Climate change and health: analysis of national policies and implementation challenges in Nepal
This study reveals that while Nepal has established national policies to address climate change and health, their implementation at the subnational level is hindered by limited awareness, insufficient capacity and financing, and a reliance on reactive disaster management rather than proactive, integrated adaptation strategies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The air we breathe, the water we drink, and the food we eat are all shifting as the planet warms. This slow, steady change is not just a story of rising temperatures; it is a story of how those changes ripple through the systems that keep us alive. When extreme heat, floods, or droughts strike, they do not just damage roads or crops; they strain the very networks of clinics, hospitals, and health workers that communities rely on. For countries with fewer resources, these pressures can be overwhelming, turning manageable health issues into crises. The central question for scientists and policymakers is no longer just whether climate change affects health, but how to build health systems that can withstand these shocks without breaking. This means moving beyond simply reacting to disasters after they happen and instead preparing communities to face the changing climate before the next storm arrives.
In Nepal, a nation defined by its dramatic landscapes ranging from flat, hot plains to high, snow-capped mountains, the link between a warming climate and public health is already visible. Researchers from HERD International and their partners set out to understand how the country is preparing for this reality. They looked at the official rules and plans written by the government and compared them with what is actually happening on the ground in three very different places: a bustling city in the capital, a semi-urban town in the southern plains, and a remote village in the high mountains. Their goal was to see if the strong promises made by national leaders were reaching the local officials who are responsible for protecting people's health every day.
The study began by reading through dozens of government documents, from national strategies down to local plans, to map out the country's official approach. The researchers found that Nepal has indeed created a robust set of policies. The government has recognized that climate change is a major health threat and has written plans to adapt, including a specific strategy for the health sector known as the Health National Adaptation Plan. These documents acknowledge that rising temperatures bring more diseases like dengue and malaria, that floods can contaminate water supplies, and that extreme weather can damage hospitals. At the national level, the leadership is clear, with specific ministries tasked with coordinating these efforts.
However, when the researchers spoke with the people actually doing the work in the field, a different picture emerged. They conducted in-depth interviews with thirty-five officials, including doctors, disaster managers, and local government leaders in the three selected sites. The conversation revealed a significant gap between the national plans and local reality. While the policies exist on paper, the people responsible for implementing them often do not know about them, or they lack the specific instructions on how to turn those broad ideas into daily actions. In the remote mountain village of Patarasi, for instance, the local disaster management team only becomes active when a crisis strikes. Between emergencies, the system sits dormant, and there is little routine work being done to prevent future health problems caused by the climate.
This disconnect is driven by several practical hurdles. First, there is a shortage of knowledge and training. Many local health workers and officials understand that the climate is changing, but they do not have the technical skills to figure out exactly how it will affect their specific community or what steps to take to prepare. Training programs exist, but they are rare and often focus on responding to immediate disasters rather than long-term prevention. Second, money is a major barrier. Local governments have limited budgets, and when they do have funds, they are often spent on visible, immediate projects like building roads or distributing relief supplies after a flood, rather than on the less visible work of building resilience. Politicians and local leaders often feel pressure to show quick results, which makes long-term climate planning a lower priority.
The researchers also found that the way different parts of the government work together is often fragmented. Climate change and disaster management are frequently handled by separate teams that do not talk to each other enough. In the city of Budhanilkantha, for example, the local government has a draft plan for climate resilience, but it struggles to manage waste and pollution because it relies on coordination with a neighboring city, creating a bottleneck. In the semi-urban town of Kapilvastu, health officials noted that they often wait for outside organizations to bring them resources and guidance, rather than having a clear, independent plan of their own. This reliance on external help makes it difficult to sustain efforts once the outside support leaves.
The study concludes that while Nepal has laid a strong foundation with its national policies, the work of building a climate-resilient health system is still in its early stages. The country has the right ideas on paper, but it needs to bridge the gap to practice. This means ensuring that local officials receive clear, practical guidance on how to integrate climate considerations into their everyday planning and budgeting. It requires investing in training so that health workers can confidently address climate-related health risks. Most importantly, it demands a shift in mindset from reacting to disasters to proactively preparing for them. Without these changes, the promise of a health system that can protect people in a warming world will remain just that—a promise, rather than a reality.
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