Health engagement in national climate commitments of small island developing states: A content analysis of Caribbean nationally determined contributions.

Objective: To investigate how health is incorporated into the NDCs of Caribbean SIDS and their financing challenges. Methods: The study analysed the NDCs of sixteen Caribbean SIDS using content analysis to investigate their level of engagement with health. Results: Caribbean SIDS have a high level of reference with health in their NDCs relative to other developing countries which is expected to increase as they update them. All sixteen countries included health in their NDCs, mostly with regard to adaptation to be achieved by 2025/2030. Five countries provided targets in health aimed at increasing climate resilience. This may be explained by the region's poor health profile, high exposure to climate change and disasters, inadequate health infrastructure and resources and dependence on external finance. There was hardly any information on how countries intend to finance their health goals. Conclusion: Inclusion of health in Caribbean SIDS NDCs could increase obligation to climate action at domestic and regional levels and attract international climate finance. The Caribbean should seek out funds that make finance available to tackle health-related risks from climate change. It is imperative that Caribbean SIDS compute and state their climate finance needs in health if they are to attract international finance and raise donor and investor confidence. Caribbean SIDS have the opportunity to advocate for and be an example for the integration of health into climate change policy and politics to encourage global cooperation, boost countries' climate change aspirations and ramp up international climate finance.