During the summer of 2003, 70,000 people died from a series of heat waves that crawled across the European subcontinent. Every one of these deaths was preventable, requiring only inexpensive building adaptations and social supports for the vulnerable. Under global warming, extreme heat events will only get worse. The Inter-Governmental Panel on Climate Change (IPCC), an international group of climate change experts, predicts with high confidence that heat waves will increase in frequency, duration, and intensity in the coming years. These changes would increase the likelihood of heat wave disasters on magnitudes larger than humans have ever experienced before.

Heat waves don’t often gain national attention, because they don’t create scenes of apocalyptic property destruction that crosses socioeconomic lines. Instead, they silently torture and kill the most stigmatized, marginalized and poor: the elderly woman too afraid to leave her building; the disabled man unable to call for help; or the impoverished family unable to pay their electric bill. From growing wealth inequality and social isolation to aging and the proliferation of chronic diseases, more people are now vulnerable to extreme heat than ever before, at a time when temperatures worldwide are rising. And we may be running out of time.

A recent letter in Nature magazine, written by six leading climate change and policy experts, states that we only have until the year 2020 to rapidly cut emissions or face irreversible changes, changes that could jeopardize human survival, and accelerate an already underway sixth mass extinction event. The public health community has an urgent calling, nay, a duty to act now to help the most vulnerable and prevent irreversible changes to our climate. This will require mass action to hold our elected leaders accountable to rapidly reduce emissions and scale up public investment in long-term heat adaptations. It won’t be easy, but then again when has changing the world ever been easy?

Long ago humans first recognized the dangers of heat waves, and effective adaptations have been around since humans first inhabited the deserts and tropical regions of the world. What continues to endanger millions of people from extreme heat is not a lack of awareness or solutions, but a lack of leadership willing to address the root causes of why so many people don’t have the means to adapt. Equitable public adaptations are the only way to survive a warming planet with our humanity left intact.

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Critics of equitable public-sector investment argue that a de-regulated “freer” market is more efficient at providing services and distributing resources than the government. However, the private sector is dependent on increasing profits, which creates incentives for cutting corners, increase prices, reduce wages, lay off workers, and seek backdoor deals – all which decreases accessibility for the poor. This was a starkly apparent feature of Eric Klinenberg's investigative book Heat Wave: A Social Autopsy of Disaster in Chicago that showed that during the summer of 1995, it was people living in poor Chicago communities gutted by public disinvestment and dependent on inaccessible private services, that made up a disproportionate number of the 739 deaths.

As more Americans become straddled with debt, simple and sustainable adaptations such as installing better insulation in a home or purchasing an air conditioner will become less accessible. This deterioration of economic life has also had grave social consequences. Many Americans are forced to work longer or take second jobs, reducing their capacity to check on elderly neighbors, sick friends, or disabled family members during a heat wave. The last time wealth inequity was where it is today, reviled "robber barons" like John D. Rockefeller first created corporate empires that ushered in a century of global fossil fuel addiction. Such vast accumulation of wealth into the hands of only a few billionaires removes money from circulation and threatens to replace our democratically driven public sector with the generosity of unaccountable philanthropic foundations.

One potential solution to this backslide would be to replicate the public investments of the 1930s, which helped pull the U.S. out of the Great Depression. This would require a New Deal policy fit for the 21stcentury, prioritizing equitable climate change adaptations and a rapid transition to renewable energy, paid for through a progressive tax and government subsidies. Public utilities, public infrastructure, and public spaces have largely deteriorated under the rollback of our public institutions and would need to be heavily invested in and updated. For addressing a future of worsening heat, these reforms would need to include the creation of green spaces in every urban center and neighborhood; subsidies for families to retrofit their homes with energy-efficient air conditioners and evaporative coolers; and outreach and support for the most isolated, destitute, and disabled.

An increase in extreme heat deaths is projected to threaten millions of additional people over the next thirty years. Without a rapid upsurge in political will that leads to sweeping wealth redistribution, climate change adaptations, and emission reductions, hundreds of thousands could face premature and agonizing deaths. Each preventable heat-related death is the manifestation of deep-seated inequities within our society. Massive long-term heat adaptations and rapid emissions reduction are tantamount requirements for our civilization to survive and prosper. The public health community has a duty to look beyond simply the symptoms of our economic system and instead advocate for changes that improve the lives of everyone, for generations to come.