Dr. Aparna Bole, Senior Consultant, Health and Human Services Office of Climate Change and Health Equity Dr. Eugene Livar, Chief Heat Officer, Arizona Moderator: Phil Wahba, Fortune
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00:00Let's talk about heat.
00:02It almost sounds like a pop song,
00:03but let's talk a bit about the climate crisis.
00:08It's not hitting people in the same society in the same way,
00:13let alone within a country or within regions.
00:17What makes the climate crisis a health crisis if we want to
00:20start with a very big picture view?
00:23Sure. I could start from a state perspective from Arizona.
00:27I think it is a public health crisis.
00:30I think we heard Secretary Becerra say that on a visit to
00:33Arizona when we talked about some of
00:35the impacts and initiatives and efforts that we're
00:38doing within our state to mitigate heat.
00:40When you really think about it,
00:42we saw in 2023 over 990 heat-related deaths in our state.
00:48That is an exceptional unprecedented number that we saw in 2023.
00:54When you look at that breakdown of the ages and
00:57also the impacts that we have,
00:58a lot of people may think that it's visitors coming down to
01:01our state who may not be able to acclimate to the heat,
01:04and some of those other pieces,
01:05what we're seeing amongst our community members.
01:08I believe we had just about 70 percent of
01:10those heat-related deaths were
01:11among Arizonans that lived in our state for 20 or more years.
01:15That really shows it's hitting our state's population.
01:18When you look at some of the driving factors among
01:21those socially vulnerable populations
01:23such as substance use disorder, homelessness,
01:26you can either be living in urban heat islands or in
01:29rural areas and looking at tribal communities and
01:32some of the disadvantages and
01:34social impacts that they're dealing with.
01:36It really is a community-wide urban,
01:39rural, and tribal concern within the state of Arizona.
01:43I'll just add, in addition to my federal role,
01:47my background is as a primary care pediatrician,
01:49practiced for many years in Cleveland,
01:51Ohio. We were talking about before we came up here,
01:55there's no region that really is unaffected
01:57right now by the health impacts of climate change.
01:59Speaking as a pediatrician in the upper Midwest,
02:02we're experiencing changes in air quality
02:05that can be challenging for kids with asthma,
02:07changes in allergy seasons.
02:09They're longer and more intense,
02:10especially in northern latitudes.
02:12A double whammy for some of my kids with
02:13asthma affects to water quality,
02:16as we've seen toxic algal blooms in
02:18the Great Lakes as a result of warming and runoff.
02:21Then extreme heat affecting regions,
02:24including in the northern latitudes that are not acclimated.
02:27I mean, it's a challenge in the Southwest,
02:29but it's also a challenge in the northern latitudes.
02:31I'm finding myself counseling
02:33my fall athletes about heat protection.
02:36That was not an issue 20 years ago for
02:38a football player in October in Cleveland.
02:40A lot of local impacts that we're
02:42seeing in the upper Midwest.
02:44Then nationally, in addition to those issues I just raised,
02:47there are changing patterns of infectious disease,
02:49including vector-borne diseases like Lyme disease,
02:51mosquito-borne illnesses, as well as really mental health impacts,
02:56both in the aftermath of these extreme weather events,
02:59but also for our young people who are witnessing
03:02a changing world and are going to experience
03:04climate-related disasters and extreme weather events
03:06that their parents and grandparents did not look forward to.
03:11It's really, there are both acute and chronic long-ranging impacts,
03:16and as you said, with
03:17disproportionate impacts on people who
03:19are facing already systemic disparities and physiologic disparities as well,
03:24children being disproportionately affected by climate-related health issues.
03:28I remember in February,
03:29I got bit by a mosquito in New York where I live,
03:31and I was like, this is not a good sign.
03:34Mosquitoes never bring good things,
03:36but in February, I was like,
03:39polar vortex now, please, zap them out.
03:42So Phoenix, your beautiful state's biggest city,
03:47just had 14 days of record heat in a row.
03:51As the kids would say, it's hot AF there.
03:55But it's October.
03:57So from your perch though,
04:00a lot of people, there's a lot of evidence,
04:02something's going on with the climate.
04:04Some people don't think that we're seeing climate change,
04:08but how do you counter that kind of narrative?
04:11You have to get things done.
04:13So people are saying, it's always been hot in Arizona.
04:15How do you manage to get your work done with some pushback on that front?
04:21It's funny you say that about heat because my son,
04:24he's a sophomore playing football and doing football practice,
04:26and he says that to me about every day.
04:28So starting in June when they're out there practicing.
04:32I think when we talk to individuals and make sure that it is a point of importance,
04:36we let everybody know that everybody is at risk for heat-related illness.
04:40You do not have to be in a specific vulnerable population to have a risk when it comes to,
04:45it could be an impromptu decision to go for a hike on
04:48a warm day that you weren't planning and you didn't bring enough water with you.
04:51It could be an unexpected automobile breakdown that happens on the highway and you're
04:56unprepared along with individuals who have multiple compounding risk factors,
05:02such as substance use disorder or
05:05mental health care needs or other items that could be coming to the table.
05:09I think when we talk in our state,
05:11we really talk for extreme heat,
05:14climate awareness and other pieces as a purple topic.
05:18It's not red, it's not blue because you are impacting everybody from the military,
05:23from police, emergency responders,
05:25to the unhoused, the homeless,
05:27the elderly, those in rural communities,
05:30urban communities, tribal members, the young.
05:33You're covering the gamut with this and it could be everybody's mother,
05:37grandmother, grandfather, sister, son,
05:40or daughter who's at risk when it comes to the impacts of what we're seeing for
05:44climate and what we're seeing happening now with extreme heat.
05:47I think some of the things that we're seeing within our state are
05:51unprecedented because we saw our first dengue case
05:54that wasn't travel associated a year or two ago.
05:57That's something as was mentioned with
05:59vector-borne disease coming up further north and setting in with climate change.
06:02You have to be open to those conversations and you have to be able to
06:06communicate as best as possible to those to let them know that this
06:10isn't a certain gender, social group,
06:14or any type of just fixed impact.
06:17You have to see it as the whole community and state.
06:19I just would like to add to that,
06:21that I think that that health message is a really great way
06:24to reach people across the political spectrum.
06:27I mean, everyone can relate to impacts on their health and their children's health.
06:31Actually, the messaging around health impacts of climate change have been studied,
06:35and it's found that across all segments of the population,
06:39health messaging is trusted when it comes to climate impacts.
06:42The other thing that I think is very hopeful is that climate solutions
06:45create immediate health and economic benefits in so many of our communities.
06:49We talk about built environment solutions, clean energy solutions.
06:53I think framing the benefits in terms of immediate health impacts,
06:57not 50 years from now,
06:58but right now, some of these climate solutions that can create healthier built environments,
07:03healthier energy systems, and healthier economies.
07:05That kind of messaging, I think,
07:07resonates wherever you are and whoever you're speaking with.
07:09At least that's been our experience in Ohio and beyond.
07:13Yeah, last year, the New York Times had a fantastic story,
07:17a map of every zip code in Metro Los Angeles,
07:20showing the temperature difference.
07:21And you could really see that two zip codes away,
07:24you could have a five degree average difference.
07:27And those tend to be lower income.
07:29And of course, the more affluent places have more greenery and more trees,
07:33hug trees all day long because they will save us ultimately.
07:37They absorb runoff water.
07:38Anyway, a million reasons.
07:39So what are some of the things you can do?
07:41Because I don't know when it's going to get cooler in Arizona.
07:45Well, we're not putting all of our cards on one deck
07:51that it's going to get cooler in Arizona.
07:52I think we know that it's going to stay the same or get warmer
07:55as we move forward from heat season to heat season.
07:58So really, what we're looking at is leveraging
08:00our governor's extreme heat preparedness plan
08:03that has both short term and long term recommendations,
08:06with really focusing in on energy, cooling centers,
08:10homelessness, looking at emergency response,
08:14funding and other pieces that are priorities for our state.
08:18And how do we move forward showing gains within the short term
08:21and the long term as we move, take next steps within our state?
08:25We've really moved forward to look at engaging our state agencies,
08:28along with community based organizations,
08:30stakeholders and partners across the state
08:32that have an interest in heat to give ownership
08:35and responsibility to any initiatives that we have within Arizona going forward
08:39and be able to drive those needs, have a listening ear
08:42and have make sure that people are at the table,
08:44which is really important because we've had community based movement
08:49when it comes to extreme heat in our state for more than two decades.
08:51So we don't want to reinvent the wheel.
08:54But what can we do to make that wheel spin better
08:57and be able to provide anything that's needed as they take some next steps?
09:00And so we're really looking at that transparency
09:03and collaborative approach across our state
09:05to get that engagement from community members.
09:09Your title is chief heat officer, but you also deal with cold.
09:14Chief heat officer, we deal with, as with in public health,
09:17many hats for one position.
09:19So, you know, we do deal in my previous role,
09:22I was assistant director of public health preparedness.
09:23Emergency response is part of that.
09:25And we did deal with cold.
09:26And I also have resilience, environment and policy under me.
09:29So there are some cold oversight with that, too.
09:31Yeah, and I ask you that because Edmonton, Alberta and Canada
09:35had a week at minus 50 last winter.
09:38And Edmonton has never been the tropics, admittedly,
09:41but, you know, minus 40 was sort of cold.
09:45So minus 50, so we're getting the extremes at the other end, too.
09:48And similar issues like how do you protect the population?
09:51And God forbid you have a power failure.
09:52And so since we have a room full of business people,
09:57how does this greater tendency towards having heat or even cold
10:05translate into problems for running businesses?
10:07And how can government help?
10:09And how do you see that translating?
10:13I think from my perspective,
10:14we really need to look at a partnership going forward.
10:16I think I heard some interesting DEI conversations yesterday
10:20where we can agree to disagree,
10:22but we all are community and trying to move forward on that end.
10:25So I think as the public looks at policy implementation
10:29through federal, state and local agencies,
10:31we need the private sector at the table
10:34to make sure that any policy moving forward can be implemented.
10:37And is there any unforeseen impacts that we're not looking at
10:41to make sure that this can be a viable path moving forward
10:44so that we can work in partnership
10:45to make sure that we're doing things in the right direction?
10:48I think we can also look at partnering on engaging the youth
10:51who are very energetic when it comes to climate and heat.
10:54What can we do to support STEM students going forward
10:57to make sure that we have the social, environmental
10:59and other scientists that we need to move forward?
11:02And then looking at leveraging technology such as AI
11:05and others for predictions
11:06and to see where we can move forward
11:08and do models with community helplines,
11:11such as energy, water, shelter and others,
11:14that we can see what are those impacts to the community
11:17when they're going through these events, being hot or cold?
11:20And then also, what do we need to bring them back to normal?
11:22And getting back to normalcy is such a huge piece
11:25for communities that we need to be aware of.
11:27As we can see, even just getting over the pandemic,
11:30many communities are not back to normal.
11:32So we're in a constant movement and flexibility
11:35within those communities,
11:36trying to get to normal daily life as much as possible.
11:39So I think there's often many partnering ways
11:42that we can look at and work together
11:43to make sure that we're moving forward appropriately.
11:45I think I would just add to,
11:47we work a lot with the healthcare sector
11:50around climate resilience
11:51and sort of managing effects on buildings,
11:56operations and staff around some of these issues.
11:59And I think some of the lessons from the healthcare sector
12:02apply equally to other private sector organizations.
12:05As we think about planning for facility resilience
12:08for the next 50 years, instead of just the past 50 years,
12:11thinking about impacts on our employees
12:13of some of these extreme weather events
12:15and how are we planning for protecting
12:17the health of our employees,
12:18the wellbeing of our employees.
12:20If our employees are worried about the wellbeing
12:22of their family members,
12:23how does that affect how they show up in the workplace?
12:26Understanding that extreme weather like extreme heat
12:28can have impacts on mental and behavioral health.
12:31There are great data that interpersonal conflict
12:34and violence increase during heat waves.
12:36So just thinking, and also that learning cognition
12:39and behavior in school settings
12:40are affected by extreme heat
12:42and that those effects can impact adults as well.
12:45So just as we think about planning for the resilience
12:49of our businesses, of our operations,
12:50thinking about prospective risk,
12:52looking different than retrospective risk for our facilities
12:55and thinking about the health of our employees
12:58and our communities in this larger context
13:01is important for the resilience of our businesses,
13:03healthcare and otherwise.
13:05So I wanna give people the opportunity to ask a question
13:08and we have a mic runner who'll come to you,
13:10but I'm gonna ask a question now
13:13while we look for someone.
13:15COVID showed us the difficulty of reaching consensus
13:19and let's be honest of getting people willing
13:23to make sacrifice for their fellow citizens sometimes.
13:26And I'm appalled at how many people cough on you
13:29in the subway in New York right now.
13:31And it's just like, did we just go through that?
13:35I mean, that was gross before the pandemic.
13:36I don't know, anyway.
13:38So I mean, is it,
13:41you know, there's gonna be some tough work to do
13:43as a society as the climate crisis worsens.
13:48So should we worry about people being able
13:51to make collective sacrifices?
13:54You know, I choose to take some really positive lessons
13:57from our experience in COVID.
13:58And I think as a primary care physician,
14:01there's a lot that we already know
14:02about how to compassionately message
14:04and meet people where they are.
14:06That honestly, we didn't all consistently do during COVID.
14:08There was so much divisiveness during that period.
14:11So I think that creating messaging that is relatable,
14:16that focuses on people's health,
14:18the health of their families,
14:20and focusing too on the benefits of climate solutions
14:24and giving people hope is so important.
14:26I think some of the doomsday messaging
14:28is very alienating for people.
14:30I think messaging that's based on fear or shame
14:33or divisiveness is very alienating for people.
14:36We know that in primary care clinical practice
14:39and we can apply those sorts of principles
14:41to public health messaging.
14:42And I feel like we weren't, honestly,
14:44as a society, very consistent about doing that.
14:47We need to take ownership for that and learn from it.
14:50Because I think that when we message in a way
14:52that's hope-based and personally relatable,
14:55that actually really works very well
14:56for people to come together.
14:58So that's my feeling.
15:00No, I think really leaning on the hope
15:02and the positivity and the messaging
15:03is really key as we go forward.
15:05The doomsday, I would totally agree,
15:06does not work when doing public health messaging
15:09when it comes to any topic on that end.
15:12And I would also say, you know,
15:14we've really done a push and a lesson learned from COVID
15:16is about social connectivity
15:18and push the message within our state
15:20to check on your family, your friends, and your neighbor
15:23to make sure that they're doing well
15:24in and outside of heat season
15:26and making sure that they're getting the resources
15:28or connected to services as much as possible.
15:31And that comes with an awareness campaign for the public
15:33to know where to go for those resources
15:35and taking next steps.
15:36And we've leveraged partnerships
15:38such as with the American Red Cross in our state
15:41to do canvassing campaigns to get that message out
15:44along with social media and other messaging
15:46to really do a push for that.
15:48And I think that's a positive, empathetic approach
15:51that we can all do that has a very low burden
15:53is just to get to know and check on your neighbors
15:55as we move forward.
15:57So we have a question here.
15:59Hello, Renee from United Talent Agency.
16:02And I'm very curious.
16:04My parents moved to outside of Phoenix a decade ago.
16:07So I've been able, when I go to visit from Los Angeles,
16:11we also share the Colorado River,
16:13which is a struggle for water for both our states.
16:17But I think about the energy consumption
16:20because where they live,
16:22there are just massive warehouses being built,
16:26just for miles and miles.
16:27And I think about that record heat day after day
16:30over a hundred degrees,
16:31the amount of air conditioning probably required
16:34for these facilities.
16:36And I'm just curious,
16:37what type of innovations is your state doing
16:42to accommodate for that record heat
16:45and the need for cooling
16:47and just the boom that the state is having?
16:50I'd love to hear the innovations.
16:52Sure, I'll do my best on that one.
16:54I think we try to make Arizona very business friendly.
16:56I think that's a priority for Governor Hobbs
16:59and her administration moving forward.
17:01But if you also look
17:02within the governor's extreme heat preparedness plan,
17:05grid resilience is a top priority for our state.
17:08I think we've seen some of the issues
17:10that can happen in several other areas
17:12and states that have had issues with their grids.
17:15And we've had monumental investment within our grids.
17:19We had our governor office of resiliency
17:21put 13 million towards rural grid resiliency work.
17:24And then we've had additional funds come in
17:26over the past year to help support that.
17:28And I think we're really looking at that balancing act
17:31between the population and ensuring that grid resilience
17:33and making sure that we can accommodate the needs
17:36that happen within our state.
17:38And we started with structured
17:41and also organized rolling reliefs practices
17:45in case those are needed within our state
17:47and using technology that we heard the other day,
17:49such as drones looking at power lines
17:51to see whether or not those are gonna be at risk
17:54and that we can go ahead and get those attended to
17:56before they become a problem within our state
17:58and organizing efforts when it comes to wildfires too.
18:01So I think we're really having a comprehensive approach
18:03to make sure that we can deal with our residents
18:06and also with the businesses that we've seen
18:08coming into our state too.
18:10Sorry, go ahead.
18:11I was just gonna say,
18:11and with renewable energy, microgrids and battery storage
18:13being a big part of that energy resilience solution,
18:16our office is highlighting examples
18:18of inflation reduction act supported investments
18:21in healthcare, including some in Arizona.
18:23There's some wonderful examples
18:25of solar installations on health centers
18:26with battery storage so that those facilities
18:28can serve as resilient sources of cooling
18:30for their community beyond also providing healthcare.
18:34So on that note,
18:35please join me in thanking our two panelists
18:38and thank God it's almost the middle of October.
18:43The cool weather will come to Arizona soon, knock on wood.
18:47So thank you for joining us.
18:48Appreciate it.