HOPE
Respondendo às ondas de calor no ecossistema dos idosos
Macro
Main result
Prevention plan
Title
Luxembourg Plan Canicule
Date
It has been implemented and updated every year since 2003, as a consequence of the heatwave suffered in said year.
Objectives
Plan Canicule’s general goal is to manage prolonged heatwaves within health, care and social services. This measure aims to adapt more vulnerable groups’ behaviours vis-à-vis more frequent heatwaves, enhance the presence of safer spaces, monitor medical conditions and encourage self-assessment, and ensure emergency medical care even on a large scale.
Location /geographical coverage
The geographical reach of the good practice extends to the whole territory of the Grand Duchy of Luxembourg.
Organisation responsible for good practice
Plan Canicule is implemented by the Ministry of Health, the national Red Cross and COPAS jointly. COPAS represents service providers who offer assistance and care services to the elderly, sick, suffering from mental disorders or with disabilities, whether at home or in an institution.
Stakeholders and partners
The target are older adults aged 75 and more, living alone or with an invalid person with limited independence, not provided with outside help or access to long-term care insurance benefits yet.
Short summary
The Plan is to be interpreted in the framework of the “Stratégie et plan d’action pour l’adaptation aux effets du changement climatique au Luxembourg” (Strategy and Action Plan for climate change effects adaptation in Luxembourg). It is based on a multilevel governance approach, inclusive of diverse stakeholders, the Ministry of Health, the national Red Cross and a trade union, COPAS. Plan Canicule is articulated in three levels: Level 1 (preparatory phase), Level 2 (heatwave warning), Level 3 (alert).
As concerns Level 1, the weather forecast service is involved to timely warn against incoming heatwaves in the 4 to 6 days preceding them. Hospitals monitor specific indicators for heat-related conditions in ERs. Professionals have already been trained on the negative effects of some medicines in times of extreme heat. Informative materials in multiple languages are disseminated among the population. Local municipalities are responsible to manage the list in which independently living people at risk can subscribe, to then receive home care services and monitoring from the Red Cross and COPAS.
Level 2 concerns the formal announcement of incoming heatwaves, whenever
temperatures are above 34°C or exceed 30°C for more than three days in a row. In these cases, the population is informed through the media. If necessary, the Health Ministry can launch an early warning, according to which homecare service staff can visit people at risk that have subscribed municipal lists.
Level 3 is activated when temperatures exceed 30°C for more than 4 days, without a sufficient reduction at night, and when hospitals warn against an increase in heat-related medical conditions. In this case, predefined protocols are activated in those institutions hosting people at risk (hospitals, integrated centres). The local care service visits people subscribed in municipal lists only. Official communication is done through the media.
Impact
Since 2006, 4.834 people have been subscribing to municipal lists to benefit from
monitoring visits. However, the number of incoming calls to the emergency number is low (about 10 per week). The plan has been updated yearly through a strong collaboration among the Ministry for Health, COPAS and the national Red Cross, allowing it to be adherent to the continuously emerging challenges on human health deriving from climate change and to steadily improve itself. The specific impact of the good practice needs to be interpreted in light of the more general features of the national healthcare system. As reported in 2021 OECD’s publication on the “State of Health in the EU”, public spending on health in Luxembourg is above the EU average, while it represents only 5.4% of the country’s GDP, the lowest share in the EU. The largest part of such spending (32.9%) is dedicated to outpatient care, including home care, which represents a solid starting point to deliver home care-centred action plans, such as Plan Canicule.
Innovation
The strong multilevel collaboration among the Health Ministry, COPAS and the
national Red Cross constitutes the innovative model underlying this good practice and its reason of success. Through this approach, the plan has been envisioned as a living lab, since it has been updated every year embedding the changing climate scenario and emerging challenges, in the framework of the broader Strategy and Action Plan for climate change effects adaptation in Luxembourg.
Lessons learned
On a positive note, this good practice brings along a successful multilevel
coordination approach to tackle the impacts of climate change on older adults'
health. The success of this formula might be explained considering the narrow
geographical extension of the country, which could in fact be perceived as a bias
when it comes to replicate it in other scenarios, but still, it represents a success story in terms of how it has help build effective synergies.
Whereas, on a negative note, in terms of target, such model appears to be partial. Only independently living older adults over 75 years old at risk or living with persons with disabilities, with no access to long term care insurances, are defined as target of the plan. Overall, despite presenting a universal health coverage, Luxembourg healthcare system fails to adequately provide medical care to 0.4% of the national population, in particular homeless people, residents whose welfare benefits are ending and undocumented migrants.
Sustainability
As explained, for this good practice to be institutionally sustainable, there should be strong coordination among different relevant actors providing healthcare services, as a way to enhance more effective synergies, thus offering an overall better performance of the functions of each institution or entity involved. In terms of social sustainability, this practice is directed to the part of the population that is not entitled to long term care benefits yet, in order to fill in the gap of accessibility, but perhaps it could be still improved by increasing its capacity to reach the “hard to reach”, namely homeless people and undocumented migrants. In terms of economic sustainability, Luxembourg positive national economic performance allows to give enough coverage to the public health expenditure, which amounted to 85% in 2020, vis-à-vis only 9.6% of out-of-pocket private spending (incl. Private health insurances). Finally, the practice as it has been envisioned in Luxembourg both embodies and supports environmental sustainability. As a matter of fact, it promotes older adults’ participation by phone and by filling in digital forms.
Replicability and/or up-scaling
Replicability and up-scaling possibilities should take into consideration two main
variables, the absence of which might prevent the achievement of the same results in other contexts:
- Geographical extension: the good practice is currently implemented at
national level in a country with a very narrow geographical extension, which
might explain the successful experience in terms of organisational approach, while ignoring other dimensions and variables that could emerge in broader geographical contexts or more complex and/or layered decision-making structures.
Health system efficiency and performance: Luxembourg has a flourishing economy, thanks to the profits generated by foreign-owned companies that are repatriated. A context that makes Luxembourg an almost sui generis case in Europe too, so the impact and the economic sustainability rate that the practice presents in Luxembourg cannot ignore the baseline conditions that contribute to them. A country with a different economic standing and a reduced spending capacity in the health domain might well register totally different impact and sustainability levels.
Contact details
+ 352 2755 – Dedicated telephone created by the Red Cross
+352 247-85653 – Inspection sanitaire, Direction de la Santé (Health and Sanitary
Inspection Office at the national Health Ministery)
Related Web site(s)
https://sante.public.lu/fr/espace-citoyen/dossiers-thematiques/c/canicule/plan-canicule.html
https://sante.public.lu/fr/espace-citoyen/dossiers-thematiques/c/canicule.html
Related resources that have been developed
https://sante.public.lu/fr/publications/a/attention-canicule-fr-de-pt.html
https://sante.public.lu/fr/publications/a/aff-attention-canicule-fr-de-pt.html