Hot in Here: Heat Waves, Climate Change, and Disability

I previously posted a version of this article in 2024 that did not list evidence and sources for some claims. This updated version corrects this oversight.

As a record-breaking summer of extreme heat worldwide comes to a close, we were given a harsh reminder of climate change’s growing impact. Each summer, people in regions experiencing unprecedented heat waves get the same advice: drink water, find a cooling center, check on your neighbors. Most people think that is enough to see the heat as an inconvenience, but for people with disabilities, it is closer to a recurring threat, and the standard advice quietly assumes a body and a budget that many disabled people don’t have.

Extreme heat is the deadliest weather hazard in the United States, killing roughly 2,000 people a year according to the CDC, more than hurricanes, tornadoes, and floods combined.¹ That count is almost certainly low, as heat as a cause of death doesn’t usually show up on death certificates, instead recorded as a heart attack, kidney failure, or respiratory arrest.

In 2021, a heat dome in British Columbia killed 619 people. The British Columbia Coroners Service, reviewing the deaths, found that 91% of the people who died had at least one chronic disease. 93% lived without air conditioning, 56% lived alone, and 98% died indoors.^2. The people who died were, overwhelmingly, disabled and chronically ill people who could not afford to cool the places where they lived.

Health Complications

Many disabilities come with health conditions that heat makes worse. People with Multiple Sclerosis often experience a type of heat sensitivity called Uhthoff’s phenomenon: fatigue, muscle weakness, vision problems, and cognitive symptoms spike as temperatures climb. It affects roughly 6 out of 10 people with MS, with some studies putting it as high as 80%.³

Those with respiratory conditions like asthma or chronic obstructive pulmonary disease (COPD) can find breathing harder as air quality deteriorates in the heat. Hot, sunny, stagnant days accelerate the formation of ground-level ozone, which aggravates and worsens respiratory and cardiovascular conditions. Researchers call the way climate change erodes air quality gains the “climate penalty”.⁵ A penalty that can be fatal when imposed on people with disabilities.

And because heat strains the cardiovascular system directly, forcing the heart to pump harder to shed warmth through the skin, people with heart conditions face elevated risk of heart attack and stroke during long stretches of high temperatures. In the British Columbia Coroners Service review, hypertension was the single most common condition, present in 71% of those who died.²

Mental health disorders regularly go unmentioned when discussing extreme heat and disability. They are one of the deadliest disabilities to have during a heat wave, not because of stress, but because of physiology and pharmacology. During the 2021 heat dome, people with schizophrenia had the highest risk of death of any chronic condition studied, and heat waves are associated with a nearly 10% jump in mental health hospital presentations.⁶ Part of this is the conditions themselves, which can disrupt thermoregulation and the ability to perceive that your body is overheating. Part of it is the medication. Antipsychotics can suppress sweating and blunt the brain’s temperature control. Some antidepressants and stimulants interfere with thermoregulation. Lithium becomes more dangerous with dehydration.⁶ One case-control study of the heat dome found that people with schizophrenia who had filled an antipsychotic prescription in the prior month had well over twice the risk of dying.⁷

Access to Cool Environments

Many local governments will open public cooling centers as the heat reaches extreme levels, but for disabled people, accessing these air-conditioned environments is often challenging. A study of 377 cooling centers across New York State found the distance to the nearest one ran as far as 53 miles, with access outside major cities depending on transit that was Inconsistent or nonexistent.⁸ Research on parks and outdoor cooling spaces finds the same issue: the people most vulnerable to heat are the least able to get to relief, because the transportation options assume you can walk, drive, or bike.^9. A cooling center is only a resource if you can reach it.

In older, poorly maintained housing where those with lower incomes can afford to live, air conditioning is unreliable or absent, and disabled people are disproportionately represented among low-income households. About 25% of working-age disabled Americans live in poverty, compared with about 10% of nondisabled people,¹⁰ and nondisabled people are roughly twice as likely to be employed at all.¹¹ Having a unit doesn’t mean being able to afford to run it through two weeks of heat, when the electric bill becomes a choice between cooling and groceries.

Emergency Preparedness and Response

Heat waves are natural disasters that unfold slowly, and like other disasters, they expose how little emergency planning adequately considers the needs of people with disabilities. The UN Office for Disaster Risk Reduction reports that disabled people die in disasters at two to four times the rate of those who are nondisabled. And when UNDRR surveyed disabled people worldwide in 2023, 84% said they had no personal disaster preparedness plan. In 2013 that number was 71%.¹² Disabled people were twice as likely to die in the Tōhoku earthquake that took place in Japan in 2011.¹³

Local and state agencies often share information about heat advisories, cooling center locations, and safety guidance through channels that assume everyone can see a visual alert or hear an audio one. In the United States, accessible emergency communication is not a nice-to-have that agencies can innovate toward at their leisure. State and local governments are already legally required to make their emergency communications accessible for disabled people under Title II of the Americans with Disabilities Act. ¹⁴ In 2014, the National Council on Disability documented agencies’ failure to meet compliance requirements, and this has continued every heat season since.¹⁵

Evacuation procedures during extreme heat can be particularly challenging. Leaving an overheated home is not a given for people with mobility disabilities, and emergency responders are rarely trained to assist individuals with specific disabilities. During the British Columbia heat dome, disability advocate Gabrielle Peters stated in direct terms: telling someone who cannot thermoregulate to get themselves to a cooling center is like telling someone with a broken leg to walk to the store and buy crutches.¹⁶

The Broader Context: Climate Change

The current heat wave is part of a broader pattern of climate change that will mean more frequent and intense extreme weather events. This change has long-term implications for people with disabilities. EPA’s climate indicators show that major U.S. cities averaged two heat waves a year in the 1960s and more than six a year in the 2020s, with the heat wave season now 46 days longer than it was then.¹⁷ This means extreme heat stops being an occasional emergency and becomes a standing condition of life.

The systems people lean on also get less reliable exactly when they’re needed most. Elevators and transit go down as power outages become a common occurrence during heat waves due to surging electricity use. These outages are especially dangerous for people who rely on electrically powered medical devices. The U.S. Department of Health and Human Services’ emPOWER program tracks about 4.5 million at-risk Medicare beneficiaries, roughly 3 million of whom depend on electricity-powered medical equipment at home: ventilators, oxygen concentrators, home dialysis, powered wheelchairs.¹⁸ This does not account for children and working-age adults on private insurance.

The stress and anxiety associated with struggling with extreme heat can take a severe toll on mental health. Individuals already managing Mental health disorders, the added pressure of a heat wave can exacerbate symptoms. Heat waves also deepen isolation, confining people to their homes or a cooling center. More than half the people who died during the British Columbia heat dome lived alone.²

What Can Be Done?

There are no programs to point to in some mythical, forward-thinking city as a model for others to emulate, as most governments realistically fail on the basics. Instead, here are some suggestions for targeted interventions and planning.

Emergency response plans must include people with disabilities from the outset. This includes ensuring that all communication about heat waves and available resources is accessible in multiple formats. Not “available in accessible formats on request,” which is how you guarantee the format arrives after the emergency. If a heat advisory goes out as a push notification, it also goes out as text, audio, ASL, and plain language at the same time. This is not aspirational. Title II of the ADA already requires it.¹⁴

Investing in adaptable and accessible infrastructure is crucial. Build cooling centers with step-free entry, paratransit that runs to the centers during the emergency and not on its usual schedule, room for service animals, and enough backup power to charge a powered wheelchair and run a medical device. As research shows, the barrier isn’t awareness; it’s distance and transportation.⁸

Residential power for medical-device users should be protected, not optional. No utility shutoffs during a heat advisory, priority restoration when the grid fails, and restricting the forms and red tape that slow down support. Forty-one states ban winter shutoffs; only about half do the same for heat, even with the evidence that heat is the bigger risk.¹⁹

Fund cooling the way we fund heating. LIHEAP, the federal energy assistance program, is almost completely allocated towards heating: from 2001 to 2019, just 5% of its funds went to cooling. Several of the hottest states offer no cooling assistance from it at all, and states routinely exhaust the money before summer even starts.²⁰ Meanwhile, heat still isn’t listed in the Stafford Act, so FEMA can’t even treat a deadly heat wave as a declarable disaster.²¹ Cooling should carry the same weight as heating, including the running costs, not just the price of the unit. Better yet, follow the British Columbia coroner panel’s recommendation and treat air conditioners as prescribable medical equipment for people at highest risk,²

Community-based support systems, neighbors, mutual aid networks do matter, and they save lives. But they exist because the systems above don’t. Asking disabled people and their communities to absorb a structural failure through sheer goodwill is not a plan. The rights and needs of people with disabilities should be a priority at all levels of government.

As extreme heat shifts from occasional emergency to seasonal certainty, the question is no longer whether we understand who is at risk. We have that information. The question is whether we keep neglecting to build responses for the people who need them most. A heat plan that works only for those who can walk to a cooling center, afford the electric bill, and read the push notification isn’t a plan. A society that protects only those who can already protect themselves isn’t prepared for the planet’s future.

Footnotes

Centers for Disease Control and Prevention heat-related mortality data, as reported in “As much of the US braces for extreme heat, statistics show 2,000 die from it annually,” ABC News, July 28, 2025, https://abcnews.com/Health/us-braces-extreme-heat-statistics-show-2000-die/story?id=124136576. On heat as the leading weather-related cause of death and undercounting on death certificates, see also “Rise in heat related mortality in the United States,” PLOS Climate, 2025, https://journals.plos.org/climate/article?id=10.1371/journal.pclm.0000610.
B.C. Coroners Service, Extreme Heat and Human Mortality: A Review of Heat-Related Deaths in B.C. in Summer 2021, June 2022, https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/extreme_heat_death_review_panel_report.pdf. The panel’s recommendations include reviewing the issuance of cooling devices as medical equipment to people at highest risk of dying.
MS Trust, “Heat sensitivity and MS: Uhthoff’s phenomenon,” https://mstrust.org.uk/a-z/uhthoffs-phenomenon; Panginikkod et al., “Uhthoff Phenomenon,” StatPearls, NCBI Bookshelf, https://www.ncbi.nlm.nih.gov/books/NBK470244/.
“Toward isolating perceptual and physiological contributors to heat sensitivity in multiple sclerosis,” European Journal of Applied Physiology, 2025, https://link.springer.com/article/10.1007/s00421-025-05838-7.
U.S. Environmental Protection Agency, “How Climate Change May Impact Ozone Pollution and Public Health through the 21st Century,” https://www.epa.gov/sciencematters/how-climate-change-may-impact-ozone-pollution-and-public-health-through-21st-century; U.S. EPA, “Health Effects of Ozone in Patients with Asthma and Other Chronic Respiratory Disease,” https://www.epa.gov/ozone-pollution-and-your-patients-health/health-effects-ozone-patients-asthma-and-other-chronic.
“Psychotropic prescriptions in the context of extreme heat,” CMAJ 197, no. 29 (2025), https://www.cmaj.ca/content/197/29/E915.
“Antipsychotics and other risk factors for mortality among people with schizophrenia during an extreme heat event: a population-based case-control study,” Scientific Reports, 2025, https://www.nature.com/articles/s41598-025-17591-0.
Nayak et al., “Accessibility of cooling centers to heat-vulnerable populations in New York State,” Journal of Transport & Health, https://pmc.ncbi.nlm.nih.gov/articles/PMC11157955/.
“Preparing for Extreme Heat: Are Cooling Outdoor Spaces Accessible by People with Disabilities?,” Environmental Health Perspectives 131, no. 7 (2023), https://ehp.niehs.nih.gov/doi/10.1289/EHP13373.
Annual Disability Statistics Compendium (2024), Section 6: Poverty, Institute on Disability, University of New Hampshire, https://www.researchondisability.org/annual-disability-statistics-collection.
U.S. Department of Labor, “Trends in Disability Employment,” October 2024, https://www.dol.gov/sites/dolgov/files/ETA/opder/DASP/Trendlines/posts/2024_10/Trendlines_October_2024.html.
UN Office for Disaster Risk Reduction, 2023 Global Survey Report on Persons with Disabilities and Disasters, https://www.undrr.org/report/2023-gobal-survey-report-on-persons-with-disabilities-and-disasters.
UNDRR, “Disability inclusion in Disaster Risk Reduction,” citing Disability Information Resource (2012) on Great East Japan Earthquake mortality, https://www.undrr.org/partners-and-stakeholders/disability-inclusion-disaster-risk-reduction.
U.S. Department of Justice, ADA Best Practices Tool Kit for State and Local Governments, Chapter 7: Emergency Management Under Title II of the ADA, https://www.ada.gov/pcatoolkit/chap7emergencymgmt.htm.
National Council on Disability, Effective Communications for People with Disabilities: Before, During and After Emergencies, 2014, https://www.ncd.gov/report/effective-communications-for-people-with-disabilities-before-during-and-after-emergencies/.
Gabrielle Peters, quoted in “Coroner’s report on heat wave that led to 619 deaths says B.C. needs to be better prepared for what’s next,” The Globe and Mail, June 2022, https://www.theglobeandmail.com/canada/british-columbia/article-bc-must-be-better-prepared-for-next-heat-wave-coroner/.
U.S. Environmental Protection Agency, Climate Change Indicators: Heat Waves, data for 50 large U.S. metropolitan areas, 1961–2023, https://www.epa.gov/climate-indicators; see also https://www.globalchange.gov/indicators/heat-waves.
U.S. Department of Health and Human Services, emPOWER Program, https://empowerprogram.hhs.gov/.
“As summers grow deadlier, here’s what to know about utility shutoffs,” Associated Press, September 2025, https://apnews.com/article/utilities-cost-electricity-cooling-summer-liheap-501f94370487a50db40f1b32d1fe66b0
Federation of American Scientists, “Utilizing $4bn to Protect Vulnerable Households from Extreme Heat,” 2024, https://fas.org/publication/liheap-extreme-heat/.
USAFacts, “How many people die from extreme heat in the US?,” https://usafacts.org/articles/how-many-people-die-from-extreme-heat-in-the-us/.