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How heat affects health: An overlooked outcome of climate change

Yaprak Onat, of the Connecticut Institute for Resilience & Climate Adaptation, attaches a temperature monitor to a tree in Norwalk.
Harriet Jones
Yaprak Onat, of the Connecticut Institute for Resilience & Climate Adaptation, attaches a temperature monitor to a tree in Norwalk.

By 1 p.m., it was 95 degrees in Norwalk on what would turn out to be the last day of the third mini-heat wave of this summer.

Or maybe it was the fourth.

It was hot, again. The humidity was off the charts, again. And the air quality was lousy, again.

This was not just summer in New England. Such conditions are some of the irrefutable signatures of climate change, now happening more often, more intensely and with more profound consequences. Among those consequences is their adverse, and sometimes deadly, effect on human health.

Curiously, health tends to get second-class consideration among the many ways climate change affects our lives — after the storms, floods, drought and other more instantly catastrophic and obvious events. But climate change-induced health impacts are gaining traction as a primary concern — heat chief among them, but so are air quality, water quality, disease-carrying insects and secondary impacts such as mold, loss of electricity from catastrophic events and the mental health toll from each of the above.

“Environmental professionals traditionally haven’t been trained in health, so they don’t think of it. Health professionals aren’t trained in climate change. Both of those are changing, but that’s traditionally been the case,” said Laura Bozzi, director of programs at the Center on Climate Change and Health at the Yale School of Public Health. She is the lead author on the report Climate Change and Health in Connecticut, which, inconveniently, was released in September 2020, while most health attention was focused on COVID-19, still in its pre-vaccine phase.

The report evaluated 19 indicators that reflect extreme events, from flooding to drought, heat, air quality and disease, noting the multiplier effects one factor can have on another as they impact health. It also took special notice of the disproportionate impact of climate change on the health of those in environmental justice communities and other at-risk populations. Yale also followed up with a series of issue briefs.

Since then, Connecticut has added an Office of Climate and Public Health to the state Department of Public Health, and there is now public health representation on the Governor’s Council on Climate Change. The Connecticut Equity and Environmental Justice Advisory Council is also up and running as of a few months ago, offering the possibility of better linking health and climate change because of the outsized impacts of that combination on environmental justice communities.

But it has been a balky start for all due to lack of staff, funding and other issues, including the overwhelming focus on COVID.

“There’s still catch-up to do,” Bozzi said. “They add a couple of sentences about how to fix health, but it’s like from a Google search, right?”

This summer, the New England Journal of Medicine began a more specific and in-depth focus on climate change and health in a series of monthly articles.

“I think what people need to know is that the health effects of climate change are happening now,” said Caren Solomon, the series editor and a physician at the Brigham and Women’s Hospital in Boston. “They are only going to get worse.”

Heat is a killer

“Heat is the leading weather-related killer in the United States,” according to the Environmental Protection Agency. The Centers for Disease Control says there are more than 700 heat-related deaths yearly, nearly 68,000 heat-related illnesses and nearly 10,000 heat-related hospitalizations.

But these are widely considered to be low counts, as heat can also compound other health problems such as asthma and can contribute to deaths from heart attacks, strokes and other forms of cardiovascular disease, which occur more frequently during extreme heat. That makes it difficult, if not impossible, to figure out the real causes of the death or illness, unlike with more obvious problems like heat stroke or exhaustion.

The Washington Post recently mapped 7,000 record-breaking instances of extreme heat in the U.S. this summer alone. Connecticut had some of them.

“There’s just such an increasing sense of urgency,” Solomon said. “People have asthma or their allergies are worse, and they are not linking it to the heat or the pollen and recognizing that there’s more pollen because of climate change.”

The New England Journal developed an interactive graphic that shows how organ systems and groups of people can be affected by climate change conditions, including heat. Solomon and others list concern after concern from heat alone.

Kidneys can malfunction or fail. People may get more kidney stones. Pregnant women who are exposed to extreme heat have higher rates of preterm birth and babies are smaller than they should be.

People in extreme heat, especially if it makes sleeping difficult, often have trouble concentrating. Cognition goes down; productivity goes down; their mood is lousy, along with other mental health impacts and aggressiveness — a grumpiness factor, or worse. That can mean more arguments, road rage or other violent reactions.

Heat negatively interacts with certain medications, including anti-psychotic ones. It’s not known what the cumulative effects of heat might be. It is known that the body acclimates somewhat to heat over the course of the summer so people will have more difficulty with a sudden heat wave in May than one in August.

The very old, the very young, those with other health issues and those who must work outdoors are considered high risk, but it is environmental justice communities that tend to suffer the most.

“When we look at all these health effects of climate change, heat, pregnancy complications, cardiovascular, respiratory problems, they cause greater hazards to people in low-income communities and many communities of color. And that is despite the fact that these communities contribute the least to greenhouse gas emissions and pollution,” Solomon said.

The good news, according to Bozzi at Yale, is that the environmental justice movement has been a lot better about considering health holistically, which would include its relationship to climate change.

“The traditional environmental movement has been more about protecting nature,” she said. “Maybe for climate change, it was always in the future, so you weren’t thinking about, well, how does it affect your health today? Now, we are kind of confronted with making that link because, of course, that’s what’s happening now.”

The Yale report and a follow-up issue brief go into depth on the subject of heat, pointing out the trend toward hotter summers, hotter nights and more heat waves, all compounded by air quality problems.

Among their conclusions is that climate change should be incorporated in decisions across all of government and that public health should be incorporated into all climate change decisions and policies.

The recommendations:

  • Expand the Connecticut Energy Assistance Program to include cooling assistance
  • Implement strategies to overcome the health, safety, and legal issues in homes that are barriers to efficiency upgrades, so that homes are better insulated to keep cool air inside
  • Support urban tree planting and maintenance in Connecticut’s cities to help counteract the urban heat island effect
  • Protect against heat-related illnesses at outdoor and indoor worksites
  • Protect children’s health by enacting policies to address exposure to extreme heat events while at school and playing outdoor sports
  • Develop and maintain local heat response plans at the municipal level.

New offices

The state has only recently recognized the necessity of dealing with climate change within its public health mandate by starting an Office of Climate and Public Health as a result of an executive order by Gov. Ned Lamont in 2021. But without funding or staff, as COVID-19 was the unrelenting focus for public health officials, it could only borrow Lori Mathieu from her position as the chief of environmental health, drinking water branch. Plans were to get interns on board this summer and hire at least one person. The state Department of Public Health has not responded to multiple requests from CT Mirror to update the personnel situation.

The Biden administration has somewhat taken the heat off the state, so to speak, launching the Heat.gov website this summer, along with a long series of policies. Actions included releasing $385 million through the Low-Income Home Energy Assistance Program (LIHEAP) that may also be used to reduce summer cooling costs by making more air conditioners and heat pumps available and supporting community cooling centers.

The administration is providing multiple tools that states and individuals can use.

And it is also taking steps to create the first-ever national programs and standards governing workplace heat.

Workplace heat is something those in Connecticut who are most marginalized are already facing. Unidad Latina en Accion supports immigrant workers and the issues that affect them. On one of ULA’s recent weekly zoom calls, several people offered their experiences with the heat this summer.

A woman who sells Amway products said she developed a headache and began vomiting as a result of the heat but didn’t go the hospital. Another who works in landscaping said a co-worker fainted from the heat. She was given water and did not seek medical care.

A number noted the high cost of electricity. One would only turn on air conditioning for short periods of time. Another would pile the family in one room that had an air conditioner but said going into the kitchen to cook was difficult.

Mathieu said the state climate change office will be focusing on four of the many priorities laid out in a comprehensive to-do list released in early 2021 by the GC3. But the office’s first priority will be schools.

“Our first action is to develop and implement an educational program for teachers, school nurses, administrators and other school personnel in socially vulnerable communities to reduce student exposure to extreme heat and ozone events,” she said.

The money for that is coming from a CDC five-year grant called Building Resilience Against Climate Effects (BRACE), which the state received in 2021 — the first time it ever applied for the grant, even though the program has been around for several years.

The CDC describes BRACE as a framework within which health officials “develop strategies and programs to help communities prepare for the health effects of climate change.”

Given that schools, for the most part, are closed during the hottest time of the year, Mathieu justifies the priority by noting that schools now start earlier and heat is lasting longer. So far this year, some schools in Connecticut that lack air conditioning have already had cancellations and early dismissals due to heat, including some in Bridgeport that largely service low-income areas.

“It’s incredibly difficult — almost impossible — to learn if you’re constantly overheated, never getting yourself cooled down,” Mathieu said, adding that small bodies can dehydrate quickly.

Connecticut’s baby steps are a far cry from what other places in the country are doing, especially those in the West. While statewide actions are rare, there are heat officers now in Los Angeles, Phoenix and Miami, as well as cities outside the U.S. Oregon now has a law requiring landlords to allow certain air conditioning. Washington state is providing free air conditioners to low-income people, and there are small local programs elsewhere.

“Well, we can’t do much without money and staff,” Mathieu said. “Do we need to do a lot more? Yes, absolutely. Are we getting ourselves into a position where we in the public health agency, we can do more? Absolutely. Can we learn from other states? Absolutely.”

Instead of just throwing up another cooling center, which many municipalities say go largely unused, Mathieu said her office needs to get into communities and start talking to the stakeholders directly to get an understanding of what heat response systems exist today and what the communities need.

An effort to that end has been underway through the Connecticut Institute for Resilience and Climate Adaptation (CIRCA) and Bozzi’s group at Yale. That’s not the only thing they’re working on.

How hot is it, really?

Norwalk’s 95-degree day may seem downright cool compared with the brutal Western U.S. and European heat waves this summer. But it came in a stretch when Lamont extended the state’s extreme hot weather protocol twice to run a total of eight straight days.

The protocol involves reminders of how to find cooling centers as well as the availability of state resources and the health dangers of heat — fairly minimalist for a problem thought to be under-recognized and that can cause multiple medical problems, organ failures and death.

But not all heat is equal, and Connecticut is just starting to figure out what hot really means. Norwalk is one of two places doing that this summer. The other is Danbury.

Both are working with CIRCA, which is overseeing a heat sensor project. The sensors record temperature, relative humidity and dew point every 10 minutes close to street level to get a better sense of what it feels like to people: the heat index.

The heat vulnerability index in Fairfield County, compiled by the University of Connecticut’s Connecticut Institute for Resilience & Climate Adaptation, shows areas that are more vulnerable to heat-related impacts of climate change.
The heat vulnerability index in Fairfield County, compiled by the University of Connecticut’s Connecticut Institute for Resilience & Climate Adaptation, shows areas that are more vulnerable to heat-related impacts of climate change.

There’s plenty of satellite data that measure heat, but that’s the land surface temperature and includes things like rooftops and streets and other surfaces, said Yaprak Onat, the point-person for CIRCA. CIRCA uses that data for what it calls its Climate Change Vulnerability Index, which has mapped Fairfield and New Haven counties for their heat and flood risks. Mapping for the rest of the state is underway and should be complete by the end of the year. There is also separate information for social vulnerability and at-risk infrastructure. CIRCA is also working on an environmental justice mapping tool with the Department of Energy and Environmental Protection.

“But it doesn’t really tell you what people are feeling on the street,” Onat said of the satellite measurements. “So that’s why we started the second approach, which is a more localized approach; putting sensors in different places that we choose specifically.”

Working with more than one dozen departments in Norwalk, including health, emergency services and planning and zoning, 13 sensors were strategically placed for readings that reflect different landscapes, especially the well-known heat island effect, in which paved and other hard surfaces capture more heat and then hold it longer than natural surfaces.

The sensors also get readings that reflect weather micro-climates such as shoreline breezes, different sizes and densities of buildings, and the characteristics of a variety of socioeconomic locations — especially lower-income and industrial areas where poor health outcomes are prevalent. The work is running through October.

“We need this information and data to help if we want to do an action plan related to heat,” said Deanna D’Amore, director of health in Norwalk. “Looking at where our cooling stations are. Thinking about are there going to be different triggers for actions to set different advisories. Where do we want to be implementing our educational campaigns moving forward? Where do we want to be planting trees? So really getting an understanding of what’s going on our city and how we can use this data to drive action to mitigate the health impacts for our residents.”

A similar effort in Danbury is underway with 13 locations, coordinated by Matthew Cassavechia, who runs the emergency management department after decades with the emergency medical service. He sees the sensor data as a necessary step towards making Danbury storm-ready and ensuring the health and safety of residents, especially in cases where high heat is coupled with a prolonged power outage.

“There isn’t a lot of information out there, and installing these sensors to collect critical information in our city for areas that could be identified as vulnerable, especially to certain populations, from things such as heat related illnesses,” Cassavechia said. “To get data, to get information, to take specific actions, whether that’s shading strategies, preparations, cooling strategies, shelters, etc., is all in my view related to emergency management. And that’s why I’m behind and all-in on this particular initiative.”

The vulnerability index, even just using satellite readings, is already showing differences from location to location within a municipality and revealing some unexpected results — for instance, indicating that tree cover, long considered a panacea for cooling urban areas, can sometimes generate so much humidity that it makes the climate feel worse.

This summer’s projects follow a one-year pilot in New Haven that began in August 2020. According to Onat, it definitely did what a pilot is supposed to do: help troubleshoot problems that included snow and water breaking sensors. Even with 18 out of the original 20 sensors working, it enabled CIRCA to collect data it can compare to satellite data. The results are not complete yet.

Among the lessons learned in New Haven that were applied in Norwalk and Danbury was to collaborate with municipalities on where to place sensors. In Norwalk, sensors range from just about hanging over I-95 where it cuts past the Fire Department headquarters to the shade of one of the scant trees in heavily paved South Norwalk – though it could catch breezes from Long Island Sound.

Also different is the involvement of many city departments. In New Haven, one of the key officials responsible for climate change adaptation was unaware his city’s pilot project had even existed until it was brought to his attention.

Giovanni Zinn, New Haven’s city engineer, outside the city’s new 54,000 square foot community center.
Giovanni Zinn, New Haven’s city engineer, outside the city’s new 54,000 square foot community center.

Giovanni Zinn, New Haven’s city engineer and go-to person on climate change adaptation, stood outside the city’s new 54,000 square foot community center — the Dixwell House, better known as the Q House.

It’s hot. Again.

Q House has a senior center, a health center, a youth center and a library branch. And it’s considered a cooling center when needed.

It was also built in compliance with what Zinn refers to as New Haven’s “heat island ordinance,” specifically section 60.2 of the city’s zoning ordinance that requires new industrial or commercial construction, large expansions of existing industrial or commercial buildings and even some residential buildings to follow strategies to keep buildings and areas around them cooler in summer. That includes roof reflectivity and lighter surfaces outside.

It’s been on the books for more than a decade and may be the only ordinance of its kind in the state — the sort of broad-based regulation being implemented in other parts of the country designed to lessen the impact from excessive heat.

The Q House roof has reflective materials, the sidewalks are white, there are grassy areas with newly planted trees that eventually will provide shade, and rain gardens soak up excess water.

Zinn was surprised to learn not only of the pilot study but how strong a role humidity may be playing in how hot people actually feel and pondered whether it was time to update the existing ordinance.

“I think it’s good to see studies like CIRCA’s,” he said. “What does the next generation of zoning standards here look like? And can things like CIRCA’s study inform what our zoning standards say?”

The urban canopy

New Haven has also been particularly proactive in planting trees with the Urban Resources Initiative — a collaboration between Yale and the city — leading the effort.

But not all tree locations are created equal when it comes to shading hard surfaces that would otherwise absorb heat, said Dexter Locke, a Baltimore-based research social scientist with the USDA Forest Service who has been advising URI.

“Because the shadow is moving around, those hard surfaces are only protected part of the time,” he said. If you’re not strategic about it, areas can still heat up during the day so when they finally get some shade, it won’t matter. Or areas that are in shade early may still wind up hot from later-day sun.

The size, shape and configuration of the canopy also makes a difference, Locke said.

“More, bigger contiguous blocks are better … because you have more interior core, so it’s never getting hot to begin with,” he said. “It’s better off to have one 10,000-square-foot patch of forest, as opposed to 10,000 1-square-foot street trees. The Catch-22 is you can’t get to 10,000 feet of contiguous canopy cover unless you start with a bunch of individual trees.”

In other parts of the U.S., however, tree-planting is old school. Many areas have moved on to some pretty creative ideas.

Feeling the heat from Oregon

Vivek Shandas is widely recognized as a national authority on heat research. As a professor of climate adaptation at Portland State University in Oregon, he’s had a front-row seat with now two straight summers of brutal heat waves.

“In my estimation of the last 15 years of doing heat-related research, this year was a watershed year for it. And it was one of those years that is going to change the practice of public health for years, if not decades to come,” he said.

The heat itself is one factor pushing the change. The Biden administration’s focus on heat and the policy and money attached to it is another. But Shandas hasn’t been waiting for any of that. He’s been looking at ways to address the practice of public health and heat for years.

This summer, he’s run a research project in three public housing apartment buildings, with plans to expand to seven, using indoor air temperature monitoring systems that communicate warnings to residents when temperatures meet certain thresholds. Ideally, the temperature information will help residents take action if needed. The system also allows his team to track it. The data is being crunched now, along with surveys that were conducted.

“We know also that social networks are really helpful for reducing health-related impacts,” he said. “We know that people who know their neighbors or connect with one another and have access to friends or family networks or even neighbor networks tend to fare better during heat waves. And people who are more isolated and don’t have that tend to really experience some of the most acute effects of heat waves.”

Norwalk has made some stabs at the kind of outreach Shandas is talking about. Michele DeLuca, deputy director of emergency management, said the Norwalk housing authority does a quarterly survey to record residents’ contact information and medical issues, which are then turned over to her office for use in heat or other emergencies.

Her office provides oversized water bottles with safety information sheets in them in English and Spanish. But, she said, it’s still hard to know if the information is getting where it needs to go, and then, if it’s heeded. And forcing a social network is even more difficult.

“You can’t compel people if we were to say you must check on your neighbor,” she said.

There’s an argument to be made for having a heat officer that puts heat monitoring and response coordination in one place, rather than the multi-agency system in Norwalk.

Shandas points to unique efforts in other countries, especially in south Asia, when parks were opened at night during heat waves to essentially allow people to camp out — a move he believes saved thousands of lives a few years ago.

But he too advocates systemic infrastructure code changes so heat becomes less of a problem but more robustly than New Haven does, with its heat island ordinance.

In addition to the types and colors of materials used or just adding air conditioners and heat pumps to provide cooling, how buildings are situated, their heights and other factors can make a difference in terms of sun angles and natural wind cooling.

“We’ve found the configuration of the development in relation to adjacent buildings, in relation to predominant wind patterns is really helpful,” he said. “We’ve actually run some computational models to show that in a multifamily residential development, depending on the size, we can reduce temperature upwards of 13 degrees Fahrenheit just by the physical design of the buildings.”

For instance, in a place like Connecticut, putting up big buildings along a shoreline to maximize the view often blocks wind from the water to the land that can help dissipate heat.

But will any of this happen quickly, even though it’s needed quickly?

“We’re not moving fast enough. Government work is achingly slow,” said Bozzi at Yale. “We could study this thing to death before we do something about it.

“I think there’s a balance of — we need more [research], but we can act before we have that kind of complete information.”

Mathieu at public health is equally adamant.

“It’s time, IT’S TIME, to take public health and climate change very seriously. It affects people’s health directly. People can get critically ill, and we have to help people adapt,” she said. “We have to be as proactive as we can. We have to put plans in place.”

It all comes with an ominous warning from Locke at the forest service: “I saw somebody on Twitter said, ‘Oh, my God, it’s the hottest summer on record, again,’” he said. “And somebody else responded. ‘It’s the coolest summer of the rest of your life.’”

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