Mind the gap: integrating health in local climate adaptation

Background

Climate resilience frameworks emphasize climate adaptation and public health, yet translation into local practice is limited. In urban settings, climate adaptation measures such as green and blue infrastructure can deliver health co-benefits while also introducing risks, including for infectious disease through changing mosquito habitats. This study examines how local climate adaptation is organized and identifies opportunities to better integrate public health into policy and implementation.

Methods

Our study was conducted in Rotterdam, the Netherlands, a climate-vulnerable delta city. In 12 semi-structured interviews (2024–2025) with stakeholders in climate adaptation and public health, we assessed processes, roles, and health integration in climate adaptation. Transdisciplinary focus groups (32 participants total, including national, regional, and municipal actors) were held to evaluate responsibilities, collaboration and identify entry points for integrating infectious disease considerations.

Results

The adaptation process includes policy translation, assignment, project design, realization, and monitoring. 27 Stakeholders were identified, with varying roles. Mosquito-borne risks were not considered in any phase. Barriers included competing priorities, limited resources for non-mandatory health considerations, and a lack of awareness, urgency, and policy guidance on infectious disease risks. Unclear responsibility and weak collaboration between public health and urban planning sectors led to fragmented knowledge and late involvement of health expertise. Public health input was considered most relevant during assignment, design, and monitoring.

Conclusions

Despite policy ambitions, mosquito-borne risks are weakly considered in local climate adaptation. Policy mandates, earlier involvement of public health actors, improved cross-sector collaboration, and clearer institutional responsibility are needed to support health-oriented climate resilience.

Key messages

• Competing priorities, limited awareness, and lack of clear responsibility hinder integration of mosquito-borne disease risks into local climate adaptation planning.

• Early involvement of public health actors, clearer mandates, and stronger cross-sector collaboration are essential for health-oriented climate resilience.