Extreme heat events are projected to happen more frequently, last longer, and be more severe in coming years. Exceedingly high temperatures that currently occur once every twenty years may occur as often as every two to four years by the turn of the next century. These projections are deadly — over the last three decades, extreme heat has caused more fatalities than any other weather-related event in the United States.

To address heat vulnerability in New York City, our goal must be climate justice. At its core, climate justice demands access to equitable health outcomes. To achieve this, we must intentionally integrate public health into the development of our city, particularly its most vulnerable neighborhoods. Transforming the built environment must happen in collaboration with health professionals. Preventative health care must include the design of the built environment.

While extreme heat events on their own are deadly, in cities like New York City, urban environmental factors exacerbate conditions that cause poor health. Historically disenfranchised neighborhoods are often disproportionately sited with infrastructure, heavy industry, and extensive hardscape. These burdensome elements can cause heightened exposure to air pollution and extreme heat, increasing rates of asthma and worsening chronic illnesses like heart and respiratory disease. The COVID-19 pandemic has further underscored the inequities in health outcomes that disproportionately affect communities of color.

We must commit to addressing all factors that contribute to health. According to the CDC, WHO, and others, approximately sixty-seven percent of an individual’s health is dictated by factors outside of genetics and medical care. The built environment, personal circumstance, and the increasing influence of climate change play a significant role in individual health.

The New York City Heat Vulnerability Index (NYC Dept of Health)

Despite the historical grounding of the design of the built environment in health, public health officials, medical practitioners, and designers of the built environment do not collaborate across disciplines as a standard of practice.

We need to expand preventative care to address the root of health problems. This demands interdisciplinary collaboration at varying scales. Broadly, medical professionals diagnose and treat exhibited symptoms using medication or topical solutions. Most often, they are not empowered to implement solutions that address the root of health problems, which often originate outside of the body. For example, physicians can easily prescribe an inhaler to treat asthma’s symptoms, but they cannot recommend physical improvements to building ventilation. This must change.

At the scale of the body, physicians should be empowered to prescribe air filters and apartment inspections or maintenance to address particular health concerns. These ‘tenant-attached’ solutions could be considered as preventative care measures that are covered by health insurance.

At the building scale, existing inspection processes like the Facade Inspection Safety Program (FISP), a periodic review of the condition of exterior walls, could add a review that would identify health-related problems, such as poor insulation, water leaks and evidence of mold.

Interventions at the neighborhood scale can mandate increased tree cover near schools, libraries and city facilities in order to combat the urban heat island effect and support healthier environments.

Replacing turf fields with grass and asphalt surfaces with more permeable materials can increase evaporative cooling and mitigate the heat island effect while also improving neighborhood-scale thermal comfort. Strategies at this scale should empower communities to prioritize and implement solutions in areas of greatest need. (Image courtesy Urban Design Forum)

Chronic illnesses caused by physical qualities of the city, such heavy industry and transportation which cause air pollution, and hardscape that worsens the heat island effect, can take generations to manifest within a neighborhood; the positive effects of solutions can take a similarly long time to manifest. We should apply reactive, short-term solutions, such as deploying temporary planters and hydrant spray caps for community cooling, and establish a physician-referral program for housing inspections, similar to Boston’s Breathe Easy at Home program, to immediately correct for conditions in the built environment that are making people sick. But we should also pursue long-term solutions that support proactive prevention, such as adding health criteria to existing monitoring programs and directing health funding to support physical improvements such as retrofitting building envelopes can alter the physical and material fabric of the neighborhood to further improve health and mitigate climate risk.

Scientists predict that by 2050, the number of 99°F days experienced annually by New York City will triple, from 18 to 54, matching the current climate of Birmingham, Alabama. Heat vulnerability will become more widespread, and current efforts to provide air conditioning and access to cooling centers will not be enough. The coronavirus pandemic has further indicated that climate-change health risks do not exist in isolation. Health risks are amplified by the risk caused by extreme weather events. It is time to change how human health is prioritized and protected in the built environment. We must treat design as preventative care.

Author’s Note: The proposals referenced in this text are the collaborative work of Cyrus Blankinship, Eileen Chen, Gregory Harasym, Catherine Joseph, Amritha Mahesh, Kathy Mu, and Jill Schmidt as part of the Urban Design Forum’s 2019 Forefront Fellowship. Read more of the Fellows’ research in the Turning the Heat: Resiliency in New York City’s Heat-Vulnerable Neighborhoods report here.

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