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Roman Milert -

Unequal Heat Stress: Social Disparities in Adaptive Capacity

Environmental Health, EPI,

Institute of Epidemiology carries out a range of projects on heat and health

Click here to explore current heat and health-related research projects. One example for heat and health-related projects explores the social dimensions of heat exposure and adaptive capacity:


A systematic review of thermal inequality and heat-related adaptive capacity

S. Claire Slesinski1,2,3, Eva Franziska Matthies-Wiesler2, Susanne Breitner-Busch1,2,3, Geronimo Gussmann4, Christiane Bunge4, Alexandra Schneider2

1) Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU, Munich, Germany.
2) Institute of Epidemiology, Helmholtz Munich, German Research Center for Environmental Health, Neuherberg, Germany

3) Pettenkofer School of Public Health, Munich, Germany
4) German Environment Agency (Umweltbundesamt)


Background: Heat stress is an important public health concern in Germany. Exposure to heat stress and the capacity to adapt to heat are not distributed equally across social groups, creating thermal inequality. This systematic review aimed to summarize evidence of the effect of social disadvantage on exposure to subjective and objective heat stress and adaptive capacity to prevent/reduce exposure to heat stress.

Methods: We searched for peer-reviewed publications from between 2005 and 2024. One reviewer screened and extracted data from all publications, while a second screened and extracted data from 10% for comparison. Using the identified literature, we described specific social groups that are unequally exposed to heat stress, and which have lower adaptive capacity. We also described the evidence and identified research gaps.

Results: Of the 114 identified publications, 53% included evidence on objective heat stress, 19% on subjective heat stress, and 58% on adaptive capacity. Nearly half were from North America (47%), 24% from Asia, and 17% from Europe. Publishing has increased over time, from 0 articles in 2005 to 20 articles in 2023. The majority of publications considered socioeconomic status (SES) (87%), with less focusing on race/ethnicity or other social characteristics. Lower-SES populations, immigrants, and racial/ethnic minorities are generally more exposed to heat stress and have less capacity to adapt, and lower-SES and minority neighborhoods tend to be hotter and less green. Most studies of inequality in exposure to objective heat stress use imprecise measures (e.g., land surface temperature) which do not accurately represent temperatures that we experience. Evidence from Germany, especially evidence related to inequality in exposure to objectively measured heat stress, is limited.

Conclusion: This is the first known systematic review of the available evidence on inequalities in heat stress exposure and related adaptive capacity and identifies important gaps in the evidence related to heat stress measurement and social factors apart from SES.

Publication of the project's synthesis report is envisaged for August 2024 (in German): Aufterbeck-Martin, M. et al. (im Erscheinen). Synthesebericht: Soziale Dimensionen von Klimawandelfolgen. In Climate Change. Umweltbundesamt.