Extreme heat has become a serious public health crisis. In 2022, every continent on the planet experienced record-breaking weather events. From 2013 to 2022, heat waves increased 94 percent globally, compared with 1986 to 2005. Climate change has intensified these trends, making July 2023 the hottest month on record.1Romanello M, Napoli C di, Green C, et al. The 2023 report of the Lancet countdown on health and climate change: the imperative for a health-centered response in a world facing irreversible harms. Lancet. 2023;402(10419):2346-2394. doi:10.1016/S0140-6736(23)01859-7
To protect vulnerable communities, we need a comprehensive approach that includes better infrastructure, increased public awareness, and effective policies.
“Extreme heat is deadly, dangerous, and disastrous,” says Reverend Vernon K. Walker of CREW (Communities Responding to Extreme Weather) and Clean Water Action. “As temperatures rise, it is becoming unhealthy to be outside for most summer days, even in northern areas of the United States.”2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204
Exposure to extreme heat can worsen underlying conditions. It also negatively affects health outcomes for cardiovascular and respiratory diseases, fertility and birth, and mental health conditions, but these links are rarely noted in official records.2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204
Research shows that as temperatures rise, so do suicide and homicide rates.2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204 Workers in uncooled indoor settings or outdoors are particularly at risk. In 2022, an average of 143 potential hours of labor capacity per person was lost due to heat exposure. Estimated annual heat-related mortality increased by 85 percent from 2013 to 2022 compared to 1991 to 2000, driven by rising temperatures and changing demographics.1Romanello M, Napoli C di, Green C, et al. The 2023 report of the Lancet countdown on health and climate change: the imperative for a health-centered response in a world facing irreversible harms. Lancet. 2023;402(10419):2346-2394. doi:10.1016/S0140-6736(23)01859-7 Researchers increasingly refer to extreme heat as a critical environmental justice issue.
The impact of rising temperatures extends beyond the hot days we experience, leading to more droughts, wildfires, and rising sea levels. While global warming contributes to excessive heat, not everyone is affected equally. Vulnerable populations are more exposed to the dangers of extreme weather and have fewer resources to protect themselves from its effects.2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204
“Heat exposure is the leading climate-related cause of death, and heat-related deaths are on the rise worldwide,” says Rupa Basu of the California Environmental Protection Agency. “The countries responsible for most of the world’s carbon emissions are spared the worst of climate change’s impacts. [However], populations especially vulnerable to heat exposure exist in every country. This includes older adults, young children, pregnant people, athletes, outdoors workers, people on certain medications, and anyone living with limited resources.”2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204
People living with limited resources form a diverse group subject to both past and present structural and systemic inequities. For example, historic redlining practices in the United States denied Black and other racialized people the ability to get mortgages in certain areas, forcing them to live in “heat islands” near power plants and highways. When combined with the fact that poverty and racial discrimination can limit healthcare access, it’s no surprise that residents of these areas experience worse health outcomes.2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204,3Mentias A, Mujahid MS, Sumarsono A, et al. Historical redlining, socioeconomic distress, and risk of heart failure among Medicare beneficiaries. Circulation. 2023;148(3):210-219. doi:10.1161/CIRCULATIONAHA.123.064351
Although redlining was banned in 1968 with the passage of the Fair Housing Act, 55 years isn’t long enough to remove all traces of this racist practice. As Ijeoma Nnodim Opara, MD, notes, the legacy of redlining continues to affect Black and racialized communities today. “Such neighborhoods often have substandard housing, fewer parks, more exposure to pollutants from such sources as highways, and less access to quality health care and other crucial services,” she says. “People who live in these neighborhoods also experience generational poverty, increased stress and mental illness, and more engagement with the criminal justice system.”4Opara IN. The deadly legacy of redlining—and a mission to reverse it. Association of American Medical Colleges. August 1, 2023. https://www.aamc.org/news/deadly-legacy-redlining-and-mission-reverse-it Research has linked redlining with a host of health hazards: a higher risk of heart failure,3Mentias A, Mujahid MS, Sumarsono A, et al. Historical redlining, socioeconomic distress, and risk of heart failure among Medicare beneficiaries. Circulation. 2023;148(3):210-219. doi:10.1161/CIRCULATIONAHA.123.064351 diabetes, high blood pressure, mental health struggles, and more severe COVID–19 outcomes.5Egede LE, Walker RJ, Campbell JA, Linde S, Hawks LC, Burgess KM. Modern-day consequences of historic redlining: finding a path forward. J Gen Intern Med. 2023;38(6):1534-1537. doi:10.1007/s11606-023-08051-4
In the 1930s, redlining maps of New York City identified neighborhoods like the Bronx, Brooklyn, Manhattan, Queens, and Staten Island as “hazardous” areas. While much has changed since then, this history has undoubtedly influenced the city we know today.6Hwa Jung K, Pitkowsky Z, Argenio K, et al. The effects of the historical practice of residential redlining in the United States on recent temporal trends of air pollution near New York City schools. Environ Int. 2022;169:107551. https://doi.org/10.1016/j.envint.2022.107551
New Yorkers are no strangers to heat waves. But the city’s bouts with intense heat are becoming increasingly severe, more frequent, and more drawn out, seriously affecting equity-deserving communities. “These groups often live in older, crowded, and poorly maintained apartment buildings,” says Sonal Jessel of WE ACT for Environmental Justice. “Their neighborhoods have fewer trees, less green space, and more pollution, and they are more likely to have difficulty paying for food or rent. They are also more likely to experience poverty, food and energy insecurity, chronic health problems, and historical and structural racism, which amplifies heat risks and other health risks. If you’re having an issue with extreme heat, you’re probably having an issue with a bunch of other things, too.”2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204
Escaping extreme heat can be a luxury for those with limited resources. Many cannot afford air conditioning, especially with rising energy costs. Additionally, owning a car or traveling to cooler areas is often financially out of reach.2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204
Healthcare Practitioners Can Keep People Safe During Extreme Heat
A comprehensive approach involving housing, urban infrastructure, and occupational health is essential to protect families from extreme heat. However, the healthcare system also plays a crucial role. At a 2023 National Academies workshop on climate change and health equity, experts highlighted four critical actions for healthcare practitioners.2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204
- Knowledge Sharing Among Practitioners: There is a need to break down barriers between professionals with valuable insights on extreme heat, including clinicians, emergency responders, occupational and environmental medicine specialists, epidemiologists, health departments, community organizations, and traditional healers.
- Learning from Indigenous Health Systems: A holistic view of health encompasses mental, physical, spiritual, and emotional well-being, acknowledging the deep connection between health and environmental conditions. This whole-health perspective is rooted in Indigenous knowledge, which deserves greater recognition and inclusion in climate and health policies and systems.
- Collaborating with Community Organizations: Healthcare responses to extreme heat are typically reactive rather than proactive, and solutions often fall outside the healthcare system. Additionally, healthcare actions often lag behind rapid environmental changes. Health practitioners must collaborate with community organizations to expand knowledge and safeguard public health following extreme heat events.
- Expanding Training and Patient Resources: Practitioner education has not kept pace with climate change realities. Healthcare professionals need training to identify those most at risk during extreme heat and understand its impact on people with chronic conditions.
Naturopathic Doctors Promote Resilience
Naturopathic doctors have long understood the connection between individual health and planetary health. With their holistic approach that recognizes environmental impacts on well-being, they are uniquely equipped to support patients during extreme heat events. Helping build resilience in individuals and communities prepares people for rising temperatures and related challenges.
Dr. Tabatha Parker, ND, executive director of the Academy of Integrative Health & Medicine, is facilitating research on extreme heat and air pollution as two pervasive human health issues. “Naturopathic medicine is about getting to the root cause of a person’s illness. If you don’t change the root cause, you often don’t get better,” explains Dr. Parker. “Climate change is causing increases in temperature, drought, and other extreme weather conditions, and impacting the nutrition of our food. NDs are like investigative journalists, helping patients connect the root causes of illness and climate health.”
Footnotes
- 1Romanello M, Napoli C di, Green C, et al. The 2023 report of the Lancet countdown on health and climate change: the imperative for a health-centered response in a world facing irreversible harms. Lancet. 2023;402(10419):2346-2394. doi:10.1016/S0140-6736(23)01859-7
- 2Johnson A, Thévenon A, Vadnais S, eds. Communities, climate change, and health equity: lessons learned in addressing inequities in heat-related climate change impacts—proceedings of a workshop-in brief. National Academies Press; 2023. doi:10.17226/27204
- 3Mentias A, Mujahid MS, Sumarsono A, et al. Historical redlining, socioeconomic distress, and risk of heart failure among Medicare beneficiaries. Circulation. 2023;148(3):210-219. doi:10.1161/CIRCULATIONAHA.123.064351
- 4Opara IN. The deadly legacy of redlining—and a mission to reverse it. Association of American Medical Colleges. August 1, 2023. https://www.aamc.org/news/deadly-legacy-redlining-and-mission-reverse-it
- 5Egede LE, Walker RJ, Campbell JA, Linde S, Hawks LC, Burgess KM. Modern-day consequences of historic redlining: finding a path forward. J Gen Intern Med. 2023;38(6):1534-1537. doi:10.1007/s11606-023-08051-4
- 6Hwa Jung K, Pitkowsky Z, Argenio K, et al. The effects of the historical practice of residential redlining in the United States on recent temporal trends of air pollution near New York City schools. Environ Int. 2022;169:107551. https://doi.org/10.1016/j.envint.2022.107551
