Executive Summary
Current status of national climate and health policies
Germany faces growing health challenges due to climate change, particularly from more intense heatwaves and UV exposure, extreme weather events, and the spread of vector-borne diseases and allergens. These health impacts strain Germany’s healthcare system, which is already confronted with an aging population, funding gaps, and staff shortages. Efforts to tackle these issues have advanced in recent years. Climate adaptation was most prominently addressed at national level through the German Adaptation Strategy to Climate Change, the Federal Climate Adaptation Act and national as well as state-level and municipal heat action plans. However, integration of health aspects into climate mitigation and adaptation legislation and vice versa remains limited. Public awareness of climate change impacts is high. While support for climate action in general is strong, debates about specific mitigation policies are increasing.
Views about optimal integration of climate and health policies
Participants who were interviewed for this study, generally agreed that climate and health policies should be more closely integrated, though health stakeholders emphasized the urgency of this integration more than climate actors. There was a consensus that both sectors require greater policy coherence. While health stakeholders advocated for a “health in all policies” approach, climate actors focused more on mainstreaming climate policies into other fields. The integration of climate and health is seen as crucial for addressing broader determinants of health through social, transport and nutrition policies. Some participants also highlighted the need for policies that address social justice, with a focus on the disproportionate climate impacts on vulnerable populations, and the importance of collective responsibility and systemic change for a sustainable, equitable society.
Barriers to optimal integration
There was a strong consensus among participants that limited financial and human resources pose major barriers to the integration of climate and health policy. Challenges in intersectoral collaboration, as well as limited competencies at the interface of health and climate in related sectors and institutions were seen to hamper the development and implementation of holistic climate and health policies. Voluntary initiatives, such as measures to reduce the ecological footprint of the health sector without binding requirements or earmarked budgets, were described as having a very limited impact.
Germany’s federal governance structure and self-administration of the health system make decision-making and coordination more complex, at times resulting in poor communication between branches of government, legislators and the involved sectors. Many participants also pointed to the lack of urgency and attention in both policy-making and public awareness resulting in insufficient prioritization of climate-health integration. Electoral cycles, economic interests and vested stakeholders were seen to incentivize policy-makers to prioritize short-term strategies and financial concerns over long-term climate and health benefits. The science-to-policy interface remains weak and the scarcity of reliable indicators and data further impedes progress and accountability.
Moreover, a focus on pilot projects often undermines the scaling of systemic solutions. Path dependency within existing systems hampers necessary change. Finally, the absence of a strong focus on prevention, combined with a lack of accountability for long-term outcomes, undermines efforts to address the complex interplay of climate and health issues effectively.
Opportunities to advance and integrate climate and health policy
Several participants from the health sector viewed the integration of climate considerations in health sector reforms as an obvious opportunity to tap into synergies between improving health outcomes and climate protection. They often referred to the current hospital reform that aims to restructure and condense the hospital infrastructure, without taking its carbon footprint or other ecological aspects into account. The planned establishment of a new national public health agency was also seen to potentially conduct better monitoring and assessment of climate impacts on health depending on its mandate and resources for this topic.
The huge potential of co-benefits of climate action for health, for instance from reduced air pollution, increased active mobility, more green spaces or health-promoting food systems, was seen as barely tapped yet. Some participants also saw opportunities in political shifts and elections, as well as local initiatives and businesses promoting climate-friendly technologies and products, for new alliances and windows of opportunity for climate and health integration. International policy platforms such as the Conference of the Parties (COP) Health Day, were also seen as important drivers to solidify the climate-health nexus on a global scale. At the same time, some participants observed a lack of attention and follow-up after COP28.
Strategies to advance and integrate climate and health policies
To effectively integrate climate and health policies, participants saw a need to strengthen collaboration, joint strategies and aligned policy considerations across relevant ministries, sectors and levels of governance. With regard to overcoming financial barriers, several participants mentioned a need for loosening Germany’s strict debt limits for government spending, as well as redirecting climate- and health-harming subsidies. Some also suggested creating joint budgets between sectors, exploring new funding sources, and making health gains and averted costs related to climate action more visible in decision-making.
Strengthening the evidence-to-policy nexus through a solid evidence base, addressing related gaps, improving communication of scientific findings, and training professionals in science-to-policy translation, was also perceived as strategic priorities. Building on existing interministerial working groups and cross-sector exchange formats, participants suggested that improved intersectoral collaboration could be fostered by taking a long-term strategic approach, identifying change agents, moving from individual projects to integrated and institutionalized mechanisms and structures, and strengthening leadership in the climate-health nexus.
Participants proposed to include binding requirements in legislative strategies, strengthen impact assessments, adapt existing laws, and use litigation to enforce climate action. They also described effective communication strategies using skilled communicators to engage a broad range of stakeholders, with a focus on positive narratives and emphasizing co-benefit. Advocacy efforts should target policy-makers with tailored messaging, use political windows of opportunity such as elections to influence party positions, and involve civil society and public pressure.
Overarching strategies with a continuous focus on ambitious and socially just climate action were seen as essential. These should include political education of the public and an emphasis on justice and equity in policy measures to safeguard democratic stability and public trust. Additionally, collaboration with non-state actors through networks for advocacy, sharing best practices, as well as using evidence and recommendations to influence policy remains critical, participants pointed out.
Potential implications for decision-makers and non-state actors
National policy-makers can seize opportunities to integrate climate resilience into health sector reforms and include health aspects in climate strategies to tap into the potential of co-benefits for climate action, public health outcomes and long-term public finances. Developing legislation that mandates binding requirements for climate mitigation in the health sector, climate adaptation with health implications, and public health measures with climate benefits could scale-up and speed-up progress. Policy-makers can focus on structural prevention measures, regulate the influence of commercial interests, and ensure that climate mitigation policies are socially equitable and counteract the unequal impact of climate change on disadvantaged population groups.
Federal ministries and agencies with responsibilities for health, climate, environmental and social affairs can build on their joint working on the national climate adaptation legislation with closer interministerial collaboration and alignment of policies. Shifting the focus from temporary projects and reliance on committed individuals to sustainable structures and programs for climate and health integration can provide a more reliable guidance for non-governmental actors and citizens.
The health sector has substantial influence on health policy through the self-governance structures. Therefore, it can align on common goals and strategies with the health ministries at national and state level to work towards climate-neutrality of the sector, prioritize public health outcomes and become more resilient to the impacts of climate change. The integration of the climate-health nexus into the training and continuous professional development of healthcare professionals, can be scaled up to ensure adequate handling and awareness raising of health impacts of climate change.
Researchers continue to play a crucial role in building a strong evidence base for climate and health integration. Addressing key evidence gaps, particularly in the area of implementation research and evaluation of existing policy measures, as well as providing more quantifiable health impact assessments related to climate change may be very helpful. Potential focus areas could also include studies on governance at the intersection of climate and health at all levels, as well as interdisciplinary research on behavioral, social and cultural dynamics. Capacity building for communicating scientific findings effectively to policy-makers and the public can be an opportunity for strengthening the evidence-to-policy nexus.
Research funders and philanthropic organizations can explore joint funding sources to support climate and health integration efforts. They may also focus on scaling up successful pilot projects and supporting the development of sustainable structures for long-term impact. Funding initiatives that strengthen the evidence-to-policy nexus and improve science-to-policy translation, and programs that help build bridges between sectors and policy-makers could be prioritized.
Health and climate advocacy organizations could further build on existing and growing networks for sharing best practices, coordinating efforts and developing intersecting policy demands. Developing tailored messaging that considers the views and interests of policy-makers while holding them accountable and utilizing multidisciplinary evidence, is key for effective advocacy work. Networks, alliances, and advocacy organizations can utilize political windows of opportunity, such as elections, to influence political party positions on climate and health issues. Strategic communication campaigns can help build bridges between different population groups, the media and policy-makers. Advocates can play a key role in pushing for a more systematic integration of climate and health considerations into the national policy agenda, challenging vested interests and moving beyond isolated efforts to contribute to a more unified and cohesive policy framework.
Authors
Sophie Gepp, Remco van de Pas, Maike Voss, Dorothea Baltruks, Greta Sievert, Juliane Mirow
Citation
Gepp, S., van de Pas, R., Voss, M., Baltruks, D., Sievert, G., Mirow, J. (2025). Advancing Climate Change and Health Policies in Germany: Insights from National Policy Stakeholders. https://doi.org/10.5281/zenodo.14917029
Funding Sources
We thank Wellcome Trust for funding this research.