“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.

As 2023 was the hottest year on record, America must start to prepare for even hotter years in the future. To meet this moment, the Federation of American Scientists (FAS) has launched the Extreme Heat Policy Sprint, an initiative to accelerate experts’ high-impact policy recommendations to comprehensively address the extreme heat crisis.

The urgency of this initiative is underscored by global average temperatures soaring to a record 2.63°F (1.46°C) increase from pre-industrial levels and heat-related mortalities forecasted to surge 370% within the next three decades. In Maricopa County, Arizona alone, at least 579 people lost their lives to heat last year, with senior citizens accounting for one in three deaths. This staggering number is widely considered an undercount, as heat-related mortalities are difficult to document.

With heat being the top weather-related killer of Americans and the nation having faced the hottest summer on record, the federal government made the largest resourcing of extreme heat mitigation in history last year. The United States Department of Agriculture (USDA) distributed $1 billion in grants to projects expanding urban tree canopies to reduce average temperatures during extreme heat events, amongst other co-benefits like flood reduction and improved public health outcomes. In addition, the National Oceanic and Atmospheric Administration (NOAA) provided $5 million in funding for two centers of excellence to deliver actionable, place-based climate information for community heat resilience. These efforts were complemented by the Federal Emergency Management Agency’s (FEMA) distribution of $1.8 billion through two grant programs designed to help communities increase their resilience to the impacts of climate change, including extreme heat. 

Despite these federal programs, the resourcing needs for future extreme heat conditions are growing exponentially, with anticipated exposure to dangerous heat (>125 °F) expected to impact 107.6 million Americans by 2053. Several key U.S. cities are expected to experience risky wet bulb temperatures of +87°F, which would trigger deadly heat stress and stroke in vulnerable populations within just a few years. These conditions would completely suspend safe outdoor operations of the city during the summer months. Further, the exponential growth of cooling technology adoption across the country catalyzes increased demand for energy, thereby increasing fossil fuel emissions and straining electric grids to the point of risky blackouts. 

With such immense risks coming alarmingly soon, there is a need for transformative strategies to protect Americans from the heat where they live, where they work, and in their communities. Resilience to heat must be included in nationwide planning and management. The built environment must be adapted to chronic, sustained heat. Novel resilient cooling technologies need to be brought rapidly to market. Communities need climate services that include heat risk and offer regionally-specific solutions. The full health and economic costs of heat must be accounted for and responded to. All of this requires integrating heat resilience into every part of the federal government and developing new governance models for climate and health, focusing on adaptation-forward, people-centered disaster response approaches.  

Introducing the Participants of the Extreme Heat Policy Sprint

This critical situation sets the stage for the pivotal contributions of the experts in the Extreme Heat Policy Sprint. Each of these professionals offer innovative and impactful policy recommendations, drawing from diverse areas of expertise, including but not limited to climate resilience, health care, public policy, law, and urban planning. This collaboration is essential in shaping effective federal strategies to mitigate the far-reaching impacts of extreme heat on communities nationwide.

Infrastructure and the Built Environment

• Bill Updike, Smart Surfaces Coalition, Program Manager
• Jacob Miller, Smart Surfaces Coalition, Project Manager
• Dan Metzger, Sabin Center for Climate Change Law, Smart Surfaces Fellow
• Kurt Shickman, Adrienne Arsht-Rockefeller Foundation Resilience Center, Former Director of Extreme Heat Initiatives
• Justin Schott, University of Michigan, Lecturer and Project Manager of the Energy Equity Project 
• Dr. Vivek Shandas, Portland State University, Professor
• Dr. Larissa Larsen, University of Michigan, Professor

Workforce Safety and Development

• Dr. June Spector, University of Washington, Physician-scientist
• Dr. Margaret Morrissey-Basler, Providence College, Assistant Professor of Health Sciences
• Douglas Casa, University of Connecticut Korey Stringer Institute, Chief Executive Officer

Public Health and Preparedness

• Dr. Kari Nadeau, Harvard University Center for Climate, Health and the Global Environment, Professor and Director
• Nile Nair, Harvard University Center for Climate, Health and the Global Environment, Ambassador and PhD Fellow 
• Nathaniel Matthews-Trigg, Americares, Associate Director of Climate and Disaster Resilience 
• Dr. Arnab Ghosh, Cornell University, Assistant Professor of Medicine

Food Security

• Lori Adornato, Defense Advanced Research Projects Agency, former Program Manager 

Planning and Response

• Louis Blumberg, Senior Climate Policy Advisor, Climate Resolve 
• Johanna Lawton, Project Manager, Rebuild by Design
• Dr. Julie Robinson, Pima County Department of Health, Program Officer of Climate & Environmental Health Justice
• Kat Davis, Pima County, Division Manager of Emergency Mitigation and Preparedness
• Dr. Theresa Cullen, Pima County, Public Health Director

Data and Indices

• Dr. Alistair Hayden, Cornell University, Professor of Practice Public & Ecosystem Health
• Rebecca Morgenstern-Brenner, Cornell University Brooks School Public Policy, Senior Lecturer 
• Dr. Amie Patchen, Cornell University Department of Public & Ecosystem Health, Chief Lecturer
• Dr. Nathaniel Hupert, Weill Cornell Medical College, Internal Medicine Physician and Public Health Researcher 
• Bianca Corpuz, Johns Hopkins University, PhD Candidate 
• Dr. Jeremy Hess, University of Washington, Director of Center for Health and the Global Environment (CHanGE) and Professor in the Schools of Medicine and Public Health
• Dr. Tim Sheehan, University of Washington Center for Health and the Global Environment (CHanGE), Postdoctoral Research Fellow

Extreme heat is the number one weather-related killer of Americans, yet receives minimal targeted federal support and dedicated funding for planning, mitigation, and recovery.

This summer, 130 million Americans were placed under some type of heat alert. National records for heat continue to be shattered each month, with July estimated to be the hottest month recorded on Earth. This relentless heat will continue to affect millions of Americans in August and for every summer to come. 

Extreme heat is the number one weather-related killer of Americans, yet receives minimal targeted federal support and dedicated funding for planning, mitigation, and recovery. Unlike other weather-related disasters, the consequences of extreme heat are hard to respond to and challenging to account for under current federal law. For starters, the Stafford Act does not consider extreme heat to be a Major Disaster (Sec. 102), barring sufficient coordinated federal action. Further, extreme heat is not only risky to infrastructure, like our power grids, roads, and homes, but also has devastating direct impacts on public health.

Prolonged exposure to extreme heat increases the risk of developing potentially fatal heat-related illnesses, such as heat stroke where the human body reaches dangerously high internal temperatures. If a person cannot cool down, especially when the nights bring no relief from the heat, this high core temperature can result in organ failure, cognitive damage, and death. These human health impacts are harder to account for in benefit-cost analyses that drive disaster preparedness funding allocations. Extreme heat is a crisis that impacts everyone. However, certain populations are more vulnerable to the increased health risks from heat, including older adults, outdoor workers, those with preexisting health conditions, low income communities, and people experiencing homelessness. 

Extreme heat also creates conditions that increase the likelihood and severity of other natural hazards, such as droughts and wildfires, further threatening public health. These compounding disasters put a major strain on national and global agricultural systems and threaten food security. This is particularly true for low-income communities as “heatflation” makes staple foods more unaffordable. 

We can better prevent, manage, and recover from extreme heat. With increased federal attention towards the effects of extreme heat and climate adaptation and resilience, there is an opportunity to take action. Federal policy can be a powerful lever of systems change, ensuring better coordination across federal agencies, state and local governments, and public and private sectors to beat the heat.

Starting now, the Federation of American Scientists is launching an Open Call for Extreme Heat Policy Ideas to source policy solutions to improve how the federal government coordinates a comprehensive response to heat. FAS is collecting ideas throughout Fall 2023 to prepare effectively for the next heat season. More information can be found by following this link.

FAS has completed a preliminary diagnosis of six opportunity areas for innovative extreme heat policy ideas that can make the most substantial impact on American heat resiliency: Infrastructure, Workforce, Public Health, Food Security, Planning and Management, and Data and Indices.

Infrastructure

Many Americans offset heat through increasing their use of air conditioning. Yet, this creates many issues, including the risk of overloading our electrical grids, equity concerns surrounding who has continuous access to air conditioning, and variance in the effectiveness of different air conditioning units. 1 in 4 Americans experience energy insecurity which puts them at risk of energy shut-offs, and Americans at large hold $19.3 billion in energy debt as of March 2023.

Further, AC units fail to address fundamental issues in infrastructure, such as the poor design of buildings or lack of building codes that specify maximum temperature inside buildings. A study done by CAPA Strategies and the Portland Bureau of Emergency Management on heat in public housing found that even units with AC saw observed temperatures consistently greater than 80℉, putting the health of residents at risk. Even more alarming, research has projected that in the event of a multi-day blackout during a heatwave, the heat-related mortality rate in Phoenix, Atlanta, and Detroit would increase dramatically. In Phoenix, more than 50% of the urban population would require medical attention. This calls into question an AC-only heat mitigation strategy. Rather, how we design and build our infrastructure can make our communities more heat resilient. 

Extreme heat presents multiple challenges to our current infrastructure, including concerns over grid and transportation resilience, lack of building codes for heat, lack of well-researched passive cooling technologies (i.e. non-air conditioning) to combat heat, and urban planning and design to beat the heat. Infrastructure investments, such as increasing grid resilience and creating more urban green space and nature-based solutions, can serve as preventive measures to keep communities cool as temperatures continue to rise. 

With the Bipartisan Infrastructure Law and the Inflation Reduction Act, several federal agencies have created programs that could address infrastructure concerns surrounding extreme heat. 

• The Department of Energy has allotted $2.5 billion in grants to support grid resilience programs designed to reduce impacts from extreme weather and natural disasters.
• The Department of Energy Weatherization Assistance Program increases energy efficiency in homes to reduce costs to low-income households.
• The Department of Transportation PROTECT grants provides $1.4 billion to improving surface transportation resilience from natural hazards.
• The Department of Housing and Urban Development provides $4.8 billion for green and resilient retrofits of assisted multifamily properties.
• The Department of Agriculture has allotted $250 million in urban and community forestry grants to provide funding to increase urban canopy in disadvantaged communities. 
• The Federal Emergency Management Agency has the Building Resilient Infrastructure and Communities (BRIC) program to support hazard mitigation projects.
• The Department of Health and Human Services created the Low Income Home Energy Assistance Program (LIHEAP) to assist families with energy costs.

While these programs provide necessary support and funding to address infrastructure concerns, multiple gaps still persist. First, federal agencies may have capital but are not coordinated in their approach to addressing extreme heat and proactively building community resilience to heat. The Equitable Long-Term Recovery and Resilience Interagency Working Group has found difficulties in interagency coordination of notices of funding opportunities, place-based engagement for deployment of funds, direct technical assistance to communities, and maintenance of continuous sources of funding along a project’s timeline (i.e. ensure once infrastructure is built that there are people to upkeep passive infrastructure such as green spaces or people to staff active infrastructure like cooling centers). Without strategy and clarity for how communities should proceed and what they should invest in, there will be no sustainable change in infrastructure across the nation. 

Second, nuances in specific programs and the way grants are chosen through benefit-cost analysis (i.e. greater value to property damage over harder to quantify measures like impacts on human lives) may limit funding that goes to projects specifically focused on extreme heat. For example, while communities have been told that FEMA’s BRIC can fund extreme heat resilience, BRIC grant applications have been repeatedly rejected for extreme heat-related projects, a consequence of the “cost-effective” statute for BRIC. Even if a cooling center is approved, BRIC money cannot staff the center in the event of a disaster. 

Third, many jurisdictions around the country lack building codes that specify a maximum indoor temperature inside buildings as well as required strategies to mitigate extreme heat – contributing to heightened risk for individuals developing heat-related illnesses.  

Workforce

Rising temperatures place many members of the workforce, such as farmworkers and construction workers, at increased risk for heat-related illnesses. Extreme heat also leads to immense losses in workplace productivity, with research estimating a total annual loss of $100 billion to the U.S. economy. Without any measures to address the impacts of extreme heat in the future, this figure could double to $200 billion by 2030 and $500 billion by 2050. The Occupational Safety and Health Administration (OSHA) within the Department of Labor recently released a heat hazard alert which provides information to employers about how they should be protecting employees in extreme heat conditions as well as information on employees’ rights. With recent direction from the White House, OSHA will also increase its inspections and enforcement of violations in industries at higher risk for extreme heat, such as agriculture. Yet, OSHA is historically under-resourced in its ability to effectively carry out inspections and enforcement, with each inspector now responsible for securing the rights of 200,000 workers. 

This under-resourcing extends to OSHA’s ability to create a national standard for protection against extreme heat which is still years off from implementation. This leaves employee protection to state-level standards. Some states, including California and Oregon, have issued heat standards to protect workers. Yet, other states, such as Texas, have eliminated the requirement for employers to provide basic safety measures like water breaks. In this current system, employees are being put at significant risk. Providing employees consistent breaks for water and shade while working in extreme heat conditions is a simple way to mitigate these risks while lowering costs of workers’ compensation for employers in the event of a work-exposure related heat illness. 

Public Health

Each summer, extreme heat can cost the healthcare industry upwards of $1 billion dollars. Exposure to extreme heat, and often accompanying high humidity, can cause multiple heat-related illnesses, including heat cramps, heat exhaustion and heat stroke. The risks of developing severe symptoms are heightened by social and environmental factors, such as lack of access to air conditioning, shade, or transportation to medical centers. Individual factors, including types of medication being taken, can also increase sensitivity towards heat. Further, rising temperatures exacerbate negative mental health outcomes, such as fatigue and aggression. 

When patients with a heat-illness are admitted to the hospital, there are numerous limitations with coordination and response. Diagnostic codes, used for insurance claims, exist for heat-related illness. However, physicians may not recognize the symptoms of heat-related illnesses and instead diagnose and assign other related codes, such as dehydration. Therefore, patients may not be properly diagnosed and treated. This also leads to significant underreporting of the effects of extreme heat on health. 

Quick coordination and response by health care professionals is critical in preventing long-term damage. A nationwide survey by Americares found that less than 20% of staff in clinics feel that their clinics are “very resilient” to extreme weather. During the Northwest Heat Dome in 2021, a lack of coordinated public health preparation led to 229 deaths, more than any other disaster that year. In order to increase preparedness and timely response, it is essential for the public health workforce to be educated on best practices in responding to heat-illnesses. For example, after the Northwest Heat Dome, Seattle has begun to implement new plans for hospitals to meet to review best practices if extreme heat is forecasted, including checking whether centers have ice and body bags available. 

Extreme heat can also have unexpected consequences on public health. For instance, extreme heat creates favorable conditions for infectious disease carriers, such as ticks and fungal spores, to exist in areas of the country where they were historically unable to survive. Transmission of disease is also more likely as people congregate in community hubs, such as cooling centers or beaches. 

As heat waves become more frequent and intense across the nation, it’s critical to create standardized coordination efforts. The Office of Climate Change and Health Equity serves as a resource hub, producing a seasonal Climate and Health Outlook and the new Heat-Related Emergency Medical Services Activation Surveillance Dashboard. Yet, they are not federally funded and are therefore limited in their capacity to coordinate heat and health resilience. In terms of public health preparedness resources, the Center for Disease Control’s (CDC) Climate Ready States and Cities Initiative can only support nine states, one city, and one county, despite 40 jurisdictions having applied. The Trust for America’s Health (TFAH) found increasing funding from $10 million to $110 million is required to support all states, and improve climate surveillance. 

The threat of extreme heat speaks to a critical need for a funded agency or office to take a leadership role in the following three efforts: 1) strengthening holistic natural disaster resiliency and response efforts within the healthcare and public health sectors through interagency collaboration 2) orchestrating and supporting efforts to close information gaps, synthesize data, and identify practical applications of information on natural disasters and climate threats and 3) coordinate efforts to develop communication and education on climate-related health threats. 

Food Security

Extreme heat and its exacerbation of other natural hazards, including droughts, can have a significant impact on our agricultural productivity and food security. The COVID-19 pandemic has illustrated the impact of large-scale emergencies on our national and global food supply chains and distribution systems. 

Increases in temperature may directly cause a reduction in crop growth and agricultural yields by affecting plants’ growth cycle. Rising temperatures affect livestock, potentially leading to increased mortality and reduced production of certain products, such as milk and eggs. It also impacts the way food can be stored and transported. Changes in food supply can ultimately increase the costs of certain foods and thus may not be affordable for everyone, particularly low-income populations. 

Extreme heat also contributes to the creation of favorable conditions for droughts, increasing the risk for crop failure. For instance, in Texas and the Midwest, extended droughts are causing farmers to be concerned about their agricultural yields and placing too heavy of a reliance on irrigation systems. Over a thousand communities are currently under disaster designation by the USDA this summer because of extended drought exacerbated by extreme heat.

It is critical for resources to be devoted to the research and development of strategies to improve the heat resilience of crops and livestock given the economic unsustainability of evergreen emergency disaster assistance. A report by the Perry World House Center recommended specific strategies including restorative agriculture practices, diversifying crop production, and learning from indigenous agricultural practices. The US Department of Agriculture’s Climate Hubs provide information on climate resilience to inform decision-making by natural resource and agricultural managers – and would benefit from additional appropriations. Additionally, the USDA’s Partnerships for Climate Smart Commodities is investing $1 billion into financing pilot projects that use climate-smart practices, yet no projects focus explicitly on extreme heat resiliency. 

Planning and Management

Despite its immense impacts, extreme heat is not considered a hazard that can trigger a federal emergency declaration under the Stafford Act. Many agencies, such as the Department of Interior and Housing and Urban Development, are not able to unlock funds without an emergency declaration and supplemental appropriations from Congress, illustrating the need to create more active resilience measures for these agencies to strategically act on extreme heat. 

The lack of specific staff within agencies and overarching federal leadership for heat resilience, response, and recovery limits an effective and coordinated response. Communities need agencies to have the tools, guidance, and technical assistance needed for implementation of extreme heat resilience. Lastly, having no federal office with national responsibility for extreme heat presents a major risk as certain parts of the country reach the upper limits of human habitability despite all resilience efforts triggering potentially destabilizing internal climate migrations.

Within local and state governments, there is often no specific agency or officer responsible for heat. Currently, only a handful of local jurisdictions are beginning to experiment with different organizational structures to address heat, such as the appointment of a designated Chief Heat Officer in Miami-Dade, Florida. On the state and local level, there is a lack of research into which organizational structure is most effective and efficient at extreme heat mitigation and response. In addition, there’s no incentive from the federal government for local jurisdictions to create effective heat response personnel. 

Finally, many states and local jurisdictions fail to plan for heat as a part of their Hazard Mitigation Plans, often required by FEMA to unlock disaster preparedness and recovery investments. Yet, there are currently no best practices on how to plan and respond, beyond high-level, non-specific guidance documents from the CDC and Environmental Protection Agency, leaving each city to create their own plans of action.

Data and Indices

While heat blankets entire regions, its impacts are not felt equitably across the population. Urban heat island effects can make parts of cities far hotter – thus worsening the disaster for people residing in these zones. Further, there is a lack of consensus over how to name, categorize, and communicate the severity of extreme heat events. Heat is very context dependent. Temperature is not the only consideration in determining the severity of heat. Levels of humidity are an integral factor in determining the extent to which the human body can control internal temperature. 

Inadequate data collection can result in underestimating the severity of heat, particularly in urban neighborhoods. Localized factors, including neighborhood design and the infrastructure of individual buildings can exacerbate the severity and consequences of heat. Within one city or local jurisdiction, data for heat can vary by multiple degrees. When these temperatures are not accurately accounted for, it can contribute to lack of efficient planning and emergency management. The National Oceanic and Atmospheric Administration and the Center for Disease Control created the National Integrated Heat Health Information System (NIHHIS) to provide tools and information on extreme heat. While NIHHIS produces useful information, such as the vulnerability mapping tool and urban heat island mapping campaign with the EPA, there is still a gap in applying this information and connecting localities with useful data and information on which strategies are most effective at combating extreme heat. Since this issue is dependent on context and locality, it’s crucial to have a system that collects nuanced data that tracks all of the impacts of extreme heat. 

Issues in communicating extreme heat’s severity arise because different heat indices use different standards and ultimately communicate output at varying levels of severity. This contributes to confusion surrounding what temperatures should constitute extreme heat. For instance, heat index calculations are a common measurement that take humidity into account. However, the formula assumes that people are resting in the shade. On the other hand, Wet Bulb Globe temperature calculations use direct sunshine measurements and assume people are active. Both of these measurements assume people are healthy. Not only does this create confusion about which index to rely on, it also excludes and may underestimate the severity of heat in certain populations. Naming heat waves is one solution that’s been explored in Spain to make it easier to explain the severity of extreme heat to the public.

Extreme heat presents multiple challenges to our planning, response, and management systems. While the consequences of extreme heat can be deadly, they can be avoided with a coordinated and comprehensive federal response. If you’re feeling inspired to act, submit an idea to our Open Call for Extreme Heat Policy Ideas here.