It’s time for Washington to save lives and act on extreme heat

Washington is facing a clear, growing, and silent public health threat. Extreme heat is already the leading cause of weather-related deaths in the United States. In Washington, the 2021 Heat Dome was the deadliest weather event in state history, resulting in an average of 18 heat-related deaths per day. Those deaths were not inevitable. They were the result of systems that failed to protect people inside their own homes.

This legislative session, lawmakers have an opportunity to respond.

As climate change drives more frequent and severe heat events, WPSR is working to help Washington’s legislature decide whether it will treat extreme heat as a predictable, preventable public health emergency or continue to accept avoidable illness, displacement, and death.

Heat Is a Climate and Health Emergency - and a Housing Problem

From a medical perspective, extreme heat is dangerous even over short periods. Heat exposure increases the risk of heart attacks, kidney failure, respiratory illness, and long-term neurological damage, and it worsens mental health stress and anxiety. These risks fall hardest on renters, low-income households, youth, outdoor workers, older adults, and people with chronic medical conditions.

Critically, most heat-related illness and death occurs indoors. During the 2021 Heat Dome, an overwhelming majority of people who died were inside their homes, often in buildings that trapped heat, with no safe way to cool down.

Yet many Washington renters are prohibited from installing cooling devices, even portable ones they already own. Others fear eviction or retaliation if they attempt to protect themselves. In practice, this means that during extreme heat, some people are left with a dangerous choice: break the rules of their lease — or risk their health.

That is not a personal failure. It is a policy failure.

As clinicians, these impacts are not abstract.

“During extreme heat events, I see patients come in with symptoms that are entirely preventable. Patients in the emergency room are treated in tubs full of ice.” More than once, I’ve had a patient tell me they didn’t use the air conditioner they had because they were afraid their landlord would penalize them. No one should have to make that choice.”

Dehydration can progress to kidney injury, heart conditions worsened by heat stress, and anxiety can spiraling because people can’t escape the heat in their own homes. Stories like this happen too often in Washington. They reflect a basic truth: cooling is not a luxury. It is a critical health protection, one that our housing and emergency response systems have failed to provide equitably.

What WPSR Is Working on This Legislative Session

Washington Physicians for Social Responsibility is advancing a coordinated, evidence-based policy approach to extreme heat — one that improves access to cooling, protects renters’ health, and strengthens statewide preparedness.

The Right to Install Cooling (SB 6200)

SB 6200 ensures that renters and mobile home residents can install portable cooling devices without unreasonable barriers. For many households, this is the difference between safety and serious risk.

Preventing someone from installing a basic cooling device during a heat wave does nothing to protect buildings, but it does put lives at risk.

Protecting Tenants from Extreme Heat (HB 2265)

HB 2265 recognizes extreme heat as the public health emergency it is. This legislation:

• Improves renter access to cooling

• Establishes protections from eviction during periods of extreme heat

• Moves Washington toward a future where homes are safer as temperatures rise

Simply put, no one should lose their housing, or their life, because their home becomes dangerously hot.

County-Level Heat Response Plans (HB 2183)

Extreme heat requires coordination. HB 2183 would require counties to develop and implement heat response plans, improving emergency preparedness, communication, and public health response before temperatures reach dangerous levels.

Planning saves lives and reduces strain on emergency departments, first responders, and local health systems.

Why This Matters Now

Extreme heat is becoming more common, more intense, and more dangerous. Relying on cooling centers alone is not enough, and assuming people can protect themselves without structural support ignores the realities of housing insecurity and health inequity.

Health professionals across Washington are calling for policies grounded in evidence and lived experience, that reflect what we see every summer: most heat-related illness and death is preventable.

This legislative session is a critical opportunity to act.

Why heatwaves are a mental health emergency we must address

Larry Freeman, MD, McKenna Parnes PhD, and Robert Berley, PhD,  are mental health professionals who have been concerned about the emotional and psychological toll of climate change, and members of the Climate and Health Task Force at Washington Physicians for Social Responsibility.

With summer upon us, heat and smoke are once again looming threats. Among these threats is a quieter, equally as serious crisis: the mental and emotional impacts of our changing climate.

Climate change is driving a wave of emotional distress, especially among young people. A 2023 global survey found that over 85% of people around the world report some form of anxiety about climate change and their futures. The severity of distress increases as respondents indicate that they do not feel governments have addressed this problem effectively. Roughly two thirds of young adults report climate distress, but less than half of that group believes others share their fears - worsening feelings of helpless concern and isolation. A majority of adults over 30 worry about the emotional effects the younger generations will face. Chronic worry and feelings of isolation and powerlessness have not only psychological harms: physical health and interpersonal relationships suffer as well.

Even here in the Pacific Northwest where many don’t consider it to be “too hot”, excessive heat has specific mental health effects: irritability, anger and conflict; domestic violence and resultant PTSD incidents; apprehension and feeling trapped; sleep loss which undermines physical and psychological well-being. The groups most at risk, i.e., young people, outdoor workers, the elderly, and people without air conditioning deserve particular concern.

We see elderly patients who become housebound during heatwaves, developing depression from isolation. We hear stories of workers, of whom mom or dad is one, at risk in the hot weather. Children share their concerns about the future, seeing an orange sky and worrying that the apocalypse is happening. Outdoor workers wrestle with the decisions between safety and a paycheck.

A 2022 study in Environment International shows for every 1 degree celsius increase in temperature, emergency psychiatric visits increase and heat-related mental health deaths increase by 2.2%. Domestic violence incidents spike during these times.

For those already struggling with climate anxiety, extreme heat becomes confirmation that their fears are materializing. The combination creates a dangerous spiral: heat worsens mental health, while climate anxiety makes each heat event more traumatic. People taking psychiatric medicines frequently have even greater susceptibility to heat related physical health complications.

The “heat dome” we experienced in 2021 will happen again. How will we react? Or most importantly, how will we prepare? We cannot let another summer pass without acknowledging this emergency. The mental health impacts of climate emergencies need more attention.

We must treat this like the public health crisis it is. Mental health considerations must be built into every layer of our emergency response.

Ensuring mental health considerations in emergency preparedness is no longer a “nice to have”,  but a necessity. We call upon physicians, hospitals, counselors, schools, governments, religious leaders, and businesses to accept their responsibility and lead us through this crisis. When communities prepare for heat emergencies together, they build physical safety and psychological resilience.

We’re obliged to consider things we might not have considered. For example, cooling schools isn’t just about keeping a school cool, but reducing the emotional burden on children, teachers, and caregivers. Employers must adjust the expectations of workers during heatwaves. 

Governments have a significant role to play. Expanding urban tree canopy keeps those in public spaces cool, and increasing access to greenspace has significant benefits for children’s mental health. Developing heat mitigations plans will equip hospitals and emergency department with the funding and processes they need to save lives during heat crises. Buildings - both new and old - must equip the cooling infrastructure they need to protect those most vulnerable.

Being upset about the climate means one has the courage to pay attention and care appropriately. Having these concerns isn’t so-called “climate hypochondriasis”. We are facing a real crisis that needs action. The good news is that action itself heals. Community efforts to address climate change provide us the sense of agency and connection that counters climate anxiety.