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Heat health action plans

Europe has experienced several extreme summer heatwaves and continuous new records in terms of extreme temperatures since 2003, which have led to heat-related morbidity and mortality, reduced labour productivity and economic impacts. Heatwaves of a similar or larger magnitude are expected to increase in terms of frequency (AR5, 2013; Russo et al., 2014, EEA, No 1/2017), up to one every two years in the second half of the 21st century under a high emissions scenario (RCP 8.5).

In order to improve the public health response to extreme temperature and heatwaves, the EuroHEAT project has quantified the health effects of heat in cities in the WHO European Region and has identified options for improving the preparedness of health systems and their responses to protect health. The key message of the project is that heat threatens health and climate change is increasing heatwaves occurrence.

Health effects of hot weather can be prevented and public health strategies and measures can be adopted. Prevention requires a portfolio of actions at different levels, including: meteorological early warning systems, timely public and medical advice, health services targeted to particularly vulnerable groups, improvements to urban and built environment (e.g. improvement in housing and spatial planning) and ensuring that the health care and social systems are ready to take action. These actions can be integrated into a defined heat health action plan.

The following eight steps to build a heat health action plan were recommended by the EuroHEAT project:

  1. Collaboration between bodies and institutions and identification of a lead body to coordinate responses;
  2. Availability of accurate and timely alert systems;
  3. Heat-related health information developed in advance;
  4. Avoidance or reduction of heat exposure;
  5. Particular care for vulnerable population groups;
  6. Provision of health care, social services and infrastructure;
  7. Real-time health surveillance incorporated into the planning process and
  8. Monitoring and evaluation components and criteria.

Examples of heat health action plans or similar plans at the national level are:

Initiatives can also be found on the regional level as well, like the “Heat Hotline Parasol” service implemented in the Kassel region of Germany.

The systems adopted in European countries range from traditional passive communication approaches (e.g. media releases), to active communications to vulnerable individuals, e.g. alerts are sent to target groups.

Additional Details
Reference information

Adaptation Details

IPCC categories

Institutional: Government policies and programmes, Social: Informational

Stakeholder participation

In order to prepare heat health action plans, collaboration between different actors is essential. This covers actors from diverse institutions (multi-agency) and different sectors (inter-sectoral), like for nearly all emergency plans. While many actions fall to the health sector, active involvement of other sectors is also very relevant. Moreover, heat health actions plans are often developed at the national level and implemented at the regional to local levels as well; thus the involvement of and vertical collaboration among the relevant institutions and actors across all governance levels is of utmost importance.

Communication is an integral part of managing health risks, which involves an interactive process of exchange of information, concepts or concerns relating to such risks, among individuals, groups and institutions. Establishing a dialogue as early as possible between the different actors involved – including target users - provides several benefits. Therefore, at the beginning, there is a need to provide information and knowledge. This will increase awareness and concern on the part of the different actors. Especially accompanying efforts such as awareness raising in the population related to heat-related effects and health problems, especially focusing on the most vulnerable groups prone to health risks of heat, are extremely important components of any heat health plan and its successful implementation.

Success and Limiting Factors

Based on WHO Europe experience on heat and health (e.g. EuroHEAT, Health advice and the European Working Group on Health in Climate Change) and drawn from existing heat health action plans and literature, core elements for the successful implementation of heat health action plans can be identified:

  • a coordinating body responsible for the implementation of the plan and collaboration with multi-agencies;
  • accurate and timely alert systems, to determine the thresholds for action;
  • a plan for informing and communicating heat-related health information including a clear identification of what needs to be communicated, to whom and when;
  • recommendations (e.g. about reducing heat exposure and advice on how to keep indoor temperatures low during heat episodes) targeting most vulnerable population groups;
  • a more mid- to long-term preparedness of the health and social care system (e.g. through staff training and planning, appropriate health care and improvement of the physical environment);
  • Monitoring of mortality and morbidity associated with periods of heat stress and an evaluation mechanism to assess the plan performance;
  • Report key stakeholders (e.g. the Health Minister) and the general public on the activities developed during the year.

These elements are not sequential, though some are primarily about planning and others more about response.

In order to fully implement the plans, coordination efforts between diverse actors at the national, sub-national and locals level are needed. This effort can be demanding and needs to be defined in detail, especially in terms of information flow and advice on who is doing what and when. Even, if the information is well communicated, it does not necessary imply, that the most vulnerable groups of society (elderly people, small children, people with current health problems, etc.) are reached and can act upon the information provided. Some additional efforts can be needed in terms of implementing suggested actions, which implies other financial efforts and might be harder to implement in the short-term (e.g. in the case of change in buildings).

Costs and Benefits

Most existing plans are led and/or funded by related sectoral Ministries; in some cases research projects were the starting point for the plan elaboration and (pilot) implementation. The full implementation of an heat health action plan requires staff work in various areas related to the prevention of health risks, thus the estimation of costs and resources associated with the plans is rather difficult and context specific.

The plans benefits lie in the prevention of adverse health effects, especially on most vulnerable target groups. The benefits have until now not been fully analysed or calculated, since many plans are only in place for a few years and thus currently monitored, but not yet evaluated.

In general, it can be stated that the delivery of the information to sub-national and local multi-actors - who can either accordingly prevent or at least minimize the adverse health effects - compared to a lack of information is already a clear benefit. This is also true in terms of costs, as provided information helps the efficient planning for healthcare staff and related healthcare facilities.

Legal and policy basis for a heat health action plan can be of different nature, and can include documents like adaptation strategies, adaptation action plans or risk reduction/management strategies. Most plans have been developed at the national level. In some cases sub-national plans already existed; the national plan was developed harvesting these experiences and aims to provide an umbrella plan on the national level (e.g. in the case of Austria).

Implementation Time

The elaboration of a heat health action plan is a relatively quick process, which can require a few years, depending also on the level of needed collaboration between actors in the field of health and early warning. Implementation as well as its monitoring is a continuous effort. Most heat health action plans are operational from May till September.

Life Time

Actions foreseen by the plans are normally assumed to continue for the long-term. Monitoring, evaluation and reviewing are essential components of any plan, to adapt it to evolving conditions. Some plans foresee a revision of the plan after more experience is gained.

Reference information


World Health Organisation (WHO)

EuroHEAT project, including the document: WHO Regional Office for Europe, (2009). Improving public health responses to extreme weather/heatwaves – summary for policy-makers

WHO Regional Office for Europe

Published in Climate-ADAPT Mar 24 2020   -   Last Modified in Climate-ADAPT Aug 17 2023

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