Adaptive strategies to prevent heat-related mortality among populations at high-risk: Lessons learned from New York City, 2008

Available data indicate that more U.S. residents die from extreme heat events (EHE) than all other natural disasters combined. Considering predicted climate change and increased severity of EHEs, adaptive strategies to minimize excess mortality are required. In such large cities as New York City (NYC) urban heat island effect and social isolation of low-income seniors further contribute to adverse outcomes. Investigations of fatalities following EHEs in NYC identified key risk factors, including age >65 years, having multiple medical conditions or a psychiatric disorder, no home air conditioner, and living alone. Further, limited awareness of risk factors and preventive actions can reduce the protective effect of living with someone. A recent investigation noted that half of decedents lived with someone and almost all had relatives in the metro area. In 2008, the NYC Department of Health (DOHMH) piloted an adaptive strategy to prevent heat-related mortality among low-income adults aged >65 years, living alone, and without air conditioners. Strategy components included (1) disseminating educational materials to heighten awareness and perceived risk, (2) disseminating alerts to healthcare providers concerning key risk factors, (3) encouraging faith-based organization leaders to conduct community outreach during EHEs, and (4) promoting a free air conditioner program, resulting in 2,634 installations in 2008. Combined with active surveillance and opening of cooling centers during EHEs, these components comprise a successful adaptive strategy to mitigate risk for heat-related mortality. In 2009, DOHMH will expand these pilot activities to strengthen community outreach and promote air conditioner use among seniors at high-risk.