Extreme heat is one of the leading causes of weather-related deaths in the United States (JAMA, 2025). Summers are getting hotter and longer, disrupting essential services and impacting the well-being and mental health of communities. There is an urgent need for heat policy that protects human health and promotes equitable heat solutions in the face of climate change.
To better understand state and local readiness and public health engagement on extreme heat, the American Public Health Association Center for Climate, Health and Equity and the Natural Resources Defense Council conducted an online survey among APHA’s 52 Affiliated state and regional public health associations from July 22-Aug. 29, 2025. Using SurveyMonkey, 35 Affiliates completed the survey, with participation limited to one response per Affiliate. The results suggest that heat is a public health concern, and states are mostly unprepared and underresourced to address the ever-growing health risks and threats of extreme heat. About 88% of Affiliates said they were moderately or very concerned about their state government’s ability to protect people from an extreme heat event in the next four years. Heat-related policy advocacy efforts remain limited, with 40% of Affiliates reporting that they engaged in heat-related advocacy in 2024. However, there is strong interest in expanding these efforts, recognizing the need for state and local government leadership and coordinated action.
The survey responses highlight the urgency of advancing policy, action and partnerships to mitigate heat-related health risks and strengthen local heat preparedness.