As climate warms, poorer areas bear a greater burden

GRANITE STATE NEWS COLLABORATIVE

The biological effects of heat on the human body are universal and indisputable.

Hyperthermia — too much heat over a certain amount of time — can lead to heat exhaustion, heat stroke and even death.

And like other social problems today — such as the lack of affordable housing or access to healthy foods — not everyone suffers equally when it comes to the effects of heat. Those with diabetes, heart disease, other comorbidities, the elderly, people of color and the poor, suffer at higher rates.

In New Hampshire, a state with thousands of acres of forests, many people — especially in urban areas — continue to lack access to something as simple as the health benefit of shade.

Environmental justice advocates, along with public health specialists, lawyers and community organizers, are currently working to educate and assist the public about the dangers of heat-related stress and illness in New Hampshire, and they’re seeking solutions that involve empowering communities.

Of all the environmental justice issues being confronted today, UNH Professor of Health Management and Policy Semra Aytur cited heat-related stress, especially for people of color and those with comorbidities, as one of the biggest.

“Heat, and the related illnesses that come with it, is a fundamentally important environmental justice issue,” Aytur said, “because it spans various aspects within communities.”

Aytur also works with the Conservation Law Foundation with the goal of helping to create healthy communities.

Tom Irwin, CLF vice president and New Hampshire director, said his organization has been committed in the past year to building an environmental advocacy community in Manchester and has hired a part-time organizer who is currently working on a campaign to increase green spaces around the city of Manchester.

“Communities of color suffer disproportionately from the impacts of climate change,” Irwin said. “And the health impacts of heat are often lost on people. Heat itself is the weather event with the greatest impact. It kills more people than all of the other environmental justice issues.”

Irwin mentioned the 2003 European heat wave that killed 70,000 people — 14,802 in France alone — but also pointed to rising average temperatures across the world that disproportionately affect vulnerable populations.

Heat islands

A look at the number of extreme heat days in July and August in Concord from 1954 to 2018 reveals a series of peaks and valleys, as well as a steady rise, with the highest heat days recorded in the summers of 1975 and 2018, according to the National Oceanic and Atmospheric Administration.

NOAA calculated the number of extreme heat days in Concord by counting the number of days when the daily minimum apparent temperature (actual temperature adjusted for humidity) exceeded the 85th percentile of the city’s historic July and August temperatures. For each day that is counted, the temperature was above 68.1 degrees Fahrenheit even in the coolest part of the night.

People living in areas lacking green space are more susceptible to the “heat island” effect, and these areas are also where the median income is lower and social vulnerability is higher.

The CDC’s social vulnerability index (SVI) uses U.S. Census data to determine the relative social vulnerability of every census tract in the U.S. The SVI ranks each tract on 14 social factors and groups them into four related themes: socioeconomic status; household composition and disability; minority status and language; and housing and transportation.

The index ranges from zero to one, with one being the most vulnerable. Vulnerability factors include: percent of population over 65; percent of population below the poverty line; percent of population with no health insurance; and the overall social vulnerability index.

A number of areas in New Hampshire score at or near one, including portions of Concord, Manchester, Nashua, Coos and Sullivan counties.

According to New Hampshire’s Division of Public Health Services, the number of heat-related illnesses leading to emergency room visits begin to increase on days above 75 degrees Fahrenheit. From May to September in the years 2000 to 2009, for instance, Manchester and Nashua recorded 640 and 660 excess ER visits, respectively.

Between 2012 and 2019, more than 1,400 Granite Staters visited a local emergency room because of a heat-related illness, but those visits were not distributed evenly among hospitals.

According to data provided by the New Hampshire Department of Health and Human Services, nearly 20% of the total visits were concentrated in just two hospitals in Manchester — Elliot Hospital and Catholic Medical Center — far above Manchester’s share of the 2019 statewide population.

The most vulnerable living in urban areas must also contend with heat islands, which exacerbate heat-related illnesses. These urbanized areas experience higher temperatures than those around them because they tend to contain dense structures as well as roads and parking lots that absorb and then re-emit the sun’s heat more than natural landscapes do.

The CLF’s Irwin points out that social vulnerability — which includes poverty as well as health problems — often makes it difficult for people to organize on a community level.

“The people who are most affected often have the least bandwidth and capacity with everything else going on in their life to realize things could be better in their community and to organize and solve their challenges,” Irwin said. “Just as we saw communities of color experiencing harm as a result of the Covid crisis, that certainly holds true with the impacts of climate change as well, unfortunately.”

Community organizer Arnold Mikolo, who works with the CLF on creating more green spaces in Manchester, said lowincome neighborhoods in the city with a lack of access to healthcare, a higher number of smokers and other comorbidities, are at an increased risk of heat-related illness.

“Finding ways for people to cool off in cities like Concord and Manchester is not a problem for those in sections of the city with tree cover and air-conditioning. A lot of the houses in sections of Manchester don’t even need to turnthe AC on.”

Mikolo said he wants to remind people that neighborhoods where heat isn’t as much of a problem require planning and investment.

Climate change

State climatologist Mary Stampone, who is a professor of geography at UNH, said temperatures in New Hampshire are rising just as they are everywhere else.

One of the interesting things climate scientists are observing, she said, is that nighttime temperatures are rising at a greater rate than daytime temperatures regionally.

A study of temperatures form July 1901 to July 2020 found that in June, July and August temperatures are all rising significantly at night. For July, it’s almost twice as much as during the day.

“A lot has occurred in the last 50 years,” Stampone said.

And looking more closely at nighttime temperatures, she added, is important because this is the time when people cool off.

“If we don’t have that nighttime cooling, we can have a lot of poor health outcomes. Also, we’re asleep (and can’t monitor ourselves).”

Stampone cited a study of elderly populations living in Philadelphia row houses as an example of the way inequalities in urban areas exacerbate the effects of heat.

“They would just close their windows so they wouldn’t be broken into and have a fan running. But that red brick building becomes a conduction oven,” she said. “This is why we see a lot of those inequalities in urban areas, because it exacerbates the effect.”

Ellen Flaherty, director of the Dartmouth Centers for Health and Aging and assistant professor of medicine at the Geisel School of Medicine at Dartmouth College, said more than half of the population of people over 65 live in high-risk areas in terms of heat.

And as people age, she said, their bodies change in ways that make it more difficult to regulate temperature.

“One of the things we think about from that perspective is (bodily) temperature control and how that ability in older adults is diminished,” she said, adding that comorbidities, such as diabetes and respiratory disease, and specific medications, such as diuretics, can exacerbate the problem.

“When they’re combined with some cardiac medications, the risk of becoming dehydrated is much greater, compounded by their lack of a sense of thirst,” Flaherty said. “Not feeling the heat, not sweating, not drinking, is also compounded by other factors such as socioeconomic status, not having airconditioned apartments, social isolation and not having access to other people to provide support getting them out of their apartments.”

Part of what makes people particularly vulnerable, especially in urban cores, Stampone said, is that people are not acclimated to increasing temperatures and the infrastructures are not built to offset these changes.

“We don’t have air-conditioners. (People with low incomes) can’t afford, across the board, what you need to protect yourself from heat. Areas that have a greater portion of people of color tend to be overall hotter.”

Other susceptible populations, Stampone said, include the elderly, people with disabilities and families with young children.

Thomas Mee, CEO of North Country Healthcare, parent organization of three critical access hospitals and one home health agency in northern New Hampshire, said heat isn’t as much of an issue in the North Country as it is in other parts of the state but said most homes are not air-conditioned.

“We don’t see a lot of heat exhaustion and heat stroke. What we do see, especially in Coos County where it’s poorer in general and there are more health conditions, is that the heat drives those conditions. If you have any elderly person with COPD, it’s worsened. Chronic conditions are worsened.”

Lourdes B. Avilés, professor of meteorology at Plymouth State University, chairs her department’s Meteorology, Physics, Mathematics and Climate Studies Department.

Avilés said the increase in average temperatures across the world are leading to more days with higher temperatures overall and teaches about the effects this has, specifically on urban areas.

“It is a real effect, the urban heat island.

Normally a large city can be 10 degrees hotter than the surrounding environment, but we have seen it in smaller towns,” she said. “When you’re talking about an average that is increasing, it might take it from a temperature that people like the elderly can deal with to one they can’t, as long as you have an increasing average.”

Avilés expects rising average temperature trends to continue going forward.

“If we stopped putting carbon dioxide into the atmosphere right now, it would take about 100 years for the atmosphere to stabilize.”

Immigrant housing

Henry Harris, managing director of the International Institute of New England, said Manchester neighborhoods, where the majority of refugees and immigrants live, have limited green space.

And the buildings in those neighborhoods lacking green space are old and often needing weatherization updates, he said.

“They’re drafty in winter and hot in summer,” he said. “Even in planned neighborhoods, because of the amount of time it takes to grow trees, green space hasn’t developed enough to provide adequate shade. And in a lot of these old neighborhoods, the trees are aging out. Good luck finding an actual maple on Maple Street.”

With less than a 1% vacancy rate in southern New Hampshire, Harris said placing clients in apartments can be difficult.

“We pretty much have to swing at whatever is available. We do have bare minimum requirements before we allow a family to move in,” he said, adding, “Ideally, we would love everyone to live in the best apartments we can find, but it is really tight.”

Asked whether his clients have more hospitalizations or heat-related problems than the general population, Harris said he doesn’t believe the majority of his clients would even report these problems “unless it was an absolute emergency.”

“A lot of our clients come from countries that are really hot to begin with. Even the standard of living over there is far worse, plus going to the hospital is kind of a dangerous thing if you’re unfamiliar with it and don’t feel comfortable.”

Harris said his organization focuses a lot on navigating people towards healthcare and other resources, such as community action programs, but acknowledged that the apartments where his clients live often lack air-conditioners.

“People try to get air-conditioners when they can, but when you’re on a really tight budget it’s hard to do.”

Harris said solutions begin with infrastructure, including the creation of more green spaces. But creating green spaces takes time.

“It takes a long time to grow trees.

Landlords are going to claim they don’t have money.”

He also suggested the use of mesh sunscreens, which also work like modern art, stretched over certain areas allowing the wind to blow through them.

The first step in creating change, Harris explained, is identifying who’s being impacted. After this, stakeholders in those communities need to be identified.

“It’s a big enough problem that there’s no way one agency or even government can solve it on their own. Looking for options that are going to be cost-effective is really important.”

When it comes to solutions, Stampone believes more resources should be invested in vulnerable populations and that an environmental justice approach, where benefits and burdens are fairly distributed, should be adopted.

“We need to de-carbonize globally. The mitigation needs to happen,” she said, adding that, in the meantime, “adaptation and cooling centers are a greater investment in cooling, as well as providing vouchers for air-conditioning and increased access to cool spaces.”

Over time, she said, solutions include increasing green spaces and access to green spaces as well as tree maintenance.

“Trees and other vegetation are very natural coolers. And they have more of a community benefit and a long-term one, so they’re more sustainable than giving people a bunch of air-conditioners.”

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This article is being shared by partners in the Granite State News Collaborative as part of its race and equity project. For more information, visit collaborativenh.org.