Climate change as a threat to health and well-being in Europe: focus on heat and infectious diseases

Key messages

• The severity of the current and projected impacts of climate on health in Europe call for a stepping up of action in both mitigation of and adaptation to climate change.

• Heatwaves cause the largest number of deaths among weather- and climate-related events in Europe. Over the next few decades, more frequent extreme heat episodes and increasing vulnerability of the population to extreme heat will lead to a substantial increase in morbidity and mortality unless adaptation measures are taken.

• Increasingly frequent, long and intense heatwaves in combination with an ageing population and growing urbanisation mean that more vulnerable populations are exposed to high temperatures, particularly in southern and central Europe. The location of many schools and hospitals in areas experiencing the urban heat island effect, further exacerbating high temperatures, calls for urgent adaptation of those facilities.

• Increasing temperatures in Europe also affect occupational health and safety, with an average annual loss of 16 hours per worker (compared with the 20th century baseline) in highly exposed sectors, with the largest losses in southern Europe.

• Climatic conditions across Europe are becoming more suitable for emergence and transmission of climate-sensitive infectious diseases, which may particularly affect those working in agriculture, forestry or emergency services (through higher exposure) or the elderly, young children and those with compromised immune systems (through higher vulnerability).

• The projected lengthening of the transmission season and wider distribution of mosquito species that act as vectors for malaria and dengue, combined with the growing number of travel-imported disease cases, increases the likelihood of local outbreaks.

• Higher temperatures increase the risk of West Nile fever outbreaks in central, eastern and southern Europe and expand the risk of transmission to previously unaffected areas of northern and western Europe.

• The warming sea waters are increasingly suitable for the dangerous Vibrio bacteria, in particular along the Baltic Sea coastlines.

• Reducing the health impacts of heat requires implementing a wide range of solutions, including effective heat health action plans, urban greening, appropriate building design and construction, and adjusting working times and conditions. Effective monitoring of vectors and disease surveillance enable the development of early warnings and targeting of vector control or vaccination.

• Cross-sectoral collaboration between public health and the built environment, spatial planning and employment sectors is needed to prevent climate threats where people live and work. Interventions aimed at reducing exposure to heat or diseases should prioritise vulnerable groups, as well as people and locations that are particularly exposed.

• Adapting to the existing and emerging health threats arising from climate change requires better preparedness of the health sector through increasing awareness, improving knowledge and widening engagement of public health and healthcare professionals; improving the resilience of healthcare facilities to climate hazards; and ensuring that health systems have the capacity to respond to increased demand for patient care or diagnostics.

• The need to better understand and address the impacts of climate change on human health and well-being is increasingly recognised in EU and national policies, albeit the subject is covered to a greater extent in policies focused on adaptation than those focused on health. At the local level, the engagement of health or social care stakeholders with climate adaptation planning remains low.

Executive summary

Climate change poses multiple threats to human health and well-being in Europe. Extreme weather events, such as devastating floods, extensive wildfires or intense and long-lasting heatwaves, that are more likely and more severe due to the changing climate have become part of our reality in recent years. The greatest direct climate-related threat to human health in Europe is heat, and the large number of excess deaths attributable to extremely high temperatures and prolonged heatwaves during the summer of 2022 is a case in point.

Despite high average living standards, Europe's ageing society and prevalence of chronic diseases make its population particularly vulnerable to heat. The exposure of vulnerable groups to heat is increasing, driven not only by more frequent and intense heatwaves but also by ongoing urbanisation and the associated urban heat island effect, the fact that buildings and cities in most of Europe have not been constructed to protect people from high temperatures, or outdated work practices that ignore the dangers of heat exposure to human health. Vulnerable socio-economic groups are particularly affected by heat. This high vulnerability, combined with the projected substantial global warming, creates a dire picture of a future with growing numbers of heat-related deaths and ailments, as well as reduced labour productivity, affecting well-being and prosperity across Europe.

Climate-sensitive infectious diseases are another type of emerging threat discussed in this report. The increasing suitability of the climate for various pathogens or their vectors may translate into higher likelihood of disease transmission in larger parts of Europe. The arrival of travellers and goods into Europe from regions where dengue or malaria is endemic, combined with the increasing suitability of climate conditions for the mosquitoes that carry those diseases becoming permanent in parts of Europe, increases the probability of disease outbreaks.

The key finding of the report is the marked increase in the scale and geographical extent of heat and infectious diseases that pose a threat to human health. This is corroborated by both the trends over past decades and the projections for the future.

Another aspect is the regional differences in the presence of threats. The current and projected exposure to heat is highest in southern Europe, resulting in increasing mortality rates and negative impacts on labour. Central and eastern Europe emerge as having the highest current climatic suitability for the transmission of dengue, malaria and West Nile virus. The population's vulnerability to high temperatures is highest in northern and western Europe as a result of high levels of urbanisation and high proportions of the elderly in the population. These two regions have also recorded the highest increase in climatic suitability for dengue, malaria and West Nile virus over the past few decades, which potentially has contributed to the expansion of those diseases to previously unaffected regions. The risk of Vibrio infections is highest around the Baltic Sea coastlines. These regional differences necessitate the development of specific strategies addressing both the established and the emergent climate-related health threats.

In addition, the report draws attention to social inequalities as drivers of vulnerability and exposure to climate-related health threats. Most of those at risk from heat are older people or those with pre-existing health conditions; in addition, the health of elderly people and young children can be more seriously affected if they contract an infectious disease. Low-income groups tend to be overrepresented in dense, urban environments and poor-quality housing prone to overheating. People on the lowest incomes tend to work in manual jobs that are often performed in hot indoor environments or outside, exposing them to high temperatures or infection risk through contact with vectors.

Nearly all deaths associated with high temperatures are preventable in the European context. Prevention of and better preparation for outbreaks of climate-sensitive infectious diseases can lessen the health implications. Therefore, the report also looks at measures to reduce the health impacts of heat and infectious diseases in Europe. The monitoring and surveillance of climate-related threats is an effective measure and the most frequently mentioned in national health or climate adaptation strategies. It is essential to develop early warnings: swift, well-organised and effective actions as part of heat health action plans and providing appropriate information to the public can reduce the risk of disease transmission.

The adaptation measures planned by the EEA member and collaborating countries emphasise the need to raise awareness of the health threats associated with the changing climate among the population (particularly vulnerable and exposed groups in terms of both working and living conditions) but also among public health and healthcare professionals. Inclusion of the topic of climate change in medical schools' curricula and the training of healthcare workers is key. Furthermore, improving the resilience of healthcare facilities across Europe is necessary to both the direct impacts of heat (especially given the high proportion of hospitals in areas experiencing the urban heat island effect) and the pressure on their capacity to deliver patient care during heatwaves or diagnostics during outbreaks of climate-sensitive infectious diseases.

However, involving actors beyond the health sector when planning responses to climate-related threats is also essential. Preventing the negative impacts of heat on health can be achieved by climate-proofing buildings to ensure thermal comfort during heatwaves or by integrating green spaces into urban planning and redevelopment. Changing work schedules and applying heat-aware working conditions and facilities can reduce heat stress at work, especially for outdoor workers. To successfully plan and implement such measures needs cross-disciplinary collaboration between the health sector and the built environment, planning or employment sectors.

The recent recognition of the climate-related threats to human health and the call for action in political fora such as the G7, in the EU policy framework or by professional associations in the sphere of public health can help to push the subject up the political agenda of the EEA member countries. This occurs predominantly at the national level, where monitoring and surveillance actions are decided, early warnings may be activated and decisions are made about the roll-out of vaccination programmes. Nonetheless, the local implementation of actions — such as information and check-up services for the elderly during heatwaves, targeted urban greening activities or raising awareness of the threat of disease outbreaks — is key to the successful reduction of health threats associated with heat or climate-sensitive infectious diseases. Thus, addressing the complex problem of climate change impacts on human health requires a systemic approach to problems and a collaborative way of planning and implementing measures that involves all levels of governance.

The EU, while having limited competences in the area of health, can support Member States by facilitating knowledge development and sharing through research programmes, including the EU Mission for adaptation to climate change, and through specific initiatives such as the European Climate and Health Observatory or the Health Emergency Preparedness and Response Authority. Furthermore, regulatory proposals such as that on serious cross-border threats to health can strengthen the role of the EU in developing early warnings and addressing the threats associated with climate change.