The latest Lancet Countdown report, the first to focus on European cities, finds that heat-related mortality has risen in almost all the cities it covers. As hubs of people and infrastructure, cities carry major health risks from climate hazards, but they also hold great potential for solutions. José Chen and Hedi Kriit, authors of the report, explain why older residents are especially at risk, what cities can do, and why health and climate action must go hand in hand in building cities that promote healthy ageing.
Cities concentrate populations, services, and infrastructure, but also the health risks and impacts of climate change. Around three-quarters of Europe’s population lives in urban areas, so cities are central in promoting and protecting the health of their residents. According to the World Health Organization (WHO), a healthy city is one that enables people to have good quality of life across the lifespan while reducing avoidable exposure to harm, including climate change risks. This means designing urban environments that minimise disease occurrence: roads that are safe and encourage walking and cycling, transport systems that reduce pollution, alongside workplace measures to protect outdoor workers from extreme heat and green public spaces that cool neighbourhoods and support health. From a healthy ageing perspective, the WHO highlights the role of cities in promoting health so that older people can remain mobile, socially connected, safe, and independent, especially amid increasing climate change risks and impacts.
The indicators of the ‘2026 Europe Cities Report of the Lancet Countdown on health and climate change’ Lancet Countdown Europe Cities Report indicators respond to city-level policy needs by providing strong scientific evidence on climate change and health across Europe. The indicators track exposure and health impacts of climate change, adaptation and resilience, mitigation and health co-benefits, economics and finance, and public and political engagement across 885 cities in Europe. They help identify whether cities are responding to climate risks and impacts and actively creating the conditions for healthy ageing. The indicator framework also highlights specific adaptation and mitigation actions to support healthier and longer lives, from green spaces to sustainable and active transport.
Rising heat exposure: deadly consequences and adaptation strategies
Our report shows an increased heat-related mortality in 98.7% of European cities during 2015-2024, compared to the baseline years of 1991-2000. Heat is one of the main climate hazards putting older adults especially at risk because of their greater physiological vulnerability, higher prevalence of chronic disease, medication use and reduced mobility. Additionally, for older residents, homes can become sites of prolonged heat exposure during heatwaves due to inadequate heat-reduction measures. As a result, rising heat exposure disproportionately increases disease burden and premature deaths among older adults.
Preparedness has not kept pace with the increasing risks posed by climate change. Of 206 cities, only 170 reported having conducted climate risk and vulnerability assessments that recognised heat-related illness and identified older adults as at-risk populations. This highlights the need for more tangible action from cities across Europe to recognise heat as a major public health issue now and in the future, and to target older adults with special heat-protection measures
Nevertheless, signs of city-level heat adaptation are evident across Europe, including heat-health early warnings, increasing leaf area coverage, urban green space and tree cover. Increased absolute leaf area coverage was associated with lower surface temperatures in 88% of cities during summer months, effectively helping reduce heat exposure for residents in cities. Alongside reducing urban heat island effects, urban green spaces provide health, socio-economic and environmental benefits such as promoting physical activity, reducing stress, improving air quality, and creating places for social interaction.
However, much remains to be done to improve the heat resilience of urban populations. The WHO has recently provided a comprehensive guide for heat-health action plans that can be tailored to local contexts. To ensure climate and health-resilient cities, cross-sectional collaboration is needed.
Health benefits of climate mitigation in cities
Policies that reduce fossil fuel use can generate immediate health gains by reducing air pollution levels. Older adults and people with existing chronic conditions, who are more vulnerable to the respiratory and cardiovascular effects of poor air quality, would benefit most. Attributable mortality to air pollution has reduced by 40% across European cities, with substantial regional differences. In eastern Europe, persistent coal combustion and biomass use lead to death rates three times higher than in northern Europe. Although progress on mitigating emissions from the energy sector is visible, further action is needed, for example, by promoting healthier diets (e.g. reducing meat and dairy consumption), improving the availability and affordability of healthy food options, and designing urban infrastructure that encourages physical activity.
Enabling easy access to sustainable transport solutions, such as walking, cycling and public transport, reduces greenhouse gas emissions and offers substantial health co-benefits for the total city population, by reducing air pollution and increasing physical activity levels. In the report, northern and western European cities demonstrated the highest opportunity to access sustainable transport, especially walking infrastructure. However, more effort is needed to ensure easy access to cycling infrastructure and public transport across European cities. By ensuring easy access to sustainable transport solutions, cities can simultaneously reduce emissions and chronic disease burden, especially among older adults.
Towards health-promoting cities
Health-promoting cities recognise the health co-benefits that occur alongside climate action. The Lancet Countdown indicators show that urban populations are increasingly affected by heat exposure with deadly consequences. Older adults need cities that are cool, accessible, socially connected, and resilient. The most effective urban strategies on climate and health are those that combine mitigation and adaptation, work cross-sectionally and prioritise equity. In this sense, the healthy city of the future is not only low-carbon, but also age-friendly, inclusive, and designed to protect health throughout the life course of its population.
Keep on reading
The 2026 Europe Cities Report of the Lancet Countdown tracks progress on health and climate change for European cities. Compiled with the contribution of 58 experts spanning 31 academic institutions, the new report explores 28 indicators which monitor the health impacts of climate change across five domains.
Hedi Kriit
Hedi is a research fellow for the Lancet Countdown Climate Change and Health Europe at Heidelberg University. She holds a master’s degree in public health and economics. Her doctoral thesis focused on the health and economic effects of sustainable transport solutions. Her research interests include environmental epidemiology, urban health and the impacts of climate change on population health.
José Chen
José Chen is a Postdoctoral Researcher at ISGlobal. José has a medical degree with a specialisation in Public Health, a master’s degree in Health Economics and Management and a postgraduate diploma in European Union Law. His research focuses on climate change and health impacts, health systems strengthening, and knowledge translation for policymaking.