A woman sits next to an open window as a fan circulates air throughout her rental apartment. Some doctors have begun prescribing air conditioners to patients who would otherwise be unable to afford them.Darren Calabrese/The Canadian Press
We’re coming off another scorching summer and, in much of Canada, the early fall promises more of the same.
When the mercury climbs into the high 30s and beyond, it can really make you appreciate having air conditioning at home or the office.
But what about those who don’t have any respite from the heat – people who live in older homes, or on the streets?
Should we provide them with air conditioning, or other ways to escape the sizzling sun?
That’s a “hot” debate in public health and public policy circles. After all, the single biggest threat to human health from climate change is soaring temperatures.
Excess heat kills. And it sickens, particularly those who are already suffering from chronic illnesses such as cardiovascular disease, diabetes and conditions including chronic obstructive pulmonary disease.
In Canada, though, we do a very poor job of cataloguing the breadth of the problem. There is the occasional burst of attention when something big happens, such as B.C.’s 2021 heat dome that killed 619 people. (It remains the single deadliest weather event in Canadian history.) But we pay little attention to the deaths that happen day after day, especially in cities, other than noting the occasional spike.
We know from studies of weather events like the heat dome that high temperatures are not an equal-opportunity killer. Those who die are, for the most part, poor, older and isolated. During the B.C. heat dome, 98 per cent of deaths occurred indoors, mostly among people living alone in sub-standard housing (read: no air conditioning, poor ventilation) where temperatures often exceeded 35 C. People living on social assistance were 2.4 times more likely to die than those who were not.
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Protecting those who are homeless from heat waves is a whole other matter. Many cities create temporary “cooling centres” or open up public buildings that are air-conditioned. But these are stopgap measures, with facilities rarely accessible at night, and many people missed.
Sixty-eight per cent of Canadians have air conditioning or similar cooling equipment like heat pumps in their homes, according to Statistics Canada. But that number varies greatly across the country, from a high of 83 per cent in Ontario, to a low of 45 per cent in B.C.
But what to do about those who don’t?
Some physicians, including those involved in the activist group Health Providers Against Poverty, have begun prescribing air conditioners at clinics in poor Toronto neighbourhoods.
In many provinces, that “prescription” works because it is essentially a referral letter to apply for an existing program. In Ontario, for example, anyone receiving benefits from Ontario Works (colloquially known as “welfare”) or the Ontario Disability Support Program can theoretically receive money (roughly $400) for an air conditioner. But they have to demonstrate that without it they could be hospitalized or face “severe risk to life.”
BC Hydro has a similar program offering free air conditioners to low-income customers, but they need a recommendation letter from a home-care program or a mental health and substance use program.
These programs, however, are often a Band-Aid, because recipients of the air-conditioning units must still pay for their higher power bills and for maintenance.
To mitigate the harms from excessive heat, and related issues such as wildfire smoke, we need to not just target low-income individuals, but also change building codes, reshape public spaces and update our urban architecture and city bylaws.
Most cities in Canada regulate minimum temperatures so that people don’t freeze to death in the winter. In an era of climate change, we need to regulate maximum temperatures as well. Buildings need to be routinely equipped with cooling systems. That has largely been the norm, if not the law, since the 1980s, but we need programs to encourage the retrofitting of older buildings and specialized facilities, including long-term care homes and seniors’ residences.
Again, these buildings are where people at higher risk tend to live, and dealing with high temperatures is just one tiny element of the larger housing crisis.
However, we can’t forget that air conditioning is a double-edged sword. It provides relief from extreme heat, but also contributes to greenhouse gases that accelerate climate change. Air conditioners also pump out a lot of hot air that adds to the heat-island effect in urban areas.
We have to invest in better urban design, too – more trees, more parks and other green spaces – as a way of mitigating the effects of soaring temperatures and cooling our lives, indoors and out.