Extreme Heat Public Health Preparedness Planning and Response Activities in the Most Populous Jurisdictions in the United States: Survey Results

Background and Aim: Extreme heat causes more deaths each year than any other type of extreme weather in the U.S. Urban populations can experience heightened heat risk as a result of hazard amplification from the built environment and other factors. Climate change is increasing extreme heat exposure, prompting the need for adaptation measures at all levels of governance. Our study aimed to assess the level and type of heat preparedness and response activities occurring in U.S. jurisdictions with populations of 200,000. Method: We developed and administered an online survey to public health and emergency management agencies in 99 jurisdictions representing municipalities and counties in the US with populations of at least 200,000 people. Survey questions explored heat adaptation activity implementation, including presence or absence of a written heat action plan (HAP), timing of HAP development and updates, critical HAP components, and facilitators and barriers surrounding heat activities. Results: 38.4% (38) jurisdictions responded to the survey. Of those, 60.5% reported having a formal HAP. There was considerable variability in the prevalence of various prevention activities. Jurisdictions with HAPs reported higher engagement in several heat-related activities, including communications about extreme heat, surveillance of heat-related health conditions, and providing climate-controlled shelter for populations experiencing homelessness, compared to jurisdictions without HAPs. The most prevalent communication and outreach modalities were social media, news alert, and internet, which may be less likely to reach populations identified as the most vulnerable to extreme heat (low income, elderly, and people experiencing homelessness). Conclusions: Jurisdictions with formal HAPs broadly reported more engagement in heat adaptation activities. Results indicate reliance on lower-cost outreach strategies that may not adequately reach some at-risk populations. Health departments and emergency agencies should consider establishing HAPs as temperatures rise. Keywords: Extreme heat, climate change, adaptation, public health preparedness