This publication collates and summarizes the most relevant evidence published since 2008, focusing primarily on the 53 Member States served by the WHO Regional Office for Europe.

Findings are organized around the eight elements that the original guidance document identified as “core” to a comprehensive heat–health action plan (HHAP), and each chapter is complemented with the results of WHO’s 2019 survey of heat–health action planning, where relevant to the topic covered. The main contents of each chapter are outlined below.

Chapter 1 sets the scene and outlines the heat and health impacts, both observed and projected, focusing on countries in the WHO European Region. Projections clearly indicate that without adequate efforts for adaptation to climate change, heat-related exposures and the associated health impacts will increase substantially.

Chapter 2 summarizes evidence on the governance of public health responses to heat. The need to define and implement appropriate and agreed upon public health responses and policies has become increasingly pressing, though the available evidence on what constitutes good practice in the governance of such responses is limited. The key issues to address are becoming increasingly clear, however, including adequate funding and human resources and formal involvement of subnational and non-state actors.

Chapter 3 reports on heat–health warning systems and how HHAPs should be underpinned by them for timely and effective responses. The scientific literature suggests that considerable effort has been invested in improving warning model performance and lead times, targeted dissemination and their understanding among public health stakeholders. Evaluation of warning systems needs to be carried out regularly to ensure constant improvement and understanding.

Chapter 4 summarizes the evidence on how heat/related health information plans communicate heat risks and recommendations. It outlines existing approaches to make heat–health messages effective, and considers how HHAPs can better target warnings, recommendations and information to their various stakeholders and audiences. Countries have generally shifted their HHAP communications towards web-based and mobile technology platforms, and it is important that such transitions are carried out ensuring social justice, without excluding the most vulnerable or those with fewer resources.

Chapter 5 reports on types of intervention and evidence on effectiveness in the reduction of hazardous indoor heat exposure. A wide variety of passive cooling (related to housing and cooling) and active cooling (such as air-conditioning, personal cooling devices) interventions and technologies can be applied. Understanding of the thermal comfort needs of those most vulnerable to heat is still limited, however, and data on the real-time association between outdoor and indoor temperatures in residential settings are lacking. More research is needed on risks of overheating and adaptive solutions in hospitals, residential care homes and other settings.

Chapter 6 outlines the updated evidence on risk factors and vulnerability. That evidence is evolving and becoming more specific in terms of health outcomes, biological mechanisms, causality and the vulnerability of different groups. To date, however, most national HHAPs mention vulnerable groups but do not contain actions addressed to them. More effort should be put into raising awareness and promoting active response measures and training of health and social care professionals. It is important to acknowledge that vulnerable subgroups and their needs change over time and require ongoing monitoring and study.

Chapter 7 reports on the preparedness of the health and social care system for heat. To date, evidence on planning and response measures in place within health care settings and their effectiveness is sparse. A key challenge that remains is the impact of heat-waves in health and social care facilities, despite significant heat-wave events occurring throughout the WHO European Region in recent years. Greater effort needs to be put into sharing best practice planning and response measures in the health sector.

Chapter 8 describes how long-term urban planning can reduce heat risks. Green and blue (water) spaces, urban landscape materials and colours, and urban structure modifications are key areas for the long-term mitigation of health risks from heat and of greenhouse gas emissions. Despite their health protection potential, urban planning interventions remain the least implemented HHAP core element. Tools for intersectoral action are lacking to allow public health agencies to influence urban management decisions in order to protect health from heat. 

Chapter 9 explores the use of monitoring and evaluation processes as crucial components of HHAPs. Health surveillance is important to monitor health impacts and evaluate response measures during and after heat-wave events, but it is still a marginal element in HHAPs and needs to be promoted. Evaluation entails multidisciplinary and collaborative action between various stakeholders to address the different aspects and components of the HHAP. Formal and constant monitoring and evaluation of HHAPs are essential to understand their effectiveness and potential areas of improvement.

Chapter 10 provides a summary of the key messages from the report, with specific and overarching conclusions, as well as evidence and research gaps.

Selected information from this report is visualized on the thematic page National heat-health warning systems and action plans of the European Climate and Health Observatory.

Reference information

WHO Regional Office for Europe

Published in Climate-ADAPT Feb 17, 2021   -   Last Modified in Climate-ADAPT Apr 4, 2024

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