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BACKGROUND: Increasingly, heat-health action plans are being developed and implemented across Europe, requiring collaboration across public agencies and sectors to effectively protect the population from heat-related health risks. District-level actors play a key role in implementing heat protection. OBJECTIVE: We aimed to examine how collaborative practices surrounding heat protection are facilitated in German districts with a particular focus on the perspective of the public health service. METHODS: Using thematic analysis, we deductively analyzed 21 semi-structured interviews with 23 actors from 15 districts, two federal states, and three national-level actors involved in heat protection in Germany using the Integrative Framework for Collaborative Governance. RESULTS: Collaboration practices in heat-health action planning were presented as heterogeneous in our interviews. Several districts have found ways to collaborate across public agencies and sectors. Actors galvanized for a political or legal mandate and clear guidelines amidst uncertainty regarding responsibilities among agencies tied to uncertainties of resources, leaving district-level actors unclear about mandates and often low capacity for action. In several districts, engagement was facilitated through the establishment of multi-agency and intersectoral steering committees and thematic working groups. CONCLUSIONS: Our analysis illustrates the characteristics of multi-agency and intersectoral collaboration in heat protection. Fostering collaborative structures is the key to facilitating heat-health action. Actors consider a legal or political mandate tied to resources, as well as clear guidance that accounts for structural differences between urban and rural districts, as essential. Impacts from new collaborative practices can extend beyond heat, strengthening health in all policies.
Lintener et al. (Wed,) studied this question.