The climate crisis is already one of the main threats to public health in Europe. Rising temperatures, air pollution and extreme weather events are causing more illness, preventable deaths and inequalities, with a particularly severe impact on the most vulnerable populations. In this context, the European Union’s economic decisions are decisive in determining whether these harms are prevented or merely managed once they have already occurred.
In the coming months, the EU will negotiate the new Multiannual Financial Framework (MFF) for the 2028–2034 period. This long-term budget sets spending ceilings and political priorities for a seven-year period. Beyond the nominal increase, its design determines whether Europe chooses to anticipate risks that are already affecting population health or continues to allocate resources to managing the consequences once the damage is difficult to reverse.
Against this backdrop, Salud por Derecho has analysed the budget proposal in the report Climate action, health, and the European budget: recommendations for the new Multiannual Financial Framework, published today. The analysis shows that the new financial framework does not sufficiently reflect the real impacts of the climate crisis and maintains an approach that prioritises crisis management over prevention.
The consequences of this lack of anticipation are already visible across Europe. During the summer of 2024 alone, an estimated 62,774 deaths were attributable to heat in Europe. Mortality was 46.7% higher among women and more than three times higher among people aged 75 and over. This situation is compounded by widespread exposure to air pollution, as 95% of the European Union’s urban population continues to breathe air with pollution levels above the recommendations of the World Health Organization.
Environmental degradation also translates into increasing pressure on health systems. The European Investment Bank estimates that climate change will increase demand for healthcare services by 0.5% per year, resulting in an additional 500 million hospital stays, 120 million emergency visits and 380 million outpatient consultations. However, health remains largely absent from the EU’s financing architecture, with no systematic impact assessments and no clear mechanisms to anticipate these effects.
The European Commission’s proposal sets a budget of €1.98 trillion for the 2028–2034 period and raises the expenditure ceiling to around 1.26% of EU gross national income. However, a significant share of this increase will not finance new policies, but rather the repayment of the debt generated by the Next Generation EU programme. Moreover, once inflation is taken into account, the real fiscal space for investment is smaller than the figures suggest. From a public-health perspective, the key question is not only how much the budget increases, but whether its design enables the prevention of health risks that are already intensifying.
In this regard, the 35% climate earmark proposed by the European Commission is insufficient and weaker than it appears. As highlighted in the report, this percentage is calculated on an incomplete basis, as it excludes defence and security spending, thereby reducing its real scope. In addition, the proposal removes the specific 10% biodiversity spending target included in the current framework and dilutes the LIFE programme as an independent instrument, despite it being the only EU programme fully dedicated to climate, the environment and zero-pollution objectives. Taken together, these decisions weaken the budget’s capacity to steer investment towards prevention and the reduction of climate-related risks.
The analysis also highlights a clear contradiction. In 2023, fossil-fuel subsidies in the European Union amounted to €111 billion, while the budget continues to allow support for highly polluting activities. At the same time, meeting climate objectives is estimated to require additional annual investments close to 2% of EU GDP, and a just transition would require around €1 trillion—approximately 50% of the EU budget.
The design of the new Multiannual Financial Framework also fails to adequately integrate the social gradient of climate impacts. In the absence of specific just-transition instruments or binding equity-oriented allocations, there is a risk that EU-funded climate action will not reach those most exposed to heat, pollution and social vulnerability.
From Salud por Derecho, we argue that the European budget must be clearly oriented towards prevention. This implies increasing climate ambition, reinstating binding biodiversity targets, maintaining dedicated instruments such as LIFE and a Just Transition Fund, and incorporating mandatory Health Impact Assessments for all programmes financed with EU funds.
The 2028–2034 European budget can either become a tool for prevention and health protection in the face of the climate crisis, or entrench a model that perpetuates avoidable harm and deepens inequalities. Placing health at the centre of the Multiannual Financial Framework is a necessary condition for responding fairly and effectively to the challenges that are already affecting the lives and well-being of millions of people across Europe.
Here you can read the full analysis (or download it at this link):
