Ep73 Planetary Health and Climate Finance: AIIB’s Vision, ft Vera Siesjö, Asian Infrastructure Investment Bank

Explore the powerful links between climate, health, and development. Hear from Dr Vera Siesjö how the Asia Infrastructure Investment Bank is tackling health challenges in Asia and beyond. Discover how climate change, digital innovation, and infrastructure investment shape health for millions. Learn why a healthy planet means healthier lives.

REF: INFRASTRUCTURE FOR PLANETARY HEALTH

ABOUT VERA: Vera Siesjö is a global health leader with nearly two decades of international experience advancing planetary health, health systems transformation, and sustainable development. At the Asian Infrastructure Investment Bank (AIIB), she leads the Bank’s thought leadership agenda at the nexus of health, nature, climate, and inclusion—helping shape strategies that connect human well-being with the resilience of our planet. Before joining AIIB, Vera held leadership roles across leading international organizations. As Advisor to the Swedish International Development Cooperation Agency (Sida), she oversaw health programs across Asia, North Africa, and the Middle East. She also served as Senior Program Officer and founding team member of the Defeat NCD Partnership at UNOPS in Geneva, and as Director of ACCESS Health International, a global think tank and implementation partner working to accelerate health systems reform worldwide. Throughout her career, Vera has led pioneering initiatives in health financing, climate and health integration, digital innovation, and people-centered healthcare. She has contributed to the creation and management of key global collaborations, including the Center for Health Market Innovation and the Joint Learning Network for Universal Health Coverage. An entrepreneur at heart, Vera co-founded E-Pharma and continues to advise several health sector startups driving innovation and equity in care. Vera holds a Doctor of Psychology from UP and a Master’s in International Public Health from the University of Sydney.

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Transcript

***PLEASE NOTE: The text is an automatically generated transcript and may contain errors. For accuracy, only rely on the original recording.***

Ep73 Planetary Health and Climate Finance: AIIB’s Vision, ft Vera Siesjö, Asian Infrastructure Investment Bank

JOSEPH JACOBELLI: Good morning, good afternoon or good evening wherever you may be listing from. Welcome to episode 73 of the Asia Climate Finance Podcast. It’s great to have you join us for a fascinating episode on a not-so-frequently discussed subject in the context of climate finance. Today, we’re diving into the vital intersection between climate, nature, and health—an area many of us rarely consider when we think about sustainable development or infrastructure.

So in the last episode we discussed nature’s infrastructure with two senior representatives from the Asian Infrastructure Development Bank or AIIB. Today we have a second episode with AIIB but discussing global health in the context of climate finance.

Our guest is Dr Vera Siesjö, pardon my poor Swedish pronunciation! Vera is a leading global expert whose career bridges global health, climate resilience, and development finance. We’ll unpack what “planetary health” really means and why it’s not just about saving polar bears or distant rainforests. Vera reveals how climate change, pollution, and nature loss are already shaping health outcomes across Asia. And how new strategies aim to tackle both health equity and climate risks at once.

We’ll hear fresh perspectives on AIIB’s evolving role in health. This includes landmark projects in Indonesia and Brazil. We also discuss how digital transformation is connecting even remote communities to vital health services. You’ll also get an inside look at how multilateral development banks are seeking to break old silos and unlock new funding streams that make healthier people and a healthier planet possible, together.

It’s an episode packed with real-world examples, bold ideas, and practical takeaways on advancing health and resilience in our changing world.

As always, please do reach out for comments or if you have topics or guests ideas. Our email is as at the top of the show notes.

Enjoy the discussion.

Hello, Vera, thank you so much for your time this morning. How's everything? Are you in Beijing? Thank you.

VERA SIESJÖ: Joseph. It's a pleasure to be here. Yes, I am in Beijing, sunny Beijing.

JOSEPH JACOBELLI: Nice. Very jealous. I haven't been there for a while. I'm overly due. So once again, thank you so much for this. This is very special because it is a topic that we haven't tackled, about climate health.

But before we get into the topic, could you tell us a little bit about yourself? Maybe a passion or a pet project, something beyond your formal bio, which is in the show notes?

VERA SIESJÖ: Absolutely. So I am someone who has had, I think, close to two decades now, I'm getting older of working in what I used to call the global health space.

But hopefully as we will get into this podcast, I call myself more working in the planetary health space these days. And so I have been working mostly in low middle income countries and really seeing and trying to see how we can assure equitable and accessible healthcare for people who have the hardest access to healthcare.

And there are unfortunately many millions of people still in the world. And I think maybe something that brought me onto this paradigm shift from global health to planetary health was that in 2013, I was brought to the Philippines actually to work with mayors and governors in Central Luzon, which is the Central Islands of the Philippines.

And if you remember, this was a year that one of the most devastating typhoons hit mainland Philippines. It was called typhoon Hayan, right? And I came there to work with some organisations, including the UN. And what I was seeing on the ground was absolute devastation, healthcare facilities, schools, roads, were completely wiped away. And as we were trying to think with this collaborative of mayors, how to rebuild sustainable and resilient health infrastructure, it really struck me that what we are facing today in global health is not only the threat of diseases or the lack of nutrition and so forth.

But it is increasingly the effect of climate change and nature degradation. And that I think really made me realise that we need to focus on what actually determines our health and what would be the biggest global health challenge of this century. And I think without a doubt, I would say that is climate change. So that's what brought me into this rethinking about how do we need to tackle this? And I think we have come a long way since 2013. So hopefully I can share some of that insight.

JOSEPH JACOBELLI: Right. So now you're with the Asia Infrastructure Investment Bank.

So could you give a high level description on how a kind of infrastructure focused MDB, although I know it has the infrastructure word in it, but it's not necessarily, I mean, it's a kind of broader definition of infrastructure, I guess. How does it, how does AIIB work in the area of health? What is the connection?

VERA SIESJÖ: Yeah, so we are sort of the newest multilateral development bank in the world. We were established about 10 years ago. So we celebrated our 10 year anniversary this year.

And our core mandate is infrastructure for tomorrow. So really building resilient infrastructure and water, sanitation, urban development and so forth.

But I think COVID kind of catapulted us into thinking about the healthcare space. And during the actual pandemic, we set up a crisis recovery facility that enabled a lot of lending to countries to really cope with the consequences of COVID. So I think that this was the outset of how we started to think about this and we've seen enormous demand in a lot of our member countries where there are huge health infrastructure gaps.

That need to be met. And that's how we came to launch our first health strategy and the only health strategy from any MDB that has been launched after the pandemic. And that was last year, in 2024. So we have to date, I think, almost 5 billion dollars in lending for health projects.

And very proud to say that we are collaborating with a lot of the other multilateral development banks in this space, so really moving forward in that space now to tackle what are some of the greatest challenges specifically in this region, but beyond as well.

JOSEPH JACOBELLI: Great. Just to put a little bit of colour on that, could you walk us through maybe one of AIIB's health investments today? Maybe we can talk about the largest one, which is I think, almost a billion dollars into the Indonesian Health System Modernisation Project. And also at the same time, could you explain a little bit on what measurable outcomes it is delivering?

VERA SIESJÖ: Yeah. So, in 2023, we approved a multi lending facility together with Islamic Development Bank, Asian Development Bank, and the World Bank. And this was about 4 billion dollars, so the Indonesian government for a modernisation of the health system in Indonesia. So this was particularly focusing on primary healthcare.

And for anyone who is not very familiar with health in general, I always say that primary healthcare is where we should spend our core financing because it enables prevention and early detection of diseases and really allows us not to reach the really high healthcare expenditure at tertiary level.

As soon as you step a foot into a hospital, your cost has multiplied. So it was really about focusing on primary healthcare. Indonesia is a very large country with a very large population and geographically very dispersed with a lot of different islands.

So this was really focusing on.

Helping the Indonesian government to strengthen their primary healthcare facilities. And we're talking about thousands of healthcare facilities here, tens of thousands of healthcare facilities. And we specifically focused on, I mean, a lot of these healthcare facilities had a lack of capacity and trained staff. It had lack of capacity of technologies and digital systems in place. It has a lot of different issues, but our specific component of the work was really focusing on the medical equipment and technologies at the healthcare facilities. And that is also

the interesting part about this project was one, we managed to collaborate with different multilateral development banks in a very coordinated manner, right? And that facilitates both the work, for us to learn from each other throughout the multilateral development community.

But it also allows for a member country to have a more systematic approach for their lending and a more integrated approach. So I think the important component, and I think what was really critical about that project was, A, it was a systems approach. It was really about the healthcare system.

It was really providing an overarching enhancement of the health system. So that was critical. The second part was it was really looking at tackling equity gaps. Now a lot of healthcare facilities are in hard to reach areas, and those are so many times where the populations have the least access to services, the lowest level of actual ability to reach any type of diagnostics and equipment and so forth. So it was really looking at the systematic approach. So I think that was the real added value. So it was really about the scale. It was really about also the infrastructure focus, really trying to look at what was missing.

There was a huge analysis conducted first to really identify the gaps within the healthcare system and then jointly work with different development banks in a more integrated approach where we can leverage technical assistance, we can leverage financial lending capacity and so forth.

So it's also a more synchronised way for our members to not have triple, in this case, administration burdens.

JOSEPH JACOBELLI: and, sorry, the second part of the question was what measurable outcomes have you seen this investment or this facility delivering so far?

VERA SIESJÖ: So this was a project that actually spans until 2029. So it has just been initiated this project.

So it's really hard to measure any kind of effects right now. But what we see is improved, what we want to see, improved access in terms of patients, improved access in terms of clinical and laboratory analysis and so forth. So basically having, or someone in Indonesia having increased access to healthcare services and improved technical capacity to conduct that in a qualitative way.

JOSEPH JACOBELLI: Right. Got it. So it's still early days. Basically it's great. Now talking about a specific report that AIIB recently published, the Asian Infrastructure Finance Report on infrastructure for planetary health, which focuses on integrating nature, climate, health priorities into every infrastructure investment.

Can you speak to how this approach could actually unlock financing for planetary health?

VERA SIESJÖ: Yeah. So, I think I maybe want to go back also as we started this conversation, I mean, if we look at the overall mortality and morbidity globally, so what people die from or what do they get sick from? We see that almost a third of the total burden of disease or the total burden of mortality globally is due to known environmental factors. So that is, having access to clean water, having access to clean air, having access to education and so forth. So it's really important to, first of all, understand, the real threats of climate change and nature degradation to human health.

We have almost, and air pollution right now is the largest environmental cause of disease and death. And we see that 90% of the air pollution related death occurs in low middle income countries. So I always say in a way that the importance is to understand maybe our big mistake when we started to talk about climate changes that we envision this

polar bear on a melting ice shack somewhere in the North Pole. But what we should have placed at the centre of that conversation is actually our own survival and our own health and wellbeing. And that's where we're seeing right now. So we are seeing this enormous change in what we actually get sick from and what we die from.

So I think with that, we really try to see how are these interlinkages with climate and health and nature and what can we do from an infrastructure investment bank approach. And the way that we have approached infrastructure many times is really to mitigate the excess death or the harm to the environment and so forth.

But we really haven't looked at what is the upside, like what can we do to maximise health outcomes? What can we do to maximise nature conservation, restoration or climate mitigation, adaptation through infrastructure investment? And that's what we really try to show with this report.

To say that there is such an upside and we do have much better knowledge. We have progressed with our scientific findings in the last 10 to 20 years. And so now we have much more knowledge on how we can actually build up that. So, and that really has to do again with bringing back this equity perspective I spoke to before.

Because we know that many of the climate hotspots, obviously we're sitting on this Asian climate podcast that really looks at Asia. And we know that the vast majority of the climate hotspots, or many of them are in Asia. We also know that the people who will be affected by climate change are people living in poverty.

Women, children, elderly populations. And these are also the ones that are hardest affected by the health consequences. So that's what we really try to bring into this. And to say that let's use health as an argument for climate change or climate change investment. Let's use

climate change as a way to attract more financing for health. And I think there's a huge upside on how we can change that pendulum to think more holistically and to try to break these silos between what are the realms of climate change investments and financing.

JOSEPH JACOBELLI: Right. But in practical terms, Vera, how is AIIB working to bridge the financing gap? Your report highlights that less than 1% of multilateral climate funding addresses health directly. So how are you bridging that?

VERA SIESJÖ: Yeah, we have started to do a couple of interesting things that I think are worth mentioning here.

So one was that we launched last year, we launched a new policy-based lending tool. So it's called a climate policy-based lending instrument. So it allows us to provide financing to member governments for them to implement or to support their implementation of a set of different climate actions.

And when this was set out first, it was looking at climate change. But then we started with the lens also of this report, started thinking a more holistic way. So one specific project that we have in the pipeline now is with Brazil. It's almost a 1 billion dollar lending to the Brazilian government where the Brazilian government has incorporated both climate mitigation and adaptation measures, really related to both carbon markets, facilitating private investments into the climate space, but also incorporated health and climate angle. So we are looking at a new set of policies that they are now looking at both for the adaptation and mitigation of their national health system and this is probably, if not the largest public healthcare system in the world. It's up there and it covers services to almost 90% of the Brazilian population. So this is a way to incorporate, we're using the climate policy-based lending tool, but we are incorporating also health components.

And I think likewise with, frankly, with any project, you could really look at how do you optimise and how do you look at specific projects. We had one park restoration project in Pakistan where we did an analysis of not only what is the return on investment for the projects in terms of increased real estate prices, but really looked at what are the overall health outcomes? What are the reduced hospital visits? What is the increased air quality? What are the flood mitigation measures that are resulting as a result of this project? So I think there are many ways that we are doing it.

And I think we should really think about how do we incorporate and think more holistically in these types of projects moving forward? I always say what is good for the planet is good for us and the other way around. And I think we need to be able to carry out that thinking throughout all of our projects.

JOSEPH JACOBELLI: I was going to move on to the investment strategy and finance related questions. Before I do that, I'm still a little bit unclear on something Vera. So I mean, you're a leading global health expert, but I still don't fully understand how that marries to measuring the effect. I mean, obviously, less people dying means the workforce is larger and so on. So I see the obvious. But as a bank, when you are trying to allocate the funding do you have some kind of data points that you use to measure or is it just part of a bigger and more global kind of approach to things if you know what I mean?

VERA SIESJÖ: I'll try to answer as I think I understood the question, but in terms of the projects, if we optimise most of our healthcare projects are sovereign backed financing.

So these are governments that are trying to invest in strengthening public healthcare systems in some way, shape or form. Right. Although importantly, I think, and hopefully we can touch upon that, the private sector is a huge part of the service delivery in Asia. But when we do this, when we look at supporting governments to expand healthcare coverage and healthcare services it is extremely important to look at the root causes.

What are the root causes of a lot of these diseases, as I was saying, again the return on investment, a lot of these projects, healthcare is extremely costly. And if COVID wasn't the greatest example for how costly healthcare can be and when we don't take care of our public healthcare systems, governments now realise that, of course, when we get the next pandemic, we would need to understand better how do we cope with these consequences? And equally, as you mentioned, it's also workforce, but it's not only about workforce. It also touches upon if someone gets sick. That doesn't only affect that person, but it affects a whole set of family members who need to care for that person when there is no functioning healthcare system. And I think our point is really to bring across, as our members are facing multiple challenges, they're facing lack of access to quality services. They're lacking access to basic infrastructure, whether that is road or transport.

They're lacking many times real measures for climate adaptation and mitigation. And what we are sort of proposing is to think about this, like how do you think about this in a more integrated way where you can really look at a combined set of effect and return on investment. If you build a road, if you can maximise the safety of that road and minimise the carbon footprint of that road and maximise nature conservation restorations and surrounding areas, you can maximise the profit from that road.

So it's really, it kind of needs a paradigm shift in the thinking. We can't think in silos. A road is not only a road like we see a road is actual traffic accidents in Asia are many times the second leading cause of death between people between 15 and 30 years old.

These are enormous societal costs in the end. So, we need to think about, it's not as a good thing to do, but as a real investment. And I think that's where, many times we need to shift to thinking that health is an expenditure. Health is an investment. When you invest in people, you have a functional workforce.

You don't have to incur high out-of-pocket expenditure and cost downstream, and really expensive healthcare bills or even more expensive consequences of pandemic spreads and so forth. So I think that's where we are really trying to bring in a larger set of thinking around this type of planetary health thinking. If you want.

JOSEPH JACOBELLI: The messaging of planetary health thinking is very complex, right? I mean, it's not an easy message to communicate as the world today is all about simplistic messages over 30 seconds in TikTok. So to communicate that. Like you mentioned, I love the road example because if you think about the, almost like an ecosystem? Everything that is related to the road, the environmental impact of building it, the safety aspect, the safer it is, obviously there is an economic cost when there are accidents.

So the communication of that must be very complex, right? I mean. Do you find that, is that a challenge?

VERA SIESJÖ: I think it can be a challenge, but I think in the end it sorts of boils down to really thinking about planetary health as the health of human beings and the natural systems that we depend on.

So it's really about how do we maximise that? How do we make sure if we have a sick planet, we will have sick people? And sick people cost money. They can't work; they're incurring a lot of financial burdens on countries. So I think it's that paradigm shift.

We can't have healthy people on a sick planet. And try to move away from that. And Joseph, the thing is that we are only at the outset of this, we are seeing escalating consequences of extreme weather events, rising heat temperature, increased floodings.

VERA SIESJÖ: All of these consequences of climate change are causing absolute havoc in the health community. And again, it is the most vulnerable that are most affected. If we have children under the age of five or infants, those are the ones that run the highest risk of being affected by these consequences or elderly population where we now have increasing in a lot of Asian countries and beyond. So it's really about protecting the most vulnerable, providing equity and thinking in a new way about how we do things. And really try to see how we can optimise things, like let's not stay with the current paradigm we are. I'm the only scientist within the bank, and I always say we have to operate at the speed of science and not at the status quo. We have so much evidence now on what can be done and how we can do things differently, and I think we need to move in that direction.

JOSEPH JACOBELLI: The reason I wasn't being cold-hearted about the whole communication thing is that there are so many priorities around the world and then if you think about climate related priorities and global health as far as I'm concerned personally, it's like the foundation. I mean if we're dead, we're not going to be very useful to anybody. Right. But at the same time, it kind of gets lost in the myriads of things out there because of communication. I mean, that's what the Asia Climate Finance Podcast is trying to do. To help people raise awareness on some of the key trends and key issues. But I do think that global health and communicating planetary health is definitely very challenging. But anyway, I won't go on about it, but education is something of a pet project of mine.

Moving on to a couple of other questions. Digital health is growing at almost 22% per year in Asia. Yet AIIB focuses on hard infrastructure. How do you balance traditional health infrastructure needs with emerging digital health opportunities?

VERA SIESJÖ: Yeah, so first I want to challenge you on that. I think we are very much a part of our DNA as a bank is really about digital transformation. So that is very much core of our thinking that cuts across all different sectors. But I think the importance here is, I've worked a lot in the digital space, and we are really trying to see here at the IB how we can leverage

the innovations that are happening in the digital space and how we can really bring that forward to kind of leapfrog in terms of accessibility to healthcare services, improve access to information and so forth. But I think that there are different levers here. One is if you don't have the basic infrastructure, actual internet services. None of these tools are actually useful. So, one really great project that we had recently in Indonesia, we actually supported the Indonesian government with a launch of satellite. And this satellite is looking to provide internet connectivity not only to healthcare facilities.

I think over 10,000 healthcare facilities are being provided internet access through this satellite, but also educational facilities and so forth. First of all, we need to have the basic infrastructure, that's really important. Without that, there's no equity.

JOSEPH JACOBELLI: That's a good point.

VERA SIESJÖ: Second part is that we have so much now, and I think COVID again was a great sort of proof of concept of what we can do and how we can accelerate many people who have the worst access to healthcare. People who live really far away from healthcare services and providers, and telehealth and different health tools have really enabled us to provide a better and more equitable access to services.

So that's really important and I think for us as MDB it is really about strengthening that digital health infrastructure. So it's very much part of what we do and really aligning with members national strategies on how to build up and provide better access to these services.

So, very much part of what we do and what we want to do and how we want to support member states.

JOSEPH JACOBELLI: See, I had a misconception. So there's a lot of misconceptions out there. Even I had a misconception because AIIB is working in hard infrastructure.

And another question still related to the finance side of things. With governments broadly funding something like two thirds of Asian healthcare, how does AIIB leverage its AAA credit rating to crowd in private investment for health infrastructure projects? And here we can talk about the private sector involvement and catalysing that.

VERA SIESJÖ: Yeah, so I think this is the really good part about having, under the same roof as an institution, both private sector lending and public lending.

So, we very much recognise that there's a need to crowd in more private financing to increase access to services in health. So we can do that in different ways. And we have provided both lending to PPP like public, private people initiatives that are looking at specific hospital facilities and so forth.

But we also provide lending to different equity firms that are looking at private sector health investments. So that's also one part of what we do, but it's also about de-risking financing because in some of the areas we see that we have an additional leverage where we can de-risk certain financing.

Also working together and co-financing with other MDBs that allows governments and the private sector to have more confidence in going into certain investment areas. So that's another way that we can also crowd in more financing to the private sector space.

And now we're seeing also an increase for decentralising or providing more regional distribution of actually production of medicines, production of certain healthcare equipment and so forth. And that was also a consequence of COVID, where we saw that a set of countries produced almost 80% of the total pharmaceuticals and very critical healthcare equipment.

So now we can also look at how we can allow for more private financing to build up manufacturing plants in different members in the region that could have better access to both pharmaceuticals and healthcare equipment. So, very much part of our DNA and we are hoping to accelerate this in the coming years as well to crowd in more and more private financing.

But also, of course, importantly thinking about the equity aspects. We are not looking at building healthcare facilities or hospitals that are not providing accessible. And then by accessible I mean financially accessible services. So also important to think about that these loans go into areas of investments that allow for more equitable distribution and access.

JOSEPH JACOBELLI: Vera, if I could ask, just to connect the economic case for nature investment with tangible health outcomes, could you maybe share some actual examples and put a little bit of colour on this? Share examples of how AIIB is actually financing these natural health infrastructure projects.

VERA SIESJÖ: So we are in very early days of this, and I think nature finance, to be very frank here, it's an area that we are all trying to get more financing to. And we have a couple of projects, one project in China where we are providing lending to private banks that they are then providing lending to smaller SMEs and so forth that are specifically looking at nature financing.

So this is one way to look at how we actually can provide more financing to nature. I think that is where we should start. Just providing financing to nature is hard enough. And the way that we incorporate what you call ecosystem services into our project. So what is the actual benefit of having intact nature or financing nature and what are the health consequences? We are seeing projects, for example, where we are looking at mangrove restorations, for example. We know that that has improved outcomes for health, both in terms of mitigation of actual floods.

It has a huge, as three times the carbon capture to normal forest. Many of these countries and members that we have are struggling with air pollution being something very critical. So when we invest in nature, we provide benefits to health. But we are in the very early days of really thinking about how do we bring these projects forward?

We are now very much looking at how we can also crowd more private financing for nature. We are collaborating with a different institution and think tanks to put out a report on this now by COP30. So this is very much part of a progress. And the previous flagship report we published last year was on nature's infrastructure. So really thinking about how we can invest in nature's infrastructure and that being maybe our most critical infrastructure. So I think I will be humble to say that we are early days with this, and we are really trying to get financing to nature now.

Knowing of course that the benefits for human health will be substantial.

JOSEPH JACOBELLI: Yeah. Again, I missed the point, the very important point you made earlier that we are still talking about early days and because we're still talking about early days about this, I've got a few questions about typically I, in the podcast, I only have one question about the outlook. What do you think about the future?

But in this particular case, I have actually three separate questions. One is AIIB's health strategies emphasises addressing health disparities, as I mentioned a couple of times already, and climate induced health conditions. Which specifically health challenges in Asia do you see as most urgent for infrastructure investment now and over the medium term?

VERA SIESJÖ: So, I think there's multiple to start with unfortunately. But I think in what we are seeing right now is that we are seeing shifts in terms of the needs. We have a, what you call it, almost like a triple burden of disease. We see that there is an increasing demographic shift in the region.

We are having more and older people in the region, which is a whole new set of need for access to services that are not being met. So that's a huge part that I think we have now, I think only in China, we have almost over 300 million people over the age of 65. And they have their own unique sets of needs in terms of healthcare services.

So that is a huge part. And this is actually a shift we see in most Asian countries as well. We have an elderly population that will have their own specific health needs. I think secondly, I think we still face critical health infrastructure gaps. We don't have enough healthcare facilities to serve the population.

So, expanding access to healthcare facilities and services is still very critical. I think third is what I've hopefully cut across throughout this conversation is the threats of climate change and nature degradation. This will, without a doubt, be the main challenge for this century and

it affects all of our organs in our bodies from toxins in our water and our soil. Everything from lead to PFAS in water and so forth are unfortunately resulting in both cognitive and as well as physical consequences. So I think that is very much part of what will happen.

We see increases in vector-borne disease and waterborne diseases as a result of climate change. We see injuries as a result of effects of extreme weather events and so forth. This will only increase as we go along. I think the fourth maybe is non-communicable diseases. And this is related, so it's pretty much the top of the pyramid of non-communicable diseases.

We have cardiovascular diseases. We live longer now, so we have more of these diseases as we grow older. But we see a lot of these diseases increasing rapidly, and we do not have access or proportional access of health systems and infrastructure to deal with this.

This is everything from heart diseases to cardiovascular diseases, to diabetes and so forth. And that will be an enormous challenge moving forward. And why it's also an enormous challenge is because before if you had a communicable disease, maybe you would be cured or you would die.

But non-communicable diseases are chronic and long-term diseases. So you need to be medicated and treated many times for a lifetime. That costs societies a lot of money. So that would also be an enormous shift as people live longer and as we see increased economic growth in a lot of countries and access to services.

I will probably stop at those, but I think these are some of the main challenges that we will face looking forward in this region.

JOSEPH JACOBELLI: Yeah, I think that especially the first one, I mean, I don't think any of these are fully well understood by general audiences, especially in the financial field.

But I think that the demographic shift is something that has surprised a lot of people. Because, I mean, for a long time we've been talking about Japan, recently we've been talking about Korea, and all of a sudden, China's popping out in some other countries around the region, which was quite surprising.

So it is a massive challenge.

Vera, I'll ask you a bit of a tough question now, which is AIIB is going to deploy something around the line of 75 billion dollars by 2030 or so. Roughly speaking, is there any rough idea on what potential proportion of this could support health related infrastructure? And if so, how would you measure the success beyond the traditional financial metrics?

VERA SIESJÖ: Yeah, so I mean, our health strategy is very new. It was launched less than a year ago, so it is hard to put a number on what proportion of our entire portfolio will be for health.

But what I'm hoping or what we are hoping to see is that we will have more of our traditional financing as well. Really providing improved health benefits. I mentioned roads in the beginning, renewable energies, huge benefits for health. I'm sitting in a city here in Beijing that has reduced air pollution by almost 60% in the last 15 years. That has dramatically improved health outcomes in this city. So I think what.

JOSEPH JACOBELLI: I know that from personal experience, believe me, going to China in the 90s, in the 2000s was not fun. 

VERA SIESJÖ: Yeah. I mean, going to Beijing. Yeah. And, and that was a real decision I had to think about, bringing two small children to Beijing.

But so I think what we really want to see is that we can have a catalytic effect in other sectors that really improves health outcomes. And I think that comes from bringing in this paradigm shift in our thinking to really think about health as something that can cut across all sectors or as we call this health in all infrastructure.

So I think that will be critical. And I think in terms of as you mentioned sort of results, it's really in the end to see improved health outcomes, improved access, equitable access to healthcare services, to see improved quality of healthcare services, to be able to see improvement in terms of leveraging digital technologies, as I said, but also in the way that we can really mobilise more private capital into the healthcare sector.

So I think all of these will really be a way for us to show that we are going in the right direction. But we are also very much a bank that listens to our clients, which is our members and what their needs are, and what do they need? So it will all be based on what are their needs and how can we facilitate them to really improve their national health priorities.

JOSEPH JACOBELLI: Got it. One last question looking ahead. So there's something called the development banks working group for climate and health. Looking ahead, how might AIIB's development banks working group for climate and health change how multilateral development banks approach health and health financing globally?

VERA SIESJÖ: Yes. This is actually a group that came out of a joint coordination after COP 28. And with the real intention of trying as more of a global community within the multilateral development space. Think about how we can increase health financing in a climate constrained world if you want.

And as I was saying in the beginning, historically health and climate financing has operated in complete silos. Health systems have been funded primarily through domestic budgets and traditional MDB loans while. Climate financing was largely at the beginning focusing on energy, transport, adaptation projects.

So this, I think this group, and what we can do together is one, is really to try to bridge that financing, and that is by aligning investments through our different frameworks where we really look at this. Specifically looking at the core benefits of health in climate projects as well.

So that's very much the first example, whether that is through urban infrastructure design, allowing for active transportation systems, way better to walk or to ride a bicycle than to take your car to work. Both for the planet and for people, right? And it's much more affordable,

JOSEPH JACOBELLI: of course.

VERA SIESJÖ: And then I think differently, really developing innovative financial instruments, I think that would be very important and that would also allow us to attract private capital to do more health focused climate investments. I think that will be extremely important and really using our balance sheets to leverage that.

And I think the third one is really to build knowledge and evidence. And this is critically important, in a resource constrained world. How do we make sure that we are not overlapping our efforts? How do we coordinate, how we can join in, in a way of financing new innovations and knowledge around this space.

What are the best practices? What are different cost estimates on how you do this? To really help guide countries on what they should be prioritising this space. What do they get as the best return on investment for different types of project structures? So I think that would be really important in this intersection between climate, health and infrastructure.

And I think the last one is promote cross sector collaboration. And I think that's really important because it's not only MDBs, we are working with UN entities, we are working with different institutions that are also very much moving the needle in this space. And again, working closer together, talking to each other, making sure that we are learning from each other, we are teaching each other, we are thinking together will make the results so much better.

Working in silos is not going to be beneficial for anyone.

JOSEPH JACOBELLI: I mean, that's true for the transition in general. Right. It's a rewiring of the way you think about it, right? So yeah, it's incredibly important.

Vera, I really appreciate your time. I learned so much. I apologise for the very simplistic and naive questions. I think you're doing fantastic work, and I really hope that we can catch up sometime next year or whenever and get an update on how things are progressing. So, thank you so much for participating in the Asia Climate Finance Podcast.

VERA SIESJÖ: Thank you so much, Joseph. I was very grateful to have this conversation, and I started this year after we launched this report to say that I will have more conversations with the unconverted, but really bridging gaps between the health sector and the climate sector.

And hopefully, we have shed some insights on why we should think together and work together more closely.

JOSEPH JACOBELLI: I think you've definitely achieved your target there. You've done a good job of that. Thank you so much again.

VERA SIESJÖ: Thank you.