{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:04:39Z","timestamp":1784027079251,"version":"3.55.0"},"reference-count":63,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Climate change is increasingly recognised not only as an environmental emergency but also as a structural determinant of health and health-system performance. Its clinical consequences will not be distributed evenly: high-income countries face rising heat mortality, infrastructure fragility, ageing-related vulnerability, and the need to decarbonise technologically intensive care; middle- and low-income countries face heterogeneous but often more compressed combinations of heat, infectious disease, food insecurity, water stress, displacement, conflict-related fragility, and limited fiscal capacity. Objective: This structured narrative review proposes a comparative framework for understanding how climate change will transform health care across high-, middle-, and low-income settings and identifies adaptation priorities that are resilient, equitable, and low-carbon. Methods: We synthesised major climate-health assessments, peer-reviewed epidemiological studies, modelling papers, systematic and scoping reviews, and health-system decarbonisation literature identified through targeted searches and reference chaining. Five climate-health pathways, specified a priori from established direct, indirect, and socially mediated pathway frameworks, were used to organise the review. Findings: Climate change will reshape health care through five interacting pathways: direct thermal injury and extreme-weather mortality; altered infectious disease ecology; food, water, and nutritional insecurity; mental, maternal-child, and occupational impacts; and damage to the infrastructure, workforce, supply chains, finances, and emissions profile of health systems. In high-income countries, climate stress exposes the limits of hospital-centred, carbon-intensive, just-in-time care. In middle-income countries, expanding coverage and technology coexist with uneven insurance, large informal workforces, and rapidly growing emissions. In low-income and fragile settings, the same hazards interact with undernutrition, weak surveillance, under-resourced primary care, and constrained finance to produce larger marginal health losses. Conclusions: The central contribution is the concept of the climate-health divide: the unequal conversion of shared climate hazards into clinical demand, service disruption, financial stress, and emissions-intensive responses. Climate resilience and healthcare decarbonisation should therefore be designed together rather than treated as separate agendas.<\/jats:p>","DOI":"10.3390\/ijerph23070902","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:12:53Z","timestamp":1784023973000},"page":"902","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Climate-Health Divide: How Climate Change Will Rewire Health Care Across High-, Middle-, and Low-Income Settings"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5547-4025","authenticated-orcid":false,"given":"Francisco","family":"Epelde","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Parc Taul\u00ed Hospital Universitari, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona, 08208 Sabadell, Spain"},{"name":"APTIMA Centre Clinic, Mutua de Terrassa, 08221 Terrassa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","unstructured":"P\u00f6rtner, H.O., Roberts, D.C., Tignor, M., Poloczanska, E.S., Mintenbeck, K., Alegr\u00eda, A., Craig, M., Langsdorf, S., L\u00f6schke, S., and M\u00f6ller, V. 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