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Every October, the same ritual begins across north India. Inhalers come out of drawers, school notices about outdoor assemblies start circulating, and hospital outpatient queues lengthen with coughs that will not go away. Climate change, heat and dirty air are lived as health problems long before they appear in policy documents.
Yet when a new global assessment looked at how well national climate plans protect people’s health, India’s plan barely registered. India scored 2 out of 32 on the Healthy NDC Scorecard, placing it among the three lowest performers of the 132 countries assessed.
Here is what the scorecard measures, why India scored so low, and what it means for climate and health in India ahead of COP31.
What is the Healthy NDC Scorecard?
Under the Paris Agreement, every country submits a national climate plan, known as a Nationally Determined Contribution (NDC), setting out how it will cut emissions and adapt to climate change. Countries submitted their latest plans, covering targets up to 2035, over the past year.
The Global Climate and Health Alliance (GCHA), a network of health organisations, released its 2026 Healthy NDC Scorecard on October 14. It assessed the 2035 NDCs of 132 countries, including the joint European Union plan, submitted to the UN climate body before August 1, 2026. This is the third edition, after earlier scorecards in 2021 and 2023.
Each plan is scored out of 32 points across eight categories, with up to four points each:
Health impacts: whether the plan describes or quantifies how climate change and air pollution affect health.
Air pollution: whether it names pollutants or sets air quality targets.
Health sector action: whether it prepares hospitals and health systems for climate impacts and cuts their emissions.
Health co-benefits: whether actions in energy, transport or agriculture are linked to health gains.
Just transition: whether it considers worker health and vulnerable groups.
Integrated governance: whether the health ministry is involved and the right to health is recognised.
Economics and finance: whether health-related costs, budgets and returns are counted.
Monitoring and implementation: whether health actions and outcomes are tracked.
How did India score?
India received 2 points out of 32, tied with Japan and New Zealand at the bottom of the table. The GCHA said this reflects little recognition of the links between climate change and health in these plans. It also flagged that India carries a high air pollution mortality burden, while Climate Action Tracker rates its emissions targets as not aligned with the Paris Agreement.
News reports noted that India “scores poorly on health integration in national plans.”
For comparison, Colombia topped the scorecard with 29 points, followed by Nigeria at 25, Cambodia at 24, Paraguay and Timor-Leste at 22 each. Nineteen of the top 20 scores went to low- and middle-income countries. Among large emitters, the European Union scored 12, China 9, Brazil 7 and the United States 7, while South Africa scored 13 and Indonesia 11.
That comparison matters because a common argument is that developing countries cannot afford to plan for health alongside climate. The scorecard suggests the opposite: several countries with far fewer resources than India have written health into the heart of their climate commitments.
What is in India’s 2035 NDC?
India’s updated NDC, submitted in April 2026, commits to reducing the emissions intensity of its GDP by 47% from 2005 levels by 2035, reaching 60% non-fossil installed electricity capacity, and creating an additional carbon sink of 3.5 to 4 billion tonnes of CO2 equivalent through forests and tree cover.
Its adaptation section focuses on coastal protection, mangrove restoration, cyclone early warning, water and agriculture missions, and disaster-resilient infrastructure. Health, as a stand-alone priority, is largely absent.
Climate Action Tracker has rated India’s 2035 NDC as “highly insufficient” overall, noting that its intensity- and capacity-based targets are weaker than what current policies are already expected to deliver.
Why health in climate plans matters for India
Few countries have more at stake. The State of Global Air report estimated that air pollution was linked to 2.1 million deaths in India in 2021. Much of that pollution comes from the same sources that drive climate change: coal power, vehicle exhaust, industrial emissions and crop residue burning.
That overlap is what researchers call health co-benefits. Cutting fossil fuel use reduces both greenhouse gases and the fine particulate matter (PM2.5) that damages lungs and hearts. A climate plan that counts these health gains can make the economic case for faster action, because avoided hospital visits, lost workdays and premature deaths carry real costs. The GCHA report cites estimates that air pollution costs the world about 5% of global GDP.
Short-lived climate pollutants are another gap. Black carbon, methane and ground-level ozone warm the planet quickly and also harm health and crops. Only five countries in the scorecard set black carbon targets, and India is not one of them.
Extreme heat adds a further layer. Heatwaves strain hospitals, cause heat stroke and dehydration, and worsen existing heart and kidney disease, especially among outdoor workers, the elderly and people in crowded urban housing.
Isn’t India already acting on climate and health?
Yes, but mostly outside its NDC. India runs a National Programme on Climate Change and Human Health (NPCCHH) under the health ministry, which supports state health action plans, heat-related illness surveillance and hospital preparedness for heatwaves. Several cities and states also have heat action plans, and the National Clean Air Programme targets particulate pollution in more than 100 cities.
The scorecard does not assess these domestic programmes. It measures only what is written into the NDC. A low score therefore does not mean India is doing nothing on climate and health. It means India has not used its main international climate commitment to connect the two, set health-linked targets, or show how progress will be tracked.
That gap matters because NDCs shape where climate finance flows, which sectors are prioritised, and what governments are held accountable for in international negotiations.
Why this matters before COP31
The scorecard comes weeks before COP31 in Antalya, Turkey, from November 9 to 20. At the Pre-COP31 meeting in Fiji earlier this month, Environment Minister Bhupender Yadav called for rapid implementation of the Paris Agreement and practical resources for developing countries.
The GCHA argues that developed countries should provide finance under the Paris Agreement to help countries integrate health into climate action, and that COP31, where the second global stocktake begins, is a chance to raise national health priorities.
For India, the timing is pointed. As north India enters its annual smog season, with stubble burning and Diwali typically pushing air quality to its worst levels between late October and mid-November, the link between climate policy and public health will once again be impossible to miss on the ground, even if it is missing on paper.
The bottom line
India’s 2 out of 32 on the Healthy NDC Scorecard does not measure how much the country cares about health. It measures how little of that care has made it into its climate plan. With some of the world’s highest air pollution deaths and rising heat risk, India has more to gain than most from treating climate action as health action, and putting it in writing.
References
https://climateactiontracker.org/countries/india/2035-ndc
Trends of Delhi’s air quality and stubble burning during the October-November period
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