US needs a national cooling strategy

Last summer was the hottest on record in U.S. history, and this year we have already had two major heat waves with 92 record-breaking high temperatures around the country. In this, the U.S. is not alone. Europe is experiencing historically high temperatures, with Britain registering its highest temperature ever and wildfires raging in Portugal, France, and Greece.

The fact that temperatures are rising due to climate change is not news. Even though we have known about global warming for decades, the U.S. is woefully unprepared for the health and financial impacts of a hotter world. Rising temperatures are not just uncomfortable, they are also a major cause of heat stroke and death. An average of 700 people die every year in the U.S. from heat-related illnesses, an estimate that likely understates the true extent of heat-related deaths because often the official cause of death does not account for underlying triggers such as unsafe temperatures inside the home.

A recent study in the Journal of the American Medical Association looked at the relationship between adult death rates and extreme heat events in the U.S. The study reported that from 2008 through 2017, each additional extreme heat day per month was linked to 0.07 additional deaths per 100,000 adults — or 7 deaths per 10 million adults. The study also found that while extreme heat contributed to increased death rates across the U.S. in general, they pinpointed even greater increases among older adults, men, and non-Hispanic Black persons.

But more work needs to be done to understand the exact implications of climate change for those who are most vulnerable. We know that climate change impacts patients and others with chronic diseases differently. Those with respiratory diseases or cardiac problems can be significantly more vulnerable on hot and humid days compared to patients with different types of illness. These more nuanced questions remain poorly studied but of great significance to millions of Americans with conditions like asthma, chronic obstructive pulmonary disease and heart failure.

NEADA has estimated that the average cost of summer cooling is about $540. According to the Census Pulse Survey, almost one out of three households reported that they had to forgo basic expenses — including food and medicine — at least one month a year to pay their home energy bills. Almost 6 million families with incomes of less than $40,000 annually report not having access to a working air-conditioner. Given these high costs to maintain safe and cool temperatures at home, it’s no surprise that when the heat rises, so do hospital visits and heat-related deaths.

The government is woefully behind in addressing the impacts of rising temperatures. In many states there are robust protections for cold temperatures, but heat protections are limited and primarily temperature-based. We already know heat kills, and the sooner the government acts, the more heat-related deaths we can avoid. Some states and localities are leading the way in providing protections for cooling, and it is time the rest of the country started paying attention.

With limited federal and state funding for cooling assistance, options are severely limited for families in affected areas or with complex medical conditions. Right now, the Low Income Home Energy Assistance Program (LIHEAP) is the primary federal program helping poor families pay their home energy bills. Right now, states only have sufficient funds to help with heating costs. Approximately 85 percent of LIHEAP benefit funds are used to address winter energy needs. Congress should increase funding for LIHEAP to provide cooling assistance on par with heating assistance, increasing it from $3.8 billion to $7.6 billion to support robust summer cooling programs around the country. This would cover both bill assistance and air conditioning repair or replacement.

State and local governments also must make access to cooling a priority. For example, Chicago recently passed legislation requiring nursing homes and residential buildings servicing older Americans to provide cooling. In California, a bill introduced this year would require multifamily building owners to provide cooling and develop strategies to reduce building heat. Yet these strategies will not go far enough in the absence of additional support for LIHEAP.

Finally, without additional funding for comprehensive public health research to gain a better understanding of the health implications of rising temperatures, preventing increases in mortality will be challenging.

Access to cooling is life-saving investment in preventative care that millions of Americans badly need. While local and state governments work to develop interim and stop-gap solutions like those in California or Chicago, Congress must lead by example by increasing public health research and LIHEAP cooling related funding.  

Aside from the differences in how patients are impacted by climate change, changes in weather patterns can also produce significant impacts on emergency medical services and emergency departments. More work is needed to understand the ways in which changes in weather patterns can impact these life-saving services.

Mark Wolfe is an energy economist and serves as the executive director of the National Energy Assistance Directors’ Association (NEADA) and the Energy Programs Consortium. He specializes in energy, climate, housing and related consumer finance issues. The opinions expressed in this article are his own. Follow him on Twitter @markwolfe15

Dr. Peter Kahn is a fellow in the Section of Pulmonary, Critical Care and Sleep Medicine at Yale School of Medicine. He graduated from the Albert Einstein College of Medicine with honors and his M.P.H. from the Johns Hopkins Bloomberg School of Public Health in the department of Health Policy and Management. Dr. Kahn’s research has focused on health policy with a particular interest in the impact of climate change and utilities on health policy.