In some ways, July 4, 2023, felt like a typical Fourth of July holiday for the residents of Lafayette, Louisiana. The day was hot and steamy, as usual, but kids were still playing soccer, older folks were relaxing on screened-in porches and parents were doing last-minute supermarket runs to stock up for family barbecues. The weather, however, wasn’t typical. Over the course of the holiday, the heat index hovered around 110 degrees, and the town was engulfed in a heatwave that was blanketing the southern U.S.
Indeed, last summer was the earth’s hottest summer on record since scientists began monitoring temperatures in 1880. And as it did many people around the globe, the weather caught the people of Lafayette unaware, sending residents streaming into local clinics and emergency rooms (ERs) with heat exhaustion, severe dehydration and other heat-related conditions. “In just one day, we had to triage four patients and transfer them to the hospital because of heat-related illnesses like elevated body temperatures, lethargy and abnormal heart rhythms,” says Crystal Decuir, Chief Nursing Officer at the SWLA Center for Health Services community clinic in Lafayette, part of a network of clinics that provides cost-effective healthcare services to the state’s most vulnerable patients.
Back on the East Coast, attending physician Caleb Dresser, M.D., had seen similar patterns in the ER, in normally temperate Boston. “There were people who got heatstroke in their car in the parking lot and seniors who were physically unable to install their air conditioning (AC) and ended up suffering health consequences,” says Dr. Dresser, who is also Director of Healthcare Solutions at the Harvard T.H. Chan School of Public Health’s Center for Climate, Health, and the Global Environment (Harvard Chan C-CHANGE, for short). “It’s become clear that there’s an escalating impact on people’s health from climate change—and heat is the most dangerous factor.”
The goal of the collaboration between Americares and Harvard Chan C-CHANGE, which Johnson & Johnson is supporting, is to bolster climate resilience in at least 100 free and charitable clinics and community health centers across the country by 2025.
To wit: A January 2024 report from the World Economic Forum estimates that by 2050, there will be 14.5 million deaths due to extreme weather events such as heatwaves (others include extreme flooding and droughts). That’s scary news, particularly for people who are unhoused or who can’t afford AC or transportation to cooling centers. Also vulnerable? People with health conditions that make them particularly prone to heat sickness, including those who are pregnant or have diabetes, high blood pressure or cardiovascular disease. One study published in 2023 in Circulation predicts that heat-related cardiovascular deaths will increase by 162% by mid-century.
That’s one reason Johnson & Johnson is supporting the Climate Health Equity for Community Clinics Program, a unique collaboration between Americares and Harvard Chan C-CHANGE. “Johnson & Johnson has a long history of supporting community health workers and a long history of driving climate action,” says Paulette Frank, Chief Sustainability Officer, Johnson & Johnson. “The Climate Health Equity for Community Clinics Program brings our expertise and our commitment in both areas to bear on one of the biggest human health threats of our time.
“Climate change has been described as a force multiplier, exacerbating preexisting health inequities,” she adds. “Collaboration can be a force multiplier too—a force for good—amplifying impact by bringing together diverse points of view and capabilities. I’m proud that this collaboration with Americares and Harvard Chan C-CHANGE will provide valuable resources for community health workers and clinics on the front lines of climate change, so patients can receive the care they need, when they need it most.”
The goal of the program is to bolster climate resilience in at least 100 free and charitable clinics and community health centers across the country by 2025. “Americares has 45 years of experience preparing the country’s most underserved populations for disasters and helping them respond,” says Elena Ateva, Climate and Disaster Resilience Director for Americares. “Now, the health equity crisis and the climate crisis are coming together: The poorest people are suffering from climate change the most, though they didn’t create the problem. That’s what this whole project is framed around: equity. People who have been the most marginalized will be the first to be served and protected.”
Lafayette’s SWLA is one of the first pilot clinics chosen to participate in phase one of the Climate and Health Equity program. (Other participating clinics are in Florida and Arizona, which, like Louisiana, are known for extreme summer heat.) These clinics primarily serve patients who live below the poverty line, without access to necessities such as healthy food and transportation, much less AC, something that’s vital to survival in many parts of the southern U.S.
SWLA, which is still repairing damage from back-to-back storms in 2020, was eager to participate, knowing all too well the damage a changing climate can inflict. “Four years ago, we had two hurricanes in one year, and our flagship clinic in Lake Charles was destroyed,” says Decuir. “We know the impact of disasters. This is what we live with every day.”
A dearth of knowledge can lead to fatal outcomes
As familiar as Decuir is with the challenges of her patient population in Lafayette, she still marvels at the mix of people who were affected by the heat in the summer of 2023, not just because of a lack of AC but because of a lack of awareness of how deadly extreme heat can be.
“There was a young kid who had been playing soccer—his mom brought him in because he was lethargic,” she says. “The heat is so common here that they don’t cancel these soccer games, even when temperatures become extreme.” Another patient, an elderly veteran who likes to spend summer afternoons sitting on his porch, didn’t realize that he was dehydrated. “He also had hypertension and was on medication that most likely caused his blood pressure to drop,” says Decuir.
Then there was the mother of two young children who started feeling light-headed at the grocery store. “She didn’t have air conditioning in her car and by the time she made it to the clinic, she had a rapid, irregular heartbeat,” adds Decuir. “She fainted and we had to cool her off with ice before we transferred her to the local hospital.”
In the ER in Boston, meanwhile, Dr. Dresser also cared for patients who could have been spared a trip to the hospital the summer of 2023 if only they’d known about the dangers of high temperatures. “There were construction workers who weren’t taking regular breaks or who didn’t have access to shade,” says Dr. Dresser. “In New England, we’re not used to severe heat. But if you know what to look for, conditions such as heatstroke are preventable.”
A dose of prevention
The key is getting that information out in a timely fashion. Decuir, like her counterparts at the other pilot clinics participating in the Climate Health Equity for Community Clinics Program, provided input that helped Americares and Harvard develop a new assessment tool that dozens of clinics will use going forward. The tool, a short online survey, generates a customized action plan for each clinic outlining specific, evidence-based interventions that clinic staff and volunteers can use to reduce the impact of extreme heat on their patients’ health.
The interventions are based on a clinic’s patient population and unique needs. “These specific actions might range from setting up a hotline during heat season so patients can call and get vital information on how to protect themselves, to partnering with another community organization that does home wellness checks for patients to make sure they are staying safe when the temperature rises,” says Ateva.
We were already asking about social determinants of health that could be affecting our patients’ wellbeing. Now, we will also ask patients whether they have air conditioning at home or if they’re having trouble paying their electric bill.
In addition to treating patients, clinics can play a central role in connecting patients with available resources in their communities to support ongoing patient health and well-being. In Lafayette, SWLA is looking to use its existing community partnerships in new ways to help locals beat the heat. “We started wondering how we could get fans to patients who needed them and realized that the local fire department has fans available,” says Decuir. Just as important, they are now adding questions about heat safety when they screen new patients. “We were already asking about social determinants of health that could be affecting our patients’ wellbeing—access to healthy food, secure housing, transportation and medical care—to name just a few,” says Decuir. Now, she adds, “we will also ask patients whether they have air conditioning at home or if they’re having trouble paying their electric bill.”
These may sound like common-sense measures, but they are rooted in the science that Johnson & Johnson and Harvard are known for—and they make a big difference in preventing heat-related health emergencies. “We focus on what the science says. Then we can come up with interventions to reduce the risks to those who are most vulnerable,” says Dr. Dresser.
Taking action on the ground
SWLA’s customized heat health action plan calls for stocking up on ice packs in advance of the start of heat season in mid-May and spreading the word on heat safety earlier and more often. “We’re distributing heat-safety information in April, instead of May or June, when it’s already too late,” Decuir says. Her team plans to give out sunscreen and thermometers at health fairs and post tips on avoiding heat-related health problems on social media. “We really want to focus on prevention,” she adds.
The next phase of the project will prepare clinics for wildfire smoke, which can travel thousands of miles and affect communities well beyond the immediate area of the fire. In the meantime, the Climate and Health Equity for Community Clinics Program will help clinics across the country better prepare patients for the coming heat season. “Every day, we’re learning something new about the dangers of extreme heat, who’s affected and what helps us protect them,” says Ateva. “My hope is that people understand we’re all in this together. No matter where you live, your community is impacted.”
The Climate and Health Equity for Community Clinics Program is aligned with Johnson & Johnson’s long-standing commitment to help eliminate health inequities in the United States and around the world.
