ABSTRACT Africa faces persistent sustainability challenges driven by interconnected health burdens, inadequate public investment, income disparities, and increasing climate variability. These dynamics undermine progress toward sustainable development goals (SDGs) and demand integrated policy approaches. This study thus investigates the causal pathways linking health outcomes, government health expenditure, income, and climate variability across 45 countries (2000–2022) to identify integrated strategies in achieving SDGs. Using Principal Component Analysis to build composite indices and the Juodis–Karavias–Sarafidis (JKS) approach with the Half‐Panel Jackknife inference to address cross‐sectional dependence and heterogeneity, we examine the nature of causalities in aggregated and regional panels. Results reveal heterogeneous patterns: bidirectional causality between health and income at the aggregated level, with regional variations from income‐driven health improvements (Northern/Western Africa) to health‐led growth (Central Africa) to mutual reinforcement (Eastern/Southern Africa). Climate demonstrates bidirectional causality with health and income, while government health expenditure shows primarily unidirectional effects. These differentiated causality patterns imply region‐specific policy requirements: Northern/Western Africa needs income‐redistribution mechanisms for health equity; Central Africa requires health‐system strengthening for economic development; Eastern and Southern Africa can leverage virtuous health‐economic cycles. Climate‐health feedback necessitates proactive mainstreaming adaptation rather than reacting to spending. Findings advance sustainable development in healthcare by promoting resource‐efficient, and climate‐resilient health systems that generate economic co‐benefits while enhancing health outcomes and environmental sustainability.
Mensah et al. (2026) studied this question.