Op-ed: We are undercounting heat-related deaths in the US
Knowing how many people die or get sick from heat-related causes is essential for the policy arguments to equitably adapt to and mitigate climate change.
In summer 2022, in San Antonio, Texas, 51 migrants died in an overheated truck, after being smuggled across the border from Mexico.
The day they died, temperatures peaked well past 100 degrees Fahrenheit (38 degrees Celsius), and the truck had no water and a busted cooling system. Eleven people survived thanks to a nearby worker who heard muffled cries for help. Though their deaths are in part due to the negligence of their driver, extreme heat also played a big role. However, their deaths — like thousands of others in the U.S — were likely not recorded as heat related. This common oversight is a problem that obscures the deadly effects of rising temperatures.
Heat is estimated as the number one weather-related killer in the U.S. Exposure to elevated heat can directly result in heat cramps, heat exhaustion, heatstroke and hyperthermia. Elevated heat can exacerbate chronic conditions such as asthma, heart and other cardiovascular diseases, autoimmune conditions, arthritis, and can deteriorate mental health. Knowing how many people die or get sick from heat-related causes is essential for the policy arguments to mitigate climate change, as well for environmental justice — we need to know how many people are dying and who they are.
One major step to doing this is making sure that we are thoroughly and accurately accounting for all the people who are losing their lives to heat. But exactly how many people are dying due to heat? The numbers we have now are almost certainly underestimating the true death count attributable to elevated heat. The Environmental Protection Agency (EPA) estimates 600 annual deaths attributable to elevated heat, while statistical approaches estimate more than 1,300 annual deaths.
The role of medical examiners
There are two types of heat-related deaths: heat stress deaths, caused directly by heat and recorded on a death certificate; and heat-exacerbated deaths, when heat worsens existing chronic conditions. Heat can be listed on death certificates as a contributing or underlying cause of death. However, many deaths associated with elevated heat are not identified as such by medical examiners and might not be properly coded on the death certificate, as the EPA notes. If the cause of death is classified as the result of a cardiovascular or a respiratory disease, the medical examiner may omit the role of heat in the death if they are uncertain whether it was a contributing factor. Moreover, when making such a determination, there is a lack of standardization in how medical examiners quantify heat. As per the Medical Examiners’ and Coroners’ Handbook on Death Registration and Fetal Death Reporting, the cause of death is the medical examiner’s best medical opinion and, in some cases, where it is not possible to make a precise determination of the interacting causes of death, a subjective call has to be made.
It doesn’t help that each state possesses an independent system. As of 2019, 16 states had a centralized medical examiner system, 14 had a county-based system with a mixture of coroner and medical examiner office, six had a county- or district-based medical examiner system, and 14 had a county-, district- or parish-based coroner system. Medical examiners and coroners are substantially different. While medical examiners are appointed and have board-certification in a medical specialty, coroners are elected lay people who often do not necessarily have professional training. The lack of standardization in state systems as well as in how medical examiners determine whether heat is an underlying factor of deaths contributes to the uncertainty of how many people die of elevated heat.
No standards to tally heat-related deaths
When making a determination of cause of death, there is a lack of standardization in how medical examiners quantify heat.
Though states and researchers also use statistical models to estimate the numbers of heat-related deaths, the methods are not standardized. Approaches can range from using two models that reflect different measures of hot weather – which is New York City’s chosen method – to time regression studies. Moreover, even if researchers do use the same methods, there are also different approaches to estimating minimum mortality temperatures, which can lead to different estimates of excess deaths. Since these numbers are often the ones circulated, the extent to which these methods differ opens the door for discrepancies. With the lack of a standardized approach, we propose developing a unified U.S.-wide method of excess heat-attributable deaths immediately.
Evidence for climate change action
There are many policy makers who may not see the point of such measures. For a large portion of history many politicians denied that rising temperatures were an issue. And now, polls show that though Republicans are open to some policy approaches, climate change is still considered a low priority. So, why do these details matter? We need to know how many people are suffering in order to effectively drive policies for climate and health action. Each heat-related death was a life and represents a story that ended too early. When the public hears about stories such as the migrants’ deaths in San Antonio, they are rightly shocked. If they knew the full extent of how heat kills in the U.S., they would be able to put further pressure on lawmakers to spur climate change action. Our health depends on the climate’s health.
Even if researchers do use the same methods, there are also different approaches to estimating minimum mortality temperatures, which can lead to different estimates of excess deaths.
Identifying and mitigating heat-related deaths is also relevant to the historically underserved communities that are the most exposed and vulnerable to elevated heat. In the rural parts of America, Latinos make up nearly 60% of farm laborers, an occupation infamous for having limited protection against the heat. Meanwhile in cities, racist policies and urban planning decisions from decades ago have created redlined neighborhoods that are much hotter and deadlier than other areas. Black and Brown communities are enduring the brunt of the heat’s wrath. By more accurately identifying which groups of people are disproportionately suffering the most, we can push lawmakers to take more action to avoid more heat-related tragedies.
What happened in San Antonio was a tragedy, but it was not an accident. If we don’t start taking action now, there are only more dire ‘accidents’ awaiting us. It is scary not knowing what you are up against — so improving our knowledge of heat-related deaths is the first, and one the most important, steps.
CAMERON PARISH, La. — Late into the night, John Allaire watches the facility next to his home shoot 300-foot flares from stacks.
He lives within eyesight of southwest Louisiana’s salty shores, where, for decades, he’s witnessed nearly 200 feet of land between it and his property line disappear into the sea. Two-thirds of the land was rebuilt to aid the oil and gas industry’s LNG expansion. LNG — shorthand for liquified natural gas – is natural gas that's cooled to liquid form for easier storage or transport; it equates to 1/600th the volume of natural gas in a gaseous state. It’s used to generate electricity, or fuel stove tops and home heaters, and in industrial processes like manufacturing fertilizer.
In the U.S., at least 30 new LNG terminal facilities have been constructed or proposed since 2016, according to the
Oil and Gas Watch project. Louisiana and Texas’ Gulf Coast, where five facilities are already operating, will host roughly two-thirds of the new LNG terminals – meaning at least 22 Gulf Coast LNG facilities are currently under construction, were recently approved to break ground or are under further regulatory review.
Although the U.S. didn’t ship LNG until 2016, when a freight tanker left, a few miles from where Cameron Parish’s LNG plants are today, last year the country became the global leader in LNG production and export volume, leapfrogging exporters like Qatar and Australia. The
EIA’s most recent annual outlook estimated that between the current year and 2050, U.S. LNG exports will increase by 152%.
Allaire, 68, watches how saltwater collects where rainwater once fed the area’s diminishing coastal wetlands. “We still come down here with the kids and set out the fishing rods. It's not as nice as it used to be,” he told
Environmental Health News (EHN).
That intimacy with nature drew Allaire to the area when he purchased 311 acres in 1998. An environmental engineer and 30-year oil and gas industry veteran, he helped lead environmental assessments and manage clean-ups, and although retired, he still works part-time as an environmental consultant with major petroleum companies. With a lifetime of oil and gas industry expertise, he’s watched the industry's footprint spread across Louisiana and the Gulf of Mexico’s fragile shores and beyond. Now that the footprints are at the edge of his backyard, Allaire is among a cohort of organizers, residents and fisher-folk in the region mobilizing to stop LNG facility construction. For him, the industry’s expansion usurps the right-or-wrong ethics he carried across his consulting career. For anglers, oil and gas infrastructure has destroyed fishing grounds and prevented smaller vessels from accessing the seafood-rich waters of the Calcasieu River.
From the view of Allaire’s white pickup truck as he drives across his property to the ocean’s shore, he points to where a new LNG facility will replace marshlands. Commonwealth LNG intends to clear the land of trees and then backfill the remaining low-lying field.
“You see what’s happening with the environment,” Allaire said. “When the facts change, I got to change my mind about what we’re doing.”
Community bands together
John Allaire, left, purchased 311 acres in Cameron Parish in 1998, and has watched the oil and gas industry's footprint spread to his property.
Credit: John Allaire
During an Earth Day rally in April, community members gathered in the urban center of Lake Charles to demand local oil and gas industries help deliver a safer, healthier future for all. In between live acts by artists performing south Louisiana’s quintessential zydeco musical style, speakers like James Hiatt, a Calcasieu Parish native with ties to Cameron Parish and a Healthy Gulf organizer, and RISE St. James organizer Sharon Lavigne, who’s fighting against LNG development in rural Plaquemines Parish near the city of New Orleans, asked the nearly 100 in attendance to imagine a day in which the skyline isn’t dotted by oil and gas infrastructure.
Not long ago, it was hard to imagine an Earth Day rally in southwest Louisiana at all. For decades, the area has been decorated with fossil fuel infrastructure. Sunsets on some days are highlighted by the chemicals in the air; at night, thousands of facilities’ lights dot the dark sky.
“It takes a lot of balls for people to start speaking up,” Shreyas Vasudevan, a campaign researcher with the Louisiana Bucket Brigade, told EHN in the days after the rally. In a region with its history and economy intertwined with oil and gas production, “you can get a lot of social criticism – or ostracization, as well – even threats to your life.”
Many are involved in local, regional and national advocacy groups, including the Louisiana Bucket Brigade, Healthy Gulf, the Sierra Club, the Natural Resources Defense Council, the Turtle Island Restoration Network, the Center for Biological Diversity and the National Audubon Society.
“You see what’s happening with the environment,” Allaire said. “When the facts change, I got to change my mind about what we’re doing.” - John Allaire, environmental engineer and 30-year oil and gas industry veteran
But environmental organizers are fighting a multi-billion-dollar industry with federal and state winds at its back. And LNG’s federal support is coupled with existing state initiatives.
Under outgoing Louisiana Gov. John Bel Edwards — a term-limited Democrat — the state pledged a goal of reaching net-zero greenhouse emissions by 2050. Natural gas, which the LNG industry markets as a cleaner-burning alternative, is cited as one of the state’s solutions. Louisiana is the only state that produces a majority of its carbon emissions through fossil fuels refining industries, like LNG, rather than energy production or transportation. Governor Edwards’ office did not return EHN’s request for comment.
This accommodating attitude towards oil and gas industries has resulted in a workforce that’s trained to work in LNG refining facilities across much of the rural Gulf region, said Steven Miles, a lawyer at Baker Botts LLP and a fellow at the Baker Institute’s Center on Energy Studies. Simultaneously, anti-industrialization pushback is lacking. It’s good news for industries like LNG.
“The bad news,” Miles added. “[LNG facilities] are all being jammed in the same areas.”
One rallying cry for opponents is local health. The Environmental Integrity Project found that LNG export terminals emit chemicals like carbon monoxide –potentially deadly– and sulfur dioxide, of which the American Lung Association says long-term exposure can lead to heart disease, cancer, and damage to internal or female reproductive organs.
An analysis of emissions monitoring reports by the advocacy group the Louisiana Bucket Brigade found that Venture Global’s existing Calcasieu Pass facility had more than 2,000 permit violations.That includes exceeding the permit’s authorized air emissions limit to release nitrogen oxides, carbon monoxide, particulate matter and volatile organic compounds 286 out of its first 343 days of operation.
The Marvel Crane, the first liquid natural gas carrier to transport natural gas from the Southwest Louisiana LNG facility, transits a channel in Hackberry, Louisiana, May 28, 2019.
“This is just one facility,” at a time when three more facilities have been proposed in the region and state, Vasudevan said. Venture Global’s operational LNG facility — also known as Calcasieu Pass — “is much smaller than the other facility they’ve proposed.”
In an area that experienced 18 feet of storm surge during Hurricane Laura in 2020 — and just weeks later, struck by Hurricane Delta — Venture Global is planning to build a second export terminal Known as “CP2,” it’s the largest of the roughly two dozen proposed Gulf LNG export terminals, and a key focal point for the region’s local organizing effort.
Residents “don’t really want LNG as much as they want Cameron [Parish] from 1990 back,” Hiatt told EHN of locals’ nostalgia for a community before storms like Rita in 2005 brought up to 15 feet of storm surge, only for Laura to repeat the damage in 2020. Throughout that time, the parish’s population dipped from roughly 10,000 to 5,000. “But the wolf knocking at the door is LNG. Folks in Cameron think that's going to bring back community, bring back the schools, bring back this time before we had all these storms — when Cameron was pretty prosperous.”
“Clearly,” for the oil and gas industry, “the idea is to transform what was once the center of commercial fishing in Louisiana to gas exports,” Cindy Robertson, an environmental activist in southwest Louisiana, told EHN.
Helping fishers’ impacted by LNG is about “actual survival of this unique culture,” Cooke said.
In a measure of organizers’ success, she pointed to a recent permit hearing for Venture Global’s CP2 proposal. Regionally, it’s the only project that’s received an environmental permit, but not its export permit, which remains under federal review. At the meeting, some spoke on the company’s behalf. As an organizer, it was a moment of clarity, Cooke explained. Venture Global officials “had obviously done a lot of coaching and organizing and getting people together in Cameron to speak out on their behalf,” Cooke said. “So, in a way, that was bad. But in another way, it shows that we really had an impact.”
“It also shows that we have a lot to do,” Cooke added.
Environmental organizers like Alyssa Portaro describe a sense of fortitude among activists — she and her husband to the region’s nearby town of Vinton near the Texas-Louisiana border. Since the families’ relocation to their farm, Portaro has worked with Cameron Parish fisher-folk.
“I’ve not witnessed ‘community’ anywhere like there is in Louisiana,” Portaro told EHN. But a New Jersey native, she understands the toll environmental pollution has on low-income communities. “This environment, it’s so at risk — and it’s currently getting sacrificed to big industries.”
“People don’t know what we’d do without oil and gas. It comes at a big price,” she added.
Southwest Louisiana’s Cameron Parish is one of the state’s most rural localities. Marine economies were the area’s economic drivers until natural disasters and LNG facilities began pushing locals out, commercial fishers claim.
Credit: Xander Peters for Environmental Health News
Residents “don’t really want LNG as much as they want Cameron [Parish] from 1990 back,” James Hiatt , a Healthy Gulf organizer, told EHN. "But the wolf knocking at the door is LNG."
Credit: Xander Peters for Environmental Health News
For the most part, Cameron Parish’s life and economy has historically taken place at sea. As new LNG facilities are operational or in planning locally, locals claim the community they once knew is nearly unrecognizable.
Credit: Xander Peters for Environmental Health News
A disappearing parish
The stakes are seemingly higher for a region like southwest Louisiana, which is the epicenter of climate change impacts.
In nearly a century, the state has lost roughly 2,000 square miles of land to coastal erosion. In part driving the state’s erosion crisis is the compounding impacts of Mississippi River infrastructure and oil and gas industry activity, such as dredging canals for shipping purposes, according to a March study published in the journal Nature Sustainability. Louisiana’s Coastal Protection and Restoration Authority said Cameron Parish could lose more land than other coastal parishes over the next 50 years. A recent Climate Central report says the parish will be underwater within that time frame.
On top of erosion and sea level rise impacts, in August, 2023, marshland across southwest Louisiana’s Cameron Parish burned. The fires were among at least 600 across the Bayou State this year. Statewide, roughly 60,000 acres burned — a more than six-fold increase of the state’s average acres burned per year in the past decade alone.
But while the blaze avoided coastal Louisiana communities like Cameron Parish, the fires represented a warning coming from a growing chorus of locals across the region — one that’s echoes by the local commercial fishing population, who claimed to have experienced unusually low yields during the same time, according to a statement from a local environmental group. At the site of the Cameron Parish fires are locations for two proposed LNG expansion projects.
"The idea is to transform what was once the center of commercial fishing in Louisiana to gas exports.” - Cindy Robertson, an environmental activist in southwest Louisiana
It was an unusual occurrence for an area that’s more often itself underwater this time of year due to a storm surge from powerful storms. For LNG expansion’s local opposition, it was a red flag.
As the Louisiana Bucket Brigade has noted prior, the confluence of climate change’s raising of sea levels and the construction of LNG export terminals — some are proposed at the size of nearly 700 football fields — are wiping away the marshland folks like Allaire watched wither. Among their fears is that the future facilities won’t be able to withstand the power of another storm like Laura and its storm surge, which wiped away entire communities in 2020.
Amidst these regional climate impacts, LNG infrastructure has shown potential to exacerbate the accumulation of greenhouse gasses that cause global warming. For the most part, LNG is made up of methane — a greenhouse gas that’s more than 80 times more potent than carbon dioxide in the atmosphere. Among the 22 current LNG facility proposals, the advocacy group Sierra Club described a combined climate pollution output that would roughly equal to that of about 440 coal plants.
The climate impacts prompt some of the LNG industry’s uncertainty going forward. It isn’t clear if Asian countries, key importers of U.S. LNG, will “embrace these energy transition issues,” said David Dismuke, an energy consultant and the former executive director of Louisiana State University’s Center for Energy Studies. Likewise, European nations remain skeptical of embracing LNG as a future staple fuel source.
“They really don't want to have to pull the trigger,” Dismukes added, referring to Europe’s hesitation to commit more resources to exporting LNG from the American market. “They don't want to go down that road.”
While there will be a tapering down of natural gas supply, Miles explained, “we’re going to need natural gas for a long time,” as larger battery storage for renewables is still unavailable.
“I'm not one of these futurists that can tell you where we're going to be, but I just don't see everything being extreme,” Dismukes said. “I don't see what we've already built getting stranded and going away, either.”
For now, LNG seems here to stay. From 2012 to 2022,U.S. natural gas demand — the sum of both domestic consumption and gross exports — rose by a whopping 43%, reported the U.S. Energy Information Administration, or EIA. Meanwhile, in oil and gas hotbeds like Louisiana and Texas, natural gas demand grew by 116%.
Throughout 25 years, Allaire has witnessed southwest Louisiana’s land slowly fade, in part driven by the same industrial spread regionally. Near where the front door of his travel trailer sits underneath the aluminum awning, he points to a chenier ridge located near the end of the property. It’s disappearing, he said.
“See the sand washing over, in here?” Allaire says, as he points towards the stretches of his property. “This pond used to go down for a half mile. This is all that's left of it on this side.”
The Goldman Environmental Prize celebrates its 35th year by recognizing seven environmental leaders who have made significant impacts in their regions.
Seven environmental activists, including two Indigenous leaders from Africa, received the Goldman Environmental Prize for achievements in environmental conservation.
Among the winners, efforts ranged from stopping seismic testing in South Africa to protecting forests in India and influencing clean transportation regulations in California.
These activists have effectively combated threats like deforestation and pollution, promoting sustainable practices across various regions.
Key quote:
"There is no shortage of those who are doing the hard work, selflessly. These seven leaders refused to be complacent amidst adversity, or to be cowed by powerful corporations and governments."
— John Goldman, president of the Goldman Environmental Foundation.
Trump plans to dismantle Biden's climate initiatives, including regulations on power plants and automobile emissions.
His past presidency saw over 100 environmental protections revoked, signaling a similar approach if reelected.
Climate advocates fear a second Trump term could severely hinder efforts to combat global warming due to a narrowing window for action.
Key quote:
"It would become an all-out assault on any possible progress on climate change."
— Pete Maysmith, senior vice president of campaigns at the League of Conservation Voters
Why this matters:
The prospect of former President Trump reclaiming the White House has climate advocates bracing for potential setbacks. Trump's earlier tenure was marked by an unabashed rollback of environmental regulations, an embrace of fossil fuels, and a withdrawal from the Paris Agreement, casting a long shadow on the strides made in global climate policy. If elected again, experts worry it could signal a detour from the aggressive climate action many argue is needed to stave off the worst impacts of climate change.
A recent study suggests climate change, driven by fossil fuel emissions, likely intensified the unprecedented rains in Oman and the UAE, causing significant destruction and fatalities.
The World Weather Attribution's analysis points to climate change as the main driver behind the recent extreme weather in the UAE and Oman, marking a significant increase in rainfall intensity.
This catastrophic event resulted in the deaths of 25 people across both countries and disrupted major infrastructure, including Dubai's international airport.
The report emphasizes that no other factors besides global warming have been identified to explain the surge in precipitation.
Key quote:
“The UAE and Oman floods have shown that even dry regions can be strongly affected by precipitation events, a threat that is increasing with increasing global warming due to fossil fuel burning.”
— Sonia Seneviratne, WWA member and professor at Zurich’s ETH university
Why this matters:
Climate change may be altering weather patterns, shifting the paths of storms and worsening the intensity of rainfalls. This shift disrupts typical weather in regions like typically arid regions like Oman and the UAE and poses significant environmental and health challenges, such as increased risk of floods and waterborne diseases.
Conservationists, facing prolonged marine heat waves, are prioritizing the restoration of heat-resistant coral species.
Innovative techniques, including relocating nurseries to cooler waters, are being tested to combat the escalating coral bleaching.
Last year’s extensive coral bleaching has spurred a reevaluation of coral restoration tactics amid fears of recurring heat extremes.
Key quote:
"Returning these corals felt a bit like a loved one leaving the hospital."
— Sam Burrell, senior reef restoration associate at the Coral Restoration Foundation
Why this matters:
Marine heat waves, no longer just occasional natural phenomena but increasingly common events, pose a severe risk to the biodiversity of our oceans. The response from those on the frontlines has been to focus their efforts on restoring species of coral that possess a remarkable trait: heat resistance. These hardier breeds offer a glimmer of hope, a potential bulwark against the rising temperatures. The success of these conservation strategies could dictate the future health of marine life and the communities that depend on them.
The Maldives is undertaking large-scale land reclamation to combat land scarcity and rising sea levels, but this move has sparked widespread environmental and societal concerns.
Land reclamation in the Maldives involves dredging ocean floors to create new land, affecting marine ecosystems and local communities.
Environmentalists and scientists warn that such projects harm coral reefs and disrupt natural sediment flows, increasing vulnerability to climate impacts.
Despite government claims of economic development, local critics argue that new land has remained underutilized and has not addressed fundamental economic needs.
Key quote:
“Atolls are extremely vulnerable ecosystems."
— Bregje van Wesenbeeck, scientific director of Deltares
Why this matters:
The Maldives' strategy to secure its future against sea-level rise through land reclamation might cause more harm than benefit. The push to create more land — mainly to boost infrastructure and tourism — stirs significant concerns over the destruction of marine habitats, particularly coral reefs that are vital not only for biodiversity but also for natural storm protection. Socially, these developments spark debates about sustainability and the long-term livelihoods of local communities, many of whom rely heavily on the natural resources that are now under threat.
