{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:21:43Z","timestamp":1787163703390,"version":"build-2736575974"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>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\u2014ranging from cardiovascular strain to acute kidney injury\u2014are 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\u2019s Heat Health Alert System and the NC DETECT surveillance platform. North Carolina is well-positioned to pioneer a multi-modal \u201cpush\u201d communication strategy, leveraging the ubiquity of smartphone technology and Wireless Emergency Alerts to provide \u201cjust-in-time\u201d 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\u2014ensuring that advancements in climate preparedness protect and empower the most vulnerable populations.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1801198","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:48:51Z","timestamp":1776253731000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating the heat: implementation challenges and opportunities for heat alert communication and rural health data infrastructure"],"prefix":"10.3389","volume":"14","author":[{"given":"Elizabeth M.","family":"Rojo","sequence":"first","affiliation":[{"name":"Department of Population Health Sciences, Duke University School of Medicine","place":["Durham, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayden B.","family":"Bosworth","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Duke University School of Medicine","place":["Durham, NC, United States"]},{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center","place":["Durham, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.healthplace.2018.08.017","article-title":"Heatwave and health impact research: a global review","volume":"53","author":"Campbell","year":"2018","journal-title":"Health Place"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e521","DOI":"10.1016\/S2542-5196(18)30237-7","article-title":"Workers\u2019 health and productivity under occupational heat strain: a systematic review and meta-analysis","volume":"2","author":"Flouris","year":"2018","journal-title":"Lancet Planet Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"100432","DOI":"10.1016\/j.joclim.2025.100432","article-title":"Rural heat health disparities: evidence from the U.S. National Emergency Medical Services Information System (NEMSIS)","volume":"22","author":"Ahn","year":"2025","journal-title":"J Clim Change Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"759","DOI":"10.3390\/jcm13030759","article-title":"The impact of climate change and extreme weather conditions on cardiovascular health and acute cardiovascular diseases","volume":"13","author":"De Vita","year":"2024","journal-title":"J Clin Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"101765","DOI":"10.1016\/j.smim.2023.101765","article-title":"Mechanisms of climate change and related air pollution on the immune system leading to allergic disease and asthma","volume":"67","author":"Sampath","year":"2023","journal-title":"Semin Immunol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1210\/endrev\/bnaf026","article-title":"Climate change and reproductive health","volume":"46","author":"Fernandez","year":"2025","journal-title":"Endocr Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1159\/000500344","article-title":"Climate change and the kidney","volume":"74","author":"Johnson","year":"2019","journal-title":"Ann Nutr Metab"},{"key":"ref8","volume-title":"Heat Health in General Practice","year":"2026"},{"key":"ref9","year":"2026"},{"key":"ref10","year":"2025"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1001\/jama.2024.28654","article-title":"Why capturing heat-related illness in the medical record matters more than ever","volume":"334","author":"Orrall","year":"2025","journal-title":"JAMA"},{"key":"ref12","volume-title":"Fact Sheet Archives. 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