Well-adapted health system

• Behaviour change: appropriate and accessible information and guidance, delivered through effective communication channels, are needed to enable change and are often seen as low-regret actions.
• Public cooling spaces: using pre-existing cool public spaces and buildings to help keep vulnerable people cool can be cost effective for reducing risk of health impacts from heat. However, they can be hard to access for some of the most at-risk groups.
• Preventative healthcare: in-person visits by healthcare or community workers to people at highest risk of heat-related impacts during (or shortly before expected) heat events can reduce mortality and hospital use. These can be costly, requiring increased community healthcare staffing, and therefore can be less cost-effective in northern regions. Health professionals and clinical management can also play a role by providing specialist, targeted advice for patients using heat-sensitive medication or who may require additional support.
• Mental health treatment for those exposed to flooding: trauma-focused therapy, alongside measures to reduce climate risk, can be effective with some evidence reporting a drop in Post-Traumatic Stress Disorder diagnoses of flood-affected children.

• Surveillance and monitoring of climate hazards and impacts: flooding, heatwaves, wildfire, and storms can be tracked and monitored, allowing public health agencies to issue timely warnings and take preventative action.
• Surveillance and monitoring for climate-sensitive diseases: preventing establishment of climate-sensitive vectors such as mosquitoes and ticks is more effective than managing invasive species once they are widespread.

• Heat alerts: alerts issued by the UKHSA are currently activated in England only and cover defined heatwaves. Heat-health alerts issued by UKHSA should be considered in other nations or be targeted based on local-level risk.
• Local warnings: existing early warning systems include the Met Office’s Severe Weather Warning Service. Strengthening multi-channel local warnings, while managing repeated alerts to avoid response fatigue, is required to ensure all regions and at-risk people are reached.

These adaptation actions are connected with adaptation in the public services system.

• Green and blue spaces: high quality and well-distributed green and blue spaces reduce heat exposure, mitigate the urban heat island effect, and support physical activity and wellbeing. Their effectiveness depends on quality of design. Accessibility and safety are key features to maximise co-benefits, such as encouraging physical activity.
• Building and maintaining safe water bodies: this can reduce breeding of endemic mosquitoes and harmful algal blooms. Preventative actions include designing water features with moving water and limited emergent vegetation

These adaptation actions are connected with adaptation in the built environment and communities system.

• Cooling measures: investing in retrofitting existing healthcare facilities is likely to provide high net benefits. In most areas of England and Wales, installing low-cost passive cooling for those buildings most at risk would be cost-effective for addressing health impacts from heat in the short term. Active cooling measures will be needed in some areas and buildings. Relative costs and effectiveness of different measures vary depending on whether they are being retrofitted or included at build-stage and the type of building they are applied to.
• Property-level flood resilience: hospitals may require both building and system-level defences. For example, sustainable drainage systems (SuDS), permanent external barriers, protected access routes, waterproofing electricals, building redundancy for critical areas such as theatres, labs and IT, and keeping essential equipment away from basements. Care homes in flood risk areas would benefit from property-level measures. Undefended new facilities should not be built in areas at high-risk of flooding.

These adaptation actions are connected with adaptation in the built environment and communities system.

• Capacity building: training for medical, nursing, pharmacy, and allied health professionals strengthens their ability to anticipate, recognise, and manage climate-related health risks. This helps to prevent avoidable complications and ease pressure on services during periods of high demand.
• Extreme weather business continuity plans: business continuity planning can outline how to manage absences alongside wider adverse-weather planning. For example, through workplace heat-protection policies and flexible staffing where possible.
• Occupational support: within the health and care system, the following actions should be in place to protect staff health and wellbeing: providing occupational health support, hydration stations, cool areas, ensuring appropriate breaks are taken, adapting Personal Protective Equipment (PPE), and providing support for safe travel during extreme weather.
• Emergency scenario planning: undertaking risk assessments and stress-testing health systems to identify vulnerabilities is a first step in developing effective rapid response protocols for climate-induced emergencies. This evidence can then be used to design and refine emergency protocols that clarify roles, improve coordination, and standardise response actions.