“We should treat extreme weather events as an important health issue in Europe,” says Dr Roel Vermeulen, professor of Environmental Epidemiology and Exposome Science at the Institute for Risk Assessment Sciences at Utrecht University, the Netherlands.
Across Europe, we’re seeing more extreme weather events, such as heatwaves, floods, droughts, and wildfires. What are the main health risks linked to these events?
Roel Vermeulen: I think for me, it’s best to focus on two key aspects: heat and wildfires, which are most relevant to my work. In 2024, the WHO estimated that extreme heat causes approximately 175,000 deaths annually in Europe. This significant health impact primarily affects the cardiovascular system, as heat stresses the body and strains the heart and lungs, potentially leading to health problems.
Another major concern is the rise in wildfires. A recent study from IS Global published in 2024 indicates that particulate matter from wildfires causes about 535 deaths per year in Europe, a higher figure than previously estimated. It’s important to remember these estimates are based on current climate conditions, which are expected to worsen over time, possibly increasing health risks.
When considering wildfires, we must also think about air pollution in general, which mainly impacts the cardiovascular and respiratory systems, but can also lead to other diseases like lung cancer and neurodegenerative conditions. From a public health perspective, air pollution and, in particular, exposure to fine particulate matter are responsible for around 239,000 deaths annually in Europe, according to the European Environmental Agency, highlighting the large scale of this issue.
The current situation is likely to worsen over time. Projections suggest that by 2030, wildfire incidents may increase by 14%, and by the end of the century, the rise could reach up to 50%. This increase will also bring longer fire seasons and potentially more prolonged fires. So, it’s not only the timing of when this occurs, but also the frequency, duration, and intensity that will also escalate. Given the impact wildfires already have today, we urgently need to think about how to mitigate these stressors.
What happens inside healthcare systems when extreme weather events hit? Where do you see the biggest pressures?
Roel Vermeulen: I want to emphasise that the impact of heat extends beyond healthcare and begins within people’s homes. Our primary focus should be on protecting vulnerable populations from the effects of heat so they don’t need medical attention; we know that heat events can increase pressure on healthcare systems, especially during the acute phase.
While many countries and cities have heat plans to prepare healthcare systems, the key is to develop early warning systems that advise people to adapt their behaviour, such as avoiding strenuous activities, and to implement cooling centres for vulnerable and elderly populations. Prevention is crucial to managing emergencies caused by heat events.
Who is most at risk during extreme weather events in Europe today, and what makes them more vulnerable?
Roel Vermeulen: When considering heat and air pollution from wildfires, vulnerable groups include children, who are more susceptible to these harms than adults, and the elderly, especially those with pre-existing conditions like asthma or cardiovascular issues. These exposures and their effects are unevenly distributed, with individuals in lower socioeconomic circumstances at greater risk due to both health factors and more fragile home environments.
Research shows that heat and air pollution from wildfires significantly affect child health because many of their organ systems are still developing, making them more vulnerable to environmental insults.
The elderly are also more susceptible because they are less biologically resilient and adaptable to these changing conditions. Similarly, individuals with existing comorbidities, whose bodily functions are already compromised, may also experience worsening health outcomes.
What are some practical steps, at the community or city level, that could reduce health risks from extreme weather in the near future?
Roel Vermeulen: Most heat action plans focus on reducing physical activity to prevent stress. They also emphasise cooling homes, typically with air conditioning, though not everyone has access to it, and using cold-water baths to lower body temperature.
I believe community cooling centres are preferable for two main reasons: they make targeted cooling easier and allow better monitoring of vulnerable individuals, ensuring care is provided when needed.
Additionally, they promote social interaction, helping to prevent loneliness in difficult circumstances. While individuals can take some actions, community efforts are more effective in managing heat risks.
Moreover, the buildings and houses in Europe have been built for the climate conditions that existed a few decades ago, and those conditions are now rapidly changing. As a result, many homes are not ready for these warmer temperatures, and we really have to think about how to cool down these homes.
When considering possible solutions, we must recognise that individuals in more vulnerable situations might struggle to adapt. A key focus should be on ensuring that the most vulnerable can also adjust to these new circumstances.
Examples include Britain and the Netherlands, where social housing often has designs making them more susceptible to heat because they are built differently than many other homes, potentially leading to greater impacts. Additionally, special attention should be given to elderly homes to protect vulnerable populations. These are steps we can and should take to adapt to these changes, but we must also remember the importance of mitigation.
At the policy level, what should the European Union prioritise now to better protect public health and prepare healthcare systems for more frequent extreme weather?
Roel Vermeulen: I believe it is important that, in European policy, we do not treat these extreme weather events as purely environmental issues. They are a real health problem, and therefore, we should treat them as an important health issue in Europe.
To improve regulation, we should focus on preparing communities by establishing heat-resistant infrastructure and ensuring individuals have opportunities to adapt. It is also vital that healthcare systems are ready for these events.
More importantly, policies should proactively support adaptation. When thinking about urban design, it’s essential to establish policies promoting greening in cities, following WHO guidelines on green space in neighbourhoods. Additionally, when constructing new homes and dwellings in Europe, we must ensure they are prepared for the climatic circumstances that will be there in 10 to 50 years. The new European Bauhaus is a key initiative that emphasises diversity, inclusion, and aesthetics. However, health is not a core pillar, which I see as a missed opportunity. Future buildings and neighbourhoods should be sustainable, inclusive, and diverse, and explicitly support population health. Ultimately, new constructions must be climate-adaptive to future conditions.
Is there anything you would like to add?
Roel Vermeulen: One important aspect for me is that, at the policy level, the EU should prioritise better protection of public health from extreme weather events. It’s also crucial to recognise the interactions between other environmentalrisk factors and extreme weather. Reports, including studies from our own research, have shown that air pollution effects are worsened by extreme weather or higher temperatures. The European Environment Agency highlighted this in their 2022 and 2023 studies. For example, heat combined with air pollution increases mortality risk by 21%, compared to 6% or 5% when these factors are considered separately, indicating a compounding effect. We’ve also observed this in the decline of lung function in our studies. Extreme weather events often exacerbate other existing exposures and stresses in our lives. That’s why I support a new initiative within the European Parliament called the exposome alliance, where Members of the European Parliament, scientists, and NGOs are working together to better understand how the exposome, the cumulative exposure to environmental, social and lifestyle factors, such as where we live, work, what we eat, and our social connections, impacts health.