It’s time to go beyond awareness and advice: A systematic review and policy analysis of heat-protection interventions for people experiencing homelessness.
1
Heat and Health Research Centre, University of Sydney, Sydney, Australia
Popul. Med. 2026;8(Supplement Supplement 1):A435
ABSTRACT
INTRODUCTION:
People experiencing homelessness face disproportionate heat-health risk, with global warming compounding that risk.1-4 This review aimed to identify, synthesise and characterise the types, implementation strategies, and effectiveness of interventions intended to mitigate heat-health risk among people experiencing homelessness during extreme heat.
METHODS:
The literature search included keywords for “homelessness”, “heat” and “intervention”, with peer-reviewed English-language articles retrieved from eight scholarly databases from inception to January 2026. Quality assessment was completed on implementation and health effectiveness, with data extracted and synthesised narratively. Using the same search strategy, Overton was searched for Australian policies published from January 2016 to January 2026. Extracted policy data were imported into NVivo software, creating codes and themes for narrative synthesis. PROSPERO: CRD420251104580.
RESULTS:
Thirteen articles were included. Implementation quality ranged from low to moderate; health effectiveness quality was very low. One study showed a reduction in mean body temperature and heart rate among older people experiencing homelessness after attending a cooling centre (air-conditioned space) for ≥70 minutes. However, evidence highlighted barriers to accessing cooling centres such as strict rules and limited hours, resulting in use of alternative public cool spaces, including libraries. Outreach teams providing cooling supplies and heat-health information showed high reach and acceptability. Shading propped above tents limited in-tent mean radiant temperature and, when removed overnight, increased in-tent airflow and reduced in-tent air temperature. Thirty policies were included. Beyond suggesting crucial long-term housing provision, policies relied on providing advice to attend a cool space without ensuring accessibility or evaluation. Promising exceptions aiming to improve accessibility, such as outreach-based mobile cooling hubs and provision of cooling supplies, remain under-evaluated.
CONCLUSIONS:
Interventions intended to mitigate heat-health risk among people experiencing homelessness remain predominantly passive with limited evaluation. Shifting towards active outreach and low-barrier interventions, with robust evaluation, could generate evidence to guide effective heat protection.
People experiencing homelessness face disproportionate heat-health risk, with global warming compounding that risk.1-4 This review aimed to identify, synthesise and characterise the types, implementation strategies, and effectiveness of interventions intended to mitigate heat-health risk among people experiencing homelessness during extreme heat.
METHODS:
The literature search included keywords for “homelessness”, “heat” and “intervention”, with peer-reviewed English-language articles retrieved from eight scholarly databases from inception to January 2026. Quality assessment was completed on implementation and health effectiveness, with data extracted and synthesised narratively. Using the same search strategy, Overton was searched for Australian policies published from January 2016 to January 2026. Extracted policy data were imported into NVivo software, creating codes and themes for narrative synthesis. PROSPERO: CRD420251104580.
RESULTS:
Thirteen articles were included. Implementation quality ranged from low to moderate; health effectiveness quality was very low. One study showed a reduction in mean body temperature and heart rate among older people experiencing homelessness after attending a cooling centre (air-conditioned space) for ≥70 minutes. However, evidence highlighted barriers to accessing cooling centres such as strict rules and limited hours, resulting in use of alternative public cool spaces, including libraries. Outreach teams providing cooling supplies and heat-health information showed high reach and acceptability. Shading propped above tents limited in-tent mean radiant temperature and, when removed overnight, increased in-tent airflow and reduced in-tent air temperature. Thirty policies were included. Beyond suggesting crucial long-term housing provision, policies relied on providing advice to attend a cool space without ensuring accessibility or evaluation. Promising exceptions aiming to improve accessibility, such as outreach-based mobile cooling hubs and provision of cooling supplies, remain under-evaluated.
CONCLUSIONS:
Interventions intended to mitigate heat-health risk among people experiencing homelessness remain predominantly passive with limited evaluation. Shifting towards active outreach and low-barrier interventions, with robust evaluation, could generate evidence to guide effective heat protection.
| eISSN: | 2654-1459 |
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