Integrating public health in European climate change adaptation policy and planning

Figures & data

Figure 1. The research strategy applied in this work.

Table 1. Examples of adaptation measures that can be taken to increase climate resilience in health systems.

(a) General efforts and measures to minimize health impacts related to climate change
I.1	Asthma and other diseases due to longer and more intense air pollution^a	Develop exposure forecasts for air quality and dust
		Enforce stricter air quality standards for pollution
I.2	Zoonotic diseases due to changing vector ecology^a	Expand the scope of diseases monitored and conduct monitoring at the margins of current geographic distributions
		Establish vector or pest surveillance and control programmes
		Enhance diagnostic and treatment options in high-risk regions or periods
		Ensure adequate animal and human vaccination coverage
I.3	Cardiopulmonary health due to increasing allergens^a	Develop exposure forecasts for air quality, allergens, and dust
		Establish programs to monitor pollen levels
		Establish allergen management
I.4	Diseases borne in water due to degrading water quality^a	Enhance disease surveillance systems during high-risk seasons or periods
		Establish early warning systems to anticipate outbreaks associated with extreme weather and climate events.
		Strengthen food and water quality control
I.5	Under- or malnutrition due to food supply impacts^a	Perform seasonal nutritional screening in high-risk communities
		Scale up integrated food security, nutrition, and health programming in fragile zones
		Promote public education and food hygiene
I.6	Mental stress because of environmental degradation^a	Address special needs of mental health patients (as well as patients with other disabilities) by developing emergency preparedness plans
		Address mental health needs of disaster- and trauma-exposed populations
		During extreme weather conditions, establish community watch for people with mental illness
I.7	Heat-related illness and cardiovascular failures^a	Establish occupational health exposure standards
		Ensure public education to promote behaviour change (in relation to clothing and ventilation)
		Develop heat-health action plans (including early warning, public communication, and response plans), such as cooling centres for high-risk populations
I.8	Health impacts and injuries due to severe weather^a	Include climate risks in siting, designing, or retrofitting health infrastructure
		Establish early warning and early action systems, including education and community mobilization
(b) Targeted efforts and measures to enhance the adaptive capacity in health systems
II.1	Good leadership and governance	Provide policy-relevant support for adaptation strategies
		Establish an inter-disciplinary coordination working group on climate change and health
		Facilitate cooperation between different levels: the local, regional and supranational level encompassing the European Union and other international organizations
		Build a network of research institutions, policymakers and other stakeholders to strengthen adaptation efforts
		Facilitate a continual exchange of knowledge and new information between involved institutions
		Facilitate collaboration between sectors relevant for climate change-related health impacts
		Take a ‘health in all policies’ approach
II.2	Preparation of a steady health workforce	Incorporate all climate-relevant health topics in the further education of medical staff and health professionals
		Raise awareness of the adverse health effects resulting from climate change amongst health professionals
II.3	Vulnerability, capacity, and adaptation assessment	Establish a risk assessment in the health sector
		Establish a vulnerability, capacity, and adaptation assessment in the health sector
II.4	Integrated risk monitoring and early warning	Establish monitoring systems for floods, diseases, air pollution, pollen and heat
		Establish a warning system that informs health institutions of climate hazards or disproportional air pollution, pollen, heat or diseases
II.5	Health and climate research	Increase robustness of scientific data through the integration of the findings of various research approaches and methods
		Develop data and methods that can inform decision-making on climate change adaptation in the health sector
		Identify knowledge gaps for climate change and health research that can be addressed by future research
		Create a knowledge base for best practices on climate change and health issues
II.6	Climate-resilient technologies and infrastructure	Assess and retrofit or construct public health infrastructure to be resilient to extreme weather conditions, warmer temperatures, and environmental changes^a
		Make sure plenty of medicine or vaccines are available for the adverse health effects of climate change
		Guarantee medical technologies that are able to withstand climate hazards
		Guarantee infrastructure that can handle large surges of medical cases after a climate hazard
II.7	Integrated climate-informed health programmes	Draft climate-informed health plans
		Integrate climate-informed health programmes
II.8	Emergency preparedness and management	Prepare the population, health care systems and aid organizations for environmental emergency situations
		Establish a communication system that, in case of environmental emergency situations, sends warnings to emergency rooms and health care facilities
		Establish a legal basis for a stronger embedding of health support and prevention in the health sector
		Create plans for handling increased demand for treatment during high-risk seasons or weather conditions^a
II.9	Climate and health financing	Establish funding systems for climate change-related health adaptation
		Allocate European adaptation funding to adaptation in the health sector
(c) Supportive efforts and measures that have indirect benefits for health systems
III.1	Awareness and health information systems	Establish a citizen outreach plan
		Communicate and disseminate information on the importance of climate change adaptation
		Publish a series of thematic material in various forms (brochures, flyers, websites, etc.)
		Promote activities at educational institutes to raise awareness for climate change adaptation
III.2	Risk assessment	Carry out a risk assessment at a national overarching level
		Carry out an impact and vulnerability assessment at a national overarching level
III.3	Emergency planning	Establish emergency and early warning systems.
		Establish or improve existing emergency plans.
		Coordinate rescue organizations and emergency services
		Integrate emergency plans
III.4	Continuous data and monitoring	Establish indicators or monitoring mechanisms to monitor adaptation efforts
		Establish an independent body that continuously monitors the implementation of adaptation efforts
		Monitor adaptation efforts regularly
III.5	Preparing and updating action plans	Prepare adaptation strategies and plans
		Expand existing adaptation strategies and plans, for example by adding new economic sectors or new measures or interventions
		Update adaptation strategies and plans and integrate the lessons learned from monitoring

Note: This table is an extension of the table developed by WHO (2015a).

^a Reproduced from WHO (2015a).

Table 2. The questions asked during the semi-structured expert interviews.

Topic	Question
Role and responsibility to climate and health	What is your role in the city department?
	What is the departments’ primary goal with respect to climate adaptation?
	Are there desired health outcomes to these efforts?
Capacity for implementation	What is your capacity for the implementation of the city action plans?
	Are you supportive or critical of the current national policy on climate adaptation in the health sector?
Collaboration network	Who do you regularly cooperate within the field of climate adaptation and health?
	Who would you like to cooperate with?
Research evidence	What kind of research evidence do you use to write the action plans?
	What kind of evidence would help your work, especially with regard to the health risks of climate change?
	Are you satisfied or dissatisfied with the format the evidence is presented to you?
Covid-19	Do you connect health with climate change more often since the Covid-19 pandemic started?
	Is your contribution to adaptation hindered or improved by Covid-19?

Figure 2. The integration of adaptation measures related to health topics described in the 24 national climate adaptation documents drafted in the European Union.

Figure 3. The integration of general (a), targeted (b) or supportive (c) adaptation measures related to health topics described in the national climate adaptation documents drafted in the European Union as a percentage of the measures that could be described in such documents.

WHO. (Ed.). (2015a). Operational framework for building climate resilient health systems. World Health Organization.

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