Germany’s Public Health Service and Heat Action Plans

As climate change intensifies, leading to more frequent and prolonged heat periods, the implementation of Heat Health Action Plans (HHAPs) becomes increasingly vital to protect public health. However, in Germany, these crucial plans are currently not implemented comprehensively or nationwide. A new qualitative study, “The role of the public health service in the implementation of heat health action plans for climate change adaptation in Germany: A qualitative study,” published in Health Research Policy and Systems, delves into the challenges and opportunities for the Public Health Service (PHS) in addressing this growing public health threat.

Why This Research Matters: The World Health Organization (WHO) strongly recommends HHAPs to prevent heat-related adverse health effects, particularly for vulnerable populations such as the elderly, chronically ill, pregnant women, and children. The German health minister conference and the Lancet Countdown Policy Report for Germany have also highlighted the urgent need for action and the clear designation of the PHS as a key actor in this response. Despite these recommendations, the PHS’s role remains undefined and inconsistent across Germany.

Key Findings from the Study:

• Insufficient Legal Basis: The study’s policy document analysis revealed a significant gap: none of Germany’s 16 federal states’ regulatory frameworks for the PHS explicitly mention “heat” or heat-related tasks. While environmental health tasks are vaguely addressed, there is no clear legal foundation to enforce PHS involvement in HHAPs.
• Undefined Role and Local Variation: Expert interviews confirmed that the PHS currently lacks a clearly defined role in HHAP implementation, with its actual engagement largely dependent on local circumstances, resources, and needs. Often, environmental agencies, rather than the PHS, take the lead in initiating heat measures at the municipal level.
• The Ideal vs. Real Role: Interviewees differentiated between the PHS’s current supporting role and its ideal potential. There was a strong consensus that the PHS should be a central actor due to its focus on vulnerable populations, its existing networks with health stakeholders and community multipliers, and its potential to implement a “Health in All Policies” (HiAP) approach. The PHS is also seen as ideal for quality control, such as monitoring heat measures in nursing homes.
• Key Barriers and Facilitators: The study identified several critical factors influencing PHS engagement across individual, organizational, and political levels:
  • Contextual Factors:
    • Major Barrier: Other public health emergencies (e.g., COVID-19) divert resources and de-prioritize non-mandatory tasks like HHAP implementation.
    • Major Facilitator: Awareness of the need for climate adaptation among individuals, organizations, and political actors drives action.
  • Individual Level: Motivation, knowledge, and competencies of staff are crucial. The study highlights the need for dedicated training and inclusion of climate-health topics in PHS curricula.
  • Organizational Level: Rigid administrative structures hinder interagency cooperation. Lack of sufficient financial and human resources is a major impediment, with many PHS offices struggling to apply for external funding. Conversely, strong leadership, supportive supervisors, and external networks are key enablers.
  • Political Level: While some argue existing legislation is sufficient, many experts believe a strong legal framework that explicitly assigns roles and tasks for heat measures would lead to more dedicated resources and higher prioritization.

Conclusion: This study underscores that while the PHS could and should be a pivotal actor in implementing climate change adaptation measures like HHAPs, particularly given its focus on vulnerable populations, its legal foundation in Germany is currently insufficient. To effectively scale up HHAPs at the local level, tailored approaches are needed to overcome barriers such as rigid administrative structures and competing priorities, while leveraging facilitators like political support, adequate resources, strong leadership, robust networks, and enhanced individual motivation and knowledge.

This research provides crucial insights for policymakers and public health professionals aiming to strengthen Germany’s heat response and adapt to the health impacts of climate change.

Reference for this article:

Geffert, K., Voss, S., Rehfuess, E., & Rechel, B. (2024). The role of the public health service in the implementation of heat health action plans for climate change adaptation in Germany: A qualitative study. Health Research Policy and Systems, 22(1), 161. https://doi.org/10.1186/s12961-024-01231-6.