Health, climate change and vulnerability: a policy analysis of three high-income European countries

Background

Europe is the fastest‑warming continent, with climate change increasingly affecting population health. These impacts are unevenly distributed, disproportionately affecting vulnerable populations. Yet, it remains unclear how health‑related vulnerability and justice are operationalized in climate adaptation policies across governance levels. We compared climate policies in Norway, Switzerland, and Germany to examine how such vulnerabilities are recognized and addressed in high-income countries.

Methods

We conducted a qualitative comparative analysis of climate‑related policy documents addressing health in the three countries. Documents from national, regional, and municipal levels (2010–2025) were systematically identified, screened for health content, and analyzed using a shared justice‑based framework.

Results

Seventy‑six documents were analyzed. Most identified vulnerable groups such as older adults, children, people with chronic illnesses, and socioeconomically disadvantaged populations, though recognition often lacked detail. Across all countries and governance levels, distributional justice was typically addressed in broad and generic terms, with few documents describing the design or implementation of proposed measures, which were often limited to high‑level actions such as further research, capacity building, or civil society engagement. Procedural justice was unevenly addressed, with few concrete participatory mechanisms described. No documents included monitoring or evaluation of outcomes for vulnerable populations.

Conclusions

While vulnerability is widely acknowledged in climate policies, justice considerations are insufficiently translated into actionable measures. Strengthening justice‑oriented implementation and monitoring and ensuring the integration of just resilience over different levels of governance, is critical to reducing climate‑related health inequalities.

Key messages

• Our policy analysis reveals a gap between recognizing health vulnerability and implementing justice oriented climate adaptation measures across governance levels in these three countries.

• The study highlights the need for clearer, actionable integration of distributional and procedural justice to reduce climate related health inequalities.