HMN 2025: How heat adaptation in low-income countries overlooks women’s health needs

Researchers from The George Institute for Global Health and Imperial College London have reviewed published evidence on how community-level heat adaptation interventions in low- and middle-income countries (LMICs) impact health. The study also identifies major gender gaps in existing research, providing insights to help guide more inclusive and comprehensive policy planning for populations most vulnerable to extreme heat.

Extreme heat events, commonly known as heat waves, have become more frequent and intense in recent years due to climate change. Between 2007 and 2023, the average number of heat wave days worldwide increased to 19.3 from 12 in the preceding decade. While heat waves are indeed a global phenomenon, LMICs are more seriously affected due to subpar infrastructure and limited access to health care and technology.

Such events lead to severe health conditions, both short-term and long-term. Women, particularly pregnant women, face greater risks, such as heat-induced pregnancy complications, and social risks such as informal/undocumented work without adequate protection against the elements.

The scientists from The George Institute and Imperial College London reviewed existing research in this area to assess the current state of affairs and the direction to take to develop inclusive and effective coping mechanisms and policies.

The study analyzed studies on community-level heat adaptation interventions in LMICs, published between 2013 and 2024. Only five studies met the review criteria. These included papers from India, Pakistan, Nicaragua, Burkina Faso, and El Salvador. The heat adaptation interventions included such methods as cool roofing, workplace policies like water-rest-shade breaks, and community education programs to disseminate risk information. The health outcomes sought included physiological indicators such as heart rate, sleep quality, and changes in behavior/attitude in response to heat exposure.

The scientists also examined gender integration in these studies, using the WHO-recommended scale that rates interventions from “gender-blind” to “gender-transformative.” This was used to identify the gaps in understanding and develop gender-aware strategies for heat management.

Two observations from this study stand out as a stark reminder of how much needs to be done.

One is that policymakers currently lack strong evidence on which heat-health interventions should be prioritized or scaled. Heat adaptation continues to be treated mainly as an infrastructure or climate issue, rather than a public health concern. The second observation by the scientists is that there are serious gender disparities, with most of the studies being gender-blind.

“Our review shows that evidence on heat-health interventions in LMICs remains extremely limited, and gender is almost entirely absent in existing evaluations. As heat extremes intensify, we need adaptation strategies that reflect women’s lived realities and measure real health outcomes. Strengthening this evidence base is essential to protect populathions most affected,” says Karthika Kumar, Research Fellow at George Institute Services.

Women’s participation in these interventions is important because women are key enablers of community-based interventions, and empowering women would naturally enable communities.

“This study highlights the urgent need to design climate adaptation interventions that consider the specific needs of everyone, especially women and girls,” says Dr. Jane Hirst, Program Director, Women’s Health, The George Institute for Global Health.

Practices that can help protect the LMIC population, especially women, against heat waves include developing structural solutions, both individual-based and community-based (e.g., cool roofing, shaded public areas). Heat-related health must be included in health care measures, especially in maternal and primary health centers. High-risk populations must be identified to provide equitable access to heat-relief strategies.

Extreme weather conditions are expected to worsen over the next decade, necessitating more extensive research in this area. Future interventions and research must perform rigorous gender analysis with sex-segregated data to enable equitable policies that protect the vulnerable populations of these countries.

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