We usually talk about summertime heat in terms of how hot the air is, but there’s another metric that matters: the temperatures of roads, sidewalks, buildings, parking lots and other outdoor surfaces. Hot surfaces can make the places people live and work more dangerous, and can increase the risk of contact burns.

Just consider this image, captured recently by satellite, of surface temperatures across Phoenix.

Around noon on July 10, huge parts of the nation’s fastest-growing large city were 120 degrees Fahrenheit, about 49 Celsius, or hotter to the touch. Had you been unlucky or unwise enough to actually touch it with bare skin, it could have caused injury within minutes.

On the city’s desert fringes, in territory governed by Native American nations, the land was even hotter, 150 degrees or more.

So far this summer, the Arizona Burn Center, which serves Phoenix and the broader Southwest, has admitted 65 people for severe heat-related burns, according to Dr. Kevin Foster, the center’s director. Six of these people died from their injuries. Last summer, the center recorded 14 such deaths.

Yet even that figure is small compared with the 645 heat-related deaths that were identified last year in Maricopa County, which includes Phoenix. That was the highest number on record for the county. (This year, the county has so far reported 23 heat-related deaths and is investigating 322 more.)

Surface temperatures are just one of many factors that cities are thinking about as they try to protect residents from extreme heat, said Ladd Keith, an associate professor in the School of Landscape Architecture and Planning at the University of Arizona.

In an environment as complex as a city, heat can harm people, pets and wildlife in many different settings and circumstances, Dr. Keith said. For officials, it can be tricky to figure out which exact combination of policies and actions might prove most beneficial to public health.

Phoenix, for instance, is trying to plant more trees and increase shade. The city’s “Cool Pavement” program has treated 120 miles of asphalt to help it reflect more sunlight and stay cooler as a result. But from a cost-benefit perspective, might it make more sense to put those resources toward building more heat-tolerant homes or addressing homelessness instead? “It’s really hard to know what that mix is,” Dr. Keith said.

What’s clear, he said, is the need to figure it out quickly. “Heat deaths are climbing faster than any of our investments to prevent them,” he said. And human-caused global warming keeps increasing the frequency and intensity of dangerous heat waves. “We’re chasing a moving target very slowly,” he said.

Sacramento is known, with pride, as the City of Trees. But tree cover isn’t distributed equally there, and neither is exposure to broiling heat. On the northern and southern sides of California’s capital, residents of low-income neighborhoods have long contended with a shortage of shade and green space on sweltering days like last week’s.

Victoria Vasquez is the grants and public policy manager for California ReLeaf, a coalition of nonprofit groups that protect and grow the state’s urban forests. Funding for such work is always tight, Ms. Vasquez said. That hasn’t changed very much even as the West suffers through more and more record temperatures. “I wish that it did,” she said.

Still, she sees signs of movement in the right direction. Sacramento is considering a plan to increase citywide tree cover to 35 percent from 19 percent by 2045. Under the Inflation Reduction Act, the United States Forest Service received $1.5 billion to support urban forest programs.

When neighborhood associations see how quickly they can reap the benefits of planting and maintaining trees, Ms. Vasquez said, “that is an infectious, positive change.”

In Portland, Ore., tree-filled areas like Forest Park, on the city’s west side, provided oases of cool last week. Yet Vivek Shandas, a professor of urban planning at Portland State University, and his colleagues recently discovered that the city’s overall tree cover decreased somewhat between 2014 and 2020. One likely culprit? Trees are often removed when houses are sold and residential areas redeveloped.

The medical examiner’s office in Multnomah County, which includes Portland, said last week that it was investigating five deaths for links to the recent blistering heat.

In many ways, Portland has become much more attuned to heat threats ever since a heat dome killed hundreds of people in Oregon and Washington in the summer of 2021, Dr. Shandas said. The city is communicating the risks more actively. It has provided portable cooling units to low-income residents. Still missing, Dr. Shandas said, are the changes to building codes and construction practices that would truly ready Portland for the hotter years and decades to come.

“The things that are low-hanging fruit right now, I think have pretty much been picked,” he said. “The longer-term, sustained, deep retrofit that the city needs in order to be prepared for the increasing intensity and frequency of these heat waves? I have yet to see any of that.”

An H5N1 outbreak that recently infected five poultry workers and 1.8 million chickens in northeast Colorado may have been fueled in part by heat wave conditions and slaughtering methods, according to federal health authorities.

At a press conference Tuesday, Nirav Shah, principal deputy director of the U.S. Centers for Disease Control and Prevention, said the human infections occurred as poultry workers culled infected birds in 104-degree heat — a condition that may have made wearing protective clothing and equipment nearly intolerable, and necessitated the use of large fans, which may have promoted the virus’s spread via feathers, dust and other poultry detritus.

In addition, the method used to kill the infected chickens — carbon dioxide gassing — required that workers move “from chicken to chicken” increasing their “degree of interaction with each potentially infected bird.”

“This confluence of factors may play a role in explaining why this outbreak occurred where it did and when it did,” said Shah, noting that a state and federal investigation is still underway.

He said these observations potentially “highlight a pathway for prevention,” which would include more systematic use of protective equipment as well as engineering adaptations that could help reduce exposure risk.

This weekend, Colorado and federal health officials reported five cases of bird flu in poultry workers at a single farm in northeast Colorado. Four of the cases have been confirmed by the CDC, and a fifth is considered presumptive as officials wait for the final results.

The poultry farm was infected by bird flu earlier this month. The virus is particularly deadly to poultry, and highly transmissible. Standard practice in the industry is to cull all potentially infected birds and clean the premises.

Federal officials said the chickens were slaughtered with carbon dioxide, which a 2016 Meat and Poultry magazine article described as the “gas of choice” in North America due to its availability, low cost, and track record for “attaining consistency in terms of good animal welfare and meat quality.”

Birds infected with H5N1 are discarded and do not enter the food supply.

The technique requires that workers place chickens in a sealed, portable unit in which anywhere from 20 to “several dozen” are exposed to the gas. At first the CO2 is emitted at a concentration that will render the birds unconscious — a phase of slaughter known as “the induction of insensibility.” Once the birds are knocked out, the concentration is increased, and the animals suffocate and die.

The whole thing takes “less than a minute and a half,” said Julie Gauthier, executive director for field operations at the USDA’s Animal and Plant Health Inspection Service.

Maurice Pitesky, an expert in poultry health and food safety epidemiology at UC Davis, said for “houses” as big as the one in Colorado, culling can take weeks.

The process requires that workers handle both live and dead birds. And officials on Tuesday’s call hypothesized that if their PPE was not on properly due to the excessive heat, or had been made less effective by large cooling fans (which were also kicking up dust), they may have been exposed and vulnerable to the virus.

“The heat is an issue,” Pitesky said. “The expectation that dairy workers, poultry workers, under those current heat conditions — or California’s Central Valley, for example, when it was over 110 degrees — that they would wear PPE like Tyvek suits that don’t breathe at all, and the N95 masks that USDA is offering for free, is unrealistic.”

He said there was “no way” anyone was going to wear PPE in those conditions. Instead, he said, the USDA should provide things like visors or surgical masks — protective items that might actually be worn.

“Then there’s the culture, which is probably the bigger issue,” he said, noting in his experience, most workers won’t wear masks — even for particulate matter. So, “while the USDA intentions were good, I think the practicality of what they were trying to bring about wasn’t very sensitive to that reality.”

Federal officials also noted that DNA sequencing of virus obtained from one of the patients is closely related both to infected chickens from that farm, as well as to the first dairy worker infected in Texas in April and to infected dairy herds located near the Colorado poultry farm.

The finding raises “the possibility that this virus was transmitted from a dairy herd in Colorado to the poultry farm,” said Shah, from the CDC. “That is a hypothesis … that needs and requires a full investigation.”

Pitesky said the finding implies the virus may be moving between workers employed at multiple farms, or equipment that’s being shared, “or there’s potentially some environmental connection through groundwater or some kind of habitat-type transmission.”

He said birds and rodents can be mechanical transmitters, and wild birds are common visitors in both dairy and poultry farms. He said he works with poultry farmers to keep birds from nesting inside — “that’s a no-no” — but birds, such as swallows, can and do fly through.

He also suggested that while poultry farmers have really upped their biosecurity in the past several years, the dairy industry is “light-years” behind when it comes to creating physical barriers.

He said with every update he hears, it’s becoming increasingly clear “there’s no way to model or predict how this virus is going to move when it’s in this many different species and in this many different environments.”

And it’s anyone’s guess, he said, what’s going to happen this fall when fall migration begins and things potentially get even more complex.

On a sweltering morning in Watts, community health worker Elizabeth Calvillo rapped on a shut gate with her pen, hoping the sound would carry over the rumble of an airplane.

“Good morning! ¡Buenos días!”

When a young mother emerged from the house in her pajamas, shading her eyes from the sun, Calvillo and co-worker Maria Trujillo explained they were knocking on doors to see if she or her neighbors needed anything. They asked the mother: Was she on Medi-Cal? Was there anything else she needed?

The 26-year-old said she had insurance but was tired of spending hours to get seen at a downtown clinic that said it would take months to schedule a physical for her 3-year-old daughter.

“I haven’t even gotten my checkups because it’s so hard to get an appointment,” the woman lamented.

The two promptly offered to refer her to a local clinic. Trujillo put in the referral electronically on the spot. Calvillo told her they would follow up in a week or two to make sure she had gotten an appointment.

The mother thanked them. “I’ve been stressing about it. You guys came at the right time!”

“That’s what we’re here for,” Calvillo replied.

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1. Elizabeth Calvillo, left, and Maria Trujillo go door to door in Watts trying to connect people with healthcare and other services. 2. Calvillo, left, and Trujillo speak with Brenda Montes, 26, in Watts on a recent canvassing of the neighborhood. (Dania Maxwell / Los Angeles Times)

In Los Angeles County, the public health department is trying to — quite literally — meet people where they are. This year, it has launched a pilot project that sends teams to knock on doors in neighborhoods like Watts, Pacoima and Lincoln Heights to ask residents what they need.

The county might be able to reach people with billboards or ads, X or Instagram, but knocking on doors is “more personal,” said Trujillo, a community health worker with Children’s Institute, one of the local groups carrying out the work. “You have an actual person coming and showing that they want to be of service to you.”

The Community Public Health Teams, run by community organizations and health groups in partnership with the county, are each tasked with knocking on anywhere from 8,000 to 13,000 doors in designated areas.

Community health workers ask questions for a household assessment — which covers unmet needs for medical care, assistance needed for day-to-day activities, mental health, housing instability, neighborhood violence and other issues — and try to connect people with services such as enrolling in Medi-Cal or finding a food bank. Each team is also linked to a healthcare partner that can offer primary care.

“This is bringing healthcare to the door of the individual,” said Monica Dedhia, director of community health programs for Children’s Institute, “versus waiting for someone to make an appointment.”

The pilot program is expected to last five years, with teams returning at least once a year to check on households. Tiffany Romo, director of the community engagement unit at L.A. County Public Health, likened it to “concierge service.” Even after someone has been linked with healthcare or other needed services, she said, the teams will reach out to them again, making sure they actually got what they needed.

Ashley Jackson works in the Pacoima office of Providence’s Community Public Health Team, where “successes” are listed on a poster.

(Carlin Stiehl / For The Times)

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It is a system more common in countries like Costa Rica and Cuba, credited with forging closer connections between health agencies and their communities. Costa Rica, which sends health workers to households, saw a drop in potential years of life lost — one that was sharper for its poorest residents than its wealthiest ones.

But it’s “rarely done in the U.S.” for health workers to be assigned responsibility for the whole population in a geographic area, “including the ones that don’t show up at clinics,” said Dr. Asaf Bitton, associate professor of medicine and healthcare policy at Harvard. “That’s a whole different orientation.”

“We know that most health is created outside the medical care system,” Bitton said, but commercial insurers do not typically pay for things like food or housing. Instead, the approach in the U.S. has largely been, “We will pay for whatever you need once you have the heart attack.”

The pilot program relies on $75 million from a federal grant that will be spread out over five years, providing $1.5 million to each team in 10 “high need” areas.

What success looks like under the program, Romo said, “is really up to the community to define.” But public health officials say their hope is it will drive down inequities and result in healthier neighborhoods. Analyzing the information it gathers will also help inform future efforts at the public health department.

L.A. County Public Health Director Barbara Ferrer said the pilot program emerged not only out of the successes seen in Costa Rica and Cuba, but out of the experiences of the COVID-19 pandemic, when it “became abundantly clear, particularly in lower resource communities, that people were very disconnected from services and support.”

In many cases, “it wasn’t that they were necessarily uninsured or underinsured,” Ferrer said. “They just weren’t connected to a healthcare provider” or other local services. Sometimes the problem was “an information gap,” sometimes fear or distrust and sometimes barriers like long waits or burdensome paperwork, she said.

Providence’s Community Public Health Team is reflected in a mirror in Pacoima.

(Carlin Stiehl / For The Times)

In Pacoima, a working-class neighborhood in the San Fernando Valley, many “people just don’t know those resources are available,” said Dionne Zantua, program manager for another team run by Providence Health & Services Foundation.

Scarlett Diaz, a Providence community health worker, said many Pacoima residents also fear that signing up for programs such as Medi-Cal could jeopardize their chances of a green card or citizenship, even as California officials have thrown open the program to eligible residents regardless of immigration status.

Misinformation isn’t the only obstacle: As Diaz and her co-worker Ashley Jackson rounded the neighborhood one Wednesday, clipboards in hand, they faced locked gates and growling dogs. Some residents waved them off or told them to come back another time.

But their daily rounds have made a difference. Before the Providence team in their neon vests stopped at her gate, Monica Avila said she had already seen them walking her Pacoima neighborhood. The 62-year-old tried to hush her barking dogs as Diaz and Jackson began asking about anything she needed.

Avila told them about the speed bumps she wanted the city to install on her block. She told them her husband had died and one of her sons had been killed. That she used to go out dancing, but not anymore.

She told them about the anxiety she suffered, “bad anxiety where like I feel like I’m being locked in,” so bad it was hard to stop by a community center for free resources. Diaz gave Avila her number, offering to help her get what she needed there next time without having to join the crowd inside.

Ashley Jackson of Providence’s Community Public Health Team speaks with Monica Avila in Pacoima last month.

(Carlin Stiehl / For The Times)

Avila seemed relieved. “Thank you for coming and listening to me,” she said.

The work can be slow going: After stopping at more than 40 homes that morning, Jackson and Diaz had ultimately completed two assessments with residents. They left door hangers about the project on fences, planning to return to people they hadn’t reached.

Romo said she expects that a major challenge will be simply getting people to open their doors. Dedhia said that in Watts, for instance, the community “has been heavily surveyed, but the follow-up isn’t necessarily there all the time.” Another community health worker in Watts recalled that at one home, a man grew angry when the team stopped by, asking them, “Isn’t it obvious what the community needs?”

But Ferrer said the program hinges on the fact that “a lot of people have things that they need help with — and they’re not getting help.”

“We’ll build trust very quickly,” she said, “if we can deliver on that.”