Extreme weather events (EWEs), including floods, wildfires and extreme temperatures, have substantial short-and long-term impacts on human health. This systematic review synthesises evidence on the health impacts of EWEs, their economic burden and the methods used to estimate associated costs.
Methods: Following the PRISMA guidelines, we searched PubMed, ScienceDirect, ISI Web of Science, and other sources on 9 October 2025 for peer-reviewed and grey literature reporting the costs of human health losses associated with EWEs. Eligible studies were published in English with no restrictions on publication year or location. Findings were synthesised narratively and presented using descriptive statistics, tables, and figures. The review was registered with PROSPERO (CRD42024582635).
Findings: Of 36,382 records identified, 112 studies from at least 25 countries met the inclusion criteria. Most examined extreme temperatures (75%), followed by wildfires (15%), floods (7%), cyclones/hurricanes (2%), droughts (2%), and combinations of EWEs (7%). EWEs adversely affected both physical and mental health. Although investigated in relatively few studies, mental health impacts and reduced well-being accounted for a substantial share of the economic burden. In addition to immediate impacts, many studies reported delayed, and persistent health impacts lasting months or years after exposure.
Cost-of-illness analysis (60%) was the most commonly used approach, with around 35% using the value-of-statistical-life or value-of-statistical-life-year to estimate costs associated with healthcare utilisation and mortality. Other methods included contingent valuation, defensive behaviour, willingness-to-pay and willingness-to-contribute approaches. Study quality was predominantly moderate (77%), with 6% rated as high quality.
Interpretation: The evidence demonstrates that EWEs are a major and growing public health and economic challenge. These impacts are shaped by demographic, socioeconomic, and local environmental factors, often disproportionately affecting vulnerable populations. Health consequences may occur immediately or emerge over longer periods, while the cumulative effects of multiple EWEs are likely to be greater than those of individual events.
