It’s a hot August morning and the nonprofit Circle the City has parked one of its mobile clinics in front of a north Phoenix soup kitchen. The group provides medical care to homeless patients. Inside the trailer, 64-year-old Paul Yager is getting his vitals checked. He’s HIV-positive and on most nights he sleeps in a park nearby. He credits this medical team with keeping him alive.
“I got a lot of life to live, and with God’s help, maybe I can live another 10 years,” Yager said.
But surviving summers in Phoenix without shelter is hard. Yager said he drinks a lot of water and keeps a hat on, but it’s not always enough.
Back in July, when temperatures hovered above 110 for over a week, Yager said he collapsed on a park bench one day for hours. His friends tried to cool him down by pouring water over him.
“I’m not good anyhow, so it’s just not good, it’s not healthy for me to be out in this kind of weather,” he said.
The Phoenix heat is getting more dangerous each summer. From 2005 to 2015, Maricopa County averaged 78 heat-associated deaths per year. But the death toll has reached a record-high every summer since 2016. Last year, the county reported an unprecedented 339 heat deaths. And 2022 is on track to be even deadlier.
“Unfortunately, we’ve seen a pattern over the past six, seven, eight years that is exactly the opposite of what we would be hoping to see,” said David Hondula, an associate professor with the School of Geographical Sciences and Urban Planning at Arizona State University and director of Phoenix’s Office of Heat Response and Mitigation.
The city created the Office of Heat Response and Mitigation less than a year ago. It’s the first of its kind in the country, and Hondula said the mission is simple.
“Each and every one of these deaths can be prevented,” he said.
But Hondula is up against incredible challenges. For one thing, Phoenix’s already-hot temperatures are rising. No major city in the U.S. gets more triple-digit days than Phoenix. And the National Weather Service projects, even under optimistic circumstances, Phoenix will be averaging more than 120 days per year with triple-digit heat by the end of this decade.
That concerns Hondula, but he said it’s not just climate change that’s driving the recent, staggering rise in fatalities.
“Our regional climate is absolutely the foundation of the conversation,” Hondula said, “but my interpretation is the increase is much more related to what’s happening with social services than it is related to climate.”
Maricopa County’s unsheltered homeless population has tripled since 2016.
A construction shortage dating back to the Great Recession, paired with explosive population growth, has sent housing prices skyrocketing. That’s contributing to a growing population of Arizonans without homes.
And Hondula said that’s turning heat into a more critical public health threat.
“Our unsheltered neighbors are absolutely at the highest risk of heat-associated death,” Hondula said. “Our best estimate is that the unsheltered community is at about 200 to 300 times higher risk than the rest of the population.”
It’s not just the long hours spent outdoors. Hondula said the unsheltered population also has limited access to health care, increased likelihood of chronic underlying health problems, and high rates of addiction, all of which can exacerbate the risks of heat.
County records confirm heat deaths are increasingly occurring outdoors among unhoused people. And about 60% of cases involve substance use.
Some health care providers are noting similar trends.
“This is a really bad summer for us” Dr. Kevin Foster, director of the Arizona Burn Center, told reporters in July. “The amount of drug use we’re seeing and the amount of people going down because of that is definitely much higher than we’ve seen in a long time.”
Pavement can heat up to over 150 degrees in the Phoenix sun. Every summer, Foster said he treats patients who fall, can’t get up, and develop severe contact burns. In the past, patients have typically been older adults who struggle with balance. But recently, Foster’s patients have been younger. He said now they are more often homeless, and more of their falls are related to substance abuse.
“They go down and they stay down for a long time, they end up not only getting really bad burns, but they suffer heat prostration and heat stroke. Oftentimes, their temperatures coming in are 108 or 109 degrees Fahrenheit,” Foster said.
In some cases, those injuries turn fatal, Foster said.
Back at Circle the City’s mobile clinic, psychiatric nurse practitioner Nina Gomez said she has witnessed these dangerous situations firsthand.
“We have a client here who was so psychotic and tired from not sleeping at night, that she would just sleep in the full sun,” Gomez said. “I would see her sweating, but she was too psychotic to really get her up.”
Gomez said all of her patients seem more on edge this time of year. She said dehydration and exhaustion can be disastrous for mental health.
“The stress from the heat really exacerbates psychosis and then it becomes so much harder to get people in to engage in any services,” she said.
Gomez said it feels like a vicious cycle: the unsheltered population grows, leaving more people exposed to heat risk, meanwhile, the heat makes it harder to help people out of homelessness.
Some local lawmakers are taking action to address the issue. In addition to creating the new Office of Heat Response and Mitigation, the city of Phoenix this year directed millions in federal American Rescue Plan Act funding toward affordable housing and homelessness programs. Federal pandemic relief funds have also allowed Maricopa County over the past year to make historic investments to address homelessness.
But the region’s housing shortage is an issue that can’t be solved overnight.
So as summer drags on, Circle the City and other organizations carry on as best they can with short-term solutions.
“We’re trying to intervene early,” Gomez said, “So, get people hydrated, get them some food, see if they need anything before it gets to a full crisis.”
Advocates say for now though, for more and more Arizonans, the crisis point is here.
