Beating the heat: Resources for reporting on extreme heat

A recent Associated Press article, "More cities move aggressively to stop heat death s," says that "In recent years, deadly heat waves have killed dozens to hundreds of people at a time in various U.S. cities, often catching local officials unprepared. Climate scientists say more killer heat waves lie ahead with global warming, and city officials are taking note."

The article goes on to say that some cities "open cooling centers, hand out water bottles, go door to door to check on people and even ask utilities not to shut off electricity to late-payers during a heat wave."

The Federal Emergency Management Agency, in its Aug. 4 National Situation Update, took note of the heat and plans that some cities are activating. Cities cited as having plans in place and taking action include Chicago, Philadelphia, Phoenix, Denver, Seattle, Boston and the San Francisco Bay Area.

So far, about 50 people have died this year from the heat according to the AP. North Texas, where heat has claimed the lives of at least six people in recent days, has seen temperatures above 100 degrees for 12 consecutive days. There have been two, possibly three, heat-related deaths in Kansas City this week and three in Oklahoma.

Here are some resources to help reporters cover the recent heat wave as well as the public health aspect of climate change:

Issues around heat-related deaths

June 20, 2008 – Heat-related deaths among crop workers: The CDC released a report on such deaths from 1992 through 2006. It found that 423 workers in agricultural and nonagricultural industries were reported to have died from exposure to environmental heat; 68 (16 percent) of these workers were engaged in crop production or support activities for crop production. Dawn Castillo, of the Division of Safety Research. in the CDC’s National Institute of Occupational Safety and Health, discussed the findings in a June 19 conference call.

July 2006 – U.S. heat-related deaths underestimated: The CDC released an analysis of deaths in which hyperthermia was listed as a contributing factor but not the underlying cause of death. The analysis found that including such deaths increased the number of heat-related deaths by 54 percent. Researchers concluded that the number of heat-related deaths in the United States may be underestimated as a result.

The report notes that: "Because heat-related illnesses can exacerbate existing medical conditions and death from heat exposure can be preceded by various symptoms, heat-related deaths can be difficult to identify when illness onset or death is not witnessed by a clinician. In addition, the criteria used to determine heat-related causes of death vary among states. This can lead to underreporting heat-related deaths or to reporting heat as a factor contributing to death rather than the underlying cause."

August 2007 – Heat deaths in Calif. may have been underreported: Don Thompson of The Associated Press reported the heat wave that scorched California in 2006 may have contributed to hundreds more deaths than the state has officially reported, based on statistics compiled from each of the state's 58 counties. As recently as June 2007, state officials reported that the two-week ordeal of triple-digit temperatures that began on July 14, 2006, killed 143 people. But data compiled by the AP show the number of deaths in July 2006 was 466 higher than the average over the previous six years – a spike many health officials attribute to the broiling heat. One problem is that settling on a cause of death is largely a judgment call – there is no fixed, nationwide standard for deciding whether a death was heat-related. Calif. officials said they would conduct a statistical study of deaths from the 2006 heat wave and Gov. Schwarzenegger's administration said it would update the state's emergency response plan for heat waves to include statistical analyses of deaths.

July 2002 – Dead Heat: Why don't Americans sweat over heat-wave deaths?: Eric Klinenberg, an associate professor of sociology at New York University and the author of Heat Wave: A Social Autopsy of Disaster in Chicago, writes for Slate that while "heat waves kill more people in the United States than all of the other so-called natural disasters combined," those deaths are largely invisible. He calls deaths from extreme heat "slow and preventable."

July 2008 – Calif. senator wants more labor inspectors: Sen. Dean Florez asked that money be appropriated to add 60 full-time labor inspectors at the state's Division of Occupational Safety and Health to help enforce workplace heat regulations.

The federal Occupational Safety & Health Administration has specific standards to protect workers from heat stress. In 24 states, Puerto Rico and the Virgin Islands those standards may be different as those states and territories have adopted their own plans, approved by OSHA.

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Guidelines to help people deal with the heat

CDC's extreme heat prevention guide: This page discusses steps people should take to protect their health during periods of extreme heat; describes who is considered to be at high risk during extreme heat; recognizing and treating heat stroke, heat exhaustion, heat cramps, sunburn and heat rash.

Heat stress in the elderly: Older people are more at risk during extreme heat because their bodies do not adjust to sudden changes in temperature as well as when they were younger. They are also more likely to have chronic medical conditions or be taking prescription medications that affect how their bodies respond to heat.

The National Institute on Aging offers "Hyperthermia: Too Hot for Your Health."

Heat illness – Information from MedlinePlus that includes links to journal articles, clinical trials and additional resources.

The American Red Cross offers these tips on staying cool.

FEMA offers information about heat-related illnesses.

The Environmental Protection Agency's has information about Heat Wave Response Programs.

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Journal articles and more scientific resources

Thousands Struck Down by Summer Heat, Most Are Poor (July 9, 2008): The Agency for Healthcare Research and Quality says that about 6,200 Americans are hospitalized each summer due to excessive heat, and those at highest risk are poor, uninsured or elderly. About 180 people who were hospitalized for heat exposure died in 2005, according to the AHRQ analysis. The analysis, based on 2005 data, found that:

• People from communities with average household incomes of $36,999 or less were hospitalized more than twice as often as people who came from wealthier areas where average household incomes topped $61,000.
• The rate of hyperthermia hospital admissions for uninsured patients was 17 percent higher than hospital admissions for uninsured patients as a whole (5 percent).
• The hospitalization rate for people over 65 with hyperthermia was 15 times greater than for people age 17 and younger.
• The rate of admission for hyperthermia in the South (3.1 per 100,000 population) was more than twice that of the Midwest and West (1.4 per 100,000 each). The Northeast had a rate of 1.7 per 100,000 for hyperthermia.

The analysis is based on data in Hospital Stays Resulting from Excessive Heat and Cold Exposure Due to Weather Conditions in U.S. Community Hospitals, 2005. The report uses statistics from the 2005 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-Federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.

Journal articles on extreme heat: Compiled by the CDC (last updated in June 2006)

These Mobidity and Mortality Weekly Reports look at heat-related deaths in a number of cities and states, including Arizona; Chicago; Los Angeles; Cincinnati and Dayton, Ohio; Missouri; Texas; Wichita and more.

Global Climate Change and Public Health: The Health Impacts of California Heat Waves – Get the presentations from this July 2007 workshop, including coroner reports on who was affected and where the effects occurred and epidemiologic estimates of the full health effects of the heat wave.

Urban Indicators of Climate Change is a report from the Center for Health and the Global Environment and the Boston Public Health Commission that looks at potential health impacts of climate change – asthma and other respiratory illnesses, infectious diseases, heat stress, heart disease – and preventative strategies that could improve air quality and enhance the livability of urban communities.

Relation between Elevated Ambient Temperature and Mortality: A Review of the Epidemiologic Evidence, from Epidemiologic Reviews 24:190-202 (2002)

Thermal stress in the U.S.A.: effects on violence and on employee behaviour, from Stress and Health, 2004

The impact of the 2003 heat wave on daily mortality in England and Wales and the use of rapid weekly mortality estimates. Eurosurveillance, July 2005

Relevant articles on PubMed

Prediction of heat-illness symptoms with the prediction of human vascular response in hot environment under resting condition. J Med Syst. 2008 Apr

Occupational heat illness in Washington State, 1995-2005. Am J Ind Med. 2007 Dec

Heat-related illness in athletes. Am J Sports Med. 2007 Aug;

Anatomy of heat waves and mortality in Toronto: lessons for public health protection.Can J Public Health. 2007 Sep-Oct

Articles from the American Journal of Public Health

Climate Change: The Public Health Response
Related: At Health Journalism 2008, officials from the American Public Health Association and its partners unveiled a public health blueprint for tackling climate change in advance of National Public Health Week. This one-of-a-kind consensus document, compiled by a group of leading climate change and public health professionals, outlines strategies to mitigate and prepare for the effects of climate change.

Projecting Heat-Related Mortality Impacts Under a Changing Climate in the New York City Region

The Effect of the 1995 Heat Wave in Chicago on All-Cause and Cause-Specific Mortality

Heat Wave Morbidity and Mortality, Milwaukee, Wis., 1999 vs 1995: An Improved Response?

Municipal Heat Wave Response Plans

Articles from the Annual Review of Public Health

Heat Stress and Public Health: A Critical Review

The Effects of Changing Weather on Public Health

Changing Climate Changing Public Health

Preparing the U.S. Health Community for Climate Change