Q&A: The 'insidious, chronic effects' of long-term heat exposure
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Key takeaways:
- Exposure to extreme heat can lead to cognitive decline, with significant racial and socioeconomic disparities.
- Addressing those disparities requires a comprehensive approach, but PCPs can take some steps now.
Long-term exposure to extreme heat can lead to cognitive decline, according to experts.
Eunyoung Choi, PhD, a postdoctoral associate at the NYU School of Global Public Health, and colleagues published a study that found the exposure affects everyone — but not equally.
Healio spoke with Choi to learn more about the study’s findings, the disparities they observed, what primary care providers can tell their patients about prevention and more.
Healio: Will you briefly describe your findings and their importance?
Choi: Our research reveals a relationship between cumulative exposure to extreme heat and cognitive decline in older adults. What's striking is that this heat link to cognitive decline is pronounced only among older Black individuals and those living in disadvantaged neighborhoods. It's not a uniform effect across all groups. This study shines a light on how different populations are affected by extreme heat, underscoring the need for interventions that are tailored to these specific vulnerabilities.
Healio: What are the clinical implications of your findings?
Choi: The clinical implications of our research are profound, particularly due to our focus on cumulative exposure to extreme heat. Most prior studies have looked at the immediate effects of heat exposure, such as heatstroke or dehydration, which are undoubtedly important. But we wanted to go beyond that. We wanted to understand how repeated exposure to extreme heat over time might affect people's health in the long run. What we uncovered is that this cumulative exposure may lead to accelerated cognitive decline, particularly among certain vulnerable groups. This is significant because it's not something that would be apparent right away. It's a slow, gradual process that might go unnoticed until substantial damage has occurred. Current public health policies and interventions are often designed to address the immediate dangers of extreme heat such as distributing water and issuing heat advisories. Although these measures are essential, our research shows that they may not be sufficient to tackle these more insidious, chronic effects. Our research underscores the need for a more comprehensive approach that considers both immediate and long-term risks associated with extreme heat exposure.
Healio: You noted significant racial and socioeconomic disparities. What is responsible for those disparities?
Choi: The disparities we observed in our study are rooted in a multifaceted combination of systemic, historical and structural factors that extend beyond individual vulnerabilities. For instance, decisions that may seem trivial, such as where to plant trees or place community cooling centers, can have significant consequences. In underresourced neighborhoods, a lack of shade and cooling centers can intensify the impact of heat, leading to more pronounced cognitive decline among residents. Our findings also reveal that cumulative exposure to extreme heat was associated with faster cognitive decline among Black older adults but not among white or Hispanic older adults. This pattern is not coincidental. Black older adults may have disproportionately faced chronic stress and systemic disadvantages throughout their lives. Many grew up during a time when segregated schools offered lower quality education and inadequate funding, creating barriers to quality education and upward mobility. This history of educational disparity has led to a cascade of disadvantages that accumulate over time, contributing to chronic stress. As a result, cognitive reserve among many Black individuals might be initially lower and erode more quickly, making them more susceptible to extreme heat exposure in later adulthood. Addressing these disparities requires a comprehensive approach. We must think upstream, considering not only immediate interventions to alleviate the effects of heat but also broader societal changes that tackle the root causes. It's about fostering a more equitable and resilient community that is better prepared to face the challenges of extreme heat.
Healio: Considering the projected increase in days with extreme heat, what should be done to help protect vulnerable populations?
Choi: Our research challenges the conventional view of older adults as a homogeneous high-risk group when it comes to extreme heat. Instead, we've found a complex picture with varying vulnerabilities within this population. Given the projected increase in days with extreme heat, it's crucial to recognize this heterogeneity and tailor our interventions accordingly. This means working closely with communities to understand their specific needs and developing targeted strategies. Both immediate action and long-term planning are needed.
Current Heat Action Plans (HAPs) in the U.S. often lack specificity, focusing on general strategies like well-being checks and transportation to cooling centers. However, these may not address the unique needs of certain groups, such as financial assistance for low-income residents or inspections for poor housing conditions. Tailoring strategies to these specific needs is vital. Furthermore, enhanced communication with health care providers, who are trusted sources for patients, can bridge the gap, reaching historically underserved populations with particular health concerns. A limited number of HAPs currently engage in this way, and expanding this communication is crucial. Long-term planning is also key. It's not merely about reacting to emergencies. We need to think ahead. Green roofs, parks and green spaces can cool down our cities. Collaborating with city planners on these strategies is a necessity for the future. In simple terms, our findings urge us to look at the big picture. We need to plan for a sustainable future with things like green spaces, but we also must ensure that our immediate actions are reaching the people who need help right now.
Healio: The study focused on extreme heat, but research indicates that this is due to climate change, which can also cause other weather extremes; cold, storms, etc. Do you think your findings would translate to those other weather extremes?
Choi: Our findings, although focused on extreme heat, may indeed translate to other weather extremes, reflecting the broader health dangers of climate change. The underlying social determinants of health that we observed in relation to heat exposure likely extend to various vulnerabilities associated with climate change. The exposure to extreme weather events, such as cold snaps or storms, may largely depend on geographical location. For instance, those living in coastal areas may be more susceptible to hurricanes, whereas those in northern regions may face extreme cold. However, the traditionally identified social determinants of health, such as socioeconomic status, access to health care and quality of housing, are likely to influence susceptibility to these events as well. For example, individuals in disadvantaged neighborhoods may have limited access to well-insulated homes, making them more vulnerable to extreme cold. Similarly, those in flood-prone areas without proper infrastructure may be at higher risk during storms.
The health dangers of climate change are truly concerning because they might deepen the already entrenched health disparities by affecting one's susceptibility to extreme weather events. Our study on extreme heat serves as a reminder that climate change is not just an environmental issue but a public health crisis that requires a concerted effort from all sectors of society to mitigate its far-reaching impacts.
Healio: What is the take-home message for PCPs here?
Choi: PCPs must emphasize awareness and education about the potential cognitive risks associated with extreme heat. They should inform patients about the importance of staying cool and hydrated during heat waves and offer guidance on using community resources like cooling centers. Providers should also discuss strategies to build and maintain cognitive reserve, such as engaging in mentally stimulating activities and maintaining social connections. Special attention should be given to patients in vulnerable groups, with tailored advice and support. Collaboration with other health care professionals to provide comprehensive support may also be beneficial. Providers play a crucial role in communicating these risks and preventive measures, and their proactive engagement can help mitigate the effects of extreme heat on cognitive health.
Healio: Is there anything else you’d like to add?
Choi: Our research calls for a paradigm shift in how we approach extreme heat in the context of climate change. It's not merely about emergency response; it's about long-term resilience, understanding cumulative effects and integrating this knowledge into strategies that protect all citizens' health and well-being. Urban planning, community education and health care system preparedness must align to handle the cumulative effects of heat exposure, reflecting a comprehensive and forward-thinking approach.