Countries throughout southern Africa, parts of east Africa and Madagascar are all projected to face rapidly increasing temperatures to the end of this century. High temperatures cause heat stroke, heat exhaustion, heart attacks, strokes and other cardiovascular disease. South Africa will experience more heat waves, so more heat-related deaths are likely. People in informal settlements, and badly maintained and crowded buildings, are especially vulnerable to heat stress. Cities are also hot spots. Heat absorbed by roads and buildings results in the urban “heat island effect”, while increased use of energy for cooling adds to greenhouse gas emissions.