Illnesses from extreme heat events could double by 2040, PSU study predicts

It’s been nearly five years since a deadly heat dome gripped the Pacific Northwest. Many hundreds of people died — including 69 in Multnomah County alone — from the extreme heat event that sent the temperature soaring to 116 degrees in Portland and broke other temperature records in the region.

As climate change makes extreme heat events more frequent and longer-lasting, a new Portland State University study predicts that heat-related illnesses could double by 2040 across more than 50 of the largest metro areas in the U.S., including Seattle and Portland. The cost of treating heat-related illnesses is also expected to double, according to the study, likely further straining healthcare systems and vulnerable populations.

The study’s authors developed a model integrating multiple variables, including demographic information about age, race and health; climate data; visits to hospitals and emergency rooms for heat-related illnesses; and access to air-conditioning or other cooling infrastructure. The study reveals that cities in the Pacific Northwest could bear an especially high public health burden with their aging populations and lack of cooling infrastructure.

Vivek Shandas is a professor of earth, environment and society at PSU and co-author of the study. He joins us to share more details.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. It has been nearly five years since a deadly heat wave – known as the heat dome – hit the Pacific Northwest. The temperature reached 116 degrees in Portland and broke other records throughout the region. Hundreds of people died, including 69 in Multnomah County alone.

As climate change makes extreme heat events more frequent and longer lasting, a new study from researchers at Portland State University found that heat-related illnesses in the largest metro areas in the country could double by 2040 – that includes Seattle and Portland. In fact, the study found that these cities with aging populations and a lack of cooling infrastructure could bear an especially high public health burden.

Vivek Shandas is a co-author of the study. He’s a professor of earth, environment and society at PSU, and he joins us now. It’s good to have you back on the show.

Vivek Shandas: Great to be here, Dave. Thank you.

Miller: I’m curious, just to start … With this nearly five-year anniversary of this so-called heat dome, how have you been thinking about this anniversary?

Shandas: Well, first, we are really thinking a lot about the people who died. That’s number one. It was really clear evidence that the system that we’ve created to manage weather, manage extreme events is not prepared. In fact, a piece that came out in The Guardiantoday about this study, titled it a little dramatically as “woefully unprepared.” I think that’s really where I’ve gone with it.

Ultimately, it’s really three things that came out of it for me. The heat dome shattered the myth that Oregon is naturally protected from extreme heat. So that was just a recognition first and foremost. Then a second thing is that it puts a human face on this. This was basically saying that a regional forecast is not enough. These folks who are living alone – over 81% of the people who died were living alone – were older, they were renters, they were low income, and they had limited access to cooling infrastructure. So it’s not rocket science to know where there’s going to be vulnerabilities when such extreme events hit.

Miller: In that case, it’s sort of the confluence of social vulnerability and then a kind of built environmental vulnerability. Both of those together?

Shandas: Well, I actually attribute it to three fundamental pillars of resilience. Actually, social is one of those. That’s really whether people have access to networks where they can get help. That could be mutual aid networks, [or] friends, family and neighbors. Second is really around issues of the built environment. We’re building things that are amplifying temperatures. We know from a campaign we did shortly after the heat wave to measure temperatures that it was between 17 to 20 °F different within just a few blocks. So we know that the built environment mediates a lot of what we experience.

Then third, I think it really comes down to institutional failures. I mean, we really don’t have an institutional architecture and infrastructure that allows us to respond as quickly, as efficiently and as effectively, when it comes to responding to extreme heat.

Miller: I want to turn to all those more fully in a second. But I don’t think of heat waves as being publicly talked about as the most dramatic effect of climate change, compared to say, hurricanes, floods or wildfires, which are all exacerbated by climate change and are these dramatic media events. Then there’s heat waves, which is in general more like, “Oh, it’s pretty hot.” So how does heat compare to those other real things, in terms of the impact on human health?

Shandas: I’ll just start with a basic statistic in that heat waves annually kill more people nationally than all these other natural hazards combined. So the tricky part about this is that it’s often considered an equal opportunity hazard, though it’s anything but equal. It really is a silent killer, and it kills those folks who are often least prepared and least aware of the heat and how it’s going to affect their physiology and their community. There’s a reason why you and others don’t think about it as quite as severe. It’s that we just don’t have an office that manages heat. Like there’s no way to actually know that this is happening. It often falls through the cracks.

Another reason it doesn’t make the front-page news often [is that] hurricanes and these other natural disasters often are much more upfront, very clear, impactful. You see the tree down, the tree on a building, you see the hurricane’s size and compared to the rest of the continent. Those are very dramatic images. Heat is very quiet. It kind of sneaks up on you. In fact, it sneaks up on the body itself. Physiologically, it starts to slowly work its way through your organs, through your respiratory system, and then eventually heat stroke and heat related illness.

Miller: Now, I mentioned at the beginning of my intro the shocking number of deaths from the heat dome. But you’re, in this new study, not really looking into deaths. You’re looking more broadly into heat-related illness. Why? That’s a pretty important distinction.

Shandas: We believe it is. Deaths often get the frontline image. It’s a very blunt measure. It’s kind of the last resort, if you will. What we wanted to recognize is that heat actually hurts a lot more people than that blunt measure of death. In fact, you think about the families, the jobs, the various community and social activities that have to operate with people actively involved in them. Though, when you’re ill, you can’t do that. In fact, when you have heat stroke, when you have nausea, when you have dizziness, confusion, all these things that emerge from heat, you’re not able to actively engage in those activities. So it has a big productivity impact that we’re just starting to quantify.

It also has a big impact on families and communities. That’s why we wanted to start putting a bit more of numbers, direct numbers to these heat-related illnesses. And then also start illustrating how this is going to grow over time, because we have a hunch that without the cooling infrastructure, without the active coordination of the regional entities, it’s going to continue to grow.

Miller: I’m curious about the challenges in putting numbers here. I mean, do doctors or nurses routinely write down “heat-related” in some medical record if someone comes in during a heat wave complaining of shortness of breath or dizziness? Does that actually get captured in a medical record that you, as a researcher, can come and find?

Shandas: Very difficult to get that information. In fact, I’m in conversation with medical doctors around the country and world now that are trying to figure out what, essentially, are these ICD codes. These are codes that ambulance drivers, doctors, nurses put down as the primary impact, and the reason for this person coming into the hospital or going into the ambulance. Often, these ICD codes do not directly attribute it to heat. In fact, it’s what we call a “heat-adjacent” illness. That’s like someone has asthma, and the heat exacerbates that asthma, and they get an asthma attack that drives them to the hospital. It turns out that that gets coded as “asthma,” not “heat.”

Miller: So then how do you handle that as a researcher?

Shandas: It’s a lot of real conservative approaches to this. So this study that we published today – and it just landed this morning on American Geophysical Union’s Journal – is an attempt to take a very conservative approach, saying we have a handful of heat waves that we’re looking at around the country, and we have really good records of those that were only coded as a “heat-related” illness.

When you take those – not the heat-adjacent illness, not any of those – as a heat-coded illness, that allows us to then start extrapolating from those empirical measurements into what we see as some of the attributes or some of the co-mediating factors are that affect their health and well-being in the long run.

Miller: You’ve been studying this issue in various ways for a while. You’ve been on our show talking about shade, about equity, about the built environment in a way that affects the heat in a particular place for a while. So I’m curious if you were surprised by anything in your new study?

Shandas: We’re surprised by several things. One of the things that came up was simply that when we only count deaths, we’re dramatically underestimating the true cost of extreme heat. We really wanted to emphasize that information by itself does not drive action. We found that when you put dollar values behind these kinds of assessments, that can nudge decision makers to think more seriously about investing in this.

The result is that when you put numbers on it, we can start to then characterize and quantify what the total impacts are, and that was one major surprise. And just the scale of it. The second piece is that it really varies quite a bit across the country. This was a national study of 53 metro regions. We’re finding that places in the West, for example, they have the highest count of heat-related illnesses. They will increase the most in the coming decades. And that’s largely because there’s growth of population occurring in the West, as opposed to the Midwest and the like.

However, for each event, interestingly, the Ohio River Valley, the Midwest and the Northeast have very severe impacts. That’s largely because the cooling infrastructure in these northern latitudes is not really there. Whereas, when you look at today’s 103 temperature in Phoenix, Arizona, and later this week, we’ll get 90-plus degree temperatures in this region. And what we’re finding is that much of the Midwest, Ohio River Valley, the Northwest is not well equipped to manage it.

So when you model this out to 2040, which is almost like a crystal ball to see what works, what doesn’t work and what are the impacts, we start seeing the actual effects of not having green space, not having air conditioning and cooling infrastructure, not having cooling centers and places that people can go for help during these extreme heat events … all those things add up to essentially drive these higher levels of heat-related illness.

Miller: There have been efforts in Oregon at the state level and the local level in Portland to proactively respond to this in recent years. I’m thinking about the Portland Clean Energy Community Benefits Fund or PCEF, a voter passed fund, which is, for example, to get low-income Portlanders access to heat pumps. What have you learned about the effectiveness of this program?

Shandas: Yeah, this is an incredible program. I am so grateful that the residents, community members and nonprofits all rallied to get this PCEF program established, and I’m a big fan. It’s really addressing the front line of some of these challenges that we’re dealing with. Because a big part of the challenge is, of course, money. Being able to have staff to respond to heat, being able to get the weatherization in homes, so that when it is hot outside, your indoor environment stays cool. It is about getting the green spaces and the tree canopy robust so that we can get enough shade into our neighborhoods that are baking from the heat. And so all of those are great.

The tricky part about these programs is when you’re rolling out lots of money and putting in heat pumps into an indoor space, we don’t know whether those residents are going to use that heat pump or not. In fact, some early evidence that we’re starting to interview residents around the region, who have recently received these heat pumps, we’re finding that there is some limited amount of use of these heat pumps, depending on who you talk to. So for a wealthy household, for example, at 80 degrees, they’ll turn on the heat pump and the air conditioner. A lower income household doesn’t turn on that AC until 100, 105, maybe even 110 degrees.

Miller: Because the energy bill is going to be too much?

Shandas: That’s right. Cost prohibitive. There’s two reasons. One is we’ve narrowed it down to cost. They see that on their energy bill. The second is simply that it’s a new technology and that new technology is unfamiliar. So there’s some getting used to that technology that’s still not quite there.

Miller: So what policy recommendations do you think, in your mind, follow from your new study?

Shandas: We really need to be, first, engaging a lot of the hospitals, and medical and public health agencies. They are the front line. They’re the ones who are often seeing this laid bare. We need to be really coding heat-related illness much more directly and clearly, so that researchers like me and others have really good evidence and understanding of what is the scale of the problem. Part of why we developed the study is to really illustrate the scale.

The second is to really start thinking about that a regional forecast doesn’t, by itself, give you what you need. You need much more local granular data and understanding of what happens in the morning, afternoon and evening in a particular city block in a particular neighborhood. So I would want us to really start moving into these, what we call regional observation networks, where we can actually start understanding the changes of temperature that are happening at a block scale.

And then third, I’d really want our institutions to start getting trained in heat preparedness protocols. We need to get transportation behind this. We need to get housing behind this. We need to get emergency managers thinking about this more directly. We need to get public health behind this.

Miller: It’s going to be somewhere in the 90s in parts of Oregon this weekend, going into the next week. Is there a temperature threshold where you think … I mean, that’s not 116, but at what point do you start worrying?

Shandas: Well, I will say that 116 was the airport temperature. I was measuring 125 in some neighborhoods, and in that same hour, measuring 99 to 100 in other neighborhoods. So we’re seeing, as temperatures go up, that disparity of exposure getting really, really more impactful, more clear. For this coming week and weekend, one of the things that I’m really hopeful for is that we are building communication systems to reach those communities that are historically not getting access to the information that public health alerts and these other systems that are out there. So we need to develop some more communication systems to be able to get at those in manufactured homes, mobile home parks, multi-family residential and the like.

Miller: Vivek, thanks very much.

Shandas: Thanks, Dave. Good to be with you.

Miller: Vivek Shandas is a professor of earth, environment and society at Portland State University.

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