In 1995, Chicago suffered a violent heat wave that resulted in the deaths of over 700 citizens. Many were seniors, African American and living in public housing. Reports out that many of the seniors who died were isolated from their family and community and that others felt imprisoned in their home, fearful of venturing out into their neighbourhood, shocked North America.
In 2003, eight years after the Chicago catastrophe, countries in western Europe experienced a heat wave that resulted in 27,000 dead: 15,000 deaths in France, between 4,000 and 8,000 in Italy, 1,300 in Portugal, and 2,000 in Britain. Many were seniors. Many were poor.
In both situations, political leadership initially denied the extent of the problem and minimized the risk to vulnerable populations. "It's hot", Chicago Mayor Richard Daley told the media, "But let's not blow it out of proportion … every day people die of natural causes."
Emergency responses came too little and too late. However, the massive loss of life ensured a "social autopsy": an examination of the political and social fabric that attributed to the high death toll in certain populations.
Lessons were learned. First, that accelerated death rates were linked to poverty, unaffordable housing, diminished social programs, and access to air conditioning. Second, that the most critical public health measures that can save life in a heat emergency are early warning systems, the immediate opening of neighbourhood-based cooling centres, outreach to seniors and vulnerable populations including vans to pick people up to take them to cooling centres, fan and air conditioner installation programs, and reverse 911 calls, or automated calls to people who are vulnerable.
Canada has also experienced heat waves. In 2005, at least six Toronto residents who lived in scorching rooming and boarding houses died during a heat wave. Toronto Public Health research has demonstrated that mortality rates are twice as high on extreme heat days compared to comfortable days. In recent years, Toronto has reluctantly operated cooling centres triggered by a tight temperature criteria. Only one of the centres has been open 24 hours, and only with pressure did the city begin opening centres on the first of a heat wave, instead of the third day. Infamously, several years ago, the city was caught running its 24-hour centre in a hallway without staff or food -- just a sign, tables and chairs and a jug of water. No activities to pass the time, no meals, no healthcare on site, no cots to sleep on unless you're about to pass out. No appreciation of what vulnerability can mean.
A growing list of Canadian cities now faces a frequent and unpleasant brew of extreme heat, humidity, and smog that can be felt, seen, and smelled. Yet Canada's overall response to heat waves has been lackluster. We act as if we were living in a country with one season -- cold. Very few Canadian municipalities are prepared for a heat wave. It is rare to find a Canadian city with protocols to operate neighbourhood cooling centres, deploy air-conditioned city buses, or operate a vulnerable person registry. There are no fan loan programmes, air conditioner installation programmes, or hydro rebates for those in need. Emergency heat plans have not yet made it into municipal disaster management binders, nor are they mandated or funded by provincial Ministries of Health or Public Safety. Yet, prevention today will save lives tomorrow.
In general, most cities use web sites and media advisories to inform the public how to protect themselves from the heat. Safety tips range from telling people to drink lots of water, take cool baths, wear light cotton clothing, and to go to air-conditioned shopping malls or libraries. The media help to promote stay cool tactics by showing endless shots of people licking ice cream, splashing in pools, endurance athletes training, and reporters frying an egg on the hood of a car or sidewalk. Even animals suffering the heat are depicted -- lions and tigers eating blood-flavoured ice blocks, snow monkeys being fed frozen ice treats, and polar bears eating frozen "meat-cubes."
But, what about the groups of people who do not have good health, good housing, access to air-conditioning or the financial resources to endure the discomfort? What about people whose seniors' pension cheque or disability cheque has run out by the 17th of the month? Extreme heat can be a medical emergency for vulnerable populations -- the frail and elderly, those in poor health, socially isolated, or on certain medications such as psychiatric drugs.
This year, Toronto Public Health, without any notice or consultation that I am aware of, will cease declaring heat alerts and its shelter division will no longer operate cooling centres despite their own dire prediction: "It is projected that by 2040-2050, the City can expect to experience approximately 66 days with maximum temperatures above 30°C as compared with 18 such days in the summer of 2018."
"The Heat Relief Work Group has determined that the most effective approach to mitigate impacts of heat are to continue to increase community access to cooling based on pre-existing services that are already used by the public. As a result, starting this summer, rather than providing a separate service of seven Cooling Centres the public will be able to access cool spaces available throughout the summer season at approximately 180 locations that are currently part of the Heat Relief Network, as well as other organizations as the network expands. In addition, access to cooling for people who are experiencing homelessness will be integrated into pre-existing services that already serve vulnerable populations such as shelters, drop-ins, and respite centres."
No acknowledgement that the shelter system is beyond capacity or that libraries, shopping centres, even community centres may not have the health resources, refreshments or respite services to care for people.
The city's full report can be read here. The Chicago and European heat wave deaths were not the result of an act of god, or a natural disaster. They were preventable consequences of poverty, social isolation, racism, and the withdrawal of social programs.
With Toronto's new direction we can count on the public health messages: "drink lots of liquids, wear light-coloured clothing and a hat, go to a pool, get yourself to an air-conditioned movie theatre or mall."
Sadly, vulnerable people will need more than hot air on a hot day.
Image: Cathy Crowe
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