Revised April 23, 2025. Guidance subject to change.
Original Interim Guide released September 29, 2023.

Key Updates As of October 29, 2024:

• Added information and links throughout the guide including details on CalHeat​Score, HeatReadyCA, CDPH Heat and ​S​ummer Safety Toolkit​, Safe Pregnancies in Extreme Heat web ​​page, Cal OES Website for County Cooling Centers, OSHAs Heat Illness Prevention Regulation, Cal/OSHA Heat Illness Prevention Guidance and Resources and California Department of Social Services Facility Impact Climate Section, and provided a status update to CDPH Occupational Health Branch Educational Material.
  

• Added details to long-term planning in Category 1 of the guide on healthcare facilities, physicians and other medical professionals as trusted messengers for the community including resources for clinicians including PHI's Physician Guide to Climate Change, Health and Equity and Americares Climate Resilient Clinics Guidance.

• Added recommendations on utilizing qualitative data to learn about community member experiences around heat to inform future interventions in Category 2 of the guide.

• Added details to long-term planning in Category 3 of the guide to include developing a calendar of events occurring indoors during heat season that can double as cool spaces.

• Added information about SB 1248 where the California Department of Education will provide temperature thresholds for physical activities during extreme weather/heat to Category 6 of the guide.

• Added examples to the guide including Los Angeles Extreme Heat Campaign, Maricopa County Cooling Center Evaluation, New York's Cooling Assistance Benefit, Oregon Health Authority Air Conditioner and Air Filter Deployment Program and North Carolina Air Conditioner Installation Program in State Prisons. 
  

Contents:

• I. How to Use This Guide
  

• ​​II. Heat in the Context of Climate Change​

• ​III. Health Equity-Centered Local Heat P​lan
  

• Step 1: Engage with priority populations and partner organizations in jurisdiction​

• ​Step 2: Identify heat risks to priority populations
  

• ​Step 3: Establish thresholds for declaring heat events and taking actions
  

• ​Step 4: Select Extreme Heat Plan Actions​
  

• ​Step 5: Finalize plan for implementation​
  

• References​​​

• Appendix 1: Selected Bibliography of Plans, Guidance and Templates​ (PDF)​​

• Appendix 2: Using Da​​ta and Tools for Planning​ (PDF)
  

• Appendix 3: CA Legislation Related to Heat​ (PDF)​
  

I. How to Us​e This Guide​

This guide is intended to assist local jurisdictions with incorporating health equity​ into new or existing heat action and planning efforts. Creation of heat plans and use of this guide are not mandatory but are recommended. This guide can be used by land use planning and community development agencies, emergency management planners, public health partners including local health jurisdictions and Tribal governments, as well as community members and advocates supporting or engaged in these efforts. Strategies or elements from this guide can comprise a new or updated stand-alone heat plan or be incorporated into Local Hazard Mitigation Plan updates, Climate Action and​ Adaptation Plans, General Plan Safety Elements or Public Health Emergency Preparedness Plans. 

This guide was developed based on a review of more than 40 local and regional extreme heat plans, guides for creating heat plans and other best practices for creating plans and strategies that center or work to address health equity. A selected bibliography is included in Appendix 1​ (PDF) ​for reference. 

This guide is intended as a resource for local jurisdictions to help with protecting the entire community from extreme heat regardless of residents' background and access to resources and particularly those with the least opportunity for good health. This resource can help facilitate partnerships between local health departments, offices of emergency services and other local agencies.

It is recommended that this guide be reviewed in full prior to initiating any planning efforts, to incorporate a health equity approach throughout the entire process. However, if planning has already begun, you may review the recommendations that apply to your specific phase of planning and seek opportunities to incorporate strategies that may have been missed in previous steps of the planning process where feasible. 

Organization

This guide is organized according to steps, categories and phases:

Steps: The steps indicated below outline each stage of a process for developing or updating a health-equity centered local heat plan, starting with engaging with the priority populations and partner organizations in your jurisdiction, identifying the heat risks to priority populations, establishing thresholds for determining an extreme heat event and taking actions, selecting your plan's actions and finally evaluating the success of the plan. ​

Categories: Step 4 (“Select Heat Plan Actions”) allows you to ​​select from a number of categories of actions—actions grouped together according to a specific topi​c. Categories can be thought of as areas in which to intervene to protect health. The categories are as follows:

Phases: Within each category, actions are organized by phases of implementation:

​II. Heat in ​​the Context of Climate Change

Climate change is considered the greatest public health threat of this century.¹​ The health impacts of the climate crisis are already being felt by Californians, with negative health effects projected to only worsen in the coming years.²​​ Many populations in California also currently face health inequities, unfair and unjust health differences between population groups that are systemic and avoidable.³​ People facing the greatest health inequities include populations with low income, older adults, children, communities of color, people with disabilities, people experiencing homelessness, immigrants, Tribal communities and people who have been marginalized or discriminated against based on gender, race/ethnicity or sexual orientation.⁴ Climate change disproportionately impacts these same populations.⁵​ 

The Health Impacts of Heat 

Heat is already the deadliest of all types of weather events in the United States and with climate change, increasing heat across California is projected to cause two to three times more heat-related deaths by mid-century. Exposure to high temperatures can cause negative health impacts, such as heat-related illnesses, which include heat cramps, heat rashes, heat exhaustion, heatstroke and death. Other health impacts include:

Heat Has Inequitable Health Impacts

While higher average temperatures and more frequent and severe heatwaves are and will continue to be experienced across all of California, the negative health impacts of heat are not distributed equitably across all populations. Numerous communities and populations face a disproportionate risk of experiencing heat-related health impacts because of greater exposure to heat, greater sensitivity to higher temperatures and/or reduced adaptive capacity (the ability, through resources such as financial, political and social capital, to reduce or avoid the negative impacts of climate change) resulting from historic and continuing systemic marginalization. For example, workers outdoors or in non-air-conditioned spaces, people currently unhoused, people who are incarcerated and people living within an urban heat ​island experience above average, continuous or prolonged exposure to heat, increasing their risk of health impacts. Additionally, communities with low income, low social cohesion or that have been historically and presently marginalized and underinvested in may face worse living conditions, have limited access to decision-making processes, power and resources, in turn limiting adaptive capacity prior to, during and after an extreme heat event. Finally, older adults, children, people who are pregnant, people with pre-existing health conditions and people taking prescription medications or substances are more sensitive to changes in temperature and heat, increasing their susceptibility to heat-related health impacts.

The Importance of an E​​quity Focus in Heat Planning

Given the inequitable distribution of heat-related health impacts, local heat mitigation, adaptation, response and recovery efforts must apply a health equity lens when developing, implementing, evaluating and prioritizing strategies. A health equity frame for heat planning and action is necessary to ensure that those experiencing limited adaptive capacity and the greatest exposure, sensitivity and impact are prioritized and benefit from focused efforts to achieve positive health outcomes in the face of heat events.

III. A Health Equity-Centered Local Heat Plan

We recommend following the below steps in developing or updating your jurisdiction's health equity-centered heat plan. 

Steps:

1. Engage with priority populations and partner organizations in jurisdiction
2. Identify heat risks to priority populations
   
3. Set thresholds for declaring an extreme heat event
4. Select heat plan actions
5. Finalize plan for implementation
   
6. Evaluate plan​

Extreme heat disproportionately affects certain populations. The key to developing or updating a heat plan is identifying priority populations who may be most impacted by extreme heat events and engaging with these populations and the organizations that serve them. It is critical to engage with community members and partner organizations throughout the process of developing the plan and as your jurisdiction implements the plan to protect the public from the health impacts of heat. 

​Once your jurisdiction, partner organizations, priority populations and community members have selected the heat actions to include in your jurisdiction's heat plan, collaboration should continue as you work to clarify operational details and establish a clear path to move towards implementation of heat actions. Implementation details regarding roles and responsibilities, timelines, costs, funding and prioritization of actions should be included within your heat plan or as a publicly accessible supplementary document, to ensure transparency and accountability.

Define Roles and Responsibilities

Your jurisdiction and partner organizations should review the heat actions included in your heat plan and determine which entity will take the lead in implementing each action and which entities will provide support or will need to be engaged throughout implementation. The lead organization will take primary responsibility for coordinating further development of the action, as well as activation, implementation and monitoring the heat action impacts. Lead organization roles may align with the mandated responsibilities and related jurisdiction of a specific department, agency, office or organization. Additionally, you will need to consider which populations, neighborhoods or communities will be most impacted by heat actions and include community-based organizations as well as other priority population representatives in lead or supporting roles for relevant heat actions to ensure implementation is community-driven. Establishing and integrating roles and responsibilities for partner organizations, departments or offices within your jurisdiction and specific community groups within your heat plan will provide clarity, focus and transparency for implementing entities as well as the community at large.

Timeline for Implementation

A timeline for implementation of heat actions should be developed and incorporated into your heat plan. Lead and supporting entities should work together to approximate the time they will need to conduct additional planning, analysis and community engagement; secure funds; and operationalize each heat action across your jurisdiction or within specific priority communities (based on populations identified in St​ep 1​). Implementation timelines should be developed for near- and long-term heat actions to ensure immediate relief is provided to community members who need it most, while also committing to implementation of actions that provide policy, systemic or environmental changes which can relieve heat-related health disparities and inequities overall. Integrating a timeline for implementation within your heat plan will allow for greater transparency, accountability and collective understanding of the time it will take to achieve near- and long-term goals. Include timelines to share updates on progress, challenges and roadblocks, as well as create opportunities for community members to provide feedback on progress made or changes and improvements that are needed.

Cost Estimates and Funding Sources

Finally, estimated cost and potential funding sources should be calculated, identified and listed for each heat action within your heat plan. Costs such as new staff, resources, training, equipment and fees should be factored in, as well as the scale of implementation (e.g., pilot project vs. county-wide implementation). Proposed or potential funding sources should be listed as well; consider collaborating with partner organizations and community members to identify potential funding constraints as well as innovative solutions. Incorporating associated costs and opportunities for funding within your heat plan will allow for transparency on the scope and scale of each heat action, as well as around current financial constraints and barriers. It will also allow community to track progress in applying for or securing funding and identify or share additional opportunities for potential funding. Additionally, it may allow community members and organizations to garner community support and overcome existing financial constraints by advocating for organizations or agencies to allocate funds for implementation of community-driven heat actions. Funding and financing ideas and resources can be found on the Arsht-Rockefeller Foundation Resilience ​Center's Heat Action Platform. Additional funding resources can be found in Appendix 1 (PDF).

References​ 

1. Romanello M, McGushin A, Napoli CD, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. The Lancet. 2021;398(10311). (doi.org/10.1016/S0140-6736(21)01787-6)
   

2. U.S. Global Change Research Program. Fourth National Climate Assessment. 2017;2(4):1-470. (nca2018.globalchange.gov/  
   

3. Whitehead M. The concepts and principles of equity and health. International journal of health services : planning, administration, evaluation. 1992;22(3):429-445. (doi.org/10.2190/986L-LHQ6-2VTE-YRRN) 
   

4. California Department of Public Health - Office of Health Equity. Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity (PDF, 3.4 MB)​. A Report to the Legislature and the People of California by the Office of Health Equity. 2015. (www.cdph.ca.gov/Programs/OHE/CDPH%20Document%20Library/Accessible-CDPH_OHE_Disparity_Report_Race_Equity.pdf)
   

5. Romanello M, Napoli CD, Drummond P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. The Lancet. 2022;400(10363):1619-1654. (doi.org/10.1016/S0140-6736(22)01540-9)
   

6. Lee J, Blaeser J, and Small C. Extreme heat will take an unequal toll on tribal jails. Grist. (grist.org/indigenous/tribal-jail-climate-change-extreme-heat/). Published May 10, 2023.

7. Skarha J, Peterson M, Rich JD, Dosa D. An Overlooked Crisis: Extreme Temperature Exposures in Incarceration Settings. American Journal of Public Health. 2020;110(S1):S41-S42. (doi.org/10.2105/ajph.2019.305453)
   

8. American Public Health Association. Advancing Public Health Interventions to Address the Harms of the Carceral System​. www.apha.org. 2021;202117. (www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Advancing-Public-Health-Interventions-to-Address-the-Harms-of-the-Carceral-System)
   

9. Holt DWE. Heat in US Prisons and Jails: Corrections and the Challenge of Climate Change. SSRN Electronic Journal. Published online 2015. (doi.org/10.2139/ssrn.2667260)​​​