Planning to Reduce the Health Impacts of Extreme Heat: A Content Analysis of Heat Action Plans in Local United States Jurisdictions

Thesis (Master's)--University of Washington, 2022Background: The United States is experiencing increasing temperatures and heatwaves due to anthropogenic climate change. Days of extreme heat lead to higher rates of morbidity and mortality and place greater demand on healthcare systems. Certain people, such as those older than 65, minorities, people experiencing houselessness, those with mental health issues, outdoor workers, and those living in urban areas, are more at risk for the health effects of extreme heat exposure. Heat action plans (HAPs) are one way that local jurisdictional public health and emergency management agencies prepare to respond to days or periods of extreme heat to prevent adverse health impacts. While there is evidence that these plans can decrease the health impacts of extreme heat, few studies have examined common content of local U.S. HAPs and characterized their gaps. Methods: This study uses content analysis to identify common strategies and gaps for extreme heat preparedness among written HAPs in the U.S. We obtained plans for jurisdictions that serve municipalities greater than 200,000 residents through web searches, outreach, and materials from prior research. We reviewed, coded, and analyzed plans to describe the prevalence of key components and strategies. Results: Across the twenty-one plans evaluated, plans commonly incorporated activation triggers (100%), heat-health messaging and risk communication (100%), cooling centers (100%), surveillance activities (100%), agency coordination (100%), and at-risk population outreach (95%). Gaps existed in the specific applications of these broad strategies. Discussion: Practice-based recommendations as well as future areas of research focus on addressing barriers to cooling center use, increasing targeted strategies for at-risk individuals, expanding the use of surveillance data outside of situational awareness, and planning for concurrent disasters