Keynote at the Marmara Urban Forum (MARUF), Istanbul, October 2025
Ageing Cities, Rising Temperatures
At the Marmara Urban Forum (MARUF 2025), themed “Welcome to the Age of Ageing Cities” Prof. Shereen Hussein addressed one of the defining challenges of our century: how to make ageing and care systems resilient to climate change.
Her presentation, “Ageing, Climate, and Care: Building Resilient Futures,” revealed how two global megatrends, population ageing and accelerating climate hazards, are converging to reshape health, care, and urban policy.
“Ageing is a steady, predictable rise,” she explained. “Climate hazards are accelerating faster, creating a widening gap between needs and risks.”
By 2050, one in six people worldwide will be over 65, yet climate-related mortality among older adults is already soaring. Since 2000, heat-related deaths among people aged 65+ have increased by more than 80%, with extreme heat, floods, and pollution now recognised as major threats to healthy ageing.
Hussein-UrbanForum-2Oct25Older People on the Frontline of Climate Hazards
Prof. Hussein drew on findings from the NIHR-funded CARE-CLIMATE study, which integrates global evidence on how climate events affect long-term care (LTC) users and systems.
Older people, particularly those with mobility limitations, dementia, or chronic illness, face compounded vulnerabilities during disasters. Heatwaves, floods, and air pollution increase hospital admissions, disrupt home care, and threaten the safety of care facilities themselves.
For example:
- During Europe’s 2023 heatwave, over 47,000 excess deaths occurred, mostly among older adults.
- Floods and wildfires have repeatedly cut off care homes, electricity, and medication supply chains.
- Air pollution and heat combined can increase older adults’ mortality by up to 16% on high-risk days.
These are not isolated incidents but symptoms of a systemic failure: long-term care remains “invisible” in climate adaptation planning.
Why Long-Term Care Must Be Central to Climate Policy
In her research, Prof. Hussein proposes a Climate-Tailored Integrated Long-Term Care Framework, adapting the WHO Integrated LTC model to include climate resilience across four pillars:
- Needs: Recognising the diverse vulnerabilities of older adults in heat, floods, and pollution.
- Governance: Embedding LTC in national climate adaptation and disaster preparedness plans.
- Service Delivery: Designing climate-resilient care homes and ensuring community care continuity during crises.
- System Enablers: Building capacity through training, financing, and digital tools that support emergency response.
At the centre of this framework are equity and empowerment, ensuring that both older people and care workers have the capacity, voice, and resources to adapt.
“We cannot build climate resilience without social resilience”
“Social resilience depends on how we care for our most vulnerable, and those who care for them.”
Learning from Workforce Policy: Insights from ASSERT Project
The second NIHR-funded project, ASSERT, examines social care workforce reforms in England, offering lessons for building climate resilience through care workforce empowerment.
Findings from the study show that:
- Training improves recruitment, retention, and care quality.
- But systemic barriers persist, including low pay, precarious contracts, and inequitable access to learning opportunities.
- Many migrant and part-time workers are excluded from upskilling, weakening the overall care system’s capacity.
The lesson for climate adaptation is clear: a resilient care workforce is the backbone of a resilient city.
Policies must integrate care workers into climate and emergency planning, from training in disaster response to using digital tools for care continuity during crises.
From Research to Urban Policy: The Call for Integration
At MARUF, a global platform for cities and regions hosted by Marmara Municipalities Union , Prof. Hussein’s message resonated deeply with urban leaders, planners, and researchers.
She called for urban policies that bridge climate, care, and ageing, urging city planners to:
- Integrate care infrastructure into resilience planning.
- Invest in decarbonising care facilities and improving air quality.
- Empower communities and informal caregivers as part of adaptation strategies.
- Include older people in climate decision-making to ensure inclusive design and preparedness.
“Resilient ageing cities are not just those with green infrastructure,” she said.
“They are those where older people, carers, and communities are visible, valued, and supported.”
Towards a Theory of Change for Resilient Ageing Cities
Drawing on her cross-disciplinary work, Prof. Hussein proposed a theory of change linking climate adaptation and care resilience. This model aligns health, care, housing, and climate systems, turning ageing from a perceived burden into a driver of innovation and solidarity.
Lessons for the MENA Region: Building Climate-Ready Care Systems
The insights from the CARE-CLIMATE and ASSERT studies carry urgent relevance for the Middle East and North Africa (MENA) region, where rapid demographic ageing is unfolding alongside intensifying climate stress.
Countries such as Egypt, Jordan, Tunisia, and Morocco are already witnessing the dual pressures of rising temperatures, water scarcity, and air pollution, all of which have direct consequences for older adults’ health and wellbeing. Yet, long-term care (LTC) systems in most MENA countries remain underdeveloped and heavily reliant on families and informal networks, structures that are themselves increasingly strained by migration, urbanisation, and economic precarity.
Prof. Hussein emphasised that the next decade is critical for building a trained, recognised, and supported LTC workforce across the region, one that can serve as a front line of resilience during climate emergencies.
Key priorities include:
- Developing national LTC frameworks that integrate climate adaptation into health and social care planning.
- Investing in capacity-building programmes for professional and community-based care workers, including training in heat response, disaster preparedness, and home safety during floods or sandstorms.
- Establishing regional standards and career pathways for LTC workers to strengthen retention and recognition.
- Harnessing technology to monitor vulnerable older adults remotely during heatwaves and environmental hazards.
“MENA countries can leapfrog by building climate-smart care systems, combining the region’s strong intergenerational culture with modern, resilient care models.”
This means positioning the LTC workforce not only as a provider of care, but as a pillar of climate resilience, bridging health, social protection, and community preparedness.
About MARUF (Marmara Urban Forum)
MARUF is a biennial international forum organised by the Marmara Municipalities Union, bringing together city leaders, academics, and civil society to share innovative urban solutions for sustainable futures. Learn more at marmaraurbanforum.org.
About the Studies
The Care Climate study is funded by the NIHR Policy Research Programme (PIRU), NIHR206128.
The ASSERT study is funded by the NIHR Policy Research Programme Developmental Phase for A Mixed-Methods Evaluation of Adult Social Care Workforce Reforms, NIHR206541.
The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
For further information about the research, please visit the LSHTM Centre for Care Research and Policy (C-Care).
Founder and Director
Shereen Husseinis a Health and Social Care Policy professor at the London School of Hygiene and Tropical Medicine (LSHTM), United Kingdom.
Shereen Founded the MENARAH Network in 2019, through an initial grant from the Global Challenge Research Fund, UKRI. She is a medical demographer with expertise in ageing, family dynamics, migration and long-term care systems. Shereen regularly collaborates with the United Nations, the World Health Organisation and the World Bank in policy and research focused on ageing in the Middle East and North Africa Region.
Shereen received her undergraduate degree in statistics and a postgraduate degree in computer science at Cairo University. She completed an MSc in medical demography at the London School of Hygiene and a PhD in quantitative demography and population studies at the London School of Economics and Political Science, United Kingdom.
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