Open research questions in Climate Change and Health Impacts

What the literature leaves open

• The comparison that is most important in the study of short-term impacts of heat is over time as opposed to across space. Prioritize using data with a finer temporal resolution, even if it means a coarser spatial resolution. Most studies investigating the short-term effects of heat use a daily dataset (though hourly, or weekly are also common). Specific data: All the datasets in Table 1 are available at a daily or sub-daily resolution. Suggested reading: Bhaskaran et al. 2013 Studying the long-term effects of heat requires thoughtful and explicit statement of the hypothesis of interest, ideally using a causal counterfactual framing. Example questions include, what are the health effects of: (a) being exposed to more (vs. fewer) heat waves, (b) living in a city with a warmer (vs. cooler) typical summer climate, or (c) living inside (vs. outside) of an urban heat island. Note that each of these questions calls for a potentially distinct exposure contrast, optimal dataset, and study design. Merely asking “what is the effect of heat on x” is not specific enough for most studies. Suggested reading: Zanobetti and O’Neill 2018 If your study spans locations with very different warm-season temperatures, it is analytically advantageous to define “heat” based on location-specific percentiles of temperature rather than using absolute values. Percentile-based definitions help account for differences in local climate as well as acclimatization (e.g. an extreme heat day in Seattle, WA may be 88˚F while in Phoenix, AZ it may be 110˚F). Computing locally relevant relative percentiles allows you to compare “hot days” across locations with different typical temperatures. It is common to use a 10-year period prior to your study data for the calculation of percentiles in health research. If using data across dissimilar climate zones, it may also be a good idea to use a heat metric that includes humidity as this can greatly affect the human experience of heat. Suggested reading: Stafoggia et al. 2023; Gasparrini et al. 2015 If your study focuses on a single location, or spans multiple locations with similar climates, using absolute metrics of temperature rather than percentile-based measures will typically yield results that are easier to interpret and communicate to a lay audience. Suggested reading: Ballester et al. 1997 The available gridded meteorological datasets typically are not optimal for capturing within-city variation in temperature, even if the grid sizes are small. The approach we recommend is to use an air temperature product that can be used citywide to examine temporal trends, while combining or examining effect modification with environmental or social-economic variables to resolve heat risk at an intra-urban scale.

  Data Considerations for Estimating Ambient Heat Exposure for Environmental Epidemiological Studies · 2026 · DOI

• Conclusion: High temperature and high relative humidity are associated with increased risk of COPD admission, with limited evidence of an interaction.

  Joint effects of temperature and relative humidity on COPD hospital admissions in England, 2003-2021: A nationwide case crossover study · 2026 · DOI

• It is further important to acknowledge that Thom's DI, while computationally accessible and widely benchmarked, does not account for wind speed, solar radiation, or individual physiological parameters such as clothing insulation and metabolic rate.

  Temporal Variability and Trend Analysis of Thom's Discomfort Index in Jos Plateau, Nigeria: A Mann-Kendall and Sen's Slope Estimation Approach · 2026 · DOI

• This study has several important strengths. The use of nationally representative DHS data, combined with geospatially linked climate covariates, enables population-level inference across a large, climatically diverse country. The multilevel analytical framework appropriately accounts for the hierarchical clustering of individuals within communities. The study also examines a broader set of outcomes than most prior work in this area, spanning child nutrition, infectious disease, maternal mental health, anaemia, and healthcare access within a single analytical framework, enabling comparison of climate-health pathways across multiple domains simultaneously. Nevertheless, several limitations warrant careful consideration. First, the cross-sectional design of the DHS prevents causal inference; the observed associations between climate exposures and health outcomes could be confounded by unmeasured variables that are both spatially correlated with climate and independently associated with health. These unmeasured factors include local sanitation infrastructure, food system characteristics, historical patterns of healthcare investment, and crucial socio-cultural dynamics, such as social support, community resilience, and gender norms, which uniquely shape maternal outcomes. Second, the four-year temporal gap between the climate exposure measurements (2020) and the health outcome assessments (2024). We explicitly acknowledge that environmental conditions in 2020 may not perfectly reflect the exact exposures experienced from 2021 to 2024, particularly for younger children who lacked gestational exposure to that specific period. Furthermore, 2020 was a globally atypical year marked by socio-economic disruptions from the COVID-19 pandemic and unique meteorological anomalies across parts of sub-Saharan Africa, which may limit the representativeness of that baseline. Crucially, because our climate exposure variables are derived from annual averages within the geospatial dataset, our models are unable to account for critical developmental windows, such as trimester-specific exposure during gestation, or short-term extreme events like flash floods and acute heatwaves. Because more recent validated geospatial covariate files within the DHS framework were unavailable, a sensitivity analysis using temporally closer climate data could not be performed. This temporal gap and the reliance on annual aggregations introduce the potential for ecological exposure misclassification. However, because this measurement error is independent of individual-level health status, the misclassification is strictly non-differential. In multi-level mixed-effects regression models, non-differential misclassification typically biases effect estimates towards the null, indicating that our reported associations are likely conservative and may underestimate the true magnitude of the climate-health relationships. Third, the high rates of missing data for several outcomes (notably stunting, wasting, and the maternal health modules, with over 60% missing for some nutritional indicators) raise important concerns regarding a potential reduction in statistical power and the introduction of selection bias. This substantial level of missingness warrants careful consideration regarding the overall robustness of our reported findings. Nevertheless, the fact that our multi-level models retain strong statistical significance across multiple domains despite this reduced power demonstrates the fundamental robustness and stability of the underlying climate-health relationships identified within the population. Fourth, as noted, the postpartum distress measure has not been formally validated against clinical diagnoses of postpartum depression in the Nigerian context, and its use as a proxy for this outcome should be treated with appropriate caution. Fifth, a notable limitation involves our exposure metric for ambient heat, which relied on satellite-derived daytime LST. Although LST provides comprehensive, high-resolution spatial coverage across all clusters, it represents surface skin temperature rather than ambient air temperature, with discrepancies reaching up to 10 to 15 °C depending on local canopy cover and environmental characteristics. Crucially, LST correlates poorly with indoor temperatures, which constitute the primary exposure environment for neonates, young infants, and recently delivered mothers vulnerable to postpartum distress. This structural difference introduces a degree of exposure misclassification into our models.

  Ambient temperature, rainfall, and adverse maternal and child health outcomes in Nigeria: evidence from a national cross-sectional study · 2026 · DOI

• Scoping review NR • To develop a holistic approach • To improve integration with patient-centred allied health disciplines • To focus on faculty development • To build a committed network of motivated physician leaders • To involve students and trainees in implementing curricula • To develop a cultural approach, considering sociodemographic characteristics and local context • To create regional hubs for equitable educational access Author…

  Preparing healthcare students on sustainability and green practices: Insights for educators from an integrative review · 2026 · DOI

• Though it has been posited that people with cancer are par- ticularly sensitive to heat impacts due to the physical, psychological, and socioeconomic consequences of cancer diagnosis, treatment, and survivorship care (Kokolus et al 2010, Hassan et al 2023, Wee et al 2023), very little is known about the ways that heat hazards impact quality of life among this population and how people with cancer cope and adapt.

  ‘When it comes to heat, I retreat’: heat impacts and adaptation practices among people with cancer · 2026 · DOI

• The limitations of this study include the self-reporting of health status and heat impacts, because these data are subject to bias, a type of mismatch between participants’ reality and the reality that may be presented to researchers (Bergen and Labonté 2020). To account for participant bias, interviewers were provided with probes to clarify participant responses. Future research might seek to integrate electronic medical records to verify information on comorbidities, type and duration of cancer treatment(s), and clinical encounters. Second, our study sample is limited to one academic medical center. Due to the diverse nature of heat as a hazard and complexities of healthcare delivery in the US, future research should expand upon these findings among other demographic subpopulations, geographies, and health systems. Third, South Florida is a region that suffers chronically elevated heat and humidity (Clement et al 2023, Cruz et al 2025), making it challenging to inquire about heat as an acute hazard. Some of our interview questions asked about heat as a general phenomenon, while others inquired about heat extremes, but participants did not delineate between the two, instead referring to the heat as an inevitability in this region. Cruz et al (2025) recently proposed a framework for research that consid- ers heat as a chronic hazard and called for qualitative research that will deepen our understanding of who is most impacted by chronic heat and how. Thus, while our findings may have limited applicabil- ity in locations that experience heat as an acute hazard, including periodic heat waves, our findings are situated at the forefront a new body of scholarship. Future studies should incorporate phrasing that is indicative of chronic heat as a hazard of interest by shifting away from language that conceptualizes heat exposure as an acute threat from periodically, elevated temperatures. Finally, future studies would benefit from enhanced sociodemographic diversity. For example, due to our facility-based recruiting methods, each participant in our study population had health insurance coverage, which reduces financial burdens related to medical treatment that we sought to further understand. Our sample is also over represen- tative of Black and African American people, given the demographics of South Florida. However, our study participants represent the populations of color and low-income communities that suffer a dispro- portionate burden of both cancer mortality and exposure to extreme temperatures due to the legacies of discriminatory housing and environmental policies (Berberian et al 2022, Ashad-Bishop et al 2023, Nogueira and Yabroff 2024).

  ‘When it comes to heat, I retreat’: heat impacts and adaptation practices among people with cancer · 2026 · DOI

• The following recommendations are proposed. First, contributor States should move from one-off pledges to a regular replenishment model. A replenishment cycle would not settle all debates about responsibility, but it would give the Fund predictability and allow developing countries to plan. Contributions should be reported in grant-equivalent terms and should distinguish new finance from re-labelled aid. Secondly, the FRLD Board should adopt a grant-first policy. Loans should be exceptional and justified by debt sustainability, the type of activity and the affected country's fiscal situation. Direct budget support should remain available, but it should be tied to transparent national systems, public reporting and community participation. Thirdly, the Board should issue dedicated guidance on non-economic loss. That guidance should recognise cultural heritage, health, territory, biodiversity, social cohesion, indigenous knowledge and spiritual relationships with land and water. It should allow qualitative evidence and participatory assessment, not only monetary valuation. 66 World Bank press release (n 26). 67 FRLD Board, Decision B.7/D.4 (n 25) para 20(f)-(n). https://iaeme.com/Home/journal/IJEL 25 [email protected] From Solidarity to Remedy: Operationalising the Fund for Responding to Loss and Damage After the 2025 ICJ Climate Advisory Opinion Fourthly, developing countries should create or strengthen national loss and damage mechanisms. These mechanisms should identify national focal points, develop loss databases, establish consultation procedures, prepare pipelines of eligible activities, and connect loss and damage finance with disaster risk reduction, adaptation, social protection and human rights institutions. Fifthly, the FRLD should create a simple grievance and accountability mechanism. The mechanism should be accessible in affected countries, allow complaints from communities, protect complainants from retaliation, and provide remedies such as corrective action, disclosure, suspension of disbursement or redesign of activities. Sixthly, regional organisations should be used more deliberately. They can provide technical assistance, standard templates, shared climate information and peer review for funding requests. This would help smaller administrations participate without excessive transaction costs. Seventhly, the Fund should treat the ICJ advisory opinion as interpretative context. The opinion does not dictate the Fund's operations, but its confirmation of due diligence, human rights relevance and State responsibility supports a more serious approach to predictable finance, access and accountability.68 Finally, the COP and CMA should use annual guidance to the Fund to maintain pressure on resources, direct access, debt sustainability and non-economic loss.

  FROM SOLIDARITY TO REMEDY: OPERATIONALISING THE FUND FOR RESPONDING TO LOSS AND DAMAGE AFTER THE 2025 ICJ CLIMATE ADVISORY OPINION · 2026 · DOI

• BACKGROUND: Acute decompensated heart failure (ADHF) exhibits seasonal variations, yet the short-term effects of ambient temperature, independent of seasonality, remain poorly studied.

  Short-Term Effects of Ambient Temperature on Acute Heart Failure Decompensation: Phenotype-Specific Risk in a Time-Stratified Case-Crossover Study · 2026 · DOI

• this study comes with limitations: First, participant recruitment likely introduced selection bias. since the study was introduced as exploring ‘the role of nature, environment, and climate in GP consultations’, patients with negative attitudes towards environmental and climate protection may have been reluctant to participate, likely reducing representation of sceptical perspectives in our sample. consequently, our results cannot be generalised to all patients in GPs practices in Germany or anywhere. additionally, most participants were recruited from Northern Germany, limiting transferability to other regions. Mixed data collection methods (telephone vs. face-to-face interviews) represented another potential limitation, e.g. difference in depths, though interview quality appeared unaffected by method [35]. additionally, social desirability bias and the hypothetical nature of the presented scenarios during the interviews may limit the transferability of findings to actual clinical practice. One strength of this study lies in the diversity of interviewees; there was broad variability in terms of gender, age, place of residence, chronic conditions, and medications. the sociodemographic composition of our sample reflects typical GP utilisation patterns in Germany, where consultation rates are highest among older age groups and higher in women than men [36]. the high level of environmental aware- ness observed is consistent with general population trends, with 88% of German adults rating environ- mental protection as important or very important [37]. 10 D. NeUMaNN et al.

  Patients’ perspectives in German general practice on discussing the environmental impact of medications: A qualitative study · 2026 · DOI

• Discussion Five simplifying assumptions underlie these estimates. First, risk coefficients from ten urban centers are applied to all districts including rural ones, where more participation in outdoor labor, limited healthcare access, and poor housing conditions suggest higher vulnerability than the urban populations studied. Second, baseline mortality rates are drawn from 2020, when COVID-19 introduced two countervailing distortions: elevated all-cause mortality in severely affected states (which could inflate baseline rates and overstate heatwave-attributable excess deaths) and in others (which could suppressed registration completeness depress baseline rates and understate the burden). Banerjee et al. (15) document substantial state-level variation in pandemic-related excess mortality using the same CRS data, confirming that this than uniformly uncertainty is spatially heterogeneous rather The order of magnitude agreement between the sum total of our district-level results and broader low-resolution regional estimates from prior authors, supports the general validity of the extrapolation approach and highlights the added value of subnational resolution for heat preparedness and policy planning. This study provides the first-ever nationwide, district-level estimates of excess mortality associated with extreme heat events in India. By extending empirically estimated heatwave–mortality relationships from a multi-city study to all districts, we quantify the scale and spatial concentration of heatwave-related deaths under conservative assumptions. The findings indicate that even short-duration heatwaves can result in thousands of excess deaths nationally, while prolonged heat events pose risks comparable to large-scale public health emergencies. Importantly, the mortality burden is not evenly distributed.

  Estimating heatwave-induced excess mortality in India's districts · 2026 · DOI

• Major limitations include the absence of individual-level diag- nostic and demographic data, which precludes conclusions about differential vulnerability across specific psychiatric disorders or population subgroups (e.g., age or gender). As a result, stratified analyses could not be conducted to determine whether heat-related increases in psychiatric emergency utilization are evenly distributed across patient groups or more pronounced in specific subpopula- tions. This limitation reflects the study’s deliberate reliance on anonymized aggregate hospital data and the resulting lack of access to individual-level information. Heatwaves are also correlated with other meteorological phe- nomena—such as ozone, nitrogen oxides, and drought periods— that may themselves act as independent risk factors for psychiatric destabilization. Although daily maximum and minimum tempera- tures were available, the present analyses did not specifically examine intra-day temperature variability, which may represent an additional dimension of heat exposure. Furthermore, important confounders such as air pollution, holiday-related fluctuations in population density, and changes in service organization were not measured and may partially contribute to the observed patterns. A major methodological limitation is the inclusion of non- consecutive years, which may distort underlying temporal trends and reduce comparability across observation periods. In addition, the selection of these years was constrained by the availability of complete, manually retrievable datasets, and preliminary statisti- cal assessments showed substantial differences in ARIMA param- eters across years, suggesting potential non-stationarity that would have complicated the construction of a unified multi-year time series. Despite these constraints, the primary public health impli- cation remains: anticipating increased psychiatric service demand during heatwaves.

  Heatwave-related variations in psychiatric consultations and admissions: a time-series analysis · 2026 · DOI

• Future research should focus on how easy applicable and non-invasive measurements of functional ability can be utilised, in alignment with the WHO’s extensive work on the UN Decade of Healthy Ageing 2021–2030, to address heat-related challenges in clinical practice and public health [83].

  Community-dwelling older persons’ level of functional ability and heat-related vulnerability: results from the Heat-Health Action Plan study in Cologne, Germany · 2026 · DOI

• The strength of our study lies in the inclusion of a rela- tively large and unique sample of community-dwelling senior citizens. To keep participation barriers low and to enable older persons with health problems and those who require assistance to participate in such a study, a structured interview based on a written questionnaire was performed during a home visit by specially trained staff. To include persons with insufficient German lan- guage skills the questionnaire was also offered in Russian and Turkish [30]. Considering the LUCAS FAI, this study provides unique data on independence levels of the par- ticipants, including early signs of decline and disability within the geriatric functional continuum. This FAI has been validated with comprehensive geriatric assessments Dapp et al. BMC Geriatrics (2026) 26:670 Page 11 of 14 [75] and was predictive of adverse health outcomes in the long perspective [39, 76]. We also see challenges and limitations. We used self- reported data often considered less reliable [77], and particularly regarding mental problems. This may be a drawback, although an interview-based home visit was offered. On the other hand, self-reports provide valu- able insights into individuals’ perceptions of their own functioning within their living environment [78]. The response rate of 9.3% of a randomly selected sample met the expectations and is in line with comparable study designs [79, 80]. Some effect of both selection bias (through low and thus possibly selective response rate) and confounding factors (e.g., socioeconomic sta- tus, comorbidities) has to be assumed which could not be controlled for [81]. However, the carefully (affluent, deprived, highly and less heat-impacted) predefined study areas, in combination with the variety of social, functional and behavioural heat-related characteristics addressed in this survey, demonstrated similar socio- demographic characteristics and functional resources on the basis of the German population-representative sur- vey “Health 65 + ” [43]. Despite the relatively small study sample it can be assumed that our results are transfer- able to many other cities with similar climatic and socio- economic conditions. Finally, we did not collect medical data from the participants or their GPs. Due to German data protection laws, gathering such data was considered a sensitive issue that might have jeopardised the entire study. We compensated for this by integrating survey results from a nationwide physician survey [58]. In the future, the opportunity to collect medical information would be indicated to improve the picture of interac- tions between treatment, behaviour, perception and envi- ronment before and during episodes of heat. Moreover, only a longitudinal follow-up of this study would allow to examine causal relationships and identify protective fac- tors that can effectively address heat-related challenges in the heterogeneous older population. It is crucial to expand further research to evaluate the impact of climate change on the health status of older persons by combining health and environmental data. For this purpose, heterogeneous data sources, i.e. satellite data of heat and air pollution exposure, biomarkers and longitudinal aging cohort data could be harmonised to analyse the combined influence of heat-related stress and air pollution, on the ageing process, progression of frailty, hospitalisation and mortality [82].

  Community-dwelling older persons’ level of functional ability and heat-related vulnerability: results from the Heat-Health Action Plan study in Cologne, Germany · 2026 · DOI

• Targeted intervention strategies for temperature-aware substance use prevention have not been developed or piloted in schools, healthcare systems, or communities within the identified high-risk regions of North Carolina; implementation research is needed to translate spatial epidemiological evidence into place-based climate adaptation planning.

  Spatial clustering of adolescent substance use during heatwaves and coldwaves in North Carolina: a Bernoulli SaTScan analysis (2008–2022) · 2026 · DOI

• The mechanistic pathways linking temperature extremes to adolescent substance use have not been clarified; future research should investigate whether neurodevelopmental impulsivity, stress responses, or environmental access factors drive the observed geographic disparities in heatwave-related (eastern coastal plain) versus coldwave-related (western mountains) substance use clusters.

  Spatial clustering of adolescent substance use during heatwaves and coldwaves in North Carolina: a Bernoulli SaTScan analysis (2008–2022) · 2026 · DOI

• Individual-level factors influencing adolescent substance use—including socioeconomic status, family structure, and peer networks—were not incorporated into the models despite their documented importance; linking individual-level data to spatial clusters in eastern and western North Carolina would clarify vulnerability mechanisms.

  Spatial clustering of adolescent substance use during heatwaves and coldwaves in North Carolina: a Bernoulli SaTScan analysis (2008–2022) · 2026 · DOI

• The study does not examine lag effects between extreme temperature events and emergency department visits for adolescent substance use; while previous work on temperature and hospital visits showed consistent effects across shorter lags, the specific lag structure for heatwaves and coldwaves in North Carolina remains uncharacterized.

  Spatial clustering of adolescent substance use during heatwaves and coldwaves in North Carolina: a Bernoulli SaTScan analysis (2008–2022) · 2026 · DOI

• The spatial scan statistic's circular search windows may not fully capture community boundaries in areas with substantial within-county temperature variability, potentially missing or misdefining high-risk clusters for adolescent substance use during heatwaves and coldwaves. Alternative spatial clustering methods that accommodate irregular geographic units should be evaluated.

  Spatial clustering of adolescent substance use during heatwaves and coldwaves in North Carolina: a Bernoulli SaTScan analysis (2008–2022) · 2026 · DOI

• While carbon‐emissions favoured telemedicine interventions versus face‐to‐face care, these calculations often only considered patient‐travel saved and did not account for carbon emissions associated with other parts of the delivery of the service, such as digital technology used or energy use of building or clinic equipment for face‐to‐face appointments, or wider impact on the patient care pathway such as potential need to travel for additional primary care appointments.

  Effectiveness of Interventions to Reduce Carbon‐Emissions Within Secondary Healthcare: Systematic Review and Evidence and Gap Map · 2025 · DOI

• This study is subject to the uncertainties and limitations of the forecasting model it uses, first published by the GBD 2021 Forecasting Collaborators.1 First, our forecasts are limited by the quality of data and other limitations underlying the GBD estimates used as inputs to our forecasting model. These limitations vary across causes, age, and sex, as detailed in the original studies.2,5–7 Second, while we included more than 80 drivers of health in our model, we could not incorporate all potential drivers and health threats. Possible drivers not incorporated include a range of indirect pathways through which climate change is likely to impact health; future potential pandemics; potential health threats that are difficult to quantity due to insufficient evidence on the potential magnitude of their impacts on human health at this time (including bioterrorism, nuclear escalation, and malicious artificial intelligence [AI]); potential advances in disease and injury prevention, diagnosis, treatment, and management for which there is not yet sufficient evidence for the potential populationlevel impacts (including new medications and new technology, such as AI-related health innovations); and completely unknown-to-date future threats. Third, while we developed alternative models to forecast several causes of death that are stochastic in nature, including exposure to forces of nature, conflict and terrorism, and executions, these models could be improved. Future stochastic events might be better predicted using extreme value theory54 to estimate the cumulative probability of an event. Fourth, the GBD mediation matrix we used to incorporate risk factor mediation pathways—eg, how the effect of high BMI is mediated through systolic blood pressure and LDL cholesterol— only includes a subset of mediation pathways, largely due to insufficient data on the relationship between the distal and mediator risk factors. Fifth, this was the first time that non-fatal forecasts were produced within the GBD Future Health Scenarios modelling framework. For each cause, we evaluated model performance for our non-fatal forecasts and, in some instances, chose an alternative model that better fit the data than using mortality–incidence ratios or mortality–prevalence ratios to model non-fatal outcomes. In these cases, we used a modelled future incidence or prevalence directly. In future iterations, we intend to refine our non-fatal models and add additional cause-specific covariates and risk factors. Sixth, we used average disability weights from GBD to produce YLD forecasts, which assume a www.thelancet.com Vol 404 December 7, 2024 2365 Articles static association between prevalence and disability over time.

  Burden of disease scenarios by state in the USA, 2022–50: a forecasting analysis for the Global Burden of Disease Study 2021 · 2024 · DOI

• We maintain that current policies and programs are insufficient to mitigate climate-induced energy insecurity and conclude by offering several policy recommendations that state and federal policymakers should consider as the effects of climate change mount and adversely affect energy insecure communities.

  Climate Change and Energy Insecurity: A Growing Need for Policy Intervention · 2022 · DOI

• Based on our characterization of the current urban health adaptation landscape, we identify several gaps: limited evidence of reporting of institutional adaptation at the municipal level in urban areas in the Global South; lack of information-based adaptation initiatives; limited focus on initiatives addressing infectious disease risks; and absence of monitoring, reporting, and evaluation.

  Public Health Adaptation to Climate Change in Large Cities · 2015 · DOI

• BACKGROUND: The seasonal trend of out-of-hospital coronary death (OHCD) and sudden cardiac death has been observed, but whether extreme temperature serves as a risk factor is rarely investigated.

  Extreme temperatures and out-of-hospital coronary deaths in six large Chinese cities · 2014 · DOI

• Therefore, future studies should consider gender-stratified focus group discussions to ensure more balanced representation. This limitation also has implications for the transferability of the findings, as communities vary widely in terms of socio-cultural beliefs, climate, politics, housing, poverty, and access to services. Formative research similar to this study is warranted in other African settings to understand local perceptions, priorities, and potential barriers.

  “The heat really troubles us”: community perspectives on a cool roof intervention, Umlazi, KwaZulu-Natal, South Africa · 2026 · DOI

Most-cited papers in Climate Change and Health Impacts

• Hot weather and heat extremes: health risks · The Lancet · 2021 · 1,789 citations
• The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises · The Lancet · 2020 · 1,550 citations
• The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future · The Lancet · 2021 · 1,190 citations
• Extreme Weather and Climate Change: Population Health and Health System Implications · Annual Review of Public Health · 2021 · 1,027 citations
• The 2006 California Heat Wave: Impacts on Hospitalizations and Emergency Department Visits · Environmental Health Perspectives · 2008 · 650 citations
• Heat Wave and Mortality: A Multicountry, Multicommunity Study · Environmental Health Perspectives · 2017 · 507 citations
• Neighborhood Effects on Heat Deaths: Social and Environmental Predictors of Vulnerability in Maricopa County, Arizona · Environmental Health Perspectives · 2012 · 391 citations
• Heat-Related Mortality and Adaptation to Heat in the United States · Environmental Health Perspectives · 2014 · 321 citations
• The 2024 state of the climate report: Perilous times on planet Earth · BioScience · 2024 · 305 citations
• Short- and Long-term Outcomes of Heatstroke Following the 2003 Heat Wave in Lyon, France · Archives of Internal Medicine · 2007 · 266 citations

Most recent work

• Climate change: UK hospitals urgently need cooling systems as deaths and admissions are set to rise, government backed report warns · BMJ · 2026
• WHO should declare climate crisis a global public health emergency, experts say · BMJ · 2026
• A multidimensional assessment of systemic cooling poverty in the global south · Nature Sustainability · 2026
• Estimating heatwave-induced excess mortality in India's districts · Frontiers in Environmental Health · 2026
• Climate Vulnerability and Cardiometabolic Health Among Children · JAMA Network Open · 2026
• REPLY TO: “Daylight Saving Time and Mortality—Proceed with Caution “in response to “Daylight saving time affects European mortality patterns” by Levy et al · Nature Communications · 2026
• Winter Temperature and Long-Term Mortality After Coronary Artery Bypass Grafting: A Multicenter Cohort Study · Journal of Clinical Medicine · 2026
• Emergence of Uncompensable Heat Stress During Monsoon Season in India · AGU Advances · 2026
• Climate change and environmental pollutants - an international survey of naturopathic perceptions and clinical behaviour · medRxiv · 2026
• Improving cancer care while reducing its carbon footprint: GHG-mitigating strategies highlighted at ESMO 2025 · BJC Reports · 2026

Related topics in Environmental Science