IN SUMMARY
- As heat becomes a year-round reality, California is often still responding like it’s an emergency.
- In the field, health providers fundraise for one basic need that grants can’t buy.
In southwest Santa Rosa teenagers skip sports practices to avoid getting burned by the hot turf. Some will end up at the air conditioned mall. In southeast Los Angeles County people wait at unshaded bus stops, covering their faces with umbrellas and bags.
Temperatures topped 100 degrees in some parts of the state this week — and it’s only March.
Heat doesn’t just disrupt people’s days. It’s dangerous, even fatal.
California leaders have known about the danger of extreme heat for decades, and the state has spent hundreds of millions of dollars on plans to address it. But these plans require little or nothing from state agencies or local governments, and experts say the result is a patchwork response that is leaving the most vulnerable Californians behind.
The state has made real progress: more messaging and education campaigns, more data and tools to assess the hazard of heat, and targeted grants to local communities. But without a mandate to act, which communities are protected depends on local budgets and political will.
The state’s response remains largely organized around emergency management — mobilizing resources during crises rather than treating heat as the ongoing public health threat that researchers say it is. As climate change drives longer and stronger heat waves beyond the summer season, experts say heat must become a mainstream piece of public health work, with a focus on prevention.
That’s hard to do. Public health departments are often stretched thin – required to respond to competing emergencies, outbreaks and other surveillance work – while facing funding uncertainties.
Dr. David Eisenman, a professor at the UCLA Fielding School of Public Health, said too much heat response work is run by emergency management. “This is really a well-known public health emergency that should be thought of under public health, and they should be the prime movers on this.”
A patchwork response
Responding to extreme heat requires coordination across multiple levels of government – pulling together state and local emergency services, planning departments and public health. California has a state blueprint, and cities and counties also have plans. But it’s not clear whether any of them are making a big difference for people feeling the burden of heat.
“How we prepare for both more extreme heat and chronically higher everyday temperatures is a test of how we protect health, equity, and community in a warming world,” said Ali Frazzini, a policy director for Los Angeles County’s sustainability office.
The human cost of the gap is already visible. For every 100,000 residents, 14.4 people visited the emergency room in 2023 for heat-related illness. The state reported 460 deaths linked to extreme heat between 2013 to 2022, although researchers say there are also the deaths that are attributed to other underlying conditions but that may have been exacerbated by heat.
A state analysis of one of the most dangerous heat waves in recent years – in September of 2022 – showed a 5% increase in overall deaths during that 10-day period, or 395 more deaths than expected.
Katherine Pocock, a physician assistant and researcher with Healthcare in Action said heat waves add another layer to the many struggles unhoused people already face. During heat waves in Boyle Heights, near downtown, she would make street medicine rounds. When she came across people clearly struggling with an altered state of mind, she would have to figure out if it was a consequence of heat or substance use.
What homeless patients need most is simple: water and ice.
“A lot of conversations so far have been around frameworks and strategies,” Pocock said. But she wants actionable steps. “What do I need to do to really be prepared to help support folks?”
Street medicine providers say they have to fundraise privately to buy patients water.
Hundreds of millions, no mandate
In 2022, Gov. Gavin Newsom announced a commitment to spend $800 million to support programs that protect people from heat along with the state’s overarching heat action plan. The state clawed back part of that, and a large portion of what remains – $351 million – is tied to a 2024 climate bond that hasn’t been fully spent.
The California Natural Resources Agency, the Strategic Growth Council and the Office of Land Use and Climate Innovation distribute one-time funding to nonprofits and local governments as small one-time grants for projects that align with the state’s four goals: building public awareness, strengthening community services, improving indoor infrastructure and using nature-based solutions to reduce risks outdoors.
This year, the governor has proposed another $241 million in spending from the bond for heat programs, including $50 million for local heat action plans, $700,000 for green space and $55 million for community resilience centers.
The state points to tangible progress toward its heat response – updated building codes, a real-time dashboard showing community vulnerability and cooling centers, and a second iteration of its plan is in development.
But the limits of that progress are evident in the details. One law passed last year enshrined into state law residents’ right to a cool living space. But while the state Housing and Community Development Department recommended the state set a maximum indoor temperature standard of 82 degrees for all homes, the law set no requirements for landlords to keep their tenants cool.
The state’s plan doesn’t direct local governments on specific action because every region has unique challenges. Amanda Hansen, deputy secretary for climate change with the state Natural Resources Agency, said that’s by design.
“I don’t think that the state would ever put forward ‘this is what all local extreme heat action plans should look like or should contain,’ because it’s going to be really different depending on their needs and their challenges,” Hansen said.
Local organizers say they appreciate the state’s financial support, but they want something more lasting. The grants the state distributes – for hydration stations, building shade structures and promoting heat safety education to outdoor workers – help, but they aren’t guidance to local governments or a statewide strategy.
“If we’re really going to protect our communities from the rising threat of heat, we need to come up with an integrated model,” said Enrique Huerta of Climate Resolve, a group that is working alongside Los Angeles County in one of the state-funded projects.
Counties and cities don’t just need some guidance, says Agustin Cabrera, Deputy Director of Programs and Policy for the nonprofit Strategic Concepts in Organizing and Policy Education. They need funding.
“Not all of them are resourced enough to develop a heat action plan,” he said.
Local governments fill the void
Local governments are stepping up on heat resilience, but uncertain state and federal support constrain even the most committed cities and counties.
Los Angeles County has gone further than most. It has approved a policy to require that landlords maintain homes in unincorporated areas at or below 82 degrees starting in 2027 – which goes a step further than the state. As part of its heat action plan published recently, county officials are also surveying nonprofits about serving as cooling centers and helping cities develop their own cool housing policies.
The city of Los Angeles is exploring a similar policy. But its budget problems are undermining its ambitions. Mayor Karen Bass recently proposed cutting the city’s Office of Climate Emergency Mobilization, led by the first chief heat officer in the city, Marta Segura. Segura’s office received $750,000 from the state to develop a heat action plan. Advocates pushed back, and the city changed course, but Segura’s role was ultimately moved to the city’s Emergency Management Department.
Some communities with longer experience managing extreme heat have developed more robust systems. Fresno makes public transit free during heat waves, removing a barrier for residents who need to reach cooling centers. The county also coordinates with social service providers to reach vulnerable clients — including people with disabilities — when temperatures spike.
Heat doesn’t have a home
The structural problem, researchers say, is that no one single agency owns the issue – and that’s true around the country.
In Arizona, Maricopa County and Phoenix treat heat as a seasonal chronic health hazard, and the state has a heat officer – located in the health services department. In New Jersey, the state resilience officer handles heat as a health problem – within its environment department. And while the city of Miami has a heat officer, the state of Florida has banned cities and counties from establishing heat protections for workers.
In California, the state Department of Public Health collects data and offers guidance to counties and cities, but hands out no funding for the extreme heat action plan.
Local public health departments have largely focused on managing heat crises — surveillance systems, advisories, educational campaigns — rather than building long-term resilience. That’s left to land use and urban planning departments.
“Very, very few public health departments are engaged in more long term resilience, sustainability efforts,” said Kelly Turner, Associate Director at the UCLA Luskin Center for Innovation. WIth tight budgets and competing demands that’s unlikely to change on its own.
According to a national survey of public health professionals last month, extreme heat is a growing concern – but states are generally unprepared or underresourced to address its threats. More than half of local public health associations said barriers to addressing heat included a lack of understanding of heat-related solutions, competing priorities and funding.
“It’s not like the Department of Heat, right?” said Turner. “Heat doesn’t have a home.”
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.
