Summer now spells fear for some as study shows poverty carried highest risk of death in the BC Heat Dome

When BC was smothered by a blanket of oppressive heat in late June 2021, Q Lawrence and their roommate began sleeping on the coolest place they could find: the kitchen floor.

Temperatures in their Fraser Valley community, Chilliwack, soared to record highs, reaching above 40 C for days at a time.

“I felt really, really trapped,” Lawrence recalled. “The house built up temperature throughout the day, and at night there wouldn’t even be a subtle drop. It would just stay the same temperature, and then it would start building again the next day.”

The 26-year-old gets by on less than $1,400 a month in disability assistance from the BC government, with small additions from teaching disability rights workshops, so buying an air conditioner was out of reach. The smoke from wildfires made it risky to open the windows or stay outside for long periods of time.

The consequences were deadly for hundreds of British Columbians. An estimated 619 people died from the heat during the 2021 heat dome — Lawrence knew three.

That’s why they say it’s no surprise to learn that poverty was the highest risk of death during the heat dome, putting people at greater risk than any chronic health condition or disability, according to unpublished research from the BC Center for Disease. Control (BCCDC) .

“I think it’s not surprising to most poor people. We’re aware of how much community death we’re surrounded by,” Lawrence said.

“It’s angry because this is something that can be changed. It’s something that is an external factor that is actually, with enough political will, changeable.”

The findings prompt calls from lawyers, scientists and doctors for governments to do more to protect people from the extreme heat that is becoming more common as a result of human-induced climate change. That includes going beyond a recent government commitment for air conditioners to create permanent systems that supply units to people who can’t afford them, improve building standards and set maximum allowable temperatures for indoor spaces.

Sarah Henderson, the BCCDC’s scientific director of environmental health services, said it was imperative to act now.

“I’m scared of summer,” she told CBC News. “They describe this as a one-in-1,000-year event. So at risk.”

Those who died twice as often are poor

The BCCDC’s new research shows that people who died during the heat dome were more than twice as likely to receive government income support than a comparable sample of people who survived.

“That was the greatest risk factor for mortality during the heat dome, followed closely by evidence of schizophrenia,” Henderson said.

The vast majority of these deaths occurred indoors, in private homes, she added. The BCCDC has tracked data from smart thermometers showing that in homes without air conditioning, temperatures remained dangerously high at night for days during the heat dome, as opposed to outside, where there was some relief.

The chance to cool off at night is key, because without it, the body faces additional tax try to regulate body temperature.

To determine which of the 619 deaths depended on government assistance, the researchers used data from BC’s Pharmacare program, which tracked prescriptions filled in the previous year.

They were able to tease whose prescriptions were paid under “Plan C“which covers the full cost of eligible medicines for people receiving benefits and income assistance through the Ministry of Social Development and Poverty Alleviation.

About 15 percent of people who died during the heat dome had prescriptions filled through Plan C, compared to six percent of those who survived.

Henderson said there could be a number of reasons for this discrepancy. People living below the poverty line are more likely to be disabled and live in substandard multi-unit housing with little control over indoor temperatures, and they often lack the resources to take emergency action during a crisis.

“If I get really hot in my house, I’ll go out and buy an air conditioner,” she said.

“We need to be very clear that those options are not available to a very large segment of the population.”

Joan Casey, an assistant professor at the University of Washington School of Public Health in Seattle, described the BCCDC’s study of poverty and heat-related deaths as “perfect.”

Casey also tracks deaths from extreme heat in the Pacific Northwest, saying the BC findings illustrate a fundamental truth about climate change.

“It’s really going to exacerbate existing health inequalities,” she said. “We really need to cling on and start taking this seriously because we’re going to see this broadening more than ever. [between] who can stay healthy and who will get very sick or die unless we take steps as a society.”

She recently published research with a spike in injury deaths in Washington state during the heat dome — things like gun violence, drownings and car accidents not directly related to heat exposure. Casey’s team found 159 additional deaths from injuries over three weeks during the 2021 heat wave compared to previous years.

According to the provincial coroner, similar investigations in BC have yet to be completed.

But Casey said previous research has shown an increase in violence, collisions, workplace accidents and alcohol consumption as temperatures rise.

“I wonder what this will look like in the future if we don’t take steps to slow climate change and respond to really extreme temperatures, especially for people who are really vulnerable,” she said.

AC pledge government ‘definitely inadequate’

In the two years since the tragic events of the heat dome, there has been increasing demand for government funding for air conditioning in homes in a province where it was not traditionally required. Just over a third of all BC households will have air conditioning by 2021, compared to 84 percent in Ontario, according to Statistics Canada.

On Tuesday, Health Secretary Adrian Dix announced $10 million for BC Hydro about 8,000 air conditioners to medically vulnerable low-income households over the next three years. He said that, including some other programs operated by the public utility, a total of about 10,000 units will be made available.

Asked if this would be enough to meet the need, Dix replied, “Our view was that this would be an important place to start. It’s a very significant investment.”

But Vancouver physician Dr Karina Zeidler described the commitment as “grossly inadequate.” An estimated 382,000 British Columbians live in povertyaccording to the BC Ministry of Social Development and Poverty Alleviation.

Last summer, Zeidler tried to get the province to fund air conditioning for a patient with a disability a provincial program that covers the cost of medical devices, but she was rejected. She said she plans to try again this summer.

“I would love to see money immediately released for low-income or medically vulnerable people to pay for medical refrigeration,” Zeidler said.

Henderson described the proposal to offer air conditioners as medical devices through existing provincial programs as an “excellent idea”.

The city of Toronto, for example finances portable air conditioners for low-income people with certain medical conditions.

The BC government revised the idea in response to the June 2022 recommendations of a coroner’s death review panel, with findings expected to be public by December 1, 2022. That didn’t happen. The Health Department told CBC News it expects to complete its review by the end of June, but did not respond to questions about when it would be released to the public.

‘Summer is a time of fear and anxiety’

Henderson argues that there are a number of policy options governments across Canada should consider in response to these troubling findings.

That could include improvements to building design, with additions such as shutters and awnings to keep out some of the heat, as well as more green spaces in urban settings. BC also has improved the emergency warning system to warn residents of extreme weather.

But Henderson believes those measures won’t go that far.

She said she would like to see standards across the country for maximum allowed indoor temperatures.

“It is generally accepted that houses should not be colder than 18 degrees in winter. Now we have to generally accept that houses should not be warmer than 26 degrees in summer,” she said.

Some advocatesmeanwhile have called for maximum indoor temperatures of 23 degrees.

The BC Department of Housing says work is now underway to update the county’s building codes, including new cooling requirements. It is considering a proposal that would require any new residential building to provide at least one living space designed not to exceed 26 degrees.

As for Q Lawrence, she and their roommate now have an air conditioner strong enough to cool one room in their home, thanks to fundraising efforts. They want the same for all disabled and impoverished British Columbians, including those who are not fortunate enough to receive the strong community support they enjoy.

“There’s this idea that air conditioning units are bad for the environment, which is why I’m saying the life of disabled people isn’t on the chopping block,” Lawrence said.

But the heat dome has had a lasting effect on their health. Lawrence said pre-existing conditions in their lungs and skin were exacerbated by the heat, and even two years later they have not fully recovered.

Between the wildfires, smoke, drought, extreme heat and flooding that have hit BC in recent years – all linked to climate change – summer is no longer a source of joy for Lawrence.

“Honestly, summer is a time of fear and anxiety right now,” they said.

“Other people talk about the things they feel like doing in the summer. They talk about swimming, going to the beach, getting outside and traveling, and I think about who in my community is going to die and what it’s going to do for my health and that of my friends.”