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Title page 1

Contents 4

Executive Summary 5

1. A New Climate Reality for Europe and Central Asia 12

1.1. Mild Climates Shaped Civilizations in Europe and Central Asia 12

1.2. Heat Extremes have Become More Frequent and Intense 16

1.3. Urban Form Amplifies Heat Risks 22

1.4. Cities across the Region Will Get Much Hotter 28

1.5. Life-Threatening Heatwaves will Shift from Rare to Routine 32

2. The Toll of Extreme Heat on People, Jobs, and Infrastructure 35

2.1. Heat Causes Death and Illness among Vulnerable Groups 35

2.2. Heat-Related Mortality Will Rise in Europe and Central Asia 41

2.3. Heat Affects Workers, at a Cost to the Economy 45

2.4. Smaller Firms, Weaker Economies: Heat Stress Deepens Economic Divides 50

2.5. Cities Bear the Economic Burden of Heat Stress-and It Is Growing 56

2.6. Heat Stress Is Putting Infrastructure under Strain 59

3. What Needs to Be Done? An Action Agenda 65

3.1. Make Urban Spaces Cooler 67

1. Advance Urban Greening through Strategic Planning 67

2. Harness Wind, Shade, and Design for Cooler Cities 69

3. Tackle Indoor Heat through Building Upgrades 72

3.2. Protect Vulnerable People during Extreme Heat Events 74

4. Strengthen Heat Early Warning and Response Systems 74

5. Build Health System Readiness for Extreme Heat 79

6. Protect Heat-Exposed Workers and Residents 80

3.3. Adapt Infrastructure for a Hotter Future 83

7. Build Energy Systems' Resilience to Extreme Heat 83

8. Integrate Heat Resilience into the Transport Sector 86

9. Prevent Schools Overheating 87

3.4. Mainstream Heat Resilience into Institutions 91

10. Integrate Heat Resilience into Strategies, Operations and Budgets 91

4. Getting It Done: Achieving Heat Resilience at Scale 94

4.1. Who Leads? Governance for Heat Resilience 94

4.2. How to Deliver? Embedding Heat Resilience in Systems and Budgets 100

4.3. Conclusion 108

5. Annexes 109

Annex 1. From Stocktaking to Action on Urban Heat 109

Acknowledgments 115

Tables 32

Table 1.1. Projected Heatwave Days, Hot Nights, and Cooling Energy Needs in Central Skopje, North Macedonia 32

Table 3.1. Do Heatwave Alerting and Response Plans Save Lives? Evidence from International Studies 75

Table 3.2. Examples of Actions to Protect Heat-Exposed Workers 82

Table 3.3. Heat Impacts and Adaptation Measures in the Transport Sector 87

Table 3.4. Design Interventions to Reduce Overheating in Schools 89

Table 4.1. Who Should Do What? Responsibilities across 10 Strategic Actions 96

Table 4.2. Institutional Approaches to Heat Governance-Options and Trade-Offs 97

Figures 14

FIGURE 1.1. Changing Climate Zones across Europe and Central Asia (1991-2020 vs. 2071-2099) 14

FIGURE 1.2. Rising Temperatures across Europe and Central Asia (1850-2024) 17

FIGURE 1.3. Observed Changes in Heatwaves Frequency and Duration in Europe and Central Asia, 1970-2024 19

FIGURE 1.4. Observed Rise in Heatwave Intensity across European and Central Asian Cities (1970-2024) 21

FIGURE 1.5. The Urban Heat Island Effect: How Built Form and Vegetation Influence Temperature Patterns 23

FIGURE 1.6. Intra-Urban Heat Variation in Sofia during the July-August 2021 Heatwave 24

FIGURE 1.7. Relationship between Air Temperatures and Ground Cover Characteristics in Tirana, Albania 26

FIGURE 1.8. Projected Increase in Hot Days for Cities in Europe and Central Asia 27

FIGURE 1.9. Projected End-of-Century Warming for Cities in Europe and Central Asia (SSP2-4.5) 29

FIGURE 1.10. Projected Increase in Days with Extreme Heat Stress in European and Central Asian Cities (Present-2090) 30

FIGURE 1.11. Additional Days of Extreme Heat Exposure across European and Central Asian Cities by 2090 31

FIGURE 1.12. Projected Number of Heatwave Days per year in Skopje, North Macedonia 33

FIGURE 1.13. Projected Increase in Heatwave Severity across European and Central Asian Cities (2025-2100) 34

FIGURE 2.1. How Temperature Affects Mortality Risk in Istanbul, Türkiye 36

FIGURE 2.2. Relative Risk of Mortality on the Hottest Days in Selected Cities in Europe and Central Asia 40

FIGURE 2.3. Minimum Mortality Temperature (MMT), in °C, for 70 Cities in Europe and Central Asia 41

FIGURE 2.4. Heat-Related Mortality Rates in Cities across Europe and Central Asia, 2000-2020 42

FIGURE 2.5. The 10 Cities in Europe and Central Asia with the Most Projected Heat-related Excess Deaths 44

FIGURE 2.6. How Does Heat Affect Labor Productivity? 48

FIGURE 2.7. Higher Average Temperatures Are Associated with Lower Math Test Scores 49

FIGURE 2.8. Share of Lost Working Hours Due to Heat Stress in Europe and Central Asia (2030 Projection) 51

FIGURE 2.9. Changes in Labor Productivity Due to Increase in Hot Days between 2000-2004 and 2017-2021 53

FIGURE 2.10. Modelled Labor Productivity Loss for 62 Cities (2030 and 2050) under Different Climate Scenarios 58

FIGURE 2.11. Building Upgrades Can Cut Indoor Heat Exposure in Central Asia's Aging Housing Stock 64

FIGURE 3.1. Places, People, Infrastructure, and Institutions: 10 Strategic Actions for Heat Resilience in Europe and Central Asia 66

FIGURE 3.2. Design Principles for Harnessing Wind and Airflow in Urban Planning 71

FIGURE 3.3. Heat Adaptation and Early Warning Policies and Gaps in Europe and Central Asia 76

FIGURE 3.4. Frequency of Key Terms in National Heat Health Action Plans in 12 Countries 79

FIGURE 4.1. Timeframes for Key Heat Resilience Actions 98

FIGURE 4.2. The Heat Wave Risk Management Cycle 99

FIGURE 4.3. Benefit-cost Ratios of selected heat adaptation measures 104

Boxes 15

BOX 1. How hot is too hot? Defining heat stress and heat waves 15

BOX 1.1. The Mediterranean on Fire: Mapping Türkiye's July 2023 Heatwave 21

BOX 2.1. Heat and the Human Body 38

BOX 2.2. Interpreting Economic Modeling Estimates: A Practical Guide 54

BOX 2.3. Passive Cooling to Cut Indoor Heat Risk: Evidence from Shymkent, Kazakhstan 63

BOX 3.1. Urban Greening in Cities in Europe and Central Asia 68

BOX 3.2. Solar Protection for Everyone during the Summer in Seville 70

BOX 3.3. Stuttgart Harnesses Wind to Combat Urban Heat and Air Pollution 71

BOX 3.4. Building Retrofits in Türkiye and Croatia Saved Energy and Cooled Buildings 73

BOX 3.5. Green Roofs and Walls in Novi Sad and Osijek: A Cross-Border Pilot 74

BOX 3.6. A Decade of Progress on Heat-Health Plans, But Critical Gaps Remain 78

BOX 3.7. Paris Cools Buildings with River Water instead of Air Conditioning 85

BOX 3.8. From Tradition to Policy-Lessons from Vernacular Architecture 90

BOX 3.9. How the EU is Helping Cities Manage Urban Heat and Build Climate Resilience 93

BOX 4.1. The UK's New Building Regulations: A Model for Managing Heat Risks 101

BOX 4.2. Shaping Cooler Cities through Citizen Science in the Western Balkans 106

Annex Tables 110

Table A1. Key Questions and Actions for an Urban Heat Task Force 110

Table A2. A Simplified Catalog of Urban Heat Solutions 112

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