Intended for healthcare professionals


Climate action should learn from building design

BMJ 2023; 383 doi: (Published 08 December 2023) Cite this as: BMJ 2023;383:p2910
  1. Adele Houghton, instructor1
  1. 1Harvard TH Chan School of Public Health, Boston, MA, USA

Co-benefit climate action is the key to meeting the Paris Climate Agreement. Building design can help lead the way, writes Adele Houghton

We are halfway through the timeline set by the Paris Climate Agreement in 2015 to transition the global economy away from its dependence on fossil fuels by 2030, and it is clear we are on the wrong track.

While the Paris Climate Agreement mentions mitigation (for example by reducing the emission of greenhouse gases into Earth’s atmosphere), adaptation (i.e., increasing our resilience to climate change-related events), and the health effects of climate change as important pillars of the global response to the climate crisis, only mitigation is designated with a threshold (net zero) and a deadline (2030). Furthermore, signatories are not required to track progress below the country level or provide context to explain the co-benefits and co-harms associated with one mitigation strategy versus another. Unfortunately, the 2022 progress report for the United Nations Sustainable Development Goals (SDGs)1 estimates that global greenhouse gas emissions are moving in the wrong direction—they are predicted to increase by 14% by 2030 (SDG 13). Population health indicators associated with the built environment and amplified by the climate emergency, such as infectious and non-communicable disease (SDG 3), are also flat or worsening at the global level.

At first glance, these numbers are worrying. But, what if the national, contextless indicators we use to measure progress towards Paris are themselves standing in the way of achieving the goals they were established to measure?

The climate emergency is not experienced as an abstract national average. It is felt and fueled hyper-locally. The daily decisions to burn fossil fuels (or not), to build resilience to climate risks into our communities (or not), and to protect (or not) the populations at highest risk of climate change-related health complications, are all made in direct response to the decision makers’ context.

It is time to change from a top-down, fragmented approach to climate emergency policies and tracking to a bottom-up, co-benefit approach that prioritises the strategies bringing the greatest co-benefits and fewest co-harms to all three facets of the Agreement: mitigation, adaptation, and health.

“Co-benefit” decision-making is often used in environmental risk assessments to select the best option in a complex situation.2 Ürge-Vorsatz and colleagues have documented its relevance to climate mitigation policies, which have been found to produce co-impacts (both positive and negative) on topics like energy poverty, thermal comfort, and food security.3

It is time to use the knowledge that all climate policies have contextually-specific co-impacts as a tool for implementing and tracking climate action.

The building sector is the natural place to start this transition, because it is central to all three facets of the Paris Climate Agreement. Buildings are responsible for about 40% of global greenhouse gas emissions.4 They are society’s primary place of refuge during climate emergency-related extreme weather events. And, given that populations in industrialised nations spend roughly 90% of their lives inside,5 buildings also set the context for environmental exposures and health promoting behaviours.

Furthermore, climate action often starts at the building scale. For example, decisions governing the design and use of air conditioning, heating, lighting, water, cooking, recycling, and transportation, aggregated together, constitute over 60% of global greenhouse gas emissions,4 and set the context for societal resilience to climate emergency-related events. Decisions made by building designers and operators contribute to population health outcomes, such as the risk of injury or death from flooding events, heat-related illness during extreme heat events, and exposure to disease-carrying vectors.

My research has found that co-benefit design6 can effectively convert one-size-fits all green and healthy building toolkits into climate action accelerators and amplifiers.78 Each design or operations strategy in these toolkits is measurable, and often inter-translatable with larger scale metrics (such as the community climate action plan). As a result, the existing building-scale reporting infrastructure could be used to aggregate data up to the national level and be folded into National Determined Contributions (NDC) reports.

We cannot wait any longer to make this change. Many of the scientific papers and debates at the 2023 UIA World Congress of Architects in July 2023 called for changes to the sustainable development goals (SDG) framework, so that it rewards cross-sectoral synergies, context-driven interventions, and efforts to centre social equity.9 Maria Neira from the World Health Organization (WHO) called on architects to use their power as designers to protect building occupants and the surrounding community from public health challenges that are amplified by the climate emergency—such as air pollution, mental health, and chronic disease.10

That power would be all the greater if the SDGs were restructured to reward climate actions with measurable co-benefits. COP28 shows signs that space may be opening in international climate negotiations to make that change.

Pressure is mounting on signatory countries to centre health co-benefits in their climate action plans. In the runup to the first ever “Health Day” at COP28, WHO released a review comparing Paris signatories’ NDCs from 2019 and 2023. According to their analysis, 91% of 2023 NDCs mention health as a consideration in their national approach to climate action, up from 70% in 2019.11 Many countries identify health co-benefits associated with mitigation, adaptation, and climate finance actions. 23% highlight the co-benefits of their national climate targets and policies on SDG 3. However, the majority of the health co-benefits in NDCs remain either not cross-referenced with an SDG or not measurable—even at the national level. Only 10% of NDCs measure the health co-benefits of climate mitigation—the most easily quantifiable connection, due to its relationship with air pollution.12 The newly signed COP28 UAE Declaration on Climate and Health continues the practice of failing to set measurable thresholds for health outcomes associated with climate action.13 However, both the Declaration on Climate and Health and, another product of COP28, the Guiding Principles for Financing Climate and Health Solutions,14 emphasise the need for working across disciplines to develop holistic solutions at the intersection of climate mitigation, adaptation, and population health. They also identify buildings and infrastructure—particularly housing and healthcare facilities—as key components of a successful pathway towards achieving the targets set out by the Paris Climate Agreement.

We must take advantage of the momentum generated at COP28 to move away from the current, top-down fragmented approach to climate policy and towards a bottom-up, context-driven approach to climate action and tracking.


  • Competing interests: AH is President of Biositu, LLC. She declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

  • Provenance and peer review: commissioned, not peer reviewed.