Improving Heat Governance: Assessing Heat-Health Disparities and Policy Responses in the US Southeast

As global temperatures rise and extreme weather increases in frequency and intensity due to climate change, heat has emerged as an environmental and climate adaptation policy issue with important health and equity implications. In response, heat policy approaches aim to prevent the adverse health impacts of heat and address disparities in exposures and heat-health vulnerability between sociodemographic groups. Local and regional governments are increasingly implementing heat mitigation and adaptation strategies, although evidence on the efficacy and appropriate applications of heat policy approaches is limited. This dissertation aims to address these knowledge gaps by evaluating the effectiveness of two existing heat policy strategies and developing an approach to inform heat policy implementation in urban areas with a focus on the US Southeast. Chapter 1 examines the ability of heat alerts to prevent EMS encounters for heat-related illness in Georgia and North Carolina. Chapter 2 demonstrates a methodological framework for estimating small-area heat-health burdens by estimating census block group-level cardiovascular illness among older adults in the Research Triangle region of North Carolina. Chapter 3 evaluates the heat mitigation impacts of a large-scale cool pavement program in Raleigh, NC. The first and third chapters contribute new evidence on the effects of two popular heat policy approaches while addressing data and methodological limitations of prior studies. Specifically, I find that heat alerts and cool pavements fail to achieve their intended impacts in these cases, although the results suggest avenues for improving the effectiveness of these approaches and conditions for successful implementation. The findings from the second and third chapters also highlight the limitations of relying on heat exposures and demographics alone to select and site heat policy approaches within urban areas. Chapter 2 exemplifies one approach for improving heat policy planning by connecting heat exposures with specific health outcomes and identifying the dominant risk channels contributing to heat-health burdens at the neighborhood level. Together, the results from these chapters advance our understanding of the relationships between heat exposures, health, and policy in the US Southeast context and offer insights to support more evidence-based heat governance.