Summer heat is now an annual health crisis for millions of exposed Americans

It’s hot! In my neck of the woods in suburban Maryland, the forecast calls for 95 degrees, with 84% humidity.

For some, that’s inconvenient. For others, it’s dangerous. The Centers for Disease Control and Prevention attribute more than 700 deaths a year to extreme heat, with thousands more hospitalized with heat exhaustion and illness. It’s getting worse. Climate change is shifting the nation’s thermostat. NOAA and the Farmers Almanac both predict this summer will be hotter and drier than usual in most areas of the country. And we’ve still got a month to go.

The South, where I’m from, is especially vulnerable. The rate of emergency room visits for extreme heat in Texas is double that of California or the Northeast, and nine times the Midwest. As a child I remember my feet burning while stepping on the concrete stoop outside my grandparents’ back door in Florida. At summer camp I longed for pool days and prayed I’d be assigned to the group under the big shade tree instead of baking all day in the sun. The added humidity made it feel like someone grabbed my face and wrapped it tightly in a cloth every time I stepped outside. It didn’t make me sick, but I knew people who had to be careful. I spent every summer with my grandparents. Their friends and relatives were older, with various health conditions. Many stayed inside. Now I understand why. Warm climates can be good for some conditions, but extreme heat and health don’t mix.

People with heart disease and respiratory illnesses, outdoor workers and people who live in cities are among those with a higher risk of heat-related illnesses and complications. Scholars call areas where large populations live in close quarters with lots of buildings and pavement “urban heat islands.” They typically have large concentrations people of color and poor residents who struggle to afford air conditioning. I recently visited Jamaica, a country with unusually warm temperatures for half the year. I assumed that residents who lived there adapted to their environment, but everyone I asked told me how uncomfortable they felt dealing with high temperatures for months at a time.

There are wide economic and racial disparities in who can find relief from heat. A study of Chicago, Detroit, Minneapolis and Pittsburgh found that Black families in all four cities were half as likely to have air conditioners than White families, and faced a higher likelihood of heat-related deaths. An analysis by the New York City Health Department reports similar results: fewer air conditioners in Black and Latino neighborhoods. Researchers noted that “of 26 heat-stroke deaths with information available on home air conditioning, none had a working air conditioner.”

My own family has been going back-and-forth managing a new thermostat. I want to be comfortable; my husband wants to save money. We’re trying to find a happy medium. Years ago — in an attempt to be good stewards of the environment — we signed up for an energy-savings program that allows our electricity provider to remotely power cycle our A/C during peak demand in exchange for a small discount on our bill. This summer I canceled it. The daytime heat was unbearable. It was okay when no one was at home during the day. But since COVID, our work and school schedules have changed. Remote work and learning leave someone in the house 24/7. We need control of our air.

I realize that’s a problem of privilege. When you’re poor and hot, you can’t just crank up the air-conditioning at will. Residents may have a unit but don’t use it because they can’t afford the bill. For those without central air, installing a new system can cost thousands of dollars. A decade ago ours cost $5,000 to replace. That’s about a fifth of the annual income for a family of four in poverty. Imagine giving up two months of paychecks just to get some cool air.

Access to cool air often depends on where you live and can vary within a few miles. For example, landlords in Washington, D.C. are not required to provide it, but next door in suburban Montgomery County, Maryland, it’s mandatory. Some governments realize that the lack of access to cool air in the summer is a threat to community health, and they’re trying to do something about it. A California measure dubbed the “Right to Air Conditioning” bill faces an uphill battle. The bill would amend the state’s building code to require landlords and building owners to provide safe indoor air temperatures in both new and existing dwelling units. 

A legislative analysis of the bill cites concerns about heat-related illness and injury, noting that “disenfranchised communities actually are hotter than more wealthy communities. In fact, California metro areas have a larger temperature disparity between their poorest and wealthiest areas than any other state in the Southwest.” Opponents argue that the bill circumvents the normal building code process, would be difficult and expensive to implement, and that more air conditioners could overwhelm the state’s power grid. It’s currently stuck in committee pending a hearing.

The essential question is whether air conditioning is a necessity or a luxury. That question has yet to be resolved, and may ultimately depend on where you live. What’s clear: given how our climate is changing, the lack of cool air is a health threat, with the greatest impacts on our most vulnerable communities.