Restoring health in times of heat: Refreshing our cities to safeguard communities

Extreme heat is the most severe and pressing climate risk to human health today. Prolonged exposure to extreme heat can impair the body's ability to regulate its temperature, leading to conditions such as heat stress, heat exhaustion, heat stroke, and exacerbating existing medical issues, sometimes resulting in premature death.

Those most at risk during a heatwave include the elderly, children, pregnant women, and individuals with cardiovascular, respiratory, or kidney diseases, diabetes, or mental health conditions. As a result, heat stress – although striking silently – is the leading cause of climate-related deaths in Europe, claiming over 60 000 lives in 2022. 

Europe is the fastest-warming continent, heating at twice as fast as the global average. According to Copernicus, 23 of the 30 most severe heatwaves in Europe in the past 75 years have occurred since 2000, and five in the last three years. As heatwaves have become more frequent and intense, heat-related deaths have risen 30% in Europe over past two decades. If temperatures continue to rise at the current rate, it’s projected that in a 3-degree warming scenario, heat-related deaths could triple by 2050. 

It's clear that rising temperatures are fuelling a growing public health crisis on the continent. In July 2023, the World Health Organisation, for the first time in history, declared the climate crisis and extreme weather events a public health emergency for Europe.  

To reduce the dangers of extreme heat for everyone, it has become crucial for cities to #Refresh, creating healthy and safe places for everyone to live and thrive.

Early warning systems

Critical ways for governments to safeguard health in times of heatwaves are early heat warning systems and keeping updated databases on vulnerable populations for targeted emergency responses. Maintaining widespread awareness on how to stay safe during heat waves is also crucial, as well as laws protecting outdoor workers.

In Europe, less than half of the EEA’s 38 countries have heat alert systems at national level. Around the same proportion have heat-health action plans.

Source: EEA Report, 'The Impact of Heat on Health'

Heat Action Plans

Cities are bridging this gap by developing strategies of their own at local level. We can name some of the most advanced strategies such as 'Paris under 50 degrees’ plan or Athens’ move to appoint the first Chief Heat Officer in Europe in 2021, dedicated to preparing Athens for heat waves and monitoring heat's impact on the city's population.

But heat not only hits big capital cities in Southern Europe. It’s increasingly becoming a problem in all of Europe, and small to mid-size cities are also increasingly suffering the risks of extreme heat.

The city of Worms was the first mid-size city in Germany to develop a Heat Action Plan. Near the Rhine River, Worms ranks among Germany’s hottest regions. Frequent heatwaves, sometimes reaching 39°C, threaten Worms’ 86 000 residents. Recognising the risks of rising temperatures led the city to develop a robust Heat Action Plan (Hitzeaktionsplan). 

This plan, in line with Worms overarching climate adaption plan, prioritises community-driven measures: from warning system for older adults living alone (the “Hitzetelefon”) to on-the-ground workshops ensuring vulnerable groups shape each solution and that social organisations themselves rise to the challenge of heatwaves.  

Photo: Rudolf Uhrig & Stadtverwaltung Worms

Refreshing areas with vulnerable populations

Adding to the challenge, as outlined in the European Environment Agency’s Report on Cooling Buildings Sustainably, nearly half of urban hospitals and schools are located in areas severely affected by the Urban Heat Island effect - meaning in dense, urban areas where temperatures are considerably higher (sometimes by 10 to 15 degrees) than in surrounding rural areas. This puts vulnerable groups such as children and individuals with health conditions at greater risk from high temperatures.

Many cities have started focusing their attention on schools and playgrounds to protect children from the blows of extreme heat, with the concept of “oasis schoolyards” like the ones being developed in Paris. In Paris, 165 “oasis schoolyards" have been created since 2017. 

In Poznán, Poland, the city began to create a network of natural playgrounds and green schoolyards in 2018 to integrate more vegetation across the city, especially in parts with scarce green areas such as the historic districts. 

Playgrounds and schoolyards can sometimes be the only public green spaces in the neighbourhoods, yet they are often characterised by concrete. The city council has decided to turn these spaces into “green oases” free from concrete, considerably reducing temperatures. These spaces thus not only protect vulnerable children from heat, but also offer the opportunity to refresh for the whole neighbourhood.

Widespread awareness

A public health crisis also calls for widespread awareness amongst the community. Campaigns to warn residents of upcoming heatwaves and associated risks can save many lives.

As part of their initiative to respond to heat waves, Cool Athens, the city of Athens has established a comprehensive communication, awareness and support programme. This includes categorising heat waves based on their danger, sending text message alerts to residents, putting in place a helpline, developing a dedicated app for people to navigate cool routes in the city, extending hours of Cool Centres and providing direct support in homes of vulnerable people. 

Source: Cool Athens

The programme also issues recommendations for residents to keep themselves, their family and their neighbours safe during a heatwave. These include tips to keep your home cool, as well as simple reminders to hydrate, wear a hat, and help your vulnerable neighbours and friends. 

Although the physical transformation of cities is crucial to address heatwaves, community-driven and social responses are just as important to safeguard public health. Raising awareness on heat-related health risks crucially strengthens existing community support networks, with neighbours checking in on one another and mutual aid groups activating to help those in need. 

What is your city doing to #Refresh and restore health? 

Join the #CitiesRefresh Campaign by submitting an action and getting featured on our map here!

To find out more about the health impacts of heat, check out the EEA's 2024 Report, 'The impacts of heat on health: surveillance and preparedness in Europe'.