geographic Distribution

The Rockefeller report categorizes funding across three priority areas aligned with the WHO’s climate and health framework:

• Priority Area 1 — Address direct health impacts (infectious diseases, nutrition, maternal health): 68% of DAC funding
• Priority Area 2 — Strengthen climate-resilient health systems (infrastructure, workforce, surveillance): 30% of DAC funding
• Priority Area 3 — Climate change mitigation in the health sector (green hospitals, clean energy in facilities): 3% of DAC funding

The geographic distribution reveals both alignment and gaps with vulnerability. Sub-Saharan Africa and Asia each received 31% of climate-health finance (approximately US$3.2 billion each). Bangladesh (US$829M), India (US$721M), and the Philippines (US$360M) were the largest country recipients — all lower-middle-income countries with high climate vulnerability scores.

“Only 34% of DAC climate-health funding is channeled directly through recipient governments. Approximately 45% flows through international stakeholders — donor governments, donor-based NGOs, the UN system, and private sector entities in donor countries.”

This channeling pattern raises concerns about country ownership and sustainability. When nearly half of all funding flows through intermediaries based in donor countries, the capacity-building impact in recipient nations is diminished, and transaction costs increase.

Multilateral Development Banks: Scaling Fast but Loan-Heavy

The four MDBs analyzed — the World Bank, Asian Development Bank (ADB), Inter-American Development Bank (IDB), and African Development Bank (AfDB) — committed US$3.5 billion to climate and health between 2019 and 2023. MDB commitments more than doubled from US$625 million in 2022 to US$1.36 billion in 2023, with ADB’s US$500 million growth accounting for 73% of the increase.

Yet climate and health represents only 2% of total MDB climate finance commitments in 2023. The modality mix is heavily skewed toward loans: over 90% of ADB and IDB climate-health funding is loan-based. For the World Bank, 58% comes as IBRD loans, 22% as IDA credits, and only 20% as IDA grants.

This loan-heavy approach has implications for the most vulnerable countries. While Indonesia (US$500M), Morocco (US$289M), and the Philippines (US$220M) received the largest MDB allocations, these are predominantly middle-income countries with the creditworthiness to take on loans. Low-income countries like Haiti (US$82M) and Ethiopia (US$64M) received far less.

The MDBs have set ambitious targets: the World Bank committed 45% of all lending to climate finance by FY2025, while at COP29, MDBs jointly pledged US$120 billion in climate finance, including US$42 billion for adaptation and US$65 billion in private sector mobilization. Whether health receives a proportional share of these commitments remains to be seen.

Multilateral Climate Funds: The Biggest Gap in the Architecture

Perhaps the most striking finding is the near-absence of multilateral climate funds from health financing. Between 2018 and 2022, multilateral climate funds committed only approximately US$52 million to health sector projects — just 9 projects total. This makes health one of the most neglected sectors in the climate finance architecture.

The Green Climate Fund (GCF) is the largest climate fund investing in health, with approved projects in Lao PDR (US$25M), Cook Islands (US$12.5M), and Malawi (US$33M). The GCF has also committed approximately US$460 million to 13 non-health sector projects that deliver health co-benefits. With US$12.8 billion secured in replenishments for 2024–2027, the GCF has capacity to dramatically scale health investments.

A promising development is the GCF-UNDP-WHO co-investment facility of US$122 million for climate and health, along with the GCF’s US$500 million readiness program providing up to US$10 million per country. The Adaptation Fund, with US$133 million in 2024 pledges and WHO’s 2023 accreditation as an implementing partner, also signals growing institutional readiness.

Yet the structural barriers remain formidable. The report found that 54% of countries surveyed cited “lack of information on opportunities” as a core challenge in accessing international climate financing for health — suggesting that the problem is not only insufficient funds but also insufficient access pathways.

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Philanthropic Investment: Small Scale, Outsized Influence

Philanthropic funding for climate and health grew from US$9 million in 2018 to US$112 million in 2023, totaling approximately US$300 million over the six-year period. While this represents a tiny fraction of the total landscape, philanthropies punch above their weight in shaping agendas and catalyzing innovation.

The Wellcome Trust dominates, contributing US$235 million (78% of all philanthropic funding), primarily directed toward research institutions — 67% went to universities and research institutes, with 56% flowing to UK- and US-based recipients. Excluding Wellcome, the philanthropic landscape is more diverse:

Recent commitments signal acceleration: the Rockefeller Foundation pledged US$100 million, Foundation S committed US$42 million, and Novo Nordisk Foundation, Wellcome, and the Gates Foundation jointly pledged US$300 million for R&D on health impacts of climate change. Bloomberg Philanthropies and the Clean Air Fund committed US$30 million to reduce air pollution by 30% by 2030 in selected cities.

Excluding Wellcome, 80% of philanthropic funds targeted low- and middle-income countries, with Tanzania (US$10M), India (US$6M), and Nigeria (US$5M) as top recipients. Seven of the ten largest recipient countries rank among the 50 most climate-health vulnerable nations.

Health-Determining Sectors: The $13.5 Billion Opportunity

Beyond direct health sector investments, the report identifies a critical “Layer 2” of funding: US$13.5 billion annually (2018–2022 average) committed by DAC donors and climate multilateral funders to health-determining sectors — energy, transport, water and sanitation, agriculture, and urban development — with potential to deliver significant health improvements.

The three largest sectors account for 73% of this funding:

• Energy: 33% of climate finance with health co-benefit potential — clean energy transitions directly reduce respiratory diseases and indoor air pollution deaths
• Transport and storage: 25% — sustainable transport reduces air pollution exposure and road traffic injuries
• Water and sanitation: 15% — WASH improvements directly prevent waterborne diseases exacerbated by climate change

This represents a massive opportunity for “health mainstreaming” — integrating health outcomes as explicit objectives in climate investments across sectors. If even 10% of these health-determining sector investments were designed with explicit health co-benefit targets, it would more than double the effective climate-health finance reaching vulnerable populations.

Multilateral Health Funds: Climate Mainstreaming in Action

Two multilateral health funds — the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and Gavi, the Vaccine Alliance — demonstrate how climate considerations can be embedded within existing health financing mechanisms.

The Global Fund contributed an estimated US$1.2 billion toward climate-relevant health projects, with 71% of its 2023–2025 grant cycle investments targeting the 50 most climate-vulnerable countries. Over 80% of its malaria spending — a disease whose geographic range is expanding due to rising temperatures — went to these vulnerable nations.

Gavi invested an estimated US$320 million annually in climate-relevant programming, spending US$1.6 billion between 2021 and 2025 on vaccines for seven climate-sensitive diseases: cholera, malaria, typhoid, dengue, meningitis A, Japanese encephalitis, and yellow fever. This represents 28% of Gavi’s total vaccine expenditure for the period — a substantial mainstreaming effort that could serve as a model for other health institutions.

These funds demonstrate that climate mainstreaming in health need not require new institutions or funding channels. By systematically assessing climate vulnerability in allocation decisions and prioritizing climate-sensitive diseases, existing mechanisms can significantly increase their climate responsiveness.

Strategic Recommendations: Eight Priorities for Closing the Gap

The Rockefeller report outlines a clear pathway for scaling climate-health finance to meet the US$11 billion annual need. The following recommendations synthesize the report’s analysis:

1. Reform climate-health tracking methodologies: Move beyond the OECD Rio marker system to develop dedicated climate-health markers that distinguish genuine new investment from relabeled existing programs. The current system likely overstates true climate-health investment by up to 50%.
2. Unlock multilateral climate funds for health: With only 0.5% of multilateral climate funding reaching health, there is enormous headroom. The GCF’s US$12.8 billion replenishment, combined with WHO’s Adaptation Fund accreditation, creates pathways that must be actively pursued.
3. Rebalance grant-loan ratios: The current 76% grant / 24% loan split among DAC donors masks the loan-heavy MDB portfolio. Low-income countries facing the greatest climate-health burdens cannot absorb additional debt — grant financing must be prioritized for the most vulnerable.
4. Increase country ownership: Only 34% of funds flow through recipient governments. Strengthening national health adaptation plans and building in-country capacity to design, submit, and manage climate-health projects is essential for sustainability.
5. Scale mitigation investments in health: At only 3% of DAC funding, health sector decarbonization is severely underfunded. The health sector contributes approximately 4.4% of global greenhouse gas emissions — greening healthcare delivery is both a mitigation imperative and a resilience strategy.
6. Leverage health-determining sectors: The US$13.5 billion flowing annually to energy, transport, and WASH sectors must be designed with explicit health co-benefit targets. Cross-sector collaboration between health and climate ministries is key.
7. Catalyze private sector engagement: Private sector channeling of climate-health finance grew from 2% in 2018 to 17% in 2022. Blended finance instruments, impact bonds, and insurance mechanisms can unlock additional capital.
8. Address information barriers: With 54% of countries citing lack of information as a core challenge, the international community must invest in technical assistance, capacity building, and knowledge platforms that connect countries with available financing.

The Road Ahead: From Commitment to Implementation

The Rockefeller Foundation’s report arrives at a pivotal moment. The COP29 commitments — including the MDB pledge of US$120 billion in climate finance and the new collective goal on climate finance — provide a political framework for scaled action. The WHO’s accreditation with the Adaptation Fund, the GCF-UNDP-WHO co-investment facility, and the growing philanthropic commitments all suggest institutional momentum.

Yet the gap between commitment and disbursement remains wide. The report’s finding that only 28% of countries receive any international climate-health funding, and that more than half lack information about available opportunities, underscores that scaling supply without fixing access will not solve the problem.

The projected 14.5–15.6 million climate-attributable deaths between 2026 and 2050 are not inevitable. They are a function of choices made today — in allocation committees, donor capitals, multilateral boardrooms, and national health ministries. The financing architecture exists; the data shows it is growing. The question is whether it will grow fast enough, reach the right places, and be structured in ways that build lasting resilience rather than perpetuate dependency.

For organizations, policymakers, and analysts working at the intersection of climate and health, this report is an essential resource — not just for its data, but for the framework it provides to evaluate progress, identify gaps, and hold institutions accountable.

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