America’s cities are structured to create highly concentrated areas that subsequently hold in heat, making metropolitan landscapes significantly hotter than suburbs and rural regions. This phenomenon is scientifically dubbed the “urban heat island effect.”
Today, we explore the detrimental impact of hotter streets on unsheltered individuals currently sleeping rough on concrete slabs across LA.
It is unfathomably hot on the asphalt this California summer. The latest data suggests the streets are at least 8 degrees Fahrenheit hotter in 65 US cities, with mid-afternoon temperatures exceeding suburban temperatures by 15-20 degrees in some instances. LA, the proverbial capital of American homelessness, is among those statistically hotter places.
As the sweltering heat brings Death Valley to a record-setting 128 degrees, an unsheltered pregnant woman is forced into premature labor, her screams drowned out by the political cries for criminalization. She is not the first or the last but one of many premature deliveries happening as the urban heat island effect makes its mark.
Exacerbated asthma. Respiratory issues. Cardiac arrests. Clinical burns.
These are among the most common conditions that clinical instructor of family medicine Kate Pocock witnesses in real life on a daily basis. Kate Pocock, MHS, PA-C, is a member of an LA-based street medicine team who continues to study the social determinants of health in the unhoused community, a subject that includes the urban heat island effect. She recently sat down with Invisible People to discuss the adverse impact of the urban heat island effect on rough sleepers, specifically in the California region. Before we delve deep into her firsthand stories, some context is required.
Who Are Rough Sleepers?
Homelessness is not a black-and-white condition. There are many different ways people experience it. Some people endure homelessness in shelters, hotel rooms, or on the sofas of friends and family members. This kind of homelessness is known as sheltered homelessness because it involves some level of housing, albeit unstable housing, which, incidentally, is the alternative term used for unsheltered homelessness. Rough sleeping, on the other hand, involves an individual or family that is living outside in a completely unsheltered situation. When we refer to people hailing from the unsheltered homeless community, we sometimes say they are “sleeping rough,” hence the moniker rough sleepers.
Rough sleepers represent a specific demographic of homeless people. They are more likely to be veterans, men, or people from historically oppressed ethnic groups. These are the homeless people who are most harmed by the urban heat island effect, which is why they are the focus of this particular discussion.
What is the Urban Heat Island Effect?
According to the National Integrated Heat Health Information System,
“The term ‘urban heat island’ refers to the fact that cities tend to get much warmer than their surrounding rural landscapes, particularly during the summer.”
The government-sponsored website states that some urban landscapes can surge 15- 20 degrees Fahrenheit hotter than surrounding suburbs and towns, especially on roads that lack trees and vegetation.
While this is the technical definition, the urban heat island effect means something more personal for street medicine professionals like Kate. They administer medication and services to unhoused people and witness the adverse impact of the phenomenon firsthand.
“What it looks and feels like on the ground in street medicine is so profound,” Kate said. “I’ve had the opportunity to practice medicine in two different areas of Los Angeles and then I’ve gone out on street rounds with street teams all over the city. So, I’ve been able to feel that difference that you experience based on where you are.”
“Currently, my patient population is in a really heavily warehoused district with sparse greenery. There’s only one street that’s lined with trees in the vicinity that comes to mind,” she continued. “I haven’t specifically brought out a thermometer to identify the temperature differences. But when you go between some of the more affluent areas that have trees and greenery built into the landscape, it is significantly cooler. And then you go into these warehouse areas where there’s a lot of asphalt and metal and you can feel the significant difference.”
“I can take it to this granular level,” Kate said, “but my patients who are also utilizing various types of voluminous materials as shelter experience its full extent because it makes their dwelling spaces that much hotter.”
Invisible People: Drawing from experience, could you give specific examples of this heat phenomenon?
Kate Pocock: “I specifically know this couple that lives in an old car trailer. So, there’s no windows, there’s no airflow, there’s nothing. And they are parked in a very exposed area that doesn’t have any shade. It’s all surrounded by warehouses. When they come out, to me, it might feel relatively cool, but I’ll ask them what the temperature is inside for them and it’s at least 15 to 20 degrees hotter in their trailer.“
“It’s really difficult for folks to be able to adapt and modify when they are resource-limited and they can’t necessarily choose as much. I’ve started to ask a lot of questions to find out what that feels like for some of the folks that we take care of.”
“In terms of feedback, I hear them making a lot of effort to overcome adversity, and then as time wears on, sadly, they seem to kind of accept it, their circumstance, as a fact. This can be disheartening for us as a street medicine team, seeing our patients trying to overcome adversity and systemic changes, and sometimes giving in to them exasperated.”
Invisible People: Can you describe some of the harmful impacts this heat has on unsheltered homeless patients?
Kate Pocock: “Regarding harmful impacts, we’re seeing significant degrees of dehydration. Interestingly enough, because this is street medicine, when we take vital signs on everybody, there is a baseline tachycardia secondary to dehydration that I witness amongst all of my patients.”
“So, I have to sit there with almost everybody during the summertime and delineate whether this is a tachycardia secondary to dehydration that can be mitigated with some water bottles or whether there is a deeper disease process that I need to be identifying and possibly sending them to the ER.”
“On top of that, folks are coming out from the heat and saying they’re not sleeping well. This is something I think about a lot. When we talk about ideal sleep habits, we often talk about having a cool, dark room. Many unsheltered folks don’t get a good rest during the night because it stays so warm that sleep deprivation is even greater, which has secondary effects on their mental health and so forth. It becomes a vicious cycle.”
“Sleep deprivation is something that we witness pretty significantly. I also see greater exacerbations with respiratory and cardiac issues. For example, remember the couple I spoke about who lives in the car trailer? The man from that couple has pretty significant asthma and we are always up against it the whole summer in the heat.”
“The two of us are working incredibly hard to try to manage his asthma under these extreme heat conditions that I’m trying to help him get through. He has high health literacy because he was an army medic and he’s also a veteran. So, he understands what he needs, and even still, it’s really difficult to help him work through the disease processes.”
Invisible People: Are any of these ill effects increasing, or are you witnessing a steady stream of events each summer?
Kate Pocock: “We’ve been taking care of quite a few pregnant people recently, which is one increasing number we’re witnessing. The folks that we’ve been caring for have had higher rates of premature deliveries and we know the heat and more intense weather play a role in that.”
“And then, from what I’ve heard, some regions where they’re seeing rapidly increasing temperatures, such as Arizona and Florida, are seeing a lot more burns from folks who are resting on pavement or cement. These are significant clinical burns that require hospital interventions and so forth.”
Invisible People: Does this have a noteworthy impact on emergency room trips for the unhoused community?
Kate Pocock: “Definitely, and I think we’re hearing about that from the data. Hospital emergency rooms have some of the most comprehensive data because they are in a comprehensive system that can be analyzed. I know the emergency rooms are experiencing increased numbers of folks coming in with heat-induced illnesses, and they know that a lot of those folks are unsheltered.”
“There are still many holes in the data, even from these emergency rooms. They’re only getting the sickest of the sick, and they’re also only getting folks they can take care of before they pass away. This means they’re not seeing folks who are at the beginning phases of heat-induced illness or those who are too far into the process to be treated. Even so, we’re certainly seeing more ER visits due to the heat.”
Final Thoughts from Kate Pocock:
“I’m observing and listening, but we need more comprehensive qualitative and quantitative data that truly focuses on this population. When you look at the studies we have available, it is just people experiencing homelessness. What we need to delineate is unsheltered people. Because if you’re in a sheltered environment, you have access to some of these vital survival resources, but if you’re unsheltered you don’t have that same access.”
“We need to confirm that we fully understand this problem, as it’s advancing and moving into this new phase. We still have a lot to learn. We always say at USC that we’re building the plane while we fly it. At the same time, as we’re gaining a better understanding of the problem, we also need to get creative with our interventions. Street medicine is primed for this! We are the folks that are on the ground with these patients. We have so many opportunities to meet our folks and make genuine connections.”
“We do lots of outreach with supplies. Sometimes, something that seems small, like passing out sunscreen, can have a huge impact. We need to start being more thoughtful about how we’re looking to help folks get through some of these experiences. There’s lots of room to do it, and a lot of people working hard to try to fill some of the gaps in care. Suffice it to say, we got a lot of work done, and we’ve got a lot more work left to do.”
Tell Your Elected Officials to Work Toward Making Housing a Human Right
In the hostile and literally heated environment, many of our cities exhibit, nobody should be living outside, giving premature birth to babies on burning asphalt, and winding up in the ER with critical scalds. Tell your elected officials to take a stand and make housing a human right for all.
