The 2026 Europe Cities Report of the Lancet Countdown on health and climate change: cities at the forefront of climate change action

Executive summary

Cities are hubs for innovation, economic activity, and socioeconomic development, concentrating not only population, assets, and infrastructure, but also health risks of climate hazards. Cities have a central role in addressing climate change by implementing adaptation and mitigation solutions that deliver resilient and low-carbon communities, boost local economies, and improve citizens’ health.

In this Lancet Countdown Report, we present for the first time a systematic, policy-relevant set of climate change and health indicators for European cities. Developed by 58 researchers from 31 academic institutions, a set of 28 indicators track trends in climate change and health across five domains.

Urban residents are increasingly at risk from growing climate change-related hazards

The increase over time in wildfire danger (indicator 1.2.1) and heat-related mortality (indicator 1.1.2) was highest in southern European cities (ie, an increase of 7% from 2003 to 2023, and of 160·6% from 1991–2000 to 2015–24, respectively), whereas the increase in climate suitability to dengue was largest in eastern Europe (ie, a 369·3% increase from 1982–2010 to 2015–24; indicator 1.3.2). Concentrations of allergenic pollen more than doubled in southern and eastern European cities from 1991–2000 to 2015–24 (indicator 1.4.1), increasing exposure and morbidity of patients with allergic rhinitis.

Adaptation measures are being implemented, but are not sufficient

Signs of city-level nature-based adaptation are evident across European subregions; however, much remains to be done to adequately protect Europe's urban dwellers from growing climate hazards. During summer months, an increase in absolute leaf area coverage was related to a reduction in surface temperature in 88% of European cities (indicator 2.2.2). Tree cover gains from 2000 to 2020 (indicator 2.2.4) were largest in eastern and northern Europe (21·8% and 24·5%, respectively). However, shaded cycling infrastructure (indicator 2.2.5) was low across European cities, and particularly low in cities in Türkiye and Cyprus (6·6% in 2018–20).

Low-carbon cities in northern Europe lead the way

While progress on mitigation is being made across European cities, much remains to be done to deliver health co-benefits from mitigation actions, including reduced air pollution, healthier diets, and equitable transport systems that promote physical activity. Cities in northern Europe had the largest decreases in emissions derived from local fossil fuel burning (indicator 3.1.1) and PM2·5-attributable mortality (indicator 3.2.1) compared with cities in other European subregions. However, northern European cities had higher emissions related to food demand in 2020 compared with other regions (indicator 3.4.1). Death rates attributable to unhealthy diets (4·5 per 1000 people; indicator 3.4.2) and associated health costs per person (€526; indicator 4.1.2) were largest in eastern European cities in 2020. Western Asian cities in Cyprus and Türkiye were behind in most indicators. The residential sector was the dominant contributor to PM2·5-attributable mortality across most European cities, accounting for 38% of total urban PM2·5-attributable mortality in 2023. Particularly in eastern Europe, the use of solid fuels led to a PM2·5-related all-cause mortality rate more than three times that of northern cities in 2023 (indicator 3.2.1). Accessibility to sustainable transport, including walking, cycling, and public transportation stops was highest in northern and western European cities in 2022 (indicator 3.3.1), essential enablers to reduce air pollution, including transport-related greenhouse gas (GHG) emissions, and increase physical activity.

Tackling climate change at the city level requires adequate financing and tools

In 2024, cities across Europe reported requiring additional funds for climate-related projects on transport (16·4%), buildings (14·3%), and renewable energies (13·6%). Only 0·5% of adaptation and mitigation projects reported by the cities directly addressed health systems and services. Financial and technical constraints pose considerable barriers to implement climate change adaptation and mitigation measures for nearly a third of surveyed cities (indicator 4.2.1).

Low engagement with the intersection of climate change and health in cities

While political engagement with climate and health in cities remained low from 2020 to 2024 (indicator 5.2.1), climate change and health received more engagement from the media: nearly a quarter of newspaper articles on climate change addressed health issues at the urban level between 2023 and 2025 (indicator 5.4.1).

Prioritising city-level climate change action

The indicators from this Report inform priority actions to protect the health of European urban dwellers in the face of climate change. First, European cities experiencing heat risks would benefit from strengthening and evaluating heat-health early warning systems and heat-health adaptation plans to keep city residents informed, safe, and healthy as heat exposure increases. These adaptation strategies (ie, early warnings and heat-health planning) are important as European cities are highly susceptible to heat due to large populations, high population density, at-risk groups, and heat island effects.

Second, intersectoral urban planning in cities is crucial to reduce climate change impacts. Healthy actions include increased urban green spaces (especially tree canopy), the use of less heat-absorbent building materials, de-sealing impermeable surfaces, and the promotion of active and public transport. Compact urban forms that also include urban green spaces can effectively support active travel while offsetting negative trade-offs related to the urban heat island effect.

Third, accelerating the reduction of GHG emissions across sectors (particularly energy, transport, and food) can lead to immediate health gains from reduced air pollution and a reduction of non-communicable diseases due to improved diets.

Targeted strategies should be considered to ensure small cities are not excluded from the transition to low-carbon economies. With robust evidence, multilevel governance, and adequate financing and implementation tools, cities can lead the green transition towards a healthier and more equitable Europe.