WASHINGTON -- Federal agencies need to work together better to lessen the effects of extreme heat on the health of the population, Aaron Bernstein, MD, MPH, said Wednesday at a hearing held by the House Science, Space and Technology Subcommittee on the Environment.
"We can have all the data we want about heat, but if we don't know how to implement it and whether those strategies work, it ain't very helpful," said Bernstein, who is interim director of the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health in Boston. "We have to get information about what temperatures matter to health, [and] we need much better understanding of what kinds of interventions matter. So that means we've got to get CDC to work with NOAA [the National Oceanic and Atmospheric Administration] to implement and assess these things."
Temperatures Block by Block
Vivek Shandas, PhD, founder and director of the Sustaining Urban Places Research Lab at Portland State University, in Oregon, agreed. "Currently, most municipalities do not have a single office that coordinates heat action, which then falls upon nobody, making our ability to stave off heat-related mortality more challenging," he said. "The same is true at the federal level; while both NOAA and EPA [the Environmental Protection Agency] have extensive resources for communities to understand urban heat, we still have very limited coordination across federal bureaus. I would encourage you ... to really think about connecting the dots across the federal bureaus, so that we can support local municipalities in taking immediate action on this silent killer."
Shandas mentioned two other strategies for reducing morbidity and mortality from excess heat. "Because we know that people die in their households, we need hyper-local data about where air temperatures vary at the scale of the city block," he said. "Most cities are lacking that evidence to take swift action ... We really need to get down to the place where individual households, businesses, municipal planners, and public health agencies can identify specific places where it might be very hazardous to be able to actually go during specific times of the day; we don't have that kind of granularity of information."
In addition, "we need to integrate our understanding of heat with social infrastructure vulnerabilities that urban regions face," said Shandas. "U.S. cities generally are not designed for the kind of heat that we're starting to see as our infrastructure ages. We have an opportunity to upgrade the systems that we depend on and make them more climate-resilient."
Deaths that occur from extreme heat -- such as the recent "heat dome" in the Pacific Northwest region -- are likely vastly undercounted, subcommittee chairwoman Mikie Sherrill (D-N.J.) said in her opening statement. "The CDC officially reports that heat kills more than 600 Americans a year, but other studies point to this being a severe undercount," she said. "The number may be as high as 12,000 heat-related deaths in the U.S., with communities of color and low-income communities most at risk."
The whole issue needs more attention, said Stephanie Bice (R-Okla.), the subcommittee's ranking member. "This summer, historic heat waves across the U.S. have been making headlines, week after week, and the impacts have been tragic," she said. "Although climate change is likely making the occurrence of extreme heat more common, we cannot simply sit back and accept such a fate. With greater innovation and strategic planning from both the public and private sector, the negative effects of heat waves and other extreme weather events can be better mitigated, and lives can be saved."
The healthcare sector itself must be part of the solution, Bernstein said. "We can use the resources in Medicare and Medicaid to incentivize providers who know the conditions that put people at risk for heat, and have direct lines of communication to them. We can mobilize those resources to make sure that we get to our most vulnerable citizens."
Providers should also be aware that medications may be increasing the risks of ill effects from extreme heat, he added. "Rates of medication use in Americans are going through the roof, and you know what? The evidence we have is that medications may be increasing heat risk. So again, you can know a lot about heat exposures, but a person on medication would be far more likely to get sick. The health system knows that; public health agencies don't. We better understand whether people like me who are prescribing drugs to everybody else are causing unnecessary harm in heat events."
Short-Term Versus Long-Term Strategies
Shimon Elkabetz, CEO and co-founder of Tomorrow.io, a weather intelligence and climate security company, said the situation should be looked at in two different ways: long-term and short-term. "In the long term, we need definitely to make sure our infrastructure can sustain climate change, and we need to improve the infrastructure to sense weather, so we can predict it better," he said. "In the short term, we can [put] in place systems that translate the extreme heat into actionable insights. Any city, any educational institution, from schools to universities, can have automation in place that tells exactly on a weekly calendar what to do, and what precautionary measures to take in order to avoid the damages."
Rep. Sean Casten (D-Ill.) commented that parts of the hearing "make me very sad," noting that prior to the COVID pandemic, one of the three biggest single-day fatality incidents was a 1995 heat wave that killed more than 700 people in Chicago, mostly low-income residents.
"What makes me sad is that this isn't new," said Casten. "In 1995, the people who died were the least among us. It was people who couldn't afford air conditioning, people who didn't have social networks checking in on them. Since that time, inequality has increased. And since 1991, we've emitted 50% of all the CO2 we have ever emitted as a species, since we first learned how to make a fire a million years ago. And, you know we're talking a good game but at some point, future generations are going to watch our feet and ask if we moved." He said that some climate-related problems may only be solved by relocation and asked Shandas for his thoughts on that issue.
"Relocation has been really brought up a lot around sea level rise and 'managed retreat' discussions that are active in the literature," Shandas said. "We have yet to see those implemented in any substantial way in any parts of the country." He added, however, that "we've heard proposals with various indigenous tribes -- for example in the Northwest, like the Queets community in northwestern Washington that are considering retreating from that particular Pacific coastal zone -- but in terms of heat, the main discussions that have been happening is really around the social policy, and around the potential interventions that could be effective."