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In 2004, the High Temperature Action Plan was activated in Spain. According to the Carlos III Health Institute, this Plan works adequately from the point of view of Public Health. Thus, due to its implementation, plus other heat adaptation factors, the impact of high temperatures on mortality is decreasing.

On the other hand, the increase in temperatures due to climate change indicates a drastic increase in heat mortality in our country. Not considering the heat adaptation process means that the current threshold temperature for defining a heat wave does not vary over time.

In this way, according to the entity, a complete adaptation will be achieved when the rate of increase in temperature coincides with the rate of increase in the definition of a heat wave, guaranteeing that there will be no increases in mortality attributable to heat.

The general objective of the project has been to determine what has been the rate of increase in the threshold temperature of heat mortality at the provincial level and compare it with the temperature increase predicted by the Representative Concentration Routes (RCP) scenarios.

The specific objectives were as follows:

• To determine the threshold temperature for the definition of a heat wave at the provincial level in retrospective five-year periods (1983-2013).
• Calculate the variation in the threshold temperature obtained (ºC/year).
• Calculate the increase in the maximum daily temperature in the different RCP 4.5 and 8.5 scenarios and in the 2021-2050 and 2051-2100 horizons at the provincial level.
• To analyse and compare the rates of change in the threshold temperatures of each province corresponding to the retrospective analysis with the calculated future forecasts.
• Evaluate and articulate preventive measures in public health based on the results.
• To disseminate the results of the research obtained.

• Calculation of the threshold temperature for triggering daily mortality in each province (determination of heat wave) during the period 1983-2018, based on the methodology previously developed by the same research team.
• Calculation of the annual rhythm in degrees/year of the evolution of threshold temperatures due to heat in the period 1983-2018 at the provincial level.
• Calculation of the projected increase for the value of the maximum daily temperature in each provincial capital based on the data provided by AEMET in the RCP 4.5 and 8.5 climate scenarios and the 2021-2050 and 2051-2100 time horizons.
• Comparison of the annual rhythm in degrees/year of the evolution of threshold temperatures due to heat in the period 1983-2013 at the provincial level and compare it with the calculation obtained from the projected increase for the value of the maximum daily temperature in each provincial capital.
• Evaluation of the efficiency of the heat adaptation process, in order to ensure that the increase in the number of heat waves would not imply an increase in the impact of heat on mortality in future horizons. If, on the other hand, the process of adaptation to the heat has not been achieved, preventive measures should be implemented, according to the entity.
• Dissemination and knowledge transfer actions: publication of 4 scientific articles in international journals, participation in 3 scientific congresses and 8 talks, preparation of a didactic guide for acclimatization and adaptation to heat aimed at Primary, Secondary and Baccalaureate teachers, edition of an infographic consisting of a decalogue to prevent heat waves, production of 500 pins and sending the results of the project to the Spanish Office for Climate Change (OECC), the Biodiversity Foundation and the Ministry of Health, Consumer Affairs and Social Welfare (MSCBS).

The development of this project has made it possible to validate an indicator that allows us to know the level of adaptation of the different Spanish capitals to heat waves and detect needs in a future scenario of extreme temperature increase. Thus, the results obtained in this research indicate which Spanish provinces have adapted best to heat in the 1983-2018 time period and offers information on which ones will adapt best in a future 2051-2100 horizon of maximum daily temperatures predicted in the RP8.5 emissions scenario.

First, it was determined that the maximum daily temperature in Spain in the period 1983-2018 increased at a rate of 0.41 ºC per decade, while the Minimum Mortality Temperature (MMT) did so at a higher rate, 0.64 ºC per decade. With these data, it has been concluded that the Spanish population, in general, is adapted to heat.

However, significant geographical heterogeneity has been observed at the provincial level. Thus, in some territories MMR has maintained a rate of increase much higher than the global average, while in others some decrease has been detected over time. In this sense, among the provinces best adapted to the heat would be Córdoba, Badajoz, Valencia or the Balearic Islands; others such as Cáceres, Granada, Ciudad Real or Valladolid would have more difficulty adapting in the future.

On the other hand, for the purposes of dissemination and communication of the results of the project, the publication of 4 scientific articles, the participation in 3 national and international congresses , including the 14th European Public Health Conference 2021, and the edition of a Didactic guide on acclimatization and adaptation to heat. Likewise, in this initiative, preventive measures in Public Health have been evaluated and articulated, including the creation of a decalogue to prevent the effects of high temperatures on health.