Heat and health

Indicator Specification
Indicator codes: CLIM 036
Created 11 Jul 2008 Published 08 Sep 2008 Last modified 28 Jun 2016
Note: new version is available!
Daily mortality rates in 15 European cities by apparent temperature in summer time

Update planned for November 2012

Assessment versions

Published (reviewed and quality assured)
  • No published assessments


Justification for indicator selection

Populations typically have an optimum temperature at which the (daily or weekly) death rate is lowest. Mortality rates rise at temperatures outside this comfort zone. Figure 1 shows a typical U/J-shaped relation (in 15 European cities assessed in the PHEWE project). The trough represents the comfort zone; the steeper (right) arm of each line shows the mortality increase at high temperatures, and the left arm of each line shows the increase at low temperatures. Overall, the impact of hot weather and heat waves depends on the level of exposure, the size and structure of the exposed population, the population sensitivity, the preparedness of health systems, and the prevention measures in place. In temperate countries, there is a seasonal variation of mortality, with higher mortality in winter than in summer. There is uncertainty on whether some current observed reductions in winter mortality can be attributed to climate change (Confalonieri et al., 2007). People with cardiovascular diseases are more at risk in winter, because of the cold-induced tendency of blood to clot.
Heat waves have caused significant mortality in Europe in recent decades. However it is difficult to compare the heat-wave effects across Europe and over time. Heat directly affects the human physiology: thermoregulation during heat stress requires a healthy cardiovascular system. When environmental heat overwhelms the heat-coping mechanism, the body's core temperature increases. This can lead to heat illness, or death from heat stroke, heart failure and many other causes.
Several medical factors can increase the risk of heat-wave mortality, including dehydration, drugs, ageing, and having a chronic disease that affects cardiac output and skin blood flow, as well as being confined to bed. Social factors, such as social isolation, may also be important, although there has been little research in Europe (Bouchama, 2007). Many housing and urban factors have also been assessed, in particular for their role in high indoor temperatures (Kovats and Hajat, 2008). One special concern relates to indoor temperatures in health-care facilities and nursing homes. Increasing numbers of older adults in the population will increase the proportion of the population at risk (Confalonieri et al., 2007). Health-system action will be needed to ensure adequate planning of locations for health care and nursing institutions, as well as for the thermal protection of their facilities.
The EuroHEAT project concluded that heat-related illnesses and deaths are largely preventable. In the long term, the most important measure is improving urban planning and architecture, and energy and transport policies. Such improvements should begin now, as the lead time for policy development is very long. Heat-wave effects can be reduced by keeping indoor temperatures low, keeping out of the heat, keeping the body cool and hydrated, and helping others. Health-system preparedness planning is essential, by collaborating with weather services in providing accurate, timely weather-related health alerts and developing strategies to reduce individual and community exposures to heat, especially among vulnerable populations, planning health and social services and infrastructure, and providing timely information to the population (Matthies et al., 2008).

Scientific references

  • References Analitis, A.; Katsouyanni, K. (in press). Short-term effects of temperature and air pollution on health: the EuroHEAT analysis. In: Matthies F, Menne B. (eds.). Preparedness and response to heat-waves in Europe, from evidence to action. Public health response to extreme weather events. Copenhagen, WHO Regional Office for Europe. Baccini M.; Biggeri, A.; Accetta, G.; Kosatsky, T.; Katsouyanni, K.; Analitis, A.; Ross Anderson, H.; Bisanti, L.; D'Ippoliti, D.; Danova, J.; Forsberg, B.; Medina, S.; Paldy, A.; Rabczenko, D.; Schindler, C. and Michelozzi, P., 2008. Effects of apparent temperature on summer mortality in 15 European cities: results of the PHEWE project. Epidemiology 19 (5). Bouchama, A., 2007. What should health professionals know? EuroHEAT final meeting, Bonn, Germany, 22-23 March 2007. Carson, C.; Hajat, S.; Armstrong, B. et al., 2006. Declining vulnerability to temperature-related mortality in London over the 20th century. American Journal of Epidemiology 164 (1): 77-84. Confalonieri. U.; Menne, B.; Akhtar, R. et al., 2007. Human Health. In: Parry, M. L. et al., eds. Impacts, Adaptation and Vulnerability. Working Group II contribution to the Intergovernmental Panel on Climate Change Fourth Assessment Report. Cambridge, United Kingdom and New York, NY, USA. Cambridge University Press. Dessai, S., 2003. Heat stress and mortality in Lisbon Part II. An assessment of the potential impacts of climate change. International Journal of Biometeorology 48 (1): 37-44. Donaldson, G.; Kovats, R. S.; Keatinge, W. R. et al., 2001. Heat-and-cold-related mortality and morbidity and climate change. In: Health effects of climate change in the UK. London, Department of Health; p. 70-80. EC, 2007. Commission Staff working document. Annex accompanying the Green paper from the commission to the council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions. Adapting to climate change in Europe -- options for EU action. http://ec.europa.eu/environment/climat/pdf/ia_sec_8.pdf . Hassi, J.; Rytkonen, M.; Kotaniemi, J. et al., 2005. Impacts of cold climate on human heat balance, performance and health in circumpolar areas. Int J Circumpolar Health 64 (5): 459-467. Koppe, C.; Jendritzky, G.; Pfaff, G., 2003. Die Auswirkungen der Hitzewelle 2003 auf die Gesundheit. In: DWD, editor. Klimastatusbericht 2003; pp. 152-162 Kovats, R. S. and Hajat, S., 2008. Heat stress and public health: a critical review. Annual Review of Public Health 29 (9): 11-55. Kovats, S., Jendritzky, G., et al., 2006. Heat Waves and Human Health. In: Menne B, Ebi KL, eds. Climate Change and Adaptation Strategies for Human Health. Darmstadt: WHO Regional Office for Europe, Steinkopff Verlag; pp. 63-90. Kunst, A. E., Looman, C. W., Mackenbach, J. P., 1991. The decline in winter excess mortality in The Netherlands. International Journal of Epidemiology 20 (4): 971-977. Lerchl, A., 1998. Changes in the seasonality of mortality in Germany from 1946 to 1995: the role of temperature. International Journal of Biometeorology 42: 84-88. Matthies, F.; Bickler, G.; Cardenosa Marin, N. et al. (eds.), 2008. Heat-Health Action Plans. Guidance. Copenhagen, WHO Regional Office for Europe. McMichael. A. J.; Woodruff, R. E.; Hales, S., 2006. Climate change and human health: present and future risks. Lancet 367 (9513): 859-869. Ranhoff, A. H., 2000. Accidental hypothermia in the elderly. Int J Circumpolar Health 59 (3-4): 255-259. Robine, J. M.; Cheung, S. L.; Le Roy, S. et al., 2007. Report on excess mortality in Europe during summer 2003. EU Community Action Programme for Public Health, Grant Agreement 2005114. 2003 Heat wave project. Available under http://ec.europa.eu/health/ph_projects/2005/action1/docs/action1_2005_a2_15_en.pdf .

Indicator definition

  • Daily mortality rates in 15 European cities by apparent temperature in summer time



Policy context and targets

Context description

In April 2009 the European Commission presented a White Paper on the framework for adaptation policies and measures to reduce the European Union's vulnerability to the impacts of climate change. The aim is to increase the resilience to climate change of health, property and the productive functions of land, inter alia by improving the management of water resources and ecosystems. More knowledge is needed on climate impact and vulnerability but a considerable amount of information and research already exists which can be shared better through a proposed Clearing House Mechanism. The White Paper stresses the need to mainstream adaptation into existing and new EU policies. A number of Member States have already taken action and several have prepared national adaptation plans. The EU is also developing actions to enhance and finance adaptation in developing countries as part of a new post-2012 global climate agreement expected in Copenhagen (Dec. 2009). For more information see: http://ec.europa.eu/environment/climat/adaptation/index_en.htm


No targets have been specified

Related policy documents

No related policy documents have been specified

Key policy question



Methodology for indicator calculation


Methodology for gap filling


Methodology references

No methodology references available.

Data specifications

EEA data references

  • No datasets have been specified here.

External data references

Data sources in latest figures


Methodology uncertainty


Data sets uncertainty


Rationale uncertainty

No uncertainty has been specified

Further work

Short term work

Work specified here requires to be completed within 1 year from now.

Long term work

Work specified here will require more than 1 year (from now) to be completed.

General metadata

Responsibility and ownership

EEA Contact Info

Hans-Martin Füssel


Joint Research Centre (JRC)
European Environment Agency (EEA)


Indicator code
CLIM 036
Version id: 1


DPSIR: Impact
Typology: Descriptive indicator (Type A - What is happening to the environment and to humans?)
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European Environment Agency (EEA)
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