Heat Is Killing More People Than Ever — What Phoenix Is Trying To Do About It
Heat is killing more people in the United States every year. And as temperatures rise with climate change, that’s only forecast to get worse.
In Phoenix, the problem is especially pressing, and the city's trying to do something about it.
A Tale Of Heatstroke
There’s a moment as heatstroke sets in when the body — no longer able to cool itself — stops sweating.
Joey Azuela remembers it well.
“My body felt hot like in a different way. It was like a ‘I’m cooking hot.'’’
Joey Azuela, 14 years old at the time, had hiked that trail in one of Phoenix’s rugged desert preserves before. But he and his father had gotten a late start that day, a cardinal sin for any outing in the summer.
He was already weak and nauseous when they reached the top. But the desert offered no shade and their water was gone. He and his father turned back.
“I remember thinking ‘man, I just got to get to the car,’” Azuela says. “Then just nothing — black.”
Azuela collapsed in the parking lot.
By time the ambulance arrived, the asphalt had already singed his arms and legs, causing second degree burns.
His mother Alicia Andazola arrived at the emergency room to find her son covered in ice and his body temperature nearing 108 degrees.
“His organs started failing. His body was shutting down,” Andazola recalled.
Doctors had to remove his blood with a machine to cool it. He wasn’t showing signs of brain activity.
“We weren’t sure for the first couple days like if he was going to make it and if he did how much was going to be left,” she said.
Eventually, Azuela did wake up with his brain intact. Now three years later, he’s made a full recovery.
But it’s a cautionary tale of heatstroke that his mother knows few here get to tell.
“It becomes too late very quickly,” she said.
In 2017, the Phoenix area hit a new record: more than 155 heat fatalities and the final tally could be even higher.
City leaders are taking notice. Earlier this year, former Phoenix Mayor Greg Stanton deemed it “a public health crisis.”
“Thousands more are getting sick. And worse, it’s our most vulnerable people and low-income neighborhoods are most at risk,” Stanton said. “In fact, nine of the 10 hottest years ever recorded in our city occurred in the last 15 years.”
The alarming trend has set the city on a major overhaul of how it deals with extreme heat.
Just as cities have comprehensive plans for the hurricane season, so too will Phoenix for heat — better alert systems, carefully coordinated response plans and a safety net for those susceptible to extreme heat.
“Heat is like a silent storm,” said Mark Hartman who is head sustainability officer for Phoenix.
Conveying the danger poses a unique challenge in a place where heat is such a part of life. It’s both a chronic and extreme threat. The city has the distinction of more than 100 days above 100 degrees.
While the scorching climate isn’t new for the city, Hartman says there hasn’t been a holistic approach to the issue.
“Our goal is to actually say to be heat ready here are all the things you need to do,” Hartman said.
The final plan will outline strategies for keeping people safe and lowering the temperature in places most prone to heat.
“In the long term, we want to cool our city by X number of degrees over what it would have been,” Hartman said.
That target is still up in the air. However, millions of dollars could be riding on what the city puts together.
Phoenix is competing with dozens of cities across the country in the Bloomberg Philanthropies’ 2018 Mayors Challenge. From rising sea levels to street repairs, cities are piloting plans to solve a specific urban issue.
Four cities will win $1 million. The top city gets $5 million to put its plan into action.
Hartman says Phoenix is hardly the only metropolis wrestling with warming temperatures, even unlikely places like his hometown of Vancouver.
“We’d like be a subject matter expert on heat among all cities,” Hartman said.
The Growing Death Toll Of Phoenix’s Heat
By 2100, the summertime is expected to resemble the 114 degree averages found in Kuwait, according to modeling by Climate Central.
Already, the city has six more days above 110 degree than it did in 1970, although the all-time record of 122 degrees has held since 1990.
Heat deaths peak during July, but begin as early as May and last through September. That makes communicating the risks especially challenging, according to Dr. Rebecca Sunenshine with the Maricopa County Department of Public Health.
“People say, ‘I’ve lived here, I’m used to it,’” said Sunenshine. “But we see people who’ve lived here for 20 years and who hike all the time, die of heat-related illness.”
More than 480 people died outdoors in the county from 2006 to 2015. Trails and desert areas were the second most common place with more than 110 deaths.
Several years ago, the problem led Phoenix to consider closing down hiking trails when temperatures reached a certain threshold. But city leaders dropped the idea after substantial pushback.
While it’s easy to fixate on the very hottest days, Sunenshine says most heat associated deaths happen on days with no extreme heat warning.
“People die in all different temperatures and it’s not dependent on how high it is, or how high the low temperature is,” she said.
When Joey Azuela nearly died from heatstroke, the high was only 103 — an average August day with no extreme heat warning.
Like any natural disaster, this persistent risk disproportionately affects the most vulnerable groups — the elderly, homeless and low-income.
Native Americans die at more than twice the rate of whites in Maricopa County.
About 40 percent of heat deaths last year occurred indoors. The victims are generally women, living alone and over the age of 75.
“Oftentimes, they won’t have their air conditioning on or it will be malfunctioning,” Sunenshine said. “Because they are older, their bodies aren’t able to detect differences in temperature.”
As part of its heat planning, Phoenix is looking at installing heat alert systems in the homes of elderly residents. Ideally, those could notify first responders and volunteers when the temperature inside a home reaches a worrying level.
Outdoors, heat predominantly kills men and the homeless are at the greatest risk.
Last year, Sunenshine says about a third of heat related deaths were among homeless individuals.
On an early June afternoon, Jowan Thornton is scanning a downtown park with his shades on and an orange bucket filled with waters in hand.
Temperatures are forecast to break 110 later that day.
“Hey, buddy. Can I get you some water?” Thornton asks one man who’s taken shelter under a tree with his belongings.
Thornton, who works for the Salvation Army, is on the front lines of the effort to keep the city’s homeless population safe during extreme heat events.
“It’s disheartening … when you see so much need out there especially when it’s so hot,” he said.
In recent years, Phoenix and dozens of local groups have teamed up to expand the region’s heat relief network. Cooling stations are strategically dispersed throughout the Valley on street corners and inside buildings.
Others like Thornton crisscross the city and dole out supplies in places where the homeless gather to stay cool.
Nighttime lows in Phoenix have gone up an average nine degrees in the recent decades. It’s one of the most striking examples of how the urban heat island effect has warmed the desert landscape.
Thornton comes across one man who's fixing his bike and says he spends nights at the bottom of a dried up canal.
“It does heat up a lot,” he said. “You do the imitation swamp cooler — get clothes wet and hope you catch a good breeze.”
Janette Archer is a psychiatric nurse in Phoenix who works with the city’s homeless population.
“The ground stays really hot all night. It’s just dangerous,” she said.
“The ground stays really hot all night. It’s just dangerous.”
—Janette Archer, psychiatric nurse
Archer says she’s known several patients who’ve died from heat while living on the street. One patient died over the weekend while he was waiting for housing.
“They were going to move into housing on Monday and this was a Friday,” she said.
Hot, But Just How Hot?
David Hondula says undoubtedly Phoenix’s future is hot. But just how hot?
Much of that, he says, is still within our control.
“This really is the extreme case,” said Hondula, assistant professor at Arizona State University’s School of Geographical Sciences and Urban Planning. “If they are successful here, then they can be successful anywhere.”
Hondula says roughly a third of people who live in the Phoenix metro area experience some kind of adverse health effect in the summer months. Surveys suggest more than 1 million people are too hot inside their homes.
“We have more of these days that are at, near, or slightly above some of the key thresholds for public health,” he said.
Hondula attributes about half of this to climate change and the other half to the built environment — the miles of parking lots and wide roads, low buildings and air conditioners.
Reversing this urban heat island effect will require a major shift in how the city grows in the coming years.
“We have a lot of asphalt surfaces that are mostly unused most of the year.” Hondula says. “We have cars and ACs operating everywhere. All those machines are dumping heat into the environment.”
Not everything will be a trade-off, though.
Existing infrastructure can be converted. Roads can be repaved with permeable materials and roofs can painted white or other reflective surfaces. Hondula says the jury is still out on whether painting roads white is the best method, though.
If done properly, Hondula says these change could even offset some of the consequences of climate change.
The best metric of success isn’t surface temperatures, though. He says it’s how comfortable people feel as they move around the city every day.
Searching For Shade
Any newcomer to the Phoenix summer quickly discovers the best parking spot isn’t the one close to the entrance. It’s the one next to the tree.
Creating more shade is a key part of Phoenix's plan to not only lower the number of heat-related deaths, but to also simply keep people cooler in their daily lives.
The city aims to have 25 percent shade cover by 2030, but it's still far from that goal. So on a recent afternoon, city employee Michael Hammett is working a line of people at a bus stop, peddling another option.
"Have you ever used an umbrella for heat?" he asked Deb Neild. A bit puzzled, she says she's used umbrellas mainly for rain. But she agrees to give it a try.
Hammett pops open a black UV-protected umbrella and hands it to her. Neild is surprised when the effect is almost immediate.
"Definitely cooler already," she said. "I can feel it."
When Hammett presses, she says she probably would use it for relief from the heat, and he lets her keep it. Others are less interested. It's too cumbersome, they say, or they just don't see the benefit.
The umbrella trials are one of many efforts to gauge how people might change their behavior to better protect themselves from heat.
In Phoenix, low-income neighborhoods suffer disproportionately from extreme heat.
Researchers at ASU have observed in some cases more than a 10 degree difference between neighborhoods less than two miles apart. Areas with more trees and vegetation fare better.
And the city’s Hispanic population is especially vulnerable — a problem that has only become more pronounced over time according to studies.
On a recent day, Maggie Messerschmidt of the Nature Conservancy is going door to door in one such area just east of Phoenix. There are few trees, lots of gravel, bare yards.
"We want to learn how to better cope with the heat together," she explained to one woman who lives nearby.
That begins with collecting heat stories from locals, she says.
"Based on that, we are going to come up with a list of priorities for the neighborhood," Messerschmidt said.
Many here are renters, so they haven't invested in shade. One man tells Messerschmidt that he plans to buy houses to rent out, and he is not sure planting trees and shrubs would be worth it.
"If it costs me an extra $300 more to maintain the homes because of the landscaping we put in, I'm not making a dime," he said.
Messerschmidt floats the idea of a financial incentive to encourage property owners to add cooling landscaping before she moves on.
Aimee Williamson of the local nonprofit Trees Matter says the whole mindset around trees needs to change, especially in a place where palm trees often pass as offering shade.
“[Trees] should be looked at as infrastructure and prioritized financially in that way. It's kind of a form of preventive health.”
— Aimee Williamson, nonprofit Trees Matter
"They're not just something that should be lumped into parks," said Williamson. "They should be looked at as infrastructure and prioritized financially in that way. It's kind of a form of preventive health."
On another street, Messerschmidt meets a woman who wants a change at bus stops.
"The seats are metal," she said. "How the heck are we not supposed to burn ourselves on the metal?"
Others ask about a fountain, a place for kids to cool down as they walk home from school.
ASU researcher Hondula has other ideas. He says roads can be repaved with permeable materials, and roofs can be painted white or made of other reflective surfaces. If done properly, Hondula says these changes could even offset some of the consequences of climate change.
Later this year, all these suggestions and others will be vetted for a final action plan. It might even include a specific, measurable target by which to lower the local temperature. Phoenix hopes it can lead the way, as cities across the country face summers that are longer and hotter.
This story is part of Elemental: Covering Sustainability, a new multimedia collaboration involving Cronkite News/Arizona PBS, KJZZ, KPCC, Rocky Mountain PBS and PBS SoCal, and part of ongoing Colorado River coverage in partnership with KUNC in Colorado.