International Journal of

Environmental Research
and Public Health

Article
Public Perceptions of Climate Change and Health—A Cross-
Sectional Survey Study
Katharina van Baal 1, * , Stephanie Stiel 1 and Peter Schulte 1,2

1 Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1,
30625 Hannover, Germany
2 Länger Besser Leben. Institute, University of Applied Sciences Weserbergland, Am Stockhof 2,
31785 Hameln, Germany
* Correspondence: vanbaal.katharina@mh-hannover.de

Abstract: Climate change is inseparably linked to human health. Although there is growing aware-
ness of the threats to human health caused by climate change, it remains unclear how the German
population perceives the relevance of climate change and its health consequences. Between May
and September 2022, German residents were invited to participate in a cross-sectional online survey
that explored three content areas: (1) the relevance of climate change, (2) health risks in connection
with climate change and (3) collective and individual options for action against climate change. A
total of 697 full data sets were collected for analysis (72% female, 51% ≥55 years old). The majority
of participants agreed that human-induced climate change exists (85%), and that it has an impact
on human health (83%). They also perceived the global population to be more strongly impacted
by climate change than themselves (89% versus 68%). Most participants (76%) claimed to person-
ally contribute to climate protection and 23% felt that their city or council contributed to climate
protection. Although the majority of participants saw climate change as a threat to human health,
they perceived other population groups to be most strongly affected. Cognitive dissonance might
explain this lack of individual concern and one approach to addressing such distorted perceptions
might be the dissemination of appropriate risk communication with health professionals involved in
the communication.

Citation: van Baal, K.; Stiel, S.; Keywords: climate change; planetary health; public perception; public health
Schulte, P. Public Perceptions of
Climate Change and Health—A
Cross-Sectional Survey Study. Int. J.
Environ. Res. Public Health 2023, 20, 1. Introduction
1464. https://doi.org/10.3390/
Currently, climate change is the greatest hazard to humankind, threatening our natural
ijerph20021464
sources of life and the survival of our civilisation [1–3]. Although countries have committed
Academic Editor: Antonia Kaltsatou to limiting global warming to well below 2 ◦ C (as part of the Paris Agreement), global
Received: 20 December 2022
greenhouse gas emissions continue to increase [1]. In fact, planetary boundaries, defined as
Revised: 9 January 2023
thresholds that should not be exceeded in order to ensure sustainable living conditions,
Accepted: 11 January 2023 have already been crossed [4]. The global scientific community agrees that global warming
Published: 13 January 2023 must be contained within 1.5 ◦ C to maintain decent living conditions. Recently, a haunting
warning was released, specifying the growing magnitude of climate-related disasters
resulting in global human suffering [5]. Despite this, the climate is changing faster than
anticipated and the 1.5 ◦ C threshold is predicted to be surpassed by 2040 or even earlier,
Copyright: © 2023 by the authors. with potentially catastrophic effects [3,5,6]. Vulnerable populations such as the elderly and
Licensee MDPI, Basel, Switzerland. young children will be most affected, resulting in growing inequalities [7].
This article is an open access article Climate change contributes significantly to human morbidity and mortality and has di-
distributed under the terms and rect effects on individuals and on global and public health [1,6,8,9]. Increasing temperatures
conditions of the Creative Commons and heat periods, extreme weather events, air pollution, water and food insecurity and
Attribution (CC BY) license (https://
changes in the spread patterns of vector-associated diseases are effects of climate change
creativecommons.org/licenses/by/
with a direct or indirect impact on human health. Science has confirmed that these changes
4.0/).

Int. J. Environ. Res. Public Health 2023, 20, 1464. https://doi.org/10.3390/ijerph20021464 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2023, 20, 1464 2 of 11

affect health in complex ways, resulting in, among other things, heat injuries, infectious
diseases, allergies, malnutrition, and mental illnesses [6,9,10].
In the international medical community, there is a growing awareness of the threats
to human health caused by climate change [11–15]. As a result, ideas for the sustainable
and efficient management of resources in health care settings have been proposed [14],
the carbon footprint of primary care practices has been measured [15] and the attitude
of medical doctors towards climate protection measures in outpatient practices has been
assessed [13]. In addition, the population in Germany [16] and in other countries [7,17]
has recently shown increasing concern about climate change and its implications on health.
However, few people understand the types of harm climate change cause on health and
know precisely who is most likely to be affected [7]. Despite this growing concern about
climate change itself and its implications on health, few studies have yet assessed public
perceptions. Active involvement of the population is crucial for the empowerment of
people participating in (health) politics, policy-making, and research [18]. However, in
Germany, current public perceptions of the relevance of climate change and the connection
between climate change and health remain unclear.
Therefore, the present study aimed at investigating public perceptions of the relevance
of climate change, the connection between climate change and health, and options for
action against climate change. The specific research questions were:
• How does the public perceive the overall relevance of climate change?
• How does the public perceive the risks and health consequences associated with
climate change?
• What are individual and collective options for action against climate change?

2. Materials and Methods

2.1. Study Design
The present study was a cross-sectional survey study. This research approach promises
to reach a large population sample with few distortions and barriers for participation. The
design was based on a previous survey by Berger et al. [16].

2.2. Study Population

The target group was an open population in a national German sample. There were no
inclusion or exclusion criteria. Participants were recruited via the websites, mailing lists and
social media accounts of the involved institutions (i.e., health insurance fund BKK24, insti-
tutes at Hannover Medical School and the University of Applied Sciences Weserbergland).

2.3. Survey
The survey content was based on a questionnaire by Berger et al. [16], which was
adapted and supplemented on the basis of the literature and the research questions. The
survey was administered as an online survey via the website of the German health insurance
fund BKK24. There was an internal pre-test with the staff of the involved institutions. The
survey was open for a duration of 20 weeks, from 2 May 2022 to 18 September 2022, and
consisted of four major parts:
• five items on demographic variables;
• four items on overall perceptions of climate change;
• seven items on suspected or perceived risks and health consequences associated with
climate change;
• eight items on individual and collective options for action against climate change.
The survey contained nominal single-choice questions (e.g., Yes/No), as well as verbal
Likert scales ranging from 1 (not at all) to 5 (fully), to determine the extent to which
participants agreed with or were concerned about certain aspects of climate change. Free
text options were provided for some items to invite elaboration on individual attitudes
and perceptions.
Int. J. Environ. Res. Public Health 2023, 20, 1464 3 of 11

2.4. Ethical Approval and Consent to Participate

Ethical approval (No. 04/2022-8) was granted by the ethics committee of University
of Applied Sciences Weserbergland on 4 April 2022. All participants provided informed
consent prior to participating in any study procedure. All data were pseudonymised.

2.5. Data Analysis

Data were analysed using version 26 of the Statistical Package for Social Sciences
software (SPSS Inc., Chicago, IL, USA). Descriptive analyses included the calculation of
means, standard deviations (SDs), medians and interquartile ranges (IQRs). Smaller sample
sizes were stated for all items, indicating missing values. Single free text comments on
certain survey items were used to describe the quantitative data. Free text comments were
categorised according to conventional content analysis by Hsieh and Shannon [19].

3. Results
During the survey period (May to September 2022), 1167 people accessed the question-
naire. Of the resulting 1167 data sets, 363 were empty and 107 only included demographic
data. These 470 data sets were excluded prior to the data analysis. In total, data from
697 participants were included in the analysis.
The study population included 503 (72.2%) female participants. Table 1 presents
further demographic details.

Table 1. Demographic data of the study population (N = 697; single choices).

Variable n %
Female 503 72.2
Sex Male 190 27.3
Diverse 4 0.6
11–24 17 2.7
25–39 113 16.2
Age group 40–54 209 30.0
(years) 55–64 204 29.3
65–74 123 17.6
>75 31 4.4
Single 163 23.4
Married 408 58.5
Widowed 32 4.6
Marital status Divorced 83 11.9
Registered partnership 10 1.4
Registered partner deceased 0 0.0
Registered partnership terminated 1 0.1
No school/leaving qualification 2 0.3
Lower secondary school 64 9.2
Highest educational degree Secondary school 180 25.8
Higher secondary school 222 31.9
University 229 32.9
Rural community (<5000 inhabitants) 198 28.4
Small town (5000–20,000 inhabitants) 194 27.8
Living area
Medium-sized city
129 18.5
(20,000–100,000 inhabitants)
Major city (≥100,000 inhabitants) 176 25.3

The majority (85.4%) of participants agreed or thought it likely that human-induced

climate change exists. A total of 504 (75.7%) participants claimed to be very or somewhat
concerned about climate change. Additionally, 82.8% agreed or thought it likely that climate
change has an impact on human health. Most (69.9%) participants were strongly or rather
concerned about the health consequences of climate change (Table 2). Participants also
Int. J. Environ. Res. Public Health 2023, 20, 1464 4 of 11

perceived the global population (88.8% agreed fully or deemed it likely) to be more strongly
impacted by climate change than the European population (80.7%), the German population
(73.8%) and themselves (67.1%) (Figure 1).

Table 2. Perceptions of climate change and its health consequences (N = 697).

Strongly Strongly Disa-

Agree/ Disagree/Not
Variable Agree/Very Neutral (%) gree/Not at All
Concerned (%) Concerned (%)
Concerned (%) Concerned (%)
To what extent do you agree with the
following statements?
Human-induced climate change exists * (N = 697) 62.8 22.5 9.0 2.6 3.0
Climate change has an impact on human health
54.2 28.6 10.8 3.6 2.8
(N = 668)
The following groups are affected by
climate change:
Global population (N = 658) 80.2 14.1 2.9 1.4 1.4
European population (N = 590) * 64.6 24.1 8.5 1.7 1.2
German population (N = 590) 61.2 21.0 13.9 2.9 1.0
Myself (N = 594) 53.2 21.0 19.4 4.9 1.5
The health of the following groups is at risk due to
climate change:
Global population (N = 633) 66.0 22.7 8.4 2.1 0.8
European population (N = 575) * 47.1 33.6 15.8 3.1 0.3
German population (N = 576) 45.0 28.8 20.3 5.4 0.5
Myself (N = 593) 39.6 27.5 22.8 8.1 2.0
To what extent are you concerned about:
Climate change (N = 666) 40.7 35.0 19.1 3.6 1.6
The health consequences of climate change (N = 632) 31.0 38.9 23.8 5.4 0.9
To what extent are you concerned about the
following risks of climate change?
More frequent occurrence of extreme weather events
(e.g., heat waves, droughts, particulate matter) 56.0 29.8 9.6 3.0 1.5
(N = 664) *
More frequent occurrence of storms and floods
51.6 35.2 8.6 3.3 1.4
(N = 665) *
Higher concentration of air pollution (e.g., ozone,
36.7 34.4 20.4 6.3 2.1
particulate matter) (N = 662) *
Increased contamination of water bodies with
33.9 33.8 21.6 8.6 2.1
pathogens (e.g., blue-green algae) (N = 666)
Increased exposure of food to pathogens (e.g.,
24.8 30.4 26.3 13.5 5.0
salmonella) (N = 658)
Spread of allergenic plant species (e.g., ragweed)
23.8 28.7 30.3 12.4 4.7
(N = 659) *
Spread of allergenic animal species (e.g., oak
28.3 30.7 27.4 10.1 3.5
processionary moth) (N = 654)
Spread of insects carrying pathogens (e.g., dengue
fever, Zika infection, West Nile fever, malaria) 34.3 36.4 18.2 8.4 2.6
(N = 664)
* Differences due to rounding.

Participants believed that extreme weather events (87.8%), problems with the qual-
ity and supply of drinking water (74.2%), and rising sea levels (66.8%) were the three
most relevant factors associated with climate change and its health risks. An additional
54 factors were proposed as free text answers. Predominantly, these fell into the categories
of hunger/food security (n = 13), flight/migration (n = 10) and war (n = 8). Furthermore,
participants ranked accidents and deaths from extreme weather events (61.6%), infectious
diseases (56.2%) and skin cancer (51.7) as the top three health risks connected to climate
change. A significant proportion (n = 114; 18.2%) had experienced changes in their own
health due to climate change (Table 3).
Int. J. Environ. Res. Public Health 2023, 20, 1464 5 of 11
Int. J. Environ. Res. Public Health 2023, 20, x FOR PEER REVIEW 5 of 11

Figure
Figure 1. Health at risk from1. Health
climateat risk from climate
change, change, by population
by population group.group
Participants believed that extreme weather events (87.8%), problems with the quality
Table 3. Suspected or and
perceived risks
supply of and water
drinking health(74.2%),
consequences
and rising associated with were
sea levels (66.8%) climate change.
the three most
relevant factors associated with climate change and its health risks. An additional 54 fac-
tors were proposed
Variableas free text answers. Predominantly, these fell(%)
Yes into the categories
No (%) of
hunger/food security (n = 13), flight/migration (n = 10) and war (n = 8). Furthermore, par-
Which factors do you consider
ticipants relevant
ranked toand
accidents climate
deathschange and its
from extreme weather events (61.6%), infectious
health(56.2%)
diseases (Nskin
risks?and = 648)
cancer (51.7) as the top three health risks connected to climate
change. A significant proportion (n = 114; 18.2%) had experienced changes in their own
Thermal stress due to heat
health due to climate change (Table 3).
65.3 34.7
Extreme weather events (e.g., heat, storms, precipitation) 87.8 12.2
Increased occurrence of pollutants
Table 3. Suspected or(e.g., ozone,
perceived risksparticulate matter) associated
and health consequences 52.9 47.1
with climate change.
Increased UV radiation Variable Yes 56.0
(%) No (%)44.0
Increased and prolonged
Which occurrence
factors do you of to
consider relevant allergens
climate change and its 33.0 67.0
health risks? (N = 648) animals
Propagation and spread of pathogen-carrying 51.9 48.1
Thermal stress due to heat 65.3 34.7
Problems with the supply and quality of drinking water
Extreme weather events (e.g., heat, storms, precipitation) 74.2
87.8 12.225.8
Food hygiene
Increased problems
occurrence of pollutants (e.g., ozone, particulate matter) 28.4
52.9 47.171.6
Degradation of bathing Increased
waterUV quality
radiation 56.0
24.5 44.075.5
Increased and prolonged occurrence of allergens 33.0 67.0
Rising sea levels
Propagation and spread of pathogen-carrying animals 66.8
51.9 48.133.2
Socialwith
Problems conflict
the supply and quality of drinking water 60.6
74.2 25.839.4
Food hygiene problems 28.4 71.6
Which health risks do you perceive asbathing
Degradation of connected to climate
water quality 24.5 75.5
change? (N = Rising
648)sea levels 66.8 33.2
Social conflict 60.6 39.4
Accidents and death from
Whichextreme
health risksweather events
do you perceive (e.g., heat,
as connected cold,
to climate
change? (N = 648) 61.6 38.4
storms, landslides)
Accidents and death from extreme weather events (e.g., heat, cold,
61.6 38.4
Skin cancer storms, landslides) 51.7 48.3
Respiratory diseases Skin cancer 51.7
51.2 48.348.8
Respiratory diseases 51.2 48.8
Allergies Allergies 39.6
39.6 42.6
42.6
Infectious diseases Infectious diseases 56.2
56.2 43.843.8
PsychologicalPsychological
trauma trauma 38.6
38.6 61.461.4
Other 9.0 91.0
Other
Have you already experienced health changes connected to climate
9.0 91.0
change? (N = 627)
Have you already experienced health changes connected to
climate change? (N = 627)
Yes 114 18.2
No 340 54.2
Perhaps 173 27.6
If yes, what are those health changes? (N = 114)
Accidents and their consequences 3 2.6
Infectious diseases 20 17.5
Cancer 10 8.8
Malnutrition 3 2.6
Psychological trauma 19 16.7
Allergies (e.g., new entrants, increases or extensions) 63 55.3
Respiratory diseases 41 36.0
Other (e.g., allergic reactions, circulation problems) 40 35.1
Int. J. Environ. Res. Public Health 2023, 20, 1464 6 of 11

The majority (81.1%) of participants believed that they could personally contribute
to climate protection, while 15.3% were unsure and 3.6% thought that they could not
contribute (N = 634). Most (77.3%) participants claimed to already be contributing in some
way to climate protection, while 17.8% were unsure of their personal contribution and 4.9%
claimed that they were not actively contributing (N = 616). Asked to describe their options
for personally contributing to climate protection, participants most frequently mentioned
actions related to mobility (n = 291), resource management (n = 195) and food procurement
(n = 179) (Table 4). The same categories were mentioned most frequently when participants
were asked to describe the contributions they were already making to climate protection
(Table 4).

Table 4. Individual options for action against climate change.

Can Personally Does Personally

Category (Examples)
Contribute (N) Contribute (N)
Mobility (less car driving, more bicycling, more electric
291 252
mobility, greater use of public transportation)
Resource management (thrifty/cautious/sensible use of
195 139
energy, water and other resources)
Food procurement (preference for regional and seasonal
food, preference for food with an organic certification, 179 124
avoidance of food waste, self-supply)
Nutrition (less consumption of meat and animal
products, adoption of a vegetarian and vegan diet, less 160 110
consumption of processed food)
Handling of waste (package-free shopping, waste
153 99
separation, recycling, consciousness of microplastics)
Consumption (upcycling, shopping second-hand,
buying fewer items/clothes, minimalism, prolonged use 134 76
of electronics)
Travel (no/less air travel, no/fewer cruises, vacations by
97 67
train in Europe/regionally)
Use of renewable energy sources
(modernisation/renovation of residential properties, use 61 89
of photovoltaic plants, use of green electricity)
Biodiversity (insect-friendly planting, renaturation, tree
50 42
planting, no/less use of pesticides)
Involvement and donations (participation in
politics/projects, voting, support for 24 17
non-governmental organisations)
Sensitisation and education (talking about climate
change locally, acting as a good example, talking to kids 22 10
about climate change)
Other (no fireworks, overall emissions savings,
36 13
adaptation of lifestyle habits)

The majority (75.1%) of participants believed that their city or council could contribute
to climate protection, while 20.7% were unsure and 4.2% did not believe in the possible
contribution of their city or council (N = 627). Moreover, 23.3% perceived that their city
or council was already taking action for climate protection, whereas 68.4% were unsure
about this and 8.3% did not see any action being taken. When participants were asked to
describe any concrete contributions to climate protection that their city or council could
make, they most frequently mentioned actions related to traffic and mobility (n = 242),
modernisation and extension of renewable energy sources (n = 141), and green spaces
Int. J. Environ. Res. Public Health 2023, 20, 1464 7 of 11

and planting (n = 139) (Table 5). While fewer actual contributions of the city or council
were mentioned, those that were tended to fall into the same categories as the possible
contributions (Table 5).
Table 5. Collective options for action against climate change.

Can City/Council Does City/Council

Category (Examples)
Contribute (n) Contribute (n)
Traffic and mobility (more/better/safer bikeways,
expansion of public transportation, car-free cities,
242 63
more charging stations, car sharing, speed limits,
greater traffic control)
Modernisation and extension of renewable energy
sources (photovoltaic plants on public buildings,
141 32
benefits for private reconstruction, standards for
building extensions)
Green spaces and planting (more tree planting, less
logging, more parks, more community gardens,
139 25
more conservation areas, renaturation,
green roofing)
Sustainable construction (less impervious surfaces,
eco-friendly building regulations, fewer parking 71 11
spaces, regulations for rockeries)
Resource saving (public lighting, public fountains
and sprinkler installations, incentives to save 62 12
resources [e.g., CO2 taxes], bans and bids)
Education, sensitisation, consultation and inclusion
(information in schools and kindergartens, public 47 7
campaigns, more frequent referendums)
Food procurement and the promotion of regional
offers (regulations for food prices [e.g., price
29 0
increases for meat products and price decreases for
regional vegetables], regulations to prohibit waste)
Support for projects and initiatives (demonstrations,
days of action, litter clean-up events, funding for 27 16
eco-friendly companies)
Waste and packaging (prohibitions/taxes on plastics,
more public waste bins, incentives for waste 23 5
avoidance, recycling)
Adjustment of climate change and anticipatory
action (preparations for heat waves, more shaded
21 3
places in cities, flood prevention, secure
water supplies)
Adaptation of cultural offerings and living spaces
(river bathing, playgrounds, drinking 19 2
water fountains)
Agriculture (reserve areas, promotion of sustainable
processes and organic cultivation, improvement of 11 1
animal welfare)
Adaptation of consumption (promotion of
second-hand stores, incentives and legal framework 8 2
for less consumption, adaptation of food in canteens)
Other (sanctions for non–eco-friendly industries and
companies, improvement of air quality, hiring of
23 4
personnel responsible for climate protection
in administration)
Int. J. Environ. Res. Public Health 2023, 20, 1464 8 of 11

4. Discussion
The present study was aimed at investigating public perceptions of the relevance of
climate change, the connection between climate change and health, and options for action
against climate change. The underlying research questions related to (1) how the public
perceives the overall relevance of climate change; (2) how risks and health consequences
associated with climate change are perceived, and (3) what individual and collective options
for action against climate change exist. The main results regarding these research questions
were that the majority of a public population (1) acknowledged the existence of climate
change and its implications for human health and were concerned about the associated
risks of climate change, (2) perceived that other population groups would be more strongly
impacted by climate change than the German population and themselves, and (3) claimed
to contribute to climate protection, while noting potential improvements in the climate
change mitigating activities of cities and councils.
In the scientific community, there is a consensus that climate change is human-induced
and associated with wide-ranging environmental changes that may negatively impact
human health. Accordingly, climate change is considered the greatest existential challenge
faced by humanity [1,2,8,20]. Despite this, research from 2018 [16] found that the public
perception of climate change in Germany was characterised by psychological distance,
with most participants downplaying its associated health risks. The authors called for
targeted communication measures with comprehensive information and action plans for
broad parts of the population, in order to influence risk perception and willingness to act.
However, the results of the present study do not show a fundamental alteration in public
perception. Concern about climate change and its implications remained high, particularly
in relation to extreme weather events. Also, the health impacts of climate change were
perceived as stronger for other population groups than for the participants themselves.
Possible explanations for this have relevance for both climate change and its implications
for health. Climate change and greenhouse gas emissions are not visible, and they are rarely
immediately connected with their health risks [21,22]. Even though a scientific consensus
exists, concern and sense of urgency vary strongly, often due to a limited understanding of
the underlying causes and stakes [21]. In addition, the lack of immediacy is often caused
by a geographic and temporal distance between cause and effect of health-related climate
change effects [21]. The high complexity of climate change, in terms of its processes, conse-
quences and public controversies (fuelled by politicians and public figures), leads to public
questioning of the substantially confirmed scientific findings on climate change and its
implications [23–25]. Furthermore, cognitive dissonance theory might explain participants’
belief that other groups are and will be more strongly impacted by climate change than
themselves. Specifically, dissonance between knowledge, conflicting values, and actual
behaviour may contribute to a distortion of understanding, information processing and
decision-making [26]. Cognitive dissonance theory has been recognised as influential in
clinical medical practice and medical education [27], as well as in the psychology of eating
animals [28], and it might also apply to perceptions of climate change and its influence on
human health. Different models of dissonance reduction strategies have been described,
targeting attitudes, distraction and forgetting, denial of responsibility, and behaviour [29].
In particular, behavioural change strategies require significant effort, and they are not often
experienced as comfortable or easy [26,29]. This might explain why extensive action for cli-
mate protection is often lacking, on both individual and collective levels. Addressing these
barriers and strategies in decision making and public communication by policy-makers,
political stakeholders and health care professionals might contribute to emphasising the
urgency and need for action.
Nevertheless, in contrast to previous survey findings [16], a large proportion of par-
ticipants in the present study saw and acknowledged health risks from climate change,
in general. This difference may indicate the beginning of a shift in public perception re-
garding the association between climate change and human health. In recent years, media
coverage of climate change and its consequences has increased in Germany, partly driven
Int. J. Environ. Res. Public Health 2023, 20, 1464 9 of 11

by the German alliance for climate change and health (KLUG e.V.) [30], and internationally
through the reports of the Intergovernmental Panel on Climate Change (IPCC) [3]. The
health benefits connected to climate protection, especially regarding mobility and nutrition,
are topics of public interest. Thus, coverage of these benefits may contribute to increasing
the public’s awareness of the association between climate change and health. In line with
this, healthcare professionals are becoming increasingly visible and outspoken on this
association, and this might inspire the public to improve their contributions to climate
change mitigation [13,31–33]. Moreover, the idea that clinicians should play a more active
role in responding to the climate crisis is being increasingly disseminated [34,35]. To date,
it remains unclear whether—and if so how—clinicians in Germany are addressing climate
change and health issues, and if they may effectively compensate for patients’ and the
public’s lack of knowledge in this respect. Recent study results suggest that patients are not
frequently using physicians as a source of information on climate change and health, even
though they attest them high levels of trust [32]. More research is needed regarding this
significant opportunity for public education and sensitisation, specifically on how physi-
cians can be more actively involved in raising awareness and contributing to mitigation of
climate change and its health impacts.
The results of the present study should be interpreted with caution, as the sample was
not representative of the general population in Germany. Specifically, a large proportion
of the sample was comprised of women with more advanced educational qualifications,
reflecting a bias. Also, the fact that the survey was hosted by the BKK24 health insurance
fund may have influenced the sample by reaching proportionately more individuals who
were insured by that specific fund.

5. Conclusions
Concluding from the results, one solution for more action in climate protection could
be appropriate risk communication, including knowledge transfer highlighting existing
health risks as a result of climate change and examples of concrete options for action. This
approach could incorporate the role of healthcare professionals pointing to the health
benefits of sustainable behaviour, who enjoy a high level of public trust. The results also
suggest that cities and councils should contribute more actively to climate protection and
make their actions more visible to the population.

Author Contributions: Conceptualisation, P.S.; Data curation, K.v.B.; Formal analysis, K.v.B.; Method-
ology, K.v.B., S.S. and P.S.; Supervision, S.S. and P.S.; Writing—original draft, K.v.B.; Writing—
review & editing, K.v.B., S.S. and P.S. All authors have read and agreed to the published version of
the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted according to the guidelines of the
Declaration of Helsinki, and approved by the ethics committee of University of Applied Sciences
Weserbergland on 4 April 2022 (No. 04/2022-8).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The datasets generated and/or analysed during the current study are
available from the corresponding author upon reasonable request.
Acknowledgments: We thank BKK24 for hosting the survey and Larissa Langheim for contribut-
ing to the administration of the survey. We also thank Valerie Appleby for copy-editing the
present manuscript.
Conflicts of Interest: P.S. declares that the University of Applied Sciences Weserbergland receives
funding from the health insurance fund BKK24 to finance the ‘Länger besser leben. Institute’.
However, this funding did not influence the design of the study nor the collection, analysis or
interpretation of data. K.v.B. and S.S. declare that they have no competing interests.
Int. J. Environ. Res. Public Health 2023, 20, 1464 10 of 11

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