Background: Climate change presents a multifaceted challenge with unequal health implications, particularly for vulnerable populations with limited adaptive capacity. Socioeconomic factors are intricately linked with environmental health outcomes and environmental factors significantly exacerbate existing health inequities. Health equity as a goal of environmental justice can address these issues.
Objective: To examine the integration of health equity within climate change and health policy documents in Nepal.
Methods: Using a qualitative content analysis approach based on Schlosberg's framework of environmental justice, we analyzed the coverage of health equity considerations in climate and health policies, assessing aspects of distribution, recognition, and participation.
Results: Twenty-one national-level policies, strategies, and plans/guidelines on climate change and health were analyzed. Nepal's policy documents lack clear definitions of health equity in relation to climate change, and related terms are used inconsistently. Health vulnerability is often addressed broadly rather than specifically. Health equity-related statements from environmental justice viewpoint vary across sectors. Many documents emphasize equitable distribution of resources and benefits, with participation in decision-making processes being the least discussed.
Conclusions: In Nepal, lack of shared understanding of health equity across sectors hinders coordinated policy efforts. There is an urgent need to expand climate change responses to consider specific health vulnerabilities. By positioning health equity as a key element of environmental justice, this study provides a broader perspective on climate change-related health equity that could encourage collaborative action between the environment and health sectors.
Keywords: Environmental health equity; Nepal; climate change policy, public health policy, policy research; content analysis; environment justice.
Main Findings: Analysis of the policy documents in Nepal reflects the recognition of the need to integrate health equity into climate change policies comprehensively by various ministries due to their interconnected nature. However, when assessed through the three principles of environmental justice, health equity considerations vary significantly across sectors, each emphasizing different principles and to varying degrees.Added Knowledge: To our knowledge, this study is the first to explore health equity considerations in climate change policies in the context of Nepal. This is also the first study to use an environment justice lens to understand health equity in the realm of climate change in a low- and middle-income country.Global health impact for policy and action: This study attempts to bridge the gap between the health and the environmental sectors by proposing climate change-related health equity as an environmental justice issue and drawing on their linkages. It also provides a theoretical-based policy analysis framework for various public health and climate change researchers seeking to understand this complex landscape. In Nepal’s evolving federalized context, understanding health equity considerations in existing national policies can facilitate advocating for vulnerable groups and mainstreaming health equity into climate policies across all government levels by providing transferable insights.