Welcome to zero. I am Aksha Darati this week how to beat the heat. In twenty twenty two, the UK had a heat wave like no other. This was the kind of heat wave that shuts down airports and forces railways to stop. Heat like this is rare in the UK, and Bloomberg reporter Olivia Rudgard was here in London covering it.

Welcome to zero. I am Aksha Darati this week how to beat the heat. In twenty twenty two, the UK had a heat wave like no other. This was the kind of heat wave that shuts down airports and forces railways to stop. Heat like this is rare in the UK, and Bloomberg reporter Olivia Rudgard was here in London covering it.

I remember cycling home. I stayed really late in the office and I cycled home probably about half past eight or nine o'clock at night. You know, it felt like a sort of middle of the day on a typical hot English summer's day, and I remember thinking, wow, this is something that's really new.

I remember cycling home. I stayed really late in the office and I cycled home probably about half past eight or nine o'clock at night. You know, it felt like a sort of middle of the day on a typical hot English summer's day, and I remember thinking, wow, this is something that's really new.

I grew up in India and I'm used to the heat, but here in England, hot sunny days like this one tend to be quite unusual. So while the dangers were real, the idea that an English summer day could be life threatening that was just hard to fathom for so many people.

I grew up in India and I'm used to the heat, but here in England, hot sunny days like this one tend to be quite unusual. So while the dangers were real, the idea that an English summer day could be life threatening that was just hard to fathom for so many people.

For obvious reasons. The cultural association of heat is holidays and ice cream and going to the beach and yeah, wearing little shorts. And there is something nice about leaving the house in the morning and thinking, oh, I know, I'm not.

For obvious reasons. The cultural association of heat is holidays and ice cream and going to the beach and yeah, wearing little shorts. And there is something nice about leaving the house in the morning and thinking, oh, I know, I'm not.

Going to need a jacket.

Going to need a jacket.

There are very few English days that are like that, and I think that is one of the big challenges for the authorities, like when they're trying to say, okay, well, we're not trying to be a total kill joy here. However, this is not a twenty five degree sunny day. You know. Forty degree heat is something that possibly people have never experienced before. And if you're in that all day and you have no respite, and especially if you have certain vulnerabilities, if you're older, if you have certain medical conditions, it's genuinely.

There are very few English days that are like that, and I think that is one of the big challenges for the authorities, like when they're trying to say, okay, well, we're not trying to be a total kill joy here. However, this is not a twenty five degree sunny day. You know. Forty degree heat is something that possibly people have never experienced before. And if you're in that all day and you have no respite, and especially if you have certain vulnerabilities, if you're older, if you have certain medical conditions, it's genuinely.

Really dangerous, really dangerous, and sadly increasingly common. Heat waves are considered silent killers. Unlike other disasters, they don't leave behind destroyed buildings, and yet they do kill thousands of people. It might be the kind of disaster that's most misunderstood and the world is least prepared for. As heat waves hit more places in more extreme ways, it's time we grappled with them with the seriousness they deserve. That's why this week is Heat Weak at Bloombergrain. Across the site, we have a series of stories about the surprising impact of extreme heat and some of the creative ways people around the world are dealing with it. But before that, Olivia tells me about a surprising strategy that meteorologists are considering to make us all pay more attention to super hot weather, giving heat waves a name Olivia. So far this year in the UK, we've not had much of a summer. There have been a couple of featwave warnings, but nothing like the summer of twenty twenty two, where I remember walking out from this air conditioned office to what felt like being in Delhi. There was this hot air that hit you and that was not something Brits were used to and it had some devastating impacts.

Really dangerous, really dangerous, and sadly increasingly common. Heat waves are considered silent killers. Unlike other disasters, they don't leave behind destroyed buildings, and yet they do kill thousands of people. It might be the kind of disaster that's most misunderstood and the world is least prepared for. As heat waves hit more places in more extreme ways, it's time we grappled with them with the seriousness they deserve. That's why this week is Heat Weak at Bloombergrain. Across the site, we have a series of stories about the surprising impact of extreme heat and some of the creative ways people around the world are dealing with it. But before that, Olivia tells me about a surprising strategy that meteorologists are considering to make us all pay more attention to super hot weather, giving heat waves a name Olivia. So far this year in the UK, we've not had much of a summer. There have been a couple of featwave warnings, but nothing like the summer of twenty twenty two, where I remember walking out from this air conditioned office to what felt like being in Delhi. There was this hot air that hit you and that was not something Brits were used to and it had some devastating impacts.

Right Yeah, I mean it was really an an unprecedented event, which feels like a word we use a lot in climate reporting nowadays, but I think it was really one of the first times that the authorities, the met Office, the health care system has had to cope with an event like that, and I think it was a real challenge. We're used in the UK too, gray overcast weather. Generally the average July temperature is like twenty degree and so there was a real difficulty in communicating to people, Hey, this isn't beach weather or park weather or going get an ice cream weather, especially if you're in a group that might be vulnerable, if you're older, if you have certain pre existing health conditions. This is genuinely very dangerous.

Right Yeah, I mean it was really an an unprecedented event, which feels like a word we use a lot in climate reporting nowadays, but I think it was really one of the first times that the authorities, the met Office, the health care system has had to cope with an event like that, and I think it was a real challenge. We're used in the UK too, gray overcast weather. Generally the average July temperature is like twenty degree and so there was a real difficulty in communicating to people, Hey, this isn't beach weather or park weather or going get an ice cream weather, especially if you're in a group that might be vulnerable, if you're older, if you have certain pre existing health conditions. This is genuinely very dangerous.

And the number of debts on that particular day in twenty twenty two was astonishing.

And the number of debts on that particular day in twenty twenty two was astonishing.

Right, there were several heat events that summer, so that wasn't the only heat event that summer. I believe it was roughly three thousand deaths that summer that were linked to heat. Because when you go to hospital with the heat related condition, it doesn't go on your death certificate that you died because of a heat wave. It's something else, you know, a cardiovascular event or something like that. They look at the sort of expected death for that period without something like that happening, and then it's called excess deaths. That's I think the best available way of working out what the mortality is in situations like that.

Right, there were several heat events that summer, so that wasn't the only heat event that summer. I believe it was roughly three thousand deaths that summer that were linked to heat. Because when you go to hospital with the heat related condition, it doesn't go on your death certificate that you died because of a heat wave. It's something else, you know, a cardiovascular event or something like that. They look at the sort of expected death for that period without something like that happening, and then it's called excess deaths. That's I think the best available way of working out what the mortality is in situations like that.

And last year was the hottest year on record, and this year is likely to be the hottest year, beating last year's record. The UK might have been spared, but there have been so many heat waves around the world. There was a pretty terrible one in Mecca during the Hudje there was a really bad one in India that led to many deaths, and especially in India, counting of debts and heat is not done well enough, and so it could have been thousands, but we don't know. One of the stories you're working on is trying to figure out whether heat waves should be named like we name hurricanes, and whether that can help reduce the impact heat waves have.

And last year was the hottest year on record, and this year is likely to be the hottest year, beating last year's record. The UK might have been spared, but there have been so many heat waves around the world. There was a pretty terrible one in Mecca during the Hudje there was a really bad one in India that led to many deaths, and especially in India, counting of debts and heat is not done well enough, and so it could have been thousands, but we don't know. One of the stories you're working on is trying to figure out whether heat waves should be named like we name hurricanes, and whether that can help reduce the impact heat waves have.

Yeah, I think this is a debate that's been going on in the sort of meteorological community for quite a few years, and I think, you know, the people who are sort of pushing this idea have really picked up on a big problem for heat communication, which is that even in places where you don't have the cultural issues that you have in the UK, it's difficult to communicate I think clearly the risks and potential implications of overheating. It's not like a hurricane or a typhoon or an earthquake where you can see buildings falling over, and it's not something you can visibly see. So I think that the idea is to communicate a sense of the emergency and the immediacy of the risks, and also to kind of, I suppose, make it into something that people are likely to sort of like to stick in their brain, so something that's more tangible.

Yeah, I think this is a debate that's been going on in the sort of meteorological community for quite a few years, and I think, you know, the people who are sort of pushing this idea have really picked up on a big problem for heat communication, which is that even in places where you don't have the cultural issues that you have in the UK, it's difficult to communicate I think clearly the risks and potential implications of overheating. It's not like a hurricane or a typhoon or an earthquake where you can see buildings falling over, and it's not something you can visibly see. So I think that the idea is to communicate a sense of the emergency and the immediacy of the risks, and also to kind of, I suppose, make it into something that people are likely to sort of like to stick in their brain, so something that's more tangible.

But this is no longer just an academic debate because there are places that have tried to do this correct.

But this is no longer just an academic debate because there are places that have tried to do this correct.

There's been one peer reviewed study that's come out now which was about the city of Seville in Spain which named a few heatwaves in twenty twenty two. And the study is about heat wave Zoe, and they kind of found that, yes, among the people who were aware of this name, there was a sort of heightened understanding of what they should be doing in a heightened level of trust, and a few other people that are looking at doing it. There was a heatwave last year that was jointly named by three meteorological organizations in the sort of south of Europe. Greece, Israel, and Cyprus all co named heat wave and they called it Cleon. It was a small percentage of people that remembered it, but among those people, the level of understanding of what to do and the level of trust in the authorities was higher. But yeah, it was only six percent of people who unprompted remembered it.

There's been one peer reviewed study that's come out now which was about the city of Seville in Spain which named a few heatwaves in twenty twenty two. And the study is about heat wave Zoe, and they kind of found that, yes, among the people who were aware of this name, there was a sort of heightened understanding of what they should be doing in a heightened level of trust, and a few other people that are looking at doing it. There was a heatwave last year that was jointly named by three meteorological organizations in the sort of south of Europe. Greece, Israel, and Cyprus all co named heat wave and they called it Cleon. It was a small percentage of people that remembered it, but among those people, the level of understanding of what to do and the level of trust in the authorities was higher. But yeah, it was only six percent of people who unprompted remembered it.

But it's not like just because a hurricane has been named that people prepare to deal with the hurricane in say the Caribbean or in Florida. They just do because they know they get hurricanes and they know what to do when a hurricane hits.

But it's not like just because a hurricane has been named that people prepare to deal with the hurricane in say the Caribbean or in Florida. They just do because they know they get hurricanes and they know what to do when a hurricane hits.

Yeah, I mean, this is the central tension of the argument, right, Like a lot of the people I've talked to, you say, there are a whole bunch of other things we could be doing to help people prepare better, make them better equipped. Awareness cannot be the viewell and end all.

Yeah, I mean, this is the central tension of the argument, right, Like a lot of the people I've talked to, you say, there are a whole bunch of other things we could be doing to help people prepare better, make them better equipped. Awareness cannot be the viewell and end all.

So moving beyond awareness, the question of what we as individuals and as a society need to do when super hot weather descends. That's exactly what Howard emergency medicine physician Renee Salas has been working on. Renee tells me what extreme heat does to the body and how the entire healthcare system needs to adjust to our new reality. Renee, welcome to the show.

So moving beyond awareness, the question of what we as individuals and as a society need to do when super hot weather descends. That's exactly what Howard emergency medicine physician Renee Salas has been working on. Renee tells me what extreme heat does to the body and how the entire healthcare system needs to adjust to our new reality. Renee, welcome to the show.

Thank you so much for having me. I'm honored to be here.

Thank you so much for having me. I'm honored to be here.

You were based in Cambridge, Massachusetts, which saw a heat emergency earlier this summer. It was because of a weather phenomena called a heat dome, and there was a spike in heat related emergency department visits and the city of Boston open more than a dozen cooling centers. How did you personally experience the heat wave, both as a doctor and as a resident.

You were based in Cambridge, Massachusetts, which saw a heat emergency earlier this summer. It was because of a weather phenomena called a heat dome, and there was a spike in heat related emergency department visits and the city of Boston open more than a dozen cooling centers. How did you personally experience the heat wave, both as a doctor and as a resident.

Yeah, well, it brought climate change right into my face. And trust me, this is something that I think about all the time, but it's a different experience when you're living it and you're seeing your patients and communities experiencing it. I mean, I actually had issues with my air conditioning during that and that made me really understand heat stress, as I'm sure we're going to dive into. I mean, heat can impact so many things, but it impacts sleep, and it also impacts how we process situations. We could become a little bit more irritable and that can obviously lead to other things. It reminded me of the need for backup power when air conditioning and backup air conditioning solutions. But I think more importantly, it really showed how we have to develop solutions for patients that I had come into my emergency department and that colleagues were telling me about where they just didn't appreciate what the threats of heat are like. And so I think there's this interesting phenomenon with heat that it becomes also more humid, and climate change is increasing humidity, and that is a really dangerous combination because our body uses sweating with which to cool us off. But if the more human it becomes, the harder it is for us to sweat. So my colleague had a story of someone who was out running and could normally head run in conditions that were that hot as an absolute number, but it's that heat index or taking that humidity into account, and he started experiencing symptoms of what's called heat exhaustion, which is sort of that body's warning signs right before a heat stroke, which is a life threatening emergency. And so it was just a reminder of how we are in it, and we have an enormous opportunity to move forward in a way that protects and centers health.

Yeah, well, it brought climate change right into my face. And trust me, this is something that I think about all the time, but it's a different experience when you're living it and you're seeing your patients and communities experiencing it. I mean, I actually had issues with my air conditioning during that and that made me really understand heat stress, as I'm sure we're going to dive into. I mean, heat can impact so many things, but it impacts sleep, and it also impacts how we process situations. We could become a little bit more irritable and that can obviously lead to other things. It reminded me of the need for backup power when air conditioning and backup air conditioning solutions. But I think more importantly, it really showed how we have to develop solutions for patients that I had come into my emergency department and that colleagues were telling me about where they just didn't appreciate what the threats of heat are like. And so I think there's this interesting phenomenon with heat that it becomes also more humid, and climate change is increasing humidity, and that is a really dangerous combination because our body uses sweating with which to cool us off. But if the more human it becomes, the harder it is for us to sweat. So my colleague had a story of someone who was out running and could normally head run in conditions that were that hot as an absolute number, but it's that heat index or taking that humidity into account, and he started experiencing symptoms of what's called heat exhaustion, which is sort of that body's warning signs right before a heat stroke, which is a life threatening emergency. And so it was just a reminder of how we are in it, and we have an enormous opportunity to move forward in a way that protects and centers health.

And you're now one of the leading experts on this field that studies both climate change and health, a field that probably hadn't been fully established until about the past ten years or twenty years. How much of a growing concern is heat related health issues when it comes to climate issues.

And you're now one of the leading experts on this field that studies both climate change and health, a field that probably hadn't been fully established until about the past ten years or twenty years. How much of a growing concern is heat related health issues when it comes to climate issues.

Well, it's interesting you bring up. I think my sense of where things were twenty years ago is that there were trailblazers who clearly saw those impacts, but When I came to this field about over a decade ago, there was really little engagement for mainstream medical community. But since then there's really been a ground shift. I mean, whether it's the World Health Organization announcing climate change was one of its six strategic objectives, or the National CANABI of Medicine in the US having its largest program on climate change. But we still lack the essential ingredients, like research funding at the scale and scope that's required, at least here in the US. You know, you point to heat, and I think that heat is often termed a silent killer. I think it's underappreciated for how deadly it can be. But there was a landmark study that showed that one third if heat related deaths in forty three countries which included the US in the nineteen nineties and two thousands were attributable to climate change, and the lands A countdown report which I'm a part of last year and twenty three showed that he tests for those over the age of sixty five are projected to increase by three hundred and seventy percent by mid century, and as we approach twenty twenty five, mid century is not that far away. On a two degree celsius pathway. So I mean all of the shows is that heat is really at the forefront, but that's just the tip of the iceberg in regards to the harms that are occurring. And so we have an enormous opportunity here to really quickly leverage resources to address us at the scale scope required.

Well, it's interesting you bring up. I think my sense of where things were twenty years ago is that there were trailblazers who clearly saw those impacts, but When I came to this field about over a decade ago, there was really little engagement for mainstream medical community. But since then there's really been a ground shift. I mean, whether it's the World Health Organization announcing climate change was one of its six strategic objectives, or the National CANABI of Medicine in the US having its largest program on climate change. But we still lack the essential ingredients, like research funding at the scale and scope that's required, at least here in the US. You know, you point to heat, and I think that heat is often termed a silent killer. I think it's underappreciated for how deadly it can be. But there was a landmark study that showed that one third if heat related deaths in forty three countries which included the US in the nineteen nineties and two thousands were attributable to climate change, and the lands A countdown report which I'm a part of last year and twenty three showed that he tests for those over the age of sixty five are projected to increase by three hundred and seventy percent by mid century, and as we approach twenty twenty five, mid century is not that far away. On a two degree celsius pathway. So I mean all of the shows is that heat is really at the forefront, but that's just the tip of the iceberg in regards to the harms that are occurring. And so we have an enormous opportunity here to really quickly leverage resources to address us at the scale scope required.

All of us at some point have been hot, and so we kind of know that heat can be stifling, it can sometimes cause exhaustion. But if you are to go a little more systematically, what are the categories of medical issues that arise because of heat?

All of us at some point have been hot, and so we kind of know that heat can be stifling, it can sometimes cause exhaustion. But if you are to go a little more systematically, what are the categories of medical issues that arise because of heat?

Yeah, so I think you know. Before diving into the specific categories, I just want to take a quick second to set a frame of what happens to the body with heat. Simplastically, your body wants to protect the organs inside like the brain and the heart, and it does that by moving heat from inside to the outside as a way to then get rid of it. And it does that actually through our skin and sort of two key ways. So first it puts more blood near the skin. Second, it produces sweat, and then once that sweat is on our skin, the heat can be transferred to it, and then those drops of water are evaporated and take the heat away, and so sweating is really our friend there. And so again I just really want to stress that humidity is such a key aspect when we think about heat and think about how the heat stress is causing these multitude of harms that you noted. So the other big thing to think about with heat that is important as we think about health harms is it can also be associated with poor air quality, and so heat actually can create more ground level ozone. So in addition to high humidity, poor air quality is another thing that often comes with extreme heat, and that can also contribute to the multitude of health harms. So I mean, as you noted, there's heat exhaustion and then the life threatening heat stroke which people commonly think about with heat. And there's also more minor kind of heat related conditions like rash or cramps, swelling, passing out. But these are only a minor fraction of the health harms from heat. You know, extreme heat's been associated with worsening heart problems, lung disease, kidney issues, poor birth outcomes, wors in mental health, violence and aggression, actually worse cognition, harder to think, and poor sleep. That's just again sort of that broad overview, but it just shows that as heat impacts our entire body, it can impact every aspect of it as well.

Yeah, so I think you know. Before diving into the specific categories, I just want to take a quick second to set a frame of what happens to the body with heat. Simplastically, your body wants to protect the organs inside like the brain and the heart, and it does that by moving heat from inside to the outside as a way to then get rid of it. And it does that actually through our skin and sort of two key ways. So first it puts more blood near the skin. Second, it produces sweat, and then once that sweat is on our skin, the heat can be transferred to it, and then those drops of water are evaporated and take the heat away, and so sweating is really our friend there. And so again I just really want to stress that humidity is such a key aspect when we think about heat and think about how the heat stress is causing these multitude of harms that you noted. So the other big thing to think about with heat that is important as we think about health harms is it can also be associated with poor air quality, and so heat actually can create more ground level ozone. So in addition to high humidity, poor air quality is another thing that often comes with extreme heat, and that can also contribute to the multitude of health harms. So I mean, as you noted, there's heat exhaustion and then the life threatening heat stroke which people commonly think about with heat. And there's also more minor kind of heat related conditions like rash or cramps, swelling, passing out. But these are only a minor fraction of the health harms from heat. You know, extreme heat's been associated with worsening heart problems, lung disease, kidney issues, poor birth outcomes, wors in mental health, violence and aggression, actually worse cognition, harder to think, and poor sleep. That's just again sort of that broad overview, but it just shows that as heat impacts our entire body, it can impact every aspect of it as well.

You talked about sort of second order impacts here, heat leading to more violence and heat leading to mental health effects. How exactly does that play out.

You talked about sort of second order impacts here, heat leading to more violence and heat leading to mental health effects. How exactly does that play out.

Yeah, it's a great question, and I think this is where we see these different associations from an epidemiologic standpoint, and then we have to dive in and try to understand what those mechanisms are. So with mental health, for example, it's been associated with more anxiety or more symptoms of depression in people who have depression or bipolar and actually increased suicide. I mean, one study actually found that a one degree celsius increase in temperature was associated with a twenty two percent increase in the risk of mental health related death. And another study found that more people go to the emergency room for mental health conditions when it's hot. And then I'll just touch on the second piece you brought up, and that's you know, sort of that concept of violence and aggression, and there have been links that have showed that hotter temperatures are associated with higher rates of murder, aggravated assaults, mass shootings. It's probably multifactorial. I mean, as we talked about your body's redirecting blood from the brain to the skin in order to cool yourself down, and so perhaps that's affecting different aspects of the brain. As I mentioned, it's also associated with poor sleep, and that obviously can lead to more problems dealing with violence and aggression. So we don't one hundred percent know the exact cause, but again I think it's multifactorial.

Yeah, it's a great question, and I think this is where we see these different associations from an epidemiologic standpoint, and then we have to dive in and try to understand what those mechanisms are. So with mental health, for example, it's been associated with more anxiety or more symptoms of depression in people who have depression or bipolar and actually increased suicide. I mean, one study actually found that a one degree celsius increase in temperature was associated with a twenty two percent increase in the risk of mental health related death. And another study found that more people go to the emergency room for mental health conditions when it's hot. And then I'll just touch on the second piece you brought up, and that's you know, sort of that concept of violence and aggression, and there have been links that have showed that hotter temperatures are associated with higher rates of murder, aggravated assaults, mass shootings. It's probably multifactorial. I mean, as we talked about your body's redirecting blood from the brain to the skin in order to cool yourself down, and so perhaps that's affecting different aspects of the brain. As I mentioned, it's also associated with poor sleep, and that obviously can lead to more problems dealing with violence and aggression. So we don't one hundred percent know the exact cause, but again I think it's multifactorial.

And we have come across these statistics around heat related deaths in recent years, and some of them have been quite spectacular. The European heat wave in two thousand and three killed more than seventy thousand people. Here in the UK in twenty twenty two, there were a series of heat waves and this figure of excess deaths was three thousand, where a lot of those deaths are for elderly people who are particularly vulnerable in heat waves. But are there other types of populations that are at greater risk of being affected by heat in fatal ways.

And we have come across these statistics around heat related deaths in recent years, and some of them have been quite spectacular. The European heat wave in two thousand and three killed more than seventy thousand people. Here in the UK in twenty twenty two, there were a series of heat waves and this figure of excess deaths was three thousand, where a lot of those deaths are for elderly people who are particularly vulnerable in heat waves. But are there other types of populations that are at greater risk of being affected by heat in fatal ways.

Yeah, So it's a great question, and I think that the take home I want everyone to go away with is that we all are at risk for this, especially as we get into more and more extreme conditions, and even if you have an air conditioned home, you have a power outage and then suddenly you do not have that ability to cool yourself. Just to take a step back, I think about vulnerability in three categories. So I mean one is being more susceptible, second is being more exposed to the harm, and then third is sort of lacking the ability to adapt. First, being more susceptible, I mean that can be because of age, as you mentioned, elderly children are also more at risk to heat or having existing health conditions like heart disease or lung problems. Patients on certain medications like blood pressure medications or medications for mental health can actually make it harder for our body to do that process I talked about in order to cool ourselves down. And then second, there are people who are more exposed. So for example, in the United States, blacks have been shown to be exposed to more extreme heat and one of the drivers behind that is the concept of redlining, which is a now outlawed racist housing practice that supported segregation and limited the economic opportunities available to black American families. But even in those neighborhoods that were redlined historically are actually hotter today, sometimes upwards of twelve degrees hotter fahrenheit. I have to put that in context to a global audience. Then non red blind areas because of factors like having a lot of man made material like asphalt and lack of green space which creates these urban heat islands. And outdoor workers is another example, because they are outside working in those conditions. And then the third category is lacking that ability to adapt, and this means you don't have the ability of the resources to protect yourself. So this could be a person with a disability who can't leave their home during a heat wave even though they're getting overheated, or again not having the resources to run your air conditioner at the level required to stay safe. And so I think people can have one of those or many of those. But again recognizing that third category of space scially our ability to adapt. We all are vulnerable to that in the right circumstance.

Yeah, So it's a great question, and I think that the take home I want everyone to go away with is that we all are at risk for this, especially as we get into more and more extreme conditions, and even if you have an air conditioned home, you have a power outage and then suddenly you do not have that ability to cool yourself. Just to take a step back, I think about vulnerability in three categories. So I mean one is being more susceptible, second is being more exposed to the harm, and then third is sort of lacking the ability to adapt. First, being more susceptible, I mean that can be because of age, as you mentioned, elderly children are also more at risk to heat or having existing health conditions like heart disease or lung problems. Patients on certain medications like blood pressure medications or medications for mental health can actually make it harder for our body to do that process I talked about in order to cool ourselves down. And then second, there are people who are more exposed. So for example, in the United States, blacks have been shown to be exposed to more extreme heat and one of the drivers behind that is the concept of redlining, which is a now outlawed racist housing practice that supported segregation and limited the economic opportunities available to black American families. But even in those neighborhoods that were redlined historically are actually hotter today, sometimes upwards of twelve degrees hotter fahrenheit. I have to put that in context to a global audience. Then non red blind areas because of factors like having a lot of man made material like asphalt and lack of green space which creates these urban heat islands. And outdoor workers is another example, because they are outside working in those conditions. And then the third category is lacking that ability to adapt, and this means you don't have the ability of the resources to protect yourself. So this could be a person with a disability who can't leave their home during a heat wave even though they're getting overheated, or again not having the resources to run your air conditioner at the level required to stay safe. And so I think people can have one of those or many of those. But again recognizing that third category of space scially our ability to adapt. We all are vulnerable to that in the right circumstance.

And because this field is young and there's not enough research funding coming as is needed. What are things that we do not yet know about what heat does, especially on extended exposure, and what kind of research is required.

And because this field is young and there's not enough research funding coming as is needed. What are things that we do not yet know about what heat does, especially on extended exposure, and what kind of research is required.

Just to give an example of some emerging areas. They've actually found that microbacteria, for example, ability to be resistant to antibiotics increases with heat. And so as I think about some of the threats I face in medicine, but if heat is actually making that more difficult for me to have antibiotics at work, I mean that is a problem. And so I think that just shows that we have to really understand how is heat impacting all of these different areas, but do it in a solution oriented way. So we have to think about what we need to do from an action standpoint, and then make sure we're doing the research that guides those actions. And so I think being much more strategic in setting up research questions that get us to solutions that protect health and make the case for why we need a transition away from fossil fuels.

Just to give an example of some emerging areas. They've actually found that microbacteria, for example, ability to be resistant to antibiotics increases with heat. And so as I think about some of the threats I face in medicine, but if heat is actually making that more difficult for me to have antibiotics at work, I mean that is a problem. And so I think that just shows that we have to really understand how is heat impacting all of these different areas, but do it in a solution oriented way. So we have to think about what we need to do from an action standpoint, and then make sure we're doing the research that guides those actions. And so I think being much more strategic in setting up research questions that get us to solutions that protect health and make the case for why we need a transition away from fossil fuels.

And one of those solutions that has been deployed in recent years has been opening cooling centers and cities. My colleagues at Bloombergreen reported on distributing cooling vests to teachers who have to be outdoors in places like Phoenix, Arizona. I was also reading about how Phoenix had to provide rehydration therapy through IV to protect homeless people during heat waves. Are there other kinds of creative public health measures that have helped people tackle heat?

And one of those solutions that has been deployed in recent years has been opening cooling centers and cities. My colleagues at Bloombergreen reported on distributing cooling vests to teachers who have to be outdoors in places like Phoenix, Arizona. I was also reading about how Phoenix had to provide rehydration therapy through IV to protect homeless people during heat waves. Are there other kinds of creative public health measures that have helped people tackle heat?

Yeah? I mean I'm inspired by so many emerging innovative approaches that are happening, and we need to rapidly share these experiences across the globe so we can replicate and scale what's working. You know, you brought up cooling centers, and I think getting back to your previous question about what data do we need? So we know cooling centers create safe, cool places for people to go, but we don't actually know if they always work. Are the right people going to cooling centers? And if not, why not? Why aren't they getting there? Is it because they aren't able to have transportation? Is it because they don't know about it? Is it not communicated in their language? So there's I think a lot of movement around how to dive into things that we know can work, but how do we make sure they work better? You know, to add to your list of things that you outlined, I mean Paris is creating these cool islands, Los Angeles is using white paint experiments, Rotterdam is building green rooftops. I mean all of that are ways where we have to transform our landscape, how we build our cities and our buildings to make sure that we can create these cool spaces. But obviously, as an embergency medicine doctor, about that individual level, because oftentimes I'm seeing a patient in my emergency department in the middle of one of these events. So if I tell them to go follow up with their primary care doctor, they may not be able to actually see them in time to intervene in wherever their needs are. So you know, we're thinking about how can we create coordinated pathways to actually get them energy subsidies that allow them to run air conditioners or to weatherize their home.

Yeah? I mean I'm inspired by so many emerging innovative approaches that are happening, and we need to rapidly share these experiences across the globe so we can replicate and scale what's working. You know, you brought up cooling centers, and I think getting back to your previous question about what data do we need? So we know cooling centers create safe, cool places for people to go, but we don't actually know if they always work. Are the right people going to cooling centers? And if not, why not? Why aren't they getting there? Is it because they aren't able to have transportation? Is it because they don't know about it? Is it not communicated in their language? So there's I think a lot of movement around how to dive into things that we know can work, but how do we make sure they work better? You know, to add to your list of things that you outlined, I mean Paris is creating these cool islands, Los Angeles is using white paint experiments, Rotterdam is building green rooftops. I mean all of that are ways where we have to transform our landscape, how we build our cities and our buildings to make sure that we can create these cool spaces. But obviously, as an embergency medicine doctor, about that individual level, because oftentimes I'm seeing a patient in my emergency department in the middle of one of these events. So if I tell them to go follow up with their primary care doctor, they may not be able to actually see them in time to intervene in wherever their needs are. So you know, we're thinking about how can we create coordinated pathways to actually get them energy subsidies that allow them to run air conditioners or to weatherize their home.

Well, I mean that's a level of thinking that typically public health officials haven't had to do, which is to think about the infrastructure that surrounds people who are affected by heat related illness.

Well, I mean that's a level of thinking that typically public health officials haven't had to do, which is to think about the infrastructure that surrounds people who are affected by heat related illness.

Yeah, and I think in my mind, this is that all hands on deck moment that we're in because we have to think about this in multiple levels. We have to put health and equity at the center of our response, and we need to recognize that the solutions to protect patients and communities. So I mean my patients that I see in my emergency departm often exists outside of the traditional health sector, and so we because of this all inclusive nature, we have to be collaborative and coordinated both within our own sector, so kind of between medicine and public health, but also across these other sectors. Because you know, if you look at the reviews on heat I mean, they have tables that are two pages long about all the things that we can do to help create cool environments and protect patients and individuals. But we have to have that toolbox ready, but be able to deploy it locally and tailor it to exactly that patient in front of us and that community that we're working with.

Yeah, and I think in my mind, this is that all hands on deck moment that we're in because we have to think about this in multiple levels. We have to put health and equity at the center of our response, and we need to recognize that the solutions to protect patients and communities. So I mean my patients that I see in my emergency departm often exists outside of the traditional health sector, and so we because of this all inclusive nature, we have to be collaborative and coordinated both within our own sector, so kind of between medicine and public health, but also across these other sectors. Because you know, if you look at the reviews on heat I mean, they have tables that are two pages long about all the things that we can do to help create cool environments and protect patients and individuals. But we have to have that toolbox ready, but be able to deploy it locally and tailor it to exactly that patient in front of us and that community that we're working with.

After the break, Runny ways in on whether naming heat waves might help us better prepare for them. And if you've been enjoying this episode, please take a moment to rate and review the show on Apple Podcasts and Spotify. It helps other listeners find the show. One thing on the table during extreme heat is to potentially give heat waves a name, just the way we give hurricanes names. What do you think of that idea?

After the break, Runny ways in on whether naming heat waves might help us better prepare for them. And if you've been enjoying this episode, please take a moment to rate and review the show on Apple Podcasts and Spotify. It helps other listeners find the show. One thing on the table during extreme heat is to potentially give heat waves a name, just the way we give hurricanes names. What do you think of that idea?

Yeah, no, I love that and Seville I think Spain is naming heat waves and I think it's a way just to ensure that heat, extreme heat and especially heat waves are not silent killers anymore. And that I think that idea and that concept really builds on something else that's happening here in the United States, and that's that FEMA, So, our federal agency that responds to disasters and provides resources to disasters, doesn't currently view extreme heat and heat waves as a emergency. There's a move to try to ensure that it can be classified as a disaster because arguably it is the costliest from a human toll perspective, disaster than any other extreme weather events, whether hurricanes, bloods, etc. And so how do we make that that happen? And I think one aspect is naming them is a good way, But a second one is how do we actually calculate the true human costs of disasters. So the federal government tracks weather in climate disasters in the United States that are over a billion dollars, but that's only done based off of structural damage and so the economic damage that comes from those structural costs. But what if we start also including healthcare related costs, so the cost of more patients going to emergency departments and hospitalizations, And it's really hard to put a cost on death, but that is obviously something that we do to try to understand that full scope. But then heat could then become a financial aspect that's tracked and can start to be in line with all these other disasters. So I think it's the right move. It's the way that we have to go to really elevate extreme heat to no longer being a silent killer.

Yeah, no, I love that and Seville I think Spain is naming heat waves and I think it's a way just to ensure that heat, extreme heat and especially heat waves are not silent killers anymore. And that I think that idea and that concept really builds on something else that's happening here in the United States, and that's that FEMA, So, our federal agency that responds to disasters and provides resources to disasters, doesn't currently view extreme heat and heat waves as a emergency. There's a move to try to ensure that it can be classified as a disaster because arguably it is the costliest from a human toll perspective, disaster than any other extreme weather events, whether hurricanes, bloods, etc. And so how do we make that that happen? And I think one aspect is naming them is a good way, But a second one is how do we actually calculate the true human costs of disasters. So the federal government tracks weather in climate disasters in the United States that are over a billion dollars, but that's only done based off of structural damage and so the economic damage that comes from those structural costs. But what if we start also including healthcare related costs, so the cost of more patients going to emergency departments and hospitalizations, And it's really hard to put a cost on death, but that is obviously something that we do to try to understand that full scope. But then heat could then become a financial aspect that's tracked and can start to be in line with all these other disasters. So I think it's the right move. It's the way that we have to go to really elevate extreme heat to no longer being a silent killer.

And what tips might you have for people who think, Oh, you know, I'm in good health, I don't really get affected by heat so much. I know this heat wave is coming, I don't have to really worry.

And what tips might you have for people who think, Oh, you know, I'm in good health, I don't really get affected by heat so much. I know this heat wave is coming, I don't have to really worry.

Well.

Well.

I think one response that tends to get people's attention, at least in my past experience, is what happens if the power goes out? And I think most people will pause and say, I don't know. I mean, there's obviously some who are very well prepared and have backup generators and cooling systems, but I think that's very rare. And again it's those who have the resources with which to be able to do that. We are all in this together. And so even if you are sitting there in your air conditioned home and a record breaking heat wave, what about that neighbor that lives next door. What about the you know, the individuals down the street or others within your community. And I think some of the most innovative things that I've heard that have been really successful to build on our growing theme here in our conversation is really those community centered supportive approaches, So checking on your neighbors and having those one on one connection so that way you know you have a disabled, elderly neighbor, you know who's checking on that person in the heat wave, and if if you're not sure, then why not you? Thank you, Renne, Thank you, It was such a privilege to have this conversation.

I think one response that tends to get people's attention, at least in my past experience, is what happens if the power goes out? And I think most people will pause and say, I don't know. I mean, there's obviously some who are very well prepared and have backup generators and cooling systems, but I think that's very rare. And again it's those who have the resources with which to be able to do that. We are all in this together. And so even if you are sitting there in your air conditioned home and a record breaking heat wave, what about that neighbor that lives next door. What about the you know, the individuals down the street or others within your community. And I think some of the most innovative things that I've heard that have been really successful to build on our growing theme here in our conversation is really those community centered supportive approaches, So checking on your neighbors and having those one on one connection so that way you know you have a disabled, elderly neighbor, you know who's checking on that person in the heat wave, and if if you're not sure, then why not you? Thank you, Renne, Thank you, It was such a privilege to have this conversation.

Thank you so Olivia. We heard from Renee how much heat can affect health and how poorly it is understood what heat can do do health. Is there an example that sort of sticks out and tells you why we must be much more careful than we have been about what heat waves can do to us.

Thank you so Olivia. We heard from Renee how much heat can affect health and how poorly it is understood what heat can do do health. Is there an example that sort of sticks out and tells you why we must be much more careful than we have been about what heat waves can do to us.

Yeah, I mean there's been a whole spate of examples this summer, of tourists going on walks in Spain and Greece. There was the awful case of Michael Mosley. There's sort of UK celebrity who died in the heat but the one that I think really kind of brought it home to me. There was a case of a family that went hiking in California a few years and it was when I was actually in California, so I remember reading about it in the newspapers at the time, and they all died on the trail in really quite surprising circumstances, and all of the reporting I remember, you know, at the time, right after it had happened, they were suggesting all kinds of different causes for why this might have happened. You know, It's like chemical spills and fungus, and it was really a mystery. And then later on, you know, they realized that they'd all been killed by the heat, and it was such a tragic case. It was horrible. It was really horrible, really young child and their young parents. And you know, I think that really brought home to me the fact that even for the authorities, let alone the general public, it's not something that's expected that he would be something that's so deadly, and you know how far we are from really taking it seriously as a danger to our health.

Yeah, I mean there's been a whole spate of examples this summer, of tourists going on walks in Spain and Greece. There was the awful case of Michael Mosley. There's sort of UK celebrity who died in the heat but the one that I think really kind of brought it home to me. There was a case of a family that went hiking in California a few years and it was when I was actually in California, so I remember reading about it in the newspapers at the time, and they all died on the trail in really quite surprising circumstances, and all of the reporting I remember, you know, at the time, right after it had happened, they were suggesting all kinds of different causes for why this might have happened. You know, It's like chemical spills and fungus, and it was really a mystery. And then later on, you know, they realized that they'd all been killed by the heat, and it was such a tragic case. It was horrible. It was really horrible, really young child and their young parents. And you know, I think that really brought home to me the fact that even for the authorities, let alone the general public, it's not something that's expected that he would be something that's so deadly, and you know how far we are from really taking it seriously as a danger to our health.

Thank you, Olivia, thank you, thank you for listening to zero. And now for the sound of the That is the sound of a little fan on my desk at home. For the first ten years living here in the UK, I never needed it, but now I need it every summer. Now I might even have to get an upgrade. If you like this episode, please take a moment to rate and review the show on Apple Podcasts and Spotify. Share this episode with a friend or with someone who sweats a lot. You can get in touch at zero pod at Bloomberg dot Net. Zero's producer is miight Lerau. Bloomberg's Head a podcast is Sage Bowman and head of Talk is Brendan Nuna. Our theme music is composed by Wonderly Special thanks to Kira Bindram, Matthew Griffin and Jessica Beg. I am Actradrati Back soon.

Thank you, Olivia, thank you, thank you for listening to zero. And now for the sound of the That is the sound of a little fan on my desk at home. For the first ten years living here in the UK, I never needed it, but now I need it every summer. Now I might even have to get an upgrade. If you like this episode, please take a moment to rate and review the show on Apple Podcasts and Spotify. Share this episode with a friend or with someone who sweats a lot. You can get in touch at zero pod at Bloomberg dot Net. Zero's producer is miight Lerau. Bloomberg's Head a podcast is Sage Bowman and head of Talk is Brendan Nuna. Our theme music is composed by Wonderly Special thanks to Kira Bindram, Matthew Griffin and Jessica Beg. I am Actradrati Back soon.