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Introduction: Environmental heat can have a negative impact on health, leading to increased healthcare utilization, disability, and death. Specific clinical conditions, in combination with a global rise in temperature, may amplify the risk of heat related illnesses. Materials and Methods: We conducted a retrospective analysis of VA's national electronic health record database from January 1, 2002, through December 31, 2019. Heat related illness diagnoses were assessed for associations with patient demographics, comorbidities, and geographic residence at the time of a heat related illness diagnosis. Descriptive statistics, linear regression, and additive seasonal decomposition methods were utilized to assess risk factors and trends. Results: There were 33,114 documented cases of heat related illness, which impacted 28,039 unique patients, during our 18 year assessment period. Veterans were diagnosed with heat related illnesses in all 50 US states and there was an increase in the rate over time. The likelihood of heat related illnesses was greater for those with increased comorbidity burden. Rates increased for homeless Veterans in the first half of the assessment period, and then declined for the second half. Black, as well as American Indian/Alaska Native Veterans accounted for a greater proportion of heat related illnesses. Conclusion: There has been a statistically significant and clinically important increase in the incidence of heat related illnesses over time. There has also been an increased number of heat related diagnoses associated with existing health and demographic factors, and the increase over time did not strictly follow the expected geographic North-South climate trends.

Background: Climate change has direct impacts on human health, and these impacts are projected to grow. The National Center for Environmental Health (NCEH) at the Centers for Disease Control and Prevention (CDC) has implemented climate and health activities for more than a decade. CDC's Climate and Health Program, within NCEH, is the national leader in preparing communities for the health impacts of climate change. Recent efforts by NCEH's Division of Environmental Health Science and Practice (DEHSP) seek to expand climate work, foster collaboration, and create an updated strategy to protect human health from the impacts of climate change. Objectives: Here we outline a proposed strategy focusing on climate and health data, science, and action. The strategy expands NCEH's current climate and health activities while integrating with other programs and partners, to increase capacity across the nation to prepare for and respond to the health impacts of climate change. Methods: DEHSP developed a climate and health strategy through a planning process including division leadership, all branch chiefs within the division, and subject matter experts from across NCEH. The process began in January 2021 and is ongoing to continue to refine an adaptive and iterative strategy. This strategy, while led by DEHSP, aligns with NCEH and CDC's overall climate and health priorities and goals. Discussion: Implementation of this strategy will ensure coordination of CDC climate and health activities to create healthy climate resilient communities, while building local capacity to implement adaptations to protect health. Expanding collaborations and partnerships to support each strategy will be critical for success. The three-pronged strategy serves to increase our understanding of the impacts of climate change and the effectiveness of adaptation strategies, foster locally led response actions, and ensure accurate data to inform, track, and evaluate these actions. Government entities at all levels (from local to federal) can consider adopting similar strategies to ensure a coordinated and integrated effort. The intended outcome is healthier communities that are prepared for the impacts of climate change.