Heatwaves: how can Europe make its cities healthier and be better prepared?

Extreme weather events such as heatwaves are no longer merely an environmental concern; they are recognised as a global public health emergency. According to the WHO, approximately 175,000 deaths annually in the European region are linked to extreme heat.

As these harmful events become more frequent, affecting both our health and our healthcare system, the urgent need to create urban environments that are resilient to such conditions grows. What measures should Europe adopt to address this challenge and protect our communities?

Across Europe, extreme climate events, especially heatwaves, are becoming more common, more severe and far more lethal, with their impact often hidden behind causes such as heart attacks or respiratory failure. Over the last 20 years, heat-related deaths have risen by 30%, and this number is likely to increase further in the years to come.

Dr Paulo Morgado, associate professor at the Institute of Geography and Spatial Planning of the University of Lisbon: “Being exposed to heatwaves or extremely hot days impacts not only our physical health, but also directly influences how our bodies handle stress.”
Read the full interview with Paulo Morgado

According to Dr Morgado, this is particularly true, when considering heat alongside other factors such as noise, air pollution, aesthetics, openness and street connectivity, all of which could together increase our physiological load.

Moreover, heat and environmental factors can have several side effects on our health and well-being: they can impair our heart rate and cognitive performance, affect attention, memory, and processing speed, and ultimately increaseanxiety and fatigue, he says.

Heatwaves’ impact on healthcare systems and vulnerable groups

According to data from the European Environment Agency, heatwaves are responsible for up to 95% of climate-related deaths in Europe since 1980 and are becoming more frequent. Even if global warming is kept to 1.5°C above pre-industrial temperatures, around 100 million people in the EU and the UK could face extreme heat every year by the end of the century, far more than in the past.

An ageing population, increased chronic illnesses, and growing cities amplify the risks, with vulnerable groups like older adults, children, people with disabilities, and those residing in poor-quality housing being particularly at risk.

Wildfires

On top of this, the increasing number of wildfires doesn’t bear good news for our health:

Prof. Roel Vermeulen, professor of Environmental Epidemiology and Exposome Science at the Institute for Risk Assessment Sciences at Utrecht University: “Heat and air pollution from wildfires significantly affect child health especially, 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.” – Read the full interview with Roel Vermeulen

As Prof. Vermeulen points out, “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 will escalate.”

However, he notes that the impact of extreme climate events is not equally distributed. Vulnerable socio-economic groups are more affected, as these events exacerbate their health issues and damage their home environments, while they also have fewer financial and psychological resources to respond to these events compared with those in better socio-economic situations.

Pressure on the healthcare system and increasing costs

Heatwaves are also increasing pressure on hospitals, with emergency departments treating more patients, especially those with heart, lung, and kidney issues. A study in Portugal shows an 18.9% increase in hospital admissions during heatwave days. This surge in emergency cases can cause exhaustion and burnout among health workers.

Finally, heatwaves could cost the EU €17 billion a year in lost productivity by 2030, with even higher total costs when health and social impacts are included. Prof. Vermeulen underlines the urgent need for improved heat preparedness and prevention strategies within the healthcare system and society.

“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,” says Prof. Vermeulen.

Building climate resilient cities

“Green spaces offer multiple benefits beyond aesthetics, including noise buffering and climate change mitigation. They are recognised as nature-based solutions for extreme events like floods and heatwaves, and they improve air quality,” highlights Dr Morgado.

Going forward, Dr Morgado emphasises the importance of strengthening the link between urban planning and health to better prepare our urban environment for extreme weather events. According to him, “We must address inequalities and incorporate health data into planning decisions. City design should reflect how people perceive their environment. Additionally, we need new regulations, harmonised data, and better access to health equipment and infrastructure. All these elements are necessary to create healthier cities.”

“When thinking about the urban design, it’s essential to establish policies promoting greening in cities, following WHO guidelines on green space in neighbourhoods,” clarifies Prof. Vermeulen.

Dr Morgado continues, explaining that decision-makers and urban planners now have data identifying which types of streets induce stress and which promote relaxation. This information can help shape cities with features that benefit people, such as (streets with more greenery), calmer, less stressful transportation, and “climate shelters” (cool places to shelter from the heat):

Dr Morgado: “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“.

Building design also plays a role: plain facades can increase stress, whereas detailed, human-scale architecture encourages slower movement and enhances comfort. Even just applying simple improvements such as wider sidewalks, reduced noise, and cleaner streets can already make cities more navigable and enjoyable.

“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,” mentions Prof. Vermeulen.

He also adds that “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.”

Moving forward

So, ultimately, for Dr Morgado and Prof. Vermeulen, what is needed is a holistic urban planning approach that integrates the collected data into policymaking and urban development, with a focus on prioritising citizens’ health.

“I believe it is important that, in European policy, we do not see 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,” adds Prof. Vermeulen.

Dr Morgado concludes, stating that “the main thing is awareness, the knowledge that all citizens can use to influence policymakers and decision makers, reminding them to care about the urban environment we live in.”