Why the U.S. struggles to track heat deaths and protect people from extreme temperatures

A new analysis has revealed that the United States cannot reliably count heat deaths or identify who must act when temperatures turn dangerous.

That failure can turn a clear forecast into a patchy response, leaving protection to depend on local records, budgets, and authority.

Data gaps delay heat response

Across counties and cities, heat records, emergency plans, and death files rarely line up when extreme temperatures begin to harm people.

By tracing those mismatches across the system, Noah Ring, a doctoral researcher at University of Kansas (KU), demonstrated how warnings can stall before help reaches residents.

Even strong forecasts lose force when funding, transport, and legal authority change from one community to the next.

That mismatch does not make heat impossible to manage, but it shows why the body-level danger behind every forecast needs clearer attention.

Heat damages the human body

Heat harms the body when sweating cannot release enough energy, causing internal temperature to rise and organs to strain.

Humid air worsens the threat because moisture lingers on skin, so sweat dries more slowly and the body stores heat.

Because heat often worsens existing illness, deaths can look like heart, kidney, or breathing failures on paper.

During May through September 2023, federal data showed emergency visits for heat illness rose across several United States regions.

Heat plans need real support

City heat action plans, playbooks for warnings, cooling sites, and transport, matter because heat usually builds before ambulances fill.

Unlike disasters that trigger evacuations or shutdowns, heat demands early, ongoing action rather than short-term emergency responses.

Plans work only when agencies can move people to cooling centers, public air-conditioned spaces opened during dangerous heat.

When budgets tighten or elections change priorities, the playbook can sit on a shelf during the next hot week.

Vulnerable groups face higher risk

Risk rises fastest for people who cannot leave work, cool a room, or reach help without losing wages.

In poorer neighborhoods, older housing and fewer trees can trap heat, raising indoor temperatures when bodies need recovery overnight.

A 108-city study found formerly redlined neighborhoods, areas once denied fair lending, were about 4.7 degrees Fahrenheit hotter than non-redlined areas.

Those patterns turn heat response into a fairness problem, not just a weather-warning problem.

Heat deaths often go uncounted

Death counts wobble because heat often worsens chronic disease instead of leaving one obvious cause.

The medicolegal death investigation system, coroner and medical-examiner offices that certify deaths, differs sharply by state and county.

Official records counted 21,518 heat-related deaths from 1999 through 2023, with 2,325 in 2023 alone.

A missed heat label on one death certificate can hide a neighborhood pattern that should have triggered prevention.

Local agencies lack resources

Local health departments often carry the hardest work after forecasts arrive. A survey in the new paper found only 33% felt ready for extreme heat events, dangerous periods far above local normal.

Although 52% expressed high concern, many lacked staff, funding, or 10-year death records to guide choices.

That gap leaves officials deciding where to send outreach before they can prove which blocks are most exposed.

Responsibility is unclear

Federalism, the sharing of power among national, state, and local governments, makes heat response flexible but uneven.

The National Heat Strategy was a federal heat-resilience plan coordinating agencies, data, warnings, and community partners through 2030.

Even so, the KU paper argues that responsibility still shifts among agencies while political changes can weaken long-term planning.

A national plan can guide action, but money and authority decide whether warnings become protection.

Workers remain exposed to heat

Outdoor and warehouse workers face heat they cannot simply avoid because paychecks often depend on staying in place.

From 2011 through 2021, the Bureau of Labor Statistics, the federal labor data agency, counted 436 work-related deaths from environmental heat exposure.

Because heat stress clouds judgment and raises heart strain, injuries can occur before a worker collapses.

Without enforceable breaks, shade, water, and cooling, job-site heat becomes another weak spot in local response plans.

Better data improves response

Better public health surveillance data, records that track illness and death over time, can show where help works.

Neighborhood maps, ambulance calls, weather records, and death certificates can reveal where warnings miss people before deaths rise.

Reliable records also let cities test whether rides to cooling centers, home checks, or utility aid lowered risk.

Data alone cannot cool a bedroom, but it can stop officials from guessing where scarce dollars belong.

Heat demands coordination

A safer heat response starts with one clear chain: count deaths consistently, identify vulnerable places, fund local plans, and assign responsibility.

That approach will not remove heat from American summers, but it can turn forecasts into earlier warnings, faster outreach, and fewer preventable deaths.

The study is published in The Journal of Climate Change and Health.

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