Navigating the heat: implementation challenges and opportunities for heat alert communication and rural health data infrastructure.

Extreme heat is the most significant climate threat to public health, disproportionately impacting marginalized groups, including outdoor workers, older adults, and low-income rural populations. While the physiological consequences of heat-related illness-ranging from cardiovascular strain to acute kidney injury-are well-documented, a critical gap remains in the equitable implementation of mitigation strategies. This paper examines North Carolina as a case study due to its proactive leadership in heat-health mitigation, examining the evolution of the state's Heat Health Alert System and the NC DETECT surveillance platform. North Carolina is well-positioned to pioneer a multi-modal "push" communication strategy, leveraging the ubiquity of smartphone technology and Wireless Emergency Alerts to provide "just-in-time" guidance to high-risk outdoor workers and rural residents. Simultaneously, the state can strengthen its robust surveillance infrastructure by integrating data from non-traditional care sites, such as farmworker clinics, and standardizing occupational data collection. These advancements would transform existing systems into a comprehensive, community-informed model of resilience. By expanding communication modalities and data inclusivity, North Carolina offers a scalable framework for translating meteorological risk into actionable, equitable policy-ensuring that advancements in climate preparedness protect and empower the most vulnerable populations.