Organizing the institutional Public Health response to heat under climate change: A scoping review

Abstract

Abstract Background Extreme heat events are a major health risk, and their intensity and frequency are expected to increase under climate change. Heat health action plans (HHAP) aim to prevent adverse health effects through measures such as warning systems or communication campaigns. This scoping review asked whether the peer-reviewed Public Health literature suggests evidence for good practice governance of HHAP. Methods Databases PubMed and Web of Science were searched using search string combinations of heat, policy, warning system, and related terms. Data was extracted into a pre-defined extraction table based on theory-driven variables related to responsibilities, processes of stakeholder involvement, evaluation and whether good practice advice was provided. Findings were narratively synthesized and gaps in the current knowledge evaluated from a normative standpoint. Results Searches resulted in 6681 hits. After title, abstract and full text screening, 20 articles were assessed, 11 from Europe and 9 from other regions. Findings on structure of governance revealed that the Ministry of Health or Ministry for the Environment leads the development of an adaptation plan or HHAP guidance, while locally Departments of Health most often lead coordination of actions. Interagency cooperation was reported as essential, while in the majority of included studies the public are perceived as recipients of advice and warnings rather than as active stakeholders. Tailoring national guidance to local contexts as well as raising awareness of the plan not only among the public but also among all levels of management was one suggested good practice. Conclusions Few articles explicitly examine the organization of HHAP and no conclusions about whether a specific approach is superior can be drawn from these studies. To adequately protect human health from extreme heat events, an assessment of whether current governance structures are able to provide effective heat health action could be useful. Key messages The peer-reviewed literature does not provide information on which type of HHAP governance is superior. In the absence of a gold standard, it should be assessed what stakeholders and discourses are absent from HHAP governance to ensure vulnerable groups are adequately addressed by HHAP.