Cathy Crowe




Newsletter No. 26  August  2006


I've been a street nurse in Toronto for 17 years. In the spring of 2004 I received the Atkinson Economic Justice Award which permits me to pursue, for up to three years, my passions for nursing and working on homelessness and housing issues.  In this newsletter I hope to report on my activities, create a link to a broader group of individuals who care about these social issues and encourage critical debate.

Further information about subscribing to the newsletter is found below.  I want to hear from you - about the newsletter, about things that are happening in the homelessness sector (what a sad term!), and about good things which will provide inspiration for all of us.



Anatomy of a Heat Wave


[An abridged version of this newsletter “Toronto cool to heat-wave planning” was published in the Toronto Star on July 31st. The next day, August 1st, Toronto’s heat-index reached a dangerous 47 degrees Celsius.]



Heat Wave: “Three or more consecutive days when the maximum temperature is 32 degrees Celsius or more.” (Environment Canada )



In 1995 Chicago suffered a violent heat wave that resulted in the deaths of over 700 citizens. Many were seniors, African-American and lived in public housing. Reports that many of the seniors who died were isolated from their family and community and that others felt prisoner in their home, fearful of venturing out into their neighbourhood, shocked North America . 


In 2003, eight years after the Chicago catastrophe, countries in western Europe experienced a heat wave that resulted in 27,000 dead: 15,000 deaths in France, 4-8,000 in Italy, 1,300 in Portugal and 2,000 in Britain . Many were seniors. Many were poor.


In both situations, political leadership initially denied the extent of the problem and minimized the risk to vulnerable populations. “It’s hot”, Chicago Mayor Richard Daley told the media, “But let’s not blow it out of proportion … every day people die of natural causes.”


Emergency responses came too little and too late. However the massive loss of life ensured a ‘social autopsy’, an examination of the political and social fabric that attributed to the high death toll in certain populations. 


Lessons were learned. First, that accelerated death rates were linked to poverty, unaffordable housing, diminished social programs and no access to air conditioning. Second, that the most critical public health measures that can save life in a heat emergency are early warning systems, the immediate opening of neighbourhood-based cooling centres, outreach to seniors and vulnerable populations, and energy assistance programs. 


Given the loss of life in these heat catastrophes, it’s no surprise that European countries and American cities like Chicago have attempted to develop a more comprehensive response to a heat emergency.


Canada has also experienced heat waves. In 2005, at least six Toronto residents who lived in scorching rooming and boarding houses died during a heat wave. Toronto Public Health research has demonstrated that mortality rates are twice as high on extreme heat days compared to comfortable days. 


A growing list of Canadian cities now face a frequent and unpleasant brew of extreme heat, humidity and smog that can be felt, seen and smelled. Yet, Canada’s overall response to heat waves has been lackluster. We act as if we were living in a country with one season – cold.


Has our ‘Canadian identity’ and obsession with the inevitable arrival of cold weather, narrowed our ability to think beyond snow and ice? Although we have developed some practical responses to protect vulnerable people in winter - minimum temperature by-laws for tenants, faith based ‘Out of the Cold’ programmes and sleeping bags for people who are homeless, when it comes to heat we appear to be in hibernation.


In mid-July of this year a heat wave swept across Europe, parts of Asia, Australia, much of the United States and parts of Canada. All-time high temperature records were set in England, British Columbia , Alberta and the United States .Many communities experienced heat related power outages. Deaths related to the heat were widely reported.


How do cities deal with heat waves? When a 10-day heat wave hit Toronto on July 14, I started looking at how the rest of the world was responding to extreme heat. 


In general, most cities use web sites and media advisories to inform the public how to protect themselves from the heat. Safety tips range from telling people to drink lots of water, take cool baths and wear light cotton clothing to go to air-conditioned shopping malls or libraries. The media help to promote stay cool tactics by showing endless shots of people licking ice cream, splashing in pools, endurance athletes training and reporters frying an egg on the hood of a car or sidewalk. Even animals suffering the heat are depicted - lions and tigers eating blood-flavoured ice blocks, snow monkeys being fed frozen ice treats and polar bears eating frozen ‘meat-cubes’. 


But, what about the groups of people who do not have good health, good housing, access to air-conditioning or the financial resources to endure the discomfort? What about people whose seniors’ pension cheque or disability cheque has run out by the 17th of the month? Extreme heat can be a medical emergency for vulnerable populations – the frail and elderly, those in poor health, socially isolated, or on certain medications such as psychiatric drugs. 


American cities like Chicago and European communities know that. Fearful of a repeat of earlier heat catastrophes they were on high alert during the July heat wave. The following examples cover 10 days of a heat wave that began mid-July, 2006.


In Europe


  • Britain– the Meteorological Office declared a Level 3 Heat alert on Monday July 17, one step below the highest level. The alert requires doctors and local authorities to maintain daily contact with at-risk people who live alone. 
  • Westminster, London - council workers visited elderly and vulnerable people in their homes and other workers did street outreach to check on homeless people.
  • England and Wales - dozens of schools without air-conditioning were closed, sending children home for safety.
  • Paris, France - an orange alert was called. The French Prime Minister visited a seniors home to draw attention to the heat emergency. In addition, radio and television broadcasts alerted the elderly to the danger. Tents were encouraged along the Seine River as respite for hot city dwellers. 
  • Milan and Rome - air-conditioned shelters were opened and a 24 hour help-line was set up for vulnerable seniors.
  • Hungary- government trucks distributed water.


In the United States


Climate experts in the United States declared the first six months of 2006 as the warmest on record and predict a continuation of this trend. In addition, they offer the warning that people are not used to temperatures a few degrees higher than the norm and that certain groups such as the elderly should take extreme care.


At least sixty deaths across the United States were attributed to the heat during this period. (Note –as of August 1 the number has now reached over 200). In many cases, the deaths involved seniors. The scenario of an elderly woman or man, found dead in their home without air conditioning or unable to afford to run the air conditioner was common. 


American cities have clearly developed some practical and creative measures.


  • The Illinois government designated 130 government buildings as cooling centres.
  • Chicago opened 100 cooling centres including senior-citizen centres, district police stations, libraries and park facilities. The City operates a ‘311’ line with up to date and accurate information on heat resources and they deploy air-conditioned buses to points around the city to transport vulnerable people to cooling centres. The City’s plan also includes ‘reverse 911’ calls which are automated calls to seniors and disabled people known to be at risk. 
  • New York City opened cooling centres in over 300 buildings and sent officials on outreach to check on the elderly and homeless.
  • Boston operated a Mayor’s 24 hour hotline. Mayor Menino issued a heat advisory July 14.City measures included extending hours of air conditioned sites in city community centres, free access for seniors to a shuttle bus to and from cooling centres.
  • The Philadelphia Corporation for Aging set up a telephone ‘heatline’ with nurses available to answer questions. The Philadelphia Health Department also sent outreach workers to check on the homeless and elderly.
  • In Kansas City, Missouri a non-profit organization helped to install air conditioners in the homes of indigent elderly. In 2005 more than 600 fans and 50 air conditioners were donated in a program coordinated by Channel 9 in partnership with a local hardware store and the Salvation Army. Only new fans and air conditioners are accepted.
  • St. Louis, Missouri’s Project Elder Cool helped provide and install air conditioners to those in need and the program provides $50 towards electricity bills for seniors or people with respiratory problems. The City opened 60 cooling centres on July 17. The City Health Director cautioned that the city’s older housing, much of it made of red brick, heats up like a furnace and tenants should be cautious. After a power outage that left 300,000 homes and businesses without power, National Guard troops, police, firefighters and volunteers knocked on doors offering bottled water and cookies as they checked on elderly residents and provided transportation to cooling centres. 
  • Detroit, Michigan cranked up the air conditioning in 11 libraries and invited the public to take refuge.
  • Cincinnati, Ohio called a heat alert July 14 and city recreation centres functioned as ‘cool centres’ for individuals and families.
  • Louisville, Kentucky provided free fans or air conditioners to those in immediate need. White flags fly at Louisville’s six homeless shelters – the signal that the air conditioning is on and there’s a place to escape the heat. The City directed Meals on Wheels personnel to check on recipients. 
  • In Witchita, Kansas an overflow shelter was opened for anyone suffering from the heat and drop-in hours were extended. 
  • Omaha, Nebraska’s housing authority spent $25,000 to install window air conditioners in apartments for elderly and disabled residents
  • Los Angeles , California’s Department of Parks and Recreation distributed bottled water at seniors centres opened for cooling.
  • Baltimore, Maryland developed a two-pronged heat strategy that includes a code red heat alert plan and an energy assistance initiative. On July 11 the City opened 11 cooling centres across the city. The City ensured that fans, air conditioners and water were provided to those in need. A MTA bus provided cooling services to areas where people are left at risk. The City had developed a data base of 56,000 seniors and shut-ins and ensured they were checked. Numerous city agencies coordinated their heat response with the Mayor’s Office of Neighbourhoods. On July 20, one day after the Code Red was cancelled, Mayor Martin O’Malley reminded residents to remain wary of the heat that still continued and urged people to call ‘311’ if necessary.


In Canada


Canada’s experience with heat emergencies is not as extensive as our neighbours to the south but it is hard to justify our meager response to the mid-July heat wave where temperatures, humidity and smog have persisted together.


A number of cities (London July 16, 17, Halton July 15, Ottawa July 16, 17) issued heat alerts but did not open Cooling Centres or offer outreach. Sudbury called a heat advisory July 14 and extended the hours of 4 libraries to function as cooling sites. Tillsonburg, to its credit, opened 3 Cooling Centres for the entire summer in accessible locations. A number of large cities reported monitoring the heat (Windsor ,Montreal ,Vancouver ). However, Windsor City Council had voted to no longer open Cooling Centres because of poor attendance in 2005. Hamilton went one step further by making a decision this month to no longer call heat alerts. Community agencies were stunned. The Associate Medical Officer of Health Matthew Hodge explained the rationale behind the decision: "...we have confirmed that local weather patterns are such that alerts may be so frequent as to lack credibility. "In reality, this year Hamilton has had approximately 6 days with a maximum temperature over 30 degrees Celsius, far less than some cities.


As Canada’s largest city, Toronto’s response has been most troubling. An Extreme Heat Alert was finally issued on July 16, the third day of a heat wave and only because the formula used forecasts the likelihood of excess mortality at 90%.This triggered the opening of 3 cooling centres for partial daytime hours and one 24 hour centre. During a Heat Alert and Extreme Heat Alert, the Canadian Red Cross operates a heat information line and volunteers deliver water to outdoor locations. In addition the Public Health unit provides rooming house inspections and the City provided some additional funding for extended drop-in centre hours.  


Only 10 days later in a renewed heat wave, Toronto declared a Heat Alert however, cooling centres did not open. On July 26 Toronto City Council voted 22-20 to not debate a motion on the adequacy of the City’s heat response. The motion would have allowed discussion on the City’s heat plan including the formula used to call an alert, the need for more neighbourhood based cooling centres including opening one in Scarborough; reviewing the Property Standards by-law that still dictates windows in rooming houses must not open more than 100 mm; and how Toronto could introduce energy assistance measures such as St. Louis’ Project Elder Cool which helps to provide fans and air conditioners to seniors and people with medical problems. 


Heat wave - our silent Katrina


The Chicago and European heat wave deaths were not the result of an act of god, or a natural disaster. They were preventable consequences of poverty, social isolation, racism and the withdrawal of social programs. The botched rescue and recovery stage of Hurricane Katrina similarly demonstrated the divide of race and class.


The Canadian heat wave does the same. It reminds us that we could and should do more to protect vulnerable populations. Are we even trying?


One year after six heat related deaths in Toronto , the Coroner has announced there will be no inquest. The Toronto by-law that dictates some rooming houses, windows must be fixed with a safety device preventing the window from opening more than 100 millimetres (less than 4-inches),  where temperatures can surpass 39 Celsius, has not been modified. Meanwhile, Canada’s largest landlord, Toronto Community Housing Corporation faces capital budget challenges that mean little attention is paid to cooling options.


In reality, very few Canadian municipalities are prepared for a heat wave. There are no Canadian cities with protocols to operate neighbourhood cooling centres, deploy air-conditioned city buses, or operate a vulnerable person registry. There are no fan loan programmes, air conditioner installation programmes, or hydro rebates for those in need. Emergency heat plans have not yet made it into municipal disaster management binders, nor are they mandated or funded by provincial Ministries of Health or Public Safety. Yet, prevention today will save lives tomorrow.


While we wait for real programs, we can count on the public health messages:“ drink lots of liquids, wear light-coloured clothing and a hat, go to a pool, go to an air-conditioned movie theatre or malls, and check on your neighbours who might need help.”


Sadly, people will need more than hot air on a hot day.


For more information, research and actions that you can take, go to ‘Killer Heat’ at




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