Among today’s largest climate change concerns are the effects of extreme heat on public health. The risks are far greater for disabled and chronically ill people, not only because they are more likely to be affected by high temperatures, but also because structural barriers and social conditions make coping with the heat much more difficult. As heat waves increase in intensity and frequency, it is important to understand how these risks are interconnected and what communities can do about them.
Studies have repeatedly shown that disabled people are more susceptible to developing and dying from heat-related illness. Others may have medical issues that make them more susceptible to the effects of heat, and social isolation is also one of the risk factors when it comes to extreme temperatures.
According to a study conducted by the American Geophysical Union, there was a significant increase in illness or death among people with schizophrenia during the extreme heat event of 2022. Antipsychotic drugs (e.g., risperidone, haloperidol, quetiapine) used to treat schizophrenia can also affect the body’s ability to control temperature. The research also found that those with chronic renal disease and ischemic heart disease were at higher risk.
Taking antidepressants can also make someone more sensitive to heat. A separate 2022 study published in the Cureus Journal of Medical Science found that certain antidepressants interfere with the body’s heat regulation. Two major classes were highlighted: SSRIs, including fluoxetine, sertraline, and citalopram, and tricyclic antidepressants like amitriptyline and imipramine. These medications can push core body temperature above 106°F under specific conditions.
Heat is also especially hazardous for people in wheelchairs. Sidewalks that are not level, missing entrances, or broken wheelchair lifts can make it difficult or impossible to access a cooling center. There may be no accessible seating even if someone gets into the building. Some cooling centers operate without air conditioning or during limited hours.
Because of buildings with too narrow doorways, a lack of ramps, or inaccessible restrooms, life-saving resources become obstacle courses. These barriers highlight the fact that disabled people are frequently not considered when planning for emergencies.
These challenges are not new – they have been discussed for years by the disability community. Heat impacts all of us, albeit not equally. Conditions like dysautonomia, Postural Orthostatic Tachycardia Syndrome (POTS), Ehlers-Danlos syndrome, multiple sclerosis, and congenital heart disease can impact temperature regulation
Even at moderate temperatures, heat can lead to dizziness, fainting, dehydration, headaches, or dangerous increases in body temperature. Many medications used to treat psychiatric conditions, heart disease, and other conditions can aggravate the body’s reaction to heat or cause dehydration. Mobility vehicles may become too hot or become dangerous for use in extreme heat conditions. Mobility aids may become exhausting or unsafe to use in extreme heat. If public transportation is too crowded or not available, it becomes another hurdle and potentially a barrier to cooling efforts.
Social factors compound these risks. Disabled people are more likely to be living alone, to be in poverty, and to not have air conditioning or stable housing. Isolation prevents anyone else from noticing if symptoms are getting worse. Stigma can deter people from seeking assistance. Emergency plans do not always include disabled residents, do not provide information in alternative formats, or do not provide for the transportation of disabled persons to cooling centers.
While infrastructure and policy are important, community care is also vital. Isolation and medical emergencies can be avoided, and people can stay safe through simple acts such as a neighbour calling to check in, a friend offering to transport a person to an air-conditioned environment, a cold beverage, an additional fan, or a stranger offering someone a seat on a packed bus.
The issue isn’t whether there will be heat waves; it is whether our communities change to keep those most vulnerable safe. No one should be left at risk because of a disability. We can create a culture where helping is expected, and where nobody is alone when facing hazardous weather. Solutions to extreme heat begin at the local level: awareness, compassion, and a commitment to ensuring disabled people are not forgotten.
Sources:
Alegría, Margarita, et al. ‘Social Determinants of Mental Health: Where We Are and Where We Need to Go’. Current Psychiatry Reports, vol. 20, no. 11, Sept. 2018, p. 95, https://doi.org10.1007/s11920-018-0969-9.
Bebinger, Martha. “When Temps Rise, so Do Medical Risks. Should Doctors and Nurses Talk More about Heat?” KFF Health News, KFF, 1 Sept. 2023, kffhealthnews.org/news/article/when-temps-rise-so-do-medical-risks-should-doctors-and-nurses-talk-more-about-heat/.
Horseman, Michael, et al. “Drug-Induced Hyperthermia Review.” Cureus, July 2022, https://doi.org/10.7759/cureus.27278.
Konkel Lindsey. ‘Taking the Heat: Potential Fetal Health Effects of Hot Temperatures’. Environmental Health Perspectives, vol. 127, no. 10, Environmental Health Perspectives, p. 102002, https://doi.org10.1289/EHP6221.
Lee, Michael Joseph, et al. ‘Chronic Diseases Associated With Mortality in British Columbia, Canada During the 2021 Western North America Extreme Heat Event’. GeoHealth, vol. 7, no. 3, John Wiley & Sons, Ltd, Mar. 2023, p. e2022GH000729, https://doi.org10.1029/2022GH000729.
Sabe, Michel, et al. ‘Antipsychotics for Negative and Positive Symptoms of Schizophrenia: Dose-Response Meta-Analysis of Randomized Controlled Acute Phase Trials’. Schizophrenia, vol. 7, no. 1, Sept. 2021, p. 43, https://doi.org10.1038/s41537-021-00171-2.