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In recent years, both the EU Commission and the Belmont Forum have funded projects focusing on health and climate change with the aim of expanding research and evidence and improving intersectoral cooperation. The EU-funded ENBEL project is developing tools to streamline climate and health research to support policies and strategies and improve response and resilience. Methods: Within ENBEL a stakeholder analysis is being carried out for Europe to identify key decision makers involved in climate change and health adaptation, understand interlinkages and identify areas for action to promote collaboration and uptake. Semi-structured interviews with key institutions and stakeholders at different levels (International, European, national and local) will help identify key evidence needs and research gaps and findings will be used to define knowledge tools and policy briefs to enhance adaptation. Furthermore, current policies on adaptation in Europe and how health issues are addressed, especially taking into account the Next Generation EU (NGEU) funding in support of COVID-19 recovery as well as Green Deal and Climate Action, will be reviewed to ensure ENBEL products fit the EU policy agenda. Conclusions: ENBEL offers an opportunity to produce targeted research syntheses for decision makers as well an ensuring health becomes a key aspect in climate change policy decision making. The ENBEL project will engage with key decision makers involved in climate change and health adaptation across Europe, providing knowledge, understanding interlinkages and identifying areas for action to promote climate policies that enhance health benefits. [ABSTRACT FROM AUTHOR]

Human-induced changes in the global climate system pose a range of health risks. Irrespective of any actions, which may soon be taken to reduce or halt these environmental changes, human populations will be exposed to some degree of climate change over the coming decades.Objectives: In June 2001 the EC funded project (EVK-2000-00070) started to a) to identify the vulnerability to adverse impacts of climate change on human health; b) to review current measures, technologies, policies and barriers to improve the adaptive capacity of human populations to climate change; c) to identify for European populations the most appropriate measures, technologies and policies, as well as the most effective approaches to implementation, in order to successfully adapt to climate change; d) to provide estimates of the health benefits of specific strategies or combinations of strategies for adaptation for vulnerable populations under different climate change scenarios; e) to estimate the costs (due to climate-related damage and the implementation of adaptive measures) and benefits (both of climate change and of adaptation strategies) including co-benefits independent of climate change Methods: In order to reach the objectives, epidemiological methods from time series analysis to event-based assessments have been used to identify populations at risk and to estimate the health impacts of weather, climate variability and potential changes. The presentation will deal with the different methods used as well as illustrate some results. Results: The attribution of health outcomes to climate change is difficult. Most of our knowledge and methods deal with health impacts of particular weather parameters. There is a need of further better integrated assessment tools. The assistance of many other scientists will be acknowledged during the presentation. [ABSTRACT FROM AUTHOR]

Background: Adaptation, to reduce the health impacts of climate change, is driven by political action, public support and events (extreme weather). National adaptation policies or strategies are limited in addressing human health risks and implementation of adaptation in the public health community is not well understood., Aim: To identify key issues in climate change adaptation implementation for public health in Europe., Methods: Key informant interviews with decision-makers in international, national and local city governments in 19 European countries. Participants were recruited if a senior decision-maker working in public health, environmental health or climate adaptation., Interviews Addressed: Barriers and levers for adaptation, policy alignment, networks and evidence needs., Results: Thirty-two interviews were completed between June and October 2021 with 4 international, 5 national and 23 city/local government stakeholders. Respondents reported inadequate resources (funding, training and personnel) for health-adaptation implementation and the marginal role of health in adaptation policy. A clear mandate to act was key for implementation and resource allocation. Limited cross-departmental collaboration and poor understanding of the role of public health in climate policy were barriers to implementation., Conclusions: Across Europe, progress is varied in implementation of climate adaptation in public health planning. Providing appropriate resources, training, knowledge mobilization and supporting cross-departmental collaboration and multi-level governance will facilitate adaptation to protect human health., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: Heat is a significant cause of mortality, but impact patterns are heterogenous. Previous studies assessing such heterogeneity focused exclusively on risk rather than heat-attributable mortality burdens and assume predictors are independent., Objectives: We assessed how four interrelated regional-level sociodemographic predictors-education, life expectancy, the ratio of older to younger people (aging index), and relative income-influence heterogeneity in heat-attributable mortality burdens in Europe and then derived insights into adaptation strategies., Methods: We extracted four outcomes from a temperature-mortality study covering 16 European countries: the rate of increase in mortality risk at moderate and extreme temperatures (moderate and extreme slope, respectively), the minimum mortality temperature percentile (MMTP), and the underlying mortality rate. We used structural equation modeling with country-level random effects to quantify the direct and indirect influences of the predictors on the outcomes., Results: Higher levels of education were directly associated with lower heat-related mortality at moderate and extreme temperatures via lower slopes and higher MMTPs. A one standard deviation increase in education was associated with a - 0.46 ± 0.14 , - 0.41 ± 0.12 , and 0.41 ± 0.12 standard deviation ( ± standard error ) change in the moderate slope, extreme slope, and MMTP, respectively. However, education had mixed indirect influences via associations with life expectancy, the aging index, and relative income. Higher life expectancy had mixed relations with heat-related mortality, being associated with higher risk at moderate temperatures ( 0.33 ± 0.11 for the moderate slope; - 0.19 ± 0.097 for the MMTP) but lower underlying mortality rates ( - 0.72 ± 0.097 ). A higher aging index was associated with higher burdens through higher risk at extreme temperatures ( 0.13 ± 0.072 for the extreme slope) and higher underlying mortality rates ( 0.93 ± 0.055 ). Relative income had relatively small, mixed influences., Discussion: Our novel approach provided insights into actions for reducing the health impacts of heat. First, the results show the interrelations between possible vulnerability-generating mechanisms and suggest future research directions. Second, the findings point to the need for a dual approach to adaptation, with actions that explicitly target heat exposure reduction and actions focused explicitly on the root causes of vulnerability. For the latter, the climate crisis may be leveraged to accelerate ongoing general public health programs. https://doi.org/10.1289/EHP11766.

Background: Europe has experienced warmer summers in the past two decades and there is a need to describe the determinants of heat-related mortality to better inform public health activities during hot weather. We investigated the effect of high temperatures on daily mortality in three cities in Europe (Budapest, London, and Milan), using a standard approach., Methods: An ecological time-series study of daily mortality was conducted in three cities using Poisson generalized linear models allowing for over-dispersion. Secular trends in mortality and seasonal confounding factors were controlled for using cubic smoothing splines of time. Heat exposure was modelled using average values of the temperature measure on the same day as death (lag 0) and the day before (lag 1). The heat effect was quantified assuming a linear increase in risk above a cut-point for each city. Socio-economic status indicators and census data were linked with mortality data for stratified analyses., Results: The risk of heat-related death increased with age, and females had a greater risk than males in age groups > or =65 years in London and Milan. The relative risks of mortality (per degrees C) above the heat cut-point by gender and age were: (i) Male 1.10 (95%CI: 1.07-1.12) and Female 1.07 (1.05-1.10) for 75-84 years, (ii) M 1.10 (1.06-1.14) and F 1.08 (1.06-1.11) for > or = or =85 years in Budapest (> or =24 degrees C); (i) M 1.03 (1.01-1.04) and F 1.07 (1.05-1.09), (ii) M 1.05 (1.03-1.07) and F 1.08 (1.07-1.10) in London (> or =20 degrees C); and (i) M 1.08 (1.03-1.14) and F 1.20 (1.15-1.26), (ii) M 1.18 (1.11-1.26) and F 1.19 (1.15-1.24) in Milan (> or =26 degrees C). Mortality from external causes increases at higher temperatures as well as that from respiratory and cardiovascular disease. There was no clear evidence of effect modification by socio-economic status in either Budapest or London, but there was a seemingly higher risk for affluent non-elderly adults in Milan., Conclusion: We found broadly consistent determinants (age, gender, and cause of death) of heat related mortality in three European cities using a standard approach. Our results are consistent with previous evidence for individual determinants, and also confirm the lack of a strong socio-economic gradient in heat health effects currently in Europe.

Campylobacter is among the most important agents of enteritis in developed countries. We have described the potential environmental determinants of the seasonal pattern of infection with campylobacter in Europe, Canada, Australia and New Zealand. Specifically, we investigated the role of climate variability on laboratory-confirmed cases of campylobacter infection from 15 populations. Regression analysis was used to quantify the associations between timing of seasonal peaks in infection in space and time. The short-term association between weekly weather and cases was also investigated using Poisson regression adapted for time series data. All countries in our study showed a distinct seasonality in campylobacter transmission, with many, but not all, populations showing a peak in spring. Countries with milder winters have peaks of infection earlier in the year. The timing of the peak of infection is weakly associated with high temperatures 3 months previously. Weekly variation in campylobacter infection in one region of the UK appeared to be little affected by short-term changes in weather patterns. The geographical variation in the timing of the seasonal peak suggests that climate may be a contributing factor to campylobacter transmission. The main driver of seasonality of campylobacter remains elusive and underscores the need to identify the major serotypes and routes of transmission for this disease.

We investigated the relationship between environmental temperature and reported Salmonella infections in 10 European populations. Poisson regression adapted for time-series data was used to estimate the percentage change in the number of cases associated with a 1 degree C increase in average temperature above an identified threshold value. We found, on average, a linear association between temperature and the number of reported cases of salmonellosis above a threshold of 6 degrees C. The relationships were very similar in The Netherlands, England and Wales, Switzerland, Spain and the Czech Republic. The greatest effect was apparent for temperature 1 week before the onset of illness. The strongest associations were observed in adults in the 15-64 years age group and infection with Salmonella Enteritidis (a serotype of Salmonella). Our findings indicate that higher temperatures around the time of consumption are important and reinforce the need for further education on food-handling behaviour.