As an emergency medicine physician, I often get glimpses into our public health future as issues begin to arrive in the emergency department with greater severity and frequency, signaling something more than just one-off emergencies. One of these issues is extreme heat during our summers.

It was another busy day in the emergency department caring for patients with chest pain, abdominal pain, pregnancy complications, shortness of breath and traumatic injuries. I saw an older gentleman who was brought in by ambulance with dizziness. He was lightheaded and felt like he was going to fall. After talking with him, he was living in an apartment complex on the upper floor. It had been hot. He hadn’t slept well and was on medications that made it harder for him to tolerate the heat. His symptoms resolved once coming to the air-conditioned emergency department.

Like most of the emerging public health issues I see, we have the chance to acknowledge the issue and change course before it becomes a full-blown crisis.

First, the problem. Around the globe, our summers are getting warmer and the number of extremely hot days are increasing. In Denver, we’re seeing an annual average of 44 days hit 90 degrees or more. We are now averaging three days a year where the temperature is above 100 degrees. At the same time, a new report shows that many of our historically marginalized neighborhoods in the city are the places also likely to lack access to cooling, and particularly the most efficient forms of cooling in homes.

The fact that thousands among us lack reliable and efficient cooling in homes and workplaces is a serious public health issue. Exposure to daytime and nighttime heat is linked to many health complications. National statistics attribute 1,300 deaths, 75,000 emergency room visits and 10,000 hospitalizations annually to extreme heat events. And this is likely a significant underestimate.

Heat can directly cause organ injury or failure, and even death. For those living with health conditions, a wealth of research makes it clear that conditions such as asthma, heart disease, behavioral health disorders and diabetes are made far worse by high temperatures and humidity. I witness this in the emergency department where I work.

This link with extreme heat, lack of access to home cooling and our communities of color and our renting communities is made clear in the report. Our neighbors who are at increased risk for underlying health conditions are our same neighbors who lack access to cooling in greater numbers, along with other structural factors that challenge physical and mental health.

We have to ask ourselves if we can accept a Denver where our neighbors suffer through the summers. Or a Denver where renters can’t expect – and often can’t afford – to have cooling in their homes, and particularly the most efficient and cost-effective forms of cooling like heat pumps, which use significantly less energy to run. Some who do have cooling avoid using it because of high costs. We need to decide whether the simple fact that you make under $35,000 a year in salary should make it more likely that you can’t stay healthy during the summer heat.

And before you decide air conditioning is a luxury only to be enjoyed by those who can afford it, think of it this way: Is there any circumstance in which we would allow a rental unit where heat is a luxury and not an anticipated utility in an apartment? We are quickly moving away from the days when Denver’s more temperate climate made living without cooling a matter of enduring the random hot day. Climate change has ended that reality for our city, and our policies must keep up with that new truth.


There are options for helping to avert this growing public health issue if our city leaders take action. Denver can encourage the installation of high energy, efficient cooling through financial incentives. Cooling with methods like window heat pumps that cool and heat would use significantly less energy, lower emissions and help keep utility bills low. I know this is possible because New York just installed 30,000 of them in its public housing units. Other businesses, such as hospitals, can choose clean and renewable energy to model a culture of environmental health, too. The city’s Office of Climate Action, Sustainability and Resilience has a role to play and one that can make a meaningful difference to the quality of life for thousands.

We don’t have to stand by and watch as this emerging public health crisis unfold. We can act now to change course and protect the health of thousands. We can keep people safe and out of busy emergency departments. If I’m seeing it in my hospital, it’s only a matter of time before you are seeing it in your neighborhood.

Caitlin Rublee, M.D., of Denver, is an emergency medicine physician, and a renter. She works with Healthy Air and Water Colorado on policy at the intersection of public health and climate change.

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Caitlin Rublee, M.D., of Denver, is an emergency medicine physician.