Indicator Assessment

Extreme temperatures and health

Indicator Assessment
Prod-ID: IND-189-en
  Also known as: CLIM 036
Published 11 Sep 2014 Last modified 11 May 2021
11 min read
This is an old version, kept for reference only.

Go to latest version
This page was archived on 24 Aug 2017 with reason: A new version has been published
  • Heat waves and extreme cold spells are associated with decreases in general population well-being and with increases in mortality and morbidity, especially in vulnerable population groups. Temperature thresholds for health impacts differ according to the region and season.
  • The number of heat extremes has substantially increased across Europe in recent decades. Heat waves have caused tens of thousands of premature deaths in Europe over the last decade.
  • Length, frequency and intensity of heat waves are virtually certain to increase in the future. This increase will lead to a substantial increase in mortality over the next decades, especially in vulnerable population groups, unless adaptation measures are taken.
  • Cold-related mortality is projected to decrease due to better social, economic and housing conditions in many countries in Europe. However, recent studies have questioned whether the projected warming would lead to a further decrease in cold-related mortality.

Temperature-mortality relationship in 15 European cities

Note: Figure shows relationship between daily maximum apparent temperature (Barcelona: mean apparent temperature) and natural mortality (blue) and 95% confidence interval (grey).

Data source:

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).

Past trends

In large parts of Europe, summertime temperature records, which are associated with prolonged heat waves, increased by more than a factor of ten in the last three decades. The summer of 2003 brought temperature records in large parts of western Europe; temperature records were again broken in different parts of Europe during the summers of 2006, 2007, 2010, 2013 and 2014 [i].

The elderly, those with chronic diseases, and persons of lower socio-economic status have a heightened risk of heat-related mortality. The record warm summer of 2003 was an outstanding example of increased mortality during periods of extreme temperatures, with an estimated premature mortality of 70 000 people in Europe [ii].

Synergistic effects between high temperature and air pollution (PM10 and ozone) have been observed to have lead to an increase in hospital admissions due to cardio and respiratory diseases. Furthermore, long warm and dry periods in combination with other factors can lead to forest fires, which can also have severe health impacts  [iii].


It is virtually certain that hot extremes will continue to become more frequent over most land areas in the future. The number of monthly heat records globally is projected to be more than 12 times as high under a medium global warming scenario by the 2040s as in a climate with no long-term warming[iv]. This increase in heat extremes will lead to a marked increase in heat-attributable deaths under future warming, unless adaptation measures are taken.

Projections of heat-related mortality use evidence from epidemiological studies combined with future scenarios of climate, population and acclimatisation with regionally specific temperature-mortality relationships (Figure 1) [v]. Three studies estimating future heat-related mortality have been conducted for Europe using similar methods and arriving at largely comparable results: PESETA, ClimateCost and PESETA II [vi].

The PESETA study estimates that without adaptation and physiological acclimatisation, heat-related mortality in Europe would increase by between 60 000 and 165 000 per year by the 2080s compared to the present baseline, with the highest impacts in southern Europe. The results vary across climate models and emissions scenarios, with high emissions scenarios leading to much higher heat-related mortality than low emission scenarios. Heat-related mortality would be significantly lower under full acclimatisation, i.e. if currently cool regions would be able to achieve the temperature-mortality relationship of currently warm regions  [vii].

The PESETA study estimated that cold-related mortality could decrease by between 60 000 and 250 000 per year by the 2080s, which is about the same magnitude as the projected increase from heat-related mortality. However, recent studies have questioned whether warming would lead to a decrease in cold-related mortality. As a result, the PESETA II study no longer considers a potential reduction in cold-related mortality in its climate impact estimates [viii].

An independent study estimates that climate change will lead to an increase in hospital admission due to heat-related respiratory diseases from 11 000 in the period 1981–2010 to 26 000 in 2021–2050. The total number of hospital admissions as well as the increase due to climate change is largest in southern Europe [ix].

[i] D. Barriopedro et al., ‘The Hot Summer of 2010: Redrawing the Temperature Record Map of Europe’,Science 332, no. 6026 (17 March 2011): 220–24, doi:10.1126/science.1201224; Dim Coumou, Alexander Robinson, and Stefan Rahmstorf, ‘Global Increase in Record-Breaking Monthly-Mean Temperatures’,Climatic Change 118, no. 3–4 (1 June 2013): 771–82, doi:10.1007/s10584-012-0668-1.

[ii] M Baccini et al., ‘Impact of Heat on Mortality in 15 European Cities: Attributable Deaths under Different Weather Scenarios’,Journal of Epidemiology and Community Health 65, no. 1 (January 2011): 64–70, doi:10.1136/jech.2008.085639; Jean-Marie Robine et al., ‘Death Toll Exceeded 70,000 in Europe during the Summer of 2003’,Comptes Rendus Biologies 331, no. 2 (February 2008): 171–78, doi:10.1016/j.crvi.2007.12.001.

[iii] Baccini et al., ‘Impact of Heat on Mortality in 15 European Cities’; C. Astrom et al., ‘Heat-Related Respiratory Hospital Admissions in Europe in a Changing Climate: A Health Impact Assessment’,BMJ Open 3, no. 1 (24 January 2013): e001842–e001842, doi:10.1136/bmjopen-2012-001842; A. Analitis, I. Georgiadis, and K. Katsouyanni, ‘Forest Fires Are Associated with Elevated Mortality in a Dense Urban Setting’,Occupational and Environmental Medicine 69, no. 3 (3 January 2012): 158–62, doi:10.1136/oem.2010.064238.

[iv] Coumou, Robinson, and Rahmstorf, ‘Global Increase in Record-Breaking Monthly-Mean Temperatures’.

[v] Baccini et al., ‘Impact of Heat on Mortality in 15 European Cities’.

[vi] J. C. Ciscar et al., ‘Physical and Economic Consequences of Climate Change in Europe’,Proceedings of the National Academy of Sciences 108, no. 7 (31 January 2011): 2678–83, doi:10.1073/pnas.1011612108; R.S. Kovats et al.,The Impacts and Economic Costs on Health in Europe and the Costs and Benefits of Adaptation. Results of the EC RTD ClimateCost Project. In: The ClimateCost Project. Final Report. Volume 1: Europe (P. Watkiss, Ed.) (Sweden: Stockholm Environment Institute, 2011),; Paul Watkiss and Alistair Hunt, ‘Projection of Economic Impacts of Climate Change in Sectors of Europe Based on Bottom up Analysis: Human Health’,Climatic Change 112, no. 1 (2012): 101–26, doi:10.1007/s10584-011-0342-z; Daniele Paci,Human Health Impacts of Climate Change in Europe. Report for the PESETA II Project (Seville: Joint Research Centre, European Commission, 2014),

[vii] Ciscar et al., ‘Physical and Economic Consequences of Climate Change in Europe’; Cunrui Huang et al., ‘Projecting Future Heat-Related Mortality under Climate Change Scenarios: A Systematic Review’,Environmental Health Perspectives 119, no. 12 (4 August 2011): 1681–90, doi:10.1289/ehp.1103456.

[viii] Kristie L. Ebi and David Mills, ‘Winter Mortality in a Warming Climate: A Reassessment: Winter Mortality in a Warming Climate’,Wiley Interdisciplinary Reviews: Climate Change 4, no. 3 (May 2013): 203–12, doi:10.1002/wcc.211; Paci,Human Health Impacts of Climate Change in Europe. Report for the PESETA II Project.

[ix] Astrom et al., ‘Heat-Related Respiratory Hospital Admissions in Europe in a Changing Climate’.

Supporting information

Indicator definition

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


  • Logarithm of mortality rate


Policy context and targets

Context description

In April 2013 the European Commission presented the EU Adaptation Strategy Package ( This package consists of the EU Strategy on adaptation to climate change /* COM/2013/0216 final */ and a number of supporting documents. One of the objectives of the EU Adaptation Strategy is Better informed decision-making, which should occur through Bridging the knowledge gap and Further developing Climate-ADAPT as the ‘one-stop shop’ for adaptation information in Europe. Further objectives include Promoting action by Member States and Climate-proofing EU action: promoting adaptation in key vulnerable sectors. Many EU Member States have already taken action, such as by adopting national adaptation strategies, and several have also prepared action plans on climate change adaptation.

The European Commission and the European Environment Agency have developed the European Climate Adaptation Platform (Climate-ADAPT, to share knowledge on observed and projected climate change and its impacts on environmental and social systems and on human health; on relevant research; on EU, national and subnational adaptation strategies and plans; and on adaptation case studies.


No targets have been specified.

Related policy documents

  • Climate-ADAPT: Adaptation in EU policy sectors
    Overview of EU sector policies in which mainstreaming of adaptation to climate change is ongoing or explored
  • Climate-ADAPT: Country profiles
    Overview of activities of EEA member countries in preparing, developing and implementing adaptation strategies
  • DG CLIMA: Adaptation to climate change
    Adaptation means anticipating the adverse effects of climate change and taking appropriate action to prevent or minimise the damage they can cause, or taking advantage of opportunities that may arise. It has been shown that well planned, early adaptation action saves money and lives in the future. This web portal provides information on all adaptation activities of the European Commission.
  • EU Adaptation Strategy Package
    In April 2013, the European Commission adopted an EU strategy on adaptation to climate change, which has been welcomed by the EU Member States. The strategy aims to make Europe more climate-resilient. By taking a coherent approach and providing for improved coordination, it enhances the preparedness and capacity of all governance levels to respond to the impacts of climate change.


Methodology for indicator calculation

City-specific estimates of the relevant parameters were obtained from 15 years (1990-2004) of data by specifying a marginal Poisson model for the daily count of deaths.

Methodology for gap filling

Not applicable

Methodology references

  • Baccini et al. (2008): Heat effects on mortality in 15 European cities Baccini, M., Biggeri, A., Accetta, G., Kosatsky, T., Katsouyanni, K., Analitis, A., Anderson, H. R., Bisanti, L., D'Ippoliti, D., Danova, J., Forsberg, B., Medina, S., Paldy, A., Rabczenko, D., Schindler, C. et al. (2008) Heat effects on mortality in 15 European cities. Epidemiology 19(5), 711–719.


Methodology uncertainty

Not applicable

Data sets uncertainty

Attribution of health effects to climate change is difficult due to the complexity of interactions, and potentially modifying effects of a range of other factors (such as land use changes, public health preparedness, and socio-economic conditions). Criteria for defining a climate-sensitive health impact are not always well identified and their detection sometimes relies on complex statistical or modelling studies (e.g. health impacts of heat waves). Furthermore, these criteria as well as the completeness and reliability of observations may differ between regions and/or institutions, and they may change over time. Data availability and quality is crucial in climate change and human health assessments, both for longer term changes in climate-sensitive health outcomes, and for health impacts of extreme events. The monitoring of climate-sensitive health effects is currently fragmentary and heterogeneous. All these factors make it difficult to identify significant trends in climate-sensitive health outcomes over time, and to compare them across regions. In the absence of reliable time series, more complex approaches are often used to assess the past, current or future impacts of climate change on human health.

Further information on uncertainties is provided in Section 1.7 of the EEA report on Climate change, impacts, and vulnerability in Europe 2012 (

Rationale uncertainty

No uncertainty has been specified

Data sources

Other info

DPSIR: Impact
Typology: Descriptive indicator (Type A - What is happening to the environment and to humans?)
Indicator codes
  • CLIM 036
Frequency of updates
Updates are scheduled every 4 years
EEA Contact Info


Geographic coverage

Temporal coverage