This summer alone, extreme heat will cause $1 billion in U.S. healthcare costs | This story was originally published by Grist

All that heat is bad for human health and leads to a rise in hospitalizations for cardiovascular, kidney, and respiratory diseases, particularly among the urban poor, who often lack access to air conditioning and green spaces. 

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The Health Care Costs of Extreme Heat 

• Those hospitalizations will come with a hefty price tag. 
• A new report from the public policy research group Center for American Progress estimates extreme heat will create $1 billion in health care-related costs in the United States this summer. 
• The analysis, provided exclusively to Grist, projects that excessive heat will spur nearly 235,000 emergency department visits and more than 56,000 hospital admissions for conditions related to increased body temperature across the country this summer.

Justin S. Mankin, an assistant professor in Dartmouth University’s geography department who was not involved in this report and published a separate study last year on the economic impact of heatwaves in the U.S., acknowledged that the report is part of an essential effort to quantify the health care burden associated with extreme heat. 

But he said the methods the report’s authors used didn’t paint a complete picture, noting that a more comprehensive assessment of the economic toll of heat would have also accounted for the costs that pile up in the “weeks, months, and even years after an extreme event,” not only while the event is happening, as the report does. 

• 07-05-23

This summer alone, extreme heat will cause $1 billion in U.S. healthcare costs

Excessive heat will spur nearly 235,000 emergency department visits and more than 56,000 hospital admissions across the country this summer.

NRDC

Climate Change and Health: Extreme Heat

BY ZOYA TEIRSTEIN—GRIST5 MINUTE READ

This story was originally published by Grist. Sign up for Grist’s weekly newsletter here.

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Extreme heat—summertime temperatures and humidity that exceed the historical average—is being made more frequent and intense by climate change. In the first two weeks of June, a late-spring hot spell prompted schools in the Northeast, Mid-Atlantic, and Great Lakes areas to close or send students home early. A heat wave broke temperature records in Puerto Rico—the heat index (a measure of how temperatures feel to the human body) reached 125 degrees Fahrenheit on parts of the island. And extreme heat spurred deadly storms and power outages for hundreds of thousands of customers from Texas to Louisiana.
All that heat is bad for human health and leads to a rise in hospitalizations for cardiovascular, kidney, and respiratory diseases, particularly among the urban poor, who often lack access to air-conditioning and green spaces. Those hospitalizations will come with a hefty price tag. A new report from the public policy research group, Center for American Progress, estimates extreme heat will create $1 billion in healthcare-related costs in the United States this summer. The analysis, provided exclusively to Grist, projects that excessive heat will spur nearly 235,000 emergency department visits and more than 56,000 hospital admissions for conditions related to increased body temperature across the country this summer. 
“As the number of heat-event days increases, the probability that people are going to get rushed to the emergency room or get hospitalized increases,” said Steven Woolf, a senior fellow at the Center for American Progress, a professor of family medicine and population health at Virginia Commonwealth University School of Medicine, and a coauthor of the report. “We were interested in trying to quantify how big a risk that is.” 
Woolf and a cohort of academics, scientists, and doctors from Virginia Commonwealth University analyzed health insurance claims in Virginia during the 80 extreme heat days that occurred in the state, on average, every summer from 2016 to 2020. The claims were filed for emergency room visits, hospital admissions, and other medical care. They used that data to determine how many Virginians sought a doctor’s help during these heat waves compared to other days. The authors tallied up “heat-related illnesses,” defined as including heat cramps, heat exhaustion, and heat stroke, as well as “heat-adjacent illness”—dehydration, rapid pulse, dizziness, or fainting. 
In Virginia, extreme heat spurred some 400 outpatient care visits for heat-related illness, 4,600 emergency room visits for heat-related or heat-adjacent illness, and 2,000 heat-related hospital admissions each summer. These are likely underestimates, the report’s authors noted, since many patients with higher body weight or organ diseases such as heart disease, for example, experience complications during heat waves that could be classified as heat-adjacent illnesses but are rarely formally diagnosed as such by their physicians. And many victims of extreme heat don’t seek medical care at all, which further obscures the true burden of heat-related illness. 
The authors extrapolated from Virginia’s data to reach the conclusion that extreme heat will inflate healthcare costs across the nation by $1 billion every summer for the foreseeable future, an estimate Woolf said will probably shift as the breadth of research on this topic expands. The authors also found that the burden of extreme heat will be shouldered unequally by Americans. The costs will be felt most acutely in low-income and historically marginalized communities, where access to cooling resources such as air-conditioning is patchy and green spaces are scarce.
“People who live in nice neighborhoods, who have air-conditioned homes and tree-lined streets with plenty of shade,” Woolf said, “are protected from the heat in a way that doesn’t occur in a different part of town where there’s not much shade and people are less likely to either have air-conditioning and fans or to have the resources to pay the electrical bills.” 
These inequities point to a slew of possible solutions, starting with a recognition on behalf of local and state governments that neighborhoods need to become more resilient to the effects of extreme heat. Many cities are already adapting to protect people from climate change, Woolf said, including using building and roofing materials that reflect heat, passing laws that subsidize power bills for low-income residents, and planting trees—a relatively low-cost intervention that is surprisingly effective at bringing down street-level temperatures. Local emergency management officials could also do a better job of forecasting extreme heat so people have time to prepare, and public health officials could offer clearer communication about the symptoms of heat illness.
Justin S. Mankin, an assistant professor in Dartmouth University’s geography department who was not involved in this report and published a separate study last year on the economic impact of heatwaves in the U.S., acknowledged that the report is part of an essential effort to quantify the health care burden associated with extreme heat. But he said the methods the report’s authors used didn’t paint a complete picture, noting that a more comprehensive assessment of the economic toll of heat would have also accounted for the costs that pile up in the “weeks, months, and even years after an extreme event,” not only while the event is happening, as the report does. 
“I’d like to see more rigorous estimates of these costs using more sophisticated approaches,” he said. A more complete analysis would have looked at insurance claims from every state instead of nationally extrapolating from Virginia’s data. The problem is that many states don’t have what’s called an all-claims database, which is a full and public accounting of all of the emergency room visits and hospitalizations that occur in a given year. “If we had that for all 50 states, we could do this analysis for the whole country,” Woolf said.
The report, Woolf noted, also doesn’t take the ways in which heat may affect businesses, infrastructure, schools, and other aspects of American life into account. He called for more research on this topic. “The collective implications of severe weather are really rather intimidating,” he said. “They just strengthen the arguments for us needing to do something about climate change and to be proactive about it.”

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This article originally appeared in Grist. Grist is a nonprofit, independent media organization dedicated to telling stories of climate solutions and a just future. Learn more at Grist.org.

IN THIS ARTICLE

• Introduction and summary
• The health effects of extreme heat
• Factors that exacerbate the health consequences of extreme heat
• The increasing incidence of extreme heat
• Effects of extreme heat on health outcomes and the economy
• Effects of extreme heat on health care utilization
• The Virginia study
• Policy recommendations to address the impact of extreme heat
• Conclusion
• Acknowledgments
• Methodology

Alex Cervantes cools off with a drink of water during a heat wave in Panorama City, California, on September 9, 2022. (Getty/Mel Melcon)

Introduction and summary

Hot summer days have always posed a risk of health complications, but climate change is causing an increase in prolonged periods of extreme heat. With this has come a rise in incidences of heat-related illness, as more Americans experience health complications and need to seek medical care. The resulting increases in visits to physicians, visits to emergency departments, and admissions to hospitals will inflate U.S. health care costs.

To better understand the health impacts of extreme heat, the authors of this report used available data from Virginia to derive estimates of the increase in health care utilization—including emergency department visits and hospital admissions—and health care costs associated with extreme heat. Daily climate data collected from 15 weather stations that serve the state of Virginia show that during the five summers of 2016–2020, an average of 80 heat event days occurred per summer.1

Based on insurance claims data from Virginia’s all-payer claims database,2 the authors estimate that each summer, heat events resulted in:

• Almost 400 additional ambulatory—or outpatient—care visits for heat-related illness
• Almost 7,000 additional emergency department visits, including more than 4,600 visits for heat-related or heat-adjacent illness
• Almost 2,000 additional heat-related hospital admissions, mostly for heat-adjacent illness

Extrapolated nationally, heat event days would be responsible for almost 235,000 emergency department visits and more than 56,000 hospital admissions for heat-related or heat-adjacent illness, adding approximately $1 billion in health care costs each summer.

The growing threat of extreme heat requires all levels of government and the private sector to confront the fundamental crisis of climate change by taking action to reduce greenhouse gas emissions and to pursue policies that mitigate the effects of extreme heat and the emergencies it creates. These efforts are necessary across the United States, but especially in low-income neighborhoods, communities of color, and other settings where vulnerability to severe weather and climate change is greatest. This report makes the following policy recommendations to systematically address the challenges of extreme heat:

1. Reduce greenhouse gas emissions to slow climate change and rising temperature. Extreme heat and heat waves will increase unless governments and the private sector take decisive action to address climate change by shifting from fossil fuel use to clean renewable energy.
2. Establish and strengthen federal, state, and local governmental responsibilities for extreme heat protections. Public officials should adopt a whole-of-government approach to extreme heat—and climate change broadly—to facilitate coordinated, cross-sector action.
3. Improve data surveillance and prediction capabilities. Jurisdictions require more detailed and timely data, as well as improved modeling methods, to adequately track and predict heat events and their effects on public health.
4. Raise public awareness about the risks of extreme heat and protective measures. Long before—and during—heat emergencies, the public should receive clear, timely information about the dangers of extreme heat and how to avoid becoming ill.
5. Increase community resilience to extreme heat. Communities should increase tree canopy and take other steps to limit public exposure to extreme heat, as well as prepare comprehensive action plans to deal with heat emergencies in real time.
6. Strengthen health care services and early detection of heat-related illness. The public should receive information on the warning signs of, and have access to care for, heat-related illness, while health care systems should train providers on treatment guidelines as well as strengthen infrastructure to maintain services during heat waves and power outages.

Distinguishing between extreme heat, heat event days, and heat waves

Extreme heat refers to abnormally hot temperatures, often defined as temperatures above the 85th, 90th, or 95th percentile for that location.3 For example, a temperature above the 90th percentile means that the temperature in that location has historically been lower on 90 percent of days during that month or season.

Heat events, as used in this report, are general reference to periods of one or more days with extreme heat. This report discusses studies that refer to heat event days, a technical term referring to a specific combination of high temperature, humidity, cloud cover, windspeed, and other climatic conditions. Scientists use the Spatial Synoptic Classification to characterize various combinations of climatic conditions. In this report, a heat event day is one that meets criteria for “dry tropical” or “moist tropical” climatic conditions. (see Methodology)

Heat waves are a series of days with abnormally high temperatures that can be defined in various ways.4 For example, a heat wave in July or August could be defined as two or more consecutive days during which the temperature in a particular location exceeds the 85th percentile of historical temperatures recorded for those months over a specified period of years.