The global shift from fossil fuels to renewable and low-carbon energy (called the 'green energy transition') presents a once in a generation opportunity to redress the balance in favour of health, according to health economists and public health experts.
The team, led by researchers at Imperial College London, argues that funds from industry – including fossil fuel subsidy savings, carbon taxes, and royalties from mining critical minerals – should be ringfenced and used to fund universal healthcare (UHC) in low- and middle-income countries.
Their findings, published today in The BMJ Climate Issue, suggest the green energy transition could potentially free up billions of dollars of revenue globally from sectors which actively harm public health, offering a 'golden opportunity' to improve health at scale and boost development gains.
Dr Judite Goncalves, a health economist from the School of Public Health at Imperial College London, and lead author of the study, said: "The green transition will generate large public revenues: from carbon pricing, to royalties on minerals like lithium and cobalt, and from reforming fuel subsidies.
"The rules for how much of that money is raised, and how it will be spent, are being written now and will shape budgets for decades. Health should have a guaranteed share. Fossil fuels and mining take a heavy toll on people's health, and part of the revenue they generate should go towards protecting it."
Writing in a commentary, the researchers say that health systems have a strong claim to a guaranteed minimum share of these green revenues, they add, given the enormous health impacts of fossil fuel dependence and mining activities.
Fossil fuels and mining take a heavy toll on people's health, and part of the revenue they generate should go towards protecting it Dr Judite Goncalves School of Public Health
In 2024, $733bn was spent on fossil fuel subsidies globally, far outpacing the estimated $20-53bn annual financing gap required to achieve UHC in low- and middle-income countries, they explain. Reducing these subsidies can free up substantial resources for domestic public health programmes.
Beyond subsidy reform, carbon taxes 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.
"Not all the savings from reform can go to health, but even a modest, protected share could make a real difference," explained Dr Goncalves.
In their paper, the researchers point to examples of innovative and ambitious reforms in Indonesia and Brazil that have also shown how funds can erode or fail to translate into local health investments. They explain that health ministries, civil society, and professional health organisations must urgently engage and influence carbon pricing rules and royalty frameworks, which are being locked in now, to secure a dedicated share of revenue.
They add that because green transition revenues flow disproportionately to higher income countries, while UHC financing gaps are concentrated in lower income countries, international mechanisms (such as debt-for-health swaps) are essential to ensure a fair transition.
Dr Goncalves explains: "Our own research shows that when oil prices drive subsidies up, governments spend less on health. When prices eventually fall, there will be a window to reform, as Indonesia did when oil prices dropped in 2014–15. Governments should be ready to use it, and to make sure a share of the savings goes to health."
Professor Christopher Millett, from the School of Public Health, added: "The countries with the biggest health financing gaps aren't the ones set to gain most from green transition minerals and fossil fuel subsidy reform. Domestic reform alone won't be enough, so international partners have a role in making the green transition a fair transition."
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'Analysis: Green transition provides a crucial opportunity to finance universal health coverage' by Judite Gonçalves, Fernando Postali, Moh Shadiqur Rahman and Christopher Millett is published in The BMJ's Climate Issue. DOI: https://doi.org/10.1136/bmj-2026-100890
This article is based on materials from The BMJ.
