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A salt worker harvests salt in rural Gujarat, India. These workers often work long hours outside, in temperatures that can exceed 120 degrees Fahrenheit. (Photo courtesy of SEWA)
For tens of thousands of salt workers laboring in the deserts of Gujarat – a state in India – each year, employment was already hazardous.
These workers, many of them women, spend eight to nine months of the year harvesting and preparing salt for purchase, migrating from village life to work long hours in the open air, in heat that often exceeds 120 degrees Fahrenheit. The work is high-risk even at the best of times, often heading to injury, mineral toxicity, and heat-related health impacts. What water is available is trucked in – not enough to cool the shelters they erect from bamboo and burlap sacks, or even their bodies.
But in 2022, the situation started to change for the worse, said Reema Nanavaty, a social worker and director of the Self-Employed Women’s Association of India, or SEWA, an organization that advocates for the security, fair employment, health, and well-being of low-income women workers and their families. Temperatures soared above 125 degrees Fahrenheit during the summer, and workers were unable to labor safely in the heat.
“Whether they drank hot water or tea, it was the same,” Nanavaty recalled. “The salt, which was ready to be harvested…they had to abandon it all and return to the villages.” That meant going without the income they’d spent the past several months working to earn.
Large swathes of India and Pakistan experienced severe heat emergencies most recently in April 2025, with temperatures of 120 degrees Fahrenheit made worse by large-scale power outages, according to CNN.
Salt workers, often women from low-income communities, are vulnerable to mineral toxicity, injury, and heat-related health impacts. (Photo courtesy of SEWA)
None of these are isolated events. Direct Relief’s Research and Analysis team developed a series of recent reports showing the health impacts of a profound rise in extreme heat emergencies, as well as chronically higher temperatures and higher numbers of severely hot days, across the globe.
“Extreme heat events are occurring with increasing frequency, intensity, and duration worldwide, creating an urgent and growing threat to human health,” said Rachel Green, a Direct Relief data scientist. “These events are also deadlier than any other weather-related disaster.”
The Global Heath Health Information Network describes extreme heat’s “urgent and growing threat to human health” from immediate impacts like cell toxicity and heat exhaustion to the exacerbating effect on chronic conditions like cerebrovascular disease and diabetes to the stresses placed on health systems responding to a widespread and emergent need.
Not everyone is equally vulnerable, Direct Relief researchers noted. Infants, children, and older adults, along with people who have chronic illnesses, are pregnant, or are living with a physical or mental disability, are more likely to experience adverse effects. So are people who work outdoors, such as agricultural workers, people congregating closely together, and people who are unsheltered, low-income, or exposed to higher levels of air pollution, among other factors.
However, the dangers to health may go far beyond even heat exhaustion or exacerbated cardiovascular symptoms. Researchers at the National Bureau of Economic Research, in a working paper released earlier this year, noted that overcrowded health systems may lead to excess deaths – even among patients whose illness was not related to heat – as providers struggle to meet the increased demand for care.
For many of SEWA’s members, Nanavaty said, the most severe impacts of extreme heat at this point are economic. Agricultural workers may struggle to work enough during the heat to harvest crops (which may themselves be affected by soaring temperatures). The loss of income may mean there’s not enough food; that children go without health care; or that women turn to unscrupulous moneylenders or are compelled into sex work to ensure they and their families can eat.
“Nobody looks at these impacts,” Nanavaty said. She noted that while climate scientists often focus on large-scale data – global temperature fluctuations and increased numbers of extreme heat events over time, for example – people experience impacts that are location-specific and immediately relevant to their own lives. Many of SEWA’s members, for example, may not know what’s causing the rise in temperatures.
SEWA operates a microinsurance program for workers vulnerable to extreme heat, helping them to reduce the economic costs of protecting their health and safety. (Photo courtesy of SEWA)
“How does that science translate into action?” Nanavaty asked. “We cannot wait for policies and programs to come because their day-to-day survival is at stake.”
The experience of SEWA’s members is directly in line with what scientific research shows, Green explained. “In regions prone to extreme heat, economic losses from these conditions can create a deadly cycle where families can’t afford air conditioning, healthcare, or the luxury of staying indoors, forcing them into increasingly dangerous conditions that worsen both their health and financial situations.”
For that reason, Direct Relief researchers noted, health interventions that effectively mitigate climate impacts often focus on household or community-level solutions. Access to personal cooling strategies like self-dousing in water or soaking clothing often mitigate the most immediate threat. Healthcare workers can be trained to monitor for, recognize, and immediately treat heat-related symptoms.
Many commonly prescribed medications – including mental health treatments, drugs for cardiovascular conditions such as ACE inhibitors, diuretics, and antihistamines – may actually increase vulnerability to heat-related illness, according to the Arizona Department of Health Services. And while cooling centers can be an effective community intervention, reducing heat-related emergencies and other impacts, social stigma often prevents people from seeking relief, The New York Times reported.
Financial programs may also help vulnerable populations mitigate their heat exposure and reduce the risk to their health. The federally funded Low Income Home Energy Assistance Program, for example, assists many U.S. households with the costs of cooling their homes in summer. SEWA operates an extreme heat microinsurance program, which provides financial payouts to members when extreme heat persists for two days – insulating them from the extraordinary financial costs of protecting their health from dangerous heat levels.
Despite the need for local- and household-level intervention, Green said large-scale data have an increasing role to play as well.
A woman processes the salt harvest in Gujarat, India. (Photo courtesy of SEWA)
“Heat is deceptively dangerous,” she explained. “Unlike hurricanes or floods, extreme heat strikes without obvious warning signs, making early detection and public awareness life-saving tools.” Monitoring and analyzing climate change on a global scale allows researchers to anticipate heat surges and long-term changes – and can inform preparedness and response work.
“For healthcare systems, emergency managers, policymakers, and organizations like Direct Relief, comprehensive data enables preparation for heat surges, targeted warnings, and resource deployment to affected communities,” Green said.
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