“If you want to action great ideas, you need to apply the strength of a Himalayan mountain.”
- Bhutanese Proverb
High altitude ecosystems face special climate change-related hazards. A growing body of evidence suggests that elevation amplifies the rate of warming, with serious consequences for health: shrinking glaciers and water reservoirs; expansions to the range of mosquitoes and sandflies, and attendant increases in diseases such as malaria, dengue, and visceral leishmaniasis; more frequent flash floods and landslides; and a higher incidence of water-borne illnesses.
Perched in the Himalaya at an average elevation of 2,220m, Bhutan (the fourth-highest country in the world), is particularly vulnerable. Dengue fever, never detected in Bhutan until 2004, is now endemic during the monsoon period. Diarrhoeal diseases are responsible for as much as 15% of Bhutan’s annual morbidity. Glacial lake outburst floods have claimed scores of lives and destroyed multiple villages since the 1950s. But Bhutan, with their distinctively Bhutanese concept of Gross National Happiness, recognises that health is happiness and that development should serve the total well-being of the people.
Despite Bhutan’s susceptibility to climate change, the country has worked hard to strengthen its national capacity for climate change adaptation.
It is one of seven pilot countries in the “Piloting Climate Change Adaptation to Protect Public Health” initiative, jointly implemented by the World Health Organization (WHO) and UNDP-Global Environment Facility (GEF). The initiative works to identify and share solutions to address health risks caused and exacerbated by climate change.
The global project, financed by the Global Environment Facility’s Special Climate Change Fund, is working in seven countries: Barbados, Bhutan, China, Fiji, Jordan, Kenya and Uzbekistan. Together, these countries represent four distinctly vulnerable environments (Highlands, Small Islands, Arid Countries and Urban environments) and their related health risks.
An important innovation of the Bhutanese initiative is co-ordinating climatic data with epidemiological surveillance for climate-sensitive diseases. At six combined health/meteorological centres throughout Bhutan, cases of diarrhoea, acute respiratory infections, malaria, dengue, visceral leishmaniasis, and Japanese encephalitis are monitored and recorded, and linked with climate data and insect counts.
The result is a health system with more data on the relationship between meteorological variables and public health, greater resilience to climate change, and more advance warning for climate sensitive diseases.
The meteorological data initiative is complemented with sustainable water projects carried out by Bhutan’s Public Health Engineering Division. This aspect of the project addresses water scarcity issues and water-borne illness problems simultaneously, through the construction and installation of more than 100 composting toilets. The toilets require no water to operate, reducing demand on dwindling water supplies. They also serve to prevent human waste from making its way into water supplies, reducing diarrhoeal diseases by more than a third – significant in a country where nearly 20,000 children under five with diarrhoeal illnesses are treated annually.
The sanitation work dovetails with efforts to harvest and store rainfall more effectively, spring source revival through water catchment development, and greywater management – showing the confluence of sustainable development, climate change adaptation, and public health.
The wind never stops blowing and the river never rests - Bhutanese Proverb
Additionally, Bhutan’s government, with support from WHO and UNDP, is endeavouring to harness the lessons learned from pilot projects in order to mainstream climate change issues into government policies, strategies, and plans, and to develop action plans for climate change adaptation.
For example, the project supported the development of a Water Safety Plan (WSP) - a comprehensive risk assessment and risk management approach that includes all steps in the water supply from catchment to consumer. The WSP is being implemented nationwide and is expected to improve the safety of drinking water supplies in the country.
Bhutan’s project is an exemplar of this unique global initiative.
Chosen for their representation of common health risks associated with climate change, all seven countries in this Global Health project are working to enhance systems of early warning and early action, increase capacity, reduce health risks, and to share lessons learned.
For more information on the Global Pilot, please visit: www.who.int/globalchange/projects/adaptation and for details on the Bhutan work, visit the UNDP CCA Project Profile.
Bhutanese proverbs from The Bhutanese Guide to Happiness: 365 Proverbs from the World’s Happiest Nation by Gyonpo Tshering
© 2026 United Nations Development Programme
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