A qualitative study of local health resilience to adverse weather in England, UK

The frequency and severity of adverse weather events in England has increased, with major implications for emergency preparedness, resilience and response (EPRR), community and organisational resilience, and public health. In the UK, Local Resilience Forums (LRFs) are responsible for producing Community Risk Registers (CRRs), which assess local risks and support preparedness planning under the Civil Contingencies Act 2004. However, adverse weather and health risks in CRRs remain inconsistently addressed. This study qualitatively explores the barriers and facilitators influencing LRFs in preparing for and responding to adverse weather risks through CRRs. Semi-structured interviews were conducted with representatives from nine LRFs across England, selected to capture regional variation. Thematic analysis identified key facilitators, including multi-agency collaboration, flexible response arrangements, and recognition of increasing adverse weather severity and frequency. Barriers included unclear roles for public health in LRFs and developing CRRs, local resource limitations, low public awareness of weather-health risks, and challenges integrating national plans. Results highlighted variability in climate change risk representation, differing thresholds for action in response to weather-health alerts, and reliance on other organisations. Findings underscore the importance of clear impact-based national guidance around health, streamlined and applicable information for LRFs to prepare CRRs, stronger integration of health data, and enhanced cross-LRF and multi-agency collaboration. By explaining qualitative insights into how national frameworks are adopted and implemented locally, this study contributes to supporting those that contribute to building community and organisational resilience, EPRR, and broader disaster risk reduction and the integration of weather and health in dynamic climate risk environments. • Identifies variability in how LRFs represent climate change and adverse weather, with heat and chronic risks often underrepresented or excluded. • Reveals good awareness of alerting systems but inconsistent response actions for weather-health alert thresholds. • Shows unclear role of health actors, resource constraints, and the reliance on other agencies, restricting the systematic integration of health impacts into CRRs. • Demonstrates the benefit of qualitative thematic analysis in uncovering institutional learning needs and opportunities for cross-LRF and multi-sectoral collaboration.