Success Story: Preventing Heat-Related Illness
Preventing heat-related illness in the Sandhills region
Project Purpose
Compared to the rest of the state, communities in North Carolina’s Sandhills region—Bladen, Robeson, Hoke, Sampson and Scotland counties—experience an elevated number of extreme heat days. Residents in the Sandhills region are particularly vulnerable to the impacts of rising temperatures due to high exposure and existing health vulnerabilities. To help prevent heat-related illness in the Sandhills, the NC Department of Health and Human Services (NC DHHS) Climate and Health Program worked with local heat-related illness prevention specialists in the region to implement a heat-health alert system and a summertime educational and informational campaign (NC DHHS, 2017).
Quick Facts
- Most parts of North Carolina are projected to see at least two to three additional weeks of very hot days (maximum temperature of 95 degrees F or higher) for 2021-2040 (Kunkel, et al., 2020). On average since 2020, there are about 3,500 emergency departments visits for heat-related illness each year during the heat season, which runs May 1 to Sept. 30 (NC DHHS, 2017).
- Following interviews with community members, program partners developed a heat alert system and multilingual educational materials. As of spring 2023, partners used social media, multilingual trainings, heat stress kits distribution and heat messaging in farmworker health assessments to issue heat wave notifications and inform vulnerable residents about healthy heat management strategies.
- The programming in the Sandhills helps build resilience against public health impacts of extreme heat by increasing awareness of heat risks, promoting positive health protective behaviors and increasing access to resources.
Spotlight on Equity
The impacts of rising temperatures are higher in underserved communities, especially those living in poorly insulated mobile homes, those with limited access to adequate cooling and individuals who experience disparate asthma and cardiovascular disease. Several Sandhills counties have a high concentration of potentially underserved populations. Concentrating heat safety programming in the Sandhills region places a spotlight on equity by prioritizing the communities that face the highest exposure to heat with the lowest capacity to adapt. For example, as the number of extreme heat days is projected to increase, many households in the Sandhills region that already struggle with energy bills may not be able to adequately cool their homes.
Additionally, North Carolina’s farmworkers, a heavily migrant population, are at a disadvantage when it comes to accessing health care. They often do not speak English or speak English as a second language. Many farmworkers do not have easy access to transportation, typically have lower incomes, are unfamiliar with the local health care services available and are often scared to visit a doctor who might tell them they are unable to work. The Climate and Health Program has historically supported farmworker organizations by integrating heat health educational materials into farmworker outreach staff’s existing health promotion activities. Moving forward, the program is coordinating with the NC DHHS Office of Rural Health’s Farmworker Health Program to provide critical extreme heat education and health promotion resources to those who care for farmworkers, including community migrant health clinic workers and clinicians.
| Key Info | |
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| Location | Bladen, Robeson, Hoke, Sampson and Scotland counties, N.C. |
| Estimated Costs | ~$125,000 per year |
| Published | March 1, 2024 |
| Project Contact |
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| Sarah Hatcher Climate and Health Program Lead NC Department of Health and Human Services Sarah.Hatcher@dhhs.nc.gov |
| Related Resources |
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- In 2017, NC DHHS conducted qualitative interviews with relevant stakeholders in Bladen, Robeson, Sampson and Scotland counties to assess community readiness for heat health programming. NC DHHS reported interview results and intervention strategies in the Sandhills Heat Community Readiness Report (PDF).
- During interviews, local stakeholders reported concern about vulnerability to heat-related illness among farmworkers, individuals living in poverty, older adults, outdoor workers and children. Some of these groups are more exposed to extreme heat, such as outdoor workers and individuals who cannot afford air conditioning. Others are more sensitive to extreme heat, such as aging populations and individuals who have not yet acclimatized to the heat. Those who experience high exposure and high sensitivity are particularly vulnerable, such as farmworkers who have recently immigrated. Exposure to extreme heat during working hours is dangerous for populations that are traditionally underserved due to transportation and language barriers.
- In response to the interview results, NC DHHS outlined two prevention strategies—a heat alert system and multilingual educational materials — in the North Carolina Climate and Health Implementation and Monitoring Strategy for Heat-Related Illness (PDF), published in 2018. These programs and partnerships enable NC DHHS to reach the most heat-vulnerable populations in the region.
- To help implement these interventions, the NC DHHS Climate and Health Program established a Heat-Illness Prevention Specialists Task Force in 2018 (now known as the Sandhills Climate Resilience Task Force). The group is comprised of representatives from local health departments and community-based organizations that can speak for the needs of their target populations: agricultural workers, low-income residents that cannot afford adequate cooling, older adults and youth athletes that practice outside during the summer.
- NC DHHS and Sustainable Sandhills developed heat wave announcements, designed educational messaging and trained the prevention specialists on the Task Force on how to interpret heat data.
- Each prevention specialist identified appropriate communication channels for heat alerts to reach the populations with which they have trusted relationships. For example, the NC Farmworkers’ Project, which works with migrant and seasonal farmworkers to maintain and improve their health, conducted multilingual trainings and distributed heat stress kits, electrolytes, cooling towels, water bottles with heat health messaging and personal protective equipment such as hats. In another example, Manos Unidas incorporates heat messaging into their existing health assessments offered to farmworkers. They also do some specific heat health trainings and provide heat stress kits, educational materials and water bottles. As of spring 2023, Task Force members issued heat alerts via social media, but there was interest in expanding the approach to issue communications through more formal channels.
- The Task Force began issuing heat alerts in 2018 in Bladen, Robeson, Sampson and Scotland counties. The group also distributed educational materials and health protective resources during heat season (May to September).
- In 2019, NC DHHS and the Task Force expanded heat health programming to Hoke County.
NC DHHS allocates about $125,000 dollars per year toward heat management programs. Funding came from the Centers for Disease Control and Prevention Building Resilience Against Climate Effects (BRACE) cooperative agreement, a five-year agreement funded at $500,000 per year from 2021-2026, as of spring 2024.
NC DHHS, Sustainable Sandhills, Scotland County Health Department, NC Farmworkers’ Project, Robeson County Health Department, Manos Unidas
- Vulnerable populations, including farmworkers, in the Sandhills region have increased access to resources they can understand to help them learn about and address impacts from heat.
- NC DHHS expects to see an increase in protective actions to prevent heat-related illness among vulnerable populations within target Sandhills counties, as well as reduced heat-related illnesses among vulnerable populations in the region.
Heat health interventions can be more effective if coordinators can build on current local efforts, utilize local expertise and work through existing channels of health and social service provision.
Gathering information, making it accessible to those that need it and developing systems that monitor impacts on vulnerable members of the community are necessary steps for addressing inequality and inequity.
Kunkel, K. E., Easterling, D. R., Ballinger, A., Bililign, S., Champion, S. M., Corbett, D. R., . . . Terando, A. J. (2020). North Carolina Climate Science Report. Retrieved from North Carolina Institute for Climate Studies: https://ncics.org/wp-content/uploads/2020/10/NC_Climate_Science_Report_FullReport_Final_revised_September2020.pdf
NC DHHS. (2017). Sandhills Community Readiness: Determining Pilot Groups for Heat Safety Programming. Retrieved from North Carolina Department of Health and Human Services: https://epi.dph.ncdhhs.gov/oee/climate/HeatCommunityReadinessReport.pdf
US EPA. (2022, September 2). Heat Island Impacts. Retrieved from United State Environmental Protection Agency: https://www.epa.gov/heatislands/heat-island-impacts