Introduction
The 2024 report of the Lancet Countdown1 illustrates that the negative global impact of the climate crisis has reached unprecedented levels — especially in terms of our health. Further delays in the implementation of effective climate protection measures will result in high health, economic, social and environmental costs.2,3 The flood in the Ahr valley in 2021, for example, not only claimed 135 lives, but also incurred estimated costs of around 40.5 billion euro.4 It is therefore more urgent than ever to take the necessary measures to prevent the climate crisis from worsening while strengthening the systemic resiliencei of the health sector and society at large.
Current political and social efforts to reduce greenhouse gas (GHG) emissions in Germany are not ambitious enough to achieve national and international climate targets.6,7 Emissions in the transport and building sectors in particular, as well as in land use, are currently well above the requirements of the Climate Protection Act.7,8 One reason for this is the continued financial support for sectors that are harmful to the climate and the environment, such as the fossil fuel sector or the emissions-intensive transport sector.9,10 According to the 2024 report of the Lancet Countdown, Germany subsidised the use of fossil fuels to the tune of US$4.5 billion in 2022 alone.1 This not only contributes significantly to the climate crisis, but also has a massive negative impact on our health, our ecosystems, and society.1,2,11
To address the health risks of the climate crisis, in addition to reducing subsidies that are harmful to the climate and environment, stronger cross-sectoral governance and financing of climate adaptation measures as well as climate and environmental protection is required. At the same time, the health sector itself must also become more resilient to the multiple crises and reduce its climate and environmental impact.12 To this end, it is crucial to prioritise health promotion and prevention more strongly. The promotion of equitable and health promoting living conditions would not only relieve the burden on the healthcare system, but also contribute to its needs-oriented further development and reduce its ecological footprint.13
This policy brief focusses on three central fields of action that have been identified as particularly urgent and promising for the protection of health, climate, and the environment in Germany: Heat Protection, Nutrition, and Resilient Health Sector. Policy recommendations are formulated below for each of these fields of action.
Recommendations
1
Heat Protection
- Developing cross-sectoral adaptation of the regulatory framework: The necessary evaluation and adaptation of the existing legal regulatory framework for heat protection in health must be carried out jointly across all sectors at all decision-making levels.
- Maximising health promotion and prevention: The planning and implementation of heat protection measures requires an intersectional perspective as well as the identification and consideration of social determinants:
- Strengthening heat literacy: Targeted behavioral prevention measures are suitable for promoting individual heat literacy, i.e., knowledge of risks and protection options. Particularly important are multipliers, e.g., in health and educational institutions.
2
Nutrition
- Changing financial incentives: Taxes and subsidies should be designed in a way that supports the shift towards healthy and environmentally friendly diets.
- Setting standards in communal catering: Binding quality standards should be introduced in communal catering (e.g., schools, kindergartens, clinics and care facilities) in accordance with the new nutritional recommendations by the German society for nutrition.
- Anchoring/Strengthening nutrition in the health sector: Structures and processes should be promoted in the health sector that explicitly promote and utilise the preventive potential of nutrition in relation to individual and planetary health.
3
Resilient Health Sector
- Financing models for transformation: The federal and state governments must enable necessary investments by healthcare facilities in climate protection through an additional special programme. Moreover, health sector institutions must be considered and integrated into the climate adaptation strategy.
- Anchoring health in and for all policies: Prevention and health promotion must be anchored as a cross-cutting task in line with the health in and for all policies approach.
- Monitoring and surveillance of GHG emissions: All larger healthcare facilities should record and report their GHG emissions according to standardised criteria.
- Implementing sustainable supply and production chains: International databases with product carbon footprints as well as regulatory incentives for sustainable production and recycling of medicinal products and medical devices are required to survey Scope 3 emissions, which have often only been estimated to date, to enable sustainable purchasing decisions.
Contributing institution
The Lancet Countdown Policy Brief for Germany was written by the Institute of Epidemiology (EPI) of Helmholtz Zentrum München, the Potsdam Institute for Climate Impact Research (PIK), the Medical Faculty of Ludwig-Maximilians-Universität München and the Competence Centre for Climate Resilient Medicine and Healthcare Facilities (KliMeG). The German Alliance Climate Change and Health (KLUG e.V.) and the Centre for Planetary Health Policy (CPHP) coordinated this process. The authors of the policy brief are Annkathrin von der Haar (KLUG/ CPHP), Prof. Dr Christian Schulz (KLUG), Dr Franziska Matthies Wiesler (Helmholtz Zentrum München), Dr Lisa Pörtner (PIK/ Charité), Dr Peter von Philipsborn (LMU Munich), Maurizio Bär (KLUG/KliMeG), Dr Alexandra Schneider (Helmholtz Zentrum München), Dr Susanne Breitner-Busch (Helmholtz Zentrum München and LMU Munich), Dr Julia Schoierer (LMU Munich/ ecolo), Dr Claudia Hunecke (PIK), Dr Matthias Albrecht (KLUG/ KliMeG) and Dorothea Baltruks (KLUG/CPHP). The process was accompanied by Dr Martin Herrmann (KLUG), Maike Voss (neues Handeln AG), Prof. Dr Annette Peters (Helmholtz Zentrum München/LMU Munich), Prof. Dr Hermann Lotze-Campen (PIK) and by the Lancet Countdown, in particular Dr. Marina Romanello and Camile Oliveira.
The Policy Brief is supported by the German Medical Association, the German Association for Prevention and Health Promotion (BVPG), the German Society for General Practice and Family Medicine (DEGAM), the German Society for Internal Medicine (DGIM) and the German Society for Nutrition (DGE).