Why Extreme Heat Is a “Mass Casualty Event”

HARI SREENIVASAN: Kathy Baughman McLeod, thanks so much for joining us. This has been an exceptionally hot summer. Most people in the United States, across the Eastern Seaboard, certainly have felt that. But in Europe, it’s been much more acute. There are researchers that estimate that there were in excess of 14,000 deaths across the six hardest hit countries in Europe, and that’s just this heat wave from June of July this year. You’ve called this a mass casualty event, and yet we’re not really paying attention to it.

 

KATHY BAUGHMAN MCLEOD: Those numbers are staggering and yet we don’t quite have our arms around it and we don’t have the sense of alarm and action that’s necessary to save lives. And I think a lot of questions need to be asked about who are these people who have lost their lives to extreme heat and why do we not care more that they are gone? And what can we do to prevent more people from dying from extreme heat?

 

SREENIVASAN: So what’s happening here to make these numbers go up?

 

MCLEOD: So that number you referenced is called all-cause mortality. And so the best way we have to measure who has died from heat is to see an increase in that number when the weather is particularly hot, when the conditions are really hot. And so that excess death we account for, if we had let’s say 400 people in the city of X die every day and then during this, these heat events, let’s say one in particular over two or three days, you had 600 people die per day, you would account for those deaths as extreme heat. 

 

We’re not sophisticated yet enough to say, exactly these people died from heat. And part of that is that the medical and health systems aren’t looking for it and not — there’s not a standard training that says, is this a heat-related death? Could this heart attack — and we know the heart works really hard during extreme heat — could this heart attack be heat-driven? What about renal failure? I mean, there’s so many things driven by this and medications that are, you know, contra-indicated for heat. And so we’ve got to get our heat literacy up across all of our systems, especially in the health system.

 

SREENIVASAN: So what do we know about heat and how it affects the, you know, human body? I mean, does it break down differently across genders? Does it break down differently across class and access to capital or poverty?

 

MCLEOD: Yes and yes. Yes and yes. So gender-wise, women are disproportionately physiologically impacted by heat. That’s because our sweat rates are lower. That’s because our thermoregulation is affected by hormonal fluctuations — pregnancy, menopause. And socioeconomically, poverty is a huge driver of higher impacts of heat. Costs through loss of income be – in the informal sector. 60% of workers in the informal sector are women. And we are seeing mental health effects from heat. And there is a rise in gender-based violence. People get angry and frustrated and so it shows up in higher crime rates. It shows up in domestic violence and harm to women and kids. It’s showing up as more visits to the hospital. It’s showing up as miscarriage, preterm birth and stillborn babies. It’s got immense impacts and it does not affect people equally. 

 

And people working outside, people without like informal informality, people working without laws that protect them and their health from the heat. People who are, you know, construction workers, law enforcement, people outside who are — or in cooled or partially cooled spaces: warehouses, distribution or fulfillment centers, farm workers. I mean, immense disproportionate exposure and vulnerability to heat driven by poverty and by socioeconomic factors.

 

SREENIVASAN: You founded and run an organization called HERA, Heat Resilience Action. And I’m wondering, you focus specifically to try to protect women from extreme heat. You also increase sort of heat literacy across the board, but why specifically focus around women?

 

MCLEOD: Women put 90% of what they make back into their community and into the economy. Men put 40%. So just on a return on investment factor, it’s a great idea, just makes sense. The other reasons are that women are caring for children and elders. So this immense care burden that women have, they don’t get paid for it. And it’s been quantified in the, you know, hundreds of billions of dollars of free service to families and community. That service takes women out of the workplace and out of the paid economy. 

 

So, a few examples. So women in Pakistan in one of our programs, they are not by cultural and religious dictate, they can’t sleep outside on the porch or outside where the airflow is. They have to sleep inside. And so men and boys are on the front porch and women are inside just roasting.

 

I wanna say that women working outside and exposed to the heat are experiencing urinary tract infections, rashes that don’t go away, headaches, dizziness, miscarriage. We’re learning more and more about menstrual health, that heat has a huge effect on menstruation: the heavier flow or the frequency within the cycle or how long it lasts. And that takes girls out of school. And so when women are set back, the world is set back. And so we founded HERA specifically to focus on women and their health, their income, and their dignity because they are the key to our future. And all of the data shows us that and the stories of the work we do and the solutions that we co-deliver with women backs that up. And it’s just good for everybody.

 

SREENIVASAN: Yeah. You focus a lot on women in developing countries and many of those women are part of the labor pool, right? They do work in garment factories and they do domestic work, of course. They’re street vendors. They are working in the fields, in agriculture. Is there something about that type of work or that part of the economy that is more sensitive to heat than if, you know, obviously if they had a job in the white collar sector, they’re likely to work in an office that has air conditioning?

 

MCLEOD: Yes. And one of those reasons is that the developing world does not have air conditioning at the rates we do. And air conditioning cuts both ways in terms of an instant cooling and also a continuation and ex –  exacerbation of the drivers of climate change and global warming. And so in the places where we work, there is no expectation that air conditioning is coming. We’re working to deliver passive cooling solutions and fans that are powered by solar. And so what are the clean ways for us to cool people? And there are all kinds of ways. There – nature is a huge cost-effective solution for cooling. 

 

But specifically for people and in our focus and women, those jobs like construction workers, waste recyclers, market vendors, head loaders — people that carry things on their head from one end of the market to the other — all absolutely exposed. And of course, as you’ve already said, socioeconomically vulnerable. And so our economies and our families and communities are being set back by this. And because heat is invisible and silent, it’s still not really recognized. And so many women are losing. 

 

And in our community we work with across informal market traders in Freetown, Sierra Leone – they’re losing 60% of their income to heat. And that means they feel sick, of course, disproportionately. They’re taking care of other people who are sick. And what they’re selling, let’s say fruits and vegetables, meats, they’re going bad before they can sell them. They don’t have access to cold storage to keep, you know, extending the life of what they’re selling. And they don’t have access to a good early warning system. And what we found is if when they do have good access, they’re able to change what they buy. They might reduce what they buy so they have less loss of their inventory to the heat. 

 

And so again, there are solutions, but we’re still — this field is in its infancy of understanding heat. And women are twice as likely to die from heat in Europe than men. And so this disproportionate impact is not just in informal economies and the developing world. It’s  all over. And that London heat wave, you know, if nothing’s gonna wake us up to heat’s effects, that June heat wave that I think the UK estimated maybe 3,000 dead, from just that week of heat. So it’s here and there are lots of actions to take, but we’ve gotta wake up and start, start investing in these solutions.

 

SREENIVASAN: You know, when it comes to the maternal health crisis and, and the child health crisis, there is a stat in here from Kaiser Permanente Southern California that said heat is driving a 28% increase in life-threatening complications to pregnancies like preterm birth and stillbirth. And I wanna ask about something that your organization launched. It’s called Heat Pregnancy Insurance. What is that? How does it work?

 

MCLEOD: It’s called HERA Materna. 

 

SREENIVASAN: Okay. 

 

MCLEOD: And we co-run with communities across South Asia, Southeast Asia, and West Africa, a program called the Women’s Climate Shock Insurance and Livelihoods Initiative. And it’s a long way to say we provide insurance that the women pay a small portion toward that supplements their income that is lost to extreme heat. And so we have 300,000 women in that program. And pregnant women starting next year will be eligible for a free insurance and cash support and other things that are non-financial things like a solar fan that help them protect their health during this most susceptible, heat susceptible time. 

 

And so we’ll kick it off with a group of 30,000 women in Gujarat in India. And it will, as I said, you know, when you get certain temperatures and humidity levels, it will trigger a payment. And that payment will be bigger than it normally would and come sooner for protections that help a woman protect her pregnancy and her early days after she’s had her baby.

 

SREENIVASAN: Let’s talk a little bit about, I guess the solutions that you know are working on both kind of first an individual level, then on a structural level. So on an individual basis, what is something that someone without any air conditioning can do to help prevent getting heat exhaustion, heat stroke?

 

MCLEOD: So one of the biggest things that is happening across the developing world, and in some cases, the developed world — and I wanna talk about the urban heat island effect. And this is the phenomenon that the materials we’ve built our cities with and the rooftops of so, so many informal settlements around the world are corrugated metal roofs that absorb heat. And that same phenomenon happens in the developed world. And so think about London and the suffering that people went through. They don’t have air conditioning and the buildings are holding heat. Black asphalt holds heat and emanates it at night. Glass and steel. And so the cities are mega heat spots because of the materials we’ve built them with and because of the density. 

 

And so the first thing you can do is cool the roof. And that means coat it with a light surface. There are also green roof programs when you put some sort of nature or grass or you can use nature around your house to shade your house. So you need shade, you need to cover the windows during the day, but let the air in during the night if you can. 

 

There are ways to use a fan very strategically and using water to put air across the water to cool a room. And so that’s what I mean when I say we’ve got to get our heat literacy up. And I think one of the biggest pieces of heat literacy and, you know, the gap that we have is an understanding of nighttime temperatures. And we’re beginning to understand that. But when the city is holding heat at night and then during the day collecting it and then emanating it at night, the nighttime temperatures are not coming down anymore. 

 

And one of the biggest numbers that we have that helps, you know, show that, is that we have as a global community focused on not having the temperatures above the industrial era rise more than 1.5 degrees Centigrade. And that is the agreement we made across countries for the Paris Accord in 2015. That’s a daytime average. So the nighttime temperatures and a recent analysis we did — and there’s a  report across 100 cities in the world — we saw that some cities were increasing their nighttime temperature as much as 13 times the daytime. And so we’ve got to keep our eye on a 24-hour set of solutions. 

 

SREENIVASAN: You know, let’s talk a little bit about this structurally, right? If we have these urban heat islands all over the planet, that really comes down to a matter of city planning. You built this tool, a city heat solutions calculator. So if I’m an urban planner and I start to plug things into this calculator, what do I get? How do I try to rethink where I should make my investments in this city to decrease the effect of this?

 

MCLEOD: So the first thing you wanna do is understand where the most vulnerable communities are in your city. And what this calculator allows you to do is look at six tried and true solutions and calculate what impact in terms of saving productivity in the community and saving lives you would have if you did these things in your city. And we looked at 11,000 cities in the world and the methodology is all there for — it’s open source and people can, you know, see how we did that. But the essence is if you have a heat response plan, if you had green or cool roofs, if you had an early warning system, if you used a combination of insurance and cash support, what sort of saved productivity would you achieve in dollars and how many lives might you save if you did that? 

 

And so it’s not a direct investment tool, but it is a directionally very helpful quantification of what a city can do in terms of its economic impacts, but also looking at if I did 50% of the city in green roofs, if I put nature-based solutions in half of the city, that sort of thing, and you can come back to seeing, okay, this is the most effective solution for my city. 

 

SREENIVASAN: So what are some examples of cities that are thinking about this, that are doing something about this and where it’s working?

 

MCLEOD: So India is the birthplace of heat solutions. They’ve had heat and built for heat for centuries and centuries. And so cities, particularly the city of Ahmedabad, is famous for its heat action plan. And so hand-in-hand with the city calculator would be a heat action plan. And so the city of Ahmedabad is in the process of updating that heat action plan. Cities like Medellin have planted trees and long avenues all over their downtown that has dropped the average daily temperature in the city substantially. The city of Athens has delivered all sorts of great heat solutions that are nature-based and shade, and thinking about where do people wait for the bus? How do you cool your metro system? Looking at the city of Freetown and how they have a chief heat officer and she works with HERA and delivering all sorts of solutions that are training first line, frontline health workers, community health workers.

 

We are co-creating and designing, delivering shade, shade infrastructure. What does that mean? That’s fans and solar lights and access to cold storage for those market traders I mentioned earlier. Thinking about early warning and making sure that early warnings are reaching the people who need them. And so thinking about these solutions as integrated and multifactor, but they have to be based on understanding the community, not just the science of where the hotspots are and where the heat is going in terms of predictions, but also which communities are suffering the most and which solutions work best for them.

 

SREENIVASAN: CEO of HERA, Kathy Baughman McLeod, thanks so much for joining us.

 

MCLEOD: Thank you for having me.