California has poured hundreds of millions of dollars into fighting extreme heat since 2022, building cooling centers, distributing community grants, and developing risk-mapping tools. Yet heat-related emergency room visits and deaths keep climbing, and the state’s own environmental health agency acknowledges that the true toll is almost certainly undercounted. The gap between money spent and lives saved raises a pointed question: is the state investing in the right things?
An $800 Million Promise, Four Years Later
The state’s push began in earnest on April 28, 2022, when the governor’s office released the Extreme Heat Action Plan alongside an $800 million climate package tied to the 2022-23 fiscal year. The plan organized state actions into four tracks, including building public awareness and notification and strengthening community services. On paper, the commitment was significant. In practice, the money has flowed primarily toward physical infrastructure and planning tools rather than direct medical intervention or health outreach.
The largest single tranche went to Community Resilience Centers. In May 2023, the governor’s office announced nearly $200 million to build facilities intended to provide shelter, respite, and services during extreme heat and other hazards. The Strategic Growth Council later published detailed program guidelines spelling out eligible project types, equity targeting, and reporting requirements. These centers are designed to keep people cool during dangerous heat waves, but they do not directly address the clinical side of the crisis: treating heat stroke, reducing chronic disease exacerbated by heat, or reaching isolated residents who never make it to a cooling center.
Grants Flow, but Health Metrics Do Not Improve
A separate grant program, the Extreme Heat and Community Resilience Program created by AB-2076 in 2022, has distributed smaller awards to local governments and community organizations. The California Governor’s Office of Land Use and Climate Innovation announced a $32 million round to help communities combat extreme heat. That money funds local projects like tree planting, cool-surface installations, and neighborhood resilience planning. These are worthwhile adaptations, but no publicly available state report tracks whether these investments have reduced heat-related hospitalizations or deaths in funded communities.
That absence of outcome data is not a minor gap. The state’s own Office of Environmental Health Hazard Assessment, in its EPIC 2022 report on heat-related deaths and illnesses, documented rising heat-related emergency department visits and hospitalizations and emphasized significant underreporting of heat-related deaths and illnesses across the state. If the baseline data is incomplete and the funded programs lack health-outcome tracking, there is no reliable way to measure whether hundreds of millions of dollars are actually saving lives.
Budget Pressure Threatens Follow-Through
Even the funding that has been committed faces erosion. The Legislative Analyst’s Office, the nonpartisan fiscal arm of the California Legislature, flagged proposed reductions for the Extreme Heat and Community Resilience Program in its 2023‑24 budget review. That report raised questions about both the effectiveness and the uncertainty surrounding the new program, noting that measurable outcomes may be unclear or delayed. Separately, the LAO’s earlier analysis of the 2022‑23 spending plan detailed specific line-items for extreme heat adaptation, including Community Resilience Centers and the Community Resilience and Extreme Heat program, with multi‑year appropriations that allow independent verification of what was actually allocated versus what was announced.
The 2024‑25 budget summary proposed General Fund solutions to address a projected shortfall, putting climate programs in direct competition with other priorities. When budgets tighten, programs without clear performance metrics are the easiest to cut. Heat resilience spending, which lacks the kind of outcome tracking that would demonstrate return on investment, is especially vulnerable. Without a clear link between dollars spent and hospitalizations averted, lawmakers have little evidence to defend these programs when they are on the chopping block.
Mapping Risk Without Closing the Loop
One area where the state has made genuine progress is in identifying who is most at risk. The CalHeatScore platform, developed by OEHHA and CalEPA, maps heat-health risk at the community level. Updated as recently as January 2026, it is designed for individuals, communities, decision makers, and policy makers to understand where extreme heat poses the greatest danger. The tool integrates environmental and health vulnerability data to produce composite risk scores that highlight neighborhoods facing overlapping burdens.
CalHeatScore is useful for planning and situational awareness. But a mapping tool, no matter how well designed, does not treat a farmworker suffering heat exhaustion in the Central Valley or reach an elderly resident in a poorly ventilated apartment in South Los Angeles. The distance between identifying risk and reducing harm is where the state’s strategy breaks down. A 2024 report from the California Department of Insurance found that six of the heat events it studied showed elevated mortality rates in disadvantaged community census tracts, precisely the areas CalHeatScore flags as high risk. The question is what happens between the map and the emergency room.
Infrastructure Bias Leaves Health Gaps Exposed
The pattern across California’s heat spending is clear: the state has invested heavily in physical assets, planning documents, and data tools while underinvesting in direct health interventions. Cooling centers help people who can reach them. Tree canopy and cool roofs lower ambient temperatures over time. Risk maps guide where to spend. None of these address the acute clinical reality of heat illness or the chronic health effects that compound over years.
Clinicians who treat heat-related illness emphasize that timely response is critical. Heat stroke can become fatal in minutes, and even moderate heat stress can worsen heart and lung conditions, kidney disease, and mental health. Yet most of California’s marquee heat investments do not fund mobile health teams, after-hours clinic capacity during heat waves, or targeted outreach to people with high-risk conditions. For residents who are unhoused, homebound, or working outdoors, the most visible state-funded assets may be physically or practically out of reach.
This infrastructure bias also obscures who is left out. Community Resilience Centers are often sited in civic or nonprofit buildings that already have some organizational capacity, which may not align with the hardest-hit blocks. Grant-funded projects like tree planting can take years to mature into meaningful shade. Meanwhile, low-wage workers laboring through triple-digit days and seniors in aging apartment buildings experience dangerous heat now. Without parallel investment in health services and rapid response, the benefits of capital projects arrive too slowly and unevenly.
What a Health-Centered Strategy Would Look Like
Experts who study heat and health point to several interventions California could adopt or scale up using the same funding streams it has already created. One is to tie grants directly to measurable health outcomes, such as reductions in heat-related emergency visits in specific census tracts. Another is to require that projects using tools like CalHeatScore include a clinical partner (such as a community health clinic or local health department) and set aside funds for outreach, telehealth check-ins, or pop-up cooling and treatment sites during heat emergencies.
Data systems are another weak link. The undercounting documented by OEHHA reflects gaps in how death certificates and hospital records capture heat as a contributing factor. Improving those systems would not only clarify the true toll but also allow faster detection of spikes in heat illness. That, in turn, could trigger surge funding or staffing for clinics and emergency departments in the hardest-hit areas, creating a feedback loop between surveillance and service delivery rather than between mapping and more mapping.
Finally, advocates argue that California’s heat investments should be judged by a simple metric: are fewer people getting sick and dying when temperatures spike? That requires the state to move beyond counting facilities built or grants awarded and toward tracking outcomes in real time. Until that shift happens, the state will continue to excel at documenting where the danger is greatest, while leaving too many residents to navigate that danger on their own.
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*This article was researched with the help of AI, with human editors creating the final content.
