Key Messages 
  • A number of impacts on the health sector are expected, such as an increase in the number of heatwaves observed, increased food- or water-borne diseases and an increase in vector-borne diseases.
  • Typical adaptation options include better vaccination (against vector-borne disease) or improved building design, early heat warning systems, and emergency plans (against heatwaves). Other adaptation options include more effective urban planning, increased surveillance and monitoring.
  • Most analysis on the costs and benefits of adaptation in the health sector is focused on options that have easily measurable costs attached, such as vaccinations and heat warning systems.
  • Studies reviewed do not directly aim to address uncertainties with few examination of the costs and benefits of iterative risk management, low regret measures or robust decision-making.


Variations in air and sea temperatures, precipitation levels, sea level and extreme weather events due to climate change may affect the burden of disease. It is expected that health impacts will be noted both in developing and more developed countries. Specifically, these impacts include an increase in the number of heatwaves observed, increased food- or water-borne diseases and an increase in vector-borne diseases, as well as the physical and mental health impacts of flooding, nutritional effects from altered agricultural production and food insecurity, and health effects of climate change-induced conflict.

The effects of heatwaves can be targeted through improved building design (particularly air conditioning), more effective urban planning, early heat warning systems and emergency plans. Food- or water-borne diseases can be more effectively addressed through improved surveillance and monitoring of outbreaks and transmission factors, microbiological risk assessment and improved technological solutions.

For vector-borne diseases, adaptation measures include better vaccination, vector control as well as increased surveillance and monitoring. Lastly, there are some measures which aim to address all health impacts. These include improved diagnosis and treatment, and education and information campaigns.

Policy and methodological developments 

Studies on heatwaves

In addressing heatwaves, the primary adaptation measures suggested are heat warning systems, emergency plans, building design and urban planning. The first of these, alert systems, are considered an attractive low-regret option which can be undertaken in the short term. The most common of these is the Heat Health Watch Warning System (HHWWS), which operates when a certain critical temperature is reached, alerting the population of the heatwave and the measures which can be taken. It should be noted that there exists a lack of agreement on what characterises a heatwave, making studies on the subject difficult to compare.

Costs and benefits of such early warning systems have been assessed in various contexts; however the number of studies remains relatively low. The WHO (2009) estimated that the costs of HHWWS systems can range from under EUR 1 million to about 10 million, depending on the area and population covered, with the upper range including costs of extra personnel. In France, ONERC (2009) used ex post data to estimate the cost of the French National Heatwave Plan for 2005 at EUR 741,000. At a smaller scale, Alberini and Chiabai (2007) calculated the benefits of the HHWWS system in Rome at EUR 134 million during one summer. For a HHWWS in Germany, the value of expected avoided deaths between 2071-2100 is estimated at EUR 2.36 billion annually, with avoided hospital costs estimated at EUR 165 million (Tröltzsch et al., 2012).

Even with HHWWS in place, there are likely to be additional costs associated with heatwaves. Following the 2003 summer heatwave in France, EUR 150 million was invested in extra staff and cooled rooms in elderly residential homes (Michelon et al., 2005). However, the 2006 heatwave still resulted in fatalities This indicates that adaptation options to address heatwaves must also come from beyond the realm of public health, and include changes in the built environment and spatial planning.

Studies on other health risks

At the global level, Ebi (2008) estimated the prevention costs of adaptation to diarrhoeal disease, malnutrition and malaria at USD 5 billion annually by 2030 in the developing world. The World Bank (2010) carried out a similar study, taking into account a declining baseline incidence alongside future development, calculating the adaptation costs at only USD 1.5-2 billion per year in developing countries by 2030.

At the national level, the focus of studies is on developing countries, which will continue to bear a significant burden of disease. These studies include adaptation cost studies in Paraguay (UNDP, 2011), Ghana (UNFCCC, 2010), India (Chiabai et al., 2010) and Saint Lucia (ECLAC, 2011). These studies all agree on effective adaptation measures for developing countries in the short-term. Specifically, they point to the implementation of programmes to improve basic public health measures such as clean water and sanitation, essential care including vaccines and child health services, as well as disaster preparedness and response and enhanced surveillance and monitoring.

With regards to OECD countries, significant costs are also likely to arise. These costs will primarily stem from the need to address risks to water and waste-water infrastructures, large-scale vaccination programmes, and air pollution related risks – especially ozone.

Main implications and recommendations 

Overall, while the evidence base on the costs and benefits in the health sector has increased, this is still an area with major gaps. Most analysis is focused on options that have easily measurable costs attached. The cost coverage is also incomplete: capital costs are often neglected, as are resource and policy costs. There are, however, some initiatives which are starting to address these gaps, notably a recent tool developed by the World Health Organisation (2013), to aid decision makers in making estimates of health adaptation costs. Studies reviewed also do not directly aim to address uncertainties with few examinations of the costs and benefits of iterative risk management, low regret measures or robust decision-making - see Heltberg et. al. (2009) for an example of a methodology that could be used in the health context.


Alberini A. and Chiabai, A. (2007), Urban Environmental Health and Sensitive Populations: How Much are the Italians Willing to Pay to Reduce their Risks? Regional Science and Urban Economics, Vol. 37: 239–258.

Chiabai, A., Balakrishnan, S., Sarangi, G., and Nischal, S. (2010), Human Health. In Markandya A and Mishra A (Eds). Costing Adaptation: Preparing for Climate Change in India. TERI Press: New Delhi, India. ISBN 978-81-7993-388-6.

ECLAC (2011), An assessment of the Economic Impact of Climate Change on the Health Sector in Saint Lucia. Economic Commission for Latin America and the Caribbean (ECLAC).

Ebi, K.L. (2008), Adaptation costs for climate change-related cases of diarrhoeal disease, malnutrition, and malaria in 2030, Global Health, Vol. 4(9),

Heltberg, R., Siegel, P. B. and S. L. Jorgensen (2009), Addressing human vulnerability to climate change: Toward a ‘no-regrets’ approach. Global Environmental Change, 19, 89-99.

Michelon, T., P. Magne and F. Simon-Delaville (2005), Lessons of the 2003 heat wave in France and action taken to limit the effects of future heat waves, in Kirch, W., B. Menne and R. Bertollini (eds.), Extreme Weather Events and Public Health Responses, Springer-Verlag.

ONERC (2009), Climate change: costs of impacts and lines of adaptation, report to the Prime Minister and Parliament, Observatoire National sur les Effets du Réchauffement Climatique, Paris.

Tröltzsch, J., Görlach, B., Lückge, H., Peter, M., and Sartorius, C. (2012), Kosten und Nutzen von Anpassungsmaßnahmen an den Klimawandel: Analyse von 28 Anpassungsmaßnahme in Deutschland [Costs and benefits of climate adaptation measures. Analysis of 28 adaptation measures in Germany]. Climate Change, No. 10/2012, UBA, Dessau,

UNDP (2011), Assessment of Investment and Financial Flows to Address Climate Change (Capacity Development for Policy Makers to Address Climate Change). Country summaries,

UNFCCC (2010), Synthesis report on the National Economic, Environment and Development Study (NEEDS) for Climate Change Project, FCCC/SBI/2010/INF.7, United Nations Framework Convention on Climate Change, Bonn.

WHO (2009), Improving public health responses to extreme weather/heat-waves – EuroHEAT, Technical Summary, World Health Organisation Regional Office for Europe, Copenhagen.

WHO (2013), Climate change and health: A tool to estimate health and adaptation costs, World Health Organisation Regional Office for Europe, Bonn.

World Bank (2010), The Costs to Developing Countries of Adapting to Climate Change: New Methods and Estimates, The Global Report of the Economics of Adaptation to Climate Change Study, Synthesis Report, World Bank, Washington, DC.