Heat, health and inequalities in the WHO European region – a scoping review with an intersectional lens

Climate change exerts diverse impacts on human health, with heatwaves emerging as a substantial concern. Social and health inequalities play a decisive role in this. Older people, children, and people experiencing homelessness or with low socioeconomic status, among others, are particularly affected by the health effects of heat and heatwaves. There is little evidence on the burden of being affected by multiple determinants of inequalities in the context of heat events. We aimed to map the research evidence on inequalities in heat-related health outcomes and their determinants in the World Health Organization (WHO) European region, applying an intersectional lens. This means considering how interlocking systems of power and oppression interact to affect the health and wellbeing of people differentially based on their varying and diverse social positions and identities. To this end, we undertook a scoping review of reviews. In 7/2023 and 8/2023, we systematically searched Pubmed and Epistemonikos and updated our searches in 9/2025. We mapped included studies based on methodology and determinants of inequalities considered in the analysis of heat impacts on health. We screened 968 unique records and ultimately included 28 reviews. Included reviews cover all parts of Europe. Age and sex/gender were the most frequently assessed determinants of inequalities in this body of evidence. Only one meta-analysis presented disaggregated data for subgroups. Intersectionality or related terms were only explicitly mentioned in four reviews, and no review applied intersectionality as a foundational paradigm. The findings suggest that age and sex/gender are more broadly assessed in the literature on heat-related health outcomes than other determinants. Whether authors assessed sex or gender is mostly not explicitly stated, impeding categorization as either a structural (gender) or intermediary (sex) determinant. Overall, intermediary determinants were more frequently assessed than structural determinants. Less frequently assessed determinants such as ability, income or education require further investigation in terms of their effects on health outcomes, as well as their amenability through generic or tailored measures. Intersectionality is only minimally reflected in the included literature. Future studies should employ mixed-methods approaches that seek to not only quantify heat-related health inequalities but also establish why they arise and whether and to what extent they are policy-amenable.