Structural Inequalities and Heatwave Exposure in Developing Countries: A Structured Review of Socioeconomic and Environmental Vulnerability and Coping Strategies, with a Focus on Pakistan

Abstract

Heatwaves are among the most serious manifestations of climate change, affecting health, livelihoods, food security, and environmental sustainability. Their effects are amplified by structural inequalities, socioeconomic disadvantage, and environmental vulnerability, particularly in Pakistan and comparable developing-country settings. This structured review synthesizes evidence on the links among inequality, heat exposure, vulnerability, and adaptation. Scopus, Web of Science, PubMed, ScienceDirect, Google Scholar, and relevant institutional sources were searched between February and April 2025 for English-language material published from January 2011 through April 2025. Because the included evidence varied in design and outcome measures, it was synthesized narratively using the Intergovernmental Panel on Climate Change framework of exposure, sensitivity, and adaptive capacity. Seven themes were identified: income inequality and economic vulnerability; housing and urban infrastructure; occupational exposure and loss of labour productivity; social vulnerability and gender disparities; health-care access and institutional adaptive capacity; environmental degradation and water scarcity; and coping and adaptation. The evidence indicates that low-income households, outdoor and informal workers, women facing resource constraints, residents of informal settlements, and environmentally marginalized communities often face greater exposure or fewer resources to adapt. Inadequate housing, weak service provision, limited health-system preparedness, insecure livelihoods, and declining environmental resources can compound risk. Effective adaptation therefore requires integrated, equity-focused policies that address poverty, gender inequality, health-care access, resilient infrastructure, environmental sustainability, occupational protection, and institutional preparedness.