The aim of the Plan is to prevent and mitigate the negative impacts of excessive heat on public health, particularly among the most vulnerable groups — older adults, children, people with chronic illnesses, and socially disadvantaged populations.
The Plan sets out measures to reduce the effects associated with extreme temperatures and to coordinate the actions of the State Administration and the institutions involved. It also defines prevention and control measures to be implemented by regional and local authorities, structured into different levels of action according to the degree of risk identified.
In addition, the Plan includes the collection and analysis of predictive data on environmental temperature and daily variations in mortality, establishing criteria that enable the active monitoring of risks associated with exposure to excessive heat. Mortality surveillance also makes it possible to detect abnormal increases before risk thresholds are exceeded, thereby enabling the activation of early warning mechanisms.
Over the past decades, concern about the impacts of climate change has grown steadily, as reflected in the United Nations Framework Convention on Climate Change, the Kyoto Protocol, and, more recently, the Paris Agreement adopted at the COP21 Summit (December 2015).
The findings of the Intergovernmental Panel on Climate Change (IPCC) continue to show that global warming is unequivocal, that the effects of climate change are already negatively impacting numerous physical and biological systems, and that these impacts are projected to intensify, with wide-ranging consequences for the economy, the environment, and public health.
These effects are diverse and affect a broad spectrum of socioeconomic sectors and ecological systems, but their distribution is uneven across territories and regions, with the Mediterranean basin identified as one of the areas most vulnerable to climate change.
Forecasts indicate a likely increase in the frequency and intensity of extreme heat events, characterized by abnormally high maximum and minimum temperatures persisting over time. The recurrence of extremely hot summers across European countries is therefore plausible—a factor that justifies the continuation and reinforcement of the National Plan.
In this context, and to strengthen the capacity of the health sector to address climate change, the Ministry of Health, Consumer Affairs and Social Welfare (MSCBS) and the Ministry for the Ecological Transition (MITECO) have developed tools for analysing, diagnosing, evaluating, adapting, and monitoring the impacts of climate change on public health and the National Health System. These tools include scenario modelling and assessments designed to support decision-making, prioritise health risks, and propose adaptation and mitigation measures.
Global climate change is also leading to an increase in the frequency, duration, and intensity of heat waves, defined as episodes of unusually high temperatures relative to normal climatic conditions of temperature and humidity for a given area and season. Such events pose serious health risks, increasing mortality, morbidity, and healthcare demand during these periods.
Moreover, heat exposure also has medium- and long-term health effects, making it a significant public health concern.
Following the severe heatwave of 2003, Spain launched the National Plan for Preventive Actions against the Effects of Excessive Temperatures (hereinafter, the Plan), which sets out the necessary measures for the early detection and management of heat-related risks, structured across several levels of intervention and defined operational timeframes.
From a health perspective, excessive heat particularly affects older adults, children, and people with chronic conditions. From a social standpoint, factors such as marginalisation, isolation, dependency, disability, and poor living conditions further increase vulnerability among disadvantaged populations.
Accordingly, the National Plan establishes a coordinated framework to reduce the health impacts of excessive temperatures and to ensure coordination among State, regional, and local administrations. It also promotes preventive and responsive actions tailored to the competencies of the Autonomous Communities and local authorities.
The Plan further provides for the collection and analysis of predictive temperature data and daily mortality figures, establishing criteria and information systems that allow for the active monitoring of heat-related health risks.
Additionally, mortality surveillance data collected since the Plan’s implementation have enabled the identification of excess mortality even before established risk thresholds are surpassed during successive summer campaigns. Early warning mechanisms are therefore activated when mortality trends indicate excess deaths associated with extreme temperatures.
A key component of the Plan is its integration with social services, recognising that elderly and dependent persons represent the most unprotected and vulnerable groups. Equally important is its public information strategy, which ensures that citizens, high-risk groups, and health and social care professionals receive timely and accurate information during heatwave events.
The purpose of the National Plan for Preventive Actions against the Effects of Excessive Temperatures on Health is to prevent and mitigate the adverse health impacts of extreme heat, particularly among the most vulnerable population groups, such as older adults, children, individuals with chronic illnesses, and socially disadvantaged people.
In this regard, the Plan sets out measures to minimise the effects associated with excessive temperatures and to coordinate the actions of the State institutions involved. It also proposes preventive and control actions to be implemented by Autonomous Communities and local administrations, structured into several levels of intervention according to the degree of risk arising from rising temperatures.
In addition, the Plan includes the collection and analysis of predictive data on environmental temperature and daily mortality variations, establishing the criteria and procedures of the information system that enable active monitoring of health risks associated with heat exposure.
The National Plan defines the preventive and control actions to be taken, organised by risk level according to temperature increases, and ensures systematic monitoring of environmental and health indicators to guide timely responses.
Furthermore, mortality monitoring data collected during the years of the Plan’s implementation have made it possible to detect excess mortality before established temperature risk thresholds are exceeded, as defined in successive summer campaigns. Early warning mechanisms are therefore in place to signal mortality increases linked to high temperatures.
In essence, the Plan identifies key risk factors—personal, environmental, and local—that influence or may influence public health, with the aim of establishing a system of alert levels to reduce the health impact of high temperatures in terms of morbidity and mortality.
The objectives of this environmental information system are:
- To anticipate the risk of excessive temperatures that may affect a specific population living in a given geographical area.
- To assess the actual impact of excessive temperatures on public health.
- To identify the need to reinforce available healthcare resources.
The strategy of the National Plan is based on the following actions:
- Development of an environmental information system that includes temperature forecasting and prediction models.
- Public information and awareness campaigns on the health effects of excessive heat and on protection and prevention measures.
- Development of a mortality information and monitoring system.
- Provision of information and guidance for health and social services professionals.
- Coordination with social services to identify vulnerable groups, particularly children and the very elderly.
- Coordination with the competent administrations and relevant entities.
- To develop the guidelines for the implementation of the Plan within the General State Administration.
- To establish preventive and control strategies deemed appropriate in light of new evidence.
- To activate the corresponding intervention levels.
- To propose organisational, structural, and preventive measures to prevent or reduce the impact of extreme temperatures on health.
- To develop plans for risk assessment, management, and communication.
To this end, and in order to coordinate the actions of the different Departments in this area, an Interministerial Commission was set up by Order of the Ministry of the Presidency (Order PRE/1518/2004), whose functions are:
The Commission, whose primary functions are to alert health authorities and the general public, may request, whenever it deems appropriate, the advice of scientific societies and public or private entities it considers relevant to the performance of its duties.
In order to effectively implement the objectives and strategies of the Plan, the Interministerial Commission has established various coordination mechanisms with social services, public administrations, and other competent entities, thereby ensuring their proper application: Ministries of Health and Social Services of the Autonomous Communities
- Ministry of the Interior (General Directorate of Civil Protection and Emergencies)
- Ministry for Ecological Transition (AEMET and Directorate-General for Biodiversity and Environmental Quality)
- Ministry of Justice (Civil Registry)
- Public and private media
From here, the development of the Plan's applied strategy is based on the following actions:
Environmental Information System
Prevention of heat effects is largely possible. The State Meteorological Agency (AEMET) is currently able to predict maximum and minimum temperatures with high reliability and five days in advance.
The meteorological variables that are taken into account are:
- Maximum temperatures forecast for 3 days
- Reference thresholds for the impact on health due to heat waves
The information is providedby AEMET, which disaggregates by meteosalud areas and sends them electronically.
Risk Level Assignment System
The criterion for assigning heat risk levels is based on the simultaneous exceedance of both the maximum and minimum temperature thresholds, as well as the persistence of this exceedance over time.
The allocation of risk levels is done using the following criteria:
- if the number of days on which the maximum and minimum temperatures are expected to exceed the respective reference threshold values simultaneously is 0, the assigned level is called "LEVEL 0" or no risk, and is represented by the color green
- if the number of days is 1 or 2, the assigned level is called "LEVEL 1" or low risk, and is represented by the color yellow
- if the number of days is 3 or 4, the level assigned is called "LEVEL 2" or medium risk, and is represented by the color orange
- if the number of days is 5, the level assigned is called "LEVEL 3" or high risk, and is represented by the color red
Mortality Information and Analysis System (MoMo)
Within the framework of the Plan, daily mortality monitoring complements meteorological information, enabling the assessment of health risk situations, the evaluation of the impact of excessive temperatures on mortality, and the identification of excess all-cause mortality.
This monitoring is based on a predictive model developed by the National Center for Epidemiology at the Carlos III Health Institute, using mortality data observed between January 1, 2009, and December 31, 2017.
The objective is to detect possible deviations between observed and expected daily mortality, as well as to identify short-term variations or emerging trends, through comparative analysis with historical mortality series.
MoMo establishes three types of warning signs for excess mortality:
- Continued Punctual Excess
- Excess Continued Mortality
- Severe Excess Mortality
When an alert signal is produced for severe excess mortality, it is communicated to the Health Authorities of the Autonomous Communities through the Health Alerts and Emergencies Coordination Centre (CCAES), under the Directorate General of Public Health, Quality and Innovation of the MSCBS.
In addition, it evaluates according to personal vulnerability factors:
Age > 65 years
Pregnancy
Chronicdiseases
Occupational exposure
Homelessness or living alone
Non-adapted housing.
That means that the same temperature level can generate different alert levels according to the exposed population.
Information for healthcare professionals
The Plan includes health action protocols that provide essential information and recommendations for health professionals working in hospital care, primary care, and social services.
These protocols contain guidance on the identification and classification of risk groups, along with practical recommendations and advice for patients to help prevent the adverse effects of high temperatures. They also provide information on early diagnosis, enabling the prompt recognition of heat-related symptoms, as well as on medications, relevant treatments, and specialized care procedures, including the specific resources available for patient management.
Information to the population and citizens
To transmit the corresponding information on basic measures and tips for protection against heat, the MSCBS issues the corresponding press release to announce the activation of the Plan.
It also makes available to the population:
- A dedicated website providing information from previous and ongoing seasonal campaigns on heat-related risk levels, as well as recommendations for adequate protection during the summer period, particularly aimed at minimizing the effects on the most vulnerable groups.
- Information through email, SMS and direct online channels to vulnerable citizens
- information through Social Networks such as Twitter and Facebook
Episodes of extreme temperatures, particularly heat waves, cause significant alterations in the health and well-being of individuals and communities, affecting two levels:
- Biological – The impact of exposure to excessive heat is influenced by physiological aging and underlying health conditions. A healthy individual can normally tolerate a variation of approximately 3 ºC in internal temperature without significant alteration of physical or mental functions. Above 37 ºC, the body activates physiological defense mechanisms to protect itself from heat stress..
Older adults and very young children are particularly sensitive to temperature changes.
Elderly people have a reduced perception of heat and therefore a diminished ability to protect themselves — a phenomenon that parallels their decreased perception of thirst. In addition, they experience reduced thermoregulation capacity. Conversely, children exhibit specific physiological characteristics—mainly related to body water composition, sweating patterns, and metabolic heat production—that place them at a thermoregulatory disadvantage compared to adults.
- Social.- Marginalization, social isolation, dependency, disability, and precarious living conditions among disadvantaged populations introduce additional risk factors, making these groups even more vulnerable.
In this context, it is essential that political and social institutions develop and implement monitoring, information, and awareness-raising measures that foster preventive behavior, correct regional inequalities, and promote technological solutions of broad public utility to help reduce these social risk factors.
Given the current situation of climate change, the National Plan for Preventive Actions against the Effects of Excessive Temperatures on Health constitutes a key instrument for detecting, preventing, and monitoring the impacts of excessive heat. It also coordinates adaptation measures proposed for Autonomous Communities, municipalities, and other local institutions to address potential risk situations. Furthermore, it serves as the main reference framework for planning structured actions and defining control parameters and warning systems.
All information related to the National Plan is available on the website of the Ministry of Health, Consumer Affairs and Social Welfare (MSCBS). In addition to providing daily updates on current risk levels, the site includes links to Regional Plans that have either officially joined the initiative or developed their own meteorological and environmental information systems.
The Plan also proposes strategies to optimize population adaptation, not only in response to current conditions but also to enhance the capacity to anticipate and respond to unforeseen threats in the future. Particular emphasis is placed on achieving the broadest possible protection for socially disadvantaged and physiologically vulnerable groups, such as children, the elderly, and the chronically ill.
In this regard, the identification and care of vulnerable populations and the activation of specialized resources are carried out through the existing health and social care networks of the Autonomous Communities and local authorities. For this purpose, the Interministerial Commission has established various collaboration agreements with the Spanish Federation of Municipalities and Provinces (FEMP).
In order to guarantee the effective application of the Plan, the Interministerial Commission carries out the functions assigned in Order PRE/1518/2004, of 28 May, by which it was created.
The Commission is chaired by the Directorate-General for Public Health, Quality and Innovation of the Ministry of Health, Consumer Affairs and Social Welfare and is made up of a representative of the following institutions:
- Directorate-General for Civil Protection and Emergencies (Ministry of the Interior)
- State Meteorological Agency (AEMET) - MITECO (Ministry for Ecological Transition)
- Secretary of State for Social Services and Equality. Institute for the Elderly and Social Services (IMSERSO) - MSCBS (Ministry of Health, Consumer Affairs and Social Welfare)
- Directorate-General for Regional and Local Cooperation - MPTFP (Ministry of Territorial Policy and Public Function)
The implementation and enforcement of all the operational and regulatory actions arising from the Plan are the responsibility of the Autonomous Communities and Local Councils, which may, where appropriate, adjust and adapt its provisions to the specific conditions of their territories—such as meteorological variables (e.g., relative humidity), climatic or geographical zoning (e.g., counties or municipal associations)—and, if deemed necessary, develop their own Preventive Action Plans.
The National Plan is updated and implemented annually, being continuously optimized and refined in light of the experience gained from previous years and the scientific and technical reports provided by the Interministerial Commission.
An important feature of the Plan is its open and systematic nature, which includes the definition of parameters for the standardization of risk factors and alert levels, the control and monitoring of preventive actions, and the establishment of thresholds and warning systems. Equally significant is its participatory structure, ensuring coordination among the various institutions involved in its implementation.
From a territorial perspective, the Plan operates at different levels of geographical disaggregation—covering Autonomous Communities, provincial capitals, and isothermal zones within those regions where such divisions are defined. In Autonomous Communities that have developed their own Preventive Action Plans, additional disaggregation levels may be established to reflect specific geographical and climatic characteristics.
Another key aspect of the Plan is its strong connection with Social Services, as elderly and chronically ill individuals represent the most vulnerable and unprotected groups. The active participation of national, regional, and local administrations, together with social organizations, and above all, community awareness and support for at-risk populations, are essential to minimizing the potential health impacts on the population.
Equally essential is the Plan’s transparent and inclusive communication strategy, which ensures the open and universal availability of all information related to high-temperature events across the country. This information—covering preventive recommendations, risk assessments, alerts, and historical data—is disseminated through the Plan’s official website and social media channels, and is directed both to the general public and to health and social care professionals.
In this regard, the National Plan also collaborates closely with the media, providing practical advice and preventive guidelines to help citizens reduce the health impacts of excessive heat exposure. These public awareness campaigns aim to enhance individual preparedness and self-protection capacity, encouraging the adoption of simple, accessible, and effective preventive measures.
Since its implementation in 2004, the National Plan for Preventive Actions against the Effects of Excessive Temperatures on Health has had a positive and measurable impact in preventing health problems and diseases associated with exposure to extreme heat. It has increased public awareness on how to protect oneself and care for the most at-risk individuals, thereby reducing the incidence of heat-related health issues, particularly among the most vulnerable and unprotected groups.
In addition, the Interministerial Commission established under the Plan has proven to be highly effective, ensuring efficient coordination among the various administrations and institutions involved.
From a technical standpoint, the design and development of meteorological and mortality information systems have been fundamental to the Plan’s success. The creation of a Mortality Information and Analysis System, which enables the daily monitoring of mortality data, has been particularly useful for the early detection of other potential public health concerns.
Furthermore, the experience gained over the years through the Plan’s implementation has allowed for the continuous identification and integration of improvements to enhance its effectiveness. For example, during the 2018 season, new sub-provincial zones (comarcal divisions) were defined in the Autonomous Communities of Aragon and Murcia, based on homogeneous climatic variables and zones within each province. This adjustment has improved the precision in identifying risk levels related to excessive temperatures, ensuring that alerts are issued only where necessary, thereby optimizing resource management and increasing public trust and awareness.
For the 2019 season, the Plan proposed the following updates and enhancements:
- Review the categorization of risk levels in coordination with the Autonomous Communities, reassessing the definitions of risk and alert situations.
- Define and establish temperature thresholds for the different isothermal zones within several Autonomous Communities (Castilla-La Mancha, Castilla y León, and Madrid).
- Prepare a technical report on the implementation of isothermal zones in those Autonomous Communities where data are already available, to be included in the seasonal assessment report.
- Develop a document outlining the evaluation criteria, specifying the various aspects to be considered when assessing the benefits of isothermal zoning in light of the experience gained.
The main limiting factors for the application and/or development of the Plan could be cited:
- The differences in budgetary capacity and infrastructure among the various Autonomous Communities and City Councils, which may affect their ability to act or support certain population groups.
- The technical challenges associated with determining specific parameters, such as obtaining biweekly breakdowns of seasonal mortality data, since the short duration of the season and data processing delays of up to 1–2 years often make this difficult.
- The definition of consistent criteria, risk levels, and warning indicators in the face of a highly variable and, at times, unpredictable climate, which requires further refinement through studies of isothermal zones and the availability of long-term time series.
Nevertheless, these are intrinsic and evolving limitations, subject to continuous improvement and technical refinement, and they do not affect the design or objectives of the Plan. Rather, they highlight the need for ongoing political commitment, social engagement, and technological modernization to further optimize its preventive measures.
Given the nature of the National Plan for Preventive Actions against the Effects of Excessive Temperatures, and the consultative, coordination, communication, evaluation, and prevention functions of the Interministerial Commission responsible for its preparation, the Plan—which does not have an executive character—does not include a specific budget for its implementation.
Its development and operation are therefore carried out using the own resources of the Directorate-General for Public Health, Quality and Innovation (MSCBS).
The Autonomous Communities and other Public Administrations with executive powers are the entities that allocate and manage the necessary funds, in accordance with their respective budgets and financing frameworks.
Order PRE/1518/2004, of 28 May, created the Interministerial Commission whose purpose is to guarantee the effective application of the National Plan for Preventive Actions against the Effects of Excessive Temperatures on Health.
In addition, the National Civil Protection Strategy, approved by the National Security Council and established by the Ministry of the Presidency, Relations with the Courts and Equality, under Order PCI/488/2019 of 26 April, also encompasses and supports the National Plan for Preventive Actions against the Effects of Excessive Temperatures on Health.
This Strategy promotes the implementation and coordination of various Protection Plans designed to address potential risk scenarios, including those related to meteorological and climatic phenomena, such as:
National Plan for the Prediction and Monitoring of Adverse Weather Phenomena: Weather-alert, of the State Meteorological Agency (AEMET)
National Plan of Preventive Actions of the Effects of Excessive Temperatures on Health
The remaining legislation and regulatory measures affecting the Plan correspond to the competence and development of each Autonomous Community and/or City Council, which establish their own ordinances and preventive measures as deemed appropriate in each case.
The National Plan for Preventive Actions against the Effects of Excessive Temperatures, in force since 2004, is implemented on an annual basis.
In general, the Plan is activated each year from 1 June to 15 September. However, it also incorporates a flexibility criterion, allowing activation outside this period through continuous monitoring during the final fifteen days of the preceding month (from 15 May) and up to one month after (until 15 October) the regular activation period.
https://www.sanidad.gob.es/areas/sanidadAmbiental/riesgosAmbientales/calorExtremo/publications/docs/planNacionalExcesoTemperaturas_2025.pdf
https://www.sanidad.gob.es/areas/sanidadAmbiental/riesgosAmbientales/calorExtremo/publications/docs/Guia_Salud_y_Calor_v2.pdf
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Margarita Palau Miguel
Ministry of Health, Consumer Affairs and Social Welfare
Email: mpalau@mscbs.es
Phone: 915962091/81
meteosalud@sanidad.gob.es
