Because it affects a wide range of fundamental determinants of health, climate change is recognized as one of the greatest risks to public health worldwide.
In this context, Santé publique France’s mission focuses on two main areas: monitoring changes in health risks and developing adaptation strategies. In this way, Santé publique France helps to better understand these health impacts and mitigate them.

Health Risk Surveillance

Assessment of the effectiveness of current surveillance and alert programs, such as SACS, and participation in the evaluation of the PNC

The various surveillance systems implemented by Santé publique France were often developed without taking climate change into account. Consequently, Santé publique France is committed to assessing the extent to which its surveillance and alert programs will remain effective in detecting health events in the context of climate change.

For example:

• The implementation since 2004 of the Heat Wave and Health Alert System (SACS) and participation in the National Heat Wave Plan enable us to anticipate heat waves and reduce their impact. The monitoring period for the Heat Wave and Health Alert System has already had to be extended until September 15 to account for climate changes.

• Lessons learned from past extreme events—such as the 2001 floods in the Gard and Hurricane Dean in the French West Indies and French Guiana in 2007—are used to improve the epidemiological response to these events and better understand their health impacts on those affected.

Assessment of Future Impacts

Santé publique France collaborates with researchers from various disciplines to envision and model possible changes in risks in the coming years.
Research on the potential health impacts of climate change must be based on epidemiological evidence documenting risks on a global scale. Multicenter studies are well-suited for this purpose, but they present various methodological and organizational challenges.

The Multi-Country Multi-City (MCC) International Collaborative Network

The MCC is an international collaborative network aimed at generating epidemiological knowledge on the associations between meteorological, climatic, and health parameters, in order to advance global understanding of the health impacts of climate change. The MCC has assembled the largest epidemiological database ever created to study the effects of environmental factors on health. It enables a better understanding of the influence of climate factors on health and allows for the modeling of future impacts. For example, the network’s research has shown that in France, heat-related mortality would be 1.7% under global warming of +1.5°C, compared to 2.4% under warming of +2°C, and 6.5% under warming of +4°C.

The AC-HIA Project

The AC-HIA project brought together air quality and climate modelers working at various scales to assess the future impacts of air pollution, taking into account climate change and two scenarios for pollutant emissions developed by the European Commission. One of the project’s key strengths was its ability to consistently produce results for global, European, and the Île-de-France regional scales.

At the global scale, the project focused on changes in PM2.5 and ozone levels resulting from the application of greenhouse gas emission reduction scenarios used by the IPCC. The effects of these pollutants on cardiovascular and respiratory mortality were then estimated for 2030 and 2050 under a scenario of rising emissions (RCP8.5) and a scenario of emission reductions (RCP2.6).
The results show that as early as 2030, the most favorable scenario (RCP2.6) could result in nearly 70,000 fewer cardiovascular deaths each year, while the unfavorable scenario (RCP8.5) would see cardiovascular mortality increase by more than 400,000 deaths annually worldwide. Regardless of the scenario, respiratory mortality would increase by more than 12,000 deaths per year under the RCP2.6 scenario, and by more than 60,000 deaths per year under the RCP8.5 scenario. By way of comparison, the WHO projects that road traffic accidents will cause 1.8 million deaths per year by 2030. Health impacts also vary significantly by region, with Asia and Africa experiencing the largest increases in mortality.

The expansion to the European scale allowed for the consideration of policies more specifically dedicated to improving air quality. For example, the project compared the health impacts of a scenario reflecting the implementation of current legislation (CLE) with a scenario in which emissions decrease more significantly through the use of cleaner technologies (MFR). In both scenarios, PM2.5 and ozone levels would decrease significantly between 2010 and 2030.
For ozone, levels rise again between 2030 and 2050 due to the “climate penalty,” as climate change is unfavorable for ozone pollution. The health benefits associated with lower levels of fine particulate matter can be considerable: more than 200,000 fewer cardiovascular deaths each year under the best-case scenario. These benefits are particularly significant for Eastern Europe. In France, between 12,000 (best-case scenario) and 7,000 cardiovascular deaths (worst-case scenario) could thus be prevented each year.
By way of comparison, in 2013 in France, 3,250 deaths were caused by traffic accidents. Changes in ozone levels are also expected to lead to improved respiratory health, with the main benefits this time being observed in Southern Europe. Some areas of Northern Europe, however, are expected to experience an increase in ozone concentrations, which could result in up to 200 respiratory deaths per year in the United Kingdom, for example.

Similar trends are expected in the Île-de-France region, where implementing the most ambitious scenario for reducing pollutant emissions could result in more than 2,800 fewer cardiovascular deaths each year in the Île-de-France region by 2050.

Advocacy Efforts

As part of its prevention mission, Santé publique France has established or participated in several initiatives focused on climate change.

Organization of an international workshop on climate change and health

In 2015, Santé publique France worked with the Ministry of Health to strengthen the consideration of climate change’s impact on health.

On June 8 and 9, 2015, Santé publique France brought together French and international scientists to discuss the application of current knowledge regarding the health effects of climate change, adaptation, and mitigation.
A number of key points emerged from this meeting.

• Climate change is already having significant impacts on health through the direct and indirect effects of rising temperatures and extreme weather events. Climate change also contributes to health inequalities and acts as a barrier to socioeconomic development. For example, extreme heat is already making physical activity and work very difficult in certain densely populated regions of the world.

• These impacts will increase exponentially, with major consequences for healthcare systems. The World Health Organization estimates that by 2030, the influence of climate change on malnutrition, diarrhea, and heat will already account for more than 250,000 deaths per year worldwide. Furthermore, these estimates do not account for the indirect impacts of global warming, such as difficulties accessing basic resources, loss of agricultural productivity, inability to work outdoors or in un-air-conditioned indoor spaces, poverty…

• Adaptation is essential to mitigate current impacts while preparing to address future risks. It must first and foremost rely on resilient health systems. Interdisciplinary assessments of the effectiveness of measures already in place to reduce the impacts of heat and extreme weather events are necessary to select the most effective strategies and allocate resources optimally.

• Without a reduction in the magnitude of future climate change, technological solutions alone will not be able to overcome the limits of adaptation and thus protect the health of future generations.

• Mitigation policies can have significant repercussions on public health, presenting both negative and positive synergies. Assessments of potential health impacts are therefore essential to avoid mitigation policies that are harmful to health.

• Health can serve as a lever for behavioral changes that contribute to mitigation and promote improved individual and collective health, for example through the promotion of active transportation and a more balanced diet…

• Measures to adapt to and mitigate the health consequences of climate change must demonstrate solidarity and aim to reduce social health inequalities at both local (e.g., within a city) and global levels.

• Interdisciplinary and international cooperation to advance operational research on climate change and its health effects is necessary to integrate health, demographic, political, lifestyle, and behavioral issues specific to different countries.

Participation in the national consultation on a second climate change adaptation plan

With its second National Climate Change Adaptation Plan (PNACC-2), France aims to effectively adapt to a global temperature increase of +1.5 to 2 °C between the 19th and 21st centuries.

Significant changes are proposed in this second National Climate Change Adaptation Plan. These include better addressing the relationship between different territorial scales, strengthening coordination with international and cross-border partners, and promoting nature-based solutions. This plan was developed through a national consultation process that engaged nearly 300 participants between the summer of 2016 and the summer of 2017, resulting in 34 thematic fact sheets, including one entirely dedicated to public health.

Furthermore, to inform healthcare professionals, Santé publique France published a report on the challenges posed by the potential health impacts of climate change, a special issue of the BEH titled “Identifying and Monitoring the Health Impacts of Climate Change to Adapt to Them,” and a summary titled “Adapting to Heat in the Context of Climate Change.”