Vulnerability, Capacity, and Adaptation Assessment
In the UK, the CCC, UKHSA, and NHS are actively conducting climate risk assessments to identify populations most at risk from climate change, evaluate weaknesses in health systems, and implement targeted adaptation measures to varying degrees across the devolved nations. These assessments focus on understanding how climate hazards, such as heatwaves, flooding, and vector-borne diseases, impact vulnerable groups, including older people, children, and those in disadvantaged areas. Tools like the WHO Climate Vulnerability Checklists and the Climate Just web tool provide frameworks to assess risks and guide equitable interventions.
There are specific frameworks and tools that help guide NHS organisations to identify climate change risks and adapt against these vulnerabilities. The Climate Adaptation Framework for NHS organisations in England has been modelled based on the Adaptation Capability Framework by the Scottish Government. In Wales, the Health and Social Care Climate Adaptation Toolkit has been produced to guide organisations in building climate resilience, offering structured guidance for developing adaptation strategies and action plans.
Limited access to localised climate impact data hampers comprehensive vulnerability assessments, creating significant data gaps. Inconsistent implementation of vulnerability and capacity assessments across the NHS leads to uneven levels of preparedness, with some trusts and boards failing to regularly update these critical evaluations. Insufficient engagement with local communities and patients hinders the identification of vulnerabilities and the development of tailored adaptive responses. A limited awareness of overheating, a major climate risk, puts healthcare delivery at risk, especially in facilities where these risks have not been systematically identified or managed. Furthermore, the absence of robust monitoring systems to track the effectiveness of adaptation interventions over time limits the ability to evaluate and refine these strategies, weakening the overall resilience of the health system to climate impacts.
Integrated Risk Monitoring and Early Warning
The UK Health Security Agency (UKHSA) plays a key role by leading research on climate-related health impacts and managing early warning systems for extreme weather.
Heat: The UKHSA, in partnership with the Met Office, operates the Weather-Health Alerting System, a crucial component of the AWHP. This system provides early warnings about adverse temperatures to help protect public health. It includes Heat-Health Alerts (active from June 1 to September 30) and Cold-Health Alerts (active from November 1 to March 31), with provisions for extraordinary alerts outside these periods if significant heat or cold events occur. The alerts target stakeholders such as health and social care providers, emergency responders, voluntary organisations, and government departments, ensuring they are informed and prepared to take appropriate actions. Registration is available for stakeholders to receive alerts via email, facilitating timely responses. The Heat-Health Alert Summary action cards offer clear, checklist-style guidance for various health and care settings.
Flood: The Flood Forecasting Centre, a collaboration between the Environment Agency and the Met Office, provides real-time flood risk assessments for England and Wales. These assessments are issued through daily Flood Guidance Statements, which help emergency responders anticipate and prepare for potential flooding incidents. The UK’s Environment Agency operates the Flood Warning Service, which issues three levels of alerts: Flood Alert (prepare for possible flooding), Flood Warning (immediate action required), and Severe Flood Warning (significant risk to life). In Scotland, the Scottish Environment Protection Agency (SEPA) operates its own flood forecasting and warning service, including the Floodline service, which provides specific alerts for at-risk communities. While Northern Ireland doesn’t have a dedicated flood forecasting and warning service, the Met Office works with the Department for Infrastructure (DfI) Rivers and Northern Ireland Water to forecast areas where floods are likely.
Infectious diseases: The UK has implemented several early warning systems to detect and respond to infectious diseases promptly. A key component is the Syndromic Surveillance Service, managed by the UKHSA, which monitors real-time health data from various sources, including general practitioners, emergency departments, and telehealth services. This system enables the early identification of community-based infectious disease outbreaks, facilitating swift public health interventions. Additionally, the UK has an established statutory notification system requiring healthcare professionals to report specific infectious diseases to local authorities. This mandatory reporting structure ensures that cases of notifiable diseases are promptly communicated, allowing for coordinated responses to control the spread of infections. Furthermore, the UK is developing a real-time Biothreats Radar as part of its Biological Security Strategy. This initiative aims to monitor emerging biological threats, providing early warnings to enhance national preparedness and response capabilities.
UKHSA’s risk monitoring systems are not yet fully integrated across health and environmental sectors, resulting in delays in coordinated responses to climate-related events. The lack of specialised early warning systems for healthcare facilities can lead to challenges in maintaining service provision during floods. Many early warning systems lack the granularity needed to address localised risks effectively, limiting their ability to provide precise guidance for specific regions. Research indicates that existing flood early warning systems often prioritise financial impacts over health outcomes, suggesting a gap in addressing the specific needs of healthcare services during flood events. Expansion of early warning systems to account for emerging risks such as wildfire smoke and water scarcity is needed. Additionally, warning systems are not adequately tailored to the needs of healthcare facilities and vulnerable populations, leaving critical gaps in preparedness.
Health and Climate Research
Climate and health research within healthcare institutions remains inconsistent, with varying levels of engagement across different regions and disciplines. While some institutions actively integrate climate considerations into research and policy, many lack dedicated funding, expertise, and strategic direction to advance this field. There is limited evaluation of adaptation interventions in the healthcare sector and an absence of robust economic analyses about the costs and benefits of resilience measures. Within the current fiscal environment, this makes it extremely difficult for healthcare organisations and local authorities to adopt adaptation measures, which can have significant up-front costs.
To help address these gaps, UK Research and Innovation (UKRI) has committed £15 million to support research on climate adaptation, including nature-based solutions. Additionally, the National Institute for Health and Care Research (NIHR) has announced £100,000 in grants for research focused on strengthening the resilience of health and social care services during extreme weather events. At the same time, UKRI and NIHR have recently awarded £42 million to establish 7 new transdisciplinary research hubs that will explore how the UK’s transition to net zero can also protect and improve health. This is critical, as mitigation and adaptation must go hand in hand; however, funding for adaptation must increase proportionately to address the growing challenges.
There is a need for sustained investment in climate health research, as well as improved integration of environmental sustainability and climate adaptation into clinical guidelines. The National Institute for Health and Care Excellence (NICE) provides best practice guidance to healthcare professionals in the UK, based on up-to-date evidence and research. While NICE has issued some guidance that incorporates environmental considerations, such as in asthma care and adapting inhaler prescribing and use, the Centre for Sustainable Healthcare has called for this to become a core element of all guidance.
NICE makes recommendations on how to identify, refer, diagnose, treat and manage patients’ health, playing a crucial role in disseminating climate and health research and evidence. This is a key mechanism for clinicians to receive advice about best practice clinical care, and further consideration should be given for NICE’s role in adapting to climate change. As the health effects of climate change worsen, healthcare professionals will need to be supported to help patients adapt to these changes. Healthcare professionals are trusted members of the community and are uniquely placed to discuss with their patients the health impacts of public health threats and adapting treatment and management as needed. Building on existing resources, NICE guidance should take account of adaptation efforts, including best practice for communicating to patients about adapting to climate change from a treatment perspective where appropriate. Collaborative working between the NHS, NICE and other national organisations, such as the Medicines and Healthcare products Regulatory Agency (MHRA) is essential to move beyond clinical guidance and swiftly implement climate action changes across the system.