A team led by researchers at Imperial College London suggests that funds generated from the green energy transition, including fossil fuel subsidy savings, carbon taxes, and royalties from critical minerals, should be ringfenced to support UHC. Their findings, published in The BMJ Climate Issue, indicate that this transition could potentially free up billions of dollars globally, offering a chance to improve health outcomes and boost development.
Dr Judite Goncalves, a health economist at Imperial College London and lead author, stated: “The green transition will generate large public revenues: from carbon pricing, to royalties on minerals like lithium and cobalt, and from reforming fuel subsidies. The rules for how much of that money is raised, and how it will be spent, are being written now and will shape budgets for decades. Health should have a guaranteed share. Fossil fuels and mining take a heavy toll on people’s health, and part of the revenue they generate should go towards protecting it.”
The researchers highlight that in 2024, $733bn was spent globally on fossil fuel subsidies, significantly exceeding the estimated $20-53bn annual financing gap for UHC in low- and middle-income countries. Reducing these subsidies could redirect substantial resources to domestic public health programmes. Beyond subsidy reform, carbon taxes and royalties from critical minerals also present significant new revenue streams for health funding.
However, they stress the importance of ensuring these new revenues reach health budgets directly, rather than being absorbed into general revenue or diminished by tax avoidance or pressure from investors. “Not all the savings from reform can go to health, but even a modest, protected share could make a real difference,” explained Dr Goncalves.
The paper points to reforms in Indonesia and Brazil as examples of how funds can be eroded or fail to translate into local health investments. Health ministries, civil society, and professional health organisations are urged to engage in shaping carbon pricing rules and royalty frameworks to secure a dedicated share of revenue. Given that green transition revenues often flow to higher-income countries while UHC financing gaps are concentrated in lower-income countries, international mechanisms like debt-for-health swaps are deemed essential for a fair transition.
Dr Goncalves further explained: “Our own research shows that when oil prices drive subsidies up, governments spend less on health. When prices eventually fall, there will be a window to reform, as Indonesia did when oil prices dropped in 2014–15. Governments should be ready to use it, and to make sure a share of the savings goes to health.”
Professor Christopher Millett, from the School of Public Health, added: “The countries with the biggest health financing gaps aren't the ones set to gain most from green transition minerals and fossil fuel subsidy reform. Domestic reform alone won't be enough, so international partners have a role in making the green transition a fair transition.”
