The effectiveness of heat prevention plans in reducing heat-related mortality across Europe

Heat-health warning systems and action plans, referred to as heat prevention plans (HPPs), are key public health interventions aimed at reducing heat-related mortality. Despite their importance, prior assessments of their effectiveness have yielded inconsistent results. The objective of this study is to systematically assess the effectiveness of HPPs in reducing heat-related mortality risk across Europe. We analysed daily mortality and mean temperature data from 102 locations in 14 European countries between 1990 and 2019. Using data from national experts, we identified the year of HPP implementation and categorised their development class. A three-stage analysis was conducted: (1) quasi-Poisson time series models were used to estimate location-specific warm-season exposure-response functions in 3 year subperiods; (2) mixed-effect meta-regression models with multilevel longitudinal structures were employed to quantify changes in pooled exposure-response functions due to HPP implementation, adjusted for long-term trends in heat-related mortality risks; and (3) the heat-related excess mortality due to HPP was calculated by comparing factual (with HPP) and counterfactual (without HPP) scenarios. Estimates are reported by country, region, and HPP class. HPP implementation was associated with a 25.2% [95% CI: 19.8% to 31.9%] reduction in excess deaths attributable to extreme heat, corresponding to 1.8 [95% CI: 1.3-2.4] avoided deaths annually per 100 000 inhabitants. This equates to an estimated 14 551 [95% CI: 10 118-19 072] total deaths avoided across all study locations following HPP implementation. No significant differences in HPP effectiveness were observed by European region or HPP class. Our findings provide robust evidence that HPPs substantially reduce heat-related mortality across Europe, accounting for temporal changes and geographical differences in risks. These results emphasise the importance of monitoring and evaluating HPPs to enhance adaptation to a warming climate.

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Journal
Environmental Research Letters
Published
2025-12-01
DOI
https://doi.org/10.1088/1748-9326/ae2775
Primary Topic
Climate Change and Health Impacts
Type
article
Field-Weighted Citation Impact
0.00

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article

The effectiveness of heat prevention plans in reducing heat-related mortality across Europe

Aleš Urban, Jan Kyselý, Malcolm Mistry, Susana das Neves Pereira da Silva et al.
Environmental Research Letters
Climate Change and Health Impacts
article

The effectiveness of heat prevention plans in reducing heat-related mortality across Europe

Aleš Urban, Jan Kyselý, Malcolm Mistry, Susana das Neves Pereira da Silva, Silvia Kohnová, Reija Ruuhela, Antonio Gasparrini, Niilo Ryti, Martina S. Ragettli, Francesca Katherine de'Donato, Wim Thiery, L. F. Pau, Pierre Masselot, Ivana Cvijanović, Claudia Di Napoli, Samuel Lüthi, Mathilde Pascal, Shouro Dasgupta, Simon N. Gosling, Joanna Wieczorek, Veronika Huber, Salomé Henry, Ana María Vicedo-Cabrera, Ben Armstrong, Francesco Sera, Shiri Zemah Shamir, Lucie Tušlová
article en

Abstract

Heat-health warning systems and action plans, referred to as heat prevention plans (HPPs), are key public health interventions aimed at reducing heat-related mortality. Despite their importance, prior assessments of their effectiveness have yielded inconsistent results. The objective of this study is to systematically assess the effectiveness of HPPs in reducing heat-related mortality risk across Europe. We analysed daily mortality and mean temperature data from 102 locations in 14 European countries between 1990 and 2019. Using data from national experts, we identified the year of HPP implementation and categorised their development class. A three-stage analysis was conducted: (1) quasi-Poisson time series models were used to estimate location-specific warm-season exposure-response functions in 3 year subperiods; (2) mixed-effect meta-regression models with multilevel longitudinal structures were employed to quantify changes in pooled exposure-response functions due to HPP implementation, adjusted for long-term trends in heat-related mortality risks; and (3) the heat-related excess mortality due to HPP was calculated by comparing factual (with HPP) and counterfactual (without HPP) scenarios. Estimates are reported by country, region, and HPP class. HPP implementation was associated with a 25.2% [95% CI: 19.8% to 31.9%] reduction in excess deaths attributable to extreme heat, corresponding to 1.8 [95% CI: 1.3-2.4] avoided deaths annually per 100 000 inhabitants. This equates to an estimated 14 551 [95% CI: 10 118-19 072] total deaths avoided across all study locations following HPP implementation. No significant differences in HPP effectiveness were observed by European region or HPP class. Our findings provide robust evidence that HPPs substantially reduce heat-related mortality across Europe, accounting for temporal changes and geographical differences in risks. These results emphasise the importance of monitoring and evaluating HPPs to enhance adaptation to a warming climate.

Environmental Research LettersVol. 20(12)
Slovak University of Technology in Bratislava (SK), University of Bern (CH), University of London (GB), Finnish Meteorological Institute (FI), Oeschger Centre for Climate Change Research (CH), University of Helsinki (FI), Vrije Universiteit Brussel (BE), Consejo Superior de Investigaciones Científicas (ES), University of Nottingham (GB), Ca' Foscari University of Venice (IT), European Centre for Medium-Range Weather Forecasts (GB), Swiss Tropical and Public Health Institute (CH), Copenhagen Business School (DK), University of Basel (CH), Université de Montpellier (FR), Czech University of Life Sciences Prague (CZ), AgroParisTech (FR), Generalitat Valenciana (ES), Helmholtz Zentrum München (DE), ETH Zurich (CH), Estación Biológica de Doñana (ES), London School of Hygiene & Tropical Medicine (GB), Santé Publique France (FR), Acteurs, Ressources et Territoires dans le Développement (FR), Centre d'Investigacions sobre Desertificació (ES), CMCC Foundation - Euro-Mediterranean Center on Climate Change (IT), National Research Council (LK), Institute of Social and Preventive Medicine (CH), Institute of Meteorology and Water Management (PL), National Institute of Health Dr. Ricardo Jorge (PT), Czech Academy of Sciences, Institute of Atmospheric Physics (CZ), Istituto di Cibernetica “Eduardo Caianiello” (IT), Institut de Recherche pour le Développement (FR), UMR Espace-Dev, University of Florence (IT), Erasmus University Rotterdam (NL), Universidad Pablo de Olavide (ES), University of Oulu (FI)
National Science Foundation, Wellcome Trust, European Commission, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Grantová Agentura České Republiky, Medical Research Council
Openalex Percentile: Top 50%
Climate Change and Health Impacts
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