of older generations, such as slowing down and seeking shelter when the
weather is oppressively hot.
In addition to population changes, changes in North Carolina's built envi-
ronment have led many areas of North Carolina to feel hotter today than they
had in past decades. Since the late 1950s, suburban development had led to
the development of many formerly wild or agricultural spaces replacing fields
and forests with asphalt roads and housing developments. As a result, many
areas of North Carolina have developed a so-called heat island effect because
darkened asphalt and concrete buildings absorb more of the sun's heat than
the rural pine forests and farmlands they replaced. In addition, urbanization
likely resulted in urban spaces that feel hotter because they lack the shade
offered by natural settings or mature urban areas. According to the National
Aeronautics and Space Administration's “Common Sense Heat Index,” which
measures the extent to which climatic warming trends can be perceived by
the average individual, all of the major population centers of North Carolina
have grown increasingly warmer since the 1960s (although the 1930s through
the 1950s felt roughly as warm as today) (Hansen 2005; Hansen et al. 1998).
Still, the summer of 2007 was hot even by southern standards, and the relent-
less heat of August 2007 was some of the worst on record in North Carolina
history. According to the National Oceanic and Atmospheric Administration,
the summer of 2007 was the sixth warmest summer on record, and August
was its warmest month. Throughout August, the extreme heat contributed
to several gaudy weather records. On August 9, Charlotte reached its all-
time high temperature of 104°F. On August 21, Raleigh-Durham equaled
its all-time high temperature of 105°F. The heat was sustained and extreme,
with a duration and severity not seen in North Carolina since the heat waves
of 1983 and 1954 (NOAA 2007). Fayetteville, North Carolina, experienced 6
consecutive days with high temperatures above 102°F. Just over the border
in South Carolina, Columbia experienced 14 days in August when tempera-
tures exceeded 100°F.
By the mid-2000s, several major events had raised public health officials'
awareness of the potentially catastrophic dangers of extreme heat. In 1995, a
severe heat wave in the city of Chicago resulted in widespread power outages
and other disruptions of city services along with nearly 600 deaths (Dematte
et al. 1998; Klineberg 2002). In 2003, a heat wave in Western Europe led to
approximately 33,000 deaths across the continent (Kosatsky 2005).
Whether because of changes in society, warming of the climate, or simply
increasing awareness that periods of extreme heat can have profound public
health consequences, in the summer of 2007, North Carolina public health
officials were nervous about the heat. This anxiety only increased as the sum-
mer, already unusually hot, grew historically so in the first weeks of August.
Officials wanted to protect the population from the extreme effects of heat
seen in the recent past, but they needed information to do so. Fortunately, by
2007, North Carolina had a new information system in place that could help
them monitor and respond to the problem.