From ... in Environmental Health — Jul 1, 2021

Germany: Inaction on Heat Plans Threatens Health

Germany has delayed putting into action its plans to address increasing heat waves linked to climate change, threatening public health, Human Rights Watch said today.

Current plans largely leave out the danger from extreme heat to people who are pregnant, one of the groups particularly vulnerable to extreme temperatures.

The authorities should fund, develop, and carry out heat health action plans that prioritize those most vulnerable to negative health impacts. Germany is the European Union’s biggest greenhouse gas emitter, and ranks 7th worldwide, with per capita emissions well above the average for the EU’s 27 member states.

The authorities need to do more to significantly reduce the greenhouse gas emissions that are responsible for rising temperatures. “Germany acknowledges that increasing heat is an emerging health hazard and some states have taken good first steps to help at-risk populations adapt,” said Katharina Rall, senior environment researcher at Human Rights Watch. “But given the urgency of both reducing emissions and addressing the effect of the climate crisis, German authorities need to step up their game.” Human Rights Watch reviewed climate adaptation plans for the federal government, all 16 federal states, and the country’s 10 most populous cities to determine whether they incorporated pregnant people as a group vulnerable to heat-related health issues.

The analysis found that the definition of risk groups is not universal and that these plans largely fail to include the needs of those who are pregnant during extreme heat, indicating that their needs are unlikely to be addressed. While efforts to help people adapt to climate change will benefit everyone vulnerable to heat, more awareness and targeted action is needed to address the negative effects of extreme heat on pregnancy health, Human Rights Watch found. In June 2021, the first heat wave of the year temporarily made Germany the hottest region in Europe. In response to the recent extreme temperatures and deaths during previous heat waves, Health Minister Jens Spahn has acknowledged the need for additional funds, which he termed a “climate budget,” to address health needs emerging from climate change. While his acknowledgment was a good step, more concrete measures are needed for effective climate adaptation. Germany’s usually temperate climate is already affected by climate change, resulting in rising mean temperatures and more frequent and increasingly extreme and long heat events that threaten human health. Recent research suggests that globally up to 37 percent of heat-related deaths during summer seasons may be attributed to human-made climate change. There is limited data on heat-related mortality in Germany. But during each of the previous heat waves – in 2003, 2006, and 2015 – more than 6,000 deaths were attributed to heat. Limited data from 2018 shows that almost 500 people died of heat-related causes in Berlin alone. According to research by Germanwatch, Germany was third among all countries most affected by extreme weather in 2018, its hottest summer since record-keeping began (in 1881) with temperatures 2.9 °C above average. A new report commissioned by the German Federal Environment Ministry projects that rising temperatures could increase heat-related mortality up to three-fold, compared with the 1971-2000 period, by the end of the century. According to the World Health Organization (WHO), groups more vulnerable to extreme heat include, among others, children, older people, people with cardio-vascular illnesses, and those who are pregnant.

There is no available data on the impact of heat on pregnancy in Germany, but epidemiological research from many countries suggests a link between heat exposure and premature birth as well as other adverse birth outcomes. In a landmark 2021 judgment, the German constitutional court held that the German 2019 climate change law does not adequately regulate greenhouse gas emission reduction goals from 2030 onwards, and so violates the government’s obligation to protect the human rights of the young people who brought the case. Since the ruling, the government committed to reduce emissions by 65 percent by 2030 compared to 1990 levels and reach net zero emissions by 2045. While these are more ambitious climate targets than the ones in the 2019 law, experts consider them to be insufficient to reach the “Paris Agreement goal” to limit the temperature increase to 1.5 °C above pre-industrial levels. In June, parliament passed a new climate change bill to codify these targets in law, without the support of the opposition parties.

The law is now pending approval by the Bundesrat.

The current federal cabinet has also drafted a 2022 budget proposal that includes an “immediate climate protection program” of 8 billion Euros.

The budget requires approval by the incoming parliament. Deutsche Allianz Klimawandel und Gesundheit (KLUG), an alliance of health care professionals, said that Germany’s heat preparedness has systemic shortcomings. According to KLUG, since Germany is less accustomed to hot temperatures, the population has less experience in how to stay safe during heat waves. KLUG’s concern about health risks extends to pregnant people and others susceptible to heat, showing that Germany will have to urgently adapt to the reality of climate change. At the federal level, the German Strategy for Adaptation to Climate Change (DAS), and related action plans do not include those who are pregnant as a group vulnerable to extreme heat. However, the German Federal Environment Agency has listed pregnant people as a vulnerable group in the 2021 version of its guidance for staying healthy during heat waves, “Hitzeknigge,” and references pregnancy in its June 2021 risk analysis on global warming. At the state level, Bremen is the only one of Germany’s 16 federal states with an adaptation plan that cites pregnant people as a group vulnerable to extreme heat. Human Rights Watch requested information from all 16 states about the development of heat health action plans (HHAPs) and the inclusion of pregnant people. None of the 10 states that responded have developed a heat health action plan. Only the state of Hesse put in place a heat warning system, a recommended part of a heat health action plan, and is currently working on a state-wide plan which is also set to include pregnant people specifically. Other states are either in the early stages of planning or have placed the responsibility on municipalities. Based on the 2008 WHO guidelines, an ad-hoc working group of federal and state authorities developed heat action plan guidance for states in 2017. In 2020 state health ministers acknowledged the need to speed up implementation of heat action plans at the municipality level. Heat waves especially affect urban areas due to the “heat island” effect related to urban built environments. In reviewing public information on heat and health provided by Germany’s 10 most populous cities, Human Rights Watch found that none included pregnant people as a vulnerable group and none have implemented a heat action plan based on the WHO guidelines, although some have begun developing plans. As temperatures rise due to climate change, a new government should ensure that heat risks for pregnant people are added to federal guidelines, and states and municipalities need to speed up implementation, Human Rights Watch said. Governments have a human rights obligation both to reduce carbon emissions and address their current and predicted impacts on health. All levels of government should place vulnerable populations at the center of heat planning and adaptation strategies.

They should highlight the effects of extreme heat on pregnant people in public health outreach or public awareness efforts on heat and human health, including on websites, posters, and heat advisories for media outlets. Governments should support the development of inclusive heat health action plans, including through guidance, funding, and technical support to local jurisdictions and should track and report heat-related illnesses and deaths. The government also has an obligation to mitigate climate change by drastically reducing greenhouse gas emissions. It should comply with the judgment of the German Constitutional Court by improving its emission reduction targets with a clear timeline and by fixing the climate law to ensure that it protects the rights of future generations. “Germany should urgently scale up its efforts to protect vulnerable populations, including pregnant people, from increasing heat,” Rall said. “But the government also needs to do its part to prevent the most dramatic climate change impacts by drastically reducing emissions in line with the Constitutional Court ruling.” Heat in Germany A 2021 report commissioned by the Federal Environment Ministry analyzes the risks of global warming and recognizes the urgency of adapting to heat. A vulnerability analysis for Germany shows that in an extreme case average temperatures could increase between 3.5 and 5 °C in the next 100 years while even a moderate development suggests an increase of 1.5 °C.

The numbers of “hot days” (at least 30 °C) and “tropic nights” (night temperatures at or above 20 °C) are also set to increase in coming years. Temperatures that can be harmful to health have become more common in Germany. Six out of the eleven most extreme heat waves between 1951 and 2015 took place after 2000. Since 1990, what were previously considered hot summers, have become normal with mean temperatures across Germany now well above the average temperature of just 30 years ago. Today, spring and summer temperatures in Germany have already increased by 1.4 - 1.5°C since 1881 and autumn and winter have become milder. Some researchers even speak of the “Mediterraneanization” of Germany’s climate if global warming reaches 3 - 4 °C by the end of the century. This scenario is projected if there is no change in mitigation efforts. Data from Deutscher Wetterdienst (DWD), Germany's national meteorological service, also shows that heat waves in major cities have increased in intensity as well as frequency since the 1980s. Before the 1990s, extreme and long heat waves (14 days with at least 30°C) were relatively rare in Germany, but now they affect major cities every two to four years. Heat and Poor Health Outcomes Extreme heat exposure is a serious health hazard. It can cause heat rash, cramps, heat exhaustion, or heat stroke, which can be fatal or have lifelong consequences. Heat is more likely to affect those with pre-existing conditions and vulnerabilities, which is why most deaths occurring during heat waves are “heat-related” rather than exclusively the result of heat and some groups such as older people or people with cardio-vascular illnesses are much more vulnerable to death or illness in hotter weather. While the intensity varies across countries, increased mortality due to global warming is a global trend requiring effective adaptation action. According to the 2020 Lancet Countdown on health and climate change, Germany may be the third-most-affected country – after China and India – in terms of heat-related mortality for people age 65 and over. A study analyzing excess mortality during the “heat summer” of 2003 across 12 European countries shows that an estimated 70,000 additional people died, causing a “mortality crisis” in the first half of August and in its 2019 report on environmental health inequalities in Europe, the WHO states that housing quality has a direct impact on heat-related mortality. Marginalized communities tend to have housing that is less prepared for climate change, and the data shows a clear connection between income and thermal, or temperature-related, comfort during the summer. According to the Federal Environment Agency, socioeconomic factors such as housing, social environment, and education level are relevant factors for vulnerability to the effects of climate change. Pilot Projects and Heat Action Planning Germany has some promising developments and pilot projects for heat adaptation.

The Environment Minister, Svenja Schulze, recently announced the July launch of a consultation center to support municipalities in their efforts to adapt to climate change. Schulze also said that more financial and legal frameworks would be needed for effective climate adaptation. In June, the Health Ministry, together with the federal Center for Health Education (BZgA) created a website dedicated to climate change and health, including heat wave advice. Some cities are already leading the way. Offenbach has developed a heat action plan and implementation is coordinated through a group of stakeholders, including representatives of health authorities, schools, kindergartens, and social services. Worms has working groups, including on pregnant people and children, in the drafting process for the heat action plan, and Cologne is currently developing a pilot heat action plan for older people, a group especially at risk of increased mortality and morbidity during hot weather. Pregnancy Health, Heat, and Inequality in Germany People who are pregnant are more vulnerable to heat-related illnesses because their bodies generate more heat and dissipate it more slowly.

The WHO recently included pregnant people as a group vulnerable to extreme heat exposure in its updated heat and health guidance. In recent years a growing body of research has shown that exposure to heat can lead to adverse birth outcomes including premature birth (before 37 weeks), which is linked to lifelong adverse health effects and is a leading cause of infant death globally. In Germany members of disadvantaged communities are more likely to be negatively affected by heat during pregnancy because they have less access to pregnancy health care. Research by the Center for Reproductive Rights shows that pregnant people from marginalized communities, such as those who lack legal migration status, already face difficulties in accessing adequate pregnancy health care in Germany. Germany also lacks adequate research data about the access of refugees to pregnancy and reproductive health services. In Germany, a study shows, the rate of premature births has increased between 1994 and 2006.

There are many reasons for prematurity, and it is often unclear why a particular baby is born preterm.

The study states that premature birth was more common for immigrants than non-immigrants, and was shown to be highest in large towns and cities. However, some disparity between data sources on pre-term birth remains and more research is needed. Moreover, the person’s socioeconomic status and occupation appear to affect birth outcomes alongside age and number of births, according to a 2009 study. More research is needed to assess the current and future potential impact of increasing temperatures, and other climate impacts, on pregnancy health and adverse birth outcomes in Germany. A growing body of research suggests that exposure to heat, wildfires, and other extreme weather events such as hurricanes and other disasters associated with climate change can also negatively affect pregnancy health and birth outcomes. Officials on all administrative levels should promote interdisciplinary and intersectional approaches to designing climate adaptation efforts, including by consulting families from marginalized communities, frontline birth workers, and other reproductive health experts when drafting heat health action plans and planning heat action to ensure that it reaches those vulnerable groups effectively. .

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