While access to cooling is the most protective factor against extreme heat events, the U.S. Census lacks granular, residential data to determine who has access to air conditioning (AC). The addition of a question about household access to working AC to the Census American Community Survey, a nationally representative survey on the social, economic, housing, and demographic characteristics of the population, would have life-saving impacts.

This is especially essential as the U.S. is experiencing more frequent and intense extreme heat events, and extreme heat now kills more people than all other weather-related hazards. Many vulnerable demographics — including people who are elderly, low-income, African-American, socially isolated, as well as those with preexisting health conditions— are exposed to high temperatures within their homes. 

Better data on working AC infrastructure in American homes would improve how the federal government and its state and local partners target local social services and interventions, such as emergency responder deployment during high-heat events, as well as distribute federal assistance funds, such as the Weatherization Assistance Program (WAP), Low Income Home Energy Assistance Program (LIHEAP), and funding from the Inflation Reduction Act (IRA) along with the Bipartisan Infrastructure Law (BIL).

Challenge and Opportunity 

In 2019, the U.S. Census Bureau acknowledged the danger of heat by issuing the Community Resilience Estimates (CRE) for Heat. The CRE for Heat is a measure that combines 10 questions from the existing American Community Survey questions. The questions ask about:

1. Financial hardship 
2. Older residents living alone 
3. Crowding 
4. Whether the home is a mobile home, boat, or recreational vehicle
5. Employment status for those under 65 years old
6. Whether a resident has a disability
7. Whether a resident has health insurance 
8. Access to a vehicle
9. Connection via broadband internet access
10. Communication barriers

However, the CRE for Heat lacks a question about air conditioning, the most important protective factor. Indoor temperature regulation is essential for mitigating heat illness and death on extremely hot days – temperatures above 86°F indoors can easily become dangerous and deadly.

Currently, the best information on residential AC is provided by the biennial American Housing Survey (AHS). In 2019, the AHS reported that 8.8% (11.6 million households) of all U.S. housing units have no form of AC. However, this information has three significant weaknesses. First, the American Housing Survey is based on 2,000 homes sampled across a metropolitan area. The sampling process generates an average across high-, medium-, and low-income residents; therefore, it overestimates the presence of AC in lower-income households. American households with higher incomes are more likely to have access to AC: 92.2% of households with incomes greater than $100,000 have some form of AC, compared with 88.9% of households with incomes less than $30,000. Second, lower-income households may have broken AC systems or units and lack money for repairs, skewing collected data. Third, the AHS fails to consider how poverty constrains electricity consumption. Many lower-income households reduce or abstain from using their AC in fear of costly electricity bills that trigger shutoffs. For instance, a 2022 report found that nearly 20% of households earning less than $25,000 reported keeping their indoor temperatures at levels that felt unsafe for several months of the year. These three weaknesses of the AHS data underscore the need for fine-grained information on who has access to working AC, especially in lower-income households.

The U.S. Census American Community Survey (ACS), on the other hand, samples 3.5 million addresses every year in a nationally representative annual survey. The ACS asks about housing characteristics, costs, and conditions (including heating) but not about AC nationwide. The equivalent survey administered in the four Island Areas of Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, and American Samoa — known as the “Island Areas Census” — included an AC question until 2010. This is an important precedent for adding a similar question to all Census surveys and should expedite the process. However, adding the term “working” (or a similar word) to the air-conditioning question would enhance its ability to capture low-income homes with broken systems as well as households that cannot use their existing AC due to energy insecurity.

Former question on air-conditioning in the American Community Survey for U.S. Island Areas

Better Information for Better Distribution of LIHEAP and WAP Funding

In addition to helping emergency responders, city planners, and public health departments, information collected on the presence of working AC could help ensure that the Department of Health and Human Services (HHS) Low Income Heat Energy Assistance Program (LIHEAP) and Department of Energy’s (DOE) Weatherization Assistance Program (WAP) serve the most vulnerable residents.

LIHEAP, administered by the Office of Community Services (OCS) within the Administration for Children and Families (ACF), is designed to “assist low-income households, particularly those in the lowest incomes, that pay a high proportion of household income for home energy, primarily in meeting their home energy needs.” LIHEAP is a targeted block grant program whereby states distribute their funds across three programs that subsidize home energy heating or cooling costs; fund payment in crises; and support home weatherization (limited to 15% of funds unless a state requests a waiver to increase their percentage to 25%). The largest proportion of the funds subsidizes lower-income, vulnerable residents’ energy spending. While LIHEAP is an important federal program that impacted 7.1 million American households in 2023, only approximately 20% of eligible households received LIHEAP assistance, and the program is currently facing budget shortfalls of $2 billion.

By expanding cooling assistance, LIHEAP is being asked to do more with less: 24 of 50 states now include cooling assistance, and 9.8% of funds subsidized cooling costs. As extreme heat events become more frequent and severe and households become more energy insecure in the face of rising energy prices, more states will need to expand cooling assistance programs. Data on where households are most vulnerable — that is, those households without working AC or the financial ability to operate their AC — would enable targeted distribution of federal funds. Therefore, adding a Census question on household access to working AC would provide critical information to ensure LIHEAP funds serve the most vulnerable households. 

Unlike LIHEAP, WAP’s sole focus is weatherization. Many weatherization improvements that help in cold weather also improve indoor thermal comfort during warm summer months. These improvements include fixing broken AC; adding insulation in walls, attics, and crawlspaces; and replacing leaky, inoperable windows. Compared to LIHEAP, WAP serves a much smaller number of homes — 35,000 homes annually versus LIHEAP’s 7.1 million (as of FY2023). Knowing the number of individual households in a census tract in need of investments in heat resilience adaptation and air-conditioning would enable much more targeted delivery of limited federal resources. Further, DOE can use this information to predict future grid demand and enhance necessary resilience measures for hotter summers.

Plan of Action 

To save lives in the face of growing extreme heat, the Census should add a question about working AC to the American Community Survey. This could be executed as follows:

Recommendation 1. The Office of Community Services in the Administration for Children and Families (OCS ACF) requests the addition of a question about access to working AC at the census tract level to the American Community Survey. This would directly aid the LIHEAP program’s mandate to identify and serve vulnerable individuals, and benefit other programs like DOE’s WAP as well as programs authorized by the IRA and BIL. 

Recommendation 2. Legal staff in the Office of Management and Budget (OMB) and the Census Bureau review the proposal to determine whether it meets legislative requirements. 

Recommendation 3. After a successful legal review, OMB and the Census Bureau, in consultation with the Interagency Council on Statistical Policy Subcommittee for the American Community Survey, determine whether the request merits consideration.

Recommendation 4. Subject matter experts across relevant federal government programs (i.e. LIHEAP and WAP) and external institutions (housing experts, extreme heat experts, social vulnerability experts) identify ways to ask the question. The Census Bureau conducts interviews to determine which wording produces the most accurate results. Because a similar question (but lacking the term “working”) is used on the American Community Survey for Island Areas, this process may be expedited. A potential example of the new question is below:

Do you have working air air-conditioning?

• Yes, a central air conditioning system (includes split-type)
• Yes, 1 individual room unit
• Yes, 2 or more individual room units
• No, my air conditioning system is non-functional or broken
• No, I cannot afford to run my air-conditioning system
• No, I do not have any air-conditioning system

Recommendation 5. The Census Bureau solicits public comment on the question and request OMB’s approval for field testing. 

Recommendation 6. The Census Bureau and ACF OCS review the results and decide whether to recommend adding the new survey question. Through the Federal Register Notice, the Census Bureau solicits public comment. Public comments inform the final decision that is made in consultation with the OMB and the Interagency Council on Statistical Policy Subcommittee on the American Community Survey.

Recommendation 7. If approved by OMB, the Census Bureau adds the question to its materials, and implementation begins at the start of the following calendar year (October). 

Recommendation 8. The Community Resilience Estimates (CRE) for Heat is updated with information about AC as it becomes available. This tool can be shared, along with refined guidance, with state-level administrators of programs like LIHEAP and WAP to target investments to the households most vulnerable to overheating and resulting heat illness and death. The CDC could integrate AC coverage within its existing syndromic surveillance programs on extreme heat, as an additional layer of “risk” for targeted public health deployment during high-heat events.

Conclusion 

The U.S. lacks fine-scaled data to determine whether households can access working AC systems/units and operate them during extreme heat events. Adding a question to the American Community Survey will provide life-saving information for emergency responders, social service providers, and city staff as extreme heat events become more frequent and intense. This fine-scaled information will also aid in distributing LIHEAP and WAP funding and increase the federal government’s ability to protect the most vulnerable residents from life-threatening extreme heat events.

This idea of merit originated from our Extreme Heat Ideas Challenge. Scientific and technical experts across disciplines worked with FAS to develop potential solutions in various realms: infrastructure and the built environment, workforce safety and development, public health, food security and resilience, emergency planning and response, and data indices. Review ideas to combat extreme heat here.

Extreme heat is the leading cause of weather-related deaths in the United States and has been for the past 30 years. Low-income communities and many other vulnerable populations are disproportionately affected by heat risk. As the climate continues to warm, the threat to public health will correspondingly increase. Through a presidential directive, the White House Climate Policy Office (WHCPO) should establish the National Moonshot to Combat Extreme Heat, an all-of-government program to harmonize and accelerate federal efforts to reduce heat risk and heat illness, save lives, and improve the cost-effectiveness of federal expenditures. 

The goals of the Moonshot are to:

1. Reduce heat deaths by 20% by 2030, 40% by 2035, and 60% by 2050. 
2. Build 150 heat-resilient communities by 2030 by facilitating access to funding and uplifting social infrastructure actions prioritizing at-risk, vulnerable populations.
3. Increase visibility and awareness of federal efforts to protect residents from extreme heat. 

The Moonshot will be overseen by a new, high-level appointee at WHCPO to serve as the Executive Officer of the White House Interagency Work Group on Extreme Heat (WHIWG). 

Challenge and Opportunity

The threat to public health and safety from extreme heat is serious, expansive, and increasing as the planet continues to warm. According to Heat.gov, “Extreme heat has been the greatest weather-related cause of death in the U.S. for the past 30 years — more than hurricanes, tornadoes, flooding or extreme cold.” The number of deaths from extreme heat is difficult to accurately determine and is frequently undercounted. More recently, during the Heat Dome of 2021, the state of Washington reported 1,231 heat deaths in just one month. Further, heat-related illness includes a broad spectrum of diseases, from mild heat cramps to life-threatening heat stroke. Heat exposures have been linked to mental health illnesses and adverse birth outcomes, such as preterm births and low birth weights. Extreme heat disproportionately impacts marginalized people, including those that are low-income, BIPOC, seniors, veterans, children, the unhoused, and those with compromised health status, among others. All heat illnesses and deaths are considered preventable.

Extreme heat is an all-of-society problem that requires an all-of-government response. As the frequency, intensity, duration, and breadth of heat waves have increased dramatically over the past four years, officials and leaders at all levels have begun taking action. 

The federal government has launched new programs for addressing extreme heat over the last few years as heat waves have become a front-page issue. Recent programs initiated by the Biden Administration are providing a variety of resources and increasing awareness of this threat. Key examples are:

• The White House Interagency Work Group on Extreme Heat (WHIWG) on Extreme Heat was launched in September 2021 to coordinate a “holistic” response. The WHIWG began work with the National Integrated Heat Health Information System (NIHHIS) to develop a National Heat Strategy in July 2023. Information about the WHIWG is primarily communicated to the public through press releases from the White House. The initiative announced several new actions to address heat, including a rulemaking process at the Occupational Safety and Health Administration (OSHA) to develop a workplace heat standard and actions and ongoing data collection efforts (i.e., syndromic surveillance and heat island mapping campaigns) by the Centers for Disease Control and Prevention (CDC) and NIHHIS. The White House also announced a new set of planning tools to address extreme heat in April 2023 as part of the American Rescue Plan.

• In addition to working with the WHIWG, NIHHIS collaborates with the CDC and over 20 other federal agencies through Heat.gov, a resource hub for federal extreme heat and health information. NIHHIS focuses on developing and sharing information and tools, increasing interagency coordination, and developing a National Heat Strategy. 

• The National Climate Resilience (NCR) Framework takes a high-level approach to building climate resilience through six overarching objectives. However, detailed treatment of extreme heat in the Framework is minimal. 

Actions are needed to remedy the deficit in attention to extreme heat by uplifting the role of extreme heat in the federal response to climate impacts and give greater emphasis to social infrastructure actions. 

Several bills to address extreme heat through federal legislation have been introduced in Congress, though none have advanced. Most notable are:

1. S. 2645: Senator Edward Markey’s Preventing HEAT Illness and Deaths Act of 2023 would authorize NIHHIS to prescribe actions and provide funding. 
   
2. HR 3965: Representative Ruben Gallego’s “Extreme Heat Emergency Act of 2023” would amend the Stafford Act by adding “extreme heat” as a natural disaster for which response aid is authorized.
   
3. H.R. 2945: Representative Ruben Gallego’s Excess Urban Heat Mitigation Act of 2023” would require the Department of Housing and Urban Development (HUD) to establish a grant program to fund activities to mitigate or manage heat in urban areas. The Senate version of this bill, S. 1379, is led by Senator Sherrod Brown.

Even with this momentum, actions are dispersed across many departments and agencies. Plus, many local and state governments tend to apply for federal funding on a program-by-program, agency-by-agency basis and must navigate a complicated landscape with limited funding explicitly earmarked for heat resilience. Further, most “infrastructure” and capacity-building funding is based on mitigating or restoring economic loss of property, leading to financial relief that has gone primarily to built infrastructure and natural infrastructure projects. Communities need social infrastructure: social cohesion, policy and governance, public health, communications and alerts, planning, etc., to respond to extreme heat. This requires a pathway for communities to access funds to combat extreme heat in a comprehensive and coordinated way and bring social infrastructure actions up to a level equal to built and natural infrastructure interventions. 

There is a need to improve the coordination of heat actions across the federal government, align heat resilience activities with Justice40 mandates, and promote community-based interventions to reduce heat deaths. A National Moonshot to Combat Extreme Heat can do this by leveraging several new community-focused programs to accelerate the protection of at-risk populations from heat-related death and illness. The challenge, and therefore the opportunity, for the Moonshot is to identify, integrate, and accelerate existing resources in a human-centric framework to reduce preventable deaths, promote cool and healthy communities, and deliver value nationwide. 

Plan of Action 

The WHCPO should appoint a new Deputy Director for Heat to serve as the Executive Officer of the WHIWG and coordinate the National Moonshot to Combat Extreme Heat – an all-of-government program to accelerate federal actions to address extreme heat. The goals of the Moonshot are to:

1. Reduce heat deaths by 20% by 2030, 40% by 2035, and 60% by 2050; 
   
2. Build 150 heat-resilient communities by 2030 by facilitating access to funding and uplifting social infrastructure actions prioritizing at-risk, vulnerable populations. Social infrastructure encompasses a variety of actions in four categories: social cohesion, policy, communications, and planning.  Social infrastructure centers the needs of people in resilience.  This target aligns with the U.S. goal to reduce greenhouse gas emissions by 50% by 2030. 
   
3. Improve visibility and awareness of federal efforts to protect residents from extreme heat.

The Moonshot will capitalize on existing policies, programs, and funding and establish a human-centric approach to climate resilience by uplifting extreme heat. The Moonshot will identify and evaluate existing federal activities and available funding, including funds from the Inflation Reduction Act (IRA) and the Bipartisan Infrastructure Law (BIL), as well as agency budgets, including Federal Emergency Management Agency’s funding for the Building Resilient Infrastructure and Communities (BRIC) and the Hazard Mitigation Grant Program (HMGP). The Moonshot will integrate actions among the many existing programs dispersed across the government into a well-coordinated, integrated inter-agency initiative that maximizes results and will support cool, safe, and healthy communities

Recommendation 1. Enhance the visibility, responsibility, and capacity of the WHIWG. 

Signaling high-level support through a presidential directive, the WHCPO should appoint a Deputy Director for Heat as the Executive Officer of the WHIWG to lead the Moonshot. Two additional staff positions will be established to support the assessment, stakeholder engagement, and planning processes. The WHIWG and the Deputy Director will design and implement the Moonshot working with the Department of Health and Human Services Office of Climate Change and Health Equity. A lead contact will be designated in each agency and department participating in the NIHHIS program. 

Recommendation 2. Assess and report current status. 

The Moonshot should identify, evaluate, and report on existing programs addressing heat across the federal government, including those recently launched by the White House, to establish a current baseline, identify gaps, and catalog opportunities for integration within the federal government. The Moonshot will generate a database of existing programs and a budget cross-cut analysis to identify current funding levels. The report will incorporate the NIHHIS Extreme Heat Strategy and identify existing funding opportunities, including those in the IRA, Bipartisan Infrastructure Law, and agency programs. The Moonshot will also work with CDC and NIHHIS to develop a method to identify heat deaths to establish a baseline for tracking progress on the goals. 

Recommendation 3. Build broad community support.

The Moonshot should convene conversations and conduct regional extreme heat workshops with state, local, and tribal government personnel; external experts and stakeholders; Justice40 community leaders; professional associations; private sector representatives; and philanthropies. Topics should span the spectrum of social infrastructure, including social cohesion, public health, insurance, infrastructure, communications, and more. Based on input, the Moonshot will establish an advisory committee of non-government participants and develop pathways to connect stakeholders with federal community-focused climate resilience programs, including the White House’s Justice 40 program, EPA’s Environmental Justice Thriving Communities Technical Assistance Centers Program, and the Department of Transportation’s Thriving Communities Network, and other relevant federal programs identified in Recommendation 2. The Moonshot would add extreme heat as a covered issue area in these programs.

Recommendation 4. Make a plan.

The Moonshot should expand upon the NIHHIS Extreme Heat Strategy and make a heat action plan uplifting human health and community access to harness the potential of federal heat programs. The plan would assign roles, responsibilities, and deadlines and establish a process to track and report progress annually. In addition, the Moonshot would expand the NCR Framework to include an implementation plan and establish a human-centric approach. The Moonshot will evaluate co-benefits from heat reduction strategies, including the role cool surfaces play in protecting public health while also decreasing smog, reducing energy use, and solar radiation management. And, consistent with the Biden Administration’s 2025 priorities, the Moonshot will support research and development on emerging technologies such as microfiber fabrics that keep people cool during heat waves, temperature-sensitive coatings, and high-albedo reflective materials that can reduce the need for mechanical air-conditioning. Innovation is especially needed related to resurfacing the nation’s aging roadways.

The Moonshot will also include a communications plan to increase awareness of federal programs and funding opportunities to combat extreme heat. This should all be in place in nine months to prepare for the FY 2026 budget. The NIHHIS and CDC will develop an enhanced method for improving the accuracy of tracking heat deaths. 

Recommendation 5. Connect with people and communities.

The Moonshot should emphasize social infrastructure projects and facilitate access to funding by establishing a centralized portal for comprehensive local heat action planning and programs. The Moonshot will help build cool, safe, healthy communities by integrating heat into federal climate equity programs and supporting local heat plans and projects that reflect community input and priorities. Local heat plans should be comprehensive and integrate a suite of actions that emphasize social infrastructure and include built infrastructure and natural infrastructure. 

Recommendation 6. Initiate all-of-government action.

The Moonshot will catalyze the implementation of the plan across the government, including all the agencies and departments identified in Recommendation 1. It will establish the grant portal to enhance access to federal resources for heat-related projects for state, local, tribal, and territorial governments, and community groups. It will launch a communications plan targeting press, social media, public employees at all levels of government, stakeholders, and more. 

Recommendation 7. Support legislation to secure long-term success 

In coordination with the White House Office of Legislative Affairs and Office of Management and Budget (OMB), the Moonshot should work with Congress to draft and support federal legislation and appropriations addressing extreme heat. Congressional authority is needed to firmly establish this human-centric approach to extreme heat. The Moonshot may recommend Congressional hearings on legislation or a Congressional commission to review the Administration’s work on heat. For example, the passage of S. 2645 would enshrine the position of NIHHIS in law. The Moonshot will help Congress fulfill its role in the all-of-government response and help empower local action. 

Costs

Using information gathered in Recommendation 2, the Moonshot will focus on capturing and directing existing federal funding, including from the IRA, BIL, agency budgets, and grant programs to uplift actions addressing extreme heat and implementing the Moonshot action plan. Initial costs should be minimal: $1 million to hire the Executive Director and two staff and to report on existing programs, funding, and agency budgets. The Moonshot will produce a budget cross-cut initially and annually thereafter and assemble a budget proposal for the WHIWG on Extreme Heat for the FY 2025 and FY 2026 budget.

The Moonshot recommendation is aligned with the OMB Budget Memo of August 17, 2023, which transmits Guidance for Research and Development Priorities for the FY 2025 Budget. The OMB priorities call for addressing climate change by protecting communities’ health and mitigating its health effects, especially for communities that experience these burdens disproportionately.

Conclusion

Extreme heat is a serious public health problem disproportionately impacting many vulnerable populations, and the threat is increasing tremendously. So far in winter 2023, more than 130 monthly high-temperature records were set across the U.S. 

The federal government has several programs addressing the threat of extreme heat in the U.S., and the WHIWG reflects the all-of-government approach needed to meet the threat. The next step is to capture the full potential of existing programs and funding by launching a focused and intensive National Moonshot to Combat Extreme Heat with quantitative goals to track and reduce heat deaths and build healthy communities. This  effort will enable state and local governments and communities, especially those disproportionately impacted by extreme heat, to more readily access federal funding to develop and implement comprehensive heat action plans. The Moonshot will reduce heat deaths, improve the quality of life in cities, and reduce economic productivity loss while increasing the visibility of federal leadership on this issue. 

With heat season 2024 beginning on April 29th, it’s essential to establish an all-of-government response to address extreme heat at all levels.

This idea of merit originated from our Extreme Heat Ideas Challenge. Scientific and technical experts across disciplines worked with FAS to develop potential solutions in various realms: infrastructure and the built environment, workforce safety and development, public health, food security and resilience, emergency planning and response, and data indices. Review ideas to combat extreme heat here.

Millions of workers are subjected to the dangers of extreme heat that increase their risk of heat-related illnesses and fatalities. Due to personal, social, and workplace vulnerabilities, workers are at even greater risk, particularly women, people who are Black or Brown, those who facing low-income challenges, and those employed by small businesses. With no mandated federal heat stress standard, there is no federal mechanism to ensure the adoption of appropriate heat stress prevention strategies and emergency procedures to protect vulnerable workers. 

Now is an opportune time to introduce a federal program to champion climate equity and justice in the workplace by assisting employers’ implementation of evidence-based heat stress management strategies and heat illness emergency procedures, particularly targeting underserved working populations who labor in the heat. This program should be supported by the Occupational Safety and Health Administration (OSHA), along with university and nonprofit partners, and funded through a private or public partnership. This effort will act on the principles of employer social responsibility, best practice recognition, increased resource allocation to vulnerable working groups, third-party auditing, and a non-retaliation reporting mechanism. This policy action, across multiple stakeholders, will proactively address the challenges posed by extreme heat and work toward creating safer, more equitable working environments for all.

Challenge and Opportunity

The average global surface temperature in 2023 was 2.12ºF above the 20^th century average, resulting in Earth’s warmest year on record. Extreme temperatures will continue to rise as the frequency, intensity, and duration of heat waves increase due to climate change. Climate change is a major public health priority that places workers who perform physical labor in the heat at higher risk, due to frequent prolonged, heavy physical exertion, layers of personal protective clothing, and exposure to environmental heat stress. This combination of factors exacerbates the level of heat stress placed on the body, leading to heat-related injuries, illnesses, and fatalities. While the Biden Administration has initiated federal action to establish a mandated heat standard, the bureaucratic process is slow, averaging around eight years. Congress is also working on addressing this issue through the consideration of a bill for the adoption of an emergency temporary standard. Although it offers a quicker solution, it has a limited life span of approximately six months. Moreover, in anticipation of mandating a federal heat stress standard, there is limited infrastructure to support the adoption of evidence-based heat stress management strategies to protect workers in high-temperature environments. The current enforcement solution, OSHA’s National Emphasis Program on outdoor and indoor heat hazards, has several limitations, include such as a vague definition of noncompliant following heat hazard inspection, and uses assessment tools such as Heat Index, which is not considered “best practice.” 

To address these limitations, key stakeholders from academic settings, large research institutes, and nonprofit organizations have developed evidence-based best practices to protect vulnerable workers from extreme heat. Unfortunately, there is no system in place to determine how well companies are prepared for extreme heat. The urgency of adopting evidence-based heat stress management strategies across industries cannot be overstated, as heat-related injuries and fatalities are entirely preventable with the implementation of appropriate prevention strategies and emergency procedures.

There is a critical opportunity to champion climate equity and justice to safeguard laborers from the dangers of extreme heat. Laborers from vulnerable demographics who engage in physical work in the heat are disproportionately affected and are often not protected under evidence-based heat stress management practices by their employers. Workers with personal (e.g., age, race/ethnicity, disease status) and social (e.g., employment type, income status) vulnerabilities are exploited by working in hot environments with limited heat stress prevention strategies available to them. This form of labor exploitation during periods of high heat exposure leaves millions of U.S. workers more vulnerable to preventable heat-related injuries and fatalities. 

Small businesses and other companies with limited resources are also less equipped to protect their workforce or have the means to ensure their employees are working in safe environments in the heat. To fortify workplace resilience against extreme heat and climate change, it is imperative to equitably distribute resources for enforcing evidence-based heat policies in workplaces. Organizations with employees exposed to high temperatures must be held accountable for the effective implementation of these policies. Additionally, vulnerable workers frequently refrain from reporting unsafe conditions due to the fear of employer retaliation. Advocacy efforts become even more challenging as language barriers, food insecurity, and poverty exacerbate already dire working conditions.

The present moment presents an opportune time to introduce a program supported by occupational health and safety federal agencies. As evidence-based best practices have been developed to protect workers from extreme heat, there is no system in place to protect vulnerable working populations, allocate resources, and keep companies accountable by assessing their current heat stress management practices. OSHA and the National Institute for Occupational Safety and Health (NIOSH) are key stakeholder organizations to initiate a federal response to address the lack of adoption of heat stress management policies. However, these entities often prioritize multiple projects simultaneously, are understaffed, and benefit from partnerships with universities and nonprofits. Therefore, a cooperative approach with governing like OSHA and universities/nonprofit organizations is the appropriate strategy to create a program that promotes the enforcement of evidence-based heat protection strategies (i.e., education, hydration, heat acclimatization, environmental monitoring, physiological monitoring) at the organizational level. This approach also provides under-resourced businesses with access to basic heat protection equipment and establishes a mechanism for employees to report unsafe working conditions without fear of retaliation. This program draws inspiration from the success of the Fair Food Program, a Corporate Social Responsibility model that promotes accountability among growers, buyers, and retailers. 

This comprehensive program will support all organizations that employ workers who perform physical work in the heat, such as construction, utilities, agriculture, oil, and gas. This program will facilitate employer accountability, social responsibility, increased resource allocation, third-party auditing, and a non-retaliation reporting system. 

Plan of Action

The development and implementation of this federal program, the Occupational Heat Resiliency Program (OHRP), will require a public-private partnership between OSHA, universities, and nonprofit partners. This partnership model draws inspiration from the successful collaborative partnerships between OSHA and other partners to protect the workforce against other occupational hazards. The OHRP will promote the adoption of evidence-based heat stress management practices by targeting employers with workplaces that experience high heat exposure and/or have a large population of laborers working in the heat who are classified as vulnerable workers. The establishment of OHRP will require funding through cooperative agreements, such as the OSHA Strategic Partnership Program (OSPP). To achieve the program’s objectives, both OSHA and its partners will commit their knowledge and resources to support the program.

The program will rely on the following principles to achieve this objective:

1. Employer accountability and best practice recognition:

• Employers engaging with the proposed federal program will formalize their commitment to safeguarding workers from extreme heat through evidence-based practices derived from original research from research institutes and academic organizations. These original research sources have informed governing body recommendations from institutes such as NIOSH. 
• These commitments can be publicized, creating transparency and ensuring that products are manufactured by adequately protected workers.
• The program aims to promote the adoption of evidence-based heat practices that enhance safety, health, and productivity for the U.S. workforce.
• Recognition of best practices will facilitate widespread adoption, empowering employers, safety professionals, and workers to implement strategies and emergency procedures that effectively mitigate the risk of heat-related illnesses and injuries.

2. Climate equity through increased resource allocation:

• Recognizing the disproportionate impact of climate change on vulnerable populations, the program will allocate resources to workplaces with high percentages (>50%) of at-risk workers. This includes small businesses and workplaces with a high percentage of women, people of Color, and low-income workers. Workplace needs will be performed through existing efforts related to other occupational hazards or community projects and by targeting industries associated with increased employment of vulnerable workers. 
• Support may include assistance in creating heat stress management educational materials and emergency action plans/procedures, implementing written heat stress management plans, and providing essential resources such as hydration, shade, and cooling products.

3. Safer work environments through third-party auditing and a non-retaliation reporting system:

• Third-party audits, led by university or non-profit partners, will determine feasible evidence-based practices and resource allocations.
• Audits will employ a tier system (I, II, II) to show the level of protection that the workplace has implemented based on the presented recommendations. To ensure compliance, a non-retaliation reporting system will allow workers to report incidences where their work environment was unsafe due to extreme heat. 
• A non-retaliation reporting system will be implemented to empower workers to report unsafe conditions due to extreme heat, ensuring employer compliance and accountability. This information within the report will not be shared with employers directly, but rather through the third-party auditing entity. 

The program will be led by teams composed of OSHA representatives and university/nonprofit partners that will meet virtually regularly to ensure the goals of each principle are being met and to address any partnership issues that may arise.

Conclusion

The escalating challenges to the U.S. workforce posed by extreme heat demand proactive measures, necessitating collaboration among key government entities like OSHA alongside universities and nonprofit organizations. Currently, there is a glaring absence of mechanisms to safeguard workers who engage in physical work in the heat, particularly those from vulnerable demographics. 

To tackle this issue head-on, the establishment of OHRP funded through a private or public partnership is imperative. This initiative would champion climate equity in the workplace by expediting the adoption of evidence-based heat stress management strategies and emergency procedures. The program’s framework includes commitments from employers, recognition of best practices, increased resource allocation to vulnerable working groups, third-party auditing, and a non-retaliation mechanism. OHRP will have an immediate impact at both the federal and state level. Without the implementation of such a program, a significant portion of the U.S. workforce remains at risk of entirely preventable heat-related injuries, illnesses, and fatalities.

This idea of merit originated from our Extreme Heat Ideas Challenge. Scientific and technical experts across disciplines worked with FAS to develop potential solutions in various realms: infrastructure and the built environment, workforce safety and development, public health, food security and resilience, emergency planning and response, and data indices. Review ideas to combat extreme heat here.

Year after year, record-breaking air temperatures and heat waves are reported nationwide. In 2023, Death Valley, California experienced temperatures as high as 129°F — the highest recorded temperature on Earth for the month of June—and in July,  Southwest states experienced prolonged heat waves where temperatures did not drop below 90°F. This is especially worrisome as the frequency, intensity, and duration of rising temperatures are projected to increase, and the leading weather-related cause of death in the United States is heat. To address this growing threat, the Environmental Protection Agency (EPA) and the National Oceanic and Atmospheric Administration (NOAA) should combine and leverage their existing resources to develop extreme-heat monitoring networks that can capture spatiotemporal trends of heat and protect communities from heat-related hazards. 

Urban areas are particularly vulnerable to the effects of extreme heat due to the urban heat island (UHI) effect. However, UHIs are not uniform throughout a city, with some neighborhoods experiencing higher air temperatures than others. Further, communities with higher populations of Color and lower socioeconomic status disproportionately experience higher temperatures and are reported to have the highest increase in heat-related mortality. It is imperative for local government officials and city planners to understand who is most vulnerable to the impacts of extreme heat and how temperatures vary throughout a city to develop effective heat mitigation and response strategies. While the NOAA’s National Weather Service (NWS) stations provide hourly, standardized air measurements, their data do not capture intraurban variability.

Challenge and Opportunity

Heat has killed more than 11,000 Americans since 1979, yet an extreme heat monitoring network does not exist in the country. While NOAA NWS stations capture air temperatures at a central location within a city, they do not reveal how temperatures within a city vary. This missing information is necessary to create targeted, location-specific heat mitigation and response efforts.

Synergistic Environmental Hazards and Health Impacts

UHIs are metropolitan areas that experience higher temperatures than surrounding rural regions. The temperature differences can be attributed to many factors, including high impervious surface coverage, lack of vegetation and tree canopy, tall buildings, air pollution, and anthropogenic heat. UHIs are of significant concern as they contribute to higher daytime temperatures and reduce nighttime cooling, which in turn exacerbates heat-related deaths and illnesses in densely populated areas. Heat-related illnesses include heat exhaustion, cramps, edema, syncope, and stroke, among others. However, heat is not uniform throughout a city, and some neighborhoods experience warmer temperatures than others in part due to structural inequalities. Further, it has been found that, on average, People of Color and those living below the poverty line are disproportionately exposed to higher air temperatures and experience the highest increase in heat-related mortality. As temperatures continue to rise, it becomes more imperative for the federal government to protect vulnerable populations and communities from the impacts of extreme heat. This requires tools that can help guide heat mitigation strategies, such as the proposed interagency monitoring network. 

High air temperatures and extreme heat are also associated with poor air quality. As common pavement surfacing materials, like asphalt and concrete, absorb heat and energy from the sun during the day, the warm air at the surface rises with present air pollutants. High air temperatures and sunlight are also known to help catalyze the production of air pollutants such as ozone in the atmosphere and impact the movement of air and, therefore, the movement of air pollution. As a result, during extreme heat events, individuals are exposed to increased levels of harmful pollutants. Because poor air quality and extreme heat are directly related, the EPA should expand its air quality networks, which currently only detect pollutants and their sources, to include air temperature. Projections have determined extreme heat events and poor air quality days will increase due to climate change, with compounding detriments to human health. 

Furthermore, extreme heat is linked not only to poor air quality but also to wildfire smoke—and they are becoming increasingly concomitant. Projections report with very high confidence that warmer temperatures will lengthen the wildfire season and thus increase areas burned. Similar to extreme heat’s relationship with poor air quality, extreme heat and wildfire smoke have a synergistic effect in negatively impacting human health. Extreme heat and wildfire smoke can lead to cardiovascular and respiratory complications as well as dehydration and death. These climatic hazards have an even larger impact on environmental and human health when they occur together.

As the UHI effect is localized and its causes are well understood, urban cities are ideal locations to implement heat mitigation and adaptation strategies. To execute these plans equitably, it is critical to identify areas and communities that are most vulnerable and impacted by extreme heat events through an extreme heat monitoring network. The information collected from this network will also be valuable when planning strategies targeting poor air quality and wildfire smoke. The launch of an extreme heat monitoring network will have a considerable impact on protecting lives. 

Urban Heat Mapping Efforts

Both NOAA and EPA have existing programs that aim to map, reduce, or monitor UHIs throughout the country. These efforts may have the capacity to also implement the proposed heat monitoring network. 

Since 2017, NOAA has worked with the National Integrated Heat Health Information System (NIHHIS) and CAPA Strategies LLC to fund yearly UHI mapping campaign programs, which has been instrumental in highlighting the uneven distribution of heat throughout U.S. cities. These programs rely on community science volunteers who attach NOAA-funded sensors to their cars to collect air temperature, humidity, and time data. These campaigns, however, are currently only run during summer months, and not all major cities are mapped each year. NOAA’s NIHHIS has also created a Heat Vulnerability Mapping Tool, which impressively illustrates the relationship between social vulnerability and heat exposure. These maps, however, are not updated in real-time and do not display air temperature data. Another critical tool in mapping UHIs is NWS recently created HeatRisk prototype, which identifies risks of heat-related impacts in numerous parts of the country. This prototype also forecasts levels of heat concerns up to seven days into the future. However, HeatRisk does not yet provide forecasts for the entire country and uses NWS air temperature products, which do not capture intraurban variability. The EPA has a Heat Island Reduction program dedicated to working with community groups and local officials to find opportunities to mitigate UHIs and adopt projects to build heat-resilient communities. While this program aims to reduce and monitor UHIs, there are no explicit monitoring or mapping strategies in place. 

While the products and services of each agency have been instrumental in mapping UHIs throughout the country and in heat communication and mitigation efforts, consistent and real-time monitoring is required to execute extreme heat response plans in a timely fashion. Merging the resources of both agencies would provide the necessary foundation to design and implement a nationwide extreme heat monitoring network.

Plan of Action

Heat mitigation strategies are often city-wide. However, there are significant differences in heat exposure between neighborhoods. To create effective heat adaptation and mitigation strategies, it is critical to understand how and where temperatures vary throughout a city. Achieving this requires a cross-agency extreme heat monitoring network between federal agencies. 

The EPA and NOAA should sign a memorandum of agreement to improve air temperature monitoring nationwide. Following this, agencies should collaborate to create an extreme heat monitoring network that can capture the intraurban variability of air temperatures in major cities throughout the country.

Implementation and continued success require a number of actions from the EPA and NOAA. 

1. EPA should expand its Heat Island Reduction program to include monitoring urban heat. The Inflation Reduction Act (IRA) provided the agency with $41.5 billion to fund new and existing programs, with $11 billion going toward clean air efforts. Currently, their noncompetitive and competitive air grants do not address extreme heat efforts. These funds could be used to place air temperature sensors in each census tract within cities to map real-time air temperatures with high spatial resolution.
2. EPA should include air temperature monitoring in their monitoring deployments. Due to air quality tracking efforts mandated by the Clean Air Act, there are existing EPA air quality monitoring sites in cities throughout the country. Heat monitoring efforts could be tested by placing temperature sensors in the same locations.
3. EPA and NOAA should help determine vulnerable communities most impacted by extreme heat. Utilizing EPA’s Environmental Justice Screening and Mapping (EJScreen) Tool and NIHHIS’s Heat Vulnerability Mapping Tool, EPA and NOAA could determine where to place air temperature monitors, as the largest burden due to extreme heat tends to occur in neighborhoods with the lowest economic status.
4. NOAA should develop additional air temperature sensors. NOAA’s summer UHI campaign programs highlight the agency’s ability to create sensors that capture temperature data. Given their expertise in capturing meteorological conditions, NOAA should develop national air temperature sensors that can withstand various weather conditions.
5. NOAA should build data infrastructure capable of supporting real-time monitoring. Through NIHHIS, the data obtained from the monitoring network could be updated in real-time and be publicly available. This data could also merge with the current vulnerability mapping tool and HeatRisk to examine extreme heat impacts at finer spatial scales. 

Successful implementation of these recommendations would result in a wealth of air temperature data, making it possible to monitor extreme heat at the neighborhood level in cities throughout the United States. These data can serve as a foundation for developing extreme heat forecasting models, which would enable governing bodies to develop and execute response plans in a timely fashion. In addition, the publicly available data from these monitoring networks will allow local, state, and tribal officials, as well as academic and non-academic researchers, to better understand the disproportionate impacts of extreme heat. This insight can support the development of targeted, location-specific mitigation and response efforts.

Conclusion

As temperatures continue to rise in the United States, so do the risks of heat-related hazards, morbidity, and mortality. This is especially true for urban cities, where the effects of extreme heat are most prevalent. A cross-agency extreme-heat monitoring network can support the development of equitable heat mitigation and disaster preparedness efforts in major cities throughout the country.

This idea of merit originated from our Extreme Heat Ideas Challenge. Scientific and technical experts across disciplines worked with FAS to develop potential solutions in various realms: infrastructure and the built environment, workforce safety and development, public health, food security and resilience, emergency planning and response, and data indices. Review ideas to combat extreme heat here.

“Under the President’s direction, every Federal department and agency is focused on strengthening the Nation’s climate resilience, including by tightening flood risk standards, strengthening building codes, scaling technology solutions, protecting and restoring our lands and waters, and integrating nature-based solutions.” – National Climate Resilience Framework 

Now more than ever, communities across the country need to adopt policies and implement projects that promote climate resilience. As climate change continues to impact the planet, extreme heat has become more frequent. To address this reality, the federal government needs to shift as much of its infrastructure investments as possible away from dark and impervious surfaces and toward cool and pervious “smart surfaces.”

By ensuring that a more substantial portion of federal infrastructure investments are designed to address extreme heat and climate change, instead of exacerbating the problem like many investments are doing now, the government can ensure healthy and livable communities. Making improvements, such as coating black asphalt roads with higher albedo products, installing cool roofs, and increasing tree and vegetative cover, results in positive social, political, and economic effects. Investments in safe and resilient communities provide numerous benefits, including better health outcomes, higher quality of life, an increase in proximal property values, and a reduction in business disruption. By making these changes, policymakers will engender significant long-term benefits within communities.

Challenge and Opportunity 

Extreme heat events—a period of high heat and humidity with temperatures above 90°F for at least two to three days—are the leading cause of weather-related fatalities in the United States among natural disasters. Recent surges in extreme heat have led to summers now commonly 5–9°F hotter city-wide, with some neighborhoods experiencing as much as 20°F higher temperatures than rural areas, an outcome commonly referred to as the urban heat island (UHI) effect. More than 80% of the U.S. population lives in cities experiencing these record-breaking temperatures. 

Extreme Heat and External Impacts 

As populations in urban areas continue to grow, their density will further increase the urban heat island effect and exacerbate heat inequities in the absence of more resilient infrastructure investments. Between 2004 and 2018, the Centers for Disease Control and Prevention (CDC) recorded 10,527 heat-related deaths in the United States, an average of 702 per year. In their report, the CDC emphasized that many of these deaths occurred in urban areas, particularly in low-income and communities of color. Lower-income neighborhoods commonly have fewer trees and darker surfaces, resulting in temperatures often 10–20°F hotter than wealthy neighborhoods with more trees and green infrastructure.

A wide range of other consequences result from the rise in urban heat islands. For instance, as we experience hotter days, the warming atmosphere traps in more moisture, resulting in episodes of extreme flooding. Communities are experiencing a variety of impacts such as personal property damage, infrastructure destruction, injury, and increasing morbidity and mortality. In addition to the health impacts of extreme heat, increases in urban flooding also lead to long-term impacts such as disease outbreaks and economic instability due to the destruction of businesses. According to the Environmental Protection Agency (EPA), annual damages from flooding are expected to increase by 30% by the end of the century, making it more difficult for communities, particularly low-income and communities of color, to rebuild. Implementing climate-resilient solutions for extreme heat provides multiplicative benefits that extend beyond the singular issue of heat. 

Integrating Climate Resilience in All Federal Funding Grants and Investments

As urban heat islands continue to expand in urban communities due to an increase in greenhouse gas emissions and investments in dark and impervious surfaces, it is vital that the federal government integrate climate resilience into all federal funding grants and investments. Great progress has been made by the Biden Administration via the Inflation Reduction Act (IRA) and other policy interventions that have created regulations and grant programs that promote and adopt climate-resilience policies. However, many federal investments continue to promote dark and impervious surfaces rather than requiring cooler and greener infrastructure in all projects. Investing in more sustainable resilient infrastructure is an important step toward combating urban heat islands and extreme flooding. Therefore, federal agencies such as the EPA, Department of Transportation (DOT), Federal Emergency Management Agency (FEMA), Department of Energy (DOE), and others should be encouraged to adopt a standard for integrating climate resiliency into all federal projects by funding green infrastructure and cool surface projects within their programs. 

Strengthening Climate Policy 

To address extreme heat, federal agencies should fund nature-based, light-colored, and pervious surfaces and shift away from investing in darker and more impervious surfaces. This redirection of funds will increase the cost-effectiveness of investments and yield multiplicative co-benefits. 

Mitigating extreme heat through investments in green and cool infrastructure will result in better livability, enhanced water and air quality, greater environmental justice outcomes, additional tourism, expansion of good jobs, and a reduction in global warming. As an example, in 2017, New York City initiated the Cool Neighborhoods NYC program to combat heat islands by installing more than 10 million square feet of cool roofs in vulnerable communities, which also resulted in an estimated reduction of internal building temperatures by more than 30%.

Similarly, in the nation’s capital, DC Water’s 2016 revision of its consent decree to integrate green with gray infrastructure in the $2.6 billion Clean Rivers Project is set to cut combined sewer overflows by 96% at a lower cost to ratepayers than a gray-infrastructure-only solution. By implementing nature-based solutions, the DC Water investment also helps to reduce the urban heat island effect and air pollution, as well as localized surface flooding. One dollar invested in green infrastructure provides many dollars’ worth of benefits.

Plan of Action 

To combat extreme heat within communities, federal agencies and Congress should take the following steps. 

Recommendation 1. FEMA, DOT, EPA, DOE, and other agencies should continue to shift funding to climate-resilient solutions.

Agencies should continue the advancements made in the Inflation Reduction Act and shift away from providing city and state governments with funding for more dark and impervious surfaces, and instead require that all projects include green and cool infrastructure investments in addition to any gray infrastructure deemed absolutely necessary to meet project goals. These agencies should require teams to submit a justification for funding of any dark and impervious surfaces proposed for project funding. Agencies would review the justification document to determine its validity and reject it if found invalid. 

The Interagency Working Group on Extreme Heat or a similar multi agency task force should develop a guidance document to formally establish new requirements for green and cool infrastructure investments. Similar to the standards set by the Buy America and Buy Clean initiatives, the “Buy Green” document should create a plan for addressing extreme heat in federally funded projects. Once created, the document would help support additional climate-resilience frameworks such as the Advancing Climate Resilience through Climate-Smart Infrastructure Investments and Implementation Guidance memo that was released by Office of Management and Budget (OMB). While this memo provides much-needed counsel on implementing climate and smart infrastructure, its focus on extreme flooding makes it a narrow tool. The newly established Buy Green guidance will provide necessary support and information on extreme heat to implement related cool and green infrastructure. 

Recommendation 2. All federal agencies should factor in the new social cost of carbon.

In December 2023, the EPA announced an updated number for the social cost of carbon – $190 per ton – as part of a new rule to limit methane emissions. The new social cost of carbon number is not yet included in federal projects for all agencies, nor in federal grant funding applications. Not updating the social cost of carbon skews federal funding and grant investments away from more climate-friendly and resilient projects. All federal agencies should move quickly to adopt the new social cost of carbon number and use the number to determine the cost-effectiveness of project concepts at all stages of review, including in environmental impact statements prepared under the National Environmental Policy Act.

Recommendation 3. The Ecosystem Services Guidance should be fully adopted by federal agencies.

In early March 2024, the OMB released guidance to direct federal agencies to provide detailed accounts of how proposed projects, policies, and regulations could impact human welfare from the environment. The Ecosystem Services Guidance is designed to help agencies identify, measure, and discuss how their actions might have an impact on the environment through a benefit-cost analysis (BCA). We recommend that FEMA, DOT, EPA, DOE, and other funding agencies adopt and implement this guidance in their BCAs. This move would complement Recommendation 2, as factoring the new social cost of carbon into the Ecosystem Services Guidance will further encourage federal agencies to consider green infrastructure technologies and move away from funding dark and impervious surfaces. 

Recommendation 4. The Federal Highway Administration (FHA) should revise its list of standards to include and then promote green and cool infrastructure. 

The FHA has established a list of standards to help guide organizations and agencies on road construction projects. While the standards have made progress on building more resilient roadways, much of the funding that flows through FHA to states and metro areas continues to result in more dark and impervious surfaces. FHA should include standards that promote cool and green infrastructure within their specifications. These standards should include the proposed new social cost of carbon, as well as guidance developed in partnership with other agencies (FEMA, DOT, EPA, and DOE) on a variety of green infrastructure projects, including the implementation of cool pavement products, installation of roadside solar panels, conversions of mowed grass to meadows, raingardens and bioswales, etc. In addition, we also recommend that FHA strongly consider the adoption of the CarbonStar Standard. Designed to quantify the embodied carbon of concrete, the CarbonStar Standard will supplement the FHA standards and encourage the adoption of concrete with lower embodied carbon emissions. 

Recommendation 5. EPA and DOE should collaborate to increase the ENERGY STAR standard for roofing materials and issue a design innovation competition for increasing reflectivity in steep slope roofing. 

Since 1992, ENERGY STAR products have saved American families and businesses more than five trillion kilowatt-hours of electricity, avoided more than $500 billion in energy costs, and achieved four billion metric tons of greenhouse gas reductions. While this has made a large impact, the current standards for low-slope roofs of initial solar reflectance of 0.65 and three-year aged reflectance of 0.50 are too low. The cool roofing market has advanced rapidly in recent years, and according to the Cool Roof Rating Council database, there are now more than 70 low-slope roof products with an initial solar reflectance above 0.80 and a three-year aged solar reflectance of 0.70 and above. EPA and DOE should increase the requirements of the standard to support higher albedo products and improve outcomes. 

Similarly, there have been advancements in the steep slope roofing industry, and there are now more than 20 asphalt shingle products available with initial solar reflectance of 0.27 and above and three-year aged solar reflectance of 0.25 and above. EPA and DOE should consider increasing the ENERGY STAR standard for steep slope roofs to reward the higher performers in the market and incentivize them to develop products with even greater reflectivity in the future.

In addition to increasing the standards, the agency should also issue a design competition to promote greater innovation among manufacturers, in particular for steep slope roofing solutions. Authorized under the COMPETES Act, the competition would primarily focus on steep slope asphalt roofs, helping product designers develop surfaces that have a much higher reflectivity than currently exist in the marketplace (perhaps with a minimum initial solar reflectance target of 0.5, but with an award given to the highest performers). 

Recommendation 6. Congress and the IRS should reinstate the tax credit for steep slope ENERGY STAR residential roofing.

ENERGY STAR programs are managed through Congress and the IRS, who are in charge of maintaining the standards and distributing the tax credits. Though the IRA allowed for a short-term extension of the tax credit for steep slope ENERGY STAR residential roofing, the incentive has since expired. Given the massive benefits of cool roofing for energy efficiency, climate mitigation, resilience, health, and urban heat island reduction, Congress along with the IRS should move to reinstate this incentive. Because of the multiplicative benefits, this is fundamentally one of the most important incentives that EPA/DOE/IRS could offer.

Recommendation 7. DOE or DOT should conduct testing for cool pavement products.

Currently, cities looking to reduce extreme heat are increasingly looking to cool pavement coatings as a solution but do not have the capacity to conduct third-party reviews of the products and manufacturers’ claims, and they need the federal government to provide support. Claims are being made by manufacturers in terms of the aged albedo of products and also their benefits in terms of increasing road surface longevity, but to date there has been no third party analysis to verify the claims. DOE/DOT should conduct an independent third party test of the various cool pavement products available in the marketplace.

Recommendation 8. The Biden Administration should provide support for the Extreme Heat Emergency Act of 2023.

On June 12, 2023, Representative Ruben Gallego (D-AZ) introduced the Extreme Heat Emergency Act of 2023 to amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act and include extreme heat in the definition of a major disaster. This bill is a vital piece of climate resilience legislation, as it recognizes the impact of extreme heat and seeks to address it federally. The Biden Administration, and FEMA in particular, should provide political support for the act given its transformative potential in addressing extreme heat in cities. Failing to update the list of hazards that FEMA can respond to with public assistance can amount to a de facto endorsement of policies and projects that harm our environment and economy. Congress should work with FEMA to alter the Stafford Act language to enable designating extreme heat as a major disaster. 

Recommendation 9. Create an implementation plan for a National Climate Resilience Framework. 

In September 2023, the Biden Administration issued the landmark National Climate Resilience Framework. It is our understanding that an implementation plan for the framework has not yet been developed. If that is the case, the Administration should move forward expeditiously with developing a plan that includes the proposed recommendations above and others. Ideas such as creating a standard guidance for climate resilience projects and factoring the new social cost of carbon should be included and implemented through federal investments, grants, climate action plans, legislation, and more. With help from Congress to formally enact the plan, the bill should require the Administration to issue guidance for all federal agencies referenced in the implementation plan to incorporate climate resilience in all funded projects. This would help standardize climate resilience policies to combat extreme heat and flooding.

Cost Estimates 

This proposal is largely focused on redirecting current appropriations to more resilient solutions rather than requiring more budget capacity. Agencies such as FEMA, DOT, EPA, and DOE should redirect funds allocated in infrastructure budgets and grant programs that promote dark and impervious surfaces to green and cool infrastructure projects. Items that will incur additional costs are including heat in FEMA’s definitions of natural disasters, the suggested cool roof design innovation competition, and the analysis of cool pavement technologies.

Conclusion 

Combating extreme heat urgently requires us to address climate resilient infrastructure at the federal level. Without the necessary changes to adopt green and cooler technologies and create a national resilience framework implementation plan, urban heat islands will continue to intensify in cities. Without a dedicated focus from the federal government, extreme heat will continue to create dangerous temperatures and also further disparities affecting low-income and communities of color who already do not have the adequate resources to stay cool. Shifting federal investments to address extreme heat through green and resilient infrastructure extends beyond political lines and would greatly benefit from policymaker support.

This idea of merit originated from our Extreme Heat Ideas Challenge. Scientific and technical experts across disciplines worked with FAS to develop potential solutions in various realms: infrastructure and the built environment, workforce safety and development, public health, food security and resilience, emergency planning and response, and data indices. Review ideas to combat extreme heat here.

In the United States, almost one in four Americans are vulnerable to the growing threat of extreme heat. In fact, extreme heat kills more people on average every year than any other extreme weather event. Yet scientists believe these numbers still largely underestimate the true number of heat-related deaths by up to 50-fold, suggesting tens of thousands of Americans could be dying each year from heat-related exposure. Climate change further drives the risk of extreme heat, with a hundred million Americans exposed to dangerous temperatures each summer and projections showing these numbers to further increase.

The Administration for Strategic Preparedness and Response (ASPR) within the Department of Health and Human Services (HHS) can and should play a leadership role in supporting State, Local, Tribal, and Territorial (SLTT) preparedness and response to extreme heat. Just as ASPR serves as the Sector Risk Management Agency for healthcare and Public Health (HPH) cybersecurity, ASPR is uniquely positioned to lead the federal response to extreme heat due to the distinct and disproportionate impacts of extreme heat on the medical and public health sector. As leader, ASPR would support the integration of extreme heat into healthcare preparedness and response programs, participate in an interagency workgroup to develop critical healthcare impact-based forecasts, and implement lessons learned from similar efforts to develop effective hurricane responses. This is critical for ASPR to meet its mandate in a rapidly warming world, will save thousands of American lives, and stand as a testament to U.S. innovation and resolve.

Challenge and Opportunity

Across the U.S., more communities are facing the deadly impacts of extreme heat. Local responses are often disorganized and reactive, resulting in excessive preventable injuries and deaths. Hospitals are overwhelmed, emergency services are stretched thin, and the most vulnerable suffer. Combined with potential power outages, heat waves could create catastrophic impacts, including unparalleled patient surge and mass casualty crises that would overwhelm local and state resources. Unlike other extreme weather hazards, the impacts of extreme heat are disproportionately felt by HPH organizations and agencies, a clear indicator that ASPR should play a leadership role in supporting SLTTs to ensure regional healthcare readiness, sharing of critical impact-forecast data, and effective response coordination.

On June 23, 2021, the Seattle-based National Weather Service (NWS) office alerted Washington State response agencies about a large record-breaking heat dome forecasted to impact the region. With three days until the start of the heat dome and five days until its peak, there was ample time to prepare. However, with Washington being largely unaccustomed to extreme heat —and lacking plans, an understanding of the potential impacts, and technical assistance or resource support from the federal government — SLTTs were left to fend for themselves. The results were catastrophic: more lives were lost than any other extreme weather event in the state’s history.

ASPR, with minimal additional funding from Congress, should act to better support SLTT-level healthcare and public health organizations and agencies by supporting the development of data-driven decision-making tools, heat-integrated preparedness programs, and response systems ready to pre-deploy when extreme heat threatens to overwhelm SLTT HPH resources.

Heat Impact Forecasts and Response Triggers

A major operational barrier to extreme heat response planning is a lack of data-driven decision-making resources, such as impact-based forecasts. Traditional forecasts for heat waves often focus on temperature and humidity, but do little to provide necessary information for SLTTs and national agencies to understand community risk and anticipated impacts on the HPH sectors.

Similar to ongoing efforts to move beyond traditional hurricane forecasts (wind speed, pressure, location) and toward impact-based warnings for jurisdictions and communities, the Centers for Disease Control and Prevention (CDC) and the NWS collaboratively developed the HeatRisk prototype to provide risk-focused information. Even with the tool still in the development phase and only providing forecasts for half of the continental United States, HeatRisk has already been integrated into SLTT response plans. This demonstrates a significant need to complete and expand this tool to support SLTT and federal response decision-making.

ASPR is uniquely positioned to advance this initiative by integrating healthcare data to develop impact-based forecasts that provide anticipated public health and healthcare surge information. Instead of only forecasting the level of risk posed to the public, a HeatRisk HPH platform could provide critical estimates of healthcare service demand due the extreme heat. This information would be vital to identify evidence-based thresholds that could trigger pre-event coordination, technical assistance, and activation of federal resources from ASPR and FEMA. 

Heat-Prepared Medical and Public Health Response System

Extreme temperature exposure can take just hours to days to be deadly, while federal responses often take days to weeks to organize and deploy, so saving lives during an extreme heat event that overwhelms local and state HPH resources requires rapid pre-deployment of federal assets based on extreme heat forecast data. To date, there is no plan for or example of this occurring, even when thousands of Americans are dying each year from extreme heat.

Clear legal guidelines allow ASPR to pre-deploy response personnel and supplies without a disaster declaration. Section 301, 311, 2812 of the Public Health Services Act authorizes the HHS secretary to provide public health service personnel, equipment, medical supplies, and other assistance to states and local jurisdictions to prevent or respond to any health emergency, with or without a public health emergency declaration. In addition, there are many examples of ASPR pre-deploying assets in anticipation of extreme weather hazards such as Hurricane Ian in 2022, which included the pre-deployment of Health and Medical Task Force teams, Incident Management Teams, and caches of medical supplies. 

ASPR has a mission responsibility to support SLTTs before and during an overwhelming heat emergency with technical assistance and resources – such as personnel and critical medical supplies. This will require modernizing the National Disaster Medical System (NDMS) and U.S. Public Health Service (USPHS) Commissioned Corps to meet the current and future threat landscape of extreme heat, development of heat-specific response standards and training, and integration of forecast-based pre-deployment and technical assistance into regional SLTT preparedness activities. 

Additionally, heat response standards and training could support SLTT Medical Reserve Corps (MRC) volunteer heat-response capabilities through an already existing ASPR and the National Association of County and City Health Officials collaboration, which provides MRC deployment training and readiness guides. This technical support would help meet the growing demand for MRC volunteers in local extreme heat responses.

Heat-Prepared Healthcare Systems

Healthcare systems are often caught off guard by extreme heat events due to a lack of hazard analysis and preparedness. ASPR is critical in supporting healthcare readiness via the Hospital Preparedness Program (HPP), which provides funding through grants and cooperative agreements to support local healthcare capacity, system readiness, and coordination in response to medical surge events.

There is a significant opportunity to integrate heat-specific programmatic requirements into HPP, such as requiring heat-specific hazard and vulnerability analyses and preparedness activities, which would ensure health systems are aware and prepared. Additionally, advancements in medical surge coordination, such as regional and state medical operations coordination cells (MOCC), developed or refined during the pandemic and utilized during periods of extreme heat, should be funded through HPP to ensure patient and resource coordination capabilities are developed, utilized, have appropriate authority, and are financially sustained. 

Heat-Health Response Excellence Centers

ASPR has created and funded several medical-academic centers that provide technical assistance, training, exercises, and assessments specific to unique hazards and demographics. These include two Pediatric Disaster Care Centers of Excellence and the National Emerging Special Pathogens Training & Education Center. With adequate congressional funding, ASPR should establish two national Heat-Health Response Excellence Centers that support SLTTs and ASPR in identifying preparedness and response best practices; developing heat-specific federal response standards and training; understanding regional heat impact characteristics and supporting HeatRisk data integration; connecting HPH response planners with leading national heat research and subject matter experts; and leveraging ASPR TRACIE, ASPR Project ECHO, and the National Integrated Heat Health Information Network (NIHHIS) to capture and disseminate best practices and ongoing engagement.

Plan of Action

To ensure ASPR is able to advance SLTT HPH extreme heat readiness and can effectively support jurisdictions responding to a heat-related health emergencies, the following actions should be taken.

Recommendation 1. Develop heat impact-based forecasts 

1. ASPR collaborates closely with CDC and NWS to support the expansion of the HeatRisk prototype to include HPH sector risk analysis (using ASPR-controlled healthcare data), and is socialized/integrated in SLTT heat response plans. 
2. Identify specific NDMS forecast thresholds to trigger support for SLTTs, such as prepositioning of personnel, resources, and provision of technical assistance. 
3. One-time funds of $10 million to increase HeatRisk scope and impact-based forecast planning that would include:
   1. Staff support to appropriately integrate ASPR healthcare data
   2. Cross-agency integration of HeatRisk data to identify activation thresholds
   3. Outreach and promotion for SLTT awareness and planning
4. Recurring $3 million to ensure ongoing HeatRisk refinement (incorporating new data), ASPR healthcare data integration, and ongoing assistance to SLTTs to support heat response planning.

Recommendation 2. Leverage HPP to advance healthcare readiness

1. Require HPP recipients to integrate extreme heat in the required coalition-led hazard and vulnerability assessments (HVA). This should include connections with local or regional climate projection subject matter experts.
2. Require healthcare coalitions to develop a coalition heat response plan, similar to existing requirements for hazard-specific response plans, such as the radiation emergency surge annex requirement.
3. Require healthcare coalitions to use extreme heat as a Medical Response and Surge Exercise scenario once in each cooperative agreement, or more frequently based on HVA and priorities.
4. Streamline MOCC-capability funding through HPP, require all HPP recipients to establish patient and resource transfer coordination capabilities, and institute clear transfer authority. 50% increase in annual funding per recipient, or $120 million based on 2023 funding.
   1. Current funding mechanisms for MOCCs are convoluted, tied to expiring COVID funding or reallocating funds from various response funds. A clear, streamlined approach will ensure sustainability and readiness.
   2. MOCC funding should be periodically reassessed based on innovative best practices and changes in the local and national threat landscape. For example, MOCCs may be critical during non-emergency protracted hospital strain and should be funded appropriately.
5. Ensure healthcare coalitions engage outpatient healthcare, long-term care, and federally qualified health centers and their respective regional or state associations.

Recommendation 3. Establish technical assistance resources

1. Fund and establish two regional Heat-Health Response Excellence Centers at two academic institutions that will provide technical expertise and guidance to federal agencies and SLTTs on heat preparedness and response best practices, regional heat characteristics, and connect SLTTs with heat subject matter experts.
2. Develop heat-specific response guidance—examples could include heat-sensitive pharmaceutical guidance, heat-associated mass casualty triage, and critical resources for extreme heat-related patient surges. 
3. Allocate $6 million in annual funds based on existing ASPR-funded Pediatric Disaster Care Centers of Excellence. 

Recommendation 4. Modernize NDMS and USPHS for extreme heat

1. Work with Heat-Health Response Excellence Centers to develop heat-specific response standards and training. Integrate them into current NDMS modernization efforts, starting with Disaster Medical Assistant Teams.
2. Update NDMS response plans to align with forecast-based response triggers. Integrate these plans into ongoing regional exercises that include HPP recipients. 
3. One-time funds: $17 million based on 2020 CARES Act for USPHS training.

Cost Estimates

This proposal would require a first-year cost of $153 million and future annual costs of $129 million. The economic justification to fund these efforts is apparent. The sharp increase in billion-dollar extreme weather disasters in the U. S., the growing awareness of the impact of extreme heat on human health (and associated medical expenses), and mitigation research showing that every dollar in prevention saves up to $15 in response and recovery expenses should incentivize Congress to fully fund this proposal. 

Conclusion

Increasing risks associated with extreme heat in the United States signal an urgent need to enhance national preparedness and response strategies. ASPR is ideally suited to lead in supporting SLTTs in their preparedness and response. ASPR can accomplish this through low-cost measures that develop critical decision-making tools and better integrate extreme heat into existing programs, funding mechanisms, and medical and public health deployment systems.