Abstract
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.