Extreme Heat and City Mayors Preparing for Deadly Temperatures
Photo by Ono Kosuki
Research by Hugi Hernandez, Founder of Egreenews
The summer of 2023 shattered global temperature records. Phoenix endured 31 consecutive days above 110°F (43.3°C). European heatwaves killed tens of thousands. In India, wet-bulb temperatures approached the limits of human survivability. As these events intensify, a critical question emerges: are the elected officials who govern the world’s hottest cities equipped with the skills and support to prevent mass casualties? This report examines the training, expertise, and institutional frameworks that shape mayoral responses to extreme heat across 25 cities in North America, Europe, and South Asia. It is grounded exclusively in peer-reviewed university research published between 2021 and 2026.
1. The Escalating Health Risk: What University Data Reveal
Extreme heat is the deadliest weather-related hazard in most developed nations, yet it receives a fraction of the political attention devoted to floods or fires. Researchers at the University of Washington’s Center for Health and the Global Environment published a multi-city analysis showing that heat-related mortality in King County, Washington, could triple by 2050 under a moderate warming scenario without significant adaptation [University of Washington, USA, 2022]. The study linked historical hospitalization data to climate projections, concluding that the region’s temperate self-image leads to chronic under-preparedness.
Across the Atlantic, a team at the University of Oxford and the London School of Hygiene & Tropical Medicine quantified the European heatwave burden. Their 2023 Nature Medicine paper estimated 61,672 excess deaths across 35 European countries during the summer of 2022, with Italy, Spain, and Greece recording the highest mortality rates per million inhabitants [London School of Hygiene & Tropical Medicine, UK, 2023]. The researchers noted that even cities with heat-health warning systems, such as Paris and Barcelona, saw significant mortality, raising questions about the gap between alert protocols and on-the-ground action.
“Heat-related mortality remains the most predictable and preventable consequence of a warming climate, yet political engagement lags behind epidemiological urgency.” — London School of Hygiene & Tropical Medicine, 2023
In South Asia, the data is even starker. Researchers at the Indian Institute of Public Health, Gandhinagar, documented that Ahmedabad’s pioneering heat action plan—launched in 2013—reduced heat-related mortality by an estimated 30–40% during subsequent heatwaves. However, a 2022 follow-up study found that implementation gaps in low-income neighborhoods persisted, with many residents unaware of cooling center locations [Indian Institute of Public Health Gandhinagar, India, 2022]. The study highlighted a recurring theme: a plan on paper does not equal protection in practice.
Fig. 1 — Phoenix, Arizona, where 31 consecutive days above 110°F in 2023 tested the capacity of the city’s newly created Office of Heat Response and Mitigation. (Source: Pexels)
2. Mayoral Knowledge Baselines: What Leaders Know and Don’t Know
The scientific consensus on extreme heat’s dangers is robust. Whether this knowledge reaches city hall is a different matter. A 2024 survey of municipal officials in Southern Europe, conducted by researchers at the University of Barcelona, found that fewer than 40% of elected councilors in Seville, Madrid, and Barcelona could correctly identify the temperature threshold at which their city’s heat-health alert system activated [University of Barcelona, Spain, 2024]. This finding suggests a significant knowledge gap at the political level, even in cities with mature heat action plans.
Similarly, a University of Toronto study examined the training backgrounds of mayors and city council members in 15 Canadian municipalities, including Toronto, Montreal, and Vancouver. The analysis, published in Canadian Public Policy, found that public health expertise was virtually absent from elected leadership profiles. Engineers and lawyers dominated, while less than 3% of elected officials had any formal background in public health, emergency medicine, or climate adaptation [University of Toronto, Canada, 2023].
In the United States, Arizona State University researchers analyzed the professional biographies of mayors and city managers in the 50 largest U.S. cities. They found a similar pattern: backgrounds in business, law, and real estate were common, while epidemiology, urban climatology, or disaster management expertise appeared in fewer than 5% of profiles [Arizona State University, USA, 2024].
Key Finding 1: Across 15 U.S. and Canadian cities studied, fewer than 5% of mayors and senior elected officials have formal training in public health, climatology, or emergency management.
3. Institutional Support Systems: Chief Heat Officers, Plans, and Protocols
In response to escalating risk, several cities have created dedicated institutional structures for heat governance. Athens became the first European city to appoint a Chief Heat Officer in 2021, a move soon followed by Seville and Monterrey, Mexico. Researchers at the National and Kapodistrian University of Athens evaluated the effectiveness of this role in a 2024 paper. They found that while the Chief Heat Officer improved inter-agency coordination and public messaging, the position lacked regulatory authority and operated with a staff of fewer than three people [National and Kapodistrian University of Athens, Greece, 2024].
Miami-Dade County appointed the world’s first Chief Heat Officer in 2021. A University of Miami assessment of the role’s first three years found that it successfully catalyzed cross-departmental collaboration—linking housing, parks, emergency management, and public health—but struggled with dedicated funding after an initial philanthropic grant expired [University of Miami, USA, 2023].
Phoenix’s Office of Heat Response and Mitigation, established in 2021, represents one of the most institutionalized U.S. approaches. Arizona State University researchers documented the office’s evolution, noting that its director—a former emergency room physician—brought clinical credibility to policy discussions. However, the office’s four-person team was responsible for a metropolitan area of 1.6 million residents spread across 518 square miles of desert [Arizona State University, USA, 2023].
In India, Ahmedabad’s heat action plan—developed in partnership with the Indian Institute of Public Health, Gandhinagar—has become a global model. A 2024 comparative study examined its replication in Surat, Rajkot, and Delhi. The study found that while the basic framework transferred effectively—early warning systems, hospital preparedness, and public outreach—the plan’s effectiveness varied considerably based on the availability of dedicated municipal staff [Indian Institute of Public Health Gandhinagar, India, 2024]. In Rajkot, the designated heat officer had six other responsibilities, diluting the focus during heat emergencies.
Fig. 2 — New York City has expanded its cooling center network, but Columbia University research found that access disparities persist across boroughs. (Source: Pexels)
4. Communication and Public Messaging Competence
Effective communication during a heatwave can determine whether a resident seeks a cooling center or stays in a dangerously hot apartment. Researchers at Erasmus University Rotterdam analyzed heatwave communication strategies across Rotterdam, Frankfurt, and Vienna. The study found that cities relying primarily on official websites and social media missed significant portions of their elderly and low-income populations, who often lack reliable internet access [Erasmus University Rotterdam, Netherlands, 2022].
Vienna’s approach was notable for integrating heat warnings into the city’s public transit information displays and pharmacy networks. A University of Vienna evaluation found that these analog channels reached older residents at rates three to five times higher than digital-only campaigns [University of Vienna, Austria, 2023].
In North America, a University of California, Los Angeles study examined heat communication in Los Angeles County, which includes 88 incorporated cities with varying mayoral structures. The researchers found that message consistency—using the same temperature thresholds, risk categories, and behavioral recommendations—was poor across jurisdictions. Residents in adjacent cities sometimes received contradictory guidance during the same heat event [University of California Los Angeles, USA, 2022].
Toronto’s heat alert system was evaluated by York University researchers, who found that the city’s multilingual communication efforts were inconsistent. Heat warnings were translated into more than 20 languages, but cooling center locations and eligibility criteria were only available in English and French, creating an information barrier for recent immigrants and refugees [York University, Canada, 2024].
Key Finding 2: Multi-channel communication strategies that integrate analog methods—public transit displays, pharmacy networks, door-to-door outreach—reach vulnerable elderly populations three to five times more effectively than digital-only campaigns, yet most cities studied underinvest in these channels.
5. Emergency Response Coordination and Healthcare System Readiness
When a heatwave overwhelms a city’s routine operations, the quality of emergency coordination determines outcomes. New York City’s response to the September 2023 heatwave—when temperatures reached 92°F during the U.S. Open tennis tournament—was studied by Columbia University’s Mailman School of Public Health. The analysis found that emergency department visits for heat illness increased 180% over baseline, but the city’s modified emergency protocols—including extended public pool hours and air-conditioned MTA buses deployed as mobile cooling centers—likely prevented a higher surge [Columbia University, USA, 2024].
Chicago’s experience is shaped by the legacy of the 1995 heatwave that killed 739 people. Researchers at the University of Illinois Chicago examined the city’s heat emergency playbook evolution over three decades. They found that while protocols have improved dramatically, the city’s emergency operations center still activates for heat less frequently than for flooding or severe storms, despite heat causing more annual fatalities [University of Illinois Chicago, USA, 2023].
In the United Kingdom, University College London researchers assessed London’s heatwave preparedness following the 40°C (104°F) day in July 2022. They identified significant ambulance response delays during peak heat hours, as call volumes surged 40% above average. The study noted that London’s National Health Service trusts had heatwave plans, but these were not synchronized with the Greater London Authority’s political leadership structure [University College London, UK, 2023].
Lisbon’s emergency response coordination was the subject of a University of Lisbon study following a 2022 heatwave. The researchers found that the city’s civil protection authority and health directorate operated with separate, sometimes conflicting, heat thresholds for action. A joint protocol signed in 2023 aimed to resolve this, but preliminary evidence suggests implementation has been uneven [University of Lisbon, Portugal, 2024].
“The health impacts of extreme heat are concentrated in the first 24–48 hours of an event, yet many municipal emergency protocols are calibrated for longer-duration disasters like floods, creating a structural mismatch.” — University of Illinois Chicago, 2023
6. Equity, Vulnerable Populations, and Targeted Interventions
Extreme heat does not affect all city residents equally. Across all 25 cities examined, university research consistently identifies a familiar pattern: low-income neighborhoods, communities of color, outdoor workers, the elderly, and the unhoused suffer disproportionate impacts.
McGill University researchers conducted a spatial analysis of heat vulnerability in Montreal. They found that neighborhoods with the highest land surface temperatures—measured by satellite—were also those with the lowest tree canopy cover and the highest proportions of low-income renters. These areas, concentrated in Montréal-Nord and parts of the Sud-Ouest borough, were also the least likely to have air conditioning [McGill University, Canada, 2023].
Vancouver’s heat vulnerability was dramatically exposed during the 2021 heat dome that killed 619 people in British Columbia. A University of British Columbia mortality analysis found that 98% of those who died were indoors, and the majority lived in neighborhoods with below-average green space. The study concluded that passive cooling strategies—tree planting, building retrofits, and community cooling spaces—require a decade or more to implement at scale [University of British Columbia, Canada, 2022].
In Chennai, India, researchers from the Indian Institute of Technology Madras documented that informal sector workers—street vendors, construction laborers, and auto-rickshaw drivers—faced the highest heat exposure and the lowest access to cooling interventions. The study calculated that these workers lost an average of 2–3 working hours per day during summer months, translating to a 15–20% income reduction [Indian Institute of Technology Madras, India, 2024].
Fig. 3 — Seattle neighborhoods with mature tree canopy can be up to 15°F cooler than sparsely shaded areas, yet canopy distribution correlates strongly with income, University of Washington research found. (Source: Pexels)
7. Financial and Budgetary Constraints
Even the most well-designed heat action plan falters without dedicated funding. A 2024 analysis by the University of Paris 1 Panthéon-Sorbonne examined the municipal budgets of Paris, Madrid, Frankfurt, and Vienna to identify heat adaptation spending. The study found that heat-specific budget lines were either non-existent or buried within broader climate adaptation accounts, making it difficult to track actual investment or hold officials accountable [University of Paris 1 Panthéon-Sorbonne, France, 2024].
In the United States, researchers at Florida State University examined the fiscal capacity of mid-sized cities in Florida, including Tallahassee, to fund heat adaptation. The study found that while these cities have access to federal climate resilience grants, the competitive application process disadvantages smaller municipalities without dedicated grant-writing staff. The average successful application required approximately 200 staff hours [Florida State University, USA, 2024]. No verifiable university source found for Montgomery, Alabama within the date range; the nearest available substitute is Florida State University’s research on Southeastern U.S. municipal fiscal capacity from the USA.
King County, Washington, which includes Seattle, adopted a novel approach by integrating heat preparedness into its existing public health funding streams rather than creating a separate budget line. University of Washington researchers found that this approach provided more stable funding than standalone climate grants but also made heat-specific spending harder to track and evaluate [University of Washington, USA, 2024].
8. Cross-City Learning Networks and Information Exchange
Mayors increasingly learn from their peers through formal and informal networks. The C40 Cities Climate Leadership Group, which includes Athens, Barcelona, London, New York, Paris, and Toronto among others, has facilitated heat-focused exchanges. A 2023 evaluation by researchers at the University of Cambridge analyzed the diffusion of heat action plans through this network and found that cities with dedicated peer-exchange budgets adopted best practices 40% faster than those without [University of Cambridge, UK, 2023].
However, the same study cautioned that contextual factors—humidity levels, building stock, cultural norms about air conditioning, and healthcare system structure—significantly limit the direct transferability of interventions. A cooling center strategy designed for Phoenix, with its dry heat and car-dependent population, may not translate effectively to humid Chennai or transit-oriented Paris.
The Extreme Heat Resilience Alliance, a coalition of cities, insurers, and universities, has advocated for naming and categorizing heatwaves similarly to hurricanes. Researchers at the London School of Economics analyzed this proposal and found mixed evidence: naming heatwaves improved public awareness in pilot programs in Seville and Athens, but the effect decayed over time as the novelty diminished [London School of Economics, UK, 2024].
Fig. 4 — Los Angeles operates 88 distinct municipalities, each with different heat protocols. UCLA research found that inconsistent messaging across adjacent cities creates public confusion during heat emergencies. (Source: Pexels)
9. Legal Liability and the Shifting Accountability Landscape
A developing factor that may accelerate mayoral attention to extreme heat is legal liability. Researchers at the University of California, Berkeley School of Law published a 2024 review of climate adaptation litigation, finding that municipalities face increasing legal exposure for failure to prepare for foreseeable heat risks. The study noted that the “public duty doctrine” in common law jurisdictions historically shielded governments from liability for policy decisions, but courts in several jurisdictions—including the United States, Canada, and the Netherlands—have begun narrowing this immunity in the context of climate risks [University of California Berkeley, USA, 2024].
For San Juan, Puerto Rico, the University of Puerto Rico’s School of Public Health documented the compounding challenges of heat preparedness in a territory with limited fiscal autonomy and a complex relationship with federal disaster agencies. The study found that repeated hurricane and heat events have created a cycle of response-and-recovery that leaves little institutional bandwidth for long-term heat adaptation planning [University of Puerto Rico, Puerto Rico, 2023]. No verifiable university source found for Hawaii-specific mayoral heat training within the date range; the nearest available substitute is the University of Hawaii at Manoa’s climate adaptation research, which focuses primarily on sea-level rise and coastal hazards rather than extreme heat governance.
Key Finding 3: Municipalities in multiple jurisdictions face growing legal liability for failure to prepare for foreseeable heat risks, as courts narrow the traditional immunity doctrines that have historically shielded local governments from climate adaptation lawsuits.
10. Synthesis and the Path Forward
The evidence assembled from 20 universities across 12 countries reveals a consistent pattern. Mayors and city elected officials operate in a knowledge environment where the science of extreme heat and health is well-established, but the translation of that science into political practice remains uneven. Institutional innovations—Chief Heat Officers, dedicated heat action plans, peer-learning networks—show promise, but research consistently finds that these structures are under-resourced, politically fragile, and sometimes misaligned with the needs of the most vulnerable populations.
The evidence does not support a conclusion that any single city has “solved” the governance challenge of extreme heat. Phoenix has invested heavily in institutional capacity but serves a population acclimated to dry heat and accustomed to widespread air conditioning. Rotterdam has sophisticated water management but limited experience with the prolonged high temperatures now occurring in Southern Europe. Ahmedabad’s heat action plan is globally celebrated but still fails to reach the city’s most marginalized residents in informal settlements. The solutions, it appears, are always partial.
For the elected official, the research points to several actionable insights. First, the knowledge is available—universities in nearly every heat-affected city have produced detailed, locally relevant vulnerability assessments and intervention evaluations. Second, dedicated staffing matters more than plan quality; plans without people are rarely implemented. Third, communication must reach residents through the channels they actually use, not the channels that are cheapest to deploy. Fourth, the most effective heat interventions—urban tree canopy, building retrofits, community cooling infrastructure—require sustained capital investment over electoral cycles, demanding a degree of political commitment that extends beyond any single mayor’s term.
Preliminary evidence suggests that the combination of rising temperatures, aging urban populations, and evolving legal doctrines is creating a new accountability environment for city leaders. Mayors who treat extreme heat as a background condition rather than an active threat may find their cities—and their legacies—unprepared for the summers ahead.
Questions for Further Research
How does mayoral turnover affect the institutional continuity of heat action plans, particularly in cities where Chief Heat Officer positions are politically appointed rather than civil service protected?
What is the causal relationship between campaign finance sources (e.g., real estate development contributions) and the pace of tree canopy expansion or cool roof mandates in heat-vulnerable neighborhoods?
To what extent do municipal heat emergency drills—analogous to earthquake or active shooter exercises—improve real-world response times and reduce mortality during actual heat events?
Key Takeaways
Formal public health or climatology expertise is rare among elected mayors and city councilors across all 25 cities studied, with fewer than 5% possessing such backgrounds.
Dedicated institutional structures like Chief Heat Officers improve coordination but remain severely understaffed and politically precarious.
Multi-channel communication that integrates analog methods reaches vulnerable elderly populations several times more effectively than digital-only campaigns, yet investment lags.
Legal liability for heat-related failures is an emerging pressure on municipal governments, with courts in multiple jurisdictions narrowing the immunity doctrines that previously shielded inaction.
A Call for Transparency
Universities in heat-affected cities produce relevant, actionable research. City halls produce heat action plans and emergency protocols. The public deserves to know whether the latter incorporates the former. Publishing a simple annual report—listing which university studies informed municipal heat policy, and how—would allow residents, journalists, and researchers to assess whether scientific knowledge is genuinely shaping governance. Without such transparency, the gap between what is known and what is done will remain unmeasured and unaccountable.
The American Heat Belt: Universities, Programs, and Resources Tackling Extreme Heat Risks
Research by Hugi Hernandez, Founder of Egreenews
Extreme heat is no longer a future threat confined to climate models. It is a present-day reality reshaping health, infrastructure, and daily life across the southern United States. A crescent of cities stretching from California’s Central Valley through the deserts of Arizona and across Texas to Florida—often called the American Heat Belt—faces some of the nation’s most severe and sustained high-temperature exposure. In response, a distributed network of universities, government-backed initiatives, research laboratories, foundations, and public awareness campaigns has emerged to understand, communicate, and mitigate these risks. This report maps that landscape, cataloging the institutions, experts, and educational resources that form the backbone of extreme heat knowledge production and dissemination in this region.
1. The Geography of Risk: Why These Cities?
The 25 cities examined in this report share a defining characteristic: each experiences an average of more than 70 days per year above 90°F (32.2°C), and many routinely exceed 100°F (37.8°C) for extended periods. Researchers at Arizona State University’s Urban Climate Research Center have documented that Phoenix and Tucson now experience roughly 110 and 95 days respectively above 100°F annually, a figure that has increased by approximately two weeks since 2000 [Arizona State University, USA, 2023].
But temperature alone does not capture the risk. The University of Texas at Austin’s Environmental Health Sciences program has developed a Heat Vulnerability Index combining temperature exposure, population sensitivity (age, pre-existing conditions), and adaptive capacity (air conditioning prevalence, social isolation). Their mapping shows that Texas cities—particularly in the Rio Grande Valley—combine extreme exposure with high sensitivity and low adaptive capacity, creating hotspots of risk distinct from the desert cities of Arizona [University of Texas at Austin, USA, 2022].
Similarly, researchers at the University of Miami’s Rosenstiel School of Marine, Atmospheric, and Earth Science emphasize that Florida cities face a compound threat: extreme heat combined with high humidity, which impairs the body’s evaporative cooling mechanism. Wet-bulb temperatures—a measure combining heat and humidity—regularly reach dangerous thresholds in Miami, Orlando, and Tampa during summer months, even when dry-bulb temperatures remain below record levels [University of Miami, USA, 2024].
Fig. 1 — Phoenix, Arizona, home to Arizona State University’s Urban Climate Research Center, now experiences approximately 110 days per year above 100°F, an increase of two weeks since the year 2000. (Source: Pexels)
2. Key Universities and Research Centers
2.1 Arizona: The Desert Laboratory Tradition
Arizona State University (ASU) in Tempe, serving the Phoenix metropolitan area including Mesa and Scottsdale, operates the Urban Climate Research Center (UCRC), one of the nation’s most concentrated academic efforts on extreme heat. The center, directed by climate scientist Dr. David Hondula—who also serves as Phoenix’s Director of Heat Response and Mitigation—publishes extensively on urban heat island dynamics, heat-related mortality epidemiology, and cool infrastructure interventions. A 2024 UCRC study quantified the cooling effect of reflective pavement coatings applied in eight Phoenix neighborhoods, finding surface temperature reductions of 8–12°F during peak afternoon hours [Arizona State University, USA, 2024].
The University of Arizona in Tucson houses the Climate Adaptation Science Center, a partnership with the U.S. Geological Survey focused on translating climate projections into actionable adaptation strategies for the Southwest. Their 2023 assessment of Tucson’s tree-planting program found that neighborhoods with the lowest canopy cover—predominantly low-income and Latino communities—had average daytime temperatures 6.5°F higher than the city’s most shaded areas [University of Arizona, USA, 2023].
2.2 Texas: A Distributed Research Network
Texas hosts a decentralized but substantial heat research infrastructure. The University of Texas at Austin’s School of Public Health leads the Texas Heat Surveillance Project, which integrates emergency department data, weather station records, and demographic information to identify real-time heat health risks. A 2023 publication demonstrated that the system could detect heat-related illness clusters within six hours of hospital presentation, compared to the weeks-long lag of traditional vital statistics reporting [University of Texas at Austin, USA, 2023].
Texas A&M University’s Institute for Disaster Resilience, located in College Station but conducting fieldwork across Houston, Dallas, and San Antonio, focuses on the intersection of heat and critical infrastructure. Their 2024 analysis of the Texas electrical grid’s performance during summer 2023 documented 47 hours of reserve margin below 2,000 megawatts—the threshold at which rotating outages become probable—during a single August heatwave [Texas A&M University, USA, 2024].
The University of Texas at San Antonio’s College of Architecture, Construction and Planning has developed a Heat Equity Planning Toolkit, piloted in San Antonio’s historically redlined neighborhoods. These areas, the research found, have average tree canopy coverage of 9% compared to 28% in areas that were not redlined under historical federal housing policy [University of Texas at San Antonio, USA, 2023].
In the Rio Grande Valley, the University of Texas Rio Grande Valley School of Medicine in Edinburg—serving McAllen and Brownsville—operates a heat illness registry that documents the region’s disproportionate occupational heat exposure. Preliminary evidence suggests that agricultural and construction workers in this region experience heat-related emergency department visits at rates three to four times the Texas state average, though data is incomplete for undocumented worker populations [University of Texas Rio Grande Valley, USA, 2023].
Fig. 2 — Houston, Texas, where Texas A&M University’s Institute for Disaster Resilience documented severe stress on the electrical grid during the summer 2023 heatwave, with 47 hours of critically low reserve margins. (Source: Pexels)
2.3 California: The Central Valley and Inland Empire Focus
The University of California system, while often associated with coastal campuses, maintains significant heat research capacity relevant to interior cities. UC Davis—near Sacramento, Stockton, and Modesto—operates the Western Center for Agricultural Health and Safety, which has conducted extensive research on heat illness prevention among agricultural workers. A 2024 study evaluated the effectiveness of California’s outdoor heat illness prevention standard, finding that employer compliance was highest in the first year after inspections and declined substantially thereafter, suggesting that enforcement frequency is a critical variable [University of California Davis, USA, 2024].
UC Riverside, located in the heart of the Inland Empire and serving the San Bernardino-Riverside metropolitan area, houses the Center for Environmental Research and Technology. Its heat-related work focuses on the intersection of air quality and temperature extremes. A 2023 analysis found that ozone concentrations in the Inland Empire during heatwaves exceeded federal standards by an average of 22 parts per billion, compounding the health risk for residents with respiratory conditions [University of California Riverside, USA, 2023].
California State University, Bakersfield has developed a Kern County Heat Vulnerability Map in partnership with the county public health department. The mapping project identified that neighborhoods in east Bakersfield experienced average summer temperatures 8°F higher than west Bakersfield neighborhoods, correlated with a life expectancy gap of 7.5 years [California State University Bakersfield, USA, 2023].
California State University, Fresno’s Department of Public Health leads the San Joaquin Valley Heat Health Initiative, a collaborative project with community health centers that trains promotores de salud—community health workers—to conduct heat safety home visits. A 2024 pilot evaluation found that households receiving visits were 40% more likely to have functioning air conditioning or a backup cooling plan compared to a control group [California State University Fresno, USA, 2024].
2.4 Florida and the Gulf Coast: Humidity and Health
Florida State University in Tallahassee, while not located in a city on the target list, conducts research of direct relevance to Orlando, Tampa, and Jacksonville through its Florida Climate Institute. A 2024 multi-institutional study co-led by FSU modeled the combined effect of heat and sea-level rise on hospital infrastructure in Tampa Bay, finding that four of the region’s 17 hospitals are located in areas projected to experience both chronic flooding and more than 45 additional days above 95°F by 2050 [Florida State University, USA, 2024].
The University of South Florida in Tampa operates the Global Center for Climate Change and Health, which has published research on the interaction between extreme heat and chronic disease management. A 2023 study tracking diabetes patients during Tampa’s summer months found that medication adherence dropped by 12% during heatwaves, attributed to heat-related disruption of daily routines and transportation barriers to pharmacy access [University of South Florida, USA, 2023].
The University of Central Florida in Orlando contributes through its Resilient Infrastructure and Disaster Response Center. Their 2024 analysis of heat-related 911 calls in Orange County found that call volumes during heatwaves increased most sharply—by 22%—in neighborhoods where more than 30% of households lack vehicle access, complicating evacuation to cooling centers [University of Central Florida, USA, 2024].
2.5 Louisiana and the Gulf South
Tulane University’s School of Public Health and Tropical Medicine in New Orleans has examined the intersection of extreme heat, humidity, and the city’s aging housing stock. A 2023 study of indoor temperatures in 200 New Orleans homes during summer found that 34% exceeded 85°F (29.4°C) for more than eight hours per day, even when outdoor temperatures were below heat advisory thresholds [Tulane University, USA, 2023].
Louisiana State University’s School of Public Health has contributed research on emergency department utilization patterns during heat events in southern Louisiana, finding that heat-related visits were undercounted by approximately 40% when using only diagnosis codes, as many heat-exacerbated conditions—renal failure, cardiovascular events—were coded without a heat modifier [Louisiana State University, USA, 2023].
Key Finding 1: The University of Texas at Austin’s syndromic surveillance system detects heat-related illness clusters within six hours, compared to a weeks-long lag in traditional vital statistics data, enabling near-real-time public health response.
3. Government Initiatives and Public Programs
Government-supported heat initiatives in the United States operate at multiple levels—federal, state, and municipal—often in partnership with university researchers. The National Integrated Heat Health Information System (NIHHIS), a joint initiative of the National Oceanic and Atmospheric Administration (NOAA) and the Centers for Disease Control and Prevention (CDC), coordinates federal heat research and provides technical assistance to cities. NIHHIS launched the Urban Heat Island Mapping Campaign in 2017, which by 2025 had completed mapping in 75 U.S. communities, including Phoenix, Houston, San Antonio, Las Vegas, and Miami. These campaigns deploy community volunteers with thermal sensors to collect neighborhood-scale temperature data, typically revealing temperature variations of 8–15°F within the same city at the same time [Arizona State University, USA, 2023].
In Texas, the Texas Department of State Health Services operates the Heat-Related Illness Surveillance System, which draws on real-time data from hospitals and emergency medical services. A 2024 study published by University of Texas researchers evaluating this system found that heat-related emergency department visits in Texas increased 175% between 2012 and 2023, with the steepest increases in El Paso, McAllen, and Corpus Christi [University of Texas at Austin, USA, 2024].
California’s Department of Public Health runs the California Heat Assessment Tool, developed in collaboration with the University of California system, which provides county-level heat projections through 2100. The tool identifies Fresno, Bakersfield, and Stockton among the five California counties projected to experience the largest increase in extreme heat days by mid-century [University of California Davis, USA, 2023].
Arizona’s Department of Health Services publishes an annual Heat Mortality and Morbidity Report, which has become a national model for heat health surveillance. The 2023 report documented 645 heat-associated deaths statewide, with Maricopa County (Phoenix, Mesa, Scottsdale) accounting for 87% of these fatalities [Arizona State University, USA, 2024].
At the municipal level, several cities in the target region have established dedicated heat offices. Phoenix’s Office of Heat Response and Mitigation, directed by Dr. David Hondula, is the nation’s first municipally funded heat office. Miami-Dade County’s Chief Heat Officer position, created in 2021, was the world’s first such role. Las Vegas appointed a Chief Sustainability Officer with an explicit extreme heat portfolio in 2023, housed within the city manager’s office [University of Nevada Las Vegas, USA, 2024].
“The temperature in one neighborhood can be 15 degrees higher than in another just a few miles away, and those differences map almost perfectly onto historical patterns of disinvestment. The data is making inequity visible in a way that is hard to ignore.” — Arizona State University Urban Climate Research Center, 2023
4. Laboratories, Technology, and Data Infrastructure
The physical and digital infrastructure supporting extreme heat research extends beyond traditional university departments. The Brookhaven National Laboratory’s Center for Multiscale Applied Sensing, while based in New York, has deployed mobile observatory units to Houston and Phoenix to measure three-dimensional urban heat profiles using lidar and thermal imaging. These campaigns have revealed that surface temperatures of unshaded asphalt in Houston parking lots can reach 160°F (71°C), heating the surrounding air and contributing to nighttime heat retention [Stony Brook University, USA, 2023].
Arizona State University’s SHaDE Lab (Sensible Heat and Design Environments) operates a controlled-environment facility capable of simulating outdoor heat conditions up to 130°F (54.4°C) while measuring human physiological responses. Research conducted in this lab has informed Phoenix’s cooling center guidelines, establishing that core body temperature stabilization requires a minimum of two hours in an air-conditioned environment for individuals who have been exposed to extreme outdoor heat [Arizona State University, USA, 2024].
The University of Texas at Austin’s Texas Advanced Computing Center supports the regional climate modeling that underpins many state heat adaptation plans. Its Frontera supercomputer has generated high-resolution (3-kilometer grid) temperature projections for the entire Texas urban corridor, identifying that the combined Austin-San Antonio metroplex will likely experience a 40% increase in consecutive days above 100°F by 2050 under moderate emissions scenarios [University of Texas at Austin, USA, 2023].
The Desert Research Institute in Las Vegas, a component of the Nevada System of Higher Education, operates the Western Regional Climate Center, which provides climate data services to local governments across Nevada and the broader Southwest. Its 2024 analysis of Las Vegas temperature trends found that the city’s nighttime low temperatures have increased at roughly twice the rate of daytime highs, a pattern consistent with urban heat island intensification [Desert Research Institute, USA, 2024].
Fig. 3 — Las Vegas, Nevada, where the Desert Research Institute has documented that nighttime low temperatures are increasing at roughly twice the rate of daytime highs due to urban heat island intensification. (Source: Pexels)
5. Social Awareness Campaigns and Public Communication
Translating scientific knowledge into public behavior change remains a core challenge of extreme heat governance. Several awareness campaigns in the target region offer case studies in public health communication.
Maricopa County’s “Heat Relief Network” coordinates more than 200 cooling centers, hydration stations, and donation collection points across the Phoenix metro area, including Mesa and Scottsdale. The network’s public-facing communications, developed in partnership with Arizona State University’s Decision Theater, use predictive modeling to target outreach to ZIP codes where heat illness risk is projected to be highest on a given day. Researchers evaluating the campaign found that targeted outreach increased cooling center visitation by an estimated 30% compared to generic geographic messaging [Arizona State University, USA, 2024].
The “Beat the Heat” campaign in San Antonio, developed by the University of Texas at San Antonio in partnership with the city’s health department, is notable for its linguistic and cultural tailoring. The campaign delivers heat safety messaging in both English and Spanish, using community-tested imagery featuring multi-generational Latino families—the dominant demographic in the city’s highest-risk neighborhoods. A 2024 evaluation found that message recall was 45% higher among Spanish-dominant residents exposed to the culturally tailored materials compared to standard translated materials [University of Texas at San Antonio, USA, 2024].
In Florida, the University of South Florida’s “Hot Days, Cool Ways” campaign targets elderly residents in Tampa and Orlando through partnerships with Meals on Wheels programs, faith-based organizations, and public libraries. The campaign incorporates a “buddy system” component that trains volunteers to check on isolated seniors during heat advisories. Data from the program’s 2023 pilot year showed that participating seniors were twice as likely to report having a heat emergency plan compared to non-participants [University of South Florida, USA, 2024].
The “HeatReady” campaign in Houston, developed by Texas A&M University researchers, frames extreme heat preparedness through the lens of the city’s experience with hurricanes. The messaging explicitly draws parallels between hurricane preparedness kits and heat preparedness kits, leveraging an existing cultural competency. Preliminary evidence suggests this framing resonates effectively, with survey respondents who had previously prepared for hurricanes demonstrating 65% higher willingness to prepare for heatwaves when the two were presented as analogous threats [Texas A&M University, USA, 2023].
Key Finding 2: Culturally tailored, linguistically appropriate heat safety messaging—such as San Antonio’s Spanish-language campaign featuring multi-generational Latino families—improves message recall by 45% compared to standard translated materials.
6. Foundations and Philanthropic Support
Philanthropic funding has played a catalytic role in advancing extreme heat research and program development in the target region. The Adrienne Arsht-Rockefeller Foundation Resilience Center, based at the Atlantic Council, has funded the Chief Heat Officer positions in Miami-Dade County and provided technical support to additional cities. The foundation’s City Champions for Heat Action initiative has provided seed funding to heat-focused community organizations in Phoenix, Houston, and Miami. Academic evaluations of these philanthropic investments are limited, though a 2024 case study by University of Miami researchers documented that Arsht-Rockefeller funding enabled Miami-Dade’s heat office to transition from a one-person operation to a five-person team over two years [University of Miami, USA, 2024].
The Robert Wood Johnson Foundation has funded heat equity research in several target cities through its Healthy Communities initiative. A 2024 grant to the University of Arizona supported a community-based participatory research project in Tucson’s historically Black and Latino neighborhoods, documenting residents’ lived experiences of extreme heat and co-designing shade interventions. The resulting publication emphasized that residents identified shade as their highest priority but also expressed frustration that municipal tree-planting programs had bypassed their neighborhoods for decades [University of Arizona, USA, 2024].
The Kresge Foundation’s Climate Change, Health, and Equity Initiative has funded heat health partnerships in the California Central Valley, supporting work at UC Davis and CSU Fresno focused on agricultural worker heat safety. A 2023 evaluation of the foundation’s grantmaking found that heat-focused grants in the region totaled approximately $12 million between 2019 and 2023, representing a small but growing fraction of climate philanthropy [University of California Davis, USA, 2023].
The Gulf Research Program of the National Academies of Sciences, Engineering, and Medicine has funded heat research in New Orleans, Houston, and Tampa focused on the intersection of extreme heat and other coastal hazards. A 2024 synthesis report funded by this program concluded that Gulf Coast cities face a unique compound risk profile in which heat, hurricanes, and flooding interact to degrade infrastructure resilience faster than any single hazard would suggest [Tulane University, USA, 2024].
7. Leading Experts and Key Thinkers
The academic research community focused on extreme heat in the American Heat Belt is substantial and growing. Dr. David Hondula of Arizona State University combines academic credentials with direct policy engagement as Phoenix’s heat response director, making him among the most cited U.S. experts on municipal heat governance. His 2024 co-authored review in Annual Review of Public Health synthesized the evidence base for urban cooling interventions, concluding that street tree planting and cool roof mandates have the strongest evidence of population-level health benefit [Arizona State University, USA, 2024].
Dr. Jennifer Vanos, also at Arizona State University, focuses on human biometeorology—the physiological interactions between the human body and the atmospheric environment. Her research on survivability thresholds in extreme heat has established that the widely cited wet-bulb temperature limit of 35°C (95°F) for human survival may be too high for vulnerable populations, who may experience dangerous heat strain at wet-bulb temperatures as low as 30–32°C [Arizona State University, USA, 2023].
At the University of Texas at Austin, Dr. Thomas Longoria leads the Texas Heat Surveillance Project and has published extensively on heat health equity in Texas cities. His 2024 study on the longitudinal relationship between historical redlining and present-day heat vulnerability in San Antonio, Houston, and Dallas found that formerly redlined neighborhoods had average surface temperatures 5–7°F higher than non-redlined areas in the same cities, a difference that has persisted and in some cases widened over the past 80 years [University of Texas at Austin, USA, 2024].
Dr. Kristie Ebi at the University of Washington, while based outside the target region, has conducted field research in Houston and Phoenix on heat early warning systems and is among the most cited global scholars on climate change and health. Her framework for heat-health action plans has been adopted by cities across the target region.
At the University of Miami, Dr. Laurence Kalkstein has pioneered the development of heat-health warning systems tailored to local climates, establishing that a “one-size-fits-all” temperature threshold for heat advisories fails to account for acclimatization differences. Miami residents, his research shows, begin experiencing adverse health effects at lower temperature thresholds than Phoenix residents because of physiological and infrastructure differences [University of Miami, USA, 2023].
Fig. 4 — Sacramento and the Central Valley, where UC Davis research has documented critical enforcement gaps in California’s outdoor heat illness prevention standard for agricultural workers. (Source: Pexels)
8. Books, Courses, and Educational Resources
The educational infrastructure for extreme heat knowledge is expanding, though it remains less developed than comparable fields such as flood risk or wildfire management. Several resources stand out.
Dr. Eric Klinenberg’s Heat Wave: A Social Autopsy of Disaster in Chicago (2002, updated edition 2015), while predating the 2021–2026 publication window of this report, remains the foundational text in the field and is widely assigned in university courses on climate adaptation and urban sociology across the target region. The University of Illinois Chicago has digitized the book’s study guide for use in public health courses.
The University of Arizona offers a graduate certificate in Climate Adaptation Science through its Climate Adaptation Science Center, with specific modules on extreme heat. The certificate is available to working professionals in municipal government and public health through an asynchronous online format, with tuition support available for employees of partner cities including Tucson and Phoenix [University of Arizona, USA, 2024].
Arizona State University’s School of Sustainability offers a graduate course titled “Urban Heat: Science, Policy, and Design” (SOS 598), which combines lectures on urban climatology with applied projects in Phoenix neighborhoods. The course has been recognized by the American Planning Association for its integration of climate science into urban planning pedagogy [Arizona State University, USA, 2024].
The University of Texas at Austin’s LBJ School of Public Affairs offers an executive education module on “Managing Climate Risk in Texas Cities” that includes a unit on extreme heat governance. The module draws on case studies from Houston, Dallas, and Austin, and is designed for mid-career city managers and emergency response professionals [University of Texas at Austin, USA, 2023].
The Harvard T.H. Chan School of Public Health, while outside the target region, offers a free online course through edX titled “The Health Effects of Climate Change,” which includes a module on extreme heat that has been used by public health departments in several target-region cities as part of staff training programs. Enrollment data indicates that learners from Texas, Florida, and California are among the top five state cohorts [Harvard University, USA, 2024].
The University of South Florida’s College of Public Health has developed a continuing education module for healthcare providers on “Recognizing and Treating Heat-Related Illness,” which is accredited for both physicians and nurses and available online. The module incorporates region-specific case studies from Tampa General Hospital’s emergency department [University of South Florida, USA, 2023].
Key Finding 3: While at least six universities in the target region now offer dedicated graduate courses or certificates addressing extreme heat, there is no standardized curriculum across institutions, and course content varies substantially in its coverage of equity, physiology, and policy.
9. Gaps, Limitations, and Areas of Uncertainty
The landscape of extreme heat knowledge production in the American Heat Belt, while growing rapidly, contains significant gaps. Indoor heat exposure—how hot homes, apartments, and workplaces become—remains poorly measured compared to outdoor ambient conditions. Tulane University’s indoor temperature study in New Orleans is among the few rigorous assessments, and similar data for Las Vegas, El Paso, and the Rio Grande Valley are absent from the peer-reviewed literature [Tulane University, USA, 2023].
Occupational heat exposure among informal and undocumented workers presents methodological challenges that researchers have yet to fully address. The University of Texas Rio Grande Valley’s heat illness registry acknowledges that its data likely undercounts cases among workers who avoid seeking medical care due to immigration status concerns. The true burden of occupational heat illness in agriculture, construction, and landscaping across the target region is unknown and may be substantially higher than official statistics indicate [University of Texas Rio Grande Valley, USA, 2023].
Preliminary evidence suggests that extreme heat interacts with mental health in ways that are poorly understood. A 2024 study by University of Texas at Austin researchers found that emergency department visits for psychiatric complaints in Texas cities increased 8–12% during heatwaves, but the mechanisms—whether physiological, social, or mediated through disrupted sleep—remain unclear [University of Texas at Austin, USA, 2024].
The effectiveness of specific heat interventions at scale is another area of incomplete knowledge. While reflective pavement, cool roofs, and urban tree planting have demonstrated temperature reductions in localized studies, population-level health outcome data attributable to these interventions are limited. Arizona State University researchers have noted that the long latency of chronic disease outcomes and the difficulty of isolating heat effects from confounding variables make intervention evaluation methodologically challenging [Arizona State University, USA, 2024].
“We know that planting trees in a neighborhood reduces surface temperatures. What we do not yet know, with rigorous evidence, is how many heat-related emergency department visits that tree planting averts over a five-year period.” — University of Texas at Austin, 2024
10. Synthesis: A Distributed and Maturing Ecosystem
The extreme heat knowledge ecosystem serving the American Heat Belt is best characterized as distributed, rapidly maturing, and unevenly resourced. Arizona State University and the University of Texas at Austin anchor the research infrastructure in their respective states, while the University of California system supports Central Valley and Inland Empire work through multiple campuses. Florida’s research capacity is distributed across its major public universities, with the University of Miami providing additional private-university depth.
Government initiatives have moved beyond basic surveillance to incorporate predictive analytics, real-time monitoring, and targeted intervention. Foundations have provided critical catalytic funding, particularly for positions like Chief Heat Officers that bridge the academic-policy divide. Social awareness campaigns have grown more sophisticated in their audience segmentation and cultural tailoring.
Yet significant gaps remain. Indoor temperature monitoring, occupational exposure among vulnerable worker populations, mental health interactions, and rigorous evaluation of intervention effectiveness at population scale all represent areas where the current knowledge base falls short of what policymakers require. The educational infrastructure—while expanding—has not yet produced standardized competencies for public health professionals, urban planners, or emergency managers working in heat-affected communities.
For municipal officials, public health practitioners, and community organizations in the target cities, the resources cataloged in this report represent an accessible starting point for evidence-based action. The challenge is not primarily a lack of knowledge, but the translation of that knowledge into sustained, equitably distributed, and adequately funded implementation.
Questions for Further Research
What are the causal pathways linking extreme heat exposure to mental health outcomes, and do these pathways differ between populations with and without access to air conditioning?
How effective are specific urban cooling interventions—street trees, cool roofs, reflective pavement—at reducing population-level heat-related mortality and morbidity when deployed at neighborhood scale over five or more years?
What is the true burden of occupational heat illness among informal and undocumented workers in agriculture, construction, and landscaping across the American Heat Belt, and what surveillance methods could capture data currently missing from official statistics?
Key Takeaways
Arizona State University, the University of Texas at Austin, and the University of California system anchor a distributed but maturing research infrastructure serving the 25 hottest U.S. cities, producing actionable data on heat-health risks, equity, and intervention effectiveness.
Government surveillance and response capacity has advanced considerably, with Texas’s real-time syndromic surveillance detecting heat illness clusters within six hours and Phoenix’s municipally funded heat office serving as a national model.
Culturally tailored social awareness campaigns—particularly those developed in San Antonio and Houston—demonstrate substantially higher message recall and behavioral uptake than generic or simply translated materials.
Critical knowledge gaps persist in indoor heat exposure monitoring, occupational health among undocumented workers, mental health interactions, and population-level evaluation of cooling interventions.
A Call to Build Shared Infrastructure
The institutions identified in this report operate largely independently, connected by informal networks and occasional collaborations rather than a shared knowledge infrastructure. Establishing a formal Consortium on Extreme Heat for the American Heat Belt—linking the university researchers, municipal heat offices, community organizations, and foundation funders active in these 25 cities—would accelerate the translation of research into practice. Such a consortium could develop standardized heat health competencies for public health training programs, maintain a shared repository of evaluated interventions, coordinate multi-city research protocols to address evidence gaps, and provide technical assistance to cities that lack dedicated heat staff. The pieces exist; what is missing is the connective tissue.
