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Canada: Disastrous Impact of Extreme Heat

Failure to Protect Older People, People with Disabilities in British Columbia

A woman sits to take a rest as heatwave hits Western Canada on June 30, 2021 in Victoria, British Columbia, Canada. © 2021 Mert Alper Dervis/Anadolu Agency via Getty Images © 2021 Mert Alper Dervis/Anadolu Agency via Getty Images

(Ottawa) – Inadequate government support compounded risks for people with disabilities and older people during the recent extreme and foreseeable heatwave that killed hundreds of people in the Canadian province of British Columbia (BC), Human Rights Watch said today.

Between June 25 and July 1, 2021, British Columbia experienced a heat dome, a high-pressure weather system that traps heat, with record-high temperatures across the province reaching up to 49.6°C. British Colombia does not have a heat action plan, and lack of access to cooling and targeted support for at-risk populations contributed to unnecessary suffering and possibly deaths. 

“People with disabilities and older people are at high risk of heat stress, but they were left to cope with dangerous heat on their own,” said Emina Ćerimović, senior disability rights researcher at Human Rights Watch. “The Canadian authorities need to listen to and provide much better support for people with disabilities and older people before disaster strikes again.”

Between July and September, Human Rights Watch interviewed remotely 31 people in British Columbia, including 13 people with disabilities, seven older people, and two family members of older people, as well as service providers, human rights advocates, and community leaders. Human Rights Watch also met or communicated in writing with officials across multiple branches of the BC government and the city of Vancouver, and reviewed documents related to climate adaptation planning and heat response.

Three people share their experiences living in British Columbia, Canada, during this past summer’s heatwave. Their stories show how the heat affected their physical and mental health, caused them to fear for their lives, and presented another urgent moment for change. 

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Five older people and 12 people with disabilities said the heat dome significantly affected their physical and mental health. Some said they feared for their lives.

The BC Coroners Service, a government fact-finding agency, identified 569 heat-related deaths from June 20 to July 29, 445 of which occurred during the heat dome. Of those who died, 79 percent were 65 years of age or older. The provincial government told Human Rights Watch that it did not currently have data on how many of those who died had a disability. The government also does not have data on other heat impacts, such as hospital admissions and social impacts.

An international team of climate scientists said in July that the magnitude of the BC heat dome was made 150 times more likely as a result of climate change. Two other heatwaves followed in July and August. With Canada warming at twice the global rate, or even three times in northern parts of the country, heatwaves are expected to become more frequent and more intense.

People with disabilities and older people are at particular risk of heat-related illness and death.  Some are more likely to have health conditions or use medication that can affect the body’s ability to respond to heat.

Social isolation and poverty increase these risks. The BC Centre for Disease Control said that, “Most deaths occurred in the community in private residences, and the areas of risk had … less green space, more people living alone, and lower income levels.” All but three people interviewed by Human Rights Watch lived alone and said that they did not have a reliable support system or anyone checking on them in case of emergency.

All but two out of 17 interviewees who experienced serious effects lived in subsidized housing or other small units without adequate ventilation or airflow, and in inadequately insulated buildings without natural shade. Most said they could not afford to buy cooling devices, much less the cost of running them.

Local municipal governments and First Nations operated public cooling centers, but those interviewed said that going to another location to cool down was not a viable option, as it would require them to face extreme outdoor temperatures and they had no practical transportation options. Some said cooling centers could expose them to Covid-19 or environmental irritants that could trigger adverse symptoms.

A 38-year-old woman with a disability who lives alone in a Vancouver condominium suspected she had heat stroke despite taking precautions to lower her body temperature when her apartment reached 38-39˚C: “There were several days where I don’t remember what I did, I was just lying on the floor unable to get up.”

BC Emergency Health Services did not activate their emergency operations center to coordinate their response until after the heat dome began to subside. One person said that her 88-year-old aunt who used a wheelchair died on June 28 as a result of the heat dome and had been unable to get through to 911.

News media reported several cases of older people dying while waiting for an ambulance, including Gian Goel, 71, who died while waiting 90 minutes for an ambulance on June 27, despite living about ten minutes from a hospital.

Fourteen people said they are coping with trauma, anxiety, or depression because of their experience and the uncertainty of how they will survive future heatwaves. People with pre-existing mental health conditions said the heat dome exacerbated their symptoms, and six said they feared for their life.

On July 30, more than a month after the June heat dome began, the BC government announced supports including reimbursements for communities for opening cooling centers, and help providing transportation where public transport does not exist.  

The province has committed to developing an extreme heat and wildfire smoke response strategy in 2022-2025, but urgent measures are required to ensure the safety of those most at-risk in the near term, Human Rights Watch said.

Canadian federal and provincial governments have an obligation to ensure the protection and safety of people with disabilities during natural disasters, as well as access to timely and appropriate health care for people with disabilities and older people. They also have an obligation to protect people from reasonably foreseeable threats to life, including from climate change.

The authorities should urgently investigate the full scope of the heat dome’s impact, particularly on those most at risk, including by collecting data on the basis of disability, income, and social and health impacts, such as hospital admissions, and emergency department visits. Without adequately understanding the scale of needs, the government will not be able to respond effectively to populations at risk, Human Rights Watch said.

All levels of government should ensure that people with disabilities and older people, particularly those with lived experience of dealing with natural disasters, are included in climate change adaptation and heat action planning. BC officials confirmed to Human Rights Watch they have a long way to go to achieve this.

The BC and federal governments should also rapidly reduce emissions and stop subsidizing fossil fuels to prevent the most catastrophic climate outcomes and protect the rights of at-risk populations. 

“Given the foreseeable rise of extreme heatwaves, and the impact on older people and people with disabilities, all levels of government should have a clear plan to prevent future heat-related deaths and manage other risks associated with heatwaves,” Ćerimović said. “Canada and British Columbia both need to do a lot more to protect at-risk populations and prevent worse impacts of climate change by rapidly reducing emissions.”

For more information on Canada and the health impacts of increasing heat, please see below. 

Some of those interviewed are identified by pseudonyms or only their first name to protect their privacy.

 

Climate Impact on At-Risk Populations in Canada

Extreme heat, flooding, wildfires, and other disasters – all of which are becoming more frequent and more intense as a result of climate change – are taking a mounting toll on lives and livelihoods in Canada and around the world. An international team of climate scientists found that the deadly June heat dome in British Columbia would have been “virtually impossible”  without human-caused climate change.

Canada remains a top ten global greenhouse gas emitter, contributing significantly to the climate crisis driving more extreme weather events. British Columbia is one of the biggest emitters in Canada, and will provide over CAD$1 billion in subsidies to oil and gas in 2021 alone, driving continued fossil fuel dependence at a time when governments should be rapidly transitioning away from fossil fuels toward clean, renewable energies.

Climate impacts affect everyone but are especially hard on the health and wellbeing of people who are already marginalized or at risk, including people with disabilities, older people, Indigenous peoples, pregnant people, women, and children.

In 2020 and 2021, the United Nations issued reports warning that people with disabilities and older people are at increased risk of adverse climate impacts. People with physical disabilities experience greater pain and fatigue on hot days, and some people with spinal cord and traumatic brain injuries are at higher risk of heat-related illnesses because of limited capacity to sweat, the body’s primary way of cooling down.

People with psychosocial – mental health – disabilities have a two to three times higher risk of death from heat, in part because of the impact of certain medications on the body’s ability to regulate its temperature. During the 2018 Montreal heatwaves, 25 percent of those who died had schizophrenia.

Older people are more at risk of heat-related deaths and illnesses. Research published by the medical journal The Lancet found that as of 2018, rapid warming had contributed to a 58.4 percent increase in heat-related deaths of people over 65 in Canada in less than two decades. Older people are less able to adapt to sudden changes in temperature. They are also more likely to have medical conditions that can make heat more dangerous, such as heart or respiratory conditions. Older people might also take medications that cause heat intolerance and impair the body’s response to heat, including the ability to thermoregulate. 

Under the Convention on the Rights of Persons with Disabilities, the federal and provincial governments have an obligation to ensure equal rights for people with disabilities, including older people with disabilities, and ensure their protection and safety during natural disasters. Under this treaty and the International Covenant on Economic, Social, and Cultural Rights, everyone has the right to the highest attainable standard of physical and mental health. The International Covenant on Civil and Political Rights requires governments to protect the right to life, including from foreseeable threats.

Canada’s federal and provincial governments are required to take action to prevent foreseeable negative impacts on rights from climate change, including protecting those most at risk of negative health impacts, such as older people and people with disabilities, by reducing emissions and helping people adapt to current and projected impacts.

In Canada, provincial and territorial governments carry primary responsibility for health care services, except in First Nations, where the federal government and, in British Columbia, the First Nations Health Authority, are responsible. The federal government provides financial support to provinces for health care costs and provides tax credits for people with disabilities. Municipalities and First Nations play key roles in responding to health-related community needs. Emergency management is a shared responsibility across all levels of government.

 

Physical Distress and Heat-Related Illness

“For every person who died from the heat dome, ten or more may have suffered heat stroke, dehydration or other complications, including permanent, life-altering injuries,” Dr. Melissa Lem of the Canadian Association of Physicians for the Environment, said in a news release in July. “When we heat up too much, even by just two to three degrees, we lose our ability to cope. I saw more patients with heat illness during June’s extreme heat than I have in my entire career.”

People interviewed by Human Rights Watch described symptoms of heat exhaustion and heat-related illnesses during the heat dome, including fever, headache, dizziness, loss of consciousness, nausea, confusion, swollen legs, breathing difficulties, and weakness.

“Ember,” a 69-year-old woman with a physical disability who lives in a subsidized housing unit in South Surrey, said the temperature in her apartment reached 39˚C during the heat dome and that she developed a cough and a persistent fever. “I have never been so sick in my entire life,” she said. “I have had fevers and colds, but not this dizziness, not the shakiness. I couldn’t do anything. I nearly fell off the toilet seat because I was so dizzy.”

Ember, who also has asthma, eventually took a taxi to a hospital on June 30, where she received IV fluids for dehydration, intravenous antibiotics, and was prescribed oral antibiotics for one week. Studies have shown that heat can exacerbate respiratory illness and increase the risk of complications.

Edward McArthur, 55, who has multiple disabilities, is unhoused, and lives alone with his two dogs, said: “Due to the extreme heat, I was having severe breathing problems and severe problems keeping my body cool because I can no longer regulate my own body temperature because of my spinal cord and brain injury.”

Paul Caune, executive director of the non-profit Civil Rights Now in Vancouver, which advocates for the rights of people with disabilities, has muscular dystrophy and uses a power wheelchair and a ventilator that helps him breathe. While Caune had access to a portable air conditioner, purchased by his sister in 2018, he struggled to cope with the heat in his subsidized Vancouver apartment.

“I cannot escape the heat in the place where I live,” he said. “My AC wasn’t strong enough, it was not cooling, and I was getting overwhelmed by heat, my feet swollen quite dramatically, my legs started to hurt, and I nearly called the ambulance.” Since the heat dome, Caune has purchased a new air conditioner. “I feel more serene now,” he said.

The daughter of a 68-year-old man who lives in Vancouver said the heat badly affected him: “He was mentally foggy. He was exhausted constantly. He would sit down for a second and would barely keep his eyes open for like four days.”

 

Mental Health Distress Linked to Extreme Heat

Older people and people with disabilities said they are coping with trauma, anxiety, agitation, and depression because of heatwaves, and the uncertainty and insecurity over how they will survive future ones. Dave Symington, 65, who has quadriplegia and uses a wheelchair said, “I was worried I would not be able to survive.”

People with pre-existing mental health conditions said the heat dome exacerbated their symptoms and six people mentioned that they had feared for their life.

“Anita,” 24, who has Post Traumatic Stress (PTSD), ADHD, and fibromyalgia, and lives in Burnaby, said the heat made her feel irritable and sluggish: “The longer the day went on the more anxious I felt.” Lack of sleep due to the heat made her PTSD worse:

I woke up a lot, which made my disability symptoms worse. I also have bad nightmares from my PTSD, and the nightmares were worse during the heatwave, mostly from climate change anxiety. It made me feel helpless for my future, as things are projected to get worse. 

People interviewed also described being unable to care for themselves, including to prepare meals. “Jasmine,” 31, who has PTSD, fibromyalgia, and anorexia, and lives in a subsidized single resident occupancy room in Vancouver said:

My room has terrible airflow, it feels like a sauna. …It is completely overwhelming. It makes me feel like the heat has taken all my energy and makes me feel useless. For someone who struggles with low energy… it is a struggle for me to cook a meal for myself. … My brain wasn’t working. It wasn’t safe for me to go to work or hang out with friends.

Symington said, “I would be sitting in front of the fan and feeling decently okay but if I had to get something to eat or get water, I would have to plan it out, because … it was like an oven in there.”

People interviewed described feelings of fear or anxiety because they felt abandoned or alone during the heat dome.  Gabrielle Peters, a disabled policy analyst who lives in poverty in a subsidized apartment in Vancouver, said:

I am afraid that I will be in this situation where I am in trouble and I won’t be able to access help, where an ambulance will be hours away and I’ll have no idea when it’s coming. I saw what happened during the heatwave, I read about people calling for help, and your relative dies in front of you because the ambulance doesn’t arrive. Can you imagine being that person?...

I am disappointed the government did not come out to say, ‘We are never letting this happen again, we are not going to be satisfied until we prevent any preventable deaths, we have learned from this, we are never going to allow this to happen again.’

McArthur, an unhoused man, travelled to Esquimalt to escape the heat in Golden, only to be told by the police to leave:

I was in fear of my life… I had to leave the area, because we could not find shelter, or cooling or remedy in Golden. It left me in [a] state of emotional anxiety and fear, and I had to drive 12 hours through forest fires to drive to the coast, only to find … no services available for homeless or disabled people.

People with disabilities and older people interviewed all expressed general mistrust of government services’ ability to respond to their needs during heat emergencies. Existing fear and anxiety about seeking assistance due to past negative experiences with the health and social care systems also prevented people with disabilities from seeking help.

Jasmine said she was reluctant to seek services during this heatwave because she was hospitalized against her will in a psychiatric ward because of a heat-induced mental health crisis during a 2018 heatwave. Aphrodite Janeway, a 35-year-old trans-woman with disabilities, said she was hesitant to reach out to emergency services because she feared being institutionalized in a mental health hospital and interacting with police as a trans-woman.  

 

Isolation and Loneliness 

According to an initial provincial assessment of reported deaths during the heat dome, more deaths occurred in areas where people live alone. Many of the older people and people with disabilities interviewed live alone and said they do not have any reliable support system, which leaves them feeling socially disconnected.

Existing research indicates that social isolation is associated with higher heat risks, especially for older people. The Covid-19 pandemic also exacerbated this isolation. Caune, from Vancouver, said he has had to isolate at home since March 2020 because he is at high risk of severe complications from Covid-19. “I’ve not seen my family, my sister and my nieces, since early December 2019.” He said the heat exacerbated his loneliness because he felt he was left to deal with it on his own.

Most people with disabilities interviewed said ableism and stigma against people with disabilities also played a role in their isolation.

“Anne,” a 38-year-old widow with a disability, said only her mother, who lives far away, checked in on her by phone and that the constant government messaging about “checking-in on neighbors” only added to her sense of isolation. “I feel forgotten,” she said.

Four representatives of community-based organizations providing support to older people and people with disabilities said that while they try to reach people during heatwaves, they miss those who are not already connected with them, and that more funding is needed for outreach.

 

Poverty

Most of those interviewed said that their economic situation exacerbated the impact of the heat dome, with many living in subsidized housing or low-income areas in small units with bad airflow and poor ventilation. One person was unhoused. Lower income areas often have less green space and tree cover. All but three people with disabilities interviewed relied on government assistance for disability as their only source of income, with one woman working part-time in sex work to pay for her medication. 

About one in five people in Canada, or 6.2 million people, have a disability. They are twice as likely to live below the poverty line. Only one person with a disability interviewed had steady employment.

Older people in British Columbia, meanwhile, are 45 percent more likely to live in poverty compared to older people in the rest of the country, according to 2018 data, and single older people in British Columbia experience even higher rates of poverty than older people in general.

Living in small unit apartments made it harder for people to deal with the extreme heat. All but one said they had minimal ventilation, and not enough green space or shade around their buildings. In some cases, small window size or lack of windows that fully open contributed to insufficient airflow or meant an air conditioner could not be easily installed. Most said they could not afford to buy or operate cooling devices.

Janeway said she was only able to purchase an air conditioner because of federal Covid relief money. With her partner and a roommate, they struggle to pay the electricity bill.

“Money is scarce for anything so luxurious as a proper fan or heaven forbid, an air conditioner,” Ember said. MaryBeth, 74, said: “It is stressful whenever I have to spend money being on a tight small pension.”

 

Government Response

On June 23 the federal government issued dozens of heat warnings for British Columbia, noting that temperatures might reach up to 40˚C and high temperatures would most likely persist overnight, offering few opportunities for relief from the heat. But the provincial government was slow to respond. The BC premier, John Horgan, said officials were distracted by Covid-19 and did not think the heat would be that serious.

While a “heat emergency” was declared by every regional health authority in British Columbia as of June 25, this notice was internal to the public health system and the public was not made aware of the emergency status. Further, BC Emergency Health Services only initiated their emergency response protocol, which includes activating an emergency operations center to coordinate the response, after the heat dome began to subside.

While the June heat dome broke temperature records across British Columbia, it was not unprecedented or unforeseeable. In 2009, over 100 premature deaths due to extreme heat were recorded over the course of one week in Vancouver, and approximately 200 deaths across the province. The province’s own 2019 climate risk assessment flagged heatwaves as a key risk to the health and wellbeing of people in British Columbia and noted that such an event would be likely to occur once every 11 to 50 years.

In the absence of an effective and timely provincial response, regional health authorities, municipalities, First Nations, and individual British Columbians were left to cope with the record-breaking heat. Some municipalities and First Nations, particularly those with heat action plans in place, operated cooling centers. The city of Vancouver, for example, which reviews its heat response guide annually, opened cooling centers and misting stations, added public water fountains, and gave out bottled water. The bulk of BC guidance, though, focused on the need for individual actions, advising people to stay hydrated, stay in a cool place, and check on people who may be at risk.

Provincial government officials told the media that their response “was not sufficient to reach everybody” and that they were not able to keep pace with spiking levels of demand for emergency services.

Most people interviewed learned of the heat warnings and the availability of cooling centers through online and social media messaging. But they said that the available response did not meet their needs. Peters, who is a wheelchair user, said:

Cooling centers are an absolutely ridiculous solution to suggest to people who are medically complex. I’m out of breath going to the bathroom. That’s how tired and breathless I get when I’m hot and in crisis. How do I get [to a cooling center when] it’s a couple blocks to a bus stop?

Ember was similarly frustrated: “Are you really going to go outside of your apartment and walk eight blocks or a mile to go to a cooling centre? The people that I know personally, that wouldn’t solve our problem, we’d be exposing ourselves to the heat outside then.”

Lack of standardized day or overnight hours also restricted access. Anita said, “I looked into the cooling centers, and they all closed at around 7 pm, and during this heatwave, it was just as hot at night as it was during the day, so I decided to stay home because the energy getting there and back just wasn’t worth it.”

People interviewed, particularly those who were immunocompromised, also said they were not comfortable going to cooling stations out of fear of contracting the Covid-19 virus. Some also expressed fear of exposure to allergens or other environmental irritants that could trigger or exacerbate symptoms.

Both the province and municipalities made efforts to improve their heatwave responses after the heat dome, but continued to focus on cooling centers. On July 30, the BC government announced that it would reimburse costs for First Nations and municipal cooling centers and provide individual transport in communities without scheduled or reasonable public transportation. Vancouver and other municipalities moved to provide overnight hours at cooling centers.

While BC Centers for Disease Control guidance from 2017 – developed in the wake of the deadly 2009 heatwave – emphasized the importance of ensuring access to air conditioning for “vulnerable populations in substandard housing,” the province has yet to follow through on this recommendation.

The First Nation Health authority, by contrast, in addition to providing support for communities opening cooling centers, offered financial support for air conditioning, fans, and air purifiers for Elders or others vulnerable to heat effects. Crown corporation BC Housing, which manages subsidized housing in the province, said that it will directly provide or fund cooling devices for common areas when asked by non-profit housing providers, and fans for individual tenant use.

But Ember, who lives in a non-profit managed building, said fans are not enough: “The majority of people have a fan, but that is not going to bring down the heat. I had fans going and the temperature was still 39-40˚C inside my apartment.” After making several requests for an air conditioner, Ember was able to secure one from her non-profit housing provider. “But I am one, and many I know are not so lucky,” she said.

Some municipalities have committed to reviewing their heatwave responses; others have cited lack of resources as an obstacle to coordinating heat response and said they need increased federal climate adaptation funding.

British Columbia has also initiated an overhaul of how ambulances, paramedics, and 911 dispatchers respond to medical emergencies, and the BC Coroner’s service is investigating heat-related deaths. BC’s Public Safety Minister Mike Farnworth said the government would use the coroners’ findings to inform the government’s response to future heatwaves.

British Columbia is also developing its Climate Preparedness and Adaptation Strategy. The current strategy does not mention heat-related impacts on older people and people with disabilities. The province has begun broader equity conversations around climate adaptation, but a BC Environment Ministry official acknowledged to Human Rights Watch that people with disabilities and older people have not been at the center of past consultation efforts.

 

Key Message from People Affected

People with disabilities and older people made several recommendations about how they could be better supported during heatwaves and on how responses could be improved. These included installing heat pumps – efficient heating and cooling systems that can significantly reduce energy costs – in all subsidized buildings and low income apartments, and improving accessibility of information about heatwaves.

They recommended developing more sustainable housing infrastructure and amending building codes to require higher standards of climate change and heatwave readiness, including ensuring shade and green spaces; ensuring access to air conditioning units as medical devices to allow their distribution to people who need them through the province's disability support systems; subsidizing energy costs; creating a registration list for people at risk; and improving the 911 system to ensure people have access to timely emergency health care, among others.

Anita also said the government should acknowledge the danger, intensity, and frequency of heatwaves and take action to reduce emissions and use natural climate solutions, including by halting old growth logging and increasing tree planting. “[The government] should also phase out fossil fuel use and aggressively switch to green, renewable energy and invest in job transitioning for oil and gas workers to move to green energy work,” she said. 

 

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