Public Health Experts: States Aren’t Ready for Deadly Heat

Summer is coming, along with the threat of preventable heat-related harm. There’s no time like the cold, wintry present for public health practitioners to build the case for better state- and city-level preparedness for dangerous heat events and an increasingly hotter future.  

The collision coming this summer between skyrocketing electricity bills, unaffordable health care, and above-average temperatures will almost certainly increase the risk of heat-related illness, death, and economic harm. Based on the newly published results of a survey conducted by NRDC and the American Public Health Association (APHA), public health experts share this angst. State and regional public health associations in the APHA Affiliates network reported far-reaching effects of extreme heat in the previous two years, including high utility bills, increased demand for shelter services, more emergency room visits, and deepening social and economic inequities. As a result, nearly 9 out of 10 respondents indicated they are moderately or very concerned about their state government’s ability to protect people from an extreme heat event in the next four years.  

APHA Affiliates comprise 52 independent organizations that help “promote, protect, and advocate for the public’s health” across the country. Despite the high level of concern among the 35 affiliates that responded to the 2025 survey, just 40 percent said they had advocated state and local heat policies in the previous two years. 

Why the mismatch between concern and policy engagement? Roughly half of the organizations identified two major barriers to heat-related advocacy, which we had expected: the relative urgency of other issues and resource constraints. Extreme heat rarely gets the same attention as other major public health threats, in part because it creeps in and out without the stark visuals of disasters such as wildfires and hurricanes. It’s not surprising that such a silent killer has trouble competing with other crises facing our woefully underfunded public health system. 

However, we were disheartened that 40 percent of affiliates also cited political opposition to heat solutions from powerful constituencies as a major barrier to advocacy. Extreme heat preparedness is often considered less polarizing than other climate-related issues, in part because there has previously been bipartisan support for measures such as tree planting and protecting student athletes from heat. Although we didn’t explicitly ask the affiliates about the reason for political opposition, one possibility is that heat solutions are strongly tied to the kinds of racial, environmental, and economic justice solutions that are losing ground in our current political climate.   

Take heat protections for workers, for example. Workplaces such as insufficiently cooled public schools, blazing airport tarmacs, and unshaded construction sites are a major source of dangerous heat exposure for many U.S. residents—especially those who come from Black, Latine, immigrant, rural, or low-income communities. Yet, despite a wealth of commonsense safety measures, the economic benefits that come from a healthy workforce, and strong public support for workplace heat standards, formal safeguards typically face fierce and unrelenting headwinds from industry groups.  

Thankfully, APHA Affiliates also identified that there are paths forward. As the survey results reflect, extreme heat is a multi-jurisdictional, multidisciplinary threat that will need collaboration among many kinds of changemakers, from health care systems to community groups and  faith-based organizations. APHA plans to use the survey results and an associated listening session to guide support for affiliates that want to engage in heat-related policy advocacy in their states. For example, it will soon launch a “train the trainer” model to help affiliates amplify the tools on APHA’s extreme heat resource hub. In the meantime, the organizations—and everyone else!—can start talking to state lawmakers while they’re still in their 2026 legislative sessions. One starting point for those conversations could be how to modify existing programs and policies to better protect communities and households before, during, and after a deadly heat event. A list of concrete heat-preparedness resource needs can be found in table 1 of this recent NRDC report.  

This survey highlights a growing crisis that public health leaders see playing out as summers become longer and hotter: States often lack the tools, funding, and political will to keep people safe from extreme heat. It also points to a path forward by calling for greater investments in community-based solutions, increasing clarity on state-level agency accountability, and building cross-sector partnerships that can deliver heat resilience solutions at scale.