Health plans and strategies addressing climate change in Portuguese-speaking countries: a documentary analysis

Climate change represents a burgeoning threat to global health, affecting populations through direct, indirect, and social mechanisms that exacerbate structural vulnerabilities. In developing Portuguese-speaking countries, these impacts are compounded by historical challenges of inequality and institutional fragility. Within this context, the integration of health actions into national adaptation and mitigation plans and strategies becomes a central element for climate governance in the health sector. To analyze the health plans and strategies of developing Portuguese-speaking countries regarding the management of climate change impacts. This is a qualitative documentary analysis study conducted according to the READ approach. National strategic documents from five countries of the Community of Portuguese Language Countries (CPLP) were included: Angola, Brazil, Cape Verde, Mozambique, and Timor-Leste. The identified health actions were thematically categorized and classified according to governance levels (macro, meso, and micro). No documents containing specific health actions were located in the public domain for Guinea-Bissau, Equatorial Guinea, or São Tomé and Príncipe; conversely, Angola, Brazil, Cape Verde, Mozambique, and Timor-Leste exhibited greater thematic diversity in their actions. Twenty-six health actions were identified, organized into 11 thematic categories. A predominance of actions focused on climate adaptation was observed, particularly regarding basic sanitation, water quality, monitoring of climate-sensitive diseases, early warning systems, and the production of epidemiological knowledge. Only Cape Verde included an explicit mention of climate financing within the health sector. The multilevel classification revealed a concentration of actions at the macro and meso levels, with a sparse presence of strategies explicitly directed at the micro level. The analyzed plans demonstrate institutional recognition by the study countries of the climate-health interface; however, they reveal an asymmetry between normative formulation and community operationalization. The limited incorporation of climate financing and the low capillary reach of actions at the micro level indicate challenges for the consolidation of a climate governance in health that is effectively integrated and territorialized across developing Portuguese-speaking countries.气候变化已成为全球健康领域日益严峻的威胁，通过直接、间接及社会传导机制影响人群健康，进一步加剧了结构性脆弱性。在发展中葡语国家中，这类影响还因历史遗留的不平等与制度脆弱性问题而被进一步放大。在此背景下，将健康行动纳入国家适应与减缓气候变化计划及战略，已成为卫生领域气候治理的核心要义。本研究旨在分析发展中葡语国家应对气候变化影响的卫生计划与战略。本研究采用基于READ分析框架的质性文献分析方法开展。研究纳入了葡萄牙语国家共同体（Community of Portuguese Language Countries, CPLP）下属5个国家的国家战略文件：安哥拉、巴西、佛得角、莫桑比克及东帝汶。研究对识别出的卫生行动进行主题分类，并依据治理层级（宏观、中观、微观）开展分级。公共领域中未检索到几内亚比绍、赤道几内亚及圣多美和普林西比涉及具体卫生行动的相关文件；相较而言，安哥拉、巴西、佛得角、莫桑比克与东帝汶的卫生行动主题多样性更为突出。本研究共识别出26项卫生行动，归为11个主题类别。研究发现，多数行动聚焦于气候适应领域，尤其是基本卫生设施、水质保障、气候敏感性疾病监测、早期预警系统建设及流行病学知识产出等方面。仅佛得角明确提及了卫生领域的气候融资相关内容。分级分析结果显示，卫生行动多集中于宏观与中观层级，针对微观层级的明确战略较为匮乏。本次分析的计划文件表明，受访国家已从制度层面认可气候与健康的关联界面，但同时也暴露出规范制定与社区实操之间存在的不对称性。卫生领域气候融资占比偏低，且微观层级行动的触达范围有限，这些问题都为发展中葡语国家构建有效整合且属地化的卫生气候治理体系带来了挑战。