Information from Governance Regulation reporting on adaptation (2023, 2021)

The health sector is covered in the National Adaptation to Climate Change Strategy - ENAAC 2020 (NAS, 2015), the Lisbon Metropolitan Area Climate Change Adaptation Plan (RAP, 2019), and the Climate change in Portugal: Scenarios, impacts and adaptation measures - SIAM 2006 (CRA, 2006). Health is the focus of the Regional Strategies of Adaptation to Climate Change - Health Region of Lisboa e Vale do Tejo (SAP, 2019). The implementation of health sector strategies is based on the networking of health services with other security, environmental and/or social support entities.

The health department is a part of in the Climate Action Commission, created in 2015 to enhance the involvement and promote the accountability of the various sectors for greater integration of climate policy in sectoral policies. Responsibilities of the Commission include: a) Providing political guidelines in the context of climate change; b) Promoting the articulation and integration of climate change policies in sectoral policies; c) Monitoring the implementation of sectoral measures, programmes, and actions.

The impact of climate action is identified in terms of health, amongst other fields, within an evaluation tool (Model of the Pilot Project on Prior Evaluation of Legislative Impact on Climate Action) developed to measure climate impacts of legislative proposals and sectoral policies. The pilot project is being implemented regarding preliminary legislative impact assessment on climate action, promoting alignment with the objectives undertaken by Portugal in terms of climate policy and providing an enhanced legislative procedure and a more transparent legal system.

In the health sector, it is essential to monitor the state health of the population, considering diseases transmitted by water, food, vectors and pathologies aggravated by air quality and exposure to extreme weather events. The monitoring of vectors that transmit diseases is carried out by the National Vector Surveillance Network (REVIVE).

In order to prevent the negative effects of intense cold or heat, Portugal has a Seasonal Health Contingency Plan – Winter Module and Summer Module. The Water Sanitary Surveillance Programs in the five health regions cover water for human consumption, mineral, natural and spring waters and bathing areas, and have as objectives the surveillance of the microbiological and chemical quality of the water in accordance with its uses.

Relevant to health, one of the major national issues for reducing quantitative pressures on water bodies is the promotion of water reuse from treated wastewater from any source for multiple purposes. Decree-Law No. 119/2019 of August 21 was published to control the practice, which advocates an approach similar to that provided for Regulation EU 2020/741, supported by the case-by-case definition of quality standards (fit-for-purpose) and risk management on health and environment.

Good practices for health in the field of adaptation include:

• Climate risk communication: Improved risk communication and information to the population. The progressive participation of the various public health services and departments in the National Vector Surveillance Network (REVIVE), in the Seasonal Health Contingency Plan – Winter Module and Summer Module and in the Water Sanitary Surveillance Programs, in collaboration with other entities, has allowed gains for the health resulting from knowledge and the better articulation of services.

Adaptation actions and measures addressing the health sector include:

• Definition and implementation of measures and strategies of adaptation of the health sector: This measure focuses on the definition and implementation of various actions and strategies to adapt the health sector to climate change.

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 Portugal are summarised here.

Policy documents reviewed:

National Adaptation to Climate Change Strategy (ENAAC 2020)

Action Plan for Adaptation to Climate Change (P-3AC)

National Health Plan 2020

Aspects covered in the reviewed policy document:

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

The revised National Adaptation Strategy (NAS, 2015-onwards, ENAAC 2020) covers nine priority sectors, including health. For health, Regional Strategies of Adaptation to Climate Change were completed and submitted for adoption for the period 2019-2020. The implementation of health sector strategies is based on the networking of health services with other security, environmental and/or social support entities.

The health sector published a report within the scope of the first stage of the NAS, where climate change impacts were systemised in the domains: extreme temperature events, water, air, disease transmitting vectors, food, and extreme hydrological events. However, instead of identifying an exhaustive collection of adaptation measures the report established a link between the implementation of certain plans and programs addressing environmental conditions influenced by climatic phenomena and impacts on public health. In relation to the other sectors, the approach to adaptive management for health has followed a different pathway: through decentralisation. Recently, the Regional Health Administrations prepared their own adaptation strategies, where the main impacts on health and vulnerabilities of the health services and infrastructures, and respective adaptation measures were identified.

Regarding the health sector, there are several public health programmes contributing to adaptation, namely Contingency Plans for Adverse Extreme Temperatures, Contingency Plans of Seasonal Health, and the Vector-borne Diseases Prevention Programme. It is worth noting that the Algarve Health Regional Administration has assured the integration of adaptation in their responsibilities by issuing technical-sanitary opinions and participating in advisory committees within the processes of development of territorial management instruments.

The SIAM projects (Climate change in Portugal: Scenarios, impacts and adaptation measures) from 2002 and 2006 were the most comprehensive multi-sectoral, national climate change impacts and vulnerabilities assessments for Portugal, which included health impacts and adaptation measures.

Resources in the Observatory catalogue on Portugal