Heat kills. This underfunded program could help

By Ariel Wittenberg | 08/23/2021 11:57 AM EST

Access to air conditioning is considered key to preventing heat-related illness and death. CasarsaGuru/iStock

Heat kills in the big city. So does lack of air conditioning.

Of the roughly 70 New Yorkers directly killed by heat exposure in their own homes over the past decade, the majority — some 80% — did not own air conditioners, and those who did weren’t running them when they died.

“It is striking,” said New York City Health Department senior environmental epidemiologist Kathryn Lane. “It is so consistent, but it is so preventable.”

Broader access to air conditioning could save lives in a city where climate models predict heat waves will quadruple from an average of two per year prior to 2000 to up to seven annually by 2050.

Though most city residents own air conditioners, the 10% who don’t are concentrated in low-income and minority neighborhoods made hotter by historic disinvestment and unfair housing practices. They’re also more likely to be elderly or suffer from chronic conditions, making them more vulnerable to heat.

That’s where the federal Low Income Home Energy Assistance Program could come in. Established 50 years ago, the program helps subsidize heating and cooling costs for cash-strapped families, prioritizing the elderly and those with young children or disabilities. But the $3.6 billion program has been chronically underfunded, so far helping just one in six eligible households.

Each state decides how much of its LIHEAP funding to spend on each need. Given limited funds, New York spends just 1% of its allocation on air conditioning assistance.

“We need sustainable cooling in the homes, and we need bill assistance to make that happen,” said Sonal Jessel, policy director at the community organization WE ACT for Environmental Justice. “Cooling is a human right, but in New York City, it’s a luxury.”

Heat is not an equal opportunity killer. Black New Yorkers are more than twice as likely to die from heat — and lack of air conditioning — as those of other races.

Lane says that’s for a variety of reasons, most of which boil down to structural and systemic racism.

“There are individual risk factors that can make someone more vulnerable to heat, and there are neighborhood-level factors,” Lane said. “Many of our communities of color suffer both at the same time.”

‘Vulnerable people in vulnerable areas’

Heat can kill directly, by overheating and dehydrating a person and causing heat stroke, or indirectly, by exacerbating underlying health problems. The latter is a significant killer in New York City, where Health Department models estimate an additional 100 people die annually from just that.

Research shows people of color are more likely to suffer from chronic conditions like diabetes or cardiovascular disease, which can be exacerbated by systemic problems like lack of access to adequate medical care or nutrition, thereby making them more vulnerable to heat-related health problems.

What’s more, Black New Yorkers are more likely to live in so-called heat islands, areas where vast amounts of concrete and lack of green space conspire to increase temperatures up to 10 degrees higher than in other, wealthier parts of the city. Those heat islands are frequently located in areas where city and state investment has been lacking, resulting in housing that is poorly insulated and ventilated, or other factors beyond residents’ control.

The ability to cool down at night, and let the body rest, is a key means of combating heat stress. But those heat islands have become particularly problematic now that climate change means nighttime temperatures aren’t cooling down as much as they used to. People without air conditioning who might usually open their windows to cool down in the evening aren’t able to do so as effectively anymore.

“You get used to hearing people refer to the most vulnerable areas of the city as low-income and Black and brown, but it really is shocking when you see the spatial overlap of where Black and brown communities live, the air conditioning adaptation and the very high heat,” said Timon McPhearson, who directs the Urban Systems Lab at the New School, which maps heat vulnerability in the city. “It’s long-term systemic racism that has put the most vulnerable people in vulnerable areas.”

City officials are working to increase air conditioning access and save lives.

“We see air conditioning as a critical tool in preventing heat illness and death,” said Jainey Bavishi in June. At the time, she worked in the Mayor’s Office of Climate Resiliency, but she has since been tapped by President Biden to a key leadership post at NOAA.

The coronavirus pandemic underscored the need for in-home air conditioning last summer by rendering unsafe communal cooling centers, which had been a popular strategy nationwide for keeping folks safe during heat waves.

Last year, the city used federal coronavirus relief funds to provide some 74,000 free air conditioning units to low-income seniors throughout the city, targeting those living in heat islands. Working with advocacy groups like WE ACT, it also convinced the state Public Service Commission to partially subsidize cooling costs and provide roughly $40 per month over four months to 400,000 families struggling to pay their utility bills.

Though air conditioning can contribute to climate change by releasing greenhouse gases, Bavishi says increasing access to it is a critical tool, along with increasing green spaces and other efforts.

“Some of the interventions we are trying to implement at a neighborhood scale, they take time to play out. If you plant a tree, it takes a while for it to mature and provide enough shade to make neighborhoods cool down,” Bavishi said. “In the meantime, air conditioning is a lifesaving strategy.”

One-time city programs aren’t enough to meet the need, says Bavishi: “When there’s no pandemic funding, we rely on LIHEAP to provide energy and cooling assistance for the most vulnerable members of our community.”

“But the program needs to be updated to reflect the changing climate.”

‘Heat kills just as effectively’

Created in the wake of the 1970s oil embargo, LIHEAP was initially meant to help families pay for heating fuel. The program has since expanded to include weatherization and summer cooling costs, but the lion’s share of LIHEAP’s $3.6 billion budget — some 47% — still goes toward heating.

Nationwide, an average of 618 people are killed by heat per year, according to the Centers for Disease Control and Prevention. But in fiscal 2019, just 8% of LIHEAP funds went toward cooling subsidies, less than was spent on the program’s administrative costs.

That’s largely because most northern states don’t even offer cooling assistance.

Critics of the program say states need to wake up to the threat of climate change, which will increase average temperatures nationwide. Even if the heat isn’t as intense in New York as it is in Phoenix, Ariz., the health implications could be just as extreme.

“Climate change isn’t just happening in the South, it is happening everywhere,” said Katrina Metzler, executive director of the National Energy and Utility Affordability Coalition. “We understand the need for cooling assistance, but it’s just not considered as critical as heating assistance even though heat kills just as effectively as the cold.”

The Big Apple is a perfect example. There, city models predict, the number of days per year with a maximum temperature at or above 90 degrees Fahrenheit is rising from a baseline of 18 days annually between 1971 and 2000 to an average of 57 days by midcentury.

That could be especially deadly as people living in traditionally cooler climates are less adapted to heat and fall ill at lower temperatures than their southern peers. In the South, hospitalizations from heat peak when the heat index rises above 100 degrees. In the Northeast, they peak at 90.

“The community members, they know this is a growing issue,” WE ACT’s Jessel said. “Heat health equity is a big problem because of climate change.”

Though New York spends just 1% of its $375 million in LIHEAP funding on air conditioning assistance, the Empire State is actually an outlier in the Northeast for spending any LIHEAP funds on cooling at all.

Under rules set by the New York Office of Temporary and Disability Assistance, the state provides households meeting financial eligibility requirements who also have someone suffering from a medical condition exacerbated by extreme heat with air conditioning units.

All told, more than 28,000 households in the state have benefited from the assistance over the last five years, spokesman Anthony Farmer said.

“Our cooling assistance program is designed to assist those most at risk of experiencing the effects of climate change and rising temperatures by focusing on New Yorkers with medical conditions that are exacerbated by extreme heat,” he wrote in an email. “The program is designed to provide help to vulnerable, low-income households as insufficient cooling can cause serious health and safety issues.”

While New York’s LIHEAP helps households purchase and install air conditioners, it doesn’t pay their electric bills.

That’s a serious oversight, according to New York City officials and community activists.

“The problem is that people don’t turn it on or keep it on long enough,” Jessel said. “Their bills are $300, $400 a month, really high, in the summer, and people can’t afford that even if it’s hot.”

Farmer did not directly answer questions about why the state does not provide bill assistance for cooling, only for heating, but wrote in an email that low-income families needing help with utility bills could apply for other LIHEAP funds, like for heating during the winter.

He also implied that the program is strapped for cash, writing, “New York continues to advocate for additional LIHEAP funds.”

Jessel agreed that the program needs more funding.

“The reason we are focused on LIHEAP is that it is a program that has existed for the past 50 years, it is a sustainable force,” she said.

‘Work to do’

The Biden administration recognizes that heat kills, particularly people of color. Speaking in June at an online event as record-breaking heat pummeled the Pacific Northwest, White House climate adviser Gina McCarthy discussed the lack of air conditioning in such a temperate region.

“People are not going to be able at some point in time to live without air conditioning that allows them to actually survive in the kind of temperature extremes that we’re facing,” she told the Milken Institute’s Future of Health Summit. “We have a lot of work to do.”

McCarthy’s comments echoed a letter sent by Health and Human Services Director of Office of Community Services Lanikque Howard to states reminding them that they could choose to increase funding for cooling programs “to mitigate the risks of weather events, including this and future heatwaves,” noting that “the threat of extreme weather is disproportionately felt by communities of color, lower-income households and vulnerable populations, such as aging adults, as they are more likely to live in ‘urban heat islands,’ and are often unable to afford adequate air conditioning.”

And late last month, the administration also established an Extreme Heat Interagency Working Group co-chaired by the heads of EPA, NOAA and the Department of Health and Human Services.

Yet for all its recognition that heat kills — and its emphasis on environmental justice — the Biden administration has not proposed any significant funding boost for LIHEAP.

The administration’s request of just $200 million more than current funding is not enough to meet all of the current need, let alone accommodate northern states that may want to provide cooling subsidies in addition to helping families heat their homes.

The problem dates back years. In 2015, Oregon decided warming temperatures due to climate change meant the state had to help needy families pay debts from cooling costs, not just heating costs. But the state’s LIHEAP allocation has actually shrunk since the change was made, from $38 million to $36 million.

Dan Elliott, a senior policy analyst at Oregon Housing and Community Services’ Housing Stabilization Division, says cooling needs are so great, the state believes offering assistance during the summer will actually offset some heating assistance requests in the winter. But that’s no substitute for more money, especially in a state recently battered by unprecedented heat domes.

“We need more funding, we need more money to accommodate the changes in the climate,” said Elliott.

LIHEAP has benefited from recent coronavirus relief and stimulus funding packages, which boosted the program by $4.5 billion. Some northern states have used the money to provide cooling assistance for the first time. That includes New York, which has spent $15 million on cooling the last two years as a result — nearly tripling the amount it can usually allocate.

Though the funding is a welcome addition, predictability is key for a program tasked with helping families on the brink of eviction or electricity shutoffs.

“It’s troubling because if you offer cooling in one year and not the next, that’s hard for families who are counting on it,” said Liz Berube, whose group Citizens for Citizens Inc. helps Massachusetts dole out its LIHEAP funds. “People start hoping they could pay their bill, but then are faced with termination from the utility when we don’t have the money the next year.”

Program advocates on Capitol Hill are pushing appropriators for a billion-dollar increase — to $4.7 billion — arguing the dual menaces of economic recession and climate change necessitate more funding.

“LIHEAP is about protecting vulnerable people from extreme weather,” said Rep. Peter Welch (D-Vt.). “Right now the severe weather is the heat.”

Such a surge would be widely celebrated by LIHEAP state administrators and clients alike.

“There is a social justice and equity issue in energy affordability,” said Mark Wolfe, executive director of the National Energy Assistance Directors Association. “And it’s not just about affordability, it’s public health.”