Assessing preparedness for extreme weather events in community health centers and free clinics across North Carolina

Extreme weather is increasingly affecting population health in North Carolina, with disproportionate impacts on communities served by safety-net clinics. Despite growing recognition of weather-related health risks, limited evidence exists on the readiness of community health centers and free and charitable clinics to address these challenges. We conducted a community-engaged, mixed-methods study to assess extreme weather risk perceptions, institutional barriers, anticipatory guidance, and preparedness among safety-net clinics across North Carolina. Following eight regional listening sessions with safety-net clinics, we developed and administered a statewide survey to administrators, clinicians, and staff affiliated with community health centers and charitable clinics between August and September 2024. Descriptive statistics summarized quantitative responses and narrative synthesis were applied to open-ended questions. A total of 199 respondents representing safety-net clinics statewide completed the survey. More than 90% agreed that climate change was occurring and affecting North Carolina. Nearly three-quarters of respondents (73.9%) perceived climate change as likely to significantly affect their service populations. However, fewer than half (45.8%) reported access to sufficient workplace information to take action. More than 90% of respondents ranked air pollution and extreme heat as the top climate concerns, while > 80% ranked seasonal allergies and mental health as the most salient health impacts. Safety-net clinics in North Carolina demonstrated high concern, but limited capacity to address weather-related health risks. Closing this awareness-action gap will require targeted investments in staffing, funding, clinical screening tools and anticipatory guidance, and implementation support to strengthen climate resilience in safety-net health systems.