Scientists, doctors, and advocates in British Columbia continue to urge the province to better protect low-income people from extreme heat, after the BC Centre for Disease Control (BCCDC) found that being poor more than doubled the odds of dying during the province’s 2021 heat dome.

“Poverty created the biggest risk of death during the heat dome, placing people in greater danger than any chronic health condition or disability,” reports CBC News, citing an unpublished BCCDC report.

Using data from the provincial pharmacare program, researchers determined that roughly 15% of the 619 people who died during the heat dome were receiving income assistance through the Ministry of Social Development and Poverty Reduction, compared to 6% of the population who survived.

Sarah Henderson, the centre’s scientific director of environmental health services, identified several key reasons why poor people were more than twice as likely to die during the heat dome. The list included increased odds of some kind of disability or illness, and living in substandard housing with no outdoor space to cool down, especially at night.

Confirming poverty as “the biggest risk factor for mortality during the heat dome, followed very closely by evidence of having schizophrenia,” Henderson told CBC she is “scared of summer.”

“They describe this as a one-in-1,000-year event,” she said. “I don’t buy that. I will not be surprised if we see another temperature anomaly like this within the next decade, and I fear for the people in the province who are so at risk.”

Responding to increasingly urgent calls to protect the vulnerable from increasingly fearsome summer heat, the provincial government recently announced plans to funnel C$10 million into a BC Hydro program that will “provide approximately 8,000 air conditioners to medically vulnerable low-income households over the next three years,” CBC writes. Factoring in other, smaller programs already run by the utility, about 10,000 new AC units will be made available.

Asked whether the cash infusion would be enough to meet the need, Health Minister Adrian Dix described it as “an important place to start” and a “very significant investment.”

Provincial data show an estimated 382,000 British Columbians currently living in poverty, CBC notes, and Vancouver physician Dr. Karina Zeidler described the 10,000-air conditioner commitment as “grossly inadequate.” She spent last summer trying unsuccessfully to persuade the provincial government to fund AC for a patient on disability through an existing program that covers the cost of medical devices.

“I would really love to see immediate release of funds for low-income or medically vulnerable people to be able to afford medical cooling,” Zeidler said.

But the new plan immediately ran into conditional pushback from two climate consultants who pointed to heat pumps, passive cooling, and urban greening as options for summer cooling that don’t just depend on transferring indoor heat to the outdoors.

“I say this is the good, the bad ,and the not so ugly announcement,” veteran sustainable cities practitioner Alex Boston told CBC. “Air conditioners are high cost to buy, to operate, and they increase power demand,” to the extent that spiking AC demand during a heat wave could be enough to crash the grid.

“Boston said alternative solutions include providing incentives for external shades that people can put on southern and western exposures of houses and buildings,” CBC writes. “He said the provincial government should also have targets to increase the number of urban trees—or tree canopy—to provide a cooling effect for neighbourhoods and lessen the impact of urban heat islands that are created when communities have few trees.”

Past studies elsewhere have shown that the same low-income communities that are at greatest risk in a severe heat wave are less likely to benefit from the cooling effect of adequate tree cover.

The BCCDC’s Henderson said the proposal to treat air conditioners as essential medical devices for vulnerable people was an “excellent idea”. She pointed to a number of other policy options for governments that are serious about protecting citizens from the dangers of extreme heat, with mandatory maximum allowable indoor temperatures topping the list.

“It is well accepted that homes should not be colder than 18°C in the winter,” she said. “Now we need to make it well accepted that homes should not be warmer than 26°C in the summer.”

A B.C. housing ministry spokesperson told CBC that work is now under way to update the provincial building code. One proposal under consideration is to require that every new residential building contain at least one communal area deliberately designed to never exceed 26°.

But some say that threshold is still too high. The advocacy group 619bc, formed in memory of those who died in the heat dome, says maximum indoor temperatures should not exceed 23°C.