How are local authorities responding to climate change and health impacts? A policy document analysis of four England regions

Background Climate change poses growing risks to population health. In England, local authorities can influence key determinants of climate-related health outcomes through responsibilities for housing, transport, environmental protection and public health. However, climate mitigation and adaptation are not statutory duties, and there is limited evidence on how climate and public health objectives are integrated across local policy frameworks. Aim This study reviews local climate strategies across English local governments, examining how they incorporate public health, align cross-sector objectives and prioritise interventions to protect population health. Methods We conducted a qualitative content analysis of 129 publicly available strategies from 12 local authorities across four regions of England. Documents were identified through structured web searches and analysed using an a priori framework covering climate hazards, policy domains, vulnerability and inequality, and policy responses. Results Strategies included a wide range of interventions, particularly in transport, housing energy efficiency and urban greenspace. Public health was rarely a primary objective and was more often framed as a co-benefit. Strongest cross-sector alignment was seen in active travel, housing retrofit, greenspace expansion and flood resilience. Air quality and transport strategies most clearly linked climate and health, while food, greenspace and health strategies often did so implicitly. No authority had a standalone heat strategy, though heat actions appeared across multiple plans. Conclusion Local authorities are implementing many interventions with health benefits, but public health remains weakly integrated into climate governance. Stronger coordination, clearer public health focus and improved monitoring are needed to maximise health gains.