Rising Heat, Rising Challenges
In recent years, Europe has experienced a steep increase in the frequency, duration, and intensity of heatwaves. This phenomenon has far-reaching implications for human health, with well-documented effects such as increased mortality, heat stroke, kidney damage, and cardiovascular stress. However, the challenge extends beyond individual health outcomes: heatwaves strain healthcare systems themselves. Hospitals and primary health centres see surges in patient inflows, while their staff must work in hotter, often inadequately equipped environments that compromise both patient safety and workforce well-being. Many healthcare facilities were built for cooler climates and lack sufficient adaptation measures, making extreme heat a systemic risk factor.
Recognizing the urgency of this issue, a peer-learning exchange was organized to bring together healthcare workers, policymakers, and researchers from across Europe to share experiences, challenges and strategies for heat adaptation in healthcare. The event focused on three case studies, Dresden Municipal Hospital, Grenoble University Hospital, and the Raval Nord Primary Health Centre in Barcelona, highlighting the diversity of local contexts, governance systems, and adaptation pathways. You can find the recording of the event here on Adaptation AGORA’s YouTube channel.
Insights from a participatory approach in the Dresden Municipal Hospital
The Dresden Municipal Hospital, with its 3,800 staff and 180,000 patients per year, faces the particular challenge of adapting historic buildings, which cannot be easily retrofitted. This constraint has shifted the focus toward “soft” adaptation measures: organizational, behavioural, and procedural interventions that do not require major interventions in the built environment.
Through its engagement with the Adaptation AGORA project, Dresden Municipal Hospital adopted a participatory approach. Maria Binder, Climate Protection Manager at the Dresden Municipal Hospital, was part of this process, which began with a kick-off workshop in late 2023, followed by two focus groups and a capacity-building workshop in 2024–2025. Nurses, who are at the frontline of patient care, were central participants. They reported increased physical strain, stress, and hygiene challenges during heatwaves, which negatively impacted their performance and potentially patient outcomes. Solutions identified included ensuring easy access to drinking water, modifying work schedules, and providing education on heat-related health risks.
Building on these results, the capacity-building workshop broadened participation to include doctors, administrators, and external experts, combining clinical, technical, and management perspectives. Discussions addressed building ventilation, shading optimization, safe storage of heat-sensitive medicines, and ways to integrate heat protection into daily routines. Crucially, staff engagement emerged as a key factor: healthcare workers called for early communication about adaptation initiatives, flexible participation formats, and integration of climate discussions into regular team meetings. This approach fosters shared ownership of heat protection measures and makes them more practical for shift-based work.
The hospital has already implemented digital training modules on heat protection and launched a review of building conditions to identify heat-vulnerable areas. An Occupational Safety working group now treats heat as a core concern, reframing climate adaptation as part of the hospital’s duty of care toward its employees. Civil society organizations, notably KLUG (the German Alliance for Climate Change and Health) and Health for Future, played a vital role by providing expertise and resources. These organizations, as explained by Sina Lehmann, specialist for Gynaecology and part of Health for Future Dresden, are built on volunteer engagement and professional expertise, and advocate for integrating climate action into the health sector.
Collaboration with the City of Dresden further strengthens this work. Although Germany’s national heat warning system does not impose mandatory action for municipalities, Dresden’s public health office has been proactive in fostering links with hospitals. Marit Gronwald, Health and Climate Officer at the Department of Public Health of the City of Dresden, explained that there is close collaboration between the City of Dresen and local hospitals, supporting and recommending hospital-related heat-protection plans and collaborating on information and public awareness activities. In the long term, the city also plans to adapt the buildings at its municipal hospital to make them more heat-adapted and climate-protecting.
Research-policy collaborations in the Grenoble University Hospital
Grenoble, located in the French Alps, faces a unique combination of urban heat stress and air pollution, exacerbated by its surrounding topography. The Grenoble University Hospital has seen rising heat-related emergencies, including cardiovascular crises, psychiatric destabilizations, and accidents such as drownings. Yet, until recently, the hospital’s climate-related efforts focused primarily on winter heating efficiency.
As neurologist Emmeline Lagrange emphasized, the hospital is undergoing a strategic shift by recognizing the need to reconstruct its physical infrastructure, to better withstand rising temperatures and extreme heat event, but also its relationship with the city, developing health-promoting neighbourhoods that integrate healthcare with sustainable urban design.
One of Grenoble’s key assets is its close relationship with the scientific community. The University hosts one of Europe’s leading centres for climate change and health, which collaborates with municipal authorities to monitor air pollution and heat, track health outcomes, and guide adaptation strategies. This science-policy interface exemplifies how local research capacity can directly inform evidence-based planning and ensure that health considerations remain central in urban climate strategies.
Nevertheless, Grenoble’s hospital system still faces gaps in resources and governance, as healthcare falls under the national public hospital system rather than municipal control. Political instability at the national level can limit funding and coordinated action. Despite these challenges, Grenoble offers a model of how scientific expertise and municipal ambition can work hand in hand to shape long-term resilience.
Barcelona: social vulnerability and multi-agency governance
Barcelona’s Raval neighbourhood represents one of the most heat-vulnerable urban contexts in Europe. With narrow streets, old housing stock, and a large migrant population (around 60% of residents), Raval suffers from both structural and social vulnerability. Energy poverty prevents many households from cooling their homes, while poor ventilation exacerbates heat stress.
Barcelona has been proactive in developing a Heat Wave Action Plan since 2003, coordinated by the city’s Public Health Agency. Central to this strategy is a network of climate shelters, libraries, museums, schools, and other public facilities, that provide refuge during heatwaves. Targeted communication campaigns, early warnings, and inter-institutional coordination are deployed to maximize public access to these resources.
At the Raval Nord Primary Health Centre, as described by nurse Anna Riu Llena, healthcare professionals are key intermediaries between city services and vulnerable residents. They not only treat heat-related illnesses but also adjust medication regimens, conduct home visits, and offer behavioural advice (e.g. keeping blinds closed, ventilating at night). However, infrastructure limitations and summer staff shortages place significant strain on both patients and providers. Some centres have even had to close temporarily due to failed air conditioning systems, underscoring the urgent need to upgrade healthcare facilities themselves.
Barcelona’s Climate Office recently published a 10-year “Strategy to Combat the Heat,” which explicitly addresses governance by mapping responsibilities across city and regional institutions. As noted by a representative from the Barcelona City Council participating to the peer-learning, it is crucial that climate shelter networks and healthcare providers are coordinated, since vulnerable citizens often receive their information through health centres. The city’s approach highlights that adaptation is not only a matter of technical solutions but also of coherent, multi-agency governance.
Overcoming Barriers to Health Sector Engagement
Despite mounting evidence of heat’s impacts on morbidity and mortality, engaging the health sector remains challenging in many countries. A participant, climatologist of the Babeș-Bolyai University of Cluj-Napoca (Romania), described the difficulty of convincing hospital managers and national health authorities to treat heat as an urgent public health issue, as they tend to prioritize immediate crises over longer-term climate threats.
Several strategies for overcoming this inertia emerged during the exchange. One is reframing heatwaves as occupational safety concerns, as successfully done in Dresden, calling on employers’ legal duty to protect staff by, for instance, regulating indoor working hours. Another is leveraging trusted voices within professional networks, as KLUG did in Germany by mobilizing doctors to present climate change as a health crisis. Evidence-based advocacy using international datasets and case studies can also help demonstrate the scale of the risk and the feasibility of solutions. Finally, cross-country peer exchanges like this one provide tangible examples that can inspire action and reduce resistance.
Science-Policy Integration: From Knowledge to Practice
Across all case studies, participants agreed that scientific knowledge about heat risks is abundant, but translating that knowledge into practice remains a challenge. Grenoble provides an example of a city where science is well-integrated into policy, with researchers actively shaping adaptation plans and monitoring outcomes. In contrast, Dresden’s challenge lies less in knowledge gaps and more in internal communication: ensuring that available guidelines are disseminated, responsibilities assigned, and measures implemented consistently within hospital operations.
This highlights that effective science-policy interfaces depend not just on generating evidence, but also on institutional capacity, communication infrastructure, and leadership commitment. Embedding scientific expertise into governance structures, creating feedback loops, and allocating resources for implementation are key to closing the gap between knowledge and action.
Key Learnings and Way Forward
The peer-learning exchange underscored several overarching lessons. First, heat adaptation in healthcare is as much a governance and participation challenge as it is a technical one. Successful cases like Dresden demonstrate the power of involving frontline staff, embedding adaptation into routine operations, and fostering ownership of solutions.
Second, partnerships across levels—municipal, institutional, and civil society—are critical. Multi-level collaboration strengthens capacity, aligns strategies, and ensures that vulnerable populations are not overlooked.
Third, governance coherence matters. Barcelona’s efforts to define roles and responsibilities across different authorities exemplify how a structured approach can prevent gaps in communication and service provision.
Fourth, scientific expertise must be actively embedded into decision-making, not just consulted occasionally. Translating knowledge into actionable, institution-specific measures requires both organizational structures and dedicated resources.
Finally, the exchange reinforced the importance of framing: positioning climate adaptation not merely as an environmental or infrastructural issue, but as a matter of occupational safety, workforce resilience, and health system integrity. This framing helps secure buy-in from health professionals and administrators, who must balance climate concerns with immediate clinical priorities.
Overall, the exchange showed that while heat adaptation in healthcare remains a work in progress, meaningful advances are possible through participatory processes, evidence-based planning, and multi-actor collaboration. The experiences of Dresden, Grenoble, and Barcelona offer input for other cities: combine local engagement, science-driven policymaking, and institutional commitment to create health systems capable of adapting to heatwaves and the rising temperatures of the future.
This event was part of a series of four online Peer-to-Peer Learning sessions being held until April 2025, involving the pilots of the Adaptation AGORA project and addressing key issues related to climate adaptation and public participation. This series of events aims to foster the exchange of knowledge, resources and methodologies that can facilitate public participation in Climate Adaptation Plans in different European cities, regions and communities. Sign up to the AGORA Community Hub to get access to all the material. You can subscribe to the Heat Resilience and Health theme by clicking “Join Theme” and receive regular updates.
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