Extreme Heat, Medication-Related Vulnerability and Climate Adaptation: Integrating Public Health, Ecological Conditions and Community Autonomy

Extreme heat is an increasingly important public health challenge under climate change. Its health consequences depend on environmental exposure, clinical vulnerability, medication use, housing conditions, socioeconomic resources and access to protective measures. This interdisciplinary critical evidence synthesis examines published research on heat-related health outcomes, antihypertensive medications, climate adaptation and the ecological and social determinants of vulnerability. A Portuguese observational study documented increased hospital admissions during heatwave days (IRR 1.189; 95% CI 1.179–1.198). A Japanese self-controlled case series identified differences in heat-related illness associations according to antihypertensive prescription status, without establishing medication-specific causality. European research associated comprehensive heat prevention plans with an estimated 25.2% reduction in heat-attributable excess mortality, compared with a country-specific estimate of 10.0% for Portugal. These historical, model-based findings cannot be interpreted as guaranteed future adaptation benefits. The manuscript integrates ecological and territorial conditions with People, Community and Autonomy (PCA), a conceptual framework for participation, accessibility, informed decision-making, and institutional responsibility, rather than a clinically validated intervention. Three climate pathways—SSP1-2.6, SSP2-4.5 and SSP5-8.5—are presented as conditional possibilities for future research. No original causal analysis, quantitative climate-health projections or new estimates of medication-related harm are produced. The synthesis emphasises the distinction between observed associations, causal uncertainty and potential adaptation benefits. Effective climate-health protection requires scientifically grounded interventions, equitable access, institutional accountability and respect for human autonomy. This manuscript is a critical interdisciplinary perspective, not a systematic or scoping review, and has not been peer-reviewed.