Extreme heat kills more people than any other extreme weather event – American Public Health Association

Report on Extreme Heat and Public Health: A Sustainable Development Goals Perspective

A recent workshop at APHA 2025, “Extreme Heat & Health: Clinical and Public Health Strategies for Prevention and Action,” highlighted the critical intersection of climate change, public health, and sustainable development. The session underscored that extreme heat, a direct consequence of climate change, is a significant impediment to achieving several Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 11 (Sustainable Cities and Communities), and SDG 13 (Climate Action).

Health Impacts of Extreme Heat: A Challenge to SDG 3 (Good Health and Well-being)

Extreme heat poses a direct threat to human health, undermining the core objective of SDG 3 to ensure healthy lives and promote well-being for all at all ages. The increasing frequency and intensity of heat waves are creating a global public health crisis.

Mortality and Morbidity Statistics

• Extreme heat is the leading cause of weather-related deaths globally and in the United States, surpassing all other extreme weather events combined.
• A 2024 report in JAMA noted a substantial increase in heat-related deaths in the U.S. between 1999 and 2023, with a significant rise since 2016. These figures are likely underreported.

Physiological and Psychological Effects

• Direct Impacts: Dehydration, heat exhaustion, and life-threatening heat stroke.
• Aggravation of Pre-existing Conditions: Extreme heat exacerbates cardiovascular, respiratory, kidney, and diabetic conditions as the body works harder to maintain a normal temperature.
• Mental Health: The phenomenon is also linked to increased mental health distress.

Addressing Inequities in Climate Vulnerability: Aligning with SDG 10 and SDG 11

The burden of extreme heat is not distributed equally, directly challenging SDG 10 (Reduced Inequalities) and SDG 11 (Sustainable Cities and Communities). Systemic solutions are required to protect those most at risk and build resilient communities.

Disproportionately Affected Populations

• Older adults
• Children and pregnant people
• Individuals with chronic health and psychiatric conditions
• Outdoor workers
• Historically underserved populations, including those in urban heat islands

Contributing Risk Factors

• Certain medications, including diuretics, beta-blockers, antihistamines, and various mental health medications, can impair the body’s ability to regulate temperature, increasing vulnerability.

Strategies for Prevention and Climate Action (SDG 13)

The workshop emphasized that most heat-related illnesses and deaths are preventable through proactive measures, which constitutes a critical form of climate adaptation under SDG 13 (Climate Action).

Clinical Guidance on Heat Illnesses

1. Heat Exhaustion: Characterized by heavy sweating, cool/clammy skin, rapid pulse, dizziness, and nausea. It serves as a critical warning sign.
2. Heat Stroke: A medical emergency with a high mortality rate. Symptoms include a body temperature of 104°F or higher, central nervous system dysfunction (e.g., seizures, disorientation), and dry skin. It can cause multi-organ failure.

Frameworks for Systemic Resilience

The Building Resilience Against Climate Effects (BRACE) framework provides a structured approach for communities to develop extreme heat action plans, contributing to the resilience targets of SDG 11 and SDG 13.

1. Get ready, stay ready
2. Partner
3. Listen and assess
4. Investigate options
5. Prioritize and plan
6. Take action

Fostering Partnerships and Advocacy for the Goals (SDG 17)

Achieving climate and health goals requires collaborative efforts, as outlined in SDG 17 (Partnerships for the Goals). The workshop itself, a joint effort by Climate for Health and APHA’s Center for Climate Health and Equity, exemplifies this principle.

The Role of Climate Ambassadors

Public health professionals are encouraged to become “climate ambassadors” to advance climate action and health equity. Their responsibilities align with fostering a society-wide commitment to the SDGs.

• Foster impactful conversations about climate change and health.
• Inspire community involvement in climate action and advocacy.
• Advocate for systemic climate solutions and policies.
• Engage in civic actions to promote community health and safety.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on extreme heat and its health impacts connects to several Sustainable Development Goals (SDGs). The analysis identifies the following primary and related SDGs:

• SDG 3: Good Health and Well-being: This is the most central SDG addressed. The article extensively discusses the direct health consequences of extreme heat, including heat exhaustion, heat stroke, mental health distress, and the aggravation of cardiovascular and respiratory diseases. It explicitly states that “Extreme heat kills more people in the U.S. each year than all other extreme weather events combined.”
• SDG 13: Climate Action: The article frames extreme heat as a direct consequence of climate change, quoting a book that describes “how extreme heat due to climate change has killed thousands of people.” The call for developing action plans and building resilience is a core component of climate adaptation, which is central to SDG 13.
• SDG 10: Reduced Inequalities: The article highlights the social equity dimension of the issue, noting that extreme heat “disproportionately affects vulnerable communities.” It identifies specific groups at higher risk, including “older adults, children, pregnant people, those with chronic conditions… outdoor workers, and historically underserved populations, including those living in urban heat islands.”
• SDG 11: Sustainable Cities and Communities: The mention of “urban heat islands” directly links the problem to urban planning and infrastructure. Furthermore, the promotion of community-level strategies like the BRACE (Building Resilience Against Climate Effects) framework to develop “extreme heat action plans” aligns with the goal of making human settlements more resilient to climate-related disasters.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

1. Under SDG 3 (Good Health and Well-being):
   • Target 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment…” The article connects extreme heat to the aggravation of “cardiovascular and respiratory diseases and illnesses,” which are major non-communicable diseases. Preventing heat-related complications in patients with these conditions directly supports this target.
   • Target 3.9: “By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.” Extreme heat is an environmental health hazard, and the article’s focus on preventing “heat-related illnesses and deaths” aligns with the objective of this target.
   • Target 3.d: “Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.” The article’s emphasis on educating participants on “the warning signs of heat exhaustion and heat stroke” and developing “action plans” for individuals and communities is a direct example of strengthening capacity for early warning and risk reduction.
2. Under SDG 10 (Reduced Inequalities):
   • Target 10.2: “By 2030, empower and promote the social, economic and political inclusion of all…” The article’s call to protect “vulnerable communities” and “historically underserved populations” who are disproportionately affected implies a need to ensure their health and safety are included in public health and climate action planning.
3. Under SDG 11 (Sustainable Cities and Communities):
   • Target 11.5: “By 2030, significantly reduce the number of deaths and the number of people affected… caused by disasters… with a focus on protecting the poor and people in vulnerable situations.” The article identifies extreme heat as the “No. 1 killer of people globally when it comes to extreme weather events,” classifying it as a disaster. The focus on vulnerable populations aligns perfectly with this target.
   • Target 11.b: “…increase the number of cities and human settlements adopting and implementing integrated policies and plans towards… adaptation to climate change, resilience to disasters…” The promotion of the BRACE framework for communities to develop “extreme heat action plans” is a direct implementation of this target.
4. Under SDG 13 (Climate Action):
   • Target 13.1: “Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.” The entire article is focused on building resilience against extreme heat through individual planning, community action plans (BRACE), and systemic solutions.
   • Target 13.3: “Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning.” The workshop itself, the call for public health professionals to become “climate ambassadors,” and the creation of resources like the “Extreme Heat Resource Hub” are all activities that directly support this target by improving education and institutional capacity.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article mentions and implies several quantitative and qualitative indicators that can be used to measure progress:

• Mortality Rate from Extreme Heat: The article explicitly states that “Heat-related deaths in the U.S. increased between 1999 and 2023.” This serves as a direct indicator for targets 3.9 and 11.5. A key metric for progress would be a reduction in this number.
• Disaggregated Health Data: The article’s emphasis on how heat “disproportionately affects vulnerable communities” implies the need for an indicator that measures the number of heat-related illnesses and deaths disaggregated by demographic and socioeconomic factors (e.g., age, income, pre-existing conditions, location). This would be crucial for monitoring progress on Target 10.2.
• Number of Community Action Plans: The promotion of the BRACE framework suggests an indicator such as the “number of communities that have developed and implemented extreme heat action plans.” This would measure progress towards targets 11.b and 13.1.
• Number of Trained Professionals: The article encourages public health professionals to become “climate ambassadors” and mentions a “free self-paced continuing education training.” An implied indicator is the “number of health professionals and community leaders trained in climate and health,” which would measure progress on Target 13.3.
• Incidence of Heat-Related Illnesses: The detailed description of heat exhaustion and heat stroke, along with their high mortality rates, implies that tracking the “number of hospitalizations and emergency room visits for heat exhaustion and heat stroke” would be a key indicator for Target 3.9.

4. Summary Table of SDGs, Targets, and Indicators

Source: apha.org