Managing heat-health risks in warming cities: Governance innovations and gaps from Geneva, Switzerland

As climate change intensifies, managing heat-health risks has become increasingly urgent, particularly in rapidly warming urban areas such as Geneva, Switzerland. This study examines Geneva's approach to heatwave risk management through expert interviews and an exploration of key policy and institutional innovations, including the Heatwave Directive, public advisories, and the creation of a dedicated Heatwave Unit. Findings show a shift from reactive crisis management to a more anticipatory and adaptive framework. Public health is now embedded within broader climate strategies through intersectoral collaboration and targeted measures for vulnerable populations. Geneva demonstrates emerging best practices in urban heat adaptation, yet challenges remain. Legislative gaps, limited evaluation mechanisms, and resource constraints hinder the full implementation of adaptation measures. Strengthening heat-health indicators, systematic data collection, and behavioural research is essential for tracking health impacts and informing urban policies. Addressing socio-economic vulnerabilities, increasing public education, and integrating urban cooling strategies – such as greening projects and climate-sensitive architecture – can further enhance resilience. Future efforts should focus on exploring the multi-dimensional impacts of prolonged heat events, and refining communication through participatory approaches. Geneva's experience underscores the need for equity-focused and interdisciplinary adaptation, offering practical lessons for cities worldwide facing intensifying heat and health challenges. • Data-driven analysis enhances Geneva's urban heat adaptation capacity. • Public health integration advances but climate-health policy gaps remain. • Equity, urban design, and participatory governance drive long-term resilience. • Gaps persist in addressing socio-economic burdens and tracking health metrics.