This post was revised and edited on 1st July 2025.
Innovation is expected to be our get-out-of-jail-card for decarbonization and climate adaption. It will “fight” climate change [1] and provide “new solutions” [2] for carbon neutrality.
Innovation is a Sustainable Development Goal (SDG): SDG 9 Industry Innovation and Infrastructure. The SDG aims to “build resilient infrastructure, promote inclusive and sustainable industrialisation and manufacturing and foster innovation” [3]. The SDG links innovation to sustainable infrastructure, industrialization, technology development, financing, as well as Information and Communication Technologies [4].
There are numerous initiatives claiming to be innovative such as the UNICEF Innovation30 Initiative for young climate ‘innovators’ [5].
Innovation is, then, spoken about as something concrete, positive and desirable. A solution. And integral to sustainable development in all senses of the word sustainable.
But what is meant by innovation? Is it really a shiny new piece of hardware, preferably digital? Do we know if innovation has honestly been positive and sustainable? Is it always a problem-solver?
Let’s explore the topic of innovation+climate change to understand whether innovation is working for health.
What is Innovation?
Consider a few definitions of the word from as used in climate change and health.
The Adaptation Fund gives a definition of innovation on its website.
“…creating, testing, deployment or diffusion of new, adapted or improved adaptation solutions, developed contextually and with the inclusion of the communities most vulnerable to climate change, to enable those communities to become more resilient… may include approaches, technologies and mechanisms. … (and) iterative deployment where change, learning, and new information is embraced..” [6].
The United Nations Framework Convention on Climate Change uses a definition of innovation from “The Technology Mechanism” created at the 2010 Conference of Parties (COP). The Technology Mechanism should support implementation of the 2015 Paris Agreement by “fully realizing technology development and transfer in order to improve resilience to climate change and reduce greenhouse gas emissions” [7].
The implementation arm of the Technology Mechanism is the Climate Technology Centre and Network (CTCN). The CCTN workplan to 2027 includes 4 streams of work, which includes developing ‘national systems of innovation’ [8]. Like SDG 9, the UNFCCC and the CTCN clearly link innovation with ‘technology transfer’, which then begs the question, what is ‘technology’ and what is meant by ‘transfer’.
The World Bank group is diverse but let’s get a sense of how innovation may be seen through their Climate Change Action Plan 2021-25 [9]. Innovation in this plan is found alongside words like technology, infrastructures/regulation/enabling structures, economic transformation, product and process innovations. This appears to equate innovation with hardware in an approach similar to CTCN.
Turning to a health grant-maker, the Wellcome Trust tends to equate innovation with “new knowledge” about life, health and wellbeing. “Discoveries” that “transform health in ways we can’t yet imagine… bringing together expertise from across science, innovation and society (for) equitable solutions”. Wellcome Trust see innovation as knowledge and collaboration, for a purpose [10].
Different Starting Points
All these organisations define innovation from different starting points.
The Adaptation Fund takes context as their starting point so that innovation is context specific and could be any or all of a hardware (physical tools or structures), software (processes, knowledge, skills, management approaches) or ‘orgware’ (ownership and institutional arrangements pertaining to hardware and software).
In contrast, the CTCN appear more focused on hardware, and transporting hardware between different places (‘transfer’). However, when delving further into the CTCN workplan, their technical assistance encompasses more than pure hardware. For instance, technical assistance in the area of green buildings encompasses capacity development, knowledge sharing, nature based solutions and ecosystem-based approaches as well as digital technologies to support off-grid energy systems. That is, CTCN technical assistance brings in the need to consider methods and processes for placing, using, and gaining value from, hardware. The World Bank appear to share this view, with emphasis on enabling environments including financial systems.
Wellcome Trust’s starting point seems to be process and ‘how’ to generate innovation rather than a piece of hardware per se. For Wellcome, the purposes of innovation are the pursuit of equity and commercialisation. In other words, innovation is an income-generating activity, that can result in a saleable commodity (a product or productized service) that is sold for commercial gain, or at the very least widespread diffusion.
And this sets the word ‘innovation’ apart from terms like change, invention, experiment, and creativity. Because “invention describes the first emergence of a new idea or product, (but) an innovation can be seen as the initial commercial implementation of a new idea as well as the economic optimization of knowledge utilization” [11]. These new ideas and use cause change, which may be rejected or prevented by existing stakeholders, infrastructures, systems, and processes.
Successful innovation, in other words, creates winners and losers.
Comparing and contrasting these superficial perspectives makes it clear that there is no single definition of innovation. Rather the innovation is understood in very diverse and complex ways.
A useful typology to deal with this complexity is given by Phillips and team [12] who categorise discourse about innovation into either an instrumental, strong, or democratic paradigm.
The instrumental paradigm is goal-focused on developing “more effective, efficient or sustainable solutions that can help address market failures, reduce public spending, amongst others” within existing power structures and relations of production. Universal neo-liberal market values, political hegemony, and corporate agendas aim to preserve existing power relations. Winners and losers are ignored in favour of defining success in terms of the “function of a project”. This appears to describe the CTCN perspective on innovation. Overall, the instrumental paradigm is dominant in discourse about innovation.
In contrast, a democratic paradigm aims to meet universal human needs by focusing on innovations that increase participation and empowerment of communities. Empowerment should create more access to resources and strengthen sociopolitical capacity. The democratic paradigm aims to transform power relations by means of socially-just, people-centred innovation. Rather than accepting existing power relations as simply a fact of life, innovation should turn its attention onto the system-generating injustices and overtly seek to change these.
Midway between instrumentalist and a democratic paradigms is a “strong paradigm”, in which innovation is understood as institutional change or transformation within complex adaptive systems. Institutions must change, stakeholder engagement is essential, and both of these must be done together with marginalized and excluded groups. This approach does not, though, unpick the causes of marginality and exclusion. This approach sounds a lot like the Adaptation Fund and to some extent World Bank and the Wellcome Trust since the paradigm also includes innovation “ecosystems” and connection between social actors through “supportive environments [12].
Responsible Innovation
While innovation is expected to be our get-out-of-jail-card for decarbonization and climate adaption, what if innovation is causing the climate forcing, increasing carbon emissions, and reducing our window for a livable future?
The current business models that develop, finance, and diffuse new health technologies, for instance, are “increasingly inequitable and unsustainable” [13]. There is now a common narrative that digital solutions are the only way forward and that using data will help save lives. But digital solutions raise significant ethical and social risks, especially in those operating with artificial intelligence (such as privacy, bias, discrimination) [13]. The energy required to store digital data and use it is around 4% of global emissions [14]. The production and disposal of digital end-user devices and wider digital are destructive on local ecosystems, especially for low-middle-income countries where many devices are dumped. These issues are rarely included in current impact analyses of innovation.
Responsible Innovation [13; 15] is an approach that adopts a system-level perspective to focus attention on five critical value domains for health systems. It is based on a life-cycle approach (cradle-to-grave) but could be adapted for cradle-to-cradle life-cycling for genuine circular economies.
The five domains are:
- ‘population health value’, which proposes that innovation should increase our ability to meet collective needs whilst tackling geographically specific health inequalities. The moral and ethical challenges of innovation should be assessed early and often, and exploration of exactly how the innovation package will reduce health inequities.
- ‘health system value’, which highlights whether the innovation in question enables inclusiveness, is responsive to a clear health system need or challenge, and whether the care required is compatible with health system sustainability.
- ‘economic value’ domain, which essentially proposes frugality. Will the innovation deliver more value for more people using fewer resources than current practice?
- ‘organisational value’, which asks what business model is being used to produce the innovation in question, and exactly how does that model provide more value to the innovation users, purchasers and wider society.
- ‘environmental value’, which insists that negative environmental impacts of health innovations have been identified upfront and mitigated or abolished throughout the entire lifecycle, particularly end of life, and clarity on how any innovation contributes to a circular economy of materials.
This framework crosses the paradigms considered earlier and has a clear focus that innovation should and must address social needs, reduce health inequities, and contributes to the common good.
Power relations are still largely ignored so the model cannot be considered democratic. However, it does emphasize participation from diverse perspectives in design, testing, implementation, and possible scaling, as well as transparency and accountability about the goals, processes, outcomes, and genuine impacts of innovation.
Given the financial pressures on health systems, and the tight fiscal space available for mitigation and adaptation that must co-exist with the need for health equity, taking an overtly moral approach to climate innovation could benefit healthcare.
But for genuine transparency, accountability, and impact, evidence is critical.
Evidence, evidence, evidence
The field of climate change and adaptation is rife with greenwashing to the extent that legislative action, most strongly in the European Union, is now in force.
How do we truly know if an innovation is achieving intention?
Simply by seeking the evidence in context and over time.
Ultimately innovation is a not one thing but a package of hardware, software and orgware. Any innovation package operates within dense networks (complex systems) of relationships between the implementing organization, resource teams involved, the health system, existing material infrastructure, and wider socio-cultural and economic, geographic, and ecological environments. Change in any one aspect of these can change everything.
Proof of concept for an innovation package is usually tested in very specific locations, in a specific socio-culture, by specific organisations, with specific financial and human resources. I’m overusing the word ‘specific’ because if an innovation is taken up by other organisations in other places, these organisations and locations will not be the same as the test. That’s why proof of concept by itself is meaningless: proof of concept in context is critical.
Many solutions for climate mitigation and adaption in health systems currently exist, many of these have been developed in high resource settings and cannot be translated to the specific resource, governance, and ecological contexts of low resource East Asia & the Pacific.
Proof of concept in context is the first evidence.
Commonly we see a proof of concept jump to immediate scaling. However, rapid two-stage piloting is more realistic. This means moving from establishing proof of concept in context (where an innovation package is tried out in specific conditions, with no expectation of success) to a second stage: proof of implementation in context.
Proof of implementation tests how an innovation package could be implemented under routine health system conditions.
Last, there should always be proof of performance in context. Any innovation package must perform in context. Not least because the sheer scale of financing said to be required for mitigation and adaptation must be underpinned by credible and robust evidence of effectiveness for climate, nature and health in the long run.
And so
When health systems engage with climate finance, we need to make the argument that innovation is not limited to a piece of hardware (the dominant instrumentalist paradigm) but is, rather, a package that includes people, organisations, processes, and systems.
We also need to argue that innovation and its sister, scale up, has moral dimensions that should be incorporated into innovation processes and systems. This includes systematic consideration and evaluation of relevance of the innovation package to human and ecosystem health needs, inclusiveness, appropriate financing, and value to the health system-at-large.
References
[1] International Monetary Fund imf.org/en/Publications/fandd/issues/2021/09/bezos-earth-fund-climate-change-innovation-levin#:~:text=Three innovation opportunities alone—direct,reductions between 2030 and 2050.
[2] Hough et al (2024) Supporting Decarbonization of Health Systems—A Review of International Policy and Practice on Health Care and Climate Change Current Environmental Health Reports https://doi.org/10.1007/s40572-024-00434-x
[3] Global Goals https://www.globalgoals.org/goals/9-industry-innovation-and-infrastructure/
[4] United Nations https://sdgs.un.org/sites/default/files/2023-02/2023HLPF_SDG%209%20EGM_Concept_Note_1.pdf
[5] UNICEF https://www.unicef.org/innovation/climate/innovation-30.
[6] The Adaptation Fund https://www.adaptation-fund.org/apply-funding/innovation-grants/
[8] UNFCCC https://unfccc.int/ttclear/tec/workplan
[9] World Bank Group Climate Change Action Plan 2021–2025: Supporting Green, Resilient, and Inclusive Development
[10] Wellcome Trust https://wellcome.org/news/generating-evidence-and-solutions-our-vision-climate-and-health
[11] Kelly et al (2017) Promoting Innovation in Healthcare Future Healthcare Journal https://doi: 10.7861/futurehosp.4-2-121
[12] Phillips et al (2024) Shifting The Paradigm: A Critical Review Of Social Innovation Literature International Journal of Innovation Studies https://doi.org/10.1016/j.ijis.2023.08.003
[13] Silva et al (2018) Introducing Responsible Innovation in Health: a Policy-oriented Framework Health Research Policy and Systems https://doi.org/10.1186/s12961-018-0362-5
[14] Rivard et al (2023) Thematic Analysis Of Tools For Health Innovators And Organisation Leaders To Develop Digital Health Solutions Fit For Climate Change BMJ Leader https://dx.doi. org/10.1136/leader-2022- 000697
[14] OECD On Track for 6.8 Million Years of Continuous Movie Streaming https://oecd-opsi.org/blog/digital-decarbonization
[15] Infieri infieri.online/en/home/#section-what-is-rih