In 2023, a series of climatological and political events unfolded, partly driving forward the global climate and health agenda while simultaneously exposing important disparities and vulnerabilities to climate-related events. On the policy front, a significant step forward was marked by the inaugural Health Day at COP28, acknowledging the profound impacts of climate change on health. However, the first-ever Global Stocktake showed an important gap between the current progress and the targets outlined in the Paris Agreement, underscoring the urgent need for further and decisive action. From a Latin American perspective, some questions arise: How do we achieve the change that is needed? How to address the vulnerabilities to climate change in a region with long-standing social inequities? How do we promote intersectoral collaboration to face a complex problem such as climate change? The debate is still ongoing, and in many instances, it is just starting.

The 2024 wildfires in South America, particularly in the Amazon and Pantanal, were not only a disaster for ecosystems, but also for public health and people's health and wellbeing. These record-breaking fires were likely driven by overlapping triggers: climate change-related heat and droughts and human-driven land-use change. We documented that rapidly evolving wildfires together with limited preparedness and slow responses from emergency and health agencies resulted in severe health impacts, including several fatalities and thousands people displaced, injured, and/or with cardiorespiratory symptoms. These, however, partially represent the situation as mental health outcomes were largely unrecorded and other impacts are yet to be seen. In a climate increasingly prone to severe wildfires, comprehensive action is key. Integrated disaster risk reduction strategies, strengthened health systems, and improved risk communication are essential to protect human health from this escalating threat.

A Amazônia vem sofrendo uma convergência de pressões ecológicas, climáticas e sociopolíticas que ameaçam a integridade do ecossistema, a prestação de serviços ecossistêmicos e a saúde humana. Este capítulo destaca como o desmatamento, a fragmentação florestal, os incêndios florestais, a perda de habitat, a degradação do ecossistema e a mudança climática estão acelerando os riscos de doenças infecciosas emergentes, especialmente as ameaças zoonóticas e transmitidas por vetores, doenças relacionadas ao calor, poluição do ar causada por incêndios, insegurança nutricional e impactos gerais sobre a mortalidade. Também examina como as deficiências estruturais dos sistemas de saúde pública (subfinanciamento, inacessibilidade geográfica e exclusão cultural) exacerbam as vulnerabilidades das diversas populações da Amazônia, especialmente dos Povos Indígenas (PIs) e das Comunidades Locais (CLs). A pandemia da COVID-19, os recentes surtos de arboviroses e as persistentes desigualdades na saúde ressaltam a necessidade urgente de respostas integradas e equitativas. Adotando uma perspectiva One Health, o capítulo propõe uma abordagem abrangente que posiciona a conservação do ecossistema como uma intervenção de saúde pública. As principais recomendações incluem a interrupção do desmatamento, dos incêndios florestais e da degradação, a incorporação de indicadores de saúde no planejamento climático e de uso da terra e o estabelecimento de plataformas regionais do One Health. O capítulo também enfatiza a necessidade de fortalecer a atenção primária à saúde, promover modelos interculturais que respeitem o conhecimento dos PIs e das CLs e aprimorar a vigilância comunitária e a cooperação regional. Ao vincular a governança ambiental à equidade em saúde, a Amazônia pode se tornar um modelo de resiliência em saúde planetária. A concretização dessa visão requer uma liderança política decisiva, investimento público sustentado e uma mudança em direção a uma sociobioeconomia baseada no manejo florestal, na justiça social e na colaboração científica.

To assess progress, challenges, and enabling factors for building climate-resilient and low-carbon health systems across Latin America and the Caribbean, a region facing accelerating climate-sensitive health burdens amidst persistent health system fragilities. We conducted an explanatory, sequential, mixed-methods study integrating quantitative analysis of the Pan American Health Organisation Climate Change and Health surveys from 2021/2022 (n = 24 countries) and 2023/2024 (n = 27 countries) with semi-structured interviews involving four countries demonstrating progress (Argentina, Chile, Jamaica, Peru). Quantitative data were analysed descriptively across three sub-regions (Caribbean, Central America, South America). Qualitative data underwent two-stage coding (deductive and inductive) with three-researcher consensus to identify barriers, enablers, and lessons learned. By 2023/2024, 93% of countries had designated climate-health focal points (71% in 2021/2022). However, implementation gaps persist: less than 50% of countries had integrated climate change into national health reports; 22%-40% developed national climate-health strategies; and vulnerability assessments rarely informed policy. Access to international climate finance remained inequitable. Whilst 60%-74% developed disaster preparedness plans, only 30%-44% implemented public health communication campaigns. Training focused on environmental health personnel, with doctors, nurses, and planning staff minimally engaged. Qualitative analysis revealed interconnected barriers: climate change perceived as distant rather than urgent, competing priorities overwhelming decision-makers, institutional silos, and misalignment between available training and local needs. Key enablers included linking climate action to established health priorities, institutionalising responsibilities through formal mechanisms, multi-stakeholder engagement, and committed individuals with diplomatic skills navigating cross-sectoral dynamics. Latin America and the Caribbean countries are establishing foundations for climate-resilient and low-carbon health systems, but translating governance progress into sustained implementation requires addressing systemic barriers through institutionalisation beyond political cycles, tailored capacity building, and innovative financing mechanisms. These findings inform guidance for health systems strengthening amidst accelerating climate change.

Background: Climate change is intensifying heat exposure and related health risk worldwide, particularly in low- and middle-income countries. Sustainable certification systems such as LEED, BREEAM and WELL Building Standard aim to improve construction performance, energy efficiency, and indoor environment quality. However, the global distribution of these certifications remains unclear, and there is no evidence of their implementation in the most vulnerable countries to climate-related risks.Methods: We conducted a global country-level ecological design from 2000 to 2025. Certifications from LEED, BREEAM, and WELL were collected, along with national indicators of climate vulnerability from the ND-Gain Index and heat-related health indicators from the Lancet Countdown. Certification densities were calculated and analysed across Human Development Index (HDI) groups and Small Island Developing States (SIDS). Findings: We identified 123,278 LEED and 46,508 BREEAM certifications globally, concentrated predominantly in very high HDI countries. Certification density was strongly associated with lower climate vulnerability (Spearman ρ = 0·71; p-value <0·0001). Countries with low HDI showed extremely low certification rates (median 0·03 per million inhabitants) compared with very high HDI countries (median 19·35 per million inhabitants). Overall, 110 countries were classified as “green building deserts”, characterised by high climate vulnerability and low certification density, and more than half had no certifications at all. Interpretation: Global adoption of sustainable building certification is disproportionately shaped by socioeconomic development and does not align with climate-related risks. Aligning green building investment with climate vulnerability could help reduce inequities in climate adaptation and promote healthier built environments in the most affected regions.