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Objective:Although extreme heat can impact the health of anyone, certain groups are disproportionately affected. In urban settings, cooling centers are intended to reduce heat exposure by providing air-conditioned spaces to the public. We examined the characteristics of populations living near cooling centers and how well they serve areas with high social vulnerability. Methods:We identified 1402 cooling centers in 81 US cities from publicly available sources and analyzed markers of urban heat and social vulnerability in relation to their locations. Within each city, we developed cooling center access areas, defined as the geographic area within a 0.5-mile walk from a center, and compared sociodemographic characteristics of populations living within versus outside the access areas. We analyzed results by city and geographic region to evaluate climate-relevant regional differences. Results:Access to cooling centers differed among cities, ranging from 0.01% (Atlanta, Georgia) to 63.2% (Washington, DC) of the population living within an access area. On average, cooling centers were in areas that had higher levels of social vulnerability, as measured by the number of people living in urban heat islands, annual household income below poverty, racial and ethnic minority status, low educational attainment, and high unemployment rate. However, access areas were less inclusive of adult populations aged ≥65 years than among populations aged <65 years. Conclusion:Given the large percentage of individuals without access to cooling centers and the anticipated increase in frequency and severity of extreme heat events, the current distribution of centers in the urban areas that we examined may be insufficient to protect individuals from the adverse health effects of extreme heat, particularly in the absence of additional measures to reduce risk. 

Abstract As the impacts of climate change increasingly and disproportionately affect indigenous peoples, equitable approaches to regional climate change adaptation must center the voices, needs, and priorities of Indigenous communities. Although the tribal climate change principles identify actionable recommendations to address the unique needs of Indigenous peoples in the contexts of climate change adaptation efforts undertaken at the Federal level in the United States (U.S.), there has yet to be exploration of how such principles might be applied at the regional level. Through semi-structured qualitative interviews with 18 representatives from inter-Tribal organizations and non-Tribal organizations engaged in regional climate adaptation in the U.S. Pacific Northwest, this research sought to describe challenges faced by, and opportunities available to, non-Tribal entities when engaging with Tribes on regional climate adaptation initiatives. All respondents reported high levels of motivation to work with Tribes on climate adaptation and identified several perceived benefits of integrating Tribal partnerships and indigenous ways of knowing into regional climate adaptation initiatives. Respondents underscored the need for strong, trusted relationships that respect the sovereignty and priorities of Tribal nations to guide engagement. However, non-Tribal organizations’ own capacity constraints, perceived Tribal capacity constraints, and institutional cultures rooted in colonialism and structural racism were discussed as obstacles to meaningful engagement. As such, we identify an urgent need to prioritize sustained investments in both Tribal and non-Tribal actors’ partnership capacities and climate change adaptation capabilities to place Indigenous voices and needs at the forefront of regional climate change adaptation planning and implementation. 

Heat is a dangerous hazard that causes acute heat illness, chronic disease exacerbations, adverse pregnancy outcomes, and a range of injuries. Risks are highest during extreme heat events (EHEs), which challenge the capacity of health systems and other critical infrastructure. EHEs are becoming more frequent and severe, and climate change is driving an increasing proportion of heat-related mortality, necessitating more investment in health protection. Climate-resilient health systems are better positioned for EHEs, and EHE preparedness is a form of disaster risk reduction. Preparedness activities commonly take the form of heat action plans (HAPs), with many examples at various administrative scales. HAP activities can be divided into primary prevention, most important in the pre-event phase; secondary prevention, key to risk reduction early in an EHE;and tertiary prevention, important later in the event phase. After-action reports and other postevent evaluation activities are central to adaptive management of this climate-sensitive hazard.