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The green energy transition presents a crucial opportunity to finance universal health coverage (UHC) in low- and middle-income countries, say experts in The BMJ's climate issue.

Judite Gonçalves and colleagues argue that a ring-fenced share of funds generated by reducing fossil fuel subsidies, introducing carbon taxes and capturing critical mineral royalties should be spent on improving health, which ultimately translates into development gains.

Health systems have a strong claim to a guaranteed minimum share of these green transition revenues, they add, given the enormous health impacts of fossil fuel dependence and mining activities.

In 2024, $733 billion was spent on fossil fuel subsidies globally, far outpacing the estimated $20 billion to $53 billion annual financing gap required to achieve UHC in low- and middle-income countries, they explain. Reducing these subsidies could free up substantial resources for domestic public health programs.

Beyond subsidy reform, carbon pricing and royalties from critical minerals such as lithium and cobalt also offer substantial new revenue streams to support health.

However, they say it is critical to ensure that new revenues reach health budgets, rather than disappearing into general revenue or being eroded by tax avoidance and evasion or by pressure from investors to lower royalty rates.

They point to examples of past reforms in Indonesia and Brazil which, while bold and innovative, did not translate into the sustained investments in health care that were envisioned.

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