Jonathan Bethly was upbeat as he helped his friend clean out some storage units for extra cash on a hot summer day, laughing and joking as he worked.
He later went to take a nap in his friend’s Cobb County apartment and never woke up, relatives said.
The county medical examiner’s office concluded the cause of death was asthma-related, and that a heart condition contributed. Also leading to his death was the fact that Bethly, who recently had come to metro Atlanta from Michigan, had physically exerted himself in the Georgia heat before he was acclimated to it, according to a report on the death investigation.
Temperatures were in the 90s for a few hours leading up to Bethly’s death on Sept. 6, 2019. He was only 33.
“Nobody thought that was going to happen because he was so young,” said his wife, Latasha Bethly, adding that she rarely sees public health warnings about heat in her home city of Detroit.
As human-caused climate change continues to increase the frequency of heat waves across the country, experts agree that public messaging and warnings about the health risks have improved in recent years. The Centers for Disease Control and Prevention and the National Weather Service, for instance, recently launched a tool that forecasts nationwide heat risk over a seven-day period.
Even so, experts say the warnings don’t always reach the most vulnerable residents and are not tailored to individuals based on their specific living conditions or their varied health conditions. Other barriers include a lack of accurate weather data reflecting differences in temperatures across neighborhoods. Then there is this simple fact: Many people fail to recognize that heat and humidity can kill.
“You never think it’s going to happen to you,” said Kim Cobb, a professor of Earth, environmental and planetary sciences at Brown University. “It’s creeping into the daily lives of more and more Americans. It’s representing more and more of a threat across multiple regions at the same time now.”
Another challenge is that the human body doesn’t have an efficient way to signal that core body temperature is rising, said Kristie Ebi, a professor of health and global environment at the University of Washington. Given that one of the early signs of heat illness is confusion, some older people who feel disoriented might not realize the heat is the cause, she said.
“People often don’t realize that they’re starting to suffer heat strain until they are in trouble,” Ebi said.
Jonathan Bethly’s death left behind a young daughter, who was 3 when he died.
“It was a whole lot for her to be 3 years old and have that broken heart,” Latasha Bethly said of her-now 8-year-old daughter. “And she still hurts.”
Latasha Bethly and Jonathan’s aunt, Jessie Betz, were stunned to learn the role that heat played in his death.
“You hear people say: ‘OK, it’s hot outside.’” said Betz, of Baton Rouge, La. “But I don’t think they really get it.”
Cobb, the Brown University professor, noted an uptick in the volume and quality of communication about the threats posed by extreme heat, in the media and elsewhere.
“But who is this reaching?” she asked. “We have to remember that the most vulnerable members of our community are typically going to be low-income community members. Oftentimes those are communities of color. They may or may not have access to the same kinds of communication channels, so that’s a huge barrier to the effectiveness of that messaging.”
Urban heat islands
People who work outside, rely on public transportation or are homeless may have few options for avoiding extreme heat, even when warnings reach them. In a recent move that may help protect one of these groups, the federal government announced a proposed rule that would require employers to develop plans that protect employees from excessive heat.
Cobb, who previously worked at Georgia Tech and spent years studying Atlanta’s heat islands, said some of the hottest urban areas in cities are linked to historical redlining policies that, over decades, have led to a lack of investment in those neighborhoods. Some of these communities have substandard housing and fewer homes with air conditioning, she said.
Brian Stone Jr., a Georgia Tech professor and author of the book “Radical Adaptation: Transforming Cities for a Climate Changed World,” said another communication barrier is there are too few weather stations that continuously report publicly available data. And it’s not unusual for temperatures- to vary by 8 degrees at any one time in different parts of the city. Temperatures throughout the metro area could vary by as much as 20 degrees in rare cases, he said.
Some urban areas, known as urban heat islands, are especially hot because of the prevalence of heat-radiating concrete and few trees for shade.
“If we all assume that our temperature is equivalent to Hartfield-Jackson Airport, where we have our most long running and high-quality weather station, then we may be underestimating what the risk is,” Stone said. “We don’t have good data on heat risk spatially.”
Nationwide, about 1,200 people die each year from extreme heat, according to the Atlanta-based CDC, but the actual death toll is likely much higher. One study published in 2020 found nearly 12,000 premature deaths each year in the U.S. could be linked to heat exposure.
The risk of complications is greatest in children, the elderly, pregnant women and those with certain medical conditions, like heart and lung issues, according to the CDC. Outdoor workers, athletes who exercise outside and people without access to air conditioning are also more vulnerable.
Heat-related illnesses and deaths occur when exposure to high temperatures overwhelms the human body’s natural cooling mechanisms. This can lead to a steep rise in body temperature that can risk damage to vital organs and even the brain.
“It is a somewhat sinister environmental health risk in certain ways,” said Noah Scovronick, an environmental health scientist and assistant professor at Emory’s Rollins School of Public Health.
Unlike other weather disasters, almost everyone is exposed to the heat in some way, he said, and it affects different body systems in many different ways. In addition to the effects of heat on kidney, cardiovascular and respiratory diseases, there are associations between hot weather and higher rates of suicide and violent crime, as well as evidence of increases in substance use and hospital visits for certain types of anxiety and depressive disorders in sweltering weather, Scovronick said.
“Often the risks from heat are framed as being related to extreme heat, as if there’s no heat risk in the 80s or low 90s,” said Scovronick, deputy director of the Climate & Health Actionable Research and Translation Center, known as CHART. “Actually, we find the health risks do start to increase even at temperatures that people tend to think are fairly comfortable or not extreme. It’s just that the risks get higher when it’s hotter.”
Along with researchers, health care professionals and athletic trainers are among those who are trying to educate the public on heat risks.
Sophia Brown, an athletic trainer for Children’s Healthcare of Atlanta who works at Stockbridge High School in Henry County, said many students are now training for fall sports including football, softball, cross-country and flag football. Brown works with athletes to make sure they’re well-nourished and properly hydrated.
Highlighting the dangers athletes can face, a Clayton County basketball player collapsed and died after running in extreme heat during a conditioning drill in August 2019.
Dr. Ashley Brouillette, a sports medicine physician at Children’s, explains the potential health risks to student athletes by citing the death of Korey Stringer, a Minnesota Vikings football player who died from heat stroke in August 2001. Even when heat strokes are not fatal, they can cause long-term kidney damage, liver damage and cognitive defects, Brouillette said.
“Heat stroke is one of the most preventable causes of death that we can see in the summer,” she said.
Experts also say that opportunities abound for improving future health outcomes in society with respect to heat.
As a society, we still have some control over how much warmer the planet gets because it will depend on whether humans are able to rein in emissions of greenhouse gases, which are causing the planet to warm, Scovronick said. Doing a better job of reaching vulnerable populations also could make a difference, as could making changes like increasing the number of people who have air conditioning and adjusting activity levels in hot conditions.
“There’s certainly evidence that heat risks can decline in society, but it will depend on how well we do at adapting and whether we implement smart policies to facilitate that sort of adaptation,” Scovronick said. “It’s not inevitable, in my opinion, that health burdens from heat will increase in the future, even if it gets warmer.”
