Climate change induced heat health challenges &#8211; a study on the development of health-related adaption measures in Germany
Authors: Mücke Hans-Guido 
Published: March 2024

Introduction: The increasing number of heat events of summer 2003, 2010 and 2015 induced a rising impact on heat health morbidity and mortality in Germany. A considerable proportion of urban population is affected by thermal discomfort due to the urban heat island burden during summer, particularly vulnerable people at risk. As contribution to the National Adaptation Strategy to Climate Change a federal expert working group prepared and published &#8216;Recommendations for Action for the Preparation of Heat Action Plans to Protect Human Health&#8217; in 2017, on the basis of the 2008 WHO Heat Health Guidance. A first country-wide project had been conducted in Germany between 2019 and 2023 which investigated the status and impact of current or planned Heat Health Action Plans (HHAP), and adaptation measures appropriate to protect and prevent human health. One aim of this study was to conduct an online survey on the awareness and degree of use of the 2017 recommendations and the development and implementation of HHAP.&#160;Methods: The online survey questionnaire referred to climate change, heat and health aspects. The survey had been conducted in May/June 2020 to assess the current state of affairs as well as factors of success and barriers in the development and implementation of HHAP, with a particular focus on municipal administrations. Therefore, various networks of national, regional and local environment and health administrations, as well as stakeholders had been invited via an Email, web and social media campaign to participate anonymously.&#160;&#160;Results: The study fell in the period of increasing incidence of COVID19 pandemic, which influenced and limited the responses from the public health sector country-wide. Nonetheless, the online survey had been conducted in May/June 2020. In total 116 questionnaires had been responded, mainly by participants from the environment sector (53%), and 32% from the public health sector. More than half of the respondents (n=67) indicated to be aware of the 2017 recommendations (very well-known at the federal state level: 90%, at county level known by 43%). The recommended health-related adaptation measures were appreciated very or helpful by 81%. Respondents from large cities (> 100 000 inhabitants) were main contributors to the study (41 of 81 large cities replied, while 34 rural counties responded). So far, no federal state responded, but four municipalities and one county indicated to start planning activities on HHAP.&#160;Conclusion: Recent heat events clearly indicate the demand to protect public health against heat extremes in Germany. The results of this first country-wide survey show on the one hand that currently HHAP are being developed rarely. On the other hand, results reflect that first HHAP actions turned into force after 2017 recommendation had been launched. Federal states and municipalities feel motivated and act responsible to take health-related adaptation measures in advance, such as HHAP, to prevent heat-related illnesses and deaths sustainable. Policy and decision makers must develop structures and regulations that anchor HHAP as a nationwide instrument to be established timely.&#160;