São Paulo’s sustainability vision linking health, resilience and food access

As São Paulo’s thermometers marked record-breaking temperatures last year, the heat wave refused to relent, with March 2024 hitting nearly 35°C—the highest for the month since 1943. The City of São Paulo is committed to nurturing a healthier, more resilient community by tackling health-related issues due to rising temperatures and air pollution. Here, we spotlight initiatives on how São Paulo ensures its residents stay cool, and, above all, healthy.


On Saturday 16 March 2024, São Paulo’s residents turned to swimming pools and parks to cool off the heat. According to the City of São Paulo, the 45 Unified Educational Centers’ swimming pools received more than 23 thousand people that weekend, reaching their maximum capacity. With thermometers showing a maximum of 34.7°C, the city experienced the hottest day of the year, according to the National Institute of Meteorology (Inmet). This mark represents the highest temperature recorded for March since 1943.

However, the recent heat wave in the city wasn’t unfamiliar to Paulistas. During September 2023 -the last month of winter in the southern hemisphere- temperatures surpassed 36ºC, prompting local authorities to implement measures to mitigate the effects of the climate emergency. 

Changes to São Paulo’s climate include more frequent intense rainfall – like the extreme flooding that has recently devastated the south of Brazil –  and increasingly higher temperatures, directly affecting people’s health. According to the World Health Organization, heat waves can lead to a range of health issues, from dehydration, sunburn, and heatstroke to lower blood pressure, fainting, and even hyperthermia, ultimately resulting in death.

A swift response to beat the heat

Recognizing the potential health impact of the predicted heat last September, particularly on vulnerable populations, the City of São Paulo put in motion its pioneering initiative, Operation High Temperatures (OAT). This contingency plan is activated whenever thermometers reach 32°C or equivalent thermal sensation, based on historical climate analysis parameters from São Paulo’s Climate Emergency Management Center (CGE).

Ten tents are located at strategic points in the city, where municipal staff provides free water, iced tea and fruit supplies, caps, and even pet drinking fountains. The staff also guides residents through self-care measures and refers homeless people to the city’s reception centers. The tents are equipped with fans and offer shelter from the sun, where anyone can rest and hydrate. A designated ambulance is also available at each tent for a swift response to assist in emergencies due to heat exposure.

São Paulo offers Latin America’s largest social assistance network, boasting over 25 thousand places for homeless people. Through the OAT, São Paulo also ensures that these facilities are equipped with fans and drinking fountains. From September 2023 to March of this year, the OAT provided close to 1,4 million services and distributed more than 3,1 million items, including bottles of water and fruits.

Monitoring the air

Extreme weather events, such as heat waves or extreme cold, caused by climate change, can also significantly degrade air quality. Human-made sources of air pollution compound this, exacerbating health risks and highlighting the urgent need for action.

In 2023, the City of São Paulo adopted the Environmental Health Surveillance Program Related to Populations Exposed to Atmospheric Pollutants (VIGIAR). Its mission is to guide and promote health prevention by prioritizing areas with diverse economic activities prone to air pollution. 

VIGIAR employs so-called “sentinel units” (US) to track respiratory diseases in high-risk groups, especially children under five, detecting symptoms like dyspnea (shortness of breath), wheezing, and cough. In 2023, 12,266 cases were recorded, with more than 2,000 cases reported as of 12 April this year.

During periods of low air humidity, VIGIAR issues alerts to Health Surveillance Units (UVIS) and Regional Education Directorates (DREs) in coordination with São Paulo’s Civil Defense. Health and educational facilities then implement coordinated instructions to mitigate the health impacts on residents.

VIGIAR is integrated into São Paulo’s Climate Action Plan (Planclima) 2020-2050, with a target to expand to 27 sentinel units by 2025, currently operating 13 in the city. Aligned with this, Planclima has set ambitious goals to slash carbon emissions by 2028 and achieve complete eradication by 2038, ensuring clean air for Paulistas while addressing the climate emergency head-on.

Greener, healthier communities

How can urban and human development align with environmental preservation? This is the holistic approach of São Paulo’s Green and Healthy Environments Program (PAVS). Developed in 2005, PAVS strengthens intersectoral policy management at the local level by implementing over 1,500 integrated socio-environmental projects within the scope of primary care in more than 300 Basic Health Units (UBS) under the city’s Family Health Strategy.

PAVS focuses on six guiding axes that are interrelated through the principles of a culture of peace and citizen participation: Biodiversity and Afforestation, Garden and Healthy Eating, Waste management, Environmental Agenda in Public Administration, Revitalization of Public Spaces, and Water, Air and Soil. The program employs its Manual for Elaborating Socio-Environmental Diagnoses, a tool designed to identify and georeference the actual needs of the territory, facilitating participatory planning and guiding health interventions, such as promoting better eating habits.

The program has provided environmental training to 9,000 community health and social protection agents. These municipal professionals promote education and community mobilization to raise health awareness.

In conjunction, São Paulo has grown community gardens in 130 Basic Health Units, including 43 therapeutic gardens with medicinal plants. Here, residents learn plant cultivation and composting techniques and explore herbs’ therapeutic properties. This approach integrates traditional knowledge, empowering communities and promoting sustainable health and environmental practices.

In addition, the newly launched Refresh São Paulo Project empowers youth as catalysts for change by working with them to plant native flora in schools, thus expanding urban green spaces to mitigate temperature spikes and curb air pollution. With a focus on environmental education, particularly emphasizing health and climate resilience actions, the project targets children and teenagers—the generation born into the climate emergency. São Paulo is counting on their potential to lead the charge toward a greener and healthier city.

*Photo credit: © São Paulo Municipality