What can we do to combat the deadly effects of rising temps?

One late summer evening last year, I was at an apartment in the San Fernando Valley, one where a teenage boy got sick every time the temperature spiked. I put my hands on the walls, and sure enough, they radiated warmth. Just like his mother said they would. The air was close and stifling, just like sensor data had revealed for this place and others near it in the community of Pacoima. This was a house with window air conditioners in only the most crucial rooms, where the youngest children could sleep. I thought of how many families were facing this problem, and how overlooked the problem remains.

Health statistics and other data undercount the health risk of high temperatures, and have been a constant complication for my reporting on excessive urban heat. For the past two years I’ve focused on rising temperatures as a climate-driven problem that presents immediate and direct health risks. Yet California leaders have stressed that extreme high temperatures are a significant a health hazard. “Heat has the ability to affect so many people,” Rupa Basu, an epidemiologist with the California Environmental Protection Agency’s Office of Environmental Health Hazard Assessment, told Science News in April. “Everybody’s vulnerable.”

Thanks to climate change, that hazard is growing. “Extreme heat events have long threatened public health in the United States,” write the authors of the National Climate Assessment. But now “heat waves have become more frequent and intense, especially in the West.” High temperatures are setting new records, especially at night: “Many more high temperature records are being broken as compared to low temperature records over the past three to four decades — another indicator of a warming climate,” write the authors of the NCA.

Extreme heat triggers a variety of immediate health consequences, including rashes, exhaustion and fainting. It raises the risk of stroke for people who have heart conditions. It worsens asthma and other respiratory ailments. And for those people with heart and breathing problems, climate-driven heat is compounding that risk further, because high temperatures boost the production of ground-level ozone and particulate air pollution in places such as California. All in all, climate change is a sneaky conspirator in heat’s assault on peoples’ health.

Where you live can raise this risk. A study led by Rachel Morello-Frosch, an environmental scientist at UC Berkeley, has found that people of color are more likely than whites to live in urban neighborhoods where intense heat is a health risk.

Morello-Frosch says all of these neighborhood conditions combine in cities, multiplying the health threat. “Housing quality, in addition to living in a place with a lack of tree canopy and lots of impervious surfaces, can create what I would call a perfect storm, if you will, increasing the risk of disease and death during heat waves,” she said.

Around the country, epidemiologists and climatologists are sounding alarms about the problem of urban heat and are working, often together, to quantify the problem. Yet successful interventions are elusive and complex in California. The impacts of urban heat differ widely across cities, and those impacts are poorly documented. And heat doesn’t know borders. More people die in the U.S. every year from heat-related illnesses than from hurricanes or other natural disasters combined. But without knowing who is most at risk, public health departments and politicians face significant challenges in formulating a coherent response.

Climate mandates have led California officials to begin characterizing heat across the state, not just in Los Angeles but also the Inland Empire and the Central Valley. But each county prioritizes and categorizes heat-related illness differently. As just one example, county medical examiners and coroners have told me that death certificates in California aim to document not only the direct cause of death, but also secondary and tertiary causes of death, where health interventions could have prevented or delayed a fatality. Much is left to the individual judgment, not to mention the workload, of the medical professional responsible for that form.

The response to this crisis from the government, the public and private industry is underway in California, driven by past heat waves. It takes a lot of different forms, in a lot of different places.

In its sustainability plan, the city of Los Angeles acknowledged that average temperatures in the urban core are 6 degrees higher than surrounding areas, largely due to concrete and asphalt. The plan announced the city’s intention to reduce the urban heat island effect more than any other city by 2035. And last year, LA earned national notice for developing a three-part plan to combat the urban heat island effect, focusing on cool roofs, cooler pavement, and tree planting.

Cool roofs — added to new and significantly remodeled rooftops — will roll out over decades, and may even increase air pollution. Cool pavement cannot be used on broad boulevards and major streets where dirt and oil will negate its value. And tree planting, even with enthusiastic volunteer partners, has limited funding. Beyond these logistical challenges, these solutions are explicitly directed at landscape-level change, not avoiding individual harm. So far they offer little hope for reducing harm to Angelenos. The hot walls I touched in Pacoima remain hot.

My reporting last year in the San Fernando Valley centered on urban heat and health impacts connected to apartments and homes in the hottest part of LA, occupied by people who lacked AC, or couldn’t afford to run it much. In homes where I collected data, indoor heat tracked outdoor heat, and lingered into the evening, disturbing sleep patterns and family routines in addition to producing recognized symptoms. What I found suggests that the practical solutions Los Angeles has offered so far aren’t really tailored to the risk.

But people aren’t just getting sick where it’s hot, in their homes, and in Los Angeles.

In comparatively mild Northern California, last summer was a deadly one. Two people died in Santa Clara County in June, in a car, and outdoors. Over Labor Day weekend, heat killed three people in San Mateo County and three people in San Francisco.

At the time, politicians acknowledged that heat is a wider problem than these statistics demonstrate. “The reality is it’s probably more than three,” Supervisor Aaron Peskin told the San Francisco Examiner. “The bottom line in the city of San Francisco, one of the richest cities in the world, three is three too many, and it’s embarrassing that The City did not take enough steps in advance to prevent this from happening.”

This year, I’ll continue reporting on urban heat as a climate-driven problem, with help from the Center for Health Journalism’s 2018 Impact Fund. And I’ll look closely at what happened in the Bay Area, including potential solutions and interventions.

As I report, I continue to be interested in how personal geography affects one’s heat burden. And one place we all spend a lot of time is at work.

Federal law requires employers to prevent hazards at work that could result in death, including excessive heat. And California has a more protective standard, covering outdoor workplaces where the temperature is 85 degrees or higher. Now the state has begun considering indoor workplaces too, which could potentially influence discussion of a federal standard.

Heat reduces our cognitive function and physical productivity, making work harder. But here, again, statistics undercount the risk: An investigation by reporters at the Desert Sun found that only a handful of deaths during agricultural work were counted by Cal OSHA as heat related, and only a fraction of illnesses.

For the first time in 20 years, the National Institute for Occupational Safety and Health updated its proposed criteria for a recommended standard for heat exposure, to take into account new scientific evidence and conclusions. But NIOSH’s language remains cautious. “It is likely but unclear to what extent global climate change will impact known heat-exposure hazards for workers, especially with regard to severity, prevalence, and distribution,” the updated guidance says. And the state is taking all of this information into consideration as it develops a standard for heat hazards at work indoors.

I began this project intrigued by the risk of urban heat because of my own experiences. As I’ve tried to fill in the gaps in data and current knowledge, I’ve gotten to know neighborhoods around the state. I’ve been invited into homes and schools, warehouses, garages and trailers. The creeping problem of warmer temperatures is spreading into all of these places. For the sake of understanding our health, it’s time to better understand what that means.  

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