Publications

The recent re-election of President von der Leyen, significantly influenced by the Greens, highlights an increased political commitment to tackling the climate crisis and promises to elevate this cause even further on the Commission’s agenda for the new term [1]. Recognising climate change as a fundamental public health issue, the EU leverages a One Health approach to fully appreciate the interconnectedness of human, animal, and environmental health [2]. This political resolve, coupled with active engagement from the public health community, is a positive step forward. The landmark resolution on health and climate change, passed in June by the 77^th World Health Assembly, reinforces this dedication, urging action to weave health considerations into climate policies and build resilient, low-carbon health systems [3]. This momentum, which gained significant traction at COP28 [4], is expected to continue at COP29, with the WHO preparing a special report on climate change and health [5], and the Azerbaijan Presidency spearheading several key initiatives [6].

The scientific community has long been vocal about the extensive and complex impacts of climate change on human health. Pollutants in the air, water, and soil are known for their mutagenic properties.  Air pollution in particular is a major environmental risk factors for cancer in Europe, and a leading cause for lung cancer, the fourth most commonly diagnosed cancer in the region [7]. Additionally, air pollution exacerbates respiratory conditions such as asthma and chronic obstructive pulmonary disease. Shifts in temperatures and rainfall patterns are increasing the spread of vector-borne diseases like malaria and dengue fever and disrupting food supply chains, leading to severe digestive illnesses and nutritional deficiencies, especially in regions already struggling with food security. Moreover, the psychological impact of climate change is profound, manifesting as stress, anxiety, and post-traumatic stress disorder, due to climate-related disasters and uncertainties [8, 9].

One of the most pressing health concerns linked to climate change is cardiovascular disease (CVD), the leading cause of death both in Europe [10] and worldwide [11]. Environmental risks are estimated to cause over 18% of cardiovascular disease-related deaths in Europe [12]. Extreme heat is particularly concerning in Europe, as the fastest warming WHO Region [13]. Extreme heat is a direct risk factor for CVD, and heat stress may reduce physical activity levels, crucial for preventing CVD events. Changes in food availability due to climate change can lead to less nutritious diets and increase diet-related CVD risk. Exposure to air pollutants such as particulate matter and carbon monoxide emitted from wildfires and industrial sources exacerbates pre-existing cardiovascular conditions and heightens overall CVD risk. Social and economic vulnerability compound these risks, as extreme heat exposure and climate-related food insecurity amplifies health determinants that are often found among vulnerable and marginalised groups [14] .

The impact of climate change on health in Europe is particularly significant due to its aging population. Older Europeans are especially vulnerable to heatwaves and poor air quality, which exacerbate cardiovascular and respiratory issues. These health vulnerabilities, combined with Europe’s demographic trends, underscore the urgent need for tailored policies that enhance resilience and ensure effective adaptation strategies [15, 16].

In the past months, cardiovascular disease has featured prominently on policy agendas and work plans across Europe. This includes the priorities set by the current Health Commissioner Stella Kyriakides for her successor [17], the program outlined by Ursula von der Leyen to the MEPs before her re-election [18], and the current presidency of the Council in Hungary [19]. As cardiovascular health becomes a top EU health policy priority, a crucial question arises: how can the EU align climate action and health objectives, particularly for cardiovascular health?  

Commitments to a One Health approach are increasingly reflected in current EU institutional strategies. In the Council, the Hungarian Presidency has laid a strong foundation for action in the new mandate, maintaining a steadfast focus on implementing the Green Deal and meeting climate objectives, while placing significant emphasis to CVD. The Council Conclusions on the mid-term review of the 8^th Environment Action Programme highlight the health benefits and opportunities of adopting a One Health approach to achieve ambitious climate action and ensure a green and just transition [20]. This perspective is echoed in the recent Conclusions on the Future of the European Health Union, where EU health ministers  have called for an EU agenda on climate and health that applies a One Health approach to both adaptation and mitigation [21, 22]. Moreover, the Council’s acknowledgment of the triple planetary crisis – climate change, pollution, and biodiversity loss – in its Strategic Agenda is commendable [23]. However, we continue to urge maintaining high social and health ambitions [24], countering the disproportionate focus on industrial competitiveness, and heeding calls from Environmental and Health EU ministers for an approach that prioritises public wellbeing.

The European Commission‘s political priorities for 2024-2029 clearly emphasise the need to fulfil commitments related to the Green Deal, healthcare systems’ resilience and preventive health, particularly in the area of CVD [25]. While EPHA supports these priorities [26], it is crucial to keep health considerations, especially on key NCD areas like CVDs, central to ambitious climate action and sectoral regulations. Foreseen initiatives such as the Clean Industry Deal, the creation of an Energy Union and of a Vision for Agriculture and Food present key opportunities to integrate One Health approaches and achieve synergistic objectives. Importantly, efforts to advance climate and health objectives through environmental prevention for CVD should build on the initiatives already launched within the prevention pillar of Europe’s Beating Cancer Plan (EBCP), ensuring coordinated actions across disease areas, avoiding duplication of effort, and boosting resource efficiency. Aligning these political priorities with the vision for the future EU Health Union is essential, as highlighted in EPHA’s review of the European Commission’s Health Union Communication [27].

The European Parliament’s SANT (Public Health) and ENVI (Environment, Public Health, and Food Safety) committees play a critical role in advancing comprehensive health and environmental agendas. These committees, comprising members from various political groups including the Greens and progressives, are crucial for driving forward synergic initiatives. Efforts to address CVD should mirror the success of the Special Committee on Beating Cancer (BECA), which was instrumental in advancing the Europe’s Beating Cancer Plan (EBCP) [28]. A robust strategy for cardiovascular disease (CVD) must incorporate a One Health approach, emphasizing comprehensive prevention, treatment, and survivorship while integrating environmental considerations. Building on the recent World Health Assembly Resolution on Climate Change and Health [3], this strategy should integrate climate change considerations and outline pressing mitigation measures, whose health co-benefits expand beyond CVD.

Despite the uncertainty surrounding the legislative powers and competencies of parliamentary subcommittees after the European elections [29], there’s a significant push for continuity and expansion in health and environmental policy agendas within the EU Parliament. It is imperative that this political commitment translates from strategic vision to actionable principles within EU decision-making and climate action. Timely, cross-sectoral actions are essential to mitigate climate change and its impacts on health, including CVD.

Looking ahead, the EU must fully implement a comprehensive One Health approach to safeguard public health in a changing climate, by integrating health, environmental sustainability and climate objectives across key economic sectors. This will bolster the EU’s global climate leadership while benefitting global public health. At COP 29, the EU’s role is vital in ensuring that climate action is addressed from a health perspective. A Global Green Deal centred on health, equity, and cross-sectoral collaboration is imperative for global health and environmental sustainability. In this pivotal moment, the Council’s role in elevating health and NCDs within the Nationally Determined Contributions is key. By doing so, the Council reinforces the EU’s leadership in promoting integrated, health-driven climate policies, setting a strong precedent for other nations to address the intertwined challenges of climate change and public health.

Now more than ever, decisive action from decisionmakers, health experts, and stakeholders worldwide is needed. Collaboration and knowledge sharing across disciplines and borders are imperative to foster innovation and implement policies that safeguard both public health and the environment.