Council on Energy, Environment and Water Integrated | International | Independent
Suggested citation: Global Heat Health Information Network South Asia Hub. 2026. Living with Heat in India: Heat-Health Risks, Vulnerability and Emerging Responses
This report examines India’s evolving heat risk and its implications for population health, with a focus on changing heat exposure, the populations and places most at risk, and the institutional and policy responses emerging across the country. It assesses India’s progress in responding to extreme heat, identifies gaps in implementation, coordination, data and financing, and consolidates priorities for strengthening long-term heat resilience. The report also highlights practical approaches being tested on the ground and considers how emerging evidence can inform scalable, context-specific responses to the health, livelihood and socioeconomic impacts of extreme heat.
The report draws on historical and projected temperature data, alongside evidence on heat-related health impacts, vulnerability and adaptation. It examines India’s heat governance landscape, including Heat Action Plans (HAPs), health-system preparedness, heat-health surveillance, early warning systems, and interventions led by non-governmental and community-based organisations. It then identifies priorities for institutionalising long-term heat resilience, including mainstreaming heat action across sectors and levels of governance, strengthening institutional and health-system capacities and coordination, unlocking finance for adaptation, and embedding health outcomes in the planning, implementation and evaluation of heat action.
Extreme heat is a public health threat multiplier.
Increased frequency, intensity, and duration of extreme heat events have emerged as a climate, health, and development challenge, affecting the overall well-being of communities. Rising global temperatures drive the hazard; rapid unplanned urbanisation and entrenched inequality determine who it harms. The warming record is unambiguous. Global mean temperature for January–August 2025 stood at 1.42 degrees Celsius (±0.12 degrees Celsius) above pre-industrial levels, and each of the 11 years from 2015–2025 is set to rank among the 11 warmest in the 176-year observational record (WMO 2025). The health cost is already measurable: heat-related deaths rose 63 per cent from the 1990s to 2012–2021, reaching an estimated 546,000 a year (Romanello et al. 2025). Heat also erodes economies. The International Labour Organization (ILO) projects that under a “Degrees” Celsius warming scenario, South Asia could lose 5.3 per cent of total working hours to heat stress by 2030 (ILO 2019). A World Bank report estimates that extreme heat results in productivity losses equivalent to nearly 31 million full-time jobs annually across the region, with economic output projected to decline by almost 7 per cent by 2050 (World Bank 2026).
As part of the Global Heat Health Information Network (GHHIN) South Asia Hub, this country synthesis focuses on India: the changing pattern of heat exposure, the populations and places most at risk, the institutions and policies now responding, and the practical approaches already being tested on the ground.
India’s historically stable relationship with its warm climate is shifting.
The rising temperature over India is turning a defining feature of the subcontinental civilisation into a complex developmental challenge. The average temperature over India rose by about 0.89 degrees Celsius during 2015–2024 compared with 1901–1930, with 2024 the warmest year on record since 1901 (Dhara et al. 2025; IMD 2025). This warming is uneven across seasons and geographies. While there is pronounced pre-monsoon warming over the north and summer warming across the Indo-Gangetic plains and central India, the north-western and central regions are experiencing frequent heatwaves. There has also been a significant rise in extremes, e.g., hottest days, warm days, summer nights, warm-spell duration, scorching days, and tropical nights (Bhattacharyya et al. 2025). As such, the population’s exposure to extreme heat has increased. The projected threefold increase in long-duration, large-area heatwave events at 1.5 degrees Celsius of global warming, the expansion of warming to the southern peninsula, and the rise in humid heat require concerted, systemic, and rapid institutionalisation of heat adaptation measures today.
Health impacts of extreme heat are increasingly experienced and documented.
India is experiencing growing public health impacts of extreme ambient heat, driven by increased exposure, demographic shifts, rapid urbanisation, epidemiological transitions, and existing socioeconomic inequalities. Almost 90 million Indians will be exposed to extreme heat at 1.5 degrees Celsius of global warming, the critical threshold recognized under the Paris Agreement as a key temperature limit for reducing climate risks (Lenton et al. 2023). India has recorded multiple heat-related mortalities since 1992, with most fatalities often linked to waning El Niño (NDMA 2019). Clinical evidence shows a greater representation of men and pre-existing conditions among heatstroke cases, with in-hospital mortality ranging from 11 per cent to 34 per cent (Ninan et al. 2020; J et al. 2020; Bhushan et al. 2026; Kalaiselvan, Renuka, and Arunkumar 2015). Among other heat-contributed health outcomes, evidence on cardiovascular and kidney diseases is increasing. Research has linked increases in ambient temperature with increased cardiovascular morbidity in adults—average 9 per cent excess risk with every degree temperature rise from 35 to 40 degrees Celsius (Fu et al. 2018). Known hotspots of chronic kidney disease are showing links to outdoor occupational heat exposure and high workloads with significant clustering among farmers, similar to other global clusters (Gifford et al. 2017; Venugopal et al. 2026). The synergistic impact of heat and air pollution exposure reportedly leads to higher PM2.5-related mortality (de Bont et al. 2025). Most consistent evidence now links antenatal heat exposure to adverse pregnancy outcomes, mainly preterm birth (3 per cent increase) and low birth weight (1 per cent increase), with generational consequences (4 per cent increase in low birth weight) in the high-emission scenario (Ai et al. 2025).
Occupational heat exposure and its impacts on life and livelihood are significant.
Occupational heat exposure and impacts are continuously being documented. Impacts of outdoor heat exposure and workload show a significant productivity loss (up to 5 per cent per 1 degree Celsius above Wet Bulb Globe Temperature of 26 degrees Celsius), and earning loss (up to 19 percentage points for each 1-degree Celsius Wet Bulb Temperature), highlighting the need for a calibrated work-rest schedule and basic water, shade, rest and cooling provisions (Sahu, Sett, and Kjellström 2013; Das and Somanathan 2024). The workers’ heat stress, in the northeast, could be minimised with a calibrated work-rest schedule of 50 and 20 minutes, and 35 and 22 minutes, for 29–30 degrees Celsius and 31–32 degrees Celsius, respectively (Pal and Patel 2026).
Local and individual vulnerabilities and adaptive capacities modulate health impacts.
Urban heat islands intensify heat exposure in Indian cities, with anthropogenic forcing and land-use changes amplifying temperatures beyond regional climate trends. In a study of 44 major Indian cities, the difference in land surface temperatures between urban and the surrounding rural areas was more than 2 degrees Celsius for most cities across all seasons (Raj et al. 2020). The built environment at the household level allowed for continued heat exposure by remaining 5–6 degrees Celsius higher in cities (Mukhopadhyay, Weitz, and Das 2021). Social inequalities directly and indirectly contribute to higher impacts. Lower-income wards, migrant workers, and rural women in different study settings have experienced higher heat burden, highlighting the role of basic provisions, environmental justice, and gender equality (Mitchell, Chakraborty, and Basu 2021). A recent nationwide assessment of heat-health risk found that 57 per cent of India’s 734 districts face high to very high heat risk (Prabhu et al. 2025). Multiple sub-national assessments are also carried out; however, evidence of their role in reducing health impacts is yet to emerge.
Core heat governance and policy responses are established and strengthening.
India’s national heat governance has undergone a profound evolution, moving from reactive, post-disaster response to proactive risk reduction. Guided by early state- and city-level innovations, the National Disaster Management Authority has successfully scaled this architecture across the country with Heat Action Plans (HAP) prepared by 23 states, 195 districts, and 64 cities based on its guidelines (NDMA 2026). Additionally, heatwaves were declared a nationally notified natural disaster in August 2026.
Under the Ministry of Health and Family Welfare’s National Programme on Climate Change and Human Health (NPCCHH), India’s public health system is institutionalising heat-health adaptation. Chief advancements are digitisation and expansion of the National Heat-Related Illness and Death Surveillance, and formalisation of health facility and ambulance preparedness with the operationalisation of heatstroke management units to manage severe heat-related illnesses in line with the “cool first, transport second” principle. It is sustained by massive, continuous capacity building efforts among health professionals, mobilisation of frontline health workers for awareness, and funding provisions.
On the meteorological front, the India Meteorological Department has refined early-warning precision through high-resolution Geographic Information System (GIS)-based forecasting, colour-coded messages, and experimental heat-index forecasting. These forecasts serve as triggers for HAPs and are bolstered by active collaboration among the government, civil society, and academic institutions.
India’s heat adaptation is expanding, but institutionalisation and impact assessments remain uneven.
Population, household, and individual-level heat adaptation measures are being tested and adopted across India. Model demonstrations of passive and active cooling solutions promise substantial temperature reduction, e.g., cool roofs (up to 5 degrees Celsius), cooling stations (up to 12 degrees Celsius), and green spaces (up to 6–8 degrees Celsius) (Garg et al. 2016; Jha et al. 2024; Shah, Garg, and Mishra 2021; Limaye, Kapoor, and Tiwari 2024). However, the current body of evidence on adaptation to extreme heat in India has largely focused on documenting, with occasional estimation of exposure reduction, and hardly any assessment of their effectiveness and impacts in terms of health outcomes (Takacs et al. 2024).
The parallel development of the collaborative ecosystem of research institutes, civil society and community-based organisations, development partners, philanthropic foundations, and private-sector actors has sought to fill technical, implementation, and field-level knowledge gaps through policy analysis, piloting of cooling solutions, social protection, training, tools, and knowledge products.
Scaling heat action through multi-sectoral integration and local governance
Heat action needs to be mainstreamed beyond its current concentration within disaster management and a single health programme. As the critical determinants of heat-health risk are influenced by upstream drivers—access to water, cooling, shade and rest—alignment with urban planning, labour, agriculture, water and power is essential to address the underlying vulnerabilities and reduce fragmented responses (Pillai and Dalal 2023; WHO Regional Office for Europe 2026). It will require adapting existing coordination mechanisms to include these sectors, supported by joint planning processes, interoperable data systems, and clearly defined roles and accountability across departments.
Unlocking finance for long-term heat adaptation
With dedicated finance provisions in disaster mitigation and relief funds, further opportunity lies in spearheading heat action. Moving from ad-hoc allocation towards convergent and blended financing, drawing on central funds, municipal budgets, and private and climate finance, will support investment at a greater scale and with greater continuity.
Strengthening institutional capacities and coordination mechanisms
The impacts of extreme heat, as well as scientific evidence of its effects, are emerging at an unprecedented speed. With a lack of prior tested knowledge and strategies to measure, design, implement and assess, building individual and institutional technical capacities requires a steep learning curve, dedicated financial resources, and strong leadership. Continuous translation of evidence into policy, and of field implementation into feedback to adopt effective measures and prevent maladaptation, is critical. It calls for strengthening of research, and data management and data sharing capacities. Expanding the scope of research to humid heat, chronic heat exposures, and personalised risk assessment will be relevant.
Health-centric heat action planning, implementation and evaluation
Health outcomes remain largely insufficiently integrated into the planning, implementation and evaluation of heat adaptation measures. It reflects persistent methodological, data, and financing shortfalls. Early warning systems, risk communication, health preparedness, built environment, and community measures fail to fully access, utilise, and generate health data, and often lack physiological and epidemiological grounding.
Compounding this, data related to health surveillance, civil registration, census, meteorological parameters, greenhouse gas (GHG) emissions, expenditure, and implementation remain fragmented, constrained by inadequate digital infrastructure and limited data interoperability across systems and capacities. Addressing this fragmentation requires integrating a monitoring and evaluation framework into HAPs and Heat-Health Action Plans (HHAPs) that clearly defines process, output, and health-outcome indicators, allowing programmes to assess not only whether actions were implemented, but whether they reached intended populations and reduced heat-related morbidity and mortality.
Strengthening the health system’s capacity across the full exposure-impact continuum.
It also requires strengthening the health system’s capacity to prevent, detect, manage, measure, and communicate heat-related morbidity and mortality. Implementation of case definitions, medical protocols, and diagnostic disease codes is critical. Effective utilisation of health sector-led multisectoral taskforces under the NPCCHH, sustained funding, and trained human resources remain the most consequential challenges (Chaudhry, Mukhopadhyay, and Guin 2025). State Action Plans on Climate Change and Human Health (SAPCCHHs) and, consequently, HHAPs, have remained severely underfunded and disconnected from major streams of disaster or climate-oriented financing. With India’s National Adaptation Plan under development and HHAPs approaching revision, there is an opportunity to reposition heat-health action as a core health-system and adaptation priority.
India’s heat response has made important gains, but the next frontier is to continuously translate and calibrate these advances into sustained, system-wide resilience. Over time, long-term resilience will depend not only on responding better to extreme heat but also on building systems that can anticipate, prevent, and reduce the health impacts of chronic and humid heat. As the world approaches a potential overshoot of 1.5 degrees Celsius of warming in the coming years, the effectiveness and limits of adaptation will come under strain. Adaptation, therefore, must also be complemented by deep, ongoing climate mitigation to achieve sustained reductions in heat-related risk (UNEP 2026).
The GHHIN South Asia Hub aspires to support these priorities by convening stakeholders, strengthening the regional evidence base, facilitating knowledge exchange, and building capacities for heat-health action. This can help India translate emerging evidence into practical, scalable and context-specific approaches to reducing the health, livelihood and socioeconomic impacts of extreme heat.
Emerging evidence links extreme heat to increased morbidity and mortality in India through direct and indirect impacts, in line with global evidence. Peer-reviewed research documents heat-related illnesses, increased cardiovascular and kidney disease risks, and adverse pregnancy outcomes, with higher risk among vulnerable populations. Urban heat islands, the built environment, physiological and medical vulnerabilities, and socioeconomic inequalities can further amplify health risks. A growing body of evidence also records occupational exposure and livelihood impacts, especially when heat exposure is associated with high workloads among outdoor and industrial workers. The resulting excess mortality, linked to rising temperatures, includes not only heatstroke deaths but also heat-contributed deaths. Evidence on the impact of extreme heat on other health domains is yet to emerge.
India is expanding Heat Action Plans across states, districts, and cities. The health sector is strengthening heat-health surveillance, enabling healthcare professionals and administrators, implementing heat-health action plans including initiatives like heatstroke management units and increasing community awareness and ambulance preparedness. Early warning and forecasting capabilities are enhanced for timely and wider dissemination. In 2026, heatwaves were declared a nationally notified natural disaster, which enables states to utilise national and state disaster mitigation funds for heat action. Responses from other government departments are nascent and sporadic. Apart from these, an extensive ecosystem of research, policy development and implementation support is simultaneously driven by non-governmental actors.
The report calls for institutionalising heat resilience across systems and sectors, moving beyond short-term response. This means mainstreaming heat action through joint planning, shared data and clear accountability, and strengthening institutional capacity, coordination and leadership. It also means making heat action health-centric, with health-based early warnings, stronger surveillance and clinical capacity, and access to water, shade, rest and cooling in workplaces and public spaces. Sustaining these efforts will require shifting from ad hoc funding to blended financing from public, private and climate sources.
India has made a promising start in strengthening heat action through the proliferation of heat action plans and expanded health surveillance; the next frontier is to institutionalise these plans and to assess whether the actions protect population health as intended. To achieve lasting change, we must place health outcomes at the centre of implementing and evaluating heat-health adaptation, while recognising that short-term responses need to be paired with systemic reforms and appropriate financing to build long-term resilience, alongside deep, continued climate mitigation in an increasingly warm world.
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