Assessing Heat Action Planning in Arizona Through Hierarchy of Controls and Socio-ecological Model Lens

The increasing frequency, duration, and intensity of extreme heat events due to climate change present a significant public health risk, particularly for under-resourced, underserved communities with limited access to resources and coping mechanisms. Arizona, with its arid climate, is at the forefront of heat response as temperatures reached or exceeded 100^o Fahrenheit on 133 days in 2023. In the absence of national heat safety mandates, there is a need to evaluate the degree to which ongoing heat prevention or response actions are salient, integrate health equity principles, and optimize safety. This study uses the Hierarchy of Control (HOC) and Socioecological Model (SEM) frameworks to analyze Arizona's state and county-level heat action plans and prevention strategies to understand how well they address health inequities and national safety recommendations.

Of the 5 Arizona heat action plans we analyzed, 4 are at the county level and 1 at the state level. Our findings reveal that most heat actions rely on administrative controls, such as creating education campaigns and increasing public awareness efforts. Higher-order controls, such as the elimination or substitution of heat risks, are largely absent from current plans. Engineering controls, including shading and shelters, are implemented inconsistently across jurisdictions. Analysis within the SEM framework indicates that community-level interventions, such as collaboration with communities, are more common, while individual and policy-level responses are insufficient.

The absence of higher-order HOC and inconsistent implementation of engineering controls, along with insufficient policy-level responses, undermine public health and exacerbate inequities by failing to address systemic barriers and vulnerabilities. These weaknesses in state and county planning disproportionately impact marginalized and low-income populations who are least equipped to manage heat risks. This study highlights the need for a comprehensive approach incorporating elimination and substitution strategies while strengthening policy and individual-level interventions. Behavioral change literature stresses the importance of sustained public outreach and effective communication, especially for vulnerable populations. We conclude by recommending multi-level interventions and cross-sector collaboration to improve heat resilience and address the public health challenges posed by extreme heat in Arizona, which can also be applied to other states and countries vulnerable to extreme heat.