'It's the salted fish not the cigarettes!' Doubting heat's role in heat deaths is the new cigarette's don't cause cancer.

Applying Tobacco Industry's Playbook To Heat Deaths of Low Income People

Imagine there is a town with a pineapple festival and while a number of residents were enjoying a pineapple smoothie on the sidewalk there was a multi-vehicle collision on the road beside them. Would we fund research to investigate whether pineapple smoothies played some role in the collision? Would we issue alerts about the dangers of drinking pineapple smoothies near roads? Would pundits speculate about pineapples on the Titanic?

Sound ridiculous to you?

This is how ridiculous news coverage and press conferences about heat deaths sound to me. And the latest absurd coverage by Global is the inspiration for this post.

(Alt text: Canada: 64% of Canadians have air conditioning. Is it enough for climate change? By Nathaniel Dove - Global News. Posted July 8, 2023, 4:00 am Updated July 10, 2023 8:12 am)

In the article Dr. Melissa Lem, president of the Canadian Association of Physicians for the Environment told Global News that, “One of the major risk factors for death during the 2021 heat dome on the West Coast was social isolation”…adding that many seniors — who are among those more vulnerable to extreme heat — are socially isolated.”

Discussing the social isolation of seniors in response to be asked about air conditioners to prevent heat deaths is uncomfortably close to ‘people were drinking pineapple smoothies at the time the collision occurred on the road next to them.’

Before saying more about this, let’s situate it and ourselves in some context.

We like to think of ourselves as reasonable and not easily manipulated like those ‘yokels’ in the past who bought snake oil or believed the earth was flat. Unfortunately, there are easy hacks for manipulating reasonable people and the corporate and political world figured them out long ago - thanks to marketing and public relations, (the second being the far less overt and more manipulative strategy).

In fact, it could be argued that we are the most manipulated humans in human history - with the two industries influencing what we eat, drink, wear, watch, read, listen to, think about and do.

One effective tool for manipulating modern humans is to suggest something that is actually quite obviously true is more complicated than it seems and that the obviousness of the answer reflects ignorance not ‘intelligence’ (scare quotes because it is an ableist concept). In other words, only the ‘bumpkins’ believe the answer is straight forward. Their ‘common sense’ is a reflection of their lack of ‘sophistication’ and the ‘expertise’ required to understand the nuance and complexity involved.

This is not my observation or invention. A well-known example of public ‘open-minded’ skepticism was the campaign developed by Hill for the tobacco companies when the link between cigarettes and cancer was established. This is a small excerpt from a short paper that I recommend reading:

“By the early 1960s—despite categorical research findings indicating the harms of smoking—a significant “controversy” had arisen (at the behest of the tobacco industry) over the validity and meaning of these findings. Indeed, given the widespread acceptance of the conclusion, especially among those who had analyzed and evaluated the research most closely, the persistence of debate about the harms of smoking is a striking demonstration of the powerful impact of the tobacco industry's public relations campaign. The industry insistence, at the direction of Hill & Knowlton, on the notion of no proof and the need for more research was an inspired if cynical manipulation of the natural tendencies within science to encourage skepticism and seek more complete answers to important questions.” Source

The history of this is, as I said, generally part of common knowledge now. What is less well-known perhaps is the way the tobacco companies moved to manipulating courtrooms when they finally - after filling their bank accounts and countless graveyards - lost in the court of public opinion.

A 2015 study by Stanford School of Medicine researcher Robert Jackler found that a small group of otolaryngologists operated as testimony-for-hire for the tobacco industry in more than 50 cases launched by dying patients. Their strategy was simple and a well-known one for defence lawyers - point many fingers. They “highlighted an exhaustive list of potential risk factors such as alcohol, diesel fumes, machinery fluid, salted fish, reflux of stomach acid, mouthwash and even urban living, they created doubt in the minds of the jurors as to the role of smoking in the plaintiff’s cancer.”

Of course this ignores the fact that non-smokers face all the same risk factors and yet head and neck cancer was not showing up in anywhere near the same rate among the non-smoking population. (“The risk for HNSCC [head and neck cancer] in smokers is approximately 10 times higher than that of never-smokers and 70–80% of new HNSCC diagnoses are associated with tobacco and alcohol use.” Source)

“The study reports that six board-certified otolaryngologists were paid by one or more of the tobacco companies R.J. Reynolds, Phillip Morris and Lorillard to serve as expert witnesses. These physicians gave testimony that indicated a multiplicity of environmental factors, ranging from exposure to cleaning solvents to the consumption of salted fish to the use of mouthwash, were more likely to have caused the plaintiffs' head and neck cancers than years of heavy smoking. The cases occurred between 2009 and 2014. One physician said he was paid $100,000 to testify in a single case. Another admitted that her opinion was written by tobacco company lawyers and then approved by her. Still another rejected reports from the Surgeon General as authoritative sources.”

OK so what does all this have to do with the discourse being generated around providing air conditioning for poor people?

Honestly? Everything. But before I go on I would ask you to consider the idea that there is not any reason to assume a significant variation in people willing to be testimony-for-hire now than there was then and that we are not better or ‘smarter’ than those who spent decades fooled by the tobacco industry’s shenanigans were.

The next thing I ask you to please consider is that the cause of heat illness and deaths is listed right in the name - heat.

If heat is the cause of illness and death than the solution is pretty obvious. We need to ensure people have a means to escape heat.

Social isolation is of course a real concern with real health impacts and it is disproportionately experienced by certain demographics, including disabled people. But social isolation does not cause you to die of heat.

What is a factor in whether or not you die of heat is whether you have access to mechanical cooling and that largely depends on your income and accumulated wealth. People who can afford to purchase adaptation do, the only potential barrier being landlords and strata councils. And this is reflected in BC heat deaths which found poverty was a bigger risk factor among the 619 who died than any chronic condition. Ninety-one percent of the 619 who died were disabled and 90% were aged 60 or over.

So where does social isolation come into this? Well, as it turns out there is a link between living alone and poverty among disabled people. For example, disabled who either live alone or are single parents are more likely to live in poverty. This likely explains why social isolation showed up in the list of attributes of those who died. But that does not make it a causal or even contributing factor.

The cause of death is heat. The solution is cooling. The immediate formula really is that simple.

The lack of access to adaptation is a result of poverty. The solution is to provide people with the funds in the interim and to standardize cooling in all built environment in the long term. In terms of the climate change impacts of mechanical cooling buildings - which are less than those of heating - the most energy efficient adaptation should be phased in as quickly as possible WHILE IMMEDIATELY PROVIDING AIR CONDITIONING AS A FIRST AID MEASURE TO PREVENT SUFFERING AND DEATH IN THE INTERIM. And all the while expanding alternative power sources, creating back-up power plans and changes to infrastructure to ensure the capacity of the grid.

So why is isolation being raised in an interview about air conditioning by someone who is certainly well acquainted enough with the evidence and has the science training to interpret it properly?

Dr. Lem acknowledges, “Our bodies are designed to operate in a really narrow temperature range and when we go past that temperature range, we start to get sick.”

I’m not going to get it into any detail about it here but it is also the case that there is variation in human bodies and minds and that variations means some become ill and die when others would not. The variation is not so large that one group requires arctic temperatures while another is comfortable in extreme heat, so we can address the need by providing mechanical cooling in all buildings and allowing for independent control of temperature at all times of the year inside people’s homes.

If we are serious country that seriously wants to address heat deaths this is what we will do - immediately. And we will make sure that the infrastructure, including back-up, is in place to prevent blackouts. Obviously this requires a multi-layered and multi-pronged approach. We need distribution of funding for portable air conditioners immediately and we need to start retrofitting buildings with the most energy efficient, least polluting methods as quickly as possible. Really should have been done many yesterdays ago.

Every day we are served more pineapples and salted fish instead of action needed to save lives. So many deliberately and disingenuously avoid the link between heat and dangerously poor air quality which necessitates staying inside with windows closed and air filtration and mechanical cooling operating.

And mentioning air conditioning as a cause of urban heat islands like this article does…I mean I’m tired and this post is already too long but aside from density itself, building types, cars, spatial organization, corporate head offices designed to assert power while draining the max amount of it, etc., unless you are prepared to start suggesting people go without heat in cold, stop telling people to go without cooling (which uses less energy), in the heat.

Climate change mitigation and adaptation is supposed to have the goal of creating conditions for survival - not be a survival test designed by a Social Darwinist.

The one important point raised in this article is that the National Building Code does not consider extreme heat to be an emergency and this “means most cities or apartment buildings don’t have more than two hours of emergency backup power.”

There are many complex issues around climate change that will require all the expertise we can gather to tackle inventing solutions. Ending heat deaths is not one of them. It really is a matter of those with the power to do what is necessary starting to do it.

This provides a link to a sample letter if you feel motivated to write someone in government.