Comparing heatwave experiences, behaviors, and risk perceptions across high-risk populations in the Netherlands: A cross-sectional survey study

Introduction: Heatwaves are a growing public health concern in the Netherlands, particularly for high-risk populations. To reduce heat-related health risks and increase the adoption of protective behaviors, more insight is needed into how different populations experience and manage heat. This study explores how high-risk groups in the Netherlands experienced a heatwave, how they perceived heat-related risks, and the extent of protective measures they took.

Methods: A cross-sectional online survey was conducted among older adults (50+) directly following a heatwave in July 2023 in Limburg, the Netherlands. High-risk groups were defined from the sample (n = 514) based on age (≥65 years), gender (female), health status (poor/fair self-rated health, chronic illness, or medication use), socioeconomic position (low or lower-middle income), and social isolation (self-rated social contact score ≤3/10). Quantitative analyses assessed associations between risk characteristics, heat experiences, protective behaviors, risk perception, and response efficacy.

Results: Heat was not experienced or managed uniformly. Lower health status and socioeconomic position were most strongly associated with discomfort, emotional strain, and health issues. Individuals with lower socioeconomic position adopted more protective behaviors but mostly relied on low-cost measures. Those with lower health status showed no increase in protective behaviors, possibly due to physical constraints. Adverse heat-related outcomes increased with the number of high-risk factors, indicating cumulative vulnerability. Despite this, risk perception remained low across all groups.

Conclusion: Individuals' experiences and perceptions were most strongly associated with socioeconomic and health-related disadvantages. Given the compounding nature of these vulnerabilities and low risk perception, targeted interventions tailored to lived realities are essential.