Q&A: The Centers for Disease Control and Prevention’s Response to Extreme Heat | Article

Paul Schramm, the climate science team lead with the Climate and Health Program at the Centers for Disease Control and Prevention (CDC) in Atlanta, spoke with EESI on the human health effects of extreme heat. In this interview, Schramm shares tools, plans, and awareness campaigns—all designed to help communities and their health departments increase resilience to heat.

EESI: There seem to be many ideas about what constitutes “extreme heat.” How do climate scientists define it, and why is it so significant?

Schramm: We do not have a standard definition for extreme heat, and we should not. The difficult thing about extreme heat is, what is classified as a heat wave is very different in different parts of the country depending on where you are and what you normally experience. For example, if it is 85 degrees Fahrenheit in Maine for several days in a row, that is a threat to health, with increased visits to emergency departments for heat. If that happened in Arizona, you would not see anything like that. Eighty-five degrees is nothing—that is a January day in some cases. So, the definition is typically set by each local National Weather Service forecasting office. We try to work with them to help incorporate health into the equation.

We have successfully done that with CDC grants to health departments around the country, as part of our Climate-Ready States and Cities Initiative (CRSCI) where we work with local weather forecasting offices to incorporate their health data. So, for example, in New England, the National Oceanic and Atmospheric Administration’s (NOAA’s) National Weather Service was not calling heat warnings until a certain temperature was reached, but we noted significant health impacts at lower temperatures, so this led them to actually change their threshold. Similarly, in the western United States, we worked on a pilot with NOAA to do heat forecasts based on health with a color-coded system similar to what you see for air quality alerts.

Declaring heat emergencies is not as clear-cut as identifying hurricanes, which are defined by wind speeds. We often have to consider things like nighttime temperatures and humidity and respond even when extreme heat does not impact a whole region. It is important to work at the level of at-risk communities and make sure they are informed when a heat wave is coming and know what to do. The local health department or Mayor's office then can set up cooling centers, water distribution centers, and prevent electricity from being shut off.

EESI: As utility bills keep getting higher and higher, how can people deal with extreme heat when they do not have the money to pay their electric bills, much less run their air conditioners?

Schramm: A lot of people have heard of the Low Income Home Energy Assistance Program (LIHEAP), which has mainly been used during cold weather. It is now also being used for hot weather so that people can continue to run air conditioning when a heat wave is declared. In many places, utility companies cannot shut off electricity during a declared heat wave.

An even bigger problem is that many people do not have air conditioning at all, or if they do, it is not working. So, LIHEAP cannot help them. In those cases, the CDC recommends that people spend time in a cool place, like a shopping mall, movie theater, or a local library. Many communities set up cooling centers, which might be in a school or community center.

EESI: Today, buildings in northern U.S. cities designed to deal with cold are now having to deal with extreme heat. How will this impact the design, building, and operations of new and existing buildings and what can be done to promote healthy environments that might mitigate adverse health outcomes?

Schramm: Designers, architects, and planners are starting to think more and more about that and, in general, are trying to build healthier buildings. CDC had input into the Fitwel certification system, which includes heat as a factor by ensuring thermal comfort inside a building. This is a big issue for some of the older housing stock in places that do not have air conditioning or cannot easily be retrofitted. Air conditioning is not common in places like Seattle and Portland because they have not had to deal with extreme heat until recently. The summer 2021 Pacific Northwest heat wave led to hundreds of deaths and thousands of emergency department visits, partly due to lack of access to cooling as well as power outages that prevented use of air conditioners where they had been installed.

Planners and designers can make sure that individual buildings are safe during heat events, but community-level efforts, like planting trees to reduce the urban heat island effect, can help keep people stay safe at a broader scale during heat waves.

EESI: Could you talk about your program to help communities’ health providers deal with climate and extreme heat, particularly in at-risk neighborhoods and populations?

Schramm: The CDC Climate and Health Program directly funds 11 health departments around the country to prepare for and respond to the health impacts of climate change. While they are not required to work on heat impacts, all 11 of them have identified heat as directly impacting health in their areas. CDC’s Building Resilience Against Climate Effects (BRACE) is helping these health departments identify local climate hazards and actions to help protect health, like communication campaigns, coordinating cooling centers, and identifying neighborhoods that are at higher risk because they have more pavement and fewer trees, resulting in heat islands.

CDC’s grants align with the Biden-Harris Administration's Justice40 Initiative in order to help the people who are most at risk. Anyone can be affected by heat, but there are people and communities that are disproportionately impacted for a wide variety of factors. We work closely with grant recipients to focus on higher-risk populations like communities of color, older adults (who are particularly at risk over age 65, especially if they live alone), outdoor workers, pregnant women, and outdoor athletes.

Another important planning resource is the National Integrated Heat Health Information System (NIHHIS), which CDC co-chairs with NOAA. NIHHIS is an integrated system that builds understanding of the problem of extreme heat and develops science-based products and services for the general public and health departments across the country. They also fund communities looking at and responding to urban heat islands.

EESI: Can you talk about the extreme heat impacts on Indigenous communities and how they are adapting to climate change?

Schramm: Through a partnership with the National Indian Health Board (NIHB), CDC provides funding, guidance, and training to tribes. We work with tribes to use their existing expertise and data to help prepare their communities for extreme heat. Tribal communities are a disproportionately impacted population—it is for a variety of reasons, including underlying health risks and lower access to air conditioning.

EESI: What is being done to rethink how healthcare is delivered in areas where rising temperatures are bringing new diseases?

Schramm: Medical school training and curriculums are starting to focus more on climate and heat. Part of this is because healthcare professionals know that they need to plan for increasing numbers of heat victims. One tool we have created to help them is the CDC Heat and Health Tracker, developed with the National Weather Service. The tracker provides local heat and health information so communities can better prepare for and respond to extreme heat events. The online dashboard has a monthly forecast for every county in the United States to help them anticipate heat waves and be prepared to receive people who are suffering from heat-related illness.

EESI: You and others have been working on the human health effects of climate change for a long time. How has work and coordination across federal agencies evolved?

Schramm: CDC has been working on climate health since 2009 and the field has definitely grown, with other federal agencies now working on this. When we started, few people were looking into the health impacts of climate change or preparing for those health impacts. Now we partner with a wide variety of agencies, including the National Aeronautics and Space Administration (NASA), NOAA, and the Environmental Protection Agency (EPA). Within CDC, we now have a cross-agency task force on climate and health that coordinates this work from a wider perspective, including expertise on vector-borne disease or global health surveillance. We are also seeing more local health departments working on the health impacts of climate change.

We work on raising awareness that the heat season is underway through things like Heat Awareness Week, which is promoted through state declarations, multiple federal agencies, and local health departments sharing information on social media. We created a new joint Beat the Heat Infographic, promoted by 11 federal agencies and federal offices, so people know the difference between heat exhaustion and heat stroke, and when to call 911.

Beat the Heat Infographic showing the difference between heat exhaustion and heat stroke. Credit: NIHHIS.

EESI: What gives you hope in dealing with extreme heat?

Schramm: More and more health departments are stepping up on this. They see the impact of increasing heat waves and what is happening in terms of illness and death. Health departments and cities around the country are now developing and implementing heat action plans. We are working with the National Weather Service to change the thresholds for heat alerts, so they are not just based on temperature, but also based on health impact data. There is really positive momentum on this, and it is much needed with the kind and scale of heat waves that we are seeing now.

Communities are more prepared than they have been in the past. Chicago was not prepared for the 1995 heat wave that resulted in a huge number of deaths. Today, they are ready with a full heat action plan that coordinates state and county health care systems. Another area of progress is the Federal Emergency Management Agency’s (FEMA’s) determination to find options to respond to heat waves, which sometimes can cause infrastructure damage, but always cause a lot of human damage.

Answers have been edited for clarity and length.

Author: Jonathan Herz