Addressing the Public Health Impacts of Extreme Heat: A Call to Action

By J. Nadine Gracia, M.D., MSCE, President and CEO

Welcome to TFAH’s new leadership blog Advancing Public Health and Health Equity, where I’ll share reflections on the challenges confronting the public’s health, success stories, and evidence-based solutions.  There is much to discuss. Let’s dive right in on an issue that’s top of mind:  the increasing levels and duration of extreme heat and its effect on health. In fact, just this past week, the National Weather Service, a federal agency within the National Oceanic and Atmospheric Administration, issued warnings of dangerous heat waves for parts of Arizona, California, and Nevada.

Last month, I had the pleasure of attending the Milken Institute Global Conference 2024: Shaping a Shared Future. Among the many compelling sessions was one entitled, “Strengthening Global Climate-Resilient Health Systems,” which addressed developing multisector solutions, building global consensus for climate-health action, and investing in a healthier, more equitable future. One of the session speakers, Dr. Githinji Gitahi, Group Chief Executive Officer of Amref Health Africa, passionately said that “Health is the human face of the climate crisis.”  In this powerful statement, Dr. Gitahi put an appropriate focus on the changing climate’s effect on people and communities.

Why focus on extreme heat?

Climate scientists predict that episodes of extreme and prolonged heat waves will become more frequent and more intense. According to NASA, the summer of 2023 was the hottest ever recorded since record keeping began in 1880. Extreme heat is the leading cause of weather-related death in the nation and has led to more deaths than any other type of weather event for the past 30 years. A 2021 study also found that extreme heat-related labor productivity losses cost the U.S. $100 billion annually and is anticipated to increase over time. Furthermore, extreme heat has environmental impacts, including drought, food production, and food availability. These are not records that we should be setting.

While everyone will be impacted by climate change, it does not affect all people and places equally, including the consequences of extreme heat. For example, some population groups are at higher risk from extreme heat, such as children, older adults, pregnant people, people with disabilities, or people with chronic health conditions. Other groups at heightened risk include people who work outdoors, emergency responders, and people living in urban heat islands or rural areas.

Moreover, some populations are disproportionately affected due to longstanding structural and systemic inequities, including communities of color, Indigenous populations, low-income communities, and people experiencing homelessness. The enduring effects of inequities, such as intergenerational poverty, lack of access to quality healthcare, lack of access to quality education, limited access to safe, healthy, and affordable housing, and food and nutrition insecurity, cannot be ignored.

What Steps Need to be Taken?

We can, and we must, accelerate our actions. Heat-related deaths and illnesses are preventable. Climate mitigation efforts aim to reduce or prevent greenhouse gas emissions. In addition, we must advance our climate adaptation efforts to address extreme heat by strengthening the public health and emergency readiness systems that protect health and well-being.

Leadership at all levels, multisector collaboration, community engagement, sustained investment, and an unwavering commitment to advancing health equity will be key. To build a strong foundation for the nation’s preparedness and response to extreme heat, we must invest in public health infrastructure, the public health workforce, and data modernization in a sustained manner.  Congress should invest in CDC’s environmental health work, including assistance for states, localities, tribes, and territories to develop climate adaptation capabilities. We must also increase investments in public health and healthcare readiness and response, as they are the frontlines of protecting the health and well-being of communities. It is also critical that equity and the meaningful engagement of and partnership with communities be prioritized and that we invest in the capacity to address non-medical drivers of health, such as employment, housing, education, transportation, and food and nutrition security, so that we can truly create healthy and resilient communities.

Every sector – policymakers, government agencies, public health, healthcare, employers, schools, housing, city planners, businesses, academia, and more – needs to be engaged and has a role in addressing extreme heat and the overarching climate crisis. There are opportunities before us. The Infrastructure Investment and Jobs Act and the Inflation Reduction Act are milestone legislation in both climate mitigation and adaptation, and cities and states across the country are benefiting from these climate investments. Federal agencies are developing an array of tools to help communities prepare for extreme heat, such as the U.S. Department of Health and Human Services’ recent launch of the Heat and Health Index, the first nationwide tool to provide heat-health outcome information at the ZIP code level.  In addition, Heat.gov will help local and state officials identify population groups most at risk of the health impacts of heat and how to best protect their health.

More cities and states are establishing Chief Heat Officer positions to provide leadership and coordination on extreme heat. I encourage you to read TFAH’s recent report, 2024 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, including an interview with Marta Segura, MPH, the Chief Heat Officer for the City of Los Angeles. The report and interview describe how states and localities can prepare for heat waves and policy opportunities to address extreme heat and other threats to health.

Already in 2024, we are experiencing dangerous heat waves, and there are concerns that this year will see even more heat-related deaths in the U.S. than in previous years. Let that not be the story that we tell at the end of 2024. Rather, let us mark 2024 as the year that our nation took resolute and collective action to prevent heat-related illnesses and deaths and in doing so strengthened our nation’s health security.

Learn more about the health impacts of extreme heat and its disproportionate risk for some populations in the special feature of TFAH’s 2024 Ready or Not: Protecting the Public’s Health from Disasters, Diseases, and Bioterrorism report.