FOREWORD
Health is the very foundation of every field of human endeavor. Health is wealth — not just in the economic sense, but in the broadest definition of the term. Personal wealth is built through the innovation and hard work of individuals in good mental and physical health. And national prosperity ensues. Yet one major concern humanity must address in the 21st century is the threat to health posed by the degradation of our planet’s natural ecosystems.
The intertwined crises of climate change, biodiversity loss, and environmental degradation are exacerbating global health inequities. Extreme heatwaves cause heatstroke and cardiovascular stress. Air pollution leads to respiratory diseases and cancer, now becoming the second leading cause of death worldwide. Natural disasters disrupt healthcare systems, displace communities, and accelerate the spread of waterborne diseases. Rising global temperatures expand the reach of vector-borne diseases such as malaria and dengue, threatening regions previously unaffected
When ecosystems thrive, so do human societies. However, the reality is stark. For centuries, we humans have inflicted ceaseless damage on nature. Nature is our protector. But we have treated it badly. The vandalism perpetrated by humans on the planet’s landmass and oceans has caused extensive damages far below the surface. Nature is endowed with an immense capacity to heal itself, but the pace of destruction in recent decades has outstripped its capacity for renewal. As a corollary, nature’s capacity to protect and sustain human health has also been severely enfeebled. Mountains are now denuded of forests which used to filter air and water. Wetlands have gone dry which could otherwise act as a gargantuan sponge absorbing floods. And loss of biodiversity undermines nature’s ability to contain contagious diseases. The dire consequence of the havoc wreaked on our ecosystems is the exacerbation of health crises in human society. Vulnerable populations bear the brunt of this threat despite being the least responsible for environmental degradation. Asia, for example, is expected to face climate-related mortality rates more than 13 times higher than those in North America.
Infrastructure adorns the natural world, not just in an aesthetic manner. It is also practical. Sustainable infrastructure can mitigate many of these risks referred to above while fostering long-term economic sustainability. Low-emission public transportation reduces air pollution and improves public health. Smart water systems prevent disease transmission and ensure clean drinking water. Clean energy reduces respiratory illnesses and premature deaths linked to air pollution. Resilient healthcare infrastructure ensures medical services remain operational during climate-related crises. Nature-based solutions—such as reforestation projects, wetland restoration, and urban greening—enhance climate adaptation while safeguarding public health.
Since its establishment nine years ago, AIIB has done its utmost to strengthen the intrinsic link between sustainable infrastructure and public health. Our commitment to financing the infrastructure for tomorrow is also a commitment to ensuring a healthier future. In response to growing demand from our members, AIIB has introduced its first Health Strategy, underscoring our focus on resilience, inclusivity, and sustainability in health-related infrastructure investments.
AIIB’s approach to Infrastructure for Planetary Health seeks to maximize health co-benefits across all infrastructure sectors. Many of our projects, often co-financed with other multilateral development banks such as the World Bank, Asian Development Bank, European Bank for Reconstruction and Development, and African Development Bank, are designed to address the intertwined challenges of health, climate, and nature. By adopting a synergistic, sustainability-focused approach, AIIB aims to catalyze greater private-sector financing and mobilize more private capital to meet planetary health needs.
No country can achieve its full potential with a sick population on a degraded planet. Today, there are 3.3 billion people facing increased health risks due to climate change—a number that will rise as climate-related disasters become more frequent and severe. Economic losses from climate-induced health crises already amount to billions of dollars annually. The cost of inaction will far outweigh the cost of proactive investment in resilient infrastructure.
Multilateral development banks, governments, the private sector, and civil society must work together to prioritize infrastructure that aligns with planetary health objectives. Investments in green bonds, the integration of health considerations into urban planning, and the empowerment of communities with knowledge and resources will be essential. Through the establishment of the Development Banks Working Group for Climate and Health, we hope to accelerate collective action and financing for Infrastructure for Planetary Health.
We can no longer afford to view climate change as a distant crisis. It is here, now, and its impact on global health is all too palpable. We are already falling dangerously short of the USD2.4 trillion needed annually to address climate change. Worse still, less than one percent of multilateral climate funding is directed towards health. Such a paltry amount falls egregiously short of what is required to improve planetary health, as a vital prerequisite for maintaining human health. It is high time that we begin to invest more to protect millions of lives now and in the future.
Supporting human health is about more than saving lives—it is about strengthening communities, safeguarding livelihoods, and ensuring sustainable prosperity for generations to come. Planetary health and human health go hand in hand, and this is precisely what AIIB has striven to achieve. By investing in Infrastructure for Planetary Health, we can break the cycle of environmental degradation and declining health, fostering a healthier global community built on a sustainable economy and supported by a planet that remains safe and resilient.
Jin Liqun President and Chair of the Board of Directors Asian, Infrastructure Investment Bank
PREFACE
Earth may have breached seven of nine planetary boundaries according to a recent report from the world-leading Potsdam Institute for Climate Impact Research. These boundaries contribute to the stability of the world’s life support system. Climate change, the introduction of novel entities, change of biosphere integrity and modification of biogeochemical flows are estimated to be in high-risk zones, while breaches were less severe for land system change and freshwater change. The latest boundary that may have been breached is ocean acidification due to absorption of atmospheric CO2 .
There is a strong connection between the health of our planet and human health, and both are impacted through infrastructure investment. Our infrastructure choices lock us in, sometimes for decades, sometimes for centuries. Infrastructure for Planetary Health is about getting it right for our own survival and for the ecosystems we depend on. The 2023 Asian Infrastructure Finance report on Nature as Infrastructure argued that investing in nature as infrastructure—the most precious infrastructure for sustaining life on Earth—not only holds the key to mitigating and adapting to the escalating effects of climate change and biodiversity decline but ultimately to safeguarding human health and well-being.
Over the last decades, we have made astonishing progress in global health. Child mortality has fallen by 70 percent. We have nearly eradicated polio and dramatically scaled up access to new vaccines, including for some of our major killers like malaria and cervical cancer. Contracting HIV and AIDS is no longer a death sentence, and although inequities persist, we now live, on average, almost 30 years longer than we did 50 years ago.
However, human-induced changes to climate, nature and biodiversity now profoundly impact human health and well-being, posing serious and escalating threats to our global health gains, economies and development. Currently, a quarter of global deaths yearly can be attributed to various known avoidable environmental factors. Air pollution is the largest environmental cause of disease and premature death, causing over seven million deaths every year, more than the combined global death caused by tuberculosis, HIV/AIDS and malaria.
After decades of declines in global poverty levels, as many as 44 million people could be driven into extreme poverty by climate-driven health impacts by the end of the decade, principally in Africa and South Asia. Climate and nature degradation-driven health impacts will only intensify, exposing billions more people to life-threatening extreme temperatures, outbreaks of water- and vector-borne diseases, emerging zoonotic diseases, sandstorms, wildfires and catastrophic extreme weather risks, threatening to push millions of people into poverty.
This report argues that we must go beyond a “healthcare infrastructure approach” to safeguard human health and well-being. Safeguarding human health means achieving planetary health, which will require broad societal transformation. Infrastructure for planetary health offers a paradigm shift in how we think of, invest in and build systems to safeguard human health. Infrastructure is an essential part of the solution, not only for building resilient health systems but also as part of the broader focus on health, climate mitigation, adaptation, and nature-based solutions and conservation efforts in all infrastructure.
A global planetary health response could unlock billions of dollars in additional funding from health and climate financing agencies, climate-affected countries, philanthropies and the private sector. By maximizing investments in planetary health infrastructure through the development of strategic partnerships, innovative financing and thought leadership in integrating and scaling infrastructure investment in the nexus between health, climate change and nature, we can provide our members with infrastructure based on the latest evidence in equitable, people-centered development, a science-based approach, and Universal Health Coverage. Such investments would not only avoid human suffering but also result in a more productive and prosperous economy.
The 2023 Asian Infrastructure Finance report Nature as Infrastructure provided examples of how investments in mangroves, wetlands and forests can generate significant economic returns if nature assets are properly valued. This year’s AIF report on Infrastructure for Planetary Health demonstrates that the impact on health outcomes and the associated costs provide an additional economic argument for why we should invest in nature, including in preserving keystone species, zoonotic surveillance and restoring natural habitats.
We are entering largely uncharted territory with accelerating climate change and biodiversity loss. Social and natural sciences must work more closely to better understand the interlinkages between climate, nature and human health. Part of this must be to explore the potential for nature to provide solutions to our global health challenges. We are, for example, constantly discovering new medicinal benefits of herbs and nature’s impacts on mental and physical health. In assessing the value of nature’s full potential and designing infrastructure investments, we must take these benefits into account.
There is still time for the global economy to safeguard human health from the impacts of climate change and nature degradation. A unique window exists to invest in planetary health infrastructures to mitigate and adapt to the escalating impact of the climate crisis and biodiversity loss on human health. Today’s health challenges are complex and require global effort and cross-sectoral collaboration. Planetary health focuses on understanding and quantifying human health impacts from global environmental disruptions. Building planetary health infrastructure will allow humanity and the natural systems we depend on to thrive now and in the future.
Erik Berglof Chief Economist, Asian Infrastructure Investment Bank
EXECUTIVE SUMMARY
Climate change, environmental degradation and biodiversity loss are impacting human health and well-being at an accelerating rate, increasing death, disability, loss of productivity and poverty. These changes exacerbate the risk of exposure to a myriad of climate sensitive-diseases and health conditions. Often these causes interact to amplify the impact on health. More heat and humidity increase the dangers from air pollution. More extreme rainfall and degraded wetlands combine to raise the risk of flooding which in turn leads to the spread of diseases, loss of livelihoods and damage to critical health infrastructure.
Developing economies, particularly people living in poverty, the elderly and children in these countries, are disproportionately affected by these health impacts. Income inequality is often high and healthcare systems are weak and underfunded. People with more resources can afford to reduce risks through private means, for example, by buying air purifiers and air conditioners and constructing homes with better flood protection. Investing in infrastructure that combat climate change and reverse nature loss becomes especially important to those that do not have access to these means.
Global warming brings heat-related stresses and cardiovascular diseases. Adverse extreme weather events directly affect the physical and mental well-being of populations, increasing risks of water and vector-borne diseases, threatening food and water security and damages healthcare infrastructure. Overexploitation of nature and harmful practices bring related hazards, such as the spread of zoonotic diseases, antimicrobial resistance, and chemical-related health impacts. Environment, nature and infrastructure provisions are important determinants of health beyond incomes or healthcare expenditures.
This report underscores the intricate interconnections between climate change, environmental degradation, biodiversity loss, and human health, presenting a compelling case for adopting a “planetary health” paradigm to address these global challenges. The Asian Infrastructure Finance 2025: Infrastructure for Planetary Health report aims to invest in infrastructure for development while at the same time enhancing the health of people and the planet. This can be achieved through a holistic approach that considers health, climate mitigation, adaptation, nature-based solutions and conservation efforts in all infrastructure development.
This report presents compelling evidence of the multifaceted health challenges particularly faced by developing countries due to climate change, nature degradation, and biodiversity loss. The report highlights increased water- and vector-borne diseases in select Asian countries due to flooding and rising food insecurity linked to rainfall volatility. It also points to how elevated temperatures increases infant mortality in South and Southeast Asia (SSEA) and the severe health and cognitive development impacts caused by the inadequate recycling of lead—widely used in various industries and renewable energy storage—that contaminates soil, water, and air.
The burning of coal for electricity generation is at the heart of both climate change and environmental degradation. Reducing reliance on coal and improving air quality will require various measures. This includes green investments, expanding cross-province electricity trading, implementing local pollution controls, re-naturalizing peatlands, and mitigating the effects of burning of crop fields to improve air quality and overall health outcomes. The report also highlights the staggering economic toll of health-related issues exacerbated by climate change, including antimicrobial resistance (AMR), mental health challenges, and productivity losses. Our analysis shows that annual AMR-related costs alone are projected to reach USD13 billion in Indonesia, USD20 billion in Brazil, USD82.2 billion in India, and USD85.4 billion in China by 2050.
Finally, the report highlights the interdependence of nature and human health, and how biodiversity loss threatens vital ecosystem services such as food security, traditional medicine, natural disaster protection, and disease regulation. A recent study found that the drop in vulture populations in India led to 100,000 additional human deaths per year, due to the rise of other disease-carrying scavengers such as rats and feral dogs, carrying diseases such as rabies, anthrax and tuberculosis and contamination of ground water due to the leftover carcasses. This, coupled with the rising prevalence of zoonotic diseases, underscores the urgent need for integrated approaches like “One Health,” which connect human, animal, and environmental health to address these interconnected challenges effectively.
Three key investment themes emerge in the report:
First, it is necessary to invest in accessible, green, resilient and inclusive healthcare infrastructure. Increasing the accessibility and climate resilience of healthcare would ensure effective operations during disasters and extreme weather events and adapt to changing disease patterns due to climate change and nature degradation. Investing in low-carbon sustainable health systems would reduce overall carbon emissions. Inclusive infrastructure reduces health disparities, strengthens healthcare system and overall public health, improves social and economic development, and ensures that no one is left behind in receiving the quality care they need.
Second, scaling up green infrastructure and opting for a health-in-all-infrastructure approach can support health outcomes. A planetary health-in-all-infrastructure approach integrates health, nature and climate considerations into the planning, design, and implementation of all infrastructure projects, ensuring that built environments actively promote well-being of people and planet. By prioritizing clean air, safe water, green spaces and active transportation, this approach reduces disease burdens, nature degradation and climate change and improves public health outcomes. Further, retirement of coal plants, backed by renewables and adequate transmission, reduces population exposure to air pollution. Improved flood controls and water and sanitation infrastructure reduce waterborne and related diseases, which are especially critical in post-extreme weather events. Heat stresses will increasingly pose health challenges, requiring enhanced healthcare support to vulnerable population segments and greener, natural infrastructure that mitigates heat impact.
Finally, nature is an important solution to better health. Nature-based approaches in infrastructure or investing directly in nature deliver multiple benefits to health and well-being. Well-functioning ecosystems provide clean air and water, food, medicines and protection against extreme weather events. The report highlights valuable ecosystem services that mangroves provide for human well-being and health, including prevention of damage to properties and infrastructure during floods and typhoons, carbon sequestration and food provision. The conservation of keystone species is important, as the loss of these species can have major health impacts.
These examples underscore the importance of nature conservation, such as biodiversity conservation, reforestation, marine protection, greening cities, sustainable agriculture, and livestock production to improve health outcomes, including reducing diseases, promoting physical activity and improving mental health.
The main recommendations of the report are as follows:
Adopt the Planetary Health Paradigm: Policymakers and MDBs should integrate health, climate, and biodiversity into all infrastructure development design and strategies.
Invest in Nature as Infrastructure: Prioritize nature-based solutions and technologies that promote both environmental sustainability and public health.
Expand Inclusive Healthcare Access: Focus on improving healthcare systems, particularly in vulnerable regions and for disadvantaged populations, to address inequity and the rising burden of climate-induced health conditions.
Strengthen Global Collaboration: Enhance cross-sectoral coordination through frameworks like the One Health approach, including coordination on biodiversity conservation.
Close the Financing Gap: Mobilize resources through MDBs and innovative financial instruments to address health, climate, and nature challenges.
This report emphasizes that safeguarding human health requires achieving planetary health, demanding a fundamental shift in infrastructure development. By adopting a holistic approach, stakeholders can work collectively to ensure a sustainable and healthy future for all. Well-designed infrastructure development thus brings health co-benefits; increases healthcare resilience; reduces carbon emissions, biodiversity loss and nature degradation; supports workforces; and spurs greater economic returns. The report calls for integrating health considerations into climate and nature policies, emphasizing initiatives such as urban green spaces, biodiversity conservation, and global health frameworks. The report highlights the necessity of green infrastructure and healthcare systems resilient to climate impacts.
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