Is extreme heat an extreme disaster?

Phoenix, Arizona has crossed a troubling milestone. More than one hundred days of temperatures over 100 degrees.

Across the country, extreme heat kills more Americans than hurricanes, floods and tornadoes combined.

So why don’t we label is a disaster?

Katherine Davis-Young, senior field correspondent at KJZZ, reporting on public health and climate change.

Mayor Kate Gallego, mayor of Phoenix.

Ladd Keith, associate professor of planning at the University of Arizona. Co-principal investigator for the Center for Heat Resilient Communities.

Part I

MEGHNA CHAKRABARTI: Dr. David Sklar’s been an emergency physician for about 40 years … so it’s safe to say that there’s not a whole lot left that surprises him anymore. He has seen two major health crises, the AIDS epidemic in the 1980s. And, of course, the COVID-19 pandemic.

But now, he says, he’s witnessing a third crisis: extreme heat.

DAVID SKLAR:  Depending on how hot it is that week, I was working shifts where I would see at least one or two every single shift and it was life or death. So that's a lot. I mean, that's more than the number of people I see who are on the edge of death from heart attack or major motor vehicle crash. We've seen a lot of heat stroke and heat exhaustion, some of those people also have burns. When they collapse, they will sometimes end up on the pavement and the pavement is very hot. Sometimes the pavement could be 130, 140 degrees.

CHAKRABARTI: Dr. Sklar lives and works in Phoenix, Arizona. Just recently, Phoenix crossed a milestone – 100 straight days of temperatures over 100 degrees.

Dr. Sklar isn’t saying that extreme heat is killing as many people as AIDS or COVID. But he does say that the past several months of record high temperatures, and no respite, has brought a major surge to his hospital, Valleywise Medical Center.

SKLAR: We're basically having a year's worth of people, uh, who die in motor vehicle crashes in three months, which is my mind is really, you're talking about a disaster and if, if this were a hurricane or if this were earthquake or if this were a flood or something like that, we would call it a disaster because of the number of people who are dying.

CHAKRABARTI: Phoenix is in Maricopa County. And across the county, the number of heat-related deaths went from 283 five years ago to 645 heat deaths last year, just shy of the 681 motor vehicle fatalities last year.

Extreme heat isn’t a new problem in Phoenix. The problem is the unceasing duration. That 100 day streak of triple digit temperatures beats the previous record of 76 days set in 1993.

SKLAR:  So mostly we see people who are severely affected, their temperatures, sometimes 108, 109, 110, they come in unconscious and gasping and rapid heartbeat, and in many cases, vomiting, losing control of their bowels and urine, and so really very, very ill.

CHAKRABARTI: Up to 110 degrees. The human body cannot survive temperatures that high, unless they’re cooled very quickly.

SKLAR:  We're talking really minutes, in terms of the treatment. So every minute really is critical because, you know, your brain is just not able to function at that high temperature.

CHAKRABARTI: Emergency medical staff in Phoenix are creating new solutions to treat the extreme heat victims, including what they’re calling an “immersion bag.”

SKLAR:  We will put them in a body bag, which is sort of like the bag that is used when people die. And we will then cover them with water and ice, and that begins the cooling process. And our experience has been that if we do this well and quickly, we can sometimes drop their temperature. From, say, 110 down to about 103 in about, between a half hour to an hour, and you'll see almost an immediate improvement for most of the patients.

CHAKRABARTI: But for some patients, it’s not enough.

SKLAR:  Even when we do treat people and we're able to cool them down, it becomes apparent that there's been an injury to their kidneys and liver and lungs and brain and so on. And so they often will end up in some kind of a rehabilitation unit, even when they leave the hospital. Now, some don't have too much permanent damage. And eventually if they're young and relatively healthy, they may be able to go home, you know, back to their normal life, but a lot of them, they have suffered some permanent damage.

CHAKRABARTI: Dr. Sklar says that the situation he’s seeing in Phoenix is a warning to public health officials everywhere.

SKLAR:  This is in my mind, like another pandemic, although it isn't affecting the whole country, it's not a problem that is going to just be a Phoenix problem because we're seeing increased temperatures all over the country, all over the world. And it's a very, very serious crisis.

CHAKRABARTI: That’s Dr. David Sklar. He’s an emergency physician at Valleywise Health Medical Center in Phoenix.

Extreme heat kills more than 1,300 Americans each year, according to the Environmental Protection Agency. But many experts say that there's a significant gap in heat related data and the real death toll ascribed to heat related illness.
They say those illnesses and the death toll are much higher than what we can actually measure right now. Unless Maricopa County accounts for half of America's heat related deaths, those experts are probably right. Even under current estimates, extreme heat already kills more Americans than hurricanes, floods, and storms combined.

That's why in recent years, there has been a surge of scientists, public health officials, elected officials, including in Phoenix, asking that extreme heat be considered eligible for federal disaster designation and relief. They want the federal government's help. So are we living in a world where heat has now become a disaster. Katherine Davis-Young joins us. She's Senior Field Correspondent at KJZZ, Phoenix's NPR station, and she reports on a number of issues that impact Phoenix listeners, including public health and climate change. Katherine, welcome to On Point.

KATHERINE DAVIS-YOUNG: Hi there. Thanks for having me.

CHAKRABARTI: Okay. So let me ask you the most obvious question today.

I'm looking at the forecast for the high in Phoenix, and it is once again over 100 degrees, right?

DAVIS-YOUNG: Yeah, like you said before, we've been in the triple digits now every single day since late May, so definitely starting to get cabin fever this time of year. It's pretty relentless.

We've had now 59 days above 110. The average is 21, so that should tell you about just how extreme this summer has been.

CHAKRABARTI: Overnights are what? In the 80s, which is a high for a lot of other places. By the time morning rolls around, it's pushing 100. Can you, Katie, can you describe what is it? How do you live through days like this?

DAVIS-YOUNG: Yeah, like you say, it really is the low temperatures never let up. In fact, we've had 40 days this year where the low temperature has never dropped below 90 degrees. So when you wake up in the morning, like you say, it's almost a hundred already. The average number of 90-degree nights is seven.

So the overnight lows really are, they make it much harder. If you want to walk the dog, there's no good time to do it. It doesn't cool off after the sun goes down. It's not very cool when you wake up in the morning. The heat is everywhere.

CHAKRABARTI: Can you describe to me what a day is like for you?

You have AC, right? I'm presuming.

DAVIS-YOUNG: Of course, yes.

CHAKRABARTI: And so you get up, and how has the heat impacted how you go through one of your days? Describe it to me.

DAVIS-YOUNG: Yeah, I think having lived in Phoenix a long time now, you get used to the idea that you're not going to want to go outside for much of the middle part of the day.

If you do need to go outside, it's better to try to do it early in the morning. And other than that, you want to be moving from one air conditioned space to the next, but, Lord help you if you need to go somewhere, pick up the kids, go to the grocery store in the middle of the day, and your car has been parked outside and you've got to get into this vehicle that's even hotter than the outdoor temperature.

So if the high outside is 115, your car is going to be like, 150 inside. The seat is hot. The steering wheel is hot. Your AC is going to take a long time to cool your car down. And the heat finds its way indoors, even if you're staying indoors and air conditioning, as well. The water coming out of your taps is hot.

There's a story I tell a lot. A few summers ago, my hot water heater in my house broke. And we suspected something was up, but it took a week before we could even really confirm what had happened, because our showers were still so warm. So the heat finds you no matter where you are.

And of course, I'm talking about a position of privilege where I am able to stay in air conditioning, but a lot of people are not. Their jobs require them to be outside. Or we have a huge unsheltered homeless population that has grown a lot in the last several years who can't get indoors. So there are a lot of people who are enduring these temperatures all day long.

CHAKRABARTI: Wow. And there's so many aspects of life that require people to go other places, right? As you said, they can't, if they have a home, they can't stay there. There's lots of stories around the country of school buildings, for example, that aren't in great shape, right?

And don't have good climate control. I hope that's not the case in Phoenix. How do places like schools operate?

DAVIS-YOUNG: Yeah. So Arizona is, of course, very adapted to heat. You're not going to find a lot of buildings that wouldn't have AC there. If you are a renter in Phoenix, your landlord is required to provide working AC.

So you're not going to find those cases where you have people living in very old buildings that just don't have it. But you will find houses, older houses that don't have as good insulation, where people are paying much more than they can afford to keep their AC running. Air conditioning systems just work very hard here.

They only last about 10 years at a time. So they break all summer long and they cost upwards of $15,000 to replace an AC unit. So for a low-income household, that can be devastating. And we do have about a quarter of our heat related deaths here in Maricopa County, are indoor cases.

And usually that is a case of someone who's air conditioning unit has broken, and they can't replace it, or they just haven't been running it because they can't afford to keep it running all the time. So even where there is air conditioning, it can still fail.

CHAKRABARTI: And when you're talking $15,000, these are not window units.

DAVIS-YOUNG: No, that would be like a central AC.

CHAKRABARTI: Okay, good. Just wanted to double check. Katherine Davis-Young, correspondent at KJZZ in Phoenix. Hang on for just a second. Because now that we're getting a flavor of what it's like to live with these unrelenting triple digit temperatures, of course, the focus of our show today is to explore whether or not it should be a disaster, a federal disaster designation worthy event.

Part II

CHAKRABARTI:  Katie, just as another little Anecdote. I understand that it's so hot that even if you wanted to go, I don't know, and take a refreshing dip in the pool, that may not be as effective as one thinks because the pools get boiling hot.

Not boiling, but at least very hot.

DAVIS-YOUNG: I know, doesn't it seem the lovely image of Phoenix, at some lovely resort, you could jump in the pool and cool off and sit in the sun. But like we mentioned before, a lot of the overnight lows this summer have been in the nineties. If a body of water is sitting outside all summer long, it's not really going to get below those low temperatures.

So as nice as you might think it would feel to jump into a pool, most pools in Phoenix right now are like bath water. I have just a little kiddie pool for my kids and the hose water is boiling. When I try to fill that up, I usually try to throw some ice in there to get it at least comfortable.

CHAKRABARTI: Wow. Okay. So let's then talk about what some of the health, the social and economic impacts there have been on Phoenix because of this unrelenting heat. First of all, we had mentioned the fact that it's a killer, right? How many deaths have there been so far in Phoenix?

And how does it compare to previous years?

DAVIS-YOUNG: Yeah. The heat related deaths here have absolutely skyrocketed over the last decade. If you look just back, yeah, 2014, 2013. You were seeing like maybe 75 heat related deaths per year. Last year, we had 645. So it's an exponential climb. This year, we've already had 177 heat related deaths confirmed, and there are more than 400 others still under investigation.

So it's definitely going to be one of the deadliest years we've ever seen, it may not surpass last year, but it's too early to say. And it's a number of reasons. The heat of course has become relentless. We're in this hundred day-plus now heat wave this year, like we've never seen before.

But that has coincided with this really fast rise in our homeless population here. Just over the last five years or so, the homeless population has grown by about 50%. So there are just so many more vulnerable people here on the streets than there used to be. ... The homeless shelters across Maricopa County are basically at capacity.

They're full. There is a new one under construction. It's going to bring hundreds of beds online pretty soon. And they've been just opening those beds up as they become available and they're full by the time they make them available. The city this year, for the first time, is offering overnight cooling centers. For years, they've opened up libraries and other public buildings as heat relief sites to let people come in and cool off during the summers.

But this is the first year that they have two sites that they're keeping open overnight, and those have had about, more than 20,000 visits since May. They've been in huge demand.

CHAKRABARTI: Wow. So the underlying takeaway from that at least is the need for assistance grows, as you're saying, not just amongst the homeless population, but even let's say people in terms of paying for electricity bills, for many people in Phoenix, is becoming more challenging because of the amount of power they need to keep their homes cool. And all of that is still going on while the number of heat related deaths in Phoenix, I think you've reported that the city has broken that record every year since 2016.

DAVIS-YOUNG: Yeah. Yeah, it's shocking to look at the numbers. Last year, like I said, was 645 heat related deaths. That was a 50% increase just from the previous year. And that year had broken a record. So it's just been terrifying to watch these numbers climb so much every summer.

CHAKRABARTI: Okay, so as you mentioned earlier, you get used to not being able to do things outdoors in at least, definitely the middle of the day and perhaps even early, mid-morning, early afternoon. How has that had an economic impact on Phoenix at all?

DAVIS-YOUNG: Certainly, the number of heat related deaths comes with a huge economic impact.

You had an emergency physician on earlier who spoke about just the number of cases that he's seeing and that's across the region. There's more 911 calls. There's more cases referred to the medical examiner's office. The county board of supervisors last year actually retroactively had to approve a huge budget increase for the medical examiner's office, because they had so many cases of heat related deaths over the summer, that they had gone over their budget.

They had their whole staff working overtime all summer long. So these costs add up across city budgets, county budgets, they really start to add up the expenses.

CHAKRABARTI: The reason why I asked is, of course part of what the federal government, it takes a look at when it comes to approving a federal disaster designation is, did the disaster cause an economic impact or cost a city or state so much that they can't actually meet that cost, they don't have the resources in that moment, which is a tough thing to measure when you're talking about a disaster that's unfolding over more than 100 days, right?

So has the idea to request federal aid been bandied about or even been done by Phoenix or Arizona officials?

DAVIS-YOUNG: Yes, Arizona officials have definitely been calling for more federal assistance. We have a number of mayors here who, like you mentioned, have been calling for more FEMA disaster type assistance.

But then there's also the LIHEAP program through HUD, which is low-income home energy assistance program that helps pay for things like energy costs, which can be very high. But that traditionally has gone more to cold weather states. So we've had our governor calling on kind of recalculation of how the federal government distributes that type of assistance funding.

Most of the programs, like I've mentioned, the cooling centers that have been staying overnight, to give unsheltered people cool places to go, that is paid for mostly this year by American Rescue Plan Act funding, which is a federal pandemic relief aid. That expires in 2026. So there's no guarantee that program is going to be able to continue a couple years from now. These aren't coming entirely out of city and county budgets, because the cities and counties just don't have that kind of funding at hand. So there are big expenses that officials in Arizona really would like to see more federal assistance for.

CHAKRABARTI: Okay.

Katherine Davis-Young, hang on here for just a second. In a couple of minutes, we're going to hear from Kate Gallego, the mayor of Phoenix, Arizona. But before we do that, I want to set up some background here on the law around how the federal government issues a federal disaster designation.

For that, we turn to Ladd Keith, Associate Professor of Planning at the University of Arizona and a Co-Principal Investigator at the Center for Heat Resilient Communities.

LADD KEITH: For my perspective as a policy researcher, that would be a really good step to take, is adding extreme heat to clarify that role.

But FEMA does, I think the challenge is that declaring heat disaster is a little bit different than declaring a disaster after potentially a hurricane or earthquake, right? Where you see the physical infrastructure and the visible kind of damage from those events. And a lot of times the impacts from heat might be a little bit more invisible, might be a little bit more focused on public health outcomes, such as heat related deaths.

CHAKRABARTI: Since 1988, federal disaster designation and aid distributed to state and local governments have been determined by one thing, the Stafford Disaster Relief and Emergency Assistance Act. The Stafford Act defines a major disaster as, quote, any natural catastrophe, including any hurricane, tornado, storm, high water, wind driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, or drought, or regardless of cause, any fire, flood, or explosion in any part of the United States, the quote continues here, which in the determination of the president causes damage of sufficient severity and magnitude to warrant major disaster assistance under this act, to supplement the efforts and available resources of the states, local governments, and disaster relief organizations in alleviating damage, loss, hardship, or suffering caused thereby, end quote.

KEITH: And so extreme heat is not on that list in the Stafford Act, but I would say it's important to recognize that extreme heat not being on the list, it doesn't mean that FEMA cannot respond to an extreme heat emergency.

CHAKRABARTI: And to be more clear, heat not being on the list doesn't mean that it is excluded from a disaster designation.

In fact, just recently, FEMA did provide billions of dollars in emergency funding for another kind of disaster that isn't listed in the Stafford Act: the COVID-19 pandemic. While the words COVID or virus aren't anywhere in the Stafford Act's examples of major disasters, it was clear that the state and local governments around the country were overwhelmed and needed federal assistance.

But when it comes to extreme heat, the response has been quite different. Here's FEMA Administrator Deanne Criswell speaking with the Washington Post last year.

DEANNE CRISWELL: Within our authorities on the Stafford Act, you're right, we have never issued an emergency, or a major disaster declaration based on heat. And a lot of that has to do with what is it that we're going to actually provide in a monetary sense or bringing in the rest of the federal government to support it.

But just because we don't necessarily have the authorities right now within the Stafford Act, that doesn't mean that we're sitting idly by.

CHAKRABARTI: Now, FEMA hasn't issued a heat related disaster designation, but states have requested it. According to a petition this June, led by the Center for Biological Diversity, at least three states have made such a request.

Missouri in 1980, Illinois in 1995, and California in 2022. But as you just heard, FEMA also says that regardless of a major disaster declaration, there's no reason why they can't respond to an extreme heat situation. So they don't actually need the designation. But they still haven't done it. In fact, Professor Keith says while declaring extreme heat disasters would be a meaningful symbolic gesture, it might not necessarily make procedural difference.

KEITH: Congress putting extreme heat on that list would certainly, again, signify the government's role in responding to extreme heat emergencies, but I don't think that extreme heat necessarily has to be on for FEMA to respond if we do find ourselves in a situation that requires federal assistance.

CHAKRABARTI: Okay, so recall what FEMA Administrator Deanne Criswell said, that there's a question in the monetary sense of what FEMA would actually provide.

What kind of assistance would it actually give to states? Now currently one of the biggest challenges in receiving that aid for heat related incidents is the lack of data. Let's call it the receipts that states need to provide FEMA to show that their resources have actually been depleted by heat event.

And collecting those damage estimates, by the way, also costs money. So in July, Attorneys General of several states signed a letter petitioning FEMA's list of major disasters, that list should include extreme heat. The AGs argued that for as long as FEMA did not guarantee a disaster designation for extreme heat, there was little incentive for states to collect the data needed for FEMA to make the designation. Are you following me here?

Because FEMA says it can't promise a disaster designation in the absence of that data from the state. So put more simply, the AGs said, we'll collect the data if you promise to use it to help us.

FEMA says, give us the data first. Chicken and egg. The AGs also wrote that, quote, listing extreme heat and wildfire smoke as eligible for disasters may also prompt jurisdictions not currently experiencing these disasters to proactively develop their own response plans.

So not quite a solution, but a call for being proactive. Now, meanwhile, it is up to Congress to determine if any updates to the Stafford Act are warranted, maybe including things like extreme heat. But in order to do, there needs to be updated actuarial analysis. i.e. the cost of a disaster, including the cost of human lives lost, which may be the biggest cost in heat disasters.

KEITH: I think the awareness is there that this is the nation's number one weather related killer, yet the money that we spend addressing those public health impacts of heat is a drop in the bucket compared to what we spend on fighting wildfires, addressing hurricane risk, addressing drought risk and things like that.

And again, it's a question of whether how much do you value a human life over a property that's destroyed by a major disaster. Both are incredibly important to the folks that they impact. But one has a very measurable kind of financial impact. The other one is a little bit potentially more invisible.

CHAKRABARTI: Ultimately, Professor Keith says something must change in the relationship between states and the federal government, because extreme heat events are not going away.

KEITH: Whether we declare it as a disaster or not, extreme heat is a disaster, right? It impacts our communities, infrastructure, economy is a natural environment.

I think the federal government has gone a long way to increase its ability to respond to extreme heat, but we still have quite a long way to go.

CHAKRABARTI: That's Ladd Keith, associate professor of planning at the University of Arizona. Mayor Kate Gallego joins us now. She's the mayor of Phoenix, Arizona.

Mayor Gallego, it's great to have you. Thank you for joining us. We've got about a minute before we have to take our next break. So let me just get directly to a key question here. What kind of relief are you or would you seek from the federal government?

KATE GALLEGO: The federal government can help us at scale much more quickly.

So that could be things like backup power generation, pop up shelters, cooling centers. You heard some of the things our emergency responders are doing. If we needed to scale that quickly, the federal government would be such a key partner in doing so.

CHAKRABARTI: And have you made that such requests?

GALLEGO: So we have written to FEMA, and they have shared with us that in exceptional circumstances, that FEMA can help us by declaring a disaster. We would really love that certainty. And so two of my Phoenix congressmen, Greg Stanton and Ruben Gallego, have introduced legislation to make it abundantly clear that heat would be eligible.

CHAKRABARTI: And do you think that 100 plus straight days of triple digit temperatures qualify as exceptional circumstances?

GALLEGO: We know that if we have more partners, we can save more lives. It's clear that we are not doing enough if so many people are losing lives, and we need help on areas where we at the city are not the lead, such as public health. So many of the lives lost. Addiction was a component of the vulnerability to heat.

Part III

CHAKRABARTI: Mayor Gallego, so we reached out to Phoenix, sorry, we reached out to FEMA. Let me get my names right here. And asked them, so why haven't they yet made an official disaster designation for Phoenix or places like Phoenix that have been really suffering under this massive heat problem?

And here is what FEMA told us in a statement, so it's a bit long, but bear with me because it's important to hear out their reasoning. FEMA says, quote:

"If there were to be a scenario when and where an extreme heat incident potentially exceeded state and local capacity, and a request for either an emergency or major disaster declaration was submitted, it could be considered. And if approved, it could reimburse the state for eligible costs.

CHAKRABARTI: Okay, now they give examples.

If there was a power outage incident caused from extreme heat, the state may be eligible for reimbursement of the costs of out of state electrical workers who come into the state to expedite reestablishing the power supply.

CHAKRABARTI: But generally, FEMA says:

Compared to other hazards, the response costs related to extreme heat incidents are generally low.

CHAKRABARTI: Mayor Gallego, what's your response to that?

GALLEGO: One, it does not value human life, where I think it needs to be valued, and the ability to save human life should be a top priority. But make no mistake, the federal government is helping us fund response to heat. They're doing it as you've covered, through the American Rescue Plan, which is temporary funding we've gotten to help us get through the challenging events of the last few years that is about to go away, but we have used that to stand up 24 hour cooling centers, to purchase Naloxone to support public health efforts.

We have purchased what we call cooltainers, which are mobile units that can go out and provide an air conditioned respite. We have both semi permanent and more mobile ones. All of that is expensive and some of it has been done through urban area security money, which again is federal money.

Phoenix can prepare for this. We have a permanent office in our city that thinks about heat year-round, but climate change is a reality that every mayor is likely to face at some point. Cities that are known for being cold, like Chicago, have had terrible heat emergencies. We have a little bit more preparation than most communities, and I think it's a mistake not to have this federal tool available for every part of the United States.

CHAKRABARTI: So maybe in that case, FEMA isn't the right agency for us to look at, right? Because FEMA's looking at, let's call it short term acute disasters, based on what they said in that statement. Or as the professor said earlier, visible disasters, like when a hurricane comes in and wrecks so much infrastructure that it'll cost billions of dollars to rebuild cities and states.

Are there other ways, Mayor Gallego, that you think that the federal government could help? Should there be some sort of a long-term plan to help cities and states cope with this new era of climate change?

GALLEGO: Federal programs seem to be set up more for cool weather communities. So as we've talked about. the federal energy assistance, some of the building and housing programs are really focused on helping people get through winter.

In a warming planet, we really need to think about whether those assistance programs ought to also help people for whom summer is the more challenging climate season. So we would love to see more government wide solutions. I think it's important to recognize that heat can happen with other challenges.

So if the electric grid were to go down, that would result in a much more difficult situation than what you would face if air conditioning continues to operate. And then FEMA would be absolutely the right agency partner. 10 years ago, we had a federally declared disaster for flooding in Phoenix, and it unlocked a lot of resources and expertise that helped us.

It helped us get through procurements more quickly. All of that would be very useful to communities facing heat emergencies. Right now, a lot of those networks are informal. So I'll talk to other mayors when they have their first heat emergency and talk about what our first responders and workers with vulnerable populations do.

And I'm happy to do that in an informal way. But if this is going to be a growing challenge for our entire country, then we ought to set up more formal networks to provide the support and save lives.

CHAKRABARTI: So thinking about how to manage through state and federal partnerships, long term disasters versus acute ones.

Katherine Davis-Young, let me turn back to you here because Mayor Gallego did mention something that I'd love to hear a bit of your reporting on, and that is how the very high temperatures for so long are intersecting with an addiction crisis and how that's contributing to the loss of lives in Phoenix.

Can you tell us more about that?

DAVIS-YOUNG: Yeah, of course, this increase that we've seen in heat related deaths has a lot to do with these rising temperatures, but there are these social factors playing a huge role too. I mentioned before how our unsheltered homeless population has grown a lot, but another factor is substance use.

It used to factor into like about a third of heat related deaths, about 10 years ago. That's grown, now about 60% of our heat related deaths in the last few years have been related to substance use. It can just exacerbate the dangers of heat, especially methamphetamine, is the one that kind of factors into the most of these heat and substance use deaths.

It raises the body temperature. It decreases the feeling of thirst. It can just bring on those symptoms of heat stroke so much faster. When I've spoken with city and county public health officials about this, they tell me that it's really this unique challenge in Arizona where we have this huge spike in overdose deaths in the summer.

And when they look to the CDC or other federal agencies for guidance on this, it's really not out there. They're starting from scratch, trying to tackle this combination problem of substance use and heat, because we're on the front lines of this problem here in Arizona.

CHAKRABARTI: Interesting. I should note that in the text of the Stafford Act, it does actually say that if approved, if federal assistance does come through, that states and localities can use funds for projects or activities that mitigate the impacts of natural hazards, including drought or prolonged episodes of intense heat.

But this gets us back to what it would take to shake loose that funding, if it were to come from FEMA. And that is the calculation of the cost, essentially the economic cost of the disaster, which seems to be at the heart of this. And Mayor Gallego, let me turn back to you. As you said, it doesn't seem like they're taking into account the cost of human lives.

I'm trying to find a sensitive way to put this, but even with the hundreds of people who have died due to the heat disaster that's going on in Phoenix. In the sort of brutal dollars and cents world that federal money is distributed across this country, what would you say to a lawmaker or an agency official who says, yes, the loss of those 600 plus people is terrible, but it doesn't compare financially to the billions of dollars that it takes, say, to rebuild New Jersey and New York following Hurricane Sandy?

And the government has to make decisions. It can't fund everything.

GALLEGO: To me, each of these lives is an individual who has friends and family and leaves a huge hole in our community. These are our problems where if we decided as a country, it was a priority, it is likely one of our more solvable problems.

So we are not meant at the city government level to be public health experts. We don't have that taxing authority. We are trying to do the best we can, because it is such an important problem to our community. But if we, as a country said that we wanted to address this. Think about the lives that we could save and the good we could do.

CHAKRABARTI: Tell me what you mean about, at the city level, you're not supposed to be public health experts, because you don't have that taxing authority. I'm not clear on that.

GALLEGO: Decades ago, we gave up our taxing authority to county government. But we also, we all saw during COVID what could happen with public health mobilized.

CHAKRABARTI: So this is in Arizona specifically that the cities can't levy? I'm just not --

GALLEGO: We are not the public health branch of government, but we're trying to invest more in that area because we see this as an opportunity to do better. But there have not been federal dollars really focused on how we can help with the effects of meth and heat, it's just not been a problem.

We as a country have said is a top priority, and we could save lives pretty easily if we did that. Look in my perfect world, we wouldn't have to be responding to this as an emergency. Because the whole country would do what city of Phoenix does and plan year-round. But the fact is that we haven't, and so many communities all across our country from Michigan to Maine have also been affected by heat challenges.

My message to the people who are listening is this is a problem that is getting worse. We are not doing what we should be doing to reduce greenhouse gas emissions. And so we have to plan for the fact that heat emergencies are going to become not just a Southwestern problem, but an American problem.

CHAKRABARTI: Okay, so just to clarify. Mostly because I guess  it showed my lack of understanding between how a city and county governments work in Arizona, so forgive me for that. But in terms of public health decision making, that's at the county level, Mayor Gallego, that's what you're saying.

GALLEGO: Yes. County, state, and federal.

CHAKRABARTI: County, state, and federal. Okay. Good. So Katherine Davis-Young, let me turn back to you. Because Mayor Gallego's pointing out something very important, which is essentially not just for Phoenix, not just for this American Southwest, for the nation as a whole, high heat, we've already seen that's the new norm, right?

And so perhaps maybe my entire framing of this hour is a little bit off. Because we're thinking about federal, how does the federal government need to determine disaster designations? Because that's a way to shake loose the money. Is basically a new norm a disaster? Yeah, I guess emotionally it is, but it's also the new norm.

So I wonder, Katherine, if you've got any ideas or if your reporting has dug up any sort of innovations that come along with trying to find funds to live in this new norm?

DAVIS-YOUNG: Think Like Mayor Gallego mentioned, Phoenix and Maricopa County plan for extreme heat year-round. Part of the reason that we're able to report the fact that heat related deaths have spiked so significantly here is because our community County Public Health Department tracks that very closely.

And that's not done in most of the country. We're on the front lines of that here. So it is a disaster here for sure. In the ... just scale of loss of life that we're seeing here every summer. But we do have government officials very aware of that and trying to respond to it. I do worry looking at other places like Mayor Gallego mentioned, Chicago or in Seattle or Portland, places that not every apartment building is required to have air conditioning and people aren't as used to these high temperatures where they're going to be seeing more heat disasters in future summers.

Those city governments probably don't have as much planning as Phoenix does.

CHAKRABARTI: I keep coming back to the fact that our short term federal funding is really based around infrastructure, right? And Mayor Gallego, to your point, it doesn't adequately factor in the cost of human lives, even though the kind of climate impacts of climate disasters have a lot to do with human lives lost.

But I wonder, you had mentioned the electrical grid. For example, if the grid went down, even for a day in Phoenix. I understand that would majorly spike the number of people who died, because internal temperatures would rise so dramatically. I wonder if we should start thinking, or have you started thinking of ways to involve the federal government or federal assistance in making the grid more resilient in Phoenix?

You talked about backup generators, but do we need to have a major influx of money to upgrade infrastructure ... in places like Phoenix and elsewhere.

GALLEGO: So far, data has shown that our grid is among the most reliable in our country. We appreciate the Infrastructure Jobs Act has had money to improve the electrical grid and we have applied for some of the resiliency funds to create more backup power for some of our cooling centers and other key heat infrastructure.

Unfortunately, we weren't successful, so we would love to see additional opportunities in that area. But apparently part of the reason we weren't as successful is that our grid has been more reliable. So you can, funny implications of different public policy metrics. But we know as a country and as a planet, these extreme temperatures are going to become more common.

And so we do need to both do our best to reduce greenhouse gas emissions, but also invest in a more resilient grid, and that the chance of the grid going down is exactly why FEMA should be very clear that heat should be a disaster. Because heat on top of power outage would be even more dangerous, and that is where the federal influx immediately of backup cooling centers and backup power generation could make such a lifesaving difference.