Heat Indicators for Global Health (HIGH) Horizons

Developing evidence, indicators and solutions to strengthen health system resilience to climate change.

Project Overview

HIGH Horizons (Heat Indicators for Global Health) is a multi-country research and implementation programme working to understand, measure and address the impacts of climate change and extreme heat on health systems, healthcare workers, maternal and newborn health, and healthcare infrastructure. The project develops practical tools, indicators and interventions that support climate-resilient and low-carbon health systems.

Funding

HIGH Horizons is funded by the European Union’s Horizon Research and Innovation Programme under Grant Agreement No. 101057843. Project partner LSHTM is funded by UKRI Innovate UK reference number 10038478.

The Challenge

Climate change threatens health systems through:

• Rising temperatures
• Heat-related illness
• Healthcare worker strain
• Infrastructure vulnerability
• Increased service demand
• Growing carbon emissions from healthcare delivery

Despite these risks, many health systems lack indicators, evidence and practical adaptation strategies. HIGH Horizons addresses this gap.

HIGH Horizons Sub-studies

Carbon Emissions and Mitigation in Healthcare

Objective
Supporting low-carbon and climate-resilient healthcare systems.

Activities

• Energy-efficient technologies. Cooling system optimisation. Waste management improvements. Resource efficiency interventions. Carbon footprint reduction strategies.

Mitigation Interventions

• Tree Planting
• Efficient air conditioning systems
• Waste segregation dustbins
• Waste Recycling training & programmes
• Facility-based Reflective Roof Painting
• Sustainable facility operations

Healthcare Worker Heat and Occupational Health

Objective
Understanding how heat affects: Health worker wellbeing. Occupational health. Service delivery. Productivity. Clinical performance.

Activities

• Heat-health literacy assessments. Time-motion studies. Occupational health evaluations. Training interventions

Health System Adaptation and Resilience

Objective
To identify, implement and evaluate interventions that strengthen health system resilience to extreme heat.

Facility-level interventions

• Air conditioners
• Water filter dispensers
• Facility-based Heat Champions
• Community health worker Cooling Vests
• Facility-based Temperature and humidity monitoring
• Seating in shaded areas
• HCW capacity building in Heat-Health knowledge
• HCW Cooling System Maintenance Training
• Reflective roof painting
• Tree planting

Policy-related solutions

Maternal, Newborn and Child Health Indicators

Development and validation of climate-health indicators with regional and national stakeholders aligned with:

• WHO frameworks. National monitoring systems. Health information systems. Global adaptation reporting.

Outputs

• Indicator frameworks. Monitoring guidance. Policy recommendations.

Photovoice

Community Perspectives on Climate and Health

Photovoice enables healthcare workers and community members to document their lived experiences of heat and climate-related health challenges.

Outputs

• Visual narratives. Community engagement. Policy advocacy materials. Public exhibitions.

Small Population Impacts

Objective
Developing approaches to estimate climate-health impacts among populations often missed by traditional surveillance systems.

Applications

• Vulnerability mapping. Service planning. Resource allocation. Equity-focused adaptation

Heat Early Warning Systems (EWS)

Mother Heat Alert

Development and evaluation of digital heat-health early warning systems for pregnant and postpartum women.

Focus Areas

• Risk communication
• User-centred design
• Behaviour change
• Mobile technologies
• Climate-health literacy

Countries

• South Africa, Zimbabwe and Sweden.

Key Achievements

Health Facilities

• Multiple adaptation interventions implemented. Facility climate resilience strengthened. Healthcare worker engagement expanded.

Evidence Generation

• Heat-health indicators developed. Early warning systems evaluated. Carbon mitigation interventions assessed. Occupational health evidence generated.

Capacity Building

• Healthcare worker training. Climate-health literacy strengthening. Stakeholder engagement.

Future Impact

HIGH Horizons is generating evidence that supports:

• Climate-resilient healthcare systems
• National adaptation planning
• Occupational health policies
• Maternal and newborn health protection
• Sustainable healthcare delivery
• Climate-health monitoring frameworks

HIGH Horizons Project Outputs

Peer-Reviewed Journal Articles

Indicators & data analyses of impact of heat on maternal, newborn and child health include publications such as:

• Bao et al. (2026) Environmental Research
• HIGH Horizons Study Group protocol (Zenodo, 2026)
• Fomenko et al. (2026)
• Brimicombe et al. (2025–2024 series)
• Lakhoo et al. Nature Medicine (2024)
• Brink et al. BMC Pregnancy and Childbirth (2024)
• And multiple systematic reviews, meta-analyses and pooled studies across Africa, Europe and Asia

Adaptation Interventions to Reduce Heat Impact on Health Workers

Key outputs include:

• Ethnographic and qualitative studies on heat stress in healthcare workers
• Occupational health baseline analyses
• Heat risk assessment tools for health facilities
• Intervention implementation studies across South Africa, Zimbabwe and Kenya

Early Warning System for Pregnant and Postpartum Women and Infants

Includes:

• Photovoice studies on lived experiences of heat exposure
• Global evidence on heat-health warning thresholds
• Development of ClimApp-MCH and MotherHeat Alert tools
• Protocols for testing early warning systems
• Heat-health communication tools and frameworks

Technical Reports

Includes:

• EU Horizon reporting documentation (CORDIS)
• CARBOMICA resource allocation tool
• Heat-health action plan reviews
• Indicator scoping meetings (WHO)
• Data management plans and environmental exposure studies

Tools and Guidance

• Heat-related workplace risk assessment tools
• EWS MotherHeat Alert costing tools
• CARBOMICA modelling tools
• Integrated adaptation and mitigation costing tools
• Checklists and frameworks for health worker heat stress
• Conceptual frameworks on heat-health impacts

Conference Presentations & Blogs

A wide range of dissemination outputs available at:
https://www.high-horizons.eu/co-design-in-climate-adaptation/
https://www.high-horizons.eu/science-policy-and-people-rethinking-climate-health-resilience-in-africa/
https://www.high-horizons.eu/high-horizons-at-imnch-2026-evidence-to-action-on-extreme-heat-and-mnch/
https://www.high-horizons.eu/now-showing-extreme-heat-mnch-health-workers/
(and many more listed project dissemination pages)

Data Repository 

Full repository

Contact Information

Stakeholder Engagement Officer (Climate and Health): Pamela Tshandu

Principal Investigator: Associate Prof Sibusiso Mkwananzi