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Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease logoLink to Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
. 2025 Dec 24;15(1):e044079. doi: 10.1161/JAHA.125.044079

JAHA at Scientific Sessions 2024: Climate Change–Related Cardiovascular Health Effects in the Global South

Ana Navas‐Acien 1, Joel D Kaufman 2, Sameed A M Khatana 3, Robbie M Parks 1, Sanjay Rajagopalan 4, Cara M Smith 5, Randi Foraker 6,✉
PMCID: PMC12909031  PMID: 41439354

Abstract

Climate change poses an escalating threat to cardiovascular and cerebrovascular health in the Global South, where vulnerability is amplified by rapid urbanization, poverty, and weak infrastructure. Air pollution (driven by fossil fuel use, industrial growth, and poor regulation) remains a major contributor to cardiovascular disease and respiratory illness, with regions such as South Asia and Sub‐Saharan Africa experiencing the highest burdens. Extreme heat, floods, and natural disasters further compound cardiovascular risks through direct physiological stress and disruption of health care systems. Urban heat islands intensify the impact of rising temperatures, especially in low‐income and historically marginalized communities with limited access to cooling. Meanwhile, increasingly severe floods, particularly in South and East Asia, demand improved disaster preparedness and urban planning to reduce exposure and health impacts. Many cities in rapidly urbanizing cities in Africa lack basic sanitation and access to clean water, air, and soil. These could have magnified impacts on populations during climate emergencies. To address these interconnected challenges, a global, equity‐centered approach is needed, one that strengthens regulatory frameworks, expands access to clean energy and cooling technologies, and promotes urban resilience. Collaborative efforts in air quality monitoring, disaster risk reduction, and adaptation financing must prioritize the unique needs of the Global South, guided by context‐specific, scalable solutions that also incorporate intergenerational and environmental justice considerations.

Keywords: extreme heat, floods, hot temperature, sanitation, soil, temperature, urbanization

Subject Categories: Epidemiology

Nonstandard Abbreviations and Acronyms

PM2.5

fine particulate matter

SO2

sulfur dioxide

Climate change poses a growing threat to public health worldwide, with its effects disproportionately impacting vulnerable populations in the Global South. The term “Global South” generally refers to developing and underdeveloped regions across Latin America, Eastern Europe, Asia, Africa, and Oceania that are particularly susceptible to the adverse health consequences of climate change. “Global South” lumps together incredibly diverse developed, developing, and underdeveloped countries across Latin America, Eastern Europe, Asia, Africa, and Oceania under a single umbrella. For the purposes of this statement, the term is meant to highlight regions that are particularly vulnerable to climate effects and do not have the resources and/or mechanisms to effectively combat the effects of climate change on health. This American Heart Association symposium at Scientific Sessions 2024 focused on the cardiovascular and cerebrovascular health risks linked to climate change, exploring the current evidence surrounding the impacts of heat waves, extreme cold, hurricanes, flooding, and wildfires.

Over 1.5 billion people in the Global South already live in regions where warming exceeds +1.5 °C. Countries in sub‐Saharan Africa, the Middle East, and South Asia already face an 8‐ to 10‐times increase in extreme heatwaves compared with the pre‐industrial era. 1 Small island states such as Maldives and Pacific Islands, and low‐lying delta countries such as Bangladesh face 1 meter or more of sea‐level rise. 2 Over 30 million climate‐related displacements occurred in 2022 alone: 90% in the Global South. 3 Furthermore, countries of the Global South are most likely to be affected by reductions in crop yields attributed to climate change due to profound shifts in rain patterns, reduced soil fertility, and environmental impacts on agriculture. 4 , 5

According to the World Health Organization, ≈3.6 billion people live in climate‐vulnerable areas. 6 Individuals in climate‐vulnerable areas may be exposed to a multitude of climate risks, including rises in diarrheal diseases, malaria, dengue, coastal flooding, and childhood stunting besides exposure to factors such as air pollution, which is a significant environmental risk factor for cardiovascular health in the Global South, where rapid urbanization, industrial growth, and limited regulatory enforcement have led to dangerously high levels of air pollutants. 7 Fine particulate matter (PM2.5), nitrogen dioxide, and SO2 are prevalent in many of these regions, exacerbating the incidence of heart disease, stroke, and other cardiovascular conditions. 8 , 9 Additionally, the effects of air pollution in the Global South are compounded by factors such as poverty, inadequate health care infrastructure, and limited access to preventive measures, leaving vulnerable populations at greater risk. These effects are amplified in susceptible populations including the elderly, malnourished children, women exposed to household air pollution, pregnant individuals, and those with pre‐existing cardiometabolic conditions. The interaction between climate change and air pollution is projected to impose a “climate penalty,” defined as the amplification effect on air pollutants by climate change and the associated health risks. 10 Despite growing awareness, the full extent of air pollution’s impact on cardiovascular health in these regions remains under‐researched and under‐addressed, necessitating urgent action and targeted interventions.

Flooding and other natural disasters, such as hurricanes and wildfires, which are common in many countries of the Global South, have profound impacts on cardiovascular health, particularly in vulnerable populations. 11 , 12 These events often lead to increased physical and psychological stress, which can exacerbate pre‐existing heart conditions, trigger acute cardiovascular events such as heart attacks and strokes, and lead to long‐term health complications. The direct physical stress of evacuations, injuries, and loss of shelter, coupled with environmental hazards such as contaminated water and air, further strain the cardiovascular system. 13

Climate change is projected to intensify the frequency and severity of power outages due to extreme weather events, with potentially serious implications for health care delivery. Interruptions in electricity supply can increase morbidity and mortality, particularly in settings that depend on electrically powered medical equipment (such as left ventricular assist devices, pacemakers, and refrigeration for temperature‐sensitive medications) both in health care facilities and home environments. Additionally, the psychological toll of disaster‐related trauma, displacement, and uncertainty has been linked to an increased risk of mental health issues, such as anxiety and depression, which in turn contribute to cardiovascular disease (CVD). In the aftermath of natural disasters, limited access to health care, disruptions in routine medical care, and the exacerbation of socio‐economic inequalities make it even more difficult for affected populations to seek health care and manage cardiovascular conditions, amplifying the overall impact on prevalence and incidence of disease. 12

Urban heat islands are localized areas within cities that experience significantly higher temperatures than surrounding rural areas, primarily due to human activities, dense infrastructure, and limited green spaces. 14 , 15 , 16 The increased heat in these urban hotspots has been shown to have a detrimental effect on cardiovascular health. 17 Prolonged exposure to elevated temperatures, especially during heatwaves, can lead to dehydration, heat exhaustion, and heatstroke, all of which place immense strain on the heart and circulatory system. 18 , 19 Chronic heat exposure can also exacerbate pre‐existing cardiovascular conditions, such as hypertension and atherosclerosis, by increasing the risk of blood clot formation and promoting inflammation, including the development of atherosclerosis and its attendant complications. 17 Urban heat islands can exacerbate the urban pollution problem, compounding the negative effects of heat with air pollution, which further elevates CVD risk. As urbanization continues, addressing its effects and incorporating climate‐resilient infrastructure is critical for protecting cardiovascular health in cities, particularly in the Global South. 15

The Global South, which is historically marginalized in global governance and climate negotiations, has contributed the least to climate change but faces the greatest health risks. 20 This structural imbalance (compounded by debt burdens, food insecurity, and political instability) creates a climate vulnerability trap that deepens over time. A final component integral to investments in climate adaptation and resilience for many countries of the Global South relates to global governance and power asymmetry. Countries of the Global South have little decision‐making authority, even when collectively bargaining in international climate institutions, despite carrying the heaviest burdens. Here, we summarize the existing scientific research, examining both the direct and indirect effects of climate change on heart and brain health in these regions. Highlighted are potential solutions, including innovative scientific approaches and policy interventions, aimed at mitigating these risks and improving resilience in the Global South.

AIR POLLUTION AND ITS EFFECTS ON CARDIOVASCULAR HEALTH IN THE GLOBAL SOUTH

Air pollution is a leading risk factor for CVD and chronic respiratory disease, and is a leading contributor to the global burden of disease. 21 , 22 Air pollution is the second leading risk factor for both death and disability‐adjusted life years among both sexes and all ages. 21 As a well‐established CVD risk factor, air pollution affects cardiovascular health via a few biological pathways. 22 For example, inhalation of PM2.5, a widely studied pollutant, can cause the following (1) lead to pulmonary inflammation and elaboration of systemic inflammatory mediators; (2) activate the autonomic nervous system; and (3) enter the bloodstream to exert direct toxic effects on the cardiovascular system. 23 All 3 pathways can result in oxidative stress and inflammation. 23 PM2.5 exposure leads to vasoconstriction, increased blood pressure, and accelerated atherosclerosis, as well as other cardiovascular outcomes. 23

Exposure to air pollution varies throughout the world as policies and regulations, economic standing, and geography play an important role in exposure levels. Acute air pollution events, such as the Great London Smog of 1952 and the Donora Fog of 1948, sparked air pollution regulations in the United States and Europe. 24 Countries with strong regulations have seen dramatic decreases in air pollution concentrations over the past 50 years. 24 Meanwhile, countries in the Global South without strong regulations or enforcement systems continue to have high levels of air pollution. 24 Residents of the Global South experience high levels of both ambient and household air pollution, posing a large risk for CVD. There is particular concern for Africa, South Asia, and the Middle East, because they experience the highest rates of air pollution exposure and highest rates of deaths attributable to air pollution. 21 , 25

Air pollution exposure is highest in the Global South for a few reasons, in addition to the lack of an effectively enforced regulatory framework for controlling pollutants. Natural sources such as sand and desert dust contribute to high concentrations in the Middle East, Northern Africa, and Sub‐Saharan Africa. 24 Other reasons are more structural and driven by economics. Even while wealthy nations have reduced reliance on the dirtiest fuels and developed regulations to reduce pollution, developing countries continue to rely on burning fossil fuels to accommodate their growing populations and spur infrastructure and economic development. 25 Because much manufacturing of products for the wealthy countries has been “off‐shored” to lower‐income countries with less stringent pollution regulations, this has been accompanied by the export of polluting industries and the need for more fossil fuel combustion in the South. 26 , 27 Other factors that contribute to high levels of exposure include slash‐and‐burn agricultural practices, older and more polluting vehicles and machinery, and congested transportation systems. 25 Residents of developing countries are also exposed to high levels of household air pollution because biomass fuels are commonly used for cooking and heating homes. 28 Replacing with cleaner fuel sources is challenging due to cost, reliability, and lack of support from policies and regulations aimed at reducing exposure. 29

Due to major advances in preventing and treating infectious diseases, residents in the Global South are increasingly experiencing chronic diseases as the primary cause of decreased disability‐free lifespan. 21 , 30 In high‐income countries such as the United States, declines in air pollution accounted for as much as 15% of the overall increase in life expectancy. 31 Indeed, air pollution is a modifiable risk factor for chronic diseases such as CVD, and there are important steps that can be taken to reduce air pollution–related morbidity and mortality. For one, the air pollution–monitoring infrastructure needs to be improved globally because there are still regions with little to no monitoring. 24 Fifty‐one of the 57 (89.5%) high‐income countries, classified by the World Health Organization, have ground measurements of PM2.5 and PM10. In contrast, 66 of the 145 (45.5%) low‐ and middle‐income countries have ground air pollution monitoring. As classified by the World Health Organization, in the African region, only 25.5% of countries have ground air pollution monitors for PM2.5 and PM10, compared with 90.6% of countries in the European Region. 32 Lack of air pollution data limits our understanding of air quality in these regions and the effects on the diverse populations living in these under‐resourced areas. 33 Additionally, there is a need to reduce the reliance on biomass and fossil fuels by providing cleaner fuel sources for household use and developing markets for renewable energies that can allow economic development and dissemination of technologies including electrification. 29 Perhaps most importantly, we need to develop effective incentives for emissions control across low‐income regions, including effective regulatory frameworks to achieve air quality gains across all sectors and at all levels, from individual to national. 8 , 34 , 35

INTERCONNECTION BETWEEN CLIMATE CHANGE AND URBAN CARDIOVASCULAR HEALTH

In the coming decades, the proportion of the world population living in urban areas will increase from 55% in 2018 to an estimated 68% by 2050, 36 with the largest increases in low‐ and lower‐middle‐income countries. Global urban land cover is also projected to increase by 78% to 171% between 2015 and 2050. 37 High population density and low vegetation cover, among other factors, make urban areas especially vulnerable to different aspects of climate change, especially rising temperatures. The urban heat island effect, in which developed urban areas absorb more heat than surrounding less developed rural areas, results in urban residents experiencing significantly higher temperatures than rural residents. 15

Within cities, the urban heat island effect is experienced to differing degrees by people living in different neighborhoods. In the United States, neighborhoods with a high proportion of minority residents and those historically segregated have low tree cover leading to high levels of the urban heat island effect. 38 , 39 This results in significantly higher experienced temperatures by the residents of these neighborhoods compared with people living in other neighborhoods. 40 Urban tree cover may be an important mitigating strategy against rising temperatures. 41 However, cities in the Global South tend to have significantly lower tree cover compared with those in high‐income countries. 42 Another source of disparity in experienced temperature is due to differences in access to cooling. In the United States, neighborhoods with a high proportion of minority residents have lower access to air conditioning. 43 While >90% of individuals in the United States and other high‐income countries such as Japan and South Korea have access to air conditioning, access is significantly lower in in lower‐income countries, with <10% having air conditioning access in countries in Sub‐Saharan Africa. 44

Climate change–related increases in global temperature is leading to an upturn in the frequency, duration, and intensity of heatwave events. 45 , 46 , 47 Due to the central role the cardiovascular system plays in thermoregulation, exposure to high temperatures has been associated with an increase in CVD morbidity and mortality. 48 , 49 CVD‐related deaths may be the most common cause of death due to heat exposure. The Global Burden of Disease study estimated that in 2021, >200 000 CVD deaths may be attributed to heat. 50 Another recent study, using data from 27 countries across 5 continents, estimated that extreme heat exposure was associated with ≈0.2% of all CVD deaths. 49 Extreme heat was associated with an increased risk in deaths from heart failure, stroke, and ischemic heart disease. 49 With rising temperatures, heat‐related CVD deaths have also increased worldwide in the past 2 decades, while those associated with cold temperatures have declined. 49 The increase in heat‐related deaths has been most notable in Central Asia, North America, and parts of Oceania. 51 Additionally, CVD mortality rates due to extreme heat are likely to continue to increase in the coming decades and to adversely impact urban areas compared with nonurban areas. 52

Urbanization and the heat island effect, among others, present significant challenges for local, national, and international public health officials as they tackle the health impacts of climate change. The warming climate is occurring alongside continued increases in the population and size of cities across the world. At the same time, CVD is becoming the leading cause of death across much of the Global South, making it crucial for public health leaders to tackle the impact climate change will have on urban populations across the world. 50

IMPACT OF FLOODING AND NATURAL DISASTERS ON CARDIOVASCULAR HEALTH OUTCOMES

Flooding, where typically dry land is inundated with water, is an urgent global public health concern. 53 , 54 , 55 Floods can impact health via direct and indirect pathways. 56 , 57 Drowning and other injuries are typical direct health impacts of flooding, while post‐flood chronic stress can lead to cardiovascular events. Floods can be caused by heavy rain, tropical cyclones, snowmelt, ice jams, and dam breaks. 55

Worldwide, floods are becoming more frequent and severe, particularly in South Asia and East Asia, and the largest amounts of floods are occurring in these regions. 58 , 59 People are moving to floodplains in every part of the world, often due to economic reasons, which increases their exposure to floods. 59 A study examining the relationship between floods and health outcomes, including CVD, via an exhaustive analysis of mortality following floods in the United States across several decades, 53 found heavy rain and snowmelt were primary drivers of flood‐related CVD mortality, with greater increases after more severe flooding. It is critical to understand the distinct impacts of flood causes on cause‐specific mortality and morbidity for optimal disaster management and public health preservation. Rural areas, in the United States and elsewhere, are distinctly vulnerable to the impacts of flooding on health compared with urban areas because of (1) physical vulnerabilities including landscape (eg, floodplains, riverbanks, coastal areas), land use (eg, agriculture in rural areas leading to more runoff and reduced natural water absorption capacity), infrastructure deficiencies (eg, less robust drainage systems, with roads and bridges easily overwhelmed by flooding), and remote locations less well‐served by emergency response and disaster recovery, as well as clinical treatment than urban counterparts, as well as social factors including higher poverty rates in rural areas compared with urban areas, aging and declining populations in rural areas compared with urban areas, limited social networks, and lack of insurance and financial resources to recover after flooding. 60

Tropical cyclones are a major driver of floods worldwide, and tropical cyclone–driven flooding has been increasing over time. 55 Exposure to flooding worldwide has been modified by both climate change and population growth and urbanization. 59 It is currently a challenge to understand how increases in exposure to flooding are due to population growth and urbanization or climate change. The short‐ to long‐term health impacts of flooding are also largely unknown in many parts of the world that experience flooding regularly. There is a need for a global network of public health–concerned scientists to study and mitigate the effects of floods, particularly in Asia and North America. 11 Efforts are under way to build a network called G‐TROPIC and the importance of conducting detailed studies on the impacts of floods, the origins of flooding, as well as the health impacts. 61

Disaster management and prediction across the global network is critical. There are challenges in predicting extreme weather events such as tropical cyclones and the need for better models to understand how flooding will occur. It remains critical to consider climate models in urban development and the need to balance economic development with environmental concerns. Flooding is predicted to increase in severity under climate change. 55 To protect public health worldwide, it is vital to ensure fair and efficient flood preparedness and response.

SCIENTIFIC AND POLICY STRATEGIES TO MITIGATE CLIMATE CHANGE–RELATED CARDIOVASCULAR HEALTH EFFECTS IN THE GLOBAL SOUTH

The Global South’s vulnerability to climate change stems from a mix of geography, poverty, inequity, and power asymmetry. 62 Most countries in the Global South lie in the fault lines of climate change and natural disasters (the Sahel, tropical lowlands, and densely populated deltas such as Bangladesh), where rising temperatures, changing monsoons, and sea‐level rise will have cascading effects on ecosystems, economies, and health. Economically, many of these countries rely on climate‐sensitive sectors such as agriculture, fishing, and informal labor, with extremely limited social protection or insurance. Infrastructure is typically fragile with many cities of the urban south lacking basic infrastructure such as permanent homes, navigable roads, public transportation, and access to clean water and waste disposal. 15 Access to health care is extremely limited with chronically underfunded health systems, handicapping the ability of many countries to respond to climate disasters. Many countries have no systematic mechanisms for public health surveillance and logistics needed to monitor and respond to climate disasters. Taken together, these factors create extreme vulnerability to the effects of climate change.

To reverse this trajectory, the world must prioritize climate adaptation and resilience investments in the Global South, as a matter of global health security, moral responsibility, and planetary stability. 62 This will involve some measure of funding initiatives in the Global South. A point of view is that given wealthy countries from the Global North are responsible for >75% of global accumulated emissions since the start of industrialization, they have an obligation to pay for and support climate adaptation, and for a just transition away from fossil fuels to renewable energy and climate‐resilient societies. 63 By 2050, the Global North will owe US$192 trillion in fair reparations to the Global South, which breaks down to an annual climate debt of US$5 trillion owed by countries of the Global North to poorer ones in the Global South. 64 A variety of policy initiatives backed by secure funding mechanisms are also required (Table).

Table 1.

Broad Policy Measures to Build Adaptation and Resilience in the Global South

Strengthen Climate‐Resilient Health Systems
Invest in early warning systems for climate‐sensitive diseases
Expand decentralized health infrastructure, including mobile clinics and telemedicine
Build resilient supply chains for vaccines, food, and emergency response
Train local health workers in climate‐related disease surveillance and disaster response
Scale and Localize Climate Finance
Meet and exceed funding goals for climate finance, with emphasis on adaptation
Ensure direct investments in community‐led organizations and local governments and ensuring accountability
Integrate health adaptation plans into Nationally Determined Contributions and Global Fund frameworks
Secure Food and Water Systems
Finance and invest in initiatives for climate‐smart agriculture, and drought‐resistant crops
Make investments in water harvesting, desalination, and waste management infrastructure
Protect Displaced Populations and Climate Migrants
Create policies and frameworks for climate refugee protection
Strengthen urban planning to absorb an influx of climate refugees
Embed Justice in Global Climate Policy
Ensure voices from the Global South in climate negotiations
Establish a responsibility‐sharing framework for loss and damage
Foster South–South knowledge exchange and technical capacity‐building
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These policy initiatives include strengthening climate‐resilient health systems, scaling and localizing climate finance with tangible mechanisms to track these investments, fortifying food and water infrastructure and urbanization planning, and incentivizing climate migrants with local jobs preferably aligned with win‐win climate‐occupation initiatives. 65 Finally, the world must recognize the pivotal importance of strengthening climate resilience and adaptations efforts by elevating voices and supporting scientific initiatives led directly from the Global South. 63 Winning the battle against climate change can only happen with countries in the Global South leading the way.

CONCLUSION

Climate change poses a growing threat to public health, particularly in the Global South, where developing regions are more vulnerable. Air pollution, driven by rapid urbanization, industrial growth, and weak regulation, is particularly severe in the Global South, leading to higher levels of PM2.5 and NO2. Long‐term exposure exacerbates heart disease and stroke, especially in settings with poverty and weak health care systems. Natural disasters add further strain, with physical and psychological stress triggering acute CVD events and long‐term complications. Urban heat islands further increase CVD risks by intensifying dehydration, heatstroke, and pre‐existing conditions. The Global South bears a disproportionate burden of climate‐related health challenges, requiring targeted science and policy to improve resilience and reduce risk.

Air pollution is a major contributor to cardiovascular and respiratory disease. Particulate matter exposure causes inflammation, autonomic activation, and vascular effects, leading to oxidative stress, hypertension, vasoconstriction, and accelerated atherosclerosis. While high‐income countries have reduced pollution through regulation, many Global South regions still face high levels due to fossil fuel use, weak regulations, industrial emissions, and agricultural burning. Solutions include expanding monitoring, promoting clean energy, and developing strong regulatory frameworks for emissions control. Efforts should prioritize affordable clean fuels, promote renewable energy, and strengthen policies to mitigate pollution.

By 2050, 68% of the global population will live in cities, many in the Global South. Urban areas are vulnerable to rising temperatures, especially through the heat island effect, and heatwaves are linked to higher CVD morbidity and mortality. This effect disproportionately impacts marginalized communities with low tree cover and limited access to cooling systems. In low‐income countries, scarce air conditioning further increases vulnerability. Future planning should increase green space, expand cooling access, and embed climate resilience into city design. Governments must prioritize adaptation to protect health in fast‐growing urban regions.

Floods are becoming more frequent and severe, particularly in South and East Asia. Population growth in floodplains increases exposure to flood risks. A global network of public health scientists is needed to study and mitigate flood‐related health effects. Key strategies include stronger disaster response, better weather prediction, and policies to discourage settlement in flood‐prone areas. Integrating climate data into planning and balancing development with sustainability will help reduce future risks. Addressing heat, flooding, and air pollution through coordinated policy and measures is essential.

Disaster preparedness is a foundational element that precedes and enables disaster response. As climate change intensifies the frequency and severity of extreme weather events, health systems, particularly in the Global South, must strengthen disaster preparedness and response mechanisms to safeguard cardiovascular health. Vulnerable populations in these regions face heightened risks due to limited health care infrastructure, higher burdens of CVD, and constrained access to emergency care. To mitigate the health impacts of climate‐related events, particularly power outages, floods, and heatwaves, health systems must invest in climate‐resilient infrastructure, ensure continuity of care for patients dependent on cardiovascular therapies and devices, and integrate early warning systems with health surveillance. Community‐based adaptation strategies, decentralized care models, and cross‐sectoral collaboration can enhance health system resilience. Prioritizing equity and local capacity‐building will be critical to reducing climate‐related cardiovascular morbidity and mortality and ensuring sustainable, responsive health care delivery in the face of a changing climate.

Countries in the Global South face interconnected challenges from climate, conflict, and fragile infrastructures, requiring context‐specific solutions. Greater collaboration, funding, and equity‐centered frameworks are critical. Expanding strategies in energy, transportation, and waste management can reduce exposures and improve health. Successful local models of adaptation and resilience are valuable to inform future global action.

Sources of Funding

None.

Disclosures

None.

This manuscript was sent to William W. Aitken, MD, Assistant Editor, for review by expert referees, editorial decision, and final disposition.

For Sources of Funding and Disclosures, see page 7.

REFERENCES

  • 1. Mackres E, Wong T, Null S, Campos R, Mehrotra S. The Future of Extreme Heat in Cities: What We Know—and What We Don’t. World Resources Institute; 2023. [Google Scholar]
  • 2. WMO . State of the Global Climate 2023 . 2024.
  • 3. IDMC . Global Report on Internal Displacement (GRID); 2025. 2025. doi: 10.55363/IDMC.XTGW2833. [DOI]
  • 4. Yang Y, Tilman D, Jin Z, et al. Climate change exacerbates the environmental impacts of agriculture. Science (1979). 2025;385:eadn3747. doi: 10.1126/science.adn3747 [DOI] [PubMed] [Google Scholar]
  • 5. Intergovernmental Panel on Climate Change [IPCC] . Synthesis Report of The IPCC Sixth Assessment Report (AR6) IPCC. Climate Change 2021—The Physical Science Basis. Published Online 2023. IPCC; 1992. [Google Scholar]
  • 6. World Health Organization . Climate Change ; 2023.
  • 7. Romanello M, Walawender M, Hsu SC, Moskeland A, Palmeiro‐Silva Y, Scamman D, Ali Z, Ameli N, Angelova D, Ayeb‐Karlsson S, et al. The 2024 report of the lancet countdown on health and climate change: facing record‐breaking threats from delayed action. Lancet. 2024;404:1847–1896. doi: 10.1016/S0140-6736(24)01822-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Fuller R, Landrigan PJ, Balakrishnan K, Bathan G, Bose‐O’Reilly S, Brauer M, Caravanos J, Chiles T, Cohen A, Corra L, et al. Pollution and health: a progress update. Lancet Planet Health. 2022;6:e535–e547. doi: 10.1016/S2542-5196(22)00090-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Tibuakuu M, Michos ED, Navas‐Acien A, Jones MR. Air pollution and cardiovascular disease: a focus on vulnerable populations worldwide. Curr Epidemiol Rep. 2018;5:370–378. doi: 10.1007/s40471-018-0166-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Khraishah H, Chen Z, Rajagopalan S. Understanding the cardiovascular and metabolic health effects of air pollution in the context of cumulative exposomic impacts. Circ Res. 2024;134:1083–1097. doi: 10.1161/CIRCRESAHA.124.323673 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Parks RM, Guinto RR. Invited perspective: uncovering the hidden burden of tropical cyclones on public health locally and worldwide. Environ Health Perspect. 2025;130:111306. doi: 10.1289/EHP12241 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Parks RM, Benavides J, Anderson GB, Nethery RC, Navas‐Acien A, Dominici F, Ezzati M, Kioumourtzoglou MA. Association of Tropical Cyclones with county‐level mortality in the US. JAMA. 2022;327:946–955. doi: 10.1001/jama.2022.1682 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13. Aitken WW, Brown SC, Comellas AP. Climate change and cardiovascular health. J Am Heart Assoc. 2022;11:e027847. doi: 10.1161/jaha.122.027847 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Nieuwenhuijsen MJ. Influence of urban and transport planning and the city environment on cardiovascular disease. Nat Rev Cardiol. 2018;15:432–438. doi: 10.1038/s41569-018-0003-2 [DOI] [PubMed] [Google Scholar]
  • 15. Rajagopalan S, Vergara‐Martel A, Zhong J, Khraishah H, Kosiborod M, Neeland IJ, Dazard JE, Chen Z, Munzel T, Brook RD, et al. The Urban environment and cardiometabolic health. Circulation. 2024;149:1298–1314. doi: 10.1161/CIRCULATIONAHA.123.067461 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16. Rajagopalan S, Ramaswami A, Bhatnagar A, Brook RD, Fenton M, Gardner C, Neff R, Russell AG, Seto KC, Whitsel LP, et al. Toward heart‐healthy and sustainable cities: a policy statement from the American Heart Association. Circulation. 2024;149:e1067–e1089. doi: 10.1161/CIR.0000000000001217 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17. Münzel T, Sørensen M, Lelieveld J, Hahad O, al‐Kindi S, Nieuwenhuijsen M, Giles‐Corti B, Daiber A, Rajagopalan S. Heart healthy cities: genetics loads the gun but the environment pulls the trigger. Eur Heart J. 2021;42:2422–2438. doi: 10.1093/eurheartj/ehab235 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Münzel T, Khraishah H, Schneider A, Lelieveld J, Daiber A, Rajagopalan S. Challenges posed by climate hazards to cardiovascular health and cardiac intensive care: implications for mitigation and adaptation. Eur Heart J Acute Cardiovasc Care. 2024;13:731–744. doi: 10.1093/ehjacc/zuae113 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Khraishah H, Alahmad B, Ostergard RL, AlAshqar A, Albaghdadi M, Vellanki N, Chowdhury MM, Al‐Kindi SG, Zanobetti A, Gasparrini A, et al. Climate change and cardiovascular disease: implications for global health. Nat Rev Cardiol. 2022;19:798–812. doi: 10.1038/s41569-022-00720-x [DOI] [PubMed] [Google Scholar]
  • 20. Patz JA, Gibbs HK, Foley JA, Rogers JV, Smith KR. Climate change and global health: quantifying a growing ethical crisis. EcoHealth. 2007;4:397–405. doi: 10.1007/s10393-007-0141-1 [DOI] [Google Scholar]
  • 21. Global Burden of Disease Collaborative Network . Global Burden of Disease Study 2021 (GBD 2021). Seattle, United States: Institute for Health Metrics and Evaluation (IHME); 2024. [Google Scholar]
  • 22. Brauer M, Casadei B, Harrington RA, Kovacs R, Sliwa K, Brauer M, Davaakhuu N, Hadley M, Kass D, Miller M, et al. Taking a stand against air pollution—the impact on cardiovascular disease: a joint opinion from the world heart federation, American College of Cardiology, American Heart Association, and the European Society of Cardiology. J Am Coll Cardiol. 2021;77:1684–1688. doi: 10.1016/j.jacc.2020.12.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Brook RD, Rajagopalan S, Iii CAP, et al. Particulate matter air pollution and cardiovascular disease an update to the scientific statement from the American. Circulation. 2010;121:2331–2378. doi: 10.1161/CIR.0b013e3181dbece1 [DOI] [PubMed] [Google Scholar]
  • 24. Shaddick G, Thomas ML, Mudu P, Ruggeri G, Gumy S. Half the world’s population are exposed to increasing air pollution. NPJ Climate Atmos Sci. 2020;3:1–5. doi: 10.1038/s41612-020-0124-2 [DOI] [Google Scholar]
  • 25. Rentschler J, Leonova N. Global air pollution exposure and poverty. Nat Commun. 2023;14:1–11. doi: 10.1038/s41467-023-39797-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Yoon H, Heshmati A. Do environmental regulations affect FDI decisions? The pollution haven hypothesis revisited. Sci Public Policy. 2021;48:122–131. doi: 10.1093/scipol/scaa060 [DOI] [Google Scholar]
  • 27. Singhania M, Saini N. Demystifying pollution haven hypothesis: role of FDI. J Bus Res. 2020;123:516–528. doi: 10.1016/j.jbusres.2020.10.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28. Lee KK, Bing R, Kiang J, Bashir S, Spath N, Stelzle D, Mortimer K, Bularga A, Doudesis D, Joshi SS, et al. Adverse health effects associated with household air pollution: a systematic review, meta‐analysis, and burden estimation study. Lancet Glob Health. 2020;8:e1427–e1434. doi: 10.1016/S2214-109X(20)30343-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29. Wernecke B, Langerman KE, Howard AI, Wright CY. Fuel switching and energy stacking in low‐income households in South Africa: a review with recommendations for household air pollution exposure research. Energy Res Soc Sci. 2024;109:103415. doi: 10.1016/j.erss.2024.103415 [DOI] [Google Scholar]
  • 30. Hacker K. The burden of chronic disease. Mayo Clin Proc Innov Qual Outcomes. 2024;8:112–119. doi: 10.1016/j.mayocpiqo.2023.08.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Pope CA, Ezzati M, Dockery DW. Fine‐particulate air pollution and life expectancy in the United States. N Engl J Med. 2009;360:376–386. doi: 10.1056/nejmsa0805646 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Tsati E, Ruggeri G, Shairsingh K, et al. World Health Organization Ambient Air Quality Database: 2022 Status Report. World Health Organization; 2022. [Google Scholar]
  • 33. Zalakeviciute R, Lopez‐Villada J, Ochoa A, Moreno V, Byun A, Proaño E, Mejía D, Bonilla‐Bedoya S, Rybarczyk Y, Vallejo F. Urban air pollution in the global south: a never‐ending crisis? Atmos. 2025;16:487. doi: 10.3390/atmos16050487 [DOI] [Google Scholar]
  • 34. Amann M, Kiesewetter G, Schöpp W, et al. Reducing global air pollution: the scope for further policy interventions: achieving clean air worldwide. Philos Trans R Soc A Math Phys Eng Sci. 2020;378:20190331. doi: 10.1098/rsta.2019.0331 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35. World Health Organisation . Health Consequences of Air Pollution onb Populations. WHO; 2024. https://www.who.int/news/item/25‐06‐2024‐what‐are‐health‐consequences‐of‐air‐pollution‐on‐populations [Google Scholar]
  • 36. UN‐DESA . World Urbanization Prospects. The 2018 Revision. Methodology. Department of Economic and Social Affairs, Population Division; 2018; (ESA/P/WP/252) [Google Scholar]
  • 37. Huang K, Li X, Liu X, Seto KC. Projecting global urban land expansion and heat Island intensification through 2050. Environ Res Lett. 2019;14:114037. doi: 10.1088/1748-9326/ab4b71 [DOI] [Google Scholar]
  • 38. Hsu A, Sheriff G, Chakraborty T, Manya D. Disproportionate exposure to urban heat Island intensity across major US cities. Nat Commun. 2021;12:2721. doi: 10.1038/s41467-021-22799-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39. Locke DH, Hall B, Grove JM, Pickett STA, Ogden LA, Aoki C, Boone CG, O’Neil‐Dunne JPM. Residential housing segregation and urban tree canopy in 37 US cities. NPJ Urban Sustain. 2021;1:15. doi: 10.1038/s42949-021-00022-0 [DOI] [Google Scholar]
  • 40. Chakraborty TC, Newman AJ, Qian Y, Hsu A, Sheriff G. Residential segregation and outdoor urban moist heat stress disparities in the United States. One Earth. 2023;6:738–750. doi: 10.1016/j.oneear.2023.05.016 [DOI] [Google Scholar]
  • 41. Iungman T, Cirach M, Marando F, Pereira Barboza E, Khomenko S, Masselot P, Quijal‐Zamorano M, Mueller N, Gasparrini A, Urquiza J, et al. Cooling cities through urban green infrastructure: a health impact assessment of European cities. Lancet. 2023;401:577–589. doi: 10.1016/S0140-6736(22)02585-5 [DOI] [PubMed] [Google Scholar]
  • 42. Nowak DJ, Greenfield EJ. The increase of impervious cover and decrease of tree cover within urban areas globally (2012–2017). Urban For Urban Green. 2020;49:126638. doi: 10.1016/j.ufug.2020.126638 [DOI] [Google Scholar]
  • 43. Romitti Y, Sue Wing I, Spangler KR, Wellenius GA. Inequality in the availability of residential air conditioning across 115 US metropolitan areas. PNAS Nexus. 2022;1:pgac210. doi: 10.1093/pnasnexus/pgac210 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44. IEA . The Future of Cooling: Opportunities for Energy‐Efficient Air Conditioning. IEA; 2018. [Google Scholar]
  • 45. Rahmstorf S, Coumou D. Increase of extreme events in a warming world. Proc Natl Acad Sci USA. 2011;108:17905–17909. doi: 10.1073/pnas.1101766108 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46. Perkins‐Kirkpatrick SE, Lewis SC. Increasing trends in regional heatwaves. Nat Commun. 2020;11:4655. doi: 10.1038/s41467-020-16970-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. Meehl GA, Tebaldi C. More intense, more frequent, and longer lasting heat waves in the 21st century. Science. 2004;305:994–997. doi: 10.1126/science.1098704 [DOI] [PubMed] [Google Scholar]
  • 48. Ebi KL, Capon A, Berry P, Broderick C, de Dear R, Havenith G, Honda Y, Kovats RS, Ma W, Malik A, et al. Hot weather and heat extremes: health risks. Lancet. 2021;398:698–708. doi: 10.1016/S0140-6736(21)01208-3 [DOI] [PubMed] [Google Scholar]
  • 49. Alahmad B, Khraishah H, Royé D, Vicedo‐Cabrera AM, Guo Y, Papatheodorou SI, Achilleos S, Acquaotta F, Armstrong B, Bell ML, et al. Associations between extreme temperatures and cardiovascular cause‐specific mortality: results from 27 countries. Circulation. 2023;147:35–46. doi: 10.1161/CIRCULATIONAHA.122.061832 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50. Roth GA, Abate D, Abate KH, et al. Erratum: global, regional, and national age‐sex‐specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–1788. doi: 10.1016/S0140-6736(18)32833-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51. Hundessa S, Huang W, Zhao Q, Wu Y, Wen B, Alahmad B, Armstrong B, Gasparrini A, Sera F, Tong S, et al. Global and regional cardiovascular mortality attributable to nonoptimal temperatures over time. J Am Coll Cardiol. 2024;83:2276–2287. doi: 10.1016/j.jacc.2024.03.425 [DOI] [PubMed] [Google Scholar]
  • 52. Khatana SAM, Eberly LA, Nathan AS, Groeneveld PW. Projected change in the burden of excess cardiovascular deaths associated with extreme heat by midcentury (2036–2065) in the contiguous United States. Circulation. 2023;148:1559–1569. doi: 10.1161/CIRCULATIONAHA.123.066017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53. Lynch VD, Sullivan JA, Flores AB, Xie X, Aggarwal S, Nethery RC, Kioumourtzoglou MA, Nigra AE, Parks RM. Large floods drive changes in cause‐specific mortality in the United States. Nat Med. 2025;31:663–671. doi: 10.1038/s41591-024-03358-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54. Paterson DL, Wright H, Harris PNA. Health risks of flood disasters. Clin Infect Dis. 2018;67:1450–1454. doi: 10.1093/cid/ciy227 [DOI] [PubMed] [Google Scholar]
  • 55. IPCC . Climate Change 2023: Synthesis Report. A Report of the Intergovernmental Panel on Climate Change. IPCC; 2023. [Google Scholar]
  • 56. Rappaport EN. Fatalities in the United States from Atlantic tropical cyclones: new data and interpretation. Bull Am Meteorol Soc. 2014;95:341–346. doi: 10.1175/BAMS-D-12-00074.1 [DOI] [Google Scholar]
  • 57. Du W, Fitzgerald GJ, Clark M, Hou XY. Health impacts of floods. Prehosp Disaster Med. 2010;25:265–272. doi: 10.1017/S1049023X00008141 [DOI] [PubMed] [Google Scholar]
  • 58. Rentschler J, Avner P, Marconcini M, Su R, Strano E, Vousdoukas M, Hallegatte S. Global evidence of rapid urban growth in flood zones since 1985. Nature. 2023;622:87–92. doi: 10.1038/s41586-023-06468-9 [DOI] [PubMed] [Google Scholar]
  • 59. Tellman B, Sullivan JA, Kuhn C, Kettner AJ, Doyle CS, Brakenridge GR, Erickson TA, Slayback DA. Satellite imaging reveals increased proportion of population exposed to floods. Nature. 2021;596:80–86. doi: 10.1038/s41586-021-03695-w [DOI] [PubMed] [Google Scholar]
  • 60. Tapsell SM, Penning‐Rowsell EC, Tunstall SM, Wilson TL. Vulnerability to flooding: health and social dimensions. Philos Trans R Soc Lond Ser A. 2002;360:1511–1525. doi: 10.1098/rsta.2002.1013 [DOI] [PubMed] [Google Scholar]
  • 61. SPARK Lab NYC—G‐TROPIC.
  • 62. Hogan E, Stewart P. A Closer Look at the Global South . 2024.
  • 63. Hickel J. Quantifying national responsibility for climate breakdown: an equality‐based attribution approach for carbon dioxide emissions in excess of the planetary boundary. Lancet Planet Health. 2020;4:e399–e404. doi: 10.1016/S2542-5196(20)30196-0 [DOI] [PubMed] [Google Scholar]
  • 64. Fanning AL, Hickel J. Compensation for atmospheric appropriation. Nat Sustain. 2023;6:1077–1086. doi: 10.1038/s41893-023-01130-8 [DOI] [Google Scholar]
  • 65. Eisenstadt TA, Olawole I, Toman MA. Climate adaptation finance in world bank economic development programs: the challenges of systemic transformation via “scaling up”. Sustainability. 2021;13:10553. doi: 10.3390/su131910553 [DOI] [Google Scholar]

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