Welcome to tropical Cleveland, part 2: The social & political roots of heat-related mortality

children at water park

Children attempt to escape from the heat during July 2012 in Louisville (courtesy of the AP).

In my last post, I explored some recent research that outlined projections of climate change in Cleveland and its potential to drive an increase in heat waves. But climate/weather is just one factor behind heat-related mortality; socioeconomic and political issues are, perhaps, just as, if not more important, determinants.

Just as Cleveland’s historic climate and the associated lack of acclimatization to heat waves will likely leave the region more vulnerable to extreme heat, so too do the region’s various socioeconomic and political pathologies leave it ripe for a public health crisis. (As I write this, it is 97° outside, and I just got an extreme heat advisory from the National Weather Service. On September 10.)

Last month, the Graham Sustainability Institute at the University of Michigan released a new mapping tool that explores the social and economic factors underlying climate change vulnerability in the Great Lakes region. This great new tool allows you to zero in on any county around the Great Lakes to the extent to which its economy, infrastructure, and vulnerable citizens are likely to suffer in a greenhouse world. Unsurprisingly, Cuyahoga County (of which Cleveland is the seat) does not fare particularly well.

The Greater Cleveland area possesses a number of characteristics which, if they do not change, may create a perfect storm for heat-related mortality in a warmer world. I will explore four of these – the built environment, poverty, changing demographics, and racial segregation.

The Built Environment

Northeast Ohio has suffered from decades of sprawl and uncoordinated development patterns, leading to waves of suburbanization followed by exurbanization. In 1948, Cuyahoga County’s population stood at 1,389,532; just 26% of land in the county was developed at the time. Yet, by 2002, although the county’s population had grown by a mere .32% to 1,393,978, sprawl ensured that roughly 95% of the county’s land area had been developed.

cuyahoga county land use in 1948 & 2002

Changes in land use within Cuyahoga County from 1948 (left) to 2002 (right). Red shading indicates developed land, while the beige indicates land that is still undeveloped. The maps clearly demonstrate the waves of suburbanization in the county over the last six decades (courtesy of the Cuyahoga County Planning Commission).

According to data from the Cuyahoga County Planning Commission, 33.6% of the county (and 56.2% of Cleveland) is covered by impervious surfaces. These surfaces (e.g. asphalt) conduct heat, contributing to the urban heat island effect. The EPA notes that urban areas can experience annual mean temperatures of 1.8–5.4°F higher than their surroundings, while this difference can reach an astonishing 22° during the evening.

Cuyahoga County’s sprawl-based development structure presents a number of other challenges, as well. As people have spread out throughout the region, we have become increasingly car-dependent. Car use has come to dominate our policy discussions – transportation commentators like to note Ohio stands for Only Highways In Ohio” – despite its myriad of side effects.

According to the Northeast Ohio Sustainable Communities Consortium (NEOSCC), 86% of commuters in Northeast Ohio report driving alone to work. This car culture contributes to the development of chronic disease, which I discuss below. Additionally, combined with Cleveland’s industrial base and Ohio’s coal dependence, it significantly reduces air quality in the region. In its 2012 “State of the Air” report, the American Lung Association gave Cuyahoga County an F for ozone pollution and a failing grade for annual particle pollution.

Climate change will likely exacerbate this issue further. Last year, largely due to the abnormally warm summer, Northeast Ohio experienced 28 ozone action days – double the number from 2011. We know that high air temperatures increase concentrations of ground-level ozone, which can cause respiratory distress for vulnerable groups. Accordingly, Bell and colleagues have projected that ozone-related deaths will increase 0.11-0.27% in the eastern US by 2050. This issue adds to the risk of heat-related mortality in Greater Cleveland.

Changing Demographics

Like much of the Rust Belt, Cleveland has been shrinking and aging. From its peak in the 1950s, Cleveland’s population has plummeted. The city had 914,808 in 1950; by the 2010 census, the number had fallen to 396,815 – a 56.6% decrease in six decades.

This precipitous decrease in population has left large swaths of Cleveland abandoned and, increasingly hollowed out. Even before the Great Recession and the housing crisis that precipitated it began in 2007-2008, Cleveland had foreclosure rates on par with those in the Great Depression. From 2005-2009, Cuyahoga County average roughly 85,000 foreclosure filings per year, and parts of Cleveland saw nearly half of their homes enter foreclosure. The destruction of neighborhoods undermines social capital, a key coping mechanism for surviving extreme events.

foreclosures in Cuyahoga County 1995-2012

The number of annual foreclosure filings in Cuyahoga County from 1995-2012. As the chart indicates, the number of filings spiked in 2005, two years before the housing crisis began (courtesy of Policy Matters Ohio).

As people have fled the region, particularly young people and people of means, those who remain are increasingly poor and disconnected. Accordingly, the region’s population has aged significantly. Nationally, approximately 13% of the total population is age 65 or older. In Ohio, the number is 14.3%, while it sits at 15.8% in Cuyahoga County.

Older persons are far more vulnerable to the deleterious effects of extreme heat, particularly those suffering from chronic illnesses, like diabetes, and those living alone. Unfortunately, 20.6% of people 65 years and over (PDF) in the county suffer from diabetes; this number climbs to over 35% in Cleveland. Additionally, more than one-third of older persons in the county live alone, adding further to their vulnerability.

Poverty

Given the region’s challenges, it’s perhaps unsurprising that Greater Cleveland struggles with high levels of poverty. Cleveland was named the poorest city in the country in 2004; it has remained at or near the top since that point. Roughly one-third (32.7%) of Cleveland’s residents live below the poverty level. Even worse, more than half of Cleveland’s children are growing up in poverty.

map of poverty rates in Northeast Ohio

Poverty rates and changes in poverty rates within Northeast Ohio from 2005-2009 (courtesy of Rust Wire)

Much of this poverty is concentrated in highly depressed portions of the inner city and, increasingly, in the inner-ring suburbs. It creates regions where public health suffers dramatically; the Plain Dealer recently reported that portions of Cleveland had infant mortality rates higher than most of the developing world, including Bangladesh, Haiti, Pakistan, and Rwanda.

As one would expect, poor people suffer disproportionately in disasters. Roughly 95% of disaster deaths occur in the developing world, and the same principle applies within the developed world (see: Hurricane Katrina).

Racial Segregation

Lastly, Cleveland suffers from high levels of racial segregation. It was the 8th most segregated city in the US in 2011, which likely does not surprise Cleveland natives. For decades, the Cuyahoga River has been seen as something akin to the Berlin Wall – African-Americans stay to the East of the river, while whites and Hispanics live on the West Side.

Recently, the Atlantic Cities posted a map that showed the location of every person in the country (color-coded by race), based on Census data. The close-up shot of Cleveland is below. It quite clearly illustrates the racial divide within the city: African-Americans (green dots) to the east, whites (blue dots) and Hispanics (red dots) to the West. If you look closely, you can even see the small cluster of red dots that makes up Cleveland’s Asia Town.

map of Cleveland showing racial divide

The map, a closeup from the Racial Dot Map, shows the racial divide in the city of Cleveland.

Now, such spatial segregation creates a host of problems, but it also has a connection to heat-related mortality. A study published in Environmental Health Perspectives suggests that persons of color are far more likely to live in areas at risk of suffering extreme heat waves than whites. The study found that a high risk of suffering from the urban heat island effect is more closely correlated with race than class. Accordingly, severe spatial segregation, as we find in Cleveland, will ensure that poor minority neighborhoods have yet another risk factor to account for in a greenhouse world.

Taken together, Cleveland’s combination of heavy, sprawl-based development; an aging, sickly population; high rates of concentrated poverty; and racial segregation may create a perfect storm for heat-related mortality in the coming decades. The fact that sea level rise isn’t going to drown us, and it snows 6 months a year doesn’t mean we can get complacent as the climate changes. Like I said in my last post, just because it won’t suck as much as Bangladesh doesn’t mean it won’t still suck here.

Now that I’ve thoroughly depressed everyone, I will use my next post to look at some of the things Cleveland can do to mitigate the threat of heat-related mortality, including some of the initiatives the region is already undertaking.