In many places extreme heat causes more deaths than floods, cyclones and bushfires. However, efforts to manage the health implications of heat and increase the adaptive capacity of vulnerable populations are in their infancy, requiring urgent attention from research and policy. This paper presents a case for research exploring the influence of social and contextual factors on vulnerable populations’ capacity to adapt to heat in the context of climate change. We argue such research is imperative given current prioritization of short-sighted policy solutions such as installation and use of greenhouse-intensive domestic air-conditioners as moderators of heat stress. Globally, vulnerability to heat stress is most often assessed by epidemiological analysis of past morbidity and mortality data; yet a range of other factors need to be accounted for in interpreting and understanding these patterns of ill-health and loss of life, and further in determining how vulnerability is created, exacerbated and alleviated by broader societal conditions. Such factors include: the cooling technologies and infrastructures available to householders, practical knowledge about how to moderate heat stress, and social and cultural understandings of comfort and vulnerability. To investigate these factors, new methodologies are required. Social practice theory, which conceptualizes the dynamic interactions between individuals and wider systems of power, infrastructure, technologies, society and culture as components of practices such as household cooling, is presented as a way forward. The development of a practice-based methodology and conceptual framework to understand adaptation to heat will provide a multidimensional, systems-oriented understanding of how vulnerability can potentially be reduced.