By Kathie Ragsdale, Scott Merrill and Johnny Bassett

The environmental justice series, produced in partnership with the NH Bar News and the Granite State News Collaborative, explores race and equity in New Hampshire by looking at vulnerable communities suffering the highest risk of adverse health effects due to environmental change. Factors such as poverty, race, those with comorbidities, lack of transportation, the elderly, non-english-speaking populations, and indigenous communities are the most vulnerable.

The subjects in the series will focus on heat-related illness, lead poisoning, air and water pollution, traffic, and access to healthy food.

The reporting and editing team include Scott Merrill, Editor, NH Bar News; Kathie Ragsdale; and Johnny Bassett. The articles are part of a multiyear, Granite State News Collaborative project, exploring the intersections of race and equity with variety of social issues that affect the citizens of New Hampshire.

                The biological effects of heat on the human body are universal and indisputable. Hyperthermia – too much heat over a certain amount of time – can lead to heat exhaustion, heat stroke, and even death.

             And like other social problems today –such as the lack of affordable housing or access to healthy foods – not everyone suffers equally when it comes to the effects of heat. Those with diabetes, heart disease, other comorbidities, the elderly, people of color, and the poor, suffer at higher rates.

In New Hampshire, a state with thousands of acres of forests, many people – especially in urban areas – continue to lack access to something as simple as the health benefit of shade.

Heat, one of the most pressing environmental justice issues

             Environmental justice advocates, along with public health specialists, lawyers, and community organizers, are currently working to educate and assist the public about the dangers of heat-related stress and illness in New Hampshire and they’re seeking solutions that involve empowering communities. 

             Of all the environmental justice issues being confronted today, UNH Professor of Health Management and Policy, Semra Aytur, cited heat-related stress, especially for people of color and those with comorbidities, as one of the biggest.

             “Heat, and the related illnesses that come with it, is a fundamentally important environmental justice issue,” Aytur said, “because it spans various aspects within communities.”

             As well as teaching and conducting research, Aytur works with the Conservation Law Foundation on environmental justice with the goal of helping to create healthy communities. Vice President and Director of CLF in N.H., Tom Irwin, said his organization has been committed in the past year to building an environmental advocacy community in Manchester and has hired a part-time organizer who is currently working on a campaign to increase green spaces around the city of Manchester.                                                  

“Communities of color suffer disproportionately from the impacts of climate change,” Irwin said. “And the health impacts of heat are often lost on people. We see it in the news everyday now. Flooding problems, fire, drought, those very dramatic impacts of climate change. But heat itself is the weather event with the greatest impact. It kills more people than all of the other environmental justice issues.”

             Irwin referred to the European heat wave that killed 70,000 across Europe and 14,802 people in France in 2003, but also spoke about rising average temperatures across the world that disproportionately affect vulnerable populations. 

             Looking at the number of extreme heat days in July and August in Concord from 1954-2018 reveals a series of peaks and valleys, as well as a steady rise, with the highest heat days recorded in the summers of 1975 and 2018, according to the National Oceanic and Atmospheric Administration. NOAA calculated the number of extreme heat days in Concord by counting the number of days when the daily minimum apparent temperature (actual temperature adjusted for humidity) exceeded the 85th percentile of the city’s historic July and August temperatures. For each day that is counted the temperature was above 68.1 degrees Fahrenheit even in the coolest part of the night.

Heat islands, lack of greenspace, and social vulnerability

             People living in areas lacking greenspace are more susceptible to the heat-island effect and these areas are also places where the median income is lower and social vulnerability is higher.

             The CDC’s social vulnerability index uses U.S. Census data to determine the relative social vulnerability of every census tract in the U.S. The SVI ranks each tract on 14 social factors and groups them into four related themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation.

             The index ranges from zero to one, with one being the most vulnerable. Vulnerability factors most relevant to heat and health include: percent of population over 65, percent of population below the poverty line; percent population with no health insurance; and the overall social vulnerability index.

             A number of areas in New Hampshire score at or near one, including portions of Concord, Manchester, Nashua, Coos and Sullivan Counties.

             According to New Hampshire’s Division of Public Health Services, the number of heat related illnesses leading to emergency department (ED) visits begin to increase on days above 75°F. From May-Sept. (2000-2009), for instance, Manchester and Nashua recorded 640 and 660 excess ED visits, respectively.

             Between 2012 and 2019, more than 1400 Granite Staters visited a local emergency room because of a heat-related illness, but those visits were not distributed evenly among hospitals.

             According to data provided by the N.H. Dept. of Health and Human Services, nearly 20 percent of the total visits were concentrated in just two hospitals in Manchester--Elliot and Catholic Medical Center--far above Manchester’s share of the 2019 statewide population. (See map) 

             The most vulnerable living in urban areas must also contend with heat islands – which exacerbate heat-related illnesses. These are urbanized areas that experience higher temperatures than those around them because they tend to contain dense structures, as well as roads, and parking lots, that absorb and then re-emit the sun’s heat more than natural landscapes do.

             Irwin points out that social vulnerability – which includes poverty as well as health problems – often makes it difficult for people to organize on a community level.

             “The people who are most affected often have the least bandwidth and capacity with everything else going on in their life to realize things could be better in their community and to organize and solve their challenges,” Irwin said. “Just as we saw communities of color experiencing harm as a result of the Covid crisis, that certainly holds true with the impacts of climate change as well unfortunately.”

             Community organizer Arnold Mikolo, who works with the CLF on creating more greenspaces in Manchester, said  low-income neighborhoods in the city with a lack of access to healthcare, a higher number of smokers and other comorbidities, are at an increased risk of heat-related illness.

             “Finding ways for people to cool off  in cities like Concord and Manchester is not a problem for those in sections of the city with tree cover and air conditioning. A lot of the houses in sections of Manchester don’t even need to turn AC on.”

             Mikolo said he wants to remind people that neighborhoods where heat isn’t as much of  a problem require planning and investment.

Climate change, average rising temps, are here to stay

             State Climatologist, Mary Stampone, who is a professor of geography at UNH, said temperatures in New Hampshire are rising just as they are everywhere else.

             One of the interesting things climate scientists are observing, she said, is that nighttime temperatures are rising at a greater rate than daytime temperatures regionally.

             A July 1901 to July 2020 study found that in June, July, and August, temperatures are all rising significantly at night. For July, it’s almost twice as much as during the day.

             “A lot has occurred in the last 50 years,” Stampone said.

             And looking more closely at nighttime temperatures, she added, is important because this is the time when people cool off.

             “If we don’t have that nighttime cooling, we can have a lot of poor health outcomes. Also, we’re asleep (and can’t monitor ourselves).”

             Stampone cited a study done with elderly populations living in Philadelphia row houses that she encountered in graduate school as an example of the way inequalities in urban areas exacerbate the effects of heat.

             “They would just close their windows so they wouldn’t be broken into and have a fan running. But that red brick building becomes a conduction oven,” she said.  “This is why we see a lot of those inequalities in urban areas, because it exacerbates the effect.”

             Ellen Flaherty, Director of the Dartmouth Centers for Health and Aging, and assistant professor of medicine, at the Geisel School of Medicine, at Dartmouth College, said more than half of the population of people over 65 live in high-risk areas in terms of heat. 

             And as people age, she added, their bodies change in ways that make it more difficult to regulate temperature. 

             “One of the things we think about from that perspective is (bodily) temperature control and how that ability in older adults is diminished,” she  said, adding that comorbidities such as diabetes, respiratory disease, and specific medications, such as diuretics, can exacerbate the problem.

             “When they’re combined with some cardiac medications, the risk of becoming dehydrated is much greater, compounded by their lack of a sense of thirst,” Flaherty said. “Not feeling the heat, not sweating, not drinking, is also compounded by other factors such as socioeconomic status, not having air-conditioned apartments, social isolation, and not having access to other people to provide support getting them out of their apartments.” 

             Part of what makes people particularly vulnerable, especially in urban cores, Stampone said,  is that people are not acclimated to increasing temperatures and the infrastructures are not built to offset these changes.

             “We don’t have air conditioners. (People with low incomes) can’t afford across  the board what you need to protect yourself from heat. Areas that have a greater portion of people of color tend to be overall hotter.”

             And other susceptible populations, Stampone said,  include the elderly, people with disabilities and families with young children.

             Thomas Mee, is the CEO of North Country Healthcare, the parent organization of three critical access hospitals and one home health agency in northern New Hampshire.

             Mee said heat isn’t as much of an issue in the north country as it is in other parts of the state but said most homes are not air conditioned.

             “We don’t see a lot of heat exhaustion and heat stroke. What we do see, especially in Coos County where it’s poorer in general and there are more health conditions, is that the heat drives those conditions. If you have any elderly person with COPD, it’s worsened. Chronic conditions are worsened.”

             Lourdes B. Avilés, Professor of Meteorology at Plymouth State University, teaches a severe weather course to the general public, and chairs her department’s Meterology, Physics, Mathematics and Climate Studies Department.

             Avilés said the increase in average temperatures across the world are leading to more days with higher temperatures overall and teaches about the effects this has, specifically on urban areas.

             “It is a real effect, the urban heat island. Normally a large city can be 10 degrees higher than the surrounding environment but we have seen it in smaller towns,” she said. “When you’re talking about an average that is increasing, it might take it from a temperature that people like the elderly can deal with to one they can’t, as long as you have an increasing average.”

             Aviles expects rising average temperature trends to continue going forward.

             “If we stopped putting carbon dioxide into the atmosphere right now, it would take about 100 years for the atmosphere to stabilize.”

             Solutions to the problem begin, she  said, with being informed and having a basic understanding of climate science in order to avoid misleading or inaccurate information.   “Get informed by the experts rather than politicians,” she said. “But we also depend on politicians to have environmentally friendly laws, make those in charge be responsible for not making policy and decisions that are harmful. The public has a lot of power.”

             Addressing problems related to climate change also requires an understanding of what the effects are and then determining what can be done to help the most vulnerable.

             In the climate world, she said, the two key words are mitigation and adaptation.

“For mitigating, let’s try to fix some of the problems we’ve caused. For adaptation, let’s try to figure out what to do in order to deal with the problems we’ve caused.

Immigrant housing, drafty in the winter hot in the summer

             Managing Director of the International Institute of New England, Henry Harris, said Manchester neighborhoods– where the majority of refugees and immigrants live–have limited greenspace.

             Harris described the buildings in those neighborhoods lacking greenspace as old and often needing weatherization updates.

             “They’re drafty in winter and hot in summer,” he said. “Even planned neighborhoods, because of the amount of time it takes to grow trees, green space hasn’t developed enough to provide adequate shade. And in a lot of these old neighborhoods, the trees are aging out. Good luck finding an actual maple on Maple Street.”

             With less than a one percent vacancy rate in southern New Hampshire, Harris said placing clients in apartments can be difficult.

             “We pretty much have to swing at whatever is available. We do have bare minimum requirements before we allow a family to move in,” he said, adding, “Ideally, we would love everyone to live in the best apartments we can find, but it is really tight.”

             Asked whether his clients have more hospitalizations or heat-related problems than the general population, Harris said he doesn’t believe the majority of his clients would even report these problems “unless it was an absolute emergency.”

             “A lot of our clients come from countries that are really hot to begin with. Even the standard of living over there is far worse, plus going to the hospital is kind of a dangerous thing if you’re unfamiliar with it and don’t feel comfortable.”

             Harris said the IINE focuses a lot of effort navigating people towards health care and other resources such as community action programs, but acknowledged that the apartments where his clients live often lack air conditioners.

             “People try to get air conditioners when they can but when you’re on a really tight budget it’s hard to do.”

             Asked what some solutions might be regarding heat related illnesses Harris says it begins with infrastructure. And this includes the creation of more greenspaces.

             The problem, he pointed out, is that greenspaces take time.

             “It takes a long time to grow trees. Landlords are going to claim they don’t have money.”

             He suggested the use of Mesh sunscreens which also work like modern art, stretching over certain areas allowing the wind to blow through them.

             “I guess you can take them down in the winter time. Some corporations have used them on their properties for public space things.”

             The first step in creating change, Harris explained, is identifying who’s being impacted. After this, stakeholder’s in those communities need to be identified.

“It’s a big enough problem that there’s no way one agency or even government can solve it on their own. Looking for options that are going to be cost-effective is really important.”

Solutions must focus on resources for vulnerable population

Finding cost effective solutions for the energy needs of New Hampshire’s most vulnerable populations is a major focus of New Hampshire Legal Assistance attorneys Steve Tower and Ray Burke, who operate the Utility Justice Project. 

The project addresses a number of issues related to utility services, programs and rates, and how they affect low-income households in New Hampshire.

“We participate in a number of dockets before the Public Utilities Commission, rate cases for Eversource and Unitil, and also work on issues involving the electric assistance program, a bill discount for low-income customers,” Tower said. 

One of the energy efficiency programs Tower works on is the home energy efficiency program, funded through a systems benefit charge. 

“The home energy assistance program funds the utilities through the community action agencies across the state, sending folks into low-income households to do energy efficiency upgrades, with the goal of reducing the energy demand in the state,” Tower said. “We are trying to advocate to expand the home energy assistance program as much as possible where it is cost-effective so these homes, that otherwise would be left out, can be helped through this program.”

According to Tower, the cost benefit analysis also includes non-energy impacts such as health. 

“There have been a number of studies to assess approximately the dollar value of the health benefit, how many fewer sick days are used by employees who live in these homes, how many days of school are not missed, fewer hospitalizations, reduced deaths,” he said. 

Reducing hospitalizations caused by heat related illnesses, and also addressing the unfair burden of heat for the elderly, those with certain medical conditions, and those in urban areas lacking greenspace, could be better achieved if more apartments were air conditioned. 

But according to Tower, some landlords don’t allow air conditioners in their buildings. 

“We’ve had a number of cases over the last handful of years with seniors whose landlords prohibited air conditioners because they believed installation poses a risk of damage to the unit or they’re unsightly or may fall out and be a hazard,” he said.

In order to address these cases Tower relies on the Fair Housing Act and a   state housing discrimination law under the Human Rights Commission.

“Both federal and state human rights laws prohibit discrimination based on age or disability,” he said. “It may be difficult to claim age alone requires air conditioning but if someone has a medical condition that requires air conditioning, they should be protected under the Fair Housing Act.” 

When it comes to solutions to the problem of heat, Stampone believes more resources should be invested in vulnerable populations and that an environmental justice approach, where benefits and burdens are fairly distributed, should be adopted.

“We need to decarbonize globally. The mitigation needs to happen,” she said, adding that, in the meantime, “adaptation and cooling centers are a greater investment in cooling, as well as providing vouchers for air conditioning and increased access to cool spaces.”

Over time, she says solutions include increasing green spaces and access to green spaces as well as tree maintenance.

“Trees and other vegetation are very natural coolers. And they have more of a community benefit and a long term one, so they’re more sustainable than giving people a bunch of air conditioners.”

These articles are being shared by partners in The Granite State News Collaborative as part of our race and equity project. For more information visit collaborativenh.org.