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In late 2025, ASPHER and EEA carried out a survey with staff and elected officials of local and regional authorities. The aim of the survey was to identify knowledge needs related to integrating climate-health considerations in subnational adaptation planning among people responsible for adaptation. 173 respondents from 20 countries answered the survey.

Key messages

  • The survey was completed by 173 respondents representing municipalities and regions across 20 European countries, with around half from Norway, Switzerland, and Germany. The respondents were mainly officers in climate adaptation, environment/sustainability and public health departments. Mayors or other elected officials constituted a quarter of respondents. The sample is not representative of Europe.  

  • Over 60% of the responding municipalities/regions had a climate change plan in place and a specific climate change department. Health was a dedicated component of adaptation plans in 43% of responding subnational authorities, and was minimally addressed in further 31%.  

  • Over 77% respondents responded that climate change is already affecting human health in their jurisdiction; 90% said that climate change will affect human health in their area in 10 years’ time. 

  • Respondents from small municipalities (<50k inhabitants) were much less likely to respond that they have sufficient knowledge to understand climate risks to health compared to those from large municipalities (>500k inhabitants). Only 33% of respondents from small municipalities stated they had the full knowledge needed to understand climate change health risks compared to 64% from the largest municipalities.

  • Among technical officers, the use of economic assessment tools and monitoring and evaluation, in particular related to equity, were the areas with the lowest numbers reporting sufficient knowledge.   

  • The highest number of respondents wanted to learn more about heat (73%). This was followed by health impacts on vulnerable populations (55%), flooding (44%), and air pollution (41%).

Results  

1Health in adaptation planning2Knowledge opportunities3About the respondents

Coverage of health in climate adaptation planning  

To better understand the capacity of local and regional authorities to plan and implement climate adaptation measures, respondents were asked about the administrative arrangements for climate change within their municipality. A majority (61%) reported having a dedicated climate change department. In addition, 60% of responding municipalities had a climate adaptation plan in place, while a further 23% were in the process of developing one. These findings provide an indication of the extent to which climate change and adaptation have been institutionalized within local government structures. 

Beyond the existence of climate adaptation plans, the survey also examined the extent to which health considerations were integrated into adaptation planning. 52% of adaptation plans had a dedicated health component (54 out of 104 reported adaptation plans) with 17 respondents considering including health in in future adaptation plans. This is just slightly higher than what was reported by EU Mission on Adaptation Signatories. In 2024, 60% of plans reported by Mission signatories covered health (European Climate and Health Observatory, 2025). The concept of One Health was included in 14 adaptation plans and partly included in a further 27 plans.  

Reported knowledge on climate impacts on health 

There was general agreement among respondents that climate change will affect human health in their local area in the near future (nearly 90%) and is already doing so (over 87%) (Figure 1). This finding is consistent with results from local and regional authorities participating in the EU Mission on Adaptation, where health emerged as a key area of concern in climate risk and vulnerability assessments. Health was also identified as a key outcome of adaptation actions reported under the Mission (EU Mission on Adaptation, 2026).  

Figure 1. Respondents' perception of current and future (10-year) climate change health impacts within their authority (%)

The majority of the respondents said that they had at least partial knowledge of climate change risks to health (95%), identifying vulnerable groups (91%) and engaging with the relevant stakeholders (83%). Respondents from small municipalities were less likely to respond ‘yes, fully’ to that question (Figure 2). This reflects similar data reported to the Global Covenant of Mayors (CoM) initiative, which found that small municipalities lag behind large municipalities in their capacity to plan and prepare for actions, as well as assess risks. Only 29% of small municipalities have completed or nearly completed risk assessments compared to 46% for larger municipalities (EEA, 2026).

Figure 2. Percentage of respondents responding ‘yes, fully’ to the question about sufficient knowledge, by population size of authority.

A set of more detailed questions about knowledge and skills were targeted at technical officers (132 respondents). The highest levels of knowledge were self-reported in relation to performing climate change risk assessments in relation to health - including considering vulnerable groups in climate risks assessments - and identifying and assessing adaptation options. However, only 8% of the technical officers said they would feel confident in using economic assessment tools such as cost-benefit analysis (CBA) or multi-criteria analysis (MCA) and only 9% would have sufficient knowledge to monitor health outcomes and impacts for vulnerable groups. Using evaluation results, selecting the appropriate indicators to track progress, and integrating equity were also aspects that a low percentage of technical respondents (<20%) reported they had sufficient knowledge of (Figure 3).

While many municipalities across Europe have a monitoring and reporting system defined as part of their adaptation plan, only a minority have clear indicators and objectives defined (EEA, 2023). The survey findings also reflect this gap between acknowledging the importance of monitoring and evaluation and the technical capacity to carry out these activities.

Figure 3. Technical officers’ self-reported knowledge and skills on climate and health

Knowledge opportunities for development

When asked which the climate related issues that they would like to learn about, the highest percentage of respondents selected heat (73%) and health impacts on vulnerable populations (55%). This was followed by flooding, air pollution, mental health, vector-borne diseases and food safety  (all above 30% of respondents) (Figure 4).

Over half of the respondents saw green infrastructure and spatial/development planning as relevant thematic areas to be covered by guidelines on integrating health in adaptation policies. This was followed by interest in emergency planning/response and healthcare infrastructure and service delivery (Figure 5).

Figure 5. Thematic areas for guidelines on integrating health into adaptation policies

Two-thirds of respondents pointed towards the lack of financial resources for climate-health adaptation planning as an implementation challenges where more guidance is needed. Over half selected issues with coordination between different sectors and levels of government as well as low awareness or engagement among decision-makers on climate and health (Figure 6). Similarly, financing / funding was identified by reporting signatories to the EU Mission on Adaptation as a key implementation challenge for adaptation planning (EEA, 2026).

Figure 6. Implementation challenges where more guidance or resources would be appreciated

The technical officers were asked about needs for guidelines on adaptation options addressing health. The highest number of respondents stated the need to learn more about responses to heat, followed by flooding, drought and other extreme weather events (Figure 6). For effective implementation of adaptation options, more technical knowledge was needed in relation to extreme weather events and heat (Figure 7).

Figure 7. Technical officers’ responses to multi-select item “Which adaptation options addressing health would you like us to focus on in the guidelines we will develop?”

Figure 8. Technical officers’ responses to multi-select item “For which adaptation options do you need more technical knowledge or support to implement effectively?”

The respondents

The survey targeted local-and regional-level officers and decision makers working on climate change adaptation. They survey was answered by 173 respondents. Whilst the respondents were from 20 countries, the sample was heavily dominated by several countries: Norway (18%), Switzerland (16%), Germany (15%), Moldova (12%) and Spain (9.8%) (Figure 9). The sample is not representative of Europe.

The highest number of respondents came from small municipalities, but all authority sizes were included in the sample (Figure 10).

Civil servants were the main respondent type, with most coming from climate adaptation departments or sustainability/environment departments. However, 13% were from public health department. Just under one quarter of the respondents were elected officials, including mayors (Figure 11).

Figure 9. Geographical distribution of respondents, by country

Figure 10. Number of respondents from municipalities of different size

Figure 11. Number of respondents in different roles

Conclusions

  • Survey respondents have good awareness of climate change impacts and their effect on vulnerable populations. Despite both national and sub-national authorities reporting strong knowledge of the health impacts of climate change and a high level of concern about the impacts the integration of health issues in local adaptation planning remains limited.
  • Monitoring and evaluation of adaptation measures is a persistent challenge. This finding is reflected at both the local and national level in other studies on the state of adaptation monitoring and evaluation.
  • There is a need for both technical expertise and financial resources to support municipalities across the adaptation planning cycle. Smaller municipalities, in particular, have limited resources and technical capacity to carry out adaptation planning.

Local and regional authorities need practical support to:

    • Identify opportunities and define strategies for funding / financing for climate-health adaptation planning.
    • Improve coordination between climate, environment, planning, health, social care, emergency management and infrastructure departments.
    • Develop strategies for engaging decision makers on climate-health adaptation issues.
    • Assess and address priority hazards found at the local level such as heat, flooding, drought, extreme weather events and vector-borne diseases and understand how these hazards impact vulnerable groups.
    • Select and implement measures such as early warning systems, heat-health action plans, green and blue infrastructure, flood-resilient planning, emergency preparedness and risk communication.
    • Monitor health-related outcomes and use evaluation results to improve adaptation measures over time.

A briefing document on the incorporation of health into local adaptation is in production. The goal of the document is to offer practical support in relation to these knowledge and technical gaps.

References

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