Bill Gates’ latest public memo marks a significant shift in how the world’s most influential philanthropist frames the challenge of climate change. He sees a future in which responding to climate threats and promoting well-being become two sides of the same mission, declaring, “development is adaptation.”
Gates argues that the principal metric for climate action should not be global temperature or near-term emission reductions alone, but measured improvement in the lives of the world’s most vulnerable populations.
He argues that the focus of climate action should be on the “greatest possible impact for the most vulnerable people.”
The suffering of poor communities must take priority, since, in his view, “climate change, disease, and poverty are all major problems. We should deal with them in proportion to the suffering they cause.”
Climate change is about the health of the most vulnerable
This position resonates with a core message that has emerged across global health over the past several years: climate change is about health.
New data from the 2025 Lancet Countdown draw a stark picture:
- Heat-related mortality has risen 63 percent since the 1990s.
- Deaths from wildfire smoke and air pollution caused by fossil fuels continue to climb.
- Food insecurity, driven by erratic weather, is destabilizing health and economies at once.
- Thirteen out of twenty key health indicators linked to climate impacts now signal urgent action is needed.
Health professionals, policy coalitions, scientists, and patient advocates have succeeded in bringing this nexus between climate and health squarely to the global agenda, culminating in recent summits where health finally shared the main stage with energy and economics.
Yet just as the science and advocacy align, political attention risks fragmenting.
Despite sweeping reports, evidence, and high-level declarations, momentum can ebb.
There is now a risk that the transformative potential embedded in the climate-health linkage may not be fully realized.
Here, Gates’s pivot could actually be the inflection point that the field needs.
The case for health workforce-centered adaptation
For nearly a decade, The Geneva Learning Foundation (TGLF) has been advocating and demonstrating that meeting complex humanitarian, health, and development challenges requires strengthening not just technical capacities or disease programs, but the underlying connective tissue of the health system: its workforce.
TGLF’s digital peer-learning platform now connects over 70,000 health workers across more than 130 countries.
These practitioners – mostly in government service, often in low-resource or crisis-affected settings – are the first to observe, and often the first to respond to, the local impacts of climate change on health.
Their reports show that health impacts are immediate and multi-faceted: rising malnutrition from crop failures, increases in waterborne diseases following floods, new burdens from air pollution and heat, and psychological distress from repeated disasters.
What sets this approach apart is its systemic focus.
Climate change is not a threat that can be “verticalized”.
It demands responses that are adaptive, distributed, and coordinated across all levels of the health system.
TGLF’s innovation lies in harnessing a distributed network to surface and scale locally-grounded solutions:
- Peer learning accelerates uptake of proven local adaptations – health workers share and adapt practices in near real time.
- Digital networks enable early warning and rapid, cost-effective dissemination of context-appropriate strategies, even in remote settings.
- The workforce is not merely the channel for external solutions but is positioned as a community of problem-solvers and trusted communicators, leaders in building and sustaining resilience.
Data from these initiatives demonstrate that such networked learning delivers results at scale, often with return on investment superior to parallel vertical programs, and increases system resilience and flexibility.
Development is adaptation: the need for human capital investment
The urgency and logic of these approaches are reinforced by ongoing policy developments ahead of COP30:
- WHO’s Global Action Plan on Climate Change and Health, adopted at the World Health Assembly in May 2025, recognizes that without context-sensitive system strengthening, existing approaches are insufficient, and positions knowledge and workforce mobilization as strategic imperatives.
- The COP30 Belem Health Action Plan establishes adaptation of the health sector to climate change as an international priority, calling for holistic, cross-sectoral strategies, and “community engagement and participation as foundational to implementation.”
Without empowered and connected health workers, no global action plan will reach those most at risk or maintain public trust.
A strategic investment imperative: why the next breakthrough must be human-centered
The philanthropic search for cost-effective, scalable, and measurable impact has built immense legacies in reducing child mortality and combating infectious disease.
Gates’ own approach of pioneering “vertical” innovations, optimizing delivery through metrics, and prioritizing technical solutions has been transformative, especially at the intersection of science and delivery.
However, emerging science show the limits of technical “magic bullets” absent robust, interconnected local systems.
Trust, legitimacy, and action flow from the relationships health workers build in – and with – their communities.
If development is adaptation, what does this mean for the next phase in climate-health philanthropy?
If the measure of climate action’s value is the scale and speed at which lives are improved and disasters averted, investing in the human infrastructure of the health system is the most evidence-based, cost-effective, and legacy-ensuring play available.
- Investing in the health workforce is itself a breakthrough technology: It increases the absorptive capacity of low-resource health systems, making innovations stick and catalyzing uptake well beyond single-disease silos or narrow infrastructure projects.
- Long-term, system-wide resilience is built by equipping health workers – not simply with technology or training from above, but with platforms for peer learning, rapid response, and locally-driven adaptation coordinated through agile networks.
- The network effect is real: A million motivated and networked health practitioners is likely to surface, refine, and implement interventions at a scale and pace that outstrips most top-down models. Digitally-enabled peer learning, tested by TGLF, could link to AI systems to provide distributed AI-human intelligence that supports effective action.
Without these bridges, even the best technology or policies will fail to gain a durable footprint at community level, especially as climate impacts deepen.
Health is where climate change action matters most
The world is waking to the reality that technical solutions alone cannot future-proof health against climate risks.
We need to focus on the highest-value levers.
This starts with a distributed, networked workforce at the coalface of the crisis, empowered to adapt, share, and lead.
In a world of accelerating climate shocks and retreating political will, the boldest, most rational bet for sustained global impact is to go “horizontal” – to invest in the people and the systems that connect them.
By helping build adaptive, digitally connected networks of health professionals, philanthropy can reinforce the foundation upon which all high-impact innovation rests.
This is not a departure from the pursuit of technology-driven change, but rather the necessary evolution to ensure every breakthrough finds its mark – and that trust in science and public health stays strong under pressure.
If ever there was a time for rigorous, data-driven engagement that bridges technology, health, and community resilience, this is it.
Every indicator – scientific, economic, social – suggests that communities will confront more climate disruptions in the coming years.
Investing in the people who translate science into health, who stand with their communities in crisis, is the most robust, scalable, and sustainable bet that any philanthropist or society can make.
By focusing on these vital human connections, the world can ensure that innovation works where it matters most – and that the next chapter of climate action measures true success by the health, security, and opportunity it delivers for all.
History will honor those whose support creates not only tools and policies, but the living networks of trust and craft upon which community resilience depends.
That is the climate breakthrough waiting to happen.
References
- COP30 Belém Action Plan. (2025). The Belém Health Action Plan for the Adaptation of the Health Sector to Climate Change. https://www.who.int/teams/environment-climate-change-and-health/climate-change-and-health/advocacy-partnerships/talks/health-at-cop30
- Ebi, K.L., et al. (2025). The attribution of human health outcomes to climate change: transdisciplinary practical guidance. Climatic Change, 178, 143. https://doi.org/10.1007/s10584-025-03976-7
- Ebi, K.L., Haines, A. (2019). The imperative for climate action to protect health. The New England Journal of Medicine, 380, 263–273. https://doi.org/10.1056/NEJMra1807873
- Jacobson, J., Brooks, A., Mbuh, C., Sadki, R. (2023). Learning from frontline health workers in the climate change era. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7316466
- Jones, I., Mbuh, C., Sadki, R., Steed, I. (2024). Climate change and health: Health workers on climate, community, and the urgent need for action (Version 1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.11194918
- Romanello, M., et al. (2025). The 2025 report of the Lancet Countdown on health and climate change. The Lancet S0140673625019191. https://doi.org/10.1016/S0140-6736(25)01919-1
- Sadki, R. (2024). Health at COP29: Workforce crisis meets climate crisis. The Geneva Learning Foundation. https://doi.org/10.59350/sdmgt-ptt98
- Sadki, R. (2024). Strengthening primary health care in a changing climate. The Geneva Learning Foundation. https://doi.org/10.59350/5s2zf-s6879
- Sadki, R. (2024). The cost of inaction: Quantifying the impact of climate change on health. The Geneva Learning Foundation. https://doi.org/10.59350/gn95w-jpt34
- Sanchez, J.J., et al. (2025). The climate crisis and human health: identifying grand challenges through participatory research. The Lancet Global Health. https://doi.org/10.1016/S2214-109X(25)00003-8
- Storeng, K. T. (2014). The GAVI Alliance and the Gates approach to health system strengthening. Global Public Health, 9(8), 865–879. https://doi.org/10.1080/17441692.2014.940362
- World Health Organization. (2025). Draft Global Action Plan on Climate Change and Health. Seventy-eighth World Health Assembly. https://apps.who.int/gb/ebwha/pdf_files/WHA78/A78_4Add2-en.pdf