Heat health action plans

In order to prepare heat health action plans, collaboration between different actors is essential. This covers actors from diverse institutions (multi-agency) and different sectors (inter-sectoral), like for nearly all emergency plans. While many actions fall to the health sector, active involvement of other sectors is also very relevant. Moreover, heat health actions plans are often developed at the national level and implemented at the regional to local levels as well; thus the involvement of and vertical collaboration among the relevant institutions and actors across all governance levels is of utmost importance.

Communication is an integral part of managing health risks, which involves an interactive process of exchange of information, concepts or concerns relating to such risks, among individuals, groups and institutions. Establishing a dialogue as early as possible between the different actors involved – including target users - provides several benefits. Therefore, at the beginning, there is a need to provide information and knowledge. This will increase awareness and concern on the part of the different actors. Especially accompanying efforts such as awareness raising in the population related to heat-related effects and health problems, especially focusing on the most vulnerable groups prone to health risks of heat, are extremely important components of any heat health plan and its successful implementation.

Based on WHO Europe experience on heat and health (e.g. EuroHEAT, Health advice and the European Working Group on Health in Climate Change) and drawn from existing heat health action plans and literature, core elements for the successful implementation of heat health action plans can be identified:

• a coordinating body responsible for the implementation of the plan and collaboration with multi-agencies;
• accurate and timely alert systems, to determine the thresholds for action;
• a plan for informing and communicating heat-related health information including a clear identification of what needs to be communicated, to whom and when;
• recommendations (e.g. about reducing heat exposure and advice on how to keep indoor temperatures low during heat episodes) targeting most vulnerable population groups;
• a more mid- to long-term preparedness of the health and social care system (e.g. through staff training and planning, appropriate health care and improvement of the physical environment);
• Monitoring of mortality and morbidity associated with periods of heat stress and an evaluation mechanism to assess the plan performance;
• Report key stakeholders (e.g. the Health Minister) and the general public on the activities developed during the year.

These elements are not sequential, though some are primarily about planning and others more about response.

In order to fully implement the plans, coordination efforts between diverse actors at the national, sub-national and locals level are needed. This effort can be demanding and needs to be defined in detail, especially in terms of information flow and advice on who is doing what and when. Even, if the information is well communicated, it does not necessary imply, that the most vulnerable groups of society (elderly people, small children, people with current health problems, etc.) are reached and can act upon the information provided. Some additional efforts can be needed in terms of implementing suggested actions, which implies other financial efforts and might be harder to implement in the short-term (e.g. in the case of change in buildings).

Most existing plans are led and/or funded by related sectoral Ministries; in some cases research projects were the starting point for the plan elaboration and (pilot) implementation. The full implementation of an heat health action plan requires staff work in various areas related to the prevention of health risks, thus the estimation of costs and resources associated with the plans is rather difficult and context specific.

The plans benefits lie in the prevention of adverse health effects, especially on most vulnerable target groups. The benefits have until now not been fully analysed or calculated, since many plans are only in place for a few years and thus currently monitored, but not yet evaluated.

In general, it can be stated that the delivery of the information to sub-national and local multi-actors - who can either accordingly prevent or at least minimize the adverse health effects - compared to a lack of information is already a clear benefit. This is also true in terms of costs, as provided information helps the efficient planning for healthcare staff and related healthcare facilities.

Legal and policy basis for a heat health action plan can be of different nature, and can include documents like adaptation strategies, adaptation action plans or risk reduction/management strategies. Most plans have been developed at the national level. In some cases sub-national plans already existed; the national plan was developed harvesting these experiences and aims to provide an umbrella plan on the national level (e.g. in the case of Austria).

The elaboration of a heat health action plan is a relatively quick process, which can require a few years, depending also on the level of needed collaboration between actors in the field of health and early warning. Implementation as well as its monitoring is a continuous effort. Most heat health action plans are operational from May till September.

Actions foreseen by the plans are normally assumed to continue for the long-term. Monitoring, evaluation and reviewing are essential components of any plan, to adapt it to evolving conditions. Some plans foresee a revision of the plan after more experience is gained.