This chapter examines the broader landscape of public health policies, making the case that many polices that promote public health also yield important climate co-benefits. It develops an evidence base of public health policies and measures that simultaneously deliver climate and health benefits. Pathways to achieve climate benefits through the reduction of greenhouse gas (GHG) emissions from public health measures across sectors include policy changes in the food, transportation, and household energy use sectors, through promoting sustainable diets, reducing air pollution, and encouraging physical activity. By highlighting the interconnectedness of public health policies across sectors and its relation to environmental benefits, this chapter underscores the importance of taking into account potential co-benefits during policy formulation and implementation.
Decarbonising Health Systems Across OECD Countries
Abstract
Climate change and the rising and unequal burden of non-communicable disease (NCDs) share systemic drivers. NCDs account for 88% of all deaths among OECD countries. Many of the main drivers of non-communicable diseases fuelling this growing burden, including fossil fuel dependency, car-centric transportation systems, and industrialised food systems, are also driving climate change.
Addressing demand-side solutions which influence consumer behaviours and choices yield substantial health and climate benefits. Food systems, passenger transport, and household energy use contribute substantially to climate change, and are responsible respectively for approximately a third, a quarter, and a fifth of total greenhouse gas emission among OECD countries.
By embedding environmental considerations into public health, governments can create win-win policies that drive long-term health improvements by reinforcing health system resilience that also support decarbonisation efforts. A shift towards healthy diets that are sustainably produced, or “win-win” diets, consisting of mainly plant-based foods with little to no red and processed meats, could reduce GHG emissions by 304 MtCO2eq, equivalent to emissions of 72 million cars over one year, and 26 999 premature deaths due to cancer annually in OECD countries.
A wide range of policy options are available to promote healthier and more sustainable choices across food, transportation, and household energy sectors, ranging from stringent regulatory approaches to behavioural science‑based approaches intended to “nudge” populations towards certain practices. On average across OECD countries, policies targeting changes in the household energy were more widespread than those targeting changes to the food industry and transportation sector.
OECD countries were more likely to have implemented regulatory policies impacting health in the transportation and energy sectors (82%) than in the food sector (53%). Financial incentives to shift towards healthier choices were similarly more common in transportation (76%) and energy (88%) than in the food and agriculture sector. The majority of responding countries reported information-based policies had been implemented across all three sectors, though these were also more frequent in the transportation and energy sectors (88%) than in the food and agriculture sector (65%).
Across the food, transportation and energy sectors, there are opportunities for countries to adopt policies that help to prioritise the health of people and the planet. These include:
Sustainable Diets: More than three‑fifths (63%) of OECD countries include environmental sustainability considerations in their dietary guidelines. Yet few provide clear guidance to consumers on how to transition diets towards lower-carbon food consumption. Policies from countries that explicitly link nutrition, sustainability, and climate considerations, including Belgium and Denmark, could serve as a model for others looking to transform the sustainability of their food systems. Other countries have worked to encourage the adoption of healthier behaviours by lowering the price of healthier foods. In Canada and Ireland, zoning legislation has helped shape healthier food environments by banning unhealthy food outlets in certain locations.
Sustainable Transportation: Investments in infrastructure and financial incentives, such as the development of cycling superhighways and cycling networks in Denmark and the Netherlands, can significantly increase the uptake of active transport options. Some countries, including Germany and Luxembourg, have begun providing subsidies for public transportation utilisation to encourage people to switch away from using private vehicles for trips that could be made by public transportation.
Sustainable Energy Use: Countries have also seen a strong shift towards promoting sustainable and healthy residential energy environments, including phasing out polluting energy sources for household use through regulatory and legal measures. To date, 53% of OECD countries have either complete coal phase‑outs or have committed to full phase‑out plans ranging from Belgium (2017) to Chile (2040). Others, including Czechia, Estonia, Poland, the Slovak Republic, Canada and Sweden have offered financial incentives to support the transition towards sustainable residential energy supplies. Countries have also adopted consultation services to help consumers better understand home energy use and methods for reducing energy consumption, including in Canada and Sweden.
Despite the progress, OECD countries remain hindered by the absence of standardised and harmonised reporting on emissions and health outcomes, making it difficult to conduct comprehensive integrated assessments and prioritise policy action effectively within country settings. While efforts to adopt a multisector approach are underway, the lack of a unified framework for measuring and reporting health and climate co-benefits continues to stall progress, limiting the potential to scale evidence‑based policy action.
Many of the most important determinants of the rise in non-communicable diseases in OECD countries are also the key drivers of climate change. The contribution of healthcare systems to greenhouse gas emissions and climate change is profound. As previous chapters have demonstrated, substantial potential to reduce carbon emissions exists through streamlining care pathways, enhancing energy efficiency in healthcare facilities, and optimizing supply chains.
There is significant scope to address carbon emissions beyond the health sector. Public health policies, which form the bedrock of healthcare policy, also extend beyond the healthcare sector. Many health promotion initiatives leverage intersectoral actions to address the upstream determinants of health. This means that many public health interventions not only enhance health outcomes by reducing risk factors for poor health – such as increasing physical activity, lowering air pollution, and promoting healthier diets – but also yield important environmental benefits. Many public health policies that reduce greenhouse gas emissions present a “win-win” opportunity, generating important co-benefits to both the health and climate sectors.
Today, the same forces driving the rise in non-communicable diseases in OECD countries also fuel climate change. Conditions such as cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases are now the leading causes of mortality and morbidity across OECD countries, with non-communicable diseases (NCDs) accounting for nearly nine in ten deaths in OECD countries in 2022. Many of the root causes fuelling the growing burden of NCD also contribute to climate change, highlighting a deeply interconnected crisis.
Source: Author’s compilation of literature.
Climate change directly and indirectly exacerbates NCDs in several ways:
Air pollution and respiratory diseases: Overreliance on fossil fuels for energy and electricity generation – by far the largest contributor to climate change – can increase exposure to air pollution and worsen air quality (concentrations of outdoor ozone and particulate matter) rates of asthma, chronic obstructive pulmonary disease (COPD), lung cancer, and cardiovascular disease. (D’Amato et al., 2014[1])
Extreme heat and cardiovascular stress: Increased frequency, duration, and intensity of extreme heat events elevates risks for stroke and cardiovascular complications, particular among vulnerable populations with preexisting co-morbidities (Bell, Gasparrini and Benjamin, 2024[2]).
Food system disruptions and diet-related illnesses: Climate change threatens food security leading to increased risks of malnutrition (i.e. undernutrition and obesity) and diet-related illnesses including diabetes and cardiovascular diseases (Fanzo and Downs, 2021[3]).
Given the intersecting challenges of climate change, health, and social inequalities, public health has a crucial role in shaping policies that address both health and climate impacts, particularly the consumption side. While climate mitigation efforts have traditionally focussed on supply-side interventions – such as improving energy efficiency and reducing fuel consumption in transportation – there is growing recognition of the importance of demand-side measures. Demand-side solutions are an important component of health and climate progress. The Sixth Assessment Report from the IPCC highlighted the transformative potential of demand-side solutions, including lifestyle changes and socio-cultural transitions, which could reduce global GHG emissions by 40‑70% across sectors by 2050 scenarios (Calvin et al., 2023[4]).
Well-designed public health policies – particularly in food systems, transportation, and household energy use – represent a consumption-focussed approach that can improve health outcomes and reduce inequalities. Research shows that the wealthiest 0.5% of households account for 13.6% of total lifestyle‑related emissions, while the world’s poorest 50% contribute only 10% (Otto et al., 2019[5]). By promoting equitable access to clean energy, affordable and sustainable food, and inclusive transportation options, demand-side policies can simultaneously mitigate climate change, improve public health, and help to narrow inequalities.
Whether through health-led strategic plans, or integrated multisectoral adaptation plans, countries are increasingly embedding health considerations into climate policy frameworks. By harnessing climate co-benefits of public health policies, countries have the potential to improve health outcomes, reduce health inequity, and increase health system resilience to climate‑related risks. And prioritising low-emission public health policies can do more than advance mitigation efforts: they can help to reduce health inequalities, strengthen health system resilience, and strengthen the investment case for public health in a time of extreme resource constraints.
Major environmental drivers of poor health outcomes also accelerate climate change
Public health policies can significantly improve health while also helping to reduce greenhouse gas emissions through three primary pathways policies that help reduce exposure to air pollution, that increase sustainable and health dietary intake, and that increase levels of physical activity (Figure 4.2) (Whitmee et al., 2024[6]).
Source: Adapted from Whitmee, S. et al. (2024[6]), “Pathways to a healthy net-zero future: report of the Lancet Pathfinder Commission”, https://doi.org/10.1016/S0140-6736(23)02466-2 and Gao et al. (2018[7]), Public health co-benefits of greenhouse gas emissions reduction: A systematic review”, https://doi.org/10.1016/j.scitotenv.2018.01.193.
For instance, transport policies that promote active transportation, such as walking and cycling, are considered as public health policies due to their multifaceted outcomes on population health beyond reducing congestion including improved cardiovascular and respiratory health, enhanced personal well-being, and better mental health. Additionally, these policies additionally reduce GHG emissions through the reduction in car-dependency as the primary form of transportation. Similarly, shifting towards plant-based diets lower risks of non-communicable diseases (NCDs) such as heart disease and diabetes while reducing agricultural emissions. These are “win-win” policies that deliver immediate health benefits while mitigating long-term climate risks (Table 4.1).
Source: IHPME, Global Burden of Disease Study 2022.
Dietary risks ranked as the fifth leading risk factor contributing to disease burden among OECD countries in 2021, contributing 6.4% of total DALYs
Dietary risks represented the fifth largest contributing risk factors to the disease burden in 2021 in OECD countries, contributing 6.4% of total DALYs. Within OECD countries, dietary risk factors collectively contributed to 1.3 million deaths, or 10% of all adult deaths and 30 million DALYs in 2021, with major impacts on heart disease, colon and rectal cancers, and type 2 diabetes. Dietary risk is also unevenly distributed across socio-economic strata, with populations in lower socio-economic groups at higher risk of obesity and diet-related illnesses in high-income countries (Fanzo and Davis, 2019[8]).
The aggregate dietary patterns thus have a large influence on both health outcome and climate change, representing an opportunity to develop policies that can address both health and environmental concerns simultaneously. However, addressing dietary risks also demands careful consideration of equity as access to nutrient-rich food varies significantly across socio-economic strata and geographical regions. Ensuring equitable access to healthy and sustainable foods is essential for mitigating health disparities and carbon emissions on a global scale.
Air pollution represented the leading environmental risk factor for DALYs among all environmental and occupational risks, contributing to 2.3% of total DALYs in 2021
Recognising air pollution as an important health pathway towards climate change mitigation underscores the imperative for concerted action. According to the 2021 Global Burden of Disease Study, air pollution represented the leading Level 2 risk factor in disability-adjusted life‑years (DALYs) among all environmental and occupational risks (Murray et al., 2020[9]). In 2021, ambient air pollution contributed to 485 734 deaths and 10 million DALYs, representing 3.6% and 2.3% of total mortality and DALYs, respectively, among OECD countries due to a broad spectrum of acute and chronic health effects. Over the last 25 years, air pollution has emerged as a significant mortality risk factor for cardiovascular and respiratory diseases and cancer, a trend possibly attributed to factors such as ageing population, increased prevalence of non-communicable diseases, and increased exposure to outdoor air pollution (Dhimal et al., 2021[10]).
Air pollution can generally be categorised as indoor (household) and outdoor (ambient) based on the source. Exposure to indoor air pollution has been declining since the 1990s, largely due to gas and renewable energy sources started replacing biomass (wood, agricultural waste, animal dung) as fuel for household cooking and heating (Murray et al., 2020[9]). Though air pollution adversely affects the health of all population exposed, the adverse effects are unevenly distributed. Studies have shown that young children, older peoples, and persons living with co-morbidities, those exposed to concurrent and interacting pollutants, as well as those socio‑economically deprived are at heightened vulnerability to the health effects of air pollution exposure (Makri and Stilianakis, 2008[11]).
Beyond these immediate health implications, air pollutants also constitute a co-pollutant to climate change as greenhouse gases are among the pollutants released. Consequently, addressing both indoor and outdoor pollution presents a unique opportunity not only to mitigate climate change but also to enhance public health outcomes.
Low physical activity
Low physical activity is strongly linked to increased risk of various non-communicable diseases such as coronary heart disease and type 2 diabetes, and breast and colon cancers, as well as premature mortality (Lee et al., 2012[12]). In 2021, it is estimated that low physical activity contributed to 150 619 deaths and 3.4 million DALYs, comprising 1% of total burden among OECD countries (Global Burden of Disease Collaborative Network, 2020[13]). The scale of this risk factor’s contribution to chronic illness is similar to established risk factors of smoking and obesity (Lee et al., 2012[12]). Global costs of physical inactivity to healthcare systems, based on only five health outcomes (coronary heart disease, stroke, type 2 diabetes mellitus, breast cancer, and colon cancer), were estimated at INT$ 53.8 billion (2013), of which 58% was paid by the public sector (Santos et al., 2023[14]). Despite well-established evidence of low physical activity as a leading risk factor and its substantial cost to the healthcare system, global prevalence has remained stable between 2001 and 2016 at approximately a quarter of the adult population (Guthold et al., 2018[15]).
The effects of physical inactivity on risk of illness and the potential benefits conferred from public health intervention are not evenly distributed. Prevalence of low physical activity was more than double in high-income countries as compared with low-income countries, likely driven by transition towards sedentary occupations and increased usage of motorised vehicles, whereas in lower income countries, physical activity is more prevalent in routine daily activities including at work and transportation.
In addition to its direct impacts on health, promoting physical activity also presents an opportunity for synergistic benefits with climate change mitigation, thus resulting in co-benefits for both health and the environment. Encouraging active modes of transportation such as walking, cycling and public transportation not only increases physical activity but also reduce greenhouse gas emissions from use of motorised vehicles. Thus, policies that promote increased physical activity may simultaneously offer opportunities to mitigate climate change.
Note: Agricultural practices include actions that promote productive and sustainable agriculture such as changes in farming practices (e.g. fertiliser use, nutrient recycling, biodynamic farming, etc) and using technical solutions to reduce emissions (such as nitrification inhibitors). Sustainable diet interventions include strategies designed to alter individual dietary consumption patterns. Results were extracted from an umbrella review of 26 systematic reviews that provide quantitative estimates of the impacts of climate mitigation actions on greenhouse gas emissions and health outcomes, limited to OECD countries where study location data was available. Results extracted from primary studies were either modelled or implemented across a range of spatial, temporal, and measurement scales. Outliers at the tail end of 2.5% (beyond the 97.5th percentile on the upper-end and 2.5% percentile on the lower-end are removed).
Source: Whitmee, S. et al. (2024[6]), “Pathways to a healthy net-zero future: report of the Lancet Pathfinder Commission”, https://doi.org/10.1016/S0140-6736(23)02466-2.
Public health policies to achieve win-wins for health and climate rely heavily on information-based approaches, followed by laws and regulation
Across public health policies in the areas of food, transportation, and household energy, information-based policies exhibit the highest adoption rates relative to other instrument types (Figure 4.5). This trend suggests that governments prioritise strategies such as awareness campaigns, labelling and consumer guidelines that aim to enhance public knowledge. While these policies can play a crucial role in shaping behaviour, their effectiveness is often limited without complementary structural interventions, such as regulatory measures or government investments, which can actively shift consumer choices by making healthier and more sustainable options more accessible and affordable.
A clear contrast emerges in the adoption of financial incentives across sectors. While household energy policies exhibit a high adoption rate (88%), driven by grants for energy efficiency improvements and renewable energy subsidies, and transportation policies follow closely behind at 76%, with incentives such as tax rebates for fuel efficient vehicles, food policies lag significantly behind, with only a 30% adoption rate. Instruments such as subsidies for healthy food or taxes on unhealthy and unsustainable food appears underutilised compared to financial levers in other sectors.
Behavioural science‑based instruments remain the least utilised policy instrument across all three domains, reflecting a consistent pattern of underuse. Based on the concept that consumer choices can be guided by what and how different options are presented, these tools have been increasingly recognised for their potential to complement traditional policy approaches. The low adoption rate highlights an untapped opportunity for policymakers to integrate behavioural interventions that can enhance the effectiveness of existing policies by influencing choices in ways that promote healthier and more sustainable behaviours.
Note:17 OECD Countries have responded to this survey.
Source: OECD Health and Climate Policy Survey.
Reducing the impact of unhealthy diets on health – and the environment
Across OECD countries, there is considerable opportunity to achieve a win-win scenario for both the environmental sustainability and public health by promoting healthier and sustainable dietary consumption patterns. Strategies such as limiting overconsumption of animal-sourced foods and ultra-processed foods, reducing food waste, and encouraging seasonal eating offer multiple co-benefits.
While past efforts have primarily focussed on improving production efficiency – emphasising agricultural productivity, supply chain efficiency, and food security – to meet growing population needs, this approach alone is insufficient. It fails to address pressing challenges such as environmental footprint of food systems, high rates of food waste, and the accessibility and affordability of nutrient-rich and low carbon-emitting foods. These factors have direct public health implications and could be more effectively managed through demand-side interventions that shift consumption patterns rather than relying solely on improving supply-side efficiency.
Encouraging healthier and more sustainable food choices at the consumer level has the potential to drive systemic change across the entire food system, delivering both health and environmental benefits. Consumption of lower animal-based foods (e.g. red meat, processed meat, dairy) and higher plant-based foods (e.g. vegetables, fruits, legumes, seeds, nuts, and whole grains) benefits both environmental sustainability and health outcomes ( (Aleksandrowicz et al., 2016[16]; Springmann et al., 2016[17]; Stehfest et al., 2009[18]; Nelson et al., 2016[19]) (Hallström, Carlsson-Kanyama and Börjesson, 2015[20]). Consumption-based policies provide more direct leverage to address challenges such as food waste, unhealthy dietary patterns, and limited access to sustainable food options. With obesity rates rising, policies that encourage healthier eating not only reduce diet-related diseases but also lower the carbon footprint of food systems. By shifting the focus from how food is produced to how it is consumed, governments can create more effective pathways for sustainability and public health improvements. Several countries have both a high burden of disease due to obesity and high agricultural and food system emissions (Figure 4.6).
Note: Obesity used as an indicator of health burden for unsustainable and unhealthy food consumption. Emission intensity represents the carbon emissions associated with “pre‑ and post-agricultural production processes.” Carbon emissions associated include activities before the farm gate (fertilizers manufacturing, pesticides manufacturing, generation of electricity used on farm, generation of heat used on farm) and after the farm gate (food processing, food packaging, food transport, food retail, food household consumption, agrifood systems waste disposal).
Source: IHPME and FAO.
Adopting healthier diets would avert 27 000 premature deaths due to cancer annually and reduce emissions by as much as removing 72 million cars from the roads for one year
Modelled analyses of changing dietary consumption patterns in OECD countries indicate that adopting more nutritionally balanced, plant-based diets in line with national dietary guidelines across all OECD countries would reduce 27 000 premature deaths due cancer annually and would reduce greenhouse gas emissions by 304 MtCO2eq, equivalent to pulling 72 million gasoline‑powered cars off the roads across OECD countries for one year (OECD, 2024[21]). Transitioning to a healthy and sustainable diet would have further beneficial impacts on a wide range of other non-communicable diseases (Box 4.1). Aligning dietary patterns to this reference healthy diet could not only provide substantial health benefits in terms of reductions in premature mortality, but also lead to a more sustainable food system (Springmann et al., 2018[22]).
The EAT-Lancet Commission constructed a reference healthy diet based on an integrated environment and food framework (Willett et al., 2019[23]). The reference healthy diet includes broad food groups with intake ranges that allows for different dietary preferences globally. Four different energy-balanced, low-meat diets defined within the framework of the EAT-Lancet Commission meeting public health objectives are outlined (Willett et al., 2019[23]).
Note: Diets are energy-balanced varieties of flexitarian, pescatarian, vegetarian, and vegan dietary patterns defined by the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems.
Source: Willett et al. (2019[23]),), “Food in the Anthropocene: the EAT – Lancet Commission on healthy diets from sustainable food systems”, https://doi.org/10.1016/s0140-6736(18)31788-4; Springmann et al. (2018[22]), “Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail”, https://doi.org/10.1016/s2542-5196(18)30206-7.
Researchers have shown on average a 20% reduction in premature mortality across all four diets, specifically – a 19% reduction in premature mortality for flexitarian diet across regions, 20% for pescatarian, 20% for vegetarian, and 22% for vegan (Springmann et al., 2018[24]). The changes in premature mortality were generally evenly distributed across regions (e.g. ranging from 19 to 24% for flexitarian diet), though the greatest reduction was observed in upper-middle‑income countries where there exist higher levels of nutritionally imbalanced diets (Willett, et al., 2019). In high-income countries, the biggest drop in premature deaths from the dietary change – compared to keeping current diets – was seen in cancer, followed by heart disease, diabetes, and stroke (Table 4.3).
Note: High income countries include OECD countries apart from Chile, Colombia, and Costa Rica. Business as Usual: based on current and projected levels of food consumption and weight distributions. In the main analysis, year 2010 was used for analysing nutrient adequacy and year 2030 for the mortality and environmental analyses to allow for transition time for dietary and technological changes. Food consumption was estimated based on food demand projections from the International Model for Policy Analysis of Agricultural Commodities and Trade (IMPACT) and adjusted for food waste at the household level.
Health impact was defined by premature death averted, which is avoided deaths attributable to dietary and weight‑related risk by calculating population impact fractions representing the proportion of disease cases avoided when the risk exposure changes from the baseline; environmental impact was defined by GHG emission, cropland use, freshwater use, nitrogen application, and phosphorous. GHG emission with agriculture included methane and nitrous oxide emissions, but they exclude carbon dioxide emissions which, following the methods of the IPCC, are allocated to the energy sector or others.
Source: Springmann et al. (2018[22]), “Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail”, https://doi.org/10.1016/s2542-5196(18)30206-7.
Promoting healthier choices
Food labelling
Food labelling can be an important policy instrument to shape consumer awareness and demand for healthy and sustainable food options by providing consumers with detailed food product information listing the nutritional information (typically listed in the back of food packaging) as well as a summary label indicating the nutritional quality and/or environmental impact (typically listed in the front of food packaging) thus enabling informed food choices among consumers. To motivate change in behaviour among consumers, food labels must be clear, accessible, and trustworthy (Brown et al., 2020[25]).
Under the European Commission’s Farm to Fork strategy, a harmonised, mandatory EU-wide front-of-package nutrition labelling system (FoPL) is being developed to help consumers make healthier food choices. Several OECD countries already use FoPLs, including Nutri-Score, introduced in France, and the Health Star Rating, introduced in Australia and New Zealand. Both voluntary labels grade nutritional quality on a five‑level scale and help consumers identify higher-rated food products, but their impact on purchasing decisions and actual consumption is limited (Ikonen et al., 2019[26]; Feteira-Santos et al., 2019[27]).
Some concerns have been raised about their misuse by industry as marketing tools. For example, one study found the Health Star Rating displayed on 74% of ultra-processed foods finds, potentially misrepresenting their healthiness (Dickie, Woods and Lawrence, 2018[28]). The Nordic Keyhole logo, widely recognised in Nordic countries, highlights healthier options within food groups but should not be misinterpreted as a license for overconsumption (Wanselius et al., 2022[29]). In Chile, mandatory Nutrient Warning Labels, introduced in 2016 alongside marketing restrictions and school bans on unhealthy products, have significantly reduced purchases of low-nutritional-quality foods and improved consumers’ ability to identify healthier options (Reyes et al., 2020[30]; Correa et al., 2019[31]).
Source: Kanter, Vanderlee and Vandevijvere (2018[33]), “Front-of-package nutrition labelling policy: global progress and future directions”, https://www.doi.org/10.1017/s1368980018000010.
Environmental sustainability labelling is also increasingly used on food products to encourage healthy and sustainable food choices by fostering a more transparent food environment and strengthening food system resilience through the sustainability transition. Such labels are typically used to indicate compliance with standards set by governments, private firms, NGOs, or multi-stakeholder initiatives, requiring products to meet specific environmental criteria related to attributes or production and processing methods.
Within EU countries, the use of voluntary sustainability standards and labelling schemes has steadily increased in recent years. By 2021, 20% of new food product launches in countries like the Netherlands, Germany, Belgium, Austria, Ireland, Denmark and Sweden featured sustainability labels (Sanye Mangual et al., 2024[34]). Among sustainability-related labels, the top five schemes accounted for 81% of uptake in 2021, though the labels vary significantly in stringency and focus across different evaluation dimensions (Figure 4.7).
Note: Total product launches in 2021= 74 420.
Source: Sanye Mangual et al. (2024[34]), Sustainability labelling in the EU food sector: Current status and coverage of sustainability aspect, https://data.europa.eu/doi/10.2760/90191.
Further quantitative evidence on the environmental impacts of food labelling schemes is essential to develop harmonised, reliable, comparable, and verifiable labelling systems that avoid greenwashing and reduce consumer confusion while nudging sustainable dietary choices (Bunge et al., 2021[35]). Although experimental evidence suggests that sustainability labels positively influence shopping behaviour (Potter et al., 2021[36]) and indicate a higher willingness to pay for sustainably produced products (Lusk, 2018[37]), these findings do not consistently translate into actual market demand for labelled products (Deconinck and Hobeika, 2022[38]). This gap between stated intentions and consumption behaviour may stem from social desirability bias in survey responses. Research also highlights that price, taste, and perceived health benefits often dominate consumer decision making among food products (Lusk, 2018[37]). However, design improvements, such as simplified formats (e.g. traffic light labelling) and the use of emotive communication, could enhance the effectiveness of sustainability labels (Onwezen et al., 2021[39]).
National dietary guidelines
Food-based dietary guidelines aim to promote health, prevent chronic disease and ensure a nutritionally balanced diet required for health. These guidelines often inform food procurement policies in government setting such as schools, prisons, and government workplaces. In the United States for example, “Dietary Guidelines for Americans” is renewed every 5 years and forms the foundation of nutrition policy – guiding more than USD 80 billion in federal spending, shapes decision making in the food industry, and informs consumer education on healthy diets (Blackstone et al., 2018[40]).
Evidence suggests that dietary guidelines remain predominantly health-focussed with limited mention of environmental sustainability. Among OECD countries that have in place government-endorsed dietary guidelines, 63% of the dietary guidelines integrated environmental sustainability dimension. In a study evaluating the breadth and depth of sustainability integration in national dietary guidelines, researchers found guidelines published by Belgium to cover the most comprehensive breadth of health and environmental impacts of different types of diets (James-Martin et al., 2022[41]). Additionally, authors found that while the “what” (i.e. specific food products that are healthy and sustainable) was often addressed, the why (i.e. the negative impact on health and environment) was addressed to a lesser extent, and the how (i.e. practical advice on how to change your diet in ways that are accessible and appealing) was rarely addressed. As dietary guidelines are reviewed and periodically updated, there are opportunities for countries to integrate environmental sustainability dimensions as evidence continues to accumulate.
National dietary guidelines also have the potential to inform wider changes and raise the ambition to increase health and environmental impacts, but there remains large discrepancies between impacts of national dietary guideline adoption and global health and environment targets (i.e. Action Agenda on Non-Communicable Diseases, and the Paris Climate Agreement) (Springmann et al., 2020[42]). With approximately a third of the national dietary guidelines incompatible with the agenda on reducing non-communicable diseases and three‑quarters incompatible with meeting the objectives of the Paris Climate Agreement, national guidelines could stand to be healthier and more sustainable. The largest health benefits can be derived from increasing the intake of healthy foods (e.g. whole grains, fruits and vegetables, nuts and seeds, and legumes) and reducing the intake of red and processed meat; while the largest environmental benefits will be derived from limiting the consumption of animal-sourced foods (Springmann et al., 2020[42]).
Reducing harmful behaviours
Food pricing policies can significantly shift consumer behaviour towards healthier and more sustainable options, even more so than food labelling policies (Hoek et al., 2017[43]). Affordability is a key determinant influencing food choice, particularly among lower-income households. In the context of meeting the dual objectives of increased sustainability and health outcomes, food pricing is a key policy to consider as the price of a healthy and sustainable food basket is notably higher compared to a standard food basket. In Australia for example, researchers have found that the healthy and sustainable food basket are up to 30% more expensive compared to a typical food basket in the most disadvantaged neighbourhood with household in the lowest quintile living in middle‑income neighbourhoods spending up to 48% of their weekly income (Barosh et al., 2014[44])
Evidence from systematic reviews indicate that taxes and subsidies ranging between 10 to 20% are effective in changing food consumption behaviour towards healthier alternatives, with the greatest effects observed when both tax and subsidies are implemented in conjunction (Thow, Downs and Jan, 2014[45]; Afshin et al., 2017[46]). A study modelling the effect of optimal taxing on meat consumption, accounting for health costs associated with diet-attributable ill health from red and processed meat consumption, found reduced consumption would decrease the number of deaths attributable to red and processed meat consumption by 9% and attributable health costs by 14% globally, with the greatest reductions observed in middle‑ and high-income countries (Springmann et al., 2018[24]). However, implementing taxes on unhealthy food products must be approached cautiously, as they may disproportionately burden lower-income households, leading to regressive effects that could outweigh the long-term health benefits of these policies. Several OECD countries including Germany, Poland, Finland and Portugal prioritise tax reductions on healthy and sustainable foods (e.g. fruits, vegetables, and legumes). (Pineda et al., 2022[47]).
Shaping the choice environment: Changing default options
Policies that promote the availability and accessibility of healthy and sustainable food options may accelerate the adoption of such diets. Zoning regulations, for example, can restrict the density and location of quick service restaurants that primarily sell unhealthy and unsustainable foods, particularly in underserved or low-income areas where access to healthier options may limited. In Ireland, zoning legislation for “no fry zones” prohibits placement of unhealthy food outlets within 400 metres of primary and secondary schools. Similarly, in Canada, zoning bylaws have been adopted in several municipalities banning fast food restaurants and drive‑through facilities to create healthier food environments (Nykiforuk et al., 2018[48]).
In retail environments, guidelines can encourage grocery stores and food service establishments to prioritise the placement and presentation of healthier and more sustainable food options, such as fruits and vegetables over less nutritious choices. Policies that incentivise businesses to increase the availability and visibility of sustainable food items on menus and in prominent store locations can further drive healthier consumer behaviours (Filimonau et al., 2017[49]). For instance, in Chile, a law restricting child-directed marketing was implemented that banned sale or promotion of unhealthy and unsustainable food products in schools and nurseries. Similarly, a ban on fast food advertisement targeted towards children has demonstrated a significant reduction in its consumption in Quebec (Dhar and Baylis, 2011[50]). Collectively, these strategies help shape healthier food environments, reduce carbon footprints, and improve public health outcomes, particularly in communities that have traditionally had limited access to nutritious and affordable food options.
Public food procurement is increasingly recognised as a strategic entry point to advance sustainable and healthy food environments. It has the possibility to determine (i) what food is purchased (e.g. local, nutritious, healthy, and culturally appropriate); (ii) from whom (e.g. local and/or family farming producers, small and medium food enterprises, historically disadvantaged groups); (iii) from which type of production practices (e.g. from agricultural practices that prioritises environmental sustainability principles) (Swensson and Tartanac, 2020[51]). When designed well, public food procurement has the potential to address different components of the food system, from shifting food consumption patterns to influencing food production to deliver on multiple environmental, health, economic, and social benefits (Swensson and Tartanac, 2020[51]).
Ensuring that healthy and sustainable food choices are available and encouraged in government-funded settings such as schools, hospitals, prisons, universities, and cafeterias in public buildings as well as other public social programmes may be achieved through a well-designed public food procurement that embeds both health and sustainability criteria. Though sustainable production of meat and dairy products may indeed be more expensive, research has shown that the same budget can be maintained throughout menu modifications if meat products were reduced and replaced with plant-rich foods, cooking from scratch and reducing food waste (ICLEI - Local Governments for Sustainability, 2021[52]). Other levers also include providing longer contract terms to support long-term partnership and security better terms on pricing, switching to on-site kitchens, shortening supply chains by supporting local farms.
Among OECD countries, several have included environmental and climate‑related requirements in public food procurement processes (OECD, 2024[53]).
In Austria, there is a mandatory sustainability criterion implemented at the federal level for food and catering services including increase in share of organically produced food purchased, high animal welfare standards and GMO-free feed for procurement of animal foods, reusable systems for packaging and transport systems, original labelling for meat, eggs, and milk, fish from regional waters or sustainable aquaculture, and climate plate including at least one vegetarian or vegan main course every day that is seasonal and regional and contains at least one organic ingredient.
In Canada, environmental considerations are consistently incorporated in public procurement decisions to ensure that environmentally preferable food and beverages are procured.
In Hungary, there are mandatory requirements in place for public catering which includes nutritional requirements (wholegrain, vegetables, fruits, etc), short supply chains and local food products, shorter delivery period between food preparation and dishing, organic farming practices, and a customer feedback system.
In Norway, the Norwegian Agency for Public and Financial Management launched a new Action Plan to increase the proportion of green public procurement and green innovation for the period 2021 -2030 (The Norwegian Agency for Public and Financial Management, 2021[54]). This follows from a new public procurement act which came into force in 2017 that places obligations on central government, municipality and county authorities to consider environmental impact and encourage climate friendly solutions – where food and catering services is among priority categories. For public institutions including health and care services, Armed Forces, preschools/kindergartens, schools and work canteens, food procurement will aim to reduce adverse climate impact through reducing food waste (objective to reduce food waste by 50% by 2030) and choosing a climate‑smart menu (i.e. food with a lower environmental footprint).
In Sweden, the National Agency for Public Procurement establishes different sustainability criteria for different food groups (e.g. milk, egg, fish, fruit, vegetables, coffee, meat) and meal services with the criteria tailored to the food group and connected to information on verification and follow up.
In Denmark, a joint government food policy has come to effect since 2021 requiring all governmental canteens to have a minimum organic share of 60%, measure food waste, and offer meal options that consider health and climate.
Policy options to shape consumer choices lean on information-based approaches
Governments have relied heavily on information-based policies, such as health education campaigns and food labelling, which place the responsibility on individuals to make informed dietary choices (Figure 4.8). However, these downstream interventions often lack the structural support needed for widespread behaviour change. To enhance the shift in sustainable consumption, there is an opportunity to increase the use of financial incentives. Financial incentives such as subsidies for healthier foods, taxes on unhealthy products, and behavioural science‑based interventions, could prove more effective in fostering an environment where healthy and sustainable choices become the default. By expanding the policy mix to include financial and behavioural science informed instruments, governments can create a more comprehensive and enabling environment for individuals to adopt sustainable and healthy dietary patterns.
Note: Results reflect responding countries (N=14); non‑responding countries may also have policies in place.
Source: OECD Health and Climate Change Policy Survey.
While government utilise a range of policy instruments, their effectiveness in shaping consumption patterns depends on how they are applied in specific policy domains. These domains categorise policy options based on their primary mechanism for influencing food consumption behaviour (Table 4.5.) These include policies that influence food choices such as food labelling and national food guidelines, changing food prices to tax unhealthy and unsustainable food options while providing subsidies for healthy and sustainable options, broadening choices through procurement of sustainable food options in public settings and zoning schemes to attract healthier and sustainable food, and restricting choices by banning marketing non-optimal food options to minors.
Note: Policy actions are examples and do not aim to represent all option that could be implemented by countries.
Source: FOOD-EPI (2014[55]), “Towards global benchmarking of food environments and policies to reduce obesity and diet-related non-communicable diseases: design and methods for nation-wide surveys”, https://www.doi.org/10.1136/bmjopen-2014-005339; Bonnet and Coinon (2024[56]), “Environmental co-benefits of health policies to reduce meat consumption: A narrative review”, https://www.doi.org/10.1016/j.healthpol.2024.105017 and Burgaz et al. (2024[57]), “Which government policies to create sustainable food systems have the potential to simultaneously address undernutrition, obesity and environmental sustainability?”, https://www.doi.org/10.1186/s12992-024-01060-w.
Promoting active transportation
Transportation is the fastest-growing source of greenhouse gas (GHG) emissions in OECD countries, with significant and wide‑ranging impacts on public health. In 2019, the sector accounted for roughly one‑quarter of global emissions, and projections from the International Transport Forum (ITF) suggest this share could rise to 40% by 2030 if current trends continue. Passenger transport alone contributes approximately 40% of total transportation emissions, with private vehicle use, which has a higher GHG emission intensity than public transport options such as rail or buses, remaining dominant across OECD countries. While some regions have seen a decline in vehicles per capita, countries such as Australia, Canada, Mexico, Türkiye, Eastern European countries and the United States continue to have high levels of private vehicle ownership (Mattioli et al., 2020[58]; OECD, 2022[59]).
The growing dependence on private cars not only intensifies GHG emissions but also presents serious public health risks. Car-centric urban planning is closely linked to sedentary lifestyles, low physical activity levels, increased air and noise pollution, and a higher incidence of road traffic accidents. Outdoor air pollution, one of the most pressing health risks associated with transport emissions, continues to impact populations disproportionately across OECD countries (Figure 4.9).
With consumers often locked into car-dependent mobility patterns and global transport emissions continuing to rise due to urban expansion and growing travel demand, promoting strategies such as active transportation (walking, cycling), improving public transit infrastructure, and accelerating the shift to zero‑emission vehicles offer a dual benefit: they enhance public health outcomes while also helping reduce environmental harm.
Note: Outdoor air pollution used as an indicator of health burden for passenger transportation. Emission intensity represents the carbon emissions associated with passenger transportation. Values are standardised towards the OECD average.
Source: IHPME and IEA End-Use Efficiency Indicators.
Policy options to shape consumer choices towards sustainable and healthy modes of transportation
Policies and strategies that concurrently address the negative environmental and health impacts of existing car dependent transportation systems fall under the categories reducing harmful behaviours through disincentivizing use of private vehicles, including through vehicle restriction schemes and congestion tolls, promoting healthier choices to facilitate the use of active and public transportation through investments in infrastructure and financial incentives, and shaping the default environment by improving the fuel efficiency of existing vehicles through green procurement, vehicle emission standards, and feebates (Table 4.6).
Source: ITF Transport Climate Action Directory and OECD Health and Climate Policy Survey.
Promoting healthier choices: Building sustainable modes of transportation
The benefits of active modes of transportation including walking and cycling on health and the environment are well-documented and achieve the largest benefits across both domains compared to disincentivizing car dependence and improving fuel efficiency (Mizdrak et al., 2023[60]; Whitmee et al., 2024[6]). Existing literature indicates that car trips shorter than 5km are often considered “switchable” to cycling for most users. More affordable, frequent, and extensive public transport networks have been listed as the most important improvements that could encourage regular car users to drive less (OECD, 2023[61]). Among policies to encourage increased sustainable transportation use, the importance of infrastructure provision and spatial planning has been consistently emphasised as a high priority across setting with attractive public transport and pricing instrument following behind (with certain differences between geographies) (Thaller et al., 2021[62]; Chakrabarti and Shin, 2017[63]).
Innovation in different types of bicycles, particularly the growing popularity of e-bikes, is also contributing to the promotion of active transportation. By reducing physical barriers such as long distances, hilly terrain, and physical limitations, e-bikes offer the opportunity to make cycling accessible to a broader segment of the population. This development can facilitate not only longer commutes by bicycle, but also attracts new user groups who might otherwise depend on private cars, thereby reinforcing the transition toward sustainable and active mobility.
Providing well connected, safe, and high-quality cycling infrastructure plays a significant role in enabling a shift to cycling (Panter et al., 2016[64]). Extensive experience from cities in the Netherlands and Denmark on transforming cities away from highly car-centric in the mid‑1970s due to the increasing evidenced environmental, energy, and safety harms of increased car use provides some lessons (Pucher and Buehler, 2008[65]).
Extensive and well-integrated systems of separate cycling lanes both on-road and off-road are found in cities with high cycling rates, often including priority traffic signals and advance cyclist waiting positions at intersections to increase usability and convenience. Most local neighbourhoods have traffic calming features with speed limits of up to 30 km per hour and speed bumps, curved designs, dead-ends for motor vehicles to deliberately slow down or discourage through traffic (Pucher and Buehler, 2008[65]).
“Cycling superhighways” first pioneered in the Netherlands and Denmark and now found in cities across Northern and Western Europe facilitate higher speed and safety of long-distance commutes by running parallel to major roads with minimal road crossings combined with synchronised traffic signals at intersections timed for through passing (Cabral Dias and Gomes Ribeiro, 2020[66]).
To increase adoption for longer commutes and enable multimodality transport options, bike parking facilities and integration with public transport including bike rentals or bike shares at train and suburban stations or policies to allow bicycles onto public transport is widely prevalent in many Dutch and Danish train stations (Pucher and Buehler, 2008[65]).
Improving public transport infrastructure also enables shifts away from car dependency. Subways, metros, and buses are more efficient, equitable, and less polluting than private car use and is the most widely used modes of non-car transport among nine OECD countries (ranging from 71% in Switzerland to 28% in the United States) (OECD, 2023[61]). Among frequent car users, an average of 54% indicated improved public transport services including more frequent and extensive public transport networks such as express networks for buses and wider coverage would encourage them to use their car less.
Providing financial incentives to increase affordability of public transport is also a key lever in increasing ridership. Across 9 OECD countries, affordability was rated as a very important determinant of public transportation utilisation by 42% of respondents who are frequent car users, with the highest share in Belgium and the Netherlands at 49% and 50% respectively (OECD, 2023[61]). A range of financial incentives have been implemented across cities in OECD countries.
In Spain, the introduction of public transport subsidies in Madrid, which reduced the costs per trip for frequent users by approximately 35.5% through a travel pass, led to increased ridership among regular public transportation users (Cadena et al., 2016[67]). An increase in passenger numbers could help to reduce traffic congestion, lower greenhouse gas emissions and improve urban air quality, helping to support overall sustainability and mobility goals. Public transport usage has since increased by around 33% across Spain (Government of Spain, 2025[68]).In Luxembourg, public transportation is free starting from 2020 when second-class fares were eliminated to attract increased ridership. Although an overall increase in public transport as the main mode of transportation was modelled, a resultant increase in travel time particularly for cross-border workers created resistance to modal shift (Bigi, Schwemmle and Viti, 2023[69]).
In Germany, reductions in public transportation fare to 9 Euros a month nation-wide (representing a large reduction of up to 90% in some states such as Berlin) during a pilot policy introduced between June and August of 2022 was casually linked to not only increased public transport ridership but also decreases in air pollution levels indicating car users’ substitution (Gohl and Schrauth, 2024[70])).
Improving the walkability of cities is a key strategy in promoting health in city centre while concurrently reducing carbon emissions. By prioritizing pedestrian-friendly infrastructure, cities can encourage active transportation such as walking and cycling which have a direct impact on physical and mental health. Elements within the built environment that increases walkability include the following (Baobeid, Koç and Al-Ghamdi, 2021[71]).
Improved urban connectivity: The ability to walk continuously to different amenities and destinations is among the most important aspect of walkability. Features like well-maintained sidewalks, vehicle speed limits, and traffic control systems are key to ensuring safety and accessibility. Additionally, increased density of intersections creating smaller blocks allows for more efficient walking routes, reducing travel distances and making urban areas more navigable.
Mixed land use: A walkable city includes mixed land use, where residential, commercial, and recreational spaces are integrated within close proximity. This allows residents to meet daily needs such as shopping, dining, working, and accessing community services without relying on cars. Not only does this increase physical activity, but also fosters vibrant and engaged neighbourhoods by promoting local business and creating public spaces where people can interact, further enhancing the social and economic fabric of the area. This is the core concept behind “15 minute cities,” a human-centric urban design concepts where the daily needs of a resident can be met within a 15 minute journey by ensuring cities are designed to be multifunctional and compact (Moreno et al., 2021[72]).
Improved pedestrian safety: Ensuring pedestrian safety is essential for promoting walkability. This may include traffic calming features on roads such as speed bumps, reduced speed zones, and the strategic placement of crosswalks, which help protect pedestrian from vehicle crashes. Additionally, separating walking paths from vehicular traffic through the use of buffers, such as green spaces or bike lanes enhances pedestrian safety.
Increased thermal comfort: Thermal comfort plays an increasingly critical role in walkability, especially as cities experiences rising temperatures due to climate change. Shaded streets, through tree‑lined sidewalks, canopies, green roofs all provide relief from heat, making walking home more comfortable and relaxing.
Reducing harmful behaviours: Disincentivising car dependence and use
While a range of policy tools exist to disincentivise car use, it is important to ensure public transportation coverage, investing in cycling infrastructure and pedestrianisation, and subsidies to ensure lower-income and car-dependent communities would not be disproportionately overburdened. Policies to discourage car use includes price‑based policies such as tolls, taxes, and congestion pricing and regulatory-based policies such as vehicle restriction schemes (Table 4.6). However, any effort to discourage car dependence or use must recognise the diverse mobility needs of different populations. Well-designed policies would help to accommodate individuals with disabilities, families with young children, and residents in rural or remote areas, where public transportation infrastructure may be sparse.
Vehicle restriction schemes have become increasingly popular in urban areas where sections, typically in the city centre, are protected from motor vehicle and may apply during peak traffic periods and or specific days during a week. Many cities have recognised the detrimental impact of personal motor vehicles and implemented plans for car-free city centres (see Box 4.2). Beyond the proximate impacts of improved air quality and reduced noise pollution, restricting car use has implications on land use, providing opportunities to increase the share of green space and green networks in cities which substantially improves the liveability of neighbourhoods (Nieuwenhuijsen et al., 2016[73]). However, it is important to consider potential unintended consequences and balance carbon reduction objectives with overall well-being objectives. As an example, “green gentrification” or “climate gentrification” is a phenomenon whereby the creation of green spaces or infrastructure has resulted in increased property values and housing prices, leading to displacement of local residents (Anguelovski et al., 2022[74]). Although more commonly seen across North American cities, it is also increasingly observed in European cities such as Copenhagen, Nantes and Barcelona (Anguelovski et al., 2022[74]).
The Car-free Liveability Programme was implemented in 2017 by the Oslo municipality as one of many transformative urban projects to support the climate and energy strategy. The strategy had two objectives – to reduce Oslo’s direct greenhouse gas emissions by 50% by 2030 and to become fossil fuel free by 2050.
In 2021, the municipality of Oslo had a population of 693 491 with a projected increase of 140 000 by 2030. With transport sector accounting for the largest emission share, mainly due to passenger transport emissions, the city aimed to decouple population growth from GHG emissions by implementing more sustainable transport measures. The Programme intended on “handing the urban spaces back to the people,” and thus had conducted lengthy public consultations with residents.
Based on the feedback received, Oslo launched the programme in 2017 with an emphasis on improving connections to and from the city centre, activating hidden urban spaces, and increasing interaction between destination points. It further established a longer-term goal to a comprehensive approach based on zoning laws that focussed on people (pedestrians, cyclists, children, adolescents, and seniors) instead of private cars.
Specific developments from the Car-free Liveability Programme include:
Enhancing vibrancy of city life at the expense of parking space: The city removed approximately 750 parking spaces, with the reclaimed parking spaces used by delivery trucks, tradespeople working in the city, and others dependent on driving in the city centre.
Exploratory urban development projects: Introduced “parklets” or miniparks that consist of a platform furnished with seating spaces and plants but leaving users with flexibility to do with the space as they wish – as a resting space, mobile charging space, space to pump bicycle tires etc. Additionally, “stroll-bus” which catered to the mobility needs of seniors and children makes it easier for residents living in the suburbs to get into the city centre.
New pedestrian streets and pedestrian-friendly urban spaces: Turned existing vehicular passages to pedestrian-only zones or create new pedestrian areas which prioritises people and city life to be interconnected and expand.
The success of the programme has been attributed to public engagement, continuous impact measurement, and taking a holistic approach. Engaging residents of Oslo in decision making throughout the design, implementation, and evaluation of the programme ensures the project’s sustainability as it creates trust and buy-in from users of the space. Continuous monitoring at different stages of the project through engagement with residents, business owners, people with disabilities, pedestrians, and cyclists provide practical feedback loops to support longer-term implementation. And lastly, ensuring that a comprehensive approach is taken to support urban redevelopment including mobility, biodiversity, public transport, social integration, and citizen health ensures that several objectives may be integrated and achieved deriving co-benefits for several sectors.
Source: Minja (2021[75]), The Car‐free Livability Programme, https://doi.org/10.1002/9781119821670.ch6.
In addition to vehicle restriction schemes, pricing policies to reduce vehicle utilisation and encourage the use of cleaner vehicles including pollution charges and congestion pricing. Congestion pricing policies are often used to change driving behaviour and shift traffic towards less congested roads, off-peak travel periods, other transportation modes, or to discourage travel altogether (Singichetti et al., 2021[76]). They have been implemented in cities including London, Stockholm and Milan, with widely varying structures including toll-based policies for specific road sections or zones, and non-toll-based policies (Singichetti et al., 2021[76]).
In Stockholm, a charge was imposed between the 6:30 to 18:30 weekdays in the city centre of Stockholm with price differentials between peak and off-peak hours (Eliasson, 2009[77]). Following the charge implementation, a 3.6% reduction in road traffic crashes (Eliasson, 2009[77]).
In Milan, following the implementation of a road pricing measure where car drivers passing through a restricted traffic zone must pay a congestion charge and access is limited during peak travel times has seen a 28% decrease in road congestion, 24% reduction in road casualties between 2011 and 2012 (Comune di Milano, n.d.[78]).
London’s congestion charging scheme imposes a daily charge of GBP 15 when driving within the Congestion Charge Zone between 7:00 to 18:00 on weekdays and 12:00 to 18:00 on Saturday, Sundays, and bank holidays. Emissions from motor vehicle exhaust was reduced by 16% within the congestion charging zone and by 1% for all of London following implementation (Santos and Fraser, 2006[79]).
These financial instruments not only contribute to reducing emissions but also promote a shift towards more sustainable transportation options, including public transit and non-motorised modes of transport, thereby yielding multiple environmental and social co-benefits.
The ultimate success of encouraging a modal transition from private car use to public transportation depends on the accessibility of public and alternative transportation infrastructure. Enhancing public transport coverage, ensuring integration of public transport services (including bike‑sharing for example) to facilitate multimodality trips, and subsidising the use of public transit modes can ensure that low-income, car-dependent communities do not become disproportionately burdened by road pricing schemes.
Shaping the choice environment: Improving fuel efficiency
Vehicle emission standards have been a cornerstone in the efforts to reduce the environmental impact of cars in many OECD countries. These standards set limits on the amount of pollutants that vehicles can emit, driving automakers to innovate and produce cleaner, more fuel-efficient vehicles. For example, the European Union has implemented progressively stricter Euro emission standards, which have been effective in reducing nitrogen oxides (NOx) and particulate matter (PM) from vehicles. These policies not only contribute to lowering greenhouse gas emissions but also improve air quality, leading to public health benefits such as reduced respiratory diseases.
Green procurement policies, where public authorities prioritise environmental efficiency and the pollutant levels of vehicles during tendering processes, have not only yielded direct benefits on GHG emissions and improved air quality but have also played a crucial role in stimulating the initial demand needed for automakers to increase the availability of higher efficiency and low- or zero‑emission vehicles. OECD countries have implemented ambitious targets for their public transport fleets, aiming for a significant portion to be composed of low- or zero‑emission vehicles. For example, Poland has set targets requiring 30% of its public transport fleets to be electric by 2030, while Lithuania aimed to purchase 200 public transportation vehicles that are low- or zero‑emission by 2030. In Norway, electric transport and other zero emissions solutions are key to cut emissions in the transport sector, with the government announcing its plan to ensure zero emissions for public procurement in various vehicles between 2022 and 2025. These policies not only reduce the environmental impact of public transportation but also drive broader market shifts towards cleaner vehicle technologies, paving the way for more widespread adoption across all sectors.
Feebate (or “bonus-malus”) systems effectively promote the purchase of fuel-efficient vehicles by imposing taxes on less efficient models and offering subsidies for more efficient alternatives at the point of sale. These programmes are designed to be revenue‑neutral, with the funds collected through taxes typically covering the costs of the rebates, ensuring no net cost to the government. By providing immediate financial incentives or penalties at the time of purchase, feebates encourage consumers to opt for more environmentally friendly vehicles. Unlike vehicle efficiency standards, which mandate minimum requirements for manufacturers, feebates motivate both consumers and manufacturers to exceed these standards. For example, France’s feebate scheme has significantly increased the market share of low-emission vehicles, while Norway’s CO2‑differentiated vehicle registration system has been a key driver in making electric vehicles the majority of new car sales (Yan and Eskeland, 2018[80]; D’Haultfœuille, Durrmeyer and Février, 2016[81]).
Information-based and regulatory approaches are the most common methods to promote active transportation, but financial incentives and investments are also widely used
Similar to trends seen in policies adopted in the food sector, information-based policies are the most widely adopted policy instruments to address climate change and health in the transportation sector, ahead of financial incentives (Figure 4.10). Policies aim to reduce exposure to air pollution while lowering carbon emissions, with some also promoting active mobility.
Many countries have adopted information-based strategies, such as public awareness campaigns on the benefits of active mobility and carpooling initiatives. France established a network of “Maisons Sport-Santé” (Sport-Health Centres) in partnership with the French Ministry of Sport to promote physical activity and active transport. Similarly, Denmark launched a public information campaign in 2023 to promote carpooling and car sharing, while Poland has supported shared transportation initiatives to encourage environmentally friendly behaviour among drivers and passenger.
Alongside these measures, many countries have also adopted regulatory measures, including vehicle emissions standards, low-emission zones, and urban mobility laws to curb transport related pollution. In parallel, public investment has been directed toward public transit, cycling infrastructure, and zero‑emission vehicle (ZEV) charging networks, with countries like Canada, France, Japan and Poland prioritizing these strategies. Financial incentives, such as subsidies for electric vehicles, carbon pricing, and tax benefits for green transport are also widely used to encourage low-emission mobility, particularly in France, Canada and Poland. Meanwhile, behavioural science approaches, which focus on nudging people towards active mobility choices like cycling and walking, remain underutilised.
There is an opportunity to increase behavioural science‑based interventions to increase the use of active transportation. Given their potential to encourage behavioural shifts towards active transportation, expanding the use of behavioural insights, could drive sustainable mobility and maximised health benefits.
Note: Results reflect responding countries (N=17); non‑responding countries may also have policies in place.
Source: OECD Health and Climate Change Policy Survey.
Promoting cleaner energy use in residential settings
Energy consumption in the residential sector has substantial environmental and health consequences (Li et al., 2024[82]). The energy sources used in residential settings vary widely in their environmental impact and are strongly correlated with a country’s level of economic development (Figure 4.11).
Note: *Wood is classified as renewable energy under EU law.
Source: Our world in data, “The ‘Energy Ladder’: What energy sources do people on different incomes rely on?”, https://ourworldindata.org/energy-ladder; WHO Clean Household Energy Solutions toolkit, “Defining clean fuels and technologies”, https://www.who.int/tools/clean-household-energy-solutions-toolkit/module-7‑defining-clean.
High-income countries have made significant progress in adopting renewable energy sources for electricity generation. However, despite these advancements, residential homes remain heavily dependent on oil and natural gas – both major sources of pollution – particularly for heating systems (Figure 4.12). In 2021, OECD countries continued to use polluting energy sources, including biofuels, coal gas, and oil, to varying degrees. In some nations, such as Norway, Sweden and Finland, these sources accounted for less than 25% of residential energy consumption. In contrast, other countries exhibited significantly higher reliance, with Hungary, the United Kingdom, Netherlands, Italy, Belgium and Luxembourg, all exceeding 75%.
Percentage of polluting energy consumption across OECD countries
Note: Polluting energy sources defined as consumption of “biofuels and waste”, “coal and coal products”, “Gas”, and “Oil and oil products”.
Source: IEA, Energy end-uses and efficiency indicators (2022).
Reliance on polluting energy sources not only contributes to carbon emissions but also imposes a significant burden on public health across OECD countries. Indoor air pollution, a key indicator of health risks associated with residential energy use, continues to impact populations to varying degrees. While 82% of OECD countries have a disease burden from indoor air pollution exposure below the OECD average, several countries remain above this threshold. Notably, Poland, Estonia and Hungary exhibit both a high burden of disease and high emission intensity within the residential energy sector, highlighting a dual challenge of environmental and health impacts (Figure 4.13).
Note: DALYs resulting from indoor air pollution used as an indicator of health burdens for polluting household energy use. Emission intensity represents the carbon emissions associated with residential energy use. Values are standardised towards the OECD average.
Source: IHPME and IEA End-Use Efficiency Indicators.
Energy poverty disproportionately affects vulnerable populations within OECD countries
Access to affordable, reliable, and clean energy remains a major challenge globally. While this issue is most acute in low- and middle‑income countries, where indoor air pollution from solid fuels like wood, charcoal, and coal contributes to millions of premature deaths annually (see Box 3 on the Clean Cooking agenda), energy poverty is also a significant concern within high-income countries. In OECD countries, most households have transitioned away from solid fuels, yet a subset of the population continues to struggle to afford or access clean and efficient energy for daily needs.
Access to clean fuels and technologies is a key target under Sustainable Development Goal (SDG) 7 with substantial implications for several other SDGs such as good health, gender equality and climate action. Clean cooking relies on non-polluting energy sources such as liquified petroleum gas (LPG), natural gas, electricity, biogas, and ethanol in alignment with standards defined by the World Bank’s Multi-Tier Framework for Clean Cooking and the International Energy Agency (Bhatia and Angelou, 2015[83]). Despite global efforts, 2.1 billion people (approximately 26% of the world’s population) still lack access to clean energy for cooking, primarily relying on polluting fuels, disproportionately affecting women and children through exposures to harmful air pollutants, labour-intensive fuel-collection, and time‑consuming fire tending (IEA, 2023[84]).
The economic case for scaling up clean cooking policy actions is clear. A WHO analysis demonstrates a net benefit of USD 1.4 trillion accrued between 2020 and 2050 across 120 low- and middle‑income countries due to health benefits from avoided morbidity and mortality through air pollution, time savings from reduced time spent cooking and collecting fuel, and environmental benefits from reduced fuel harvesting and GHG emissions. Although consistent progress is seen in Central and Southern Asia, led by high population density countries such as India (42%), China (28%) and Indonesia (10%), challenges remain, particularly in Sub-Saharan Africa, where population growth outpaces access to clean cooking solutions. Beyond regional differences, rural areas face greater access deficits than urban areas, highlighting the need for equitable solutions that bridge the rural-urban divide.
National policies and international support are crucial to advance clean cooking and ensure health protection in residential settings. Only 40% of countries without universal access to clean cooking have set targets aligned with SDG7 on universal access to clean energy by 2030, and less than 20% of those without access have adequately funded and resourced organisations to implement these targets (IEA, 2024[85]). At the national level, incorporating clean cooking in Nationally Determined Contributions under the Paris Agreement strengthens political commitment and provides a structured pathway for implementation. Specifying clear targets, along with implementation plans that outline roles and responsibilities can operationalise these pathways by effectively allocating resources and leveraging climate finance mechanisms to meet the targets. Establishing clear regulatory oversight can support measurement of uptake to track progress and ensure minimum quality standards are met.
Ensuring health benefits are integrated alongside environmental and climate mitigation concerns in the clean cooking agenda is crucial. The initial focus on improving fuel efficiency, financial empowerment, and emissions reductions has shifted to integrating health benefits in the clean cooking agenda as epidemiological evidence directly linking indoor air exposure to a range of significant health risks emerged. Recent initiatives from donor agencies such as USAID and NORAD for instance emphasise the substantial health benefits offered through LPG-powered stoves as a clean alternative.
As national governments and international development communities continue to advance on clean cooking in the context of differing national priorities for health and climate mitigation, an integrated approach that maximises health, economic, and environmental co-benefits, provides a robust path forward for a sustainable, healthy, and inclusive energy transition.
Note: Access deficit refers to the indicator number of population exposed to detrimental health and socio-economic effects of polluting fuels and technologies due to lack of access (IEA, 2024[85]).
Source: IEA (2024[85]), Tracking SDG 7: The Energy Progress Report 2024, https://www.iea.org/reports/tracking-sdg7-the-energy-progress-report-2024; IEA (2023[84]), A Vision for Clean Cooking Access for All, International Energy Agency, https://www.iea.org/reports/a-vision-for-clean-cooking-access-for-all.
A growing body of research links inadequate access to clean energy with a wide range of negative health outcomes. These include poorer general health and mental health, increased incidence and severity of respiratory conditions, greater complexity of chronic diseases, higher mortality, and increased use of healthcare services with substantially worse outcomes for already disadvantaged groups (Ballesteros-Arjona et al., 2022[86]; Bentley et al., 2023[87]).
Within OECD countries, Indigenous populations are among those most disproportionately affected by energy poverty (Riley et al., 2023[88]; Guzmán-Rosas, 2022[89]). Structural inequalities, including underinvestment in infrastructure and geographic isolation, have contributed to persistent energy access disparities. In Canada, for example, about 28% of Indigenous communities reside in rural and remote areas that are not connected to the main power grid. As a result, many of these communities rely on expensive and environmentally damaging diesel-powered generators to meet their basic energy (Riva et al., 2021[90]). In Australia, Indigenous residents in remote communities frequently experience energy insecurity, with many facing involuntary energy self-disconnection from electricity services due to affordability constraints (Riley et al., 2023[88]). Similar disparities are observed in Latin America. In Chile, Indigenous communities experience significantly higher levels of multidimensional energy poverty compared to non-Indigenous populations (Villalobos, Chávez and Uribe, 2021[91]). And in Mexico, Indigenous groups are disproportionately affected by energy deprivation, limiting their access to safe and efficient household energy (Guzmán-Rosas, 2022[89]).
Despite growing recognition of these disparities, comprehensive data on Indigenous energy insecurity remains limited. National energy statistics across OECD countries rarely disaggregate data by Indigenous status, making it difficult to fully assess the extent of energy deprivation and design evidence‑based interventions that address their specific needs. Nevertheless, Indigenous communities represent a significant and frequently underserved portion of the population, underscoring the urgency of targeted data collection and policy intervention. (Figure 4.13)
Distribution of indigenous population across OECD countries
Source: Mexico (2020) National Institute of Statistics and Geography. New Zealand (2018) Stats NZ. Chile (2017) National Statistics Institute of Chile. Canada (2021) Statistics Canada. Colombia (2018) National Administrative Department of Statistics. Australia (2021) Australian Bureau of Statistics. United States (2017‑2021) the United States Census Bureau. Costa Rica (2010) National Institute of Statistics and Census. Norway (up to date estimates as of 2024, there is no official census on Sami populations) Indigenous Navigator Norway. Denmark (2022) Statistics Greenland. Sweden (up to date estimates as of 2024, there is no official census on Sami populations) Official Website of Sweden. Finland (up to date estimates as of 2024, there is no official census on Sami populations) Indigenous Navigator Finland. Japan (2011) Statistics Bureau Japan.
There is wide recognition that integrated policies on clean energy transition in the residential sector may yield substantial benefits for both reducing greenhouse gas emissions and improving health outcomes by reducing indoor air pollution among other health benefits. At the core of these policies is promoting healthier choices by encouraging sustainable energy use, reducing harmful behaviours by phasing out polluting energy sources for household use through regulatory and legal measures, and shaping the decision environment to enable improved uptake of energy efficient choices.
Source: OECD Health and Climate Policy Survey, IEA.
Promoting healthier choices: Encouraging sustainable and clean energy use
Policies that encourage households to adopt clean energy technologies, improve insulation, and reduce consumption of polluting energy sources can lower energy bills while enhancing comfort, air quality, and health outcomes. Engaging the public through demand-side policy-levers can support meaningful behaviour change and reduce overall energy consumption. Small behavioural adjustments, such as turning off unused lights or selecting energy-efficient options, can reduce demand-side energy use. In OECD countries, information-based policies have been used to drive these changes by informing consumers on how their energy choices impact emissions and concrete steps they can take to reduce emission.
Targeted Awareness Initiatives: In Sweden, municipal climate advisory services provide advice on reducing energy needs for heating in homes, while France’s multi-channel campaign informs consumers on ways to decrease gas and electricity use. In Canada, energy advisors registered with Natural Resources Canada provide free assessment of homes to promote energy efficient homes.
Educational outreach: In Germany and Spain, educational campaigns have been deployed to raise awareness on energy efficiency and transition towards renewable energies, with the aim to create broader acceptance for transformation towards a climate neutral society.
Providing feedback on energy consumption: Smart metres1 allows consumers to have timely access to their energy consumption data. As of 2021, 54% of households in the EU have an electricity smart metre while in 13 EU countries, smart metre uptake was over 80% at the end of 2022. Evidence suggests that the smart metres can achieve an average energy saving of 2‑10% (Alaton and Tounquet, 2020[92]).
Reducing Harmful Behaviours: Phasing out polluting energy use
Reducing reliance on fossil fuels and decarbonising electricity through clean energy sources such as solar, wind, and hydroelectric power can drastically cut GHG emissions and improve air quality with substantial benefits for health outcomes. These transitions offer a sustainable solution to climate change while yielding substantial health benefits. Phasing out coal, the most carbon-intensive fossil fuel, has become a policy priority globally, with evidence suggesting it would yield the largest health benefits in the energy sector (Markandya and Wilkinson, 2007[93]; Friedlingstein et al., 2019[94]). OECD countries like Austria, Belgium and Sweden have completed coal phase‑outs, while Canada, France, Germany, Korea, Italy and the United Kingdom have committed to full coal phase‑out plans (IEA, 2021[95]). Given the potential job losses and local economic disruptions from coal transitions (Diluiso et al., 2021[96]), there is a need to include job creation within the clean energy sector to ensure decisions on energy transition policies centred on people’s health and economic well-being.
Many OECD countries have taken legislative steps to accelerate the shift away from polluting energy sources. For example, Norway, began phasing out oil- and paraffin-based heating systems in 2016, fully banning them in all new and renovated residential buildings by 2020. Similar restrictions on fossil fuel-based heating systems for both new and renovation of existing residential buildings have been introduced in Demark, Germany, Ireland and Belgium (EPHA, 2024[97]). Austria’s Federal Act on Renewable Heat Supply in New Buildings (EWG), effective as of 2024, is another example which prohibits fossil-fuel based heating systems in all new buildings.
Sweden, Denmark, Norway and Finland are leaders in applying carbon taxes to fossil fuels for residential heating, having introduced these measures early. In Sweden, carbon tax was introduced in the early 1990s, applying heating fuels in the residential sector and has reduced emissions by almost a third in residential building emissions since 1990 (Martinsson et al., 2024[98]). Denmark and Finland also tax fossil fuels used for heating, incentivizing a shift toward bioenergy and other low-carbon solutions.
Although natural gas combustion emits fewer air quality pollutants, methane leaks during distribution and incomplete combustion is linked to increased risks for asthma among children (Gruenwald et al., 2022[99]). Natural gas remains prevalent in OECD countries, representing 37% of residential energy use, primarily for cooking. Transitioning to stoves powered by renewably generated electricity is a healthier and more sustainable alternative to mitigate these health risks.
Shaping the choice environment: Improving energy efficiency in homes and appliances
While some policies aim to directly promote healthier behaviours or reduce harmful practices, energy efficiency interventions are best understood as shaping the environment in which choices are made by altering the default options and improving the physical or regulatory context. The health benefits of improving energy efficiency in residential settings are increasingly evident. These extend beyond reduced air pollution, including indirect health benefits through improved living comfort, and alleviating energy poverty. Among the OECD, four countries – Spain, Ireland, Poland and Latvia – explicitly elaborate on the health benefits of energy efficiency in policymaking considerations as indicated in the latest National Energy and climate plans 2021‑2030, underscoring the growing recognition of health considerations in energy efficiency policies.
The EU’s Energy performance of Buildings Directive (EPBD), updated in 2024 provides a comprehensive regulatory framework, including policies on Long-Term Building Renovation Strategies (LTRS),2 Nearly-Zero Energy Buildings (NZEB), and Energy Performance Certificates (EPC). Under LTRS, many countries have explicitly incorporated health benefits of residential building renovation (i.e. thermal comfort, improved air quality, improved lighting) in the National Long-term renovation strategies (European Commission, 2020[100]). In Estonia, for example, health objectives are explicitly specified – such as decreasing the number of premature deaths due to environmental impact of energy economy and decrease disease burden resulting from environmental impact of energy management (Ministry of Economic Affairs and Communications, 2017[101]). Implemented in 2021, all new buildings in the EU must meet nearly-zero energy standards. Although NZEB definitions vary by country, these buildings typically achieve high energy efficiency, reducing energy consumption and promoting health of residents by providing more stable indoor temperature and better air quality. The EPC scheme rates building energy performance, suggesting cost-effective renovations to improve energy efficiency and comfort. Despite inconsistencies and challenges in energy performance across countries, EPCs offer a pathway to making informed improvements in residential buildings (Gonzalez-Torres et al., 2023[102]).
Beyond the EU, countries like Australia and Canada are also advancing energy efficiency standards in residential building. In Australia, the National Construction Code, to be updated in 2025 will introduce requirements for air quality and thermal comfort, reflecting the health needs of residents. In Canada, the National Building Code (last updated in 2020) similarly addresses energy efficiency and health objectives, targeting health risks such as indoor air quality, thermal comfort, moisture control, noise protection, hygiene and sanitation to support resident’s well-being.
Residential home upgrades and retrofits
Improving energy efficiency in residential homes through retrofits like thermal insulation of outer walls, window glazing, and ventilation upgrades can reduce exposure to cold, present overheating, and enhance ventilation, which improves respiratory health and overall living comfort. Inadequate energy access, or energy poverty, is a significant barrier and is recognised as an important determinant of health. Energy poverty can lead to harmful indoor environments that exacerbate respiratory and cardiovascular conditions, stress, and mental health issues. It disproportionately affects low-income and vulnerable populations, leading to preventable health disparities.
OECD countries have implemented several policies, including financial incentives, to encourage a transition towards sustainable and healthy residential buildings. Financial incentives are essential for ensuring an equitable and just transition, as they can provide lower-income households with resources to offset the upfront costs for residential energy retrofits. For instance, Australia’s 2023‑2024 Budget includes an AUD 1.7 billion Energy Savings Package to help households and businesses access energy upgrades. Czechia, Estonia, Poland and the Slovak Republic all have national and regional financial support programmes for renovating residential buildings to improve energy efficiency and indoor climate. In Canada and Sweden, tax credits and rebates are offered to encourage energy efficiency and renewable energy use in residential buildings. Particular attention is given to vulnerable populations. In Canada, the “Clean Energy for Rural and Remote Communities” programme provides targeted funding for renewable energy projects, capacity building initiatives, and energy efficiency measures in Indigenous, rural and remote communities. In Latvia, a communications campaign “Let’s live warmer” was developed to inform the public about funding for housing insulation. Increases in applications for home renovation applications between 2009 and 2022 by over four‑fold (Ministry of Economics Republic of Latvia, 2020[103])).
Government investments
Governments are investing in clean energy infrastructure and initiatives that consider health benefits. In Australia, for example, the National Health and Climate Strategy includes a partnership with First Nations communities to enhance access to renewable energy and improve housing and health infrastructure. These investments aim to modernise power grids, demonstrate innovative clean energy technologies, and improve the energy efficiency of homes and communities.
Energy-efficient appliances and technologies
Energy-efficient appliances and heating systems are critical to achieving residential energy savings while supporting public health. Heat pumps and energy efficient residential solar powered heating systems have been shown to raise thermal comfort-levels while reducing GHG emissions as well as aggravating respiratory and cardiovascular illnesses through indoor air pollution (Lysenko et al., 2024[104]). Existing evidence from various geographies have investigated the health impacts of these technologies, including projections in avoidance of 10 000 premature deaths by 2030 in China from widespread deployment of solar photovoltaic panels (Yang et al., 2018[105]) and potential health benefits in Ireland amounting to 100 million Euros per annum from switching from solid and liquid fuels to energy efficient heat pumps (Kelly, Fu and Clinch, 2016[106]).The EU’s Ecodesign and Energy Labelling policies harmonise energy efficiency scales for household appliance across EU countries. These standards further promote the purchase of energy-efficient appliances, allowing consumers to choose options that lower both emissions and household energy costs.
Information-based, regulatory approaches and financial incentives are the most common methods to lower household energy emissions, but government procurement and investments are also widely used
Austria, Belgium, Canada, Denmark, France, Lithuania, Norway and Sweden have all adopted comprehensive strategies across multiple policy instrument categories while others have exhibited varying levels of adoption. Financial incentives and information-based policies have had the highest level of adoption with laws and regulations and government procurement closely following. There are opportunities to increase the uptake of behavioural science‑based approaches.
Note: Results reflect responding countries (N=17); non‑responding countries may also have policies in place.
Source: OECD Health and Climate Survey.
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← 1. Smart metre is an electronic device that measures how much gas and electricity is used and send these readings automatically to the energy supplier. They typically come with an in-home display screen to help monitor and reduce energy use.
← 2. Long-Term Building Renovation Strategies are regular reporting among EU countries that outline long-term strategies to renovate national building stock into a highly energy efficient and decarbonised building stock by 2050, containing an estimated energy savings expected.