Health system resilience and the health impacts of environmental degradation: a global analysis
Health system resilience and the health impacts of environmental degradation: a global analysis
Objectives: this study examines the impact of environmental degradation, focusing on air pollution and CO2 emissions, as key climate stressors on health outcomes, specifically pollution-related mortality and disability-adjusted life years (DALYs). The research explores how healthcare infrastructure, accessibility, quality, and policies contribute to climate resilience by mitigating pollution-related mortality and supporting adaptation to environmental stressors.
Study design: using panel data from 145 countries between 2009 and 2017, the study assesses both the direct effects of environmental factors on health outcomes and the mitigating role of healthcare systems. The design incorporates variation across countries and time to better understand these relationships.
Methods: panel analysis models estimate the relationship between air pollution, CO2 emissions, and health outcomes. Interaction terms between CO2 emissions and healthcare system indicators are tested to determine if stronger healthcare systems can reduce pollution-induced mortality and DALYs.
Results: the study confirms that air pollution exposure is significantly linked to increased mortality and DALYs. While improved healthcare infrastructure, accessibility, and quality help mitigate some pollution-related health risks, they are insufficient to offset the long-term negative effects of CO2 emissions. The interaction terms between CO2 emissions and healthcare resilience are statistically insignificant, suggesting that even well-functioning healthcare systems cannot fully counteract the harmful consequences of environmental degradation.
Conclusion: while strengthening healthcare systems is vital for enhancing resilience to air pollution, the persistent adverse effects of CO2 emissions stress the need for integrated environmental and health policies. Emission reduction strategies and stricter environmental regulations must complement healthcare improvements to effectively safeguard public health.
Air pollution, CO emissions, Climate and health policy, Disability-adjusted life years (DALYs), Environmental degradation, Health system resilience, Pollution-related mortality
Elkomy, Shimaa
6daaf70b-67c1-49b6-9208-9cac0c19a9f4
Jackson, Tim
55981ee9-4b0b-4479-afce-6a83c78f22f1
5 December 2025
Elkomy, Shimaa
6daaf70b-67c1-49b6-9208-9cac0c19a9f4
Jackson, Tim
55981ee9-4b0b-4479-afce-6a83c78f22f1
Elkomy, Shimaa and Jackson, Tim
(2025)
Health system resilience and the health impacts of environmental degradation: a global analysis.
Public Health, 250, [106048].
(doi:10.1016/j.puhe.2025.106048).
Abstract
Objectives: this study examines the impact of environmental degradation, focusing on air pollution and CO2 emissions, as key climate stressors on health outcomes, specifically pollution-related mortality and disability-adjusted life years (DALYs). The research explores how healthcare infrastructure, accessibility, quality, and policies contribute to climate resilience by mitigating pollution-related mortality and supporting adaptation to environmental stressors.
Study design: using panel data from 145 countries between 2009 and 2017, the study assesses both the direct effects of environmental factors on health outcomes and the mitigating role of healthcare systems. The design incorporates variation across countries and time to better understand these relationships.
Methods: panel analysis models estimate the relationship between air pollution, CO2 emissions, and health outcomes. Interaction terms between CO2 emissions and healthcare system indicators are tested to determine if stronger healthcare systems can reduce pollution-induced mortality and DALYs.
Results: the study confirms that air pollution exposure is significantly linked to increased mortality and DALYs. While improved healthcare infrastructure, accessibility, and quality help mitigate some pollution-related health risks, they are insufficient to offset the long-term negative effects of CO2 emissions. The interaction terms between CO2 emissions and healthcare resilience are statistically insignificant, suggesting that even well-functioning healthcare systems cannot fully counteract the harmful consequences of environmental degradation.
Conclusion: while strengthening healthcare systems is vital for enhancing resilience to air pollution, the persistent adverse effects of CO2 emissions stress the need for integrated environmental and health policies. Emission reduction strategies and stricter environmental regulations must complement healthcare improvements to effectively safeguard public health.
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More information
Accepted/In Press date: 7 November 2025
e-pub ahead of print date: 5 December 2025
Published date: 5 December 2025
Keywords:
Air pollution, CO emissions, Climate and health policy, Disability-adjusted life years (DALYs), Environmental degradation, Health system resilience, Pollution-related mortality
Identifiers
Local EPrints ID: 508506
URI: http://eprints.soton.ac.uk/id/eprint/508506
ISSN: 0033-3506
PURE UUID: 0d058f62-d195-4376-8fdd-11a82b00a16c
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Date deposited: 23 Jan 2026 17:56
Last modified: 24 Jan 2026 03:26
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Author:
Shimaa Elkomy
Author:
Tim Jackson
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