Urban extreme heat, climate change, and saving lives: Lessons from Washington state

Heat waves are becoming more common and intense around the world as a result of climate change, and they are affecting the resilience and livability of cities. Extreme heat can be fatal for people who are unacclimated or unable to seek relief. Heat-related illnesses and deaths are largely preventable, yet public health efforts can at times fail to account for important contextual factors in their policy responses (e.g., differential vulnerability due to pre-existing medical conditions, where people live or work, or people's self-perception of risk). Understanding these contextual factors is an essential foundation for identifying policy responses that can make tangible progress in reducing heat-related illnesses and saving lives during extreme heat events. While extreme heat is an issue faced by communities internationally, we contend that a state or region-specific contextual and problem-oriented policy analysis, such as we present here, is critical to saving lives because: (1) many of the factors driving extreme heat vulnerability are local in nature and (2) the resilience strategies best suited to improve public health outcomes generally rely on local and state policy. This article examines the key factors conditioning public health impacts of extreme heat in Washington state based on the framework of sensitivity, exposure, and adaptive capacity. Drawing upon our analysis of heat vulnerability in Washington state, we examine a suite of policy options within the context of Washington's communities that are tailored to mitigate, prepare for, respond to, or recover from heat waves and reduce heat-related illness and death in urban or suburban settings. We find extreme heat affects subpopulations differentially because of various contextual factors; this suggests a wide range of policy alternatives is necessary to meaningfully improve health outcomes community wide. Moreover, the array of policy alternatives often rely on agencies whose missions do not prioritize public health. We conclude that without mechanisms for formal coordination among implementing partners and agencies with an important role in protecting public health, important policy alternatives that serve vulnerable subpopulations will likely be neglected. We present this problem-oriented analysis of extreme heat in Washington state as a case study for identifying and evaluating contextually specific climate resilience strategies in the hopes that it can be useful across other geographies with different governance contexts, and perhaps even for other climate impacts.