Extreme heat is a growing public health threat, hitting outdoor workers, older adults, and people in rural or low-income communities the hardest. Duke University School of Medicine researchers say North Carolina is well positioned to lead efforts to reduce that impact, building on the state’s Heat Health Alert System and the NC DETECT surveillance platform.
North Carolina is home to the nation’s second-largest rural population and one of the largest farmworker populations, ranking sixth nationally, making it a critical setting for advancing protections against heat-related illness.
Recently, Duke researchers examined how extreme heat is communicated to and managed for populations at highest risk in a perspective article published in Frontiers in Public Health in April. The authors note that while there have been advances in understanding the health effects of extreme heat, such as cardiovascular strain and kidney injury, gaps remain in how prevention and response strategies reach those most at risk.
“Extreme heat is increasingly affecting the health of some of our most vulnerable populations, particularly rural communities, outdoor workers, and older adults,” said Hayden Bosworth, PhD, professor and vice chair for research in the Department of Population Health Sciences and coauthor of the article. “Improving how we identify, communicate, and respond to heat risk has the potential to prevent illness, reduce disparities, and improve communities’ ability to prepare for and respond to climate-related health threats.”
Using North Carolina as a case study, the researchers examined the state’s existing systems for tracking and responding to extreme heat, including the Department of Health and Human Services’ Heat Health Alert System (HHAS) and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). These systems provide a strong foundation, but may not fully capture or communicate risks to the populations most affected.
Currently, most heat-related alerts in North Carolina are sent through channels that don’t always reach high-risk populations in a timely manner, such as emails, web-based dashboards, and partner organizations. Broad, direct-to-individual text messaging could be a better option.
The authors recommend expanding “push” communication strategies, such as text messages or Wireless Emergency Alerts, to deliver timely, actionable guidance directly to high-risk groups, including outdoor workers and rural residents.
While some states have strong alert systems and others have more advanced surveillance tools, North Carolina stands out for having both. HHAS provides early warnings based on forecasted heat risk, and NC DETECT, a robust public health surveillance platform, tracks heat-related illness in real time. Together, the two initiatives create a unique opportunity to better connect data and communication, Bosworth said.
Still, the authors emphasize that gaps remain in how effectively these systems reach and reflect populations at highest risk, pointing to a key area for improvement.
The researchers also call for strengthening data collection by incorporating information from non-traditional care settings, such as farmworker clinics, and standardizing occupational data to better understand who is most affected.
“Refining how we deliver heat alerts and collect data is about more than improving efficiency — it’s about extending our reach to the people who need it most, saving lives, and building a foundation for stronger policy,” said Elizabeth Rojo, Duke doctoral student in population health sciences and coauthor of the article.
Bosworth and Rojo say these recommended changes could strengthen public health response efforts by making heat alert systems more responsive and grounded in community needs.
Together, these improvements could transform existing systems into a more comprehensive approach to climate preparedness. The authors suggest that North Carolina is well positioned to lead in this area and offer a model other regions can adapt — one that better translates heat risk into targeted, practical protections.