India is home to 11 % of the global urban population and is ranks as the second-largest urban system in the world. This study introduces a Heat Health Risk Index (HHRI) rankings for 37 major Indian cities with more than one million residents, using geospatial and socio-ecological data to identify potential heat health risk areas. In this study, the Otsu method was employed to determine the critical parameters in the heat health index, considering factors such as Land Surface Temperature (LST), solar radiation, population density, mean temperature, urban green cover, rainfall, specific humidity, and wind speed. All data values were standardized to a uniform scale (0–1) for comparability. The standardized values, integrated with the assigned weights, formed the HHRI. Results indicate that cities such as Chennai, Mumbai, Kolkata, and Ahmedabad, each with populations exceeding 10 million, are deemed less livable due to their high HHRI (>0.50). Both Chennai and Mumbai stand out with highest hazard index as 0.66, followed by Kolkata (0.62) and Ahmedabad (0.56). Cities that lack sufficient green spaces are often more vulnerable, display elevated risk levels, and have decreased adaptability. In contrast, cities such as Ludhiana, Theni, Amritsar, and Nabarangpur are perceived as the most livable, with a mean HHRI of 0.21, owing to their higher adaptive capacity and lower exposure. Overall, this study serves as a foundation for conceiving future perspective plans for existing urban and peri‑urban areas, compared to living standards within the realms of sustainability.