Information from EEA report. Climate change and health: the national policy overview in Europe (2022)

National policies on climate change adaptation and national health strategies were analysed to identify the coverage of climate-related impacts on health (physical, mental, and social) and the types of interventions addressing them. The report provides a European overview, while the geographical coverage of various aspects of national policies across Europe can be visualized using the map viewer. The results for Germany are summarised here.

Policy documents reviewed:

German Climate change adaptation strategy (2008) 

2019 Monitoring Report on the German Strategy for Adaptation to Climate Change 

Second Progress Report on the German Strategy for Adaptation to Climate Change (DAS) (2020)

Climate Impact and Risk Assessment 2021 for Germany. Sub-report 5: Risks and adaptation in the thematic clusters Economy and Health

Global Health Strategy of the German Federal Government 2020

Aspects covered in the reviewed policy document:

Information from EU official reporting on adaptation. GovReg reporting (2021), MMR reporting (2019)

The German National Adaptation Strategy (NAS, 2008 [editors]) and Adaptation Plan (NAP, first adopted in 2011 [editors]) are sub-divided into 15 fields of action, including human health.

One chapter of the overall national vulnerability assessment (2015 [editors]) is dedicated to human health. The report suggests medium vulnerability of human health in relation to climate change for the near future. In the area of healthcare, the report concludes that adaptive capacity is currently medium to high: capacity limits (load on emergency services, hospitals and doctors) have not been reached and there is a good basic service. With the adoption of the initial progress report on the German strategy for adaptation to climate change in 2015, the federal government decided to carry out vulnerability assessments every six years. The second progress report was published in 2020. Particular attention is given to heat exposure as one of the largest impacts on human health currently. The adopted actions include information for the wider public and health professionals, and developing outreach to particularly vulnerable groups of the population (e.g., the elderly, people with pre-existing conditions, children). Review of existing provisions and applicable state rules on occupational safety and health with regard to heat and UV radiation, for instance, the Technical Rules for Workplaces (ASR) took place. Furthermore, the Ordinance on Preventive Occupational Healthcare will be evaluated with regard to its thresholds for preventive checkups for occupations involving outdoor activities subject to intensive exposure to natural UV radiation.

Strategic cooperation between the federal government and the Federal States has also intensified in recent years. In spring 2017, for example, the Federal/Federal States Ad hoc Working Group on Adaptation to the Impacts of Climate Change in the Health Sector (GAK), led by the Federal Environment Ministry and Federal Ministry of Health, published "Recommendations for Action: Heat Action Plans to Protect Human Health". These recommendations are aimed at the local and regional authorities and are intended to serve as a basis for drawing up regional heat action plans. The objective of a heat action plan is to avoid heat- and UV-related illnesses and deaths by preventing exposure. The Ad Hoc Working Group is now established on a permanent basis to facilitate inter-agency dialogue on human health under climate change.

The federal authority climate adaptation network defined "impact chains" for each action field of the German Adaptation Strategy to visualise the cause-effect relationships between climate signals and potential climate impacts. It found that human health is greatly influenced by climate and the impact of climate change on the population can be positive and negative. Demographic change may also affect sensitivity of humans to the environment. Changes in temperature, humidity, frequency of extreme weather events and inversion weather conditions have a strong influence on humans. Overall, 4 out of 14 identified climate impacts on human health were investigated in detail including "Heat stress", "Breathing difficulty due to ground-level ozone", "Carriers of pathogens" and "Load on emergency services, hospitals and doctors". In addition to proxy indicators, expert surveys were also conducted for the operationalisation of these climate impacts.

Germany's National Meteorological Service has strengthened its warning system by improving the spatial resolution of severe weather warnings to the municipal level and by improving its dissemination, especially by using online applications. Considerable improvements have also been made to the development of the modular warning system run by the Ministry of the Interior for civil protection purposes. The system integrates warning systems running at different administrative levels (from federal to municipal) and a number of different warning devices. The two systems (National Meteorological Service's and Ministry of the Interior’s) are linked, enabling delivery of short-time warning messages to the public and connected media stations and authorities.

Most climate-sensitive pathogens are notifiable in Germany and in-depth analyses of these data are performed regularly by the national Public Health Authority. National mosquito monitoring projects have been implemented by the Federal Ministry of Nutrition and Agriculture and the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety, which also investigated the impact of climate change on the route of entry and the establishment of invasive mosquitoes in Germany and the vector competence for human pathogens in native mosquito species. Tick monitoring projects have also been implemented. Germany has established a national commission for mosquitoes as vectors for disease agents, which has developed, for example, a national action plan to deal with Aedes albopictus.

Available information on vector-and rodent-borne diseases is not sufficient to correlate climate effects and the infections. However, several funded research projects are under way, looking into climate change and ticks/tick-borne diseases, climate change and exotic mosquitoes and climate change and rodent-borne diseases (including investigation of correlation/causality of bank vole abundance and hantavirus infections).

A network of reference laboratories has been in place since 1997 and has gradually expanded to cover all pathogens sensitive to climatic changes. The National Food Agency leads a national project on climate change adaptation of drinking-water production, in cooperation with the Public Health Agency, among others.

WHO case studies from publication. Public health and climate change adaptation policies in the European Union (2018)

A masterplan for the implementation of heat-health action plans

The Federal Working Group on Adaptation to the Impacts of Climate Change in the Health Sector developed recommendations for heat-health action plans to protect human health, which serve as a masterplan to ensure better protection of public health in Germany during long periods of extremely high summertime temperatures. As a contribution to the NAS for the health sector, the recommendations aim to implement adaptation measures and prevent health consequences associated with extreme heat at the regional and local levels. From 2018 the German Environment Agency and Federal Ministry for the Environment, Nature Conservation and Nuclear Safety will keep in touch with federal state governments and the local level to obtain regular information about the implementation of any heat-health action plans in general, and about ongoing heat-health-related adaptation actions, specifically.

Surveillance of Aedes albopictus as part of IHR (2005) implementation

To detect possible routes of entry for new vector species, between 2012 and 2016 mosquitoes were regularly trapped at previously identified risk locations in Germany. Significant points of entry are motorways with tourist traffic from Italy and southern France as well as terminals for freight trains from Italy. In this regard, surveillance of Aedes albopictus contributes to the implementation of the IHR (2005) in Germany, as the mosquito can establish itself in Germany because of climate change. Regular monitoring of at-risk locations is necessary to detect introduction and establishment of Aedes albopictus at an early stage, as prompt control measures must be implemented to prevent further spread.

Regional forecast system for the occurrence of rodents

Human-pathogenic hantaviruses in Germany are transmitted by small rodents such as bank voles (Myodes glareolus), which carry Puumala virus (PUUV). Weather-based prediction models for the occurrence of PUUV-transmitting bank voles and human PUUV incidences were developed. Close correlations of bank vole abundance with weather parameters of up to two previous years were found. This allows predictions about possible population outbreaks of the PUUV rodent reservoir or PUUV epidemics in Germany 0.5–1.5 years in advance. With regard to changing climatic conditions, such a warning system offers an opportunity to alert health services and the general population in time to take preventive measures and, thus, to limit the effects of PUUV epidemics on human health.

The Climate Adaptation School project

The Climate Adaptation School project was supported by the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety. Its objective was to develop an interdisciplinary education and training programme for medical professionals, designed to develop and convey a summary of weather- or climate-related health hazards and risks and the possible responses to them, focusing on both preventive and diagnostic-therapeutic aspects. A series of lectures for doctors and nurses was delivered in various locations across Germany; overall, interest in the topic was strong. Following extensive consultation with the advisory board, the training modules of the Climate Adaptation School (especially those on UV, ozone, heat and pollen) were offered in the context of congresses in internal medicine, allergology, pneumology and dermatology, with very positive feedback. An associated climate change and health website was set up: a modern platform for knowledge sharing, which includes eLearning modules and a knowledge database.

Resources in the Observatory catalogue on Germany