PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

101 Acting early on NCDs The Partnership for Health System Sustainability and Resiliencevulnerabilities. Coordination with chronic disease management remains weak, with NCD patients receiving generic heat advice rather than condition-specific guidance. Poland exemplifies the gap between recognition and action: despite having functional weather alert systems and clear documentation of climate impacts on health, no mechanisms exist to translate meteorological warnings into adjusted clinical protocols for chronic disease management. Healthcare facilities continue operating standard procedures during heat waves rather than implementing evidence-based adaptations like adjusted medication dosing, enhanced monitoring of vulnerable patients, or modified appointment scheduling. Germany’s experience shows the same tension between ambitious national framework and local implementation. Responsibility for implementation largely lies with municipalities, many of which face resource constraints. By the end of 2024 only about 10% had developed formal adaptation strategies (Bundesregierung, 2024). France’s experience provides a sobering assessment of current adaptation capacity. Despite implementing comprehensive heat warning systems after the deadly 2003 heat wave that killed 15,000 people, the country experienced a 60% increase in heat-related deaths between 2000–04 and 2018–22 (Romanello et al., 2023). This increase, occurring despite improved warning systems and response protocols, suggests that current adaptation measures cannot keep pace with accelerating climate impacts. The health system’s growing environmental footprint contributes to the very problem it struggles to address, creating a vicious cycle of climate impact and healthcare demand. Infrastructure vulnerabilities pose additional challenges. Power outages threaten patients dependent on refrigerated medications like insulin or powered medical devices, with Greece’s island populations facing particular risk from unreliable power infrastructure. It is essential for countries to develop protocols for medication security during outages and backup power provision for essential equipment. When extreme weather disrupts routine care, preventing facility access, interrupting medication supplies, or displacing patients, previously controlled conditions deteriorate precisely when systems face maximum stress. Equity considerations: addressing differential impacts Environmental health interventions show mixed results in addressing health inequities, with some initiatives successfully targeting vulnerable populations while others inadvertently widen disparities. France’s experience reveals how technically successful interventions can exacerbate inequalities: analysis shows air pollution control measures disproportionately benefit wealthier neighbourhoods, with clean air zones and green infrastructure concentrating in affluent areas while disadvantaged communities near industrial sites experience persistent exposure (Champalaune, 2020). Canada demonstrates this challenge through significant adaptation gaps in rural, remote, and Indigenous communities, which face particular climate vulnerabilities but often lack formal adaptation plans and adequate cooling infrastructure (National Collaborating Centre for Environmental Health, 2025). These communities often experience the earliest and most severe climate impacts yet receive the least support for adaptation. Indigenous populations are especially affected by the loss of traditional food sources, which contributes both to nutritional transitions that increase NCD risk and to cultural disruption with adverse mental health effects (Public Health Agency of Canada, 2017). This pattern, where populations with greater economic and political resources receive more environmental health protection, suggests that technical capacity alone cannot ensure equitable health outcomes. Environmental health interventions may inadvertently become another mechanism through which social advantage translates into health advantage.