PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

100 Acting early on NCDs The Partnership for Health System Sustainability and Resiliencethreaten patients dependent on refrigerated medications like insulin or powered medical devices for conditions like sleep apnoea. Yet few countries have protocols for ensuring medication security during outages or providing backup power for essential medical equipment. Extreme weather events disrupt routine care for chronic conditions by preventing access to facilities, interrupting medication supplies, and displacing patients from their care networks. This leads to acute exacerbations of previously controlled conditions, creating surge demand precisely when health systems face weather-related disruptions.. It is thus vital that there are protocols in place for managing chronic diseases during environmental events, such as heatwaves or smog episodes. Climate resilience and adaptation Countries have made considerable advances in climate adaptation infrastructure and in understanding environmental health risks, particularly through early warning systems and comprehensive planning frameworks. These achievements provide important foundations for protecting populations from climate impacts. Several countries have developed frameworks explicitly linking environmental risks to chronic disease. Italy’s National System for Prevention of Health Risks (SNPS), launched in 2022, directly connects environmental and climate risks to chronic disease prevention through intervention models, capacity-building programmes, and strengthened surveillance systems. The country’s Heat Health Watch Warning Systems enable 72-hour forecasts that allow healthcare facilities to prepare for increased demand and allow providers to proactively contact vulnerable patients (Ministry of Health Italy, 2023a, 2023c). Spain’s Strategic Plan for Health and Environment (PESMA) 2022–2026 addresses air quality, chemical exposures, and urban health impacts on NCDs, while its Health and Climate Observatory monitors environmental health indicators and provides early warning of climate-related health risks. Spain’s heat warning system, operational since 2004 through its “National Plan for Preventive Actions Against Excessive Temperatures on Health”, has achieved documented mortality reductions through timely interventions (Ministry of Health Spain, 2024b). The system triggers public health alerts and activates cooling centres. Japan demonstrates innovation by combining its “Heatstroke Alert” system with housing thermal insulation subsidy programmes, recognising that effective adaptation requires action beyond healthcare facilities (Ministry of the Environment Japan, 2023; Tottori Prefecture, 2024.). The country’s “Heat Illness Prevention Action Plan” aims to halve heatstroke fatalities by 2030 compared to 2022 levels through promoting awareness, conducting research and development, and implementing countermeasures for hot environments (Cabinet Office Japan, 2023b). Germany’s national approach similarly combines broad adaptation planning with health-specific strategies. The Federal Government’s Climate Change Adaptation Strategy sets out 33 goals and 180 measures, including four under the “Human Health and Care” cluster (Bundesministerium für Umwelt, 2024). The Federal Ministry of Health’s Heat Protection Plan builds on this framework with multi-level actions such as the systematic use and expansion of the German Weather Service’s heat warning system, establishment of a national heat monitoring system by the Robert Koch Institute, and targeted protection of vulnerable groups. Critical gaps in NCD-specific adaptation Despite these advances, translation into NCD-specific protocols remains limited. Heat warnings rarely trigger modified care protocols for chronic disease patients, even though evidence shows cardiovascular medications require dosage adjustment during heat waves. Patients with heart failure face particular risks from the combination of heat stress and diuretic use, yet receive only generic heat advice rather than condition-specific guidance accounting for their particular