Summer now means fear for some, as study shows poverty brought biggest risk of death in B.C. heat dome

When a blanket of oppressive heat smothered B.C. in late June of 2021, Q Lawrence and their roommate began sleeping in the coolest place they could find — the kitchen floor.

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

"I honestly felt quite trapped," Lawrence recalled. "The house would just build in temperature throughout the day, and then at night there wouldn't even be a subtle drop. It would just stay the same temperature, and then the next day it would start to build again."

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

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 of them.

That's why they say it comes as no surprise to learn poverty created the biggest risk of death during the heat dome, placing people in greater danger than any chronic health condition or disability, according to unpublished research from the B.C. Centre for Disease Control (BCCDC).

"I think it's unsurprising to most poor people. We're aware of how much community death we're surrounded by," Lawrence said.

"It's angering, because this is something that can be changed. It's something that is an external factor that actually, with enough political will, is changeable."

The findings are prompting calls from advocates, scientists and doctors for governments to do more to keep people safe from the extreme heat events that are becoming more common because of human-caused climate change. That includes going beyond a recent government pledge for air conditioners to create permanent systems providing units to people who can't afford them, improving building standards and setting maximum allowable temperatures for indoor spaces.

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

"I'm scared of summer," she told CBC News. "They describe this as a one-in-1,000-year event. I don't buy that. I will not be surprised if we see another temperature anomaly like this within the next decade and I fear for the people in the province who are so at risk."

Those who died twice as likely to be poor

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

"That was the biggest risk factor for mortality during the heat dome, followed very closely by evidence of having schizophrenia," Henderson said.

The vast majority of these deaths happened inside, in private residences, 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 on end during the heat dome, unlike outside, where there was some relief.

The chance to cool down at night is key, because without it, the body faces extra strain trying to regulate body temperature.

To determine who among the 619 deaths depended on government assistance, the researchers used data from B.C.'s Pharmacare program, tracking prescriptions that had been filled during the previous year.

They were able to tease out whose prescriptions were paid for under "Plan C," which covers the full cost of eligible drugs for people who receive benefits and income assistance through the Ministry of Social Development and Poverty Reduction.

About 15 per cent of the people who died during the heat dome had filled prescriptions through Plan C, compared to six per cent 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 to live in substandard, multi-unit housing with little control over the temperature inside, and they often don't have the resources to take emergency measures during a crisis.

"If I get really hot in my house, I'm going to go out and buy an air conditioner," she said.

"We have 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 research on poverty and heat deaths as "spot on."

Casey has also been tracking deaths from extreme heat across the Pacific Northwest, and said the findings in B.C. illustrate a fundamental truth about climate change.

"It's going to really exacerbate existing health disparities," she said. "We really need to buckle down and start to take this seriously, because we're going to, more than ever, start to see this widening [between] who can stay healthy and who gets very sick or dies unless we as a society take some steps."

She recently published research showing a spike in injury deaths in Washington state during the heat dome — things like gun violence, drownings and car crashes that weren't directly linked to heat exposure. Casey's team found 159 excess deaths from injury over three weeks during the 2021 heat wave as compared to previous years.

Similar research has yet to be completed in B.C., according to the provincial coroner.

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

"It makes me 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, particularly for people that are really vulnerable," she said.

Government AC pledge 'grossly inadequate'

In the two years since the tragic events of the heat dome, there have been growing calls for government funding for residential air conditioning in a province where it has traditionally been unnecessary. Just a little more than a third of all households in B.C. had air conditioning in 2021, compared to 84 per cent in Ontario, according to Statistics Canada.

On Tuesday, B.C. Health Minister Adrian Dix announced $10 million for B.C. Hydro to provide approximately 8,000 air conditioners to medically vulnerable low-income households over the next three years. He said including some other programs operated by the public utility, about 10,000 units will be made available in all.

Asked whether 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 are living in poverty, according to the B.C. Ministry of Social Development and Poverty Reduction.

Last summer, Zeidler tried getting the province to fund air conditioning for a patient on disability assistance through a provincial program covering the cost of medical devices, but she was turned down. She said she plans to try again this summer.

"I would really love to see immediate release of funds for low income or medically vulnerable people to be able to afford medical cooling," Zeidler said.

Henderson described the proposal to provide air conditioners as medical devices through existing provincial programs as an "excellent idea."

The City of Toronto, for example, funds portable air conditioners for low-income earners with certain medical conditions.

The B.C. government has been conducting a review of the idea in response to June 2022 recommendations from a coroner's death review panel, with the expectation the findings would be public by Dec. 1, 2022. That did not happen. The health ministry told CBC News that 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 be considering in response to these troubling findings.

That could include improvements to building design, with additions like shutters and awnings to block out some of the heat, as well as more green spaces in urban environments. B.C. has also improved its emergency alert system to warn residents of extreme weather.

But Henderson believes those measures will only go so far.

She said she'd like to see standards across the country for maximum allowable indoor temperatures.

"It is well accepted that homes should not be colder than 18 degrees in the winter. Now we need to make it well accepted that homes should not be warmer than 26 degrees in the summer," she said.

Some advocates, meanwhile, have called for maximum indoor temperatures of 23 degrees.

B.C. 's housing ministry says work is underway now to update the province's building code, including new cooling requirements. It is considering a proposal that would require every new residential building to provide at least one living space that is designed not to exceed 26 degrees.

As for Q Lawrence, they and their roommate now have an air conditioner strong enough to cool one room in their house, thanks to fundraising efforts. They want the same for all disabled and poor British Columbians, including those who aren't lucky enough to have the strong community support they enjoy.

"There's the idea that air conditioning units are bad for the environment, and to that I say disabled people's lives are not 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 aggravated by the heat, and even two years later, they haven't fully bounced back.

Between the wildfire smoke, drought, extreme heat and flooding that have hit B.C. 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 at this point," they said.

"Other people talk about the things they're excited for in summer. They talk about going swimming, going to the beach, getting outside and going travelling, and I think about who in my community is going to die and what it's going to do to my health and my friends' health."