Human-induced climate change is causing damage and loss to the natural enviroment and affecting populations worldwide, as confirmed by the recent IPCC synthesis of the 6th AR report and the most recent Lancet Countdown reports on health and climate change.1-3 In terms of the health, over the coming decades, adverse impacts will entail an increase in climate-related morbidity and mortality, worsening of the quality of life and widening of the equity gap.2,3

As the climate crisis accelerates, the urgency to step actions, policies, and funding has become widely recognised.1-4 The compendium of responses should on one hand mitigate greenhouse gas emissions and contrast climate change and on the other promote adaptation measures and resilience to climate-related risks as advocated by the recent WHO European region Zero Regrets document published for the Seventh Ministerial Conference on Environment and Health in July 2023 and ahead of COP28.4

In this historical moment, we are facing two critical challenges, fighting climate change, and recovering from the COVID-19 pandemic, and by many it is considered a unique opportunity.2-4 The European Climate Law sets a legally binding target of net zero greenhouse gas emissions by 2050.5 Each Member State is bound to take measures to meet the target, taking into account the importance of promoting fairness and solidarity among countries. The European Green Deal sets the blueprint for this transformational change and all 27 member states pledged to reduce emissions by at least 55% by 2030, compared to 1990 levels as intermediate goal. Moreover Nextgeneration EU funding schemes and pandemic recovery plans also support climate action.6 In 2021, the European Commission adopted its new EU strategy on adaptation to climate change with the aim of stepping up action on adaptation and becoming climate resilient by 2050. 

In line with the Paris Agreement objectives and EU directives, Italy has developed both short and long-term policies aimed at contrasting climate change.7-9 Through EU and national recovery funds (Italian Plan for Recovery and Resilience, PNRR, and national complementary funding, PNC), climate objectives should be enhanced in the next few years by expanding the use of renewable energy, endorsing sustainable and energy efficient transportation and buildings as well as measures which promote climate adaptation and resilience in different sectors.10 However, although climate policies have been adopted by many countries, the recent UNEP Adaptation Gap Report has highlighted how adaptation planning and finance fails to keep the pace with increasing climate risks and impacts.11

Moreover, in Italy as in most European countries, health still has a marginal or even non-existent role in climate policies. If on one hand 37% of EU funding is assigned to climate action, a minor portion is designated to adaptation actions and in Italy only 8.16% goes to the health sector showing the imbalance towards health.6,10 The challenge we have to face in the coming years in order to achieve the objectives set by European and national agreements is to promote climate interventions that have multiple benefits for health and, at the same, time reduce emissions, the so-called policy of co-benefits.3,12 Relevant policies capable of producing relevant co-benefits are those focused on urban planning, diet, and transport. The confluence of climate change mitigation policies with those related to disease prevention can also lead to substantial economic benefits.13

The National Prevention Plan (PNP) of the Italian Ministry of Health for 2020-202514 and the PNRR10 seem to go precisely in this direction. In fact, in terms of adaptation to climate change, the plan specifically addresses climate and health among its core objectives.14 Most recently, through PNC funding, the Italian Ministry of Health has funded over 10 projects on ‘Health, environment, biodiversity and climate’ for over 500 million euro to enhance interdisciplinary research, training, collaboration between environmental and health care services and institutions, step up prevention and response actions to current and emerging risks and reduce inequalities. Italian public health and epidemiological institutions can provide significant evidence to support decision making, by identifying actions and measures which maximise the health benefits as well as monitoring and evaluating adaptation and mitigation measures put in place. 

The present monographic issue has been developed with the aim of summarizing the available evidence, providing indicators and additional research on the health impacts and the health co-benefits of climate change response measures in Italy in order to support policy makers and promote those actions which maximise the health benefits.

The first article published in this volume by Alfano et al. describes health-related climate change indicators for Italy adapted and refined from the 2022 global Lancet Countdown report. Findings from the 12 indicators show that Italy is particularly vulnerable to climate change for its geographic position, its built environment, and population distribution. As reported in both the Global and European Lancet Countdown reports,10,11 observed impacts of climate change are not uniform across Italy, with some areas and the most vulnerable groups being disproportionately at risk. The second article by Stafoggia et al. focuses on the impacts of air pollution and heat on mortality providing additional evidence on the health burden of two climate-related exposures. Concerning chronic exposure to PM2.5, on average, 72,083 deaths (11.7%) were attributable to annual mean levels of PM2.5 above the latest WHO-2021 AQG value and, of these, around half were estimated in the regions of the Po Valley (Northern Italy) alone. With reference to acute effects of heat exposure, around 14,500 deaths (2.3%) were attributed to daily temperature increases. Findings provide useful information on the impacts and where climate response measures should be targeted in Italy. 

The third article by Mangone et al. investigates the planetary (greenhouse gas emissions and land use) and health (non-communicable diseases and cancer incidence and mortality) impact of dietary habits using data from EPIC, an Italian population-based cohort, and shows the double advantage of limiting meat consumption and promoting intakes of vegetables and legumes, as also suggested by guidelines such as by the EAT-Lancet commission, that include health and environmental impacts.

The fourth article by Silenzi et al. investigates the nexus among climate change, migration, and health at global and Italian levels and suggests a shift toward ‘climate resilient health systems’ is a useful precautionary measure to address this interconnected and complex issue.

It seems clear that putting public health at the centre of an aligned response to the climate crisis is the only way forward for ensuring a healthier and sustainable future. Greater efforts and resources need to be put towards action and to improve effectiveness of plans and actions, reducing vulnerability, increasing resilience and avoid maladaptation.  The positive health impacts of many mitigation measures can help address broader health priorities and voice the urgency of tackling climate change.


  1. Pörtner HO, Roberts DC, Tignor M,  et al (eds). IPCC 2022. Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge (UK) and New York (USA): Cambridge University Press; 2022; pp. 37-118.
  2. Romanello M, Di Napoli C, Drummond P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet 2022;400(10363):1619-54. Erratum in: Lancet 2022;400(10364):1680 and Lancet 2022;400(10365):1766.
  3. van Daalen KR, Romanello M, Rocklöv J, et al. The 2022 Europe report of the Lancet Countdown on health and climate change: towards a climate resilient future. Lancet Public Health 2022;7(11):e942-65. Erratum in: Lancet Public Health 2022;7(12):e993.
  4. World Health Organization. Zero Regrets: scaling up action on climate change mitigation and adaptation for health in the WHO European Region. Second edition. Key messages from the Working Group on Health in Climate Change. Copenhagen: WHO Regional Office for Europe; 2023. Available from:
  5. European Climate Law Regulation (EU) 2021/1119 of the European Parliament and of the Council of 30 June 2021 establishing the framework for achieving climate neutrality and amending Regulations (EC) No 401/2009 and (EU) 2018/1999. Available from:
  6. European Comission. Recovery and Resilience Scoreboard. Available from:
  7. Ministero delle Infrastrutture e dei Trasporti. Piano nazionale integrato per l’energia e il clima. Roma 2019. Available from:
  8. Ministero dell’Ambiente e della Tutela del Territorio e del Mare, Ministero dello Sviluppo Economico, Ministero delle Infrastrutture e dei Trasporti, Ministero delle Politiche agricole Alimentari e Forestali. Strategia italiana di lungo termine sulla riduzione delle emissioni dei gas a effetto serra. Roma 2021. Available from:
  9. Ministero dell’Ambiente e della Tutela del Territorio e del Mare. Strategia Nazionale di Adattamento ai Cambiamenti Climatici. Roma 2015. Available from:
  10.  Governo italiano. Piano Nazionale di Ripresa e Resilienza. Rome: Italian Government; 2021. Available from: 
  11.  United Nations Environment Programme. Adaptation Gap Report 2022. Too Little, Too Slow. Climate adaptation failure puts world at risk. Nairobi 2022.  Available from:
  12.  Vineis P. Alfano R, Ancona C, et al (eds). Mitigation of climate change and health prevention in Italy: the co-benefits policy. Rome: Italian National Health Institute; 2021. Rapporti ISTISAN 21/20 Rev
  13. World Health Organization. Noncommunicable diseases - Fact sheet. Geneva: WHO; 2021. Available from:
  14. Italian Ministry of Health. Piano Nazionale della Prevenzione 2020-2025. Rome: Italian Ministry of Health; 2020. Available from: