Extreme heat kills more people in the U.S. each year than hurricanes, floods, and tornadoes combined. But how can we address a seemingly natural force?
Heat can often seem solely weather-related, with policies trying to find a solution through temperature metrics, cooling technologies, and alerts. However, a new report from the Vanderbilt Cultural Contexts of Health and Wellbeing Initiative (VU-CCH) suggests that extreme heat is not just a climate issue, but also a social one.
"Beyond Temperature: A Cultural Contexts Approach to Heat and Health," supported by the Robert Wood Johnson Foundation (RWJF) in collaboration with the World Health Organization (WHO), explores heat as a socially produced condition shaped by how people live, work, and adapt in specific cultural and environmental contexts. The report examines how heat-related illness is often made worse by environmental exposure, biological vulnerability, cultural norms, and political and economic structures.
"When we think about heat, we usually think of a temperature," said Ted Fischer, Cornelius Vanderbilt Chair and professor of anthropology, and the study's principal investigator. "It's 99 degrees today! And that tells us something important, can help us prepare for the weather that day. But when we look at the health impacts of heat, they result from cultural factors as much as meteorological ones. Clothing, access to shelter and cooling, work schedules, food and drink-all of these and many more cultural adaptations help determine how much heat reaches the body. And they are all human-made: the architectural and technological as well as the social and political."
"Beyond Temperature" challenges the limits of standard heat metrics and calls for a fundamental shift from individual advice to collective, culturally grounded, and systematic solutions. It serves as a call to action for both policymakers and society at large to address the "politics of shade," demand enforceable workplace heat standards, and invest in shade infrastructure to achieve genuine thermal justice.
The report suggests a "look local, look around, look up" approach:
- Look local: Engage communities as knowledge partners, integrate lived experience into planning processes, and collaborate across industries to craft metrics and interventions that reflect real, context-specific needs.
- Acknowledge community responses and thermal knowledge embedded in local practices, such as architecture, work rhythms, dress, and diet.
- Integrate anthropologists, sociologists, community-based organizations, and local knowledge into heat science and health policy.
- Enact policies for heat-sensitive work schedules, especially for outdoor and informal laborers.
- Look around: Build cross-sectoral and interdisciplinary coalitions, foster institutional integration, and rethink what counts as legitimate knowledge. Break down barriers between urban planning, public health, labor, environmental science, and the social sciences.
- Develop strategies that link heat adaptation to areas like housing, chronic disease, social isolation, mobility, and infrastructure.
- Redesign universal thermal metrics and standards to better reflect lived experience by complementing metrics with qualitative data on perception, behavior, and vulnerability, and reflecting diverse body types, cultural expectations, and regional variations.
- Reframe adaptation beyond technology. Avoid overreliance on technological solutions such as air conditioning, which can exacerbate inequality and environmental degradation.
- Look up: Acknowledge that existing heat mitigation strategies are embedded in cultural assumptions about normalcy, productivity, and value. Rethink taken-for-granted norms around sweat, rest, flexible labor schedules, and shared solutions.
- Shift from individualized solutions to collective, culturally grounded responses, including re-norming around temperature comfort levels.
- Employ culturally resonant communication to challenge cultural narratives that encourage people to endure heat, and to provide practical guidance on what to do. Recognize heat events as natural disasters, making them more visible and freeing funds for response.
"To fully understand the impact of heat on our health, we must look beyond biology and temperature and consider how heat impacts are shaped by our social and cultural environment-how we dress, eat, work, and live," said Karabi Acharya, senior director at the Robert Wood Johnson Foundation. "We can find new solutions to help keep people safe and healthy if we do more to understand how people experience and respond to heat in different cultures and communities around the world."
Each year, VU-CCH publishes multiple reports, enlisting expert consultants from around the world to develop a policy brief on that topic. The goal is to use cultural insights to help improve public health policy and healthcare delivery.
Their first report for 2026 focuses on extreme heat and took the team around the globe, analyzing data and practices in countries such as Bahrain, Iran, Spain, Egypt, India, and Tanzania.
Heat is not just an external temperature, but the amount of thermal energy that reaches the body. Clothing and architecture, as well as social norms and public policy, mediate the ways heat affects the body. Communities worldwide have long developed cultural strategies-shaded architecture, midday rest, water-sharing practices, flexible labor rhythms-that keep people safe. Some cities, like Lisbon, have implemented participatory planning processes that involve citizens in urban design and climate adaptation.
During extreme heat, a person with a chronic condition may suffer severe outcomes not just because of the outdoor temperature, but due to a combination of housing precarity, social isolation, lack of access to cooling, or unsafe labor conditions. This is a syndemic view of the issue, meaning that social and environmental factors interact with multiple health problems, worsening an individual's overall health. The report suggests that viewing heat-related policies through a syndemic framework could aid in understanding heat's impact on health and address the root causes of heat vulnerability.
By acknowledging the historical, cultural, and environmental contexts that contribute to a person's well-being in extreme heat, policymakers in the U.S. can develop more inclusive, equitable, and effective strategies for keeping citizens safe. The report recommends that policymakers move beyond a narrow, technical focus and adopt a cultural approach to inform policy.
"Virtually all heat related deaths are preventable," Fischer said. "They result as much from the social conditions and cultural contexts in which people find themselves as from solar radiation. It is not a coincidence that marginalized peoples suffer vastly disproportional negative outcomes from heat. We need to be investing in climate science and medical studies of heat, but looking at the cultural contexts is just as important to stopping unneeded deaths and suffering."
