Even now, after the 11 hottest years on record due to climate change, most cities and regions don’t have formal plans for extreme heat. This may be due to a lack of resources or political will, or because extreme heat is bundled into other health planning (if it’s addressed at all).

“Heat action plans are still really geographically uneven,” notes Sara Meerow, a geographer at the University of Colorado Boulder. “There are whole regions of the world that essentially don’t have any heat action plans that we’re aware of.”

That’s a major omission. Heat action plans are linked to fewer deaths during extreme heat in India and more changes in behavior in Nepal, for example.

But despite their power to save lives , these plans are far from perfect. Here are a few broad ways to strengthen them.

Meerow coauthored a recent analysis of 34 heat action plans , published by the Red Cross Red Crescent Global Disaster Preparedness Center (GDPC). One key finding may seem dull, but it’s critical: all too often, weaknesses in heat response planning come down to bureaucratic divisions. For instance, an urban development department responsible for maintaining trees might not be talking to a public health department responsible for monitoring hospital admissions during heatwaves. They might not be considering (or even reading) each other’s heat-related plans.

“If you’re not referencing the goals or information in another plan, there’s a chance that the actions that you’re proposing may not be in line with them, or might even potentially conflict,” Meerow points out. “Better integration and connections between plans is something that we really emphasize.” It’s a finding that came up again and again in the research.

Some places have appointed chief heat officers. Others have formed committees with representatives of different government agencies that are all relevant to heat. There’s not yet enough research on what works best, Meerow says. But what is clear is that someone needs to be coordinating activity.

There are some persistent holes in heat action plans. One is mental health. Like heat, mental health issues can be hard to visualize. The two can aggravate each other in ways that often go unacknowledged in policy. One study of 143 heat action plans found that while 57% mentioned mental health, this was mostly in a superficial way. Only 14% had specific activities related to the mental health effects of heat.

There’s another way. Community mental health programs in Pakistan have stepped up their monitoring and support during heatwaves, including helping with home ventilation and hydration. This has led, for instance, to early intervention to avoid hospitalization with schizophrenia. Schizophrenia is associated with especially magnified risks of death during heatwaves. Scaling up this kind of community support into formal heat planning could help protect many more vulnerable people.

Meerow stresses the importance of communities first deciding on their goals, then matching the information they collect and the strategies they plan to those goals. “That sounds really basic, but actually it’s not always how plans are developed.”

For instance, if a city’s goal is to reduce heat deaths, it would need to figure out who’s most at risk and why, and then how to most effectively cut mortality. If its goal is to improve liveability for everyone, the planning could look quite different.

This action planning is best informed by the experiences of the people the plans are seeking to support. In Delhi, according to an independent investigation of the 2026 heat action plan, “The State’s picture of what a worker needs was assembled without asking a worker.”

Remarkably, most places with heat action strategies aren’t actually evaluating whether they work. Essentially, they’re hoping for the best; relying on anecdotal reports; or simply counting up how many activities they run, not whether they’re actually making people safer.

“One of the key findings from this study is that it’s really challenging to actually measure effectiveness,” Meerow summarizes. “We do not have sufficient evidence of the comparative benefit of these different strategies.”

Richer governments may not be tracking heat-health deaths. Poorer governments may not be tracking all deaths, from any cause. In all cases, unmeasured results don’t make for the best use of scarce funds.

Vienna’s approach was one of the better ones she and her colleagues studied, Meerow says. The city evaluates which measures were implemented and how well they were perceived to work, using a simple traffic-light system. Then the city revises the plan annually based on the evaluation. It’s a time-consuming and imperfect process; perceptions of effectiveness are not the same as actual effectiveness. Still, this is an improvement on most heat action plans.

The GDPC report found that most of the heat response plans focused on immediate response. This might take the form of relatively inexpensive measures like warnings or cooling centers, for instance. These measures have limitations, though. Heat warnings often go ignored , for instance by people who think others are vulnerable, but not them . Cooling centers can sit nearly empty when they’re poorly publicized, far from the people who most need them , or just, well, boring.

Meerow understands the impulse to reach for the simple tools first. “As a first step, I think this makes a lot of sense, but of course, as we look to a hotter future, it’s also important to think about long-term heat mitigation.”

One possibility is to turn an emergency measure into a continuous offering. Abu Md. Zubair, a project officer with the anticipatory action team of the Bangladesh Red Crescent Society (BDRCS), reports that Khulna, Bangladesh is considering building some permanent cooling stations in heat hotspots, such as near bus stops. This comes in the wake of feedback from users who found temporary cooling centers useful, but wanted many more; and for these to be activated at 39°C, not just 41°C. BDRCS cooling stations are simple, but 2–4°C cooler than the outside exposed area, Zubair says. This can make a big difference.

Even more enduring changes would be to housing, public infrastructure, education and preparedness systems.

Even the best infrastructure and health-system plans in the world can’t get around the fact that often, people on limited incomes can’t afford to stop working or seek out medical care, even in dangerous conditions. One solution could be simply to strengthen those incomes ahead of heatwaves. Small cash transfers could be especially helpful for instance to gig workers in Indian cities , who might otherwise need to endure punishing temperatures to meet their daily needs.

Zubair has a long history with the Red Cross/Red Crescent movement. He started volunteering as a teenager, after he saw some older students volunteering in flooded parts of north Bengal. It stoked his curiosity, seeing how competent they seemed. He realized that volunteering could be a win-win: “I can develop my organizational skills, and I can also help the people.”

Twenty years later and now working for BDRCS, floods aren’t the only disaster concerning Zubair. Heat is increasingly a concern in Bangladesh, which is facing an extra 37.5 days per year of heat stress due to climate change. Even in the last five years, Zubair has noticed the weather getting more extreme. From power outages to melting roads, the summer is getting harder to endure.

Starting in 2024, following heat-action planning that Zubair was involved in, BDRCS trialled cash distribution during extreme heat. In 2024 they made transfers to outdoor workers in Dhaka, and in 2025 in Rajshahi , they topped up the government’s usual small transfers to elderly people by 2,400 taka (approx. US$ 20). This work depended on volunteers fanning out to identify vulnerable people, inform them of the forthcoming payments, and address any issues like mobile payments.

After receiving the money, it was most common for the elderly recipients to spend it on medical needs , which can be intensified during extreme heat. Others used it to buy food or adjust homes, for instance to limit scorching sunlight .

“I believe that cash is the best action compared to any other type of support, because for heatwaves households are having different types of problems,” Zubair says. “If you can deliver cash to the people, they can decide their own problems and solve their own problems.”

It’s not a perfect solution, of course. It can be time-consuming to identify vulnerable people, and there’s a risk of creating resentment when some people receive extra help while their neighbors are left out.

But for BDRCS, “cash is always a priority,” Zubair says. “There are people who are very much suffering from the heatwaves, and they need assistance because they don’t have any other options. If they don’t earn today, they have to be starving today.”

This is the hardest needle to thread. In Bangladesh, cash support during heatwaves has depended on international funding.

In the U.S., political shifts have meant a loss of momentum and money for heat response in the last couple of years. Scottsdale, Arizona has reported being unable to track the implementation of its heat actions because of limited federal funding.

Meerow has seen firsthand the impacts of cut-off funds. In 2024, she and colleagues established a center that planned to work with communities over a couple of years to develop strategies for heat resilience. The following year, the assigned federal funding for that was cancelled. The team was able to publish a toolkit , but not to work with the communities fully. Other cancellations of federal funding have meant an end to programs planting trees in cities, addressing heat-related illness in outdoor workers, and reducing the summer energy bills of low-income families.

But some strategies don’t require a lot of resources. The installation of water ATMs in Nepalgunj, Nepal has been a cheap and apparently successful action.

Meerow and her colleagues recognized that a universal list of heat-action indicators just wouldn’t work across diverse contexts. For instance, it might be important in a rural area to track deaths of livestock during extreme heat. In contrast, in Cape Town’s very unequal geography, ambulance teams don’t go into informal settlements with poor roads. So counting emergency calls would miss a huge proportion of city residents, who are already spatially and economically excluded.

“The data infrastructure, the resources, the capacity are just so different in these different communities,” Meerow comments. Instead, she and colleagues have created a spreadsheet with a variety of options , piloted with cities in Austria, Nepal, South Africa and the U.S. The tool will be communicated to Red Cross and Red Crescent societies, in the hope that cities will take up this general tool and develop and track their own indicators.

Meanwhile, governments continue to develop their heat action plans. For example, the national heat action plan for Bangladesh “is currently at a very early stage of development,” Zubair reports. Around the world, now is the time to be learning and planning for the next heat season.