British Columbia initially reported almost 500 sudden heat deaths, three times higher than normal in early summer, while Multnomath County, Oregon, which includes Portland, first reported 45 heat-related deaths and Seattle reported 16.

The death toll underscored both the impact of climate change on human health and what a new report rates as poor performances by numerous nations in addressing health issues in their emissions and adaptation goals—known as Nationally Determined Contributions, or NDCs—as part of the Paris Agreement.

The report, by the California-based Global Climate and Health Alliance, concluded that of 40 countries whose NDCs were reviewed (one of which covered all 27 European Union nations), few provided more than superficial detail on how they would protect their citizens’ health from climate change. Even fewer specified how such health measures would be financed. Wealthier nations scored the worst in the report.

Jeni Miller, executive director of the alliance, an international consortium of health professionals and organizations, said that recognizing the gaps in current climate change mitigation plans, and adapting them to respond to the real-time health effects of global warming, is essential to do now, so that governments will have time to adapt before this year’s rescheduled COP26 summit.

All 190 countries party to the Paris Agreement will gather in Glasgow in November to restate their commitment to limiting any increase in global temperatures to 2 degrees Celsius and update their  NDCs.

Lytton, British Columbia, which experienced the highest temperature ever recorded in Canada and was nearly destroyed by wildfire during the heatwave along with the increase of deaths in the region, are just the most recent examples of the threat that extreme weather patterns caused by global warming pose to people’s health, Miller said.

While Lytton’s population of 300 was successfully evacuated, the wildfire engulfed over 90 percent of the town in just 15 minutes, after the temperature soared to 121 degrees Fahrenheit. The heatwave, Miller said, “produced hundreds of excess deaths from what would have been expected in that time period in the province of British Columbia.”

The climate and health alliance advocates for reframing national climate change policies and goals to save thousands more lives and better communicate the urgency of the current climate crisis to the public at large.

“Understanding the benefits to health has the potential to really galvanize people to take the action that we need to take in order to protect our health,” Miller said.

The report ranked the inclusion of health within the 40 NDCs based on four factors, beginning with countries’ recognition of climate impacts on deaths and illnesses. The scorecard also considered steps taken to adapt to climate threats, such increased storm resiliency, and initiatives that produced so-called “health co-benefits,” such as reduced air pollution resulting from renewable energy. Finally, the scorecard considered whether countries’ NDCs had factored in both the cost of, and savings from, health initiatives. Countries could receive up to 15 points as an overall grade, in addition to receiving a score for their “climate ambition,” as reported by the Climate Action Tracker.

Many of the highest scoring countries were low- to middle-income nations like Argentina, Senegal and Lebanon. Costa Rica scored the highest out of all NDCs surveyed with 13 points, receiving full marks in every category except economics and finance, and a relatively high score for climate ambition, given for the country’s progress towards meeting its NDC and reducing the potential for overall global warming to under the 2-degree mark.

According to Andrea Meza, environment and energy minister of Costa Rica, the country’s prioritization of people at the center of its climate change policies is the reason it was able to score so well.

“Costa Rica recognizes that climate change will impact people’s health and that we need to take urgent action,” she said in a press release about the scorecards. “Fortunately, we have the tools to address this issue. The investments needed to tackle climate change will improve air quality, take pressure off our healthcare systems, and improve our well-being.”

High-income countries tended to receive worse scores. Australia, Iceland, New Zealand and Norway received zero points each, and the European Union, representing its 27 member states, received just one point. In countries like Australia and New Zealand, health advocates say it’s a fair representation of how lightly their national governments are taking the potential health impacts of climate change.

“This scorecard shows that Australia is again at the bottom of the pack when it comes to taking the health effects of climate change seriously,”  said Fiona Armstrong, the executive director of the Climate and Health Alliance in Australia. “The Prime Minister must both act to reduce emissions, and prioritise health in our international climate commitments before COP26 to protect our health.”

The report’s conclusions differ from the findings of some other environmental rankings because researchers only examined a country’s policies as laid out in their NDCs, without considering any additional health policies that may have been enacted under separate legislation. The United Kingdom only received seven points, for example, but could have fared better if its separate, national strategy for climate adaptation was incorporated into the tally.

Still, the researchers’ findings are representative of the relative status of and ambition for climate change adaptation of countries around the world, said Edward Maibach, director of the Center for Climate Change Communication at George Mason University in Virginia.

The United States’ score of just six points is disheartening but emblematic of the current American strategy to combat climate change, he said. The United States received full points for incorporating health co-benefits—such as reduced air pollution, increased access to mass transit and incentives for plant-based diets—but low grades in every other category.

Maibach is also a representative for the Medical Society Consortium on Climate and Health, which sent a letter to the Biden administration after the publication of the scorecards, urging the government to better incorporate health elements into American climate policy. The group would like to see more national efforts to directly limit global warming, maximize the human health benefits of initiatives for cleaner air, water and transportation, and protect vulnerable communities across the country by listening to underrepresented voices and taking historical inequalities into consideration in policy making.

“When we learned that the U.S. score was only 40 percent, we felt we had a real opportunity, real obligation as well, to comment,” Maibach said. “Because we’re actually really excited by what the Biden administration is doing to move forward with ambitious NDCs.”

President Biden’s administration has taken a strong stance on combating climate change, naming global warming as one of his top four priorities and making real progress towards a slew of federal environmental initiatives that are repositioning the United States. as a leader in the global cause. However, Maibach said, more needs to be done to maximize the positive health impacts of these policies and drive home the point that everyone’s health is at risk.

“That is the most compelling reason why most Americans at the very least support strong climate action on the part of government—because they understand that it will be good for health,” he said. “So if the governments of the world, including our own, don’t put health first and foremost in their explanation for why they are taking strong action, they may fail to build the kind of public will that is necessary to sustain a political will.”

The report recommended that most nations improve their economic and financial commitments to the health impacts of climate change by allocating funds for adaptive health care systems, in order to avoid more deaths and related health problems like those seen from the heatwave earlier this month.