This episode originally aired on July 23, 2026.
The dog days of summer are upon us. But it seems this year that summer heat has more of a bite. Extreme temperatures are changing everything from work, sleep, sports, and summer camps.
There are ways communities can deal with extreme heat, but it takes a systemic approach. In this hour of All Sides, learn about heat resilience and what it takes to build heat-resilient communities.
Plus, what does heat do to the body – how it affects the young, the old, and the in between. And what about those who work under the hot summer sun or in sweltering factories, are there legal workplace protections?
Guests:
- Ladd Keith, director of the Heat Resilience Initiative at the University of Arizona
- Dr. Stephen Auciello, program director at OhioHealth Riverside Methodist Hospital Family Medicine Residency Program
- Richard Bales, professor of law at Ohio Northern University
Transcript
This transcript is generated with AI. To ensure its accuracy, review the audio file.
Amy Juravich: Welcome to All Sides with Amy Juravich. The dog days of summer are upon us, but it seems this year the summer heat has had more of a bite. Extreme temperatures are changing everything from work to sleep to sports to summer camps. There are ways communities can deal with extreme heat, but it takes a systemic approach. What is heat resilience and what does it take to build heat resilient communities? Joining us now is Ladd Keith, director of the Heat Resilience Initiative at the University of Arizona. His research focuses on heat planning, policy, and governance to help increase the heat resilience of communities, regions, and nations across the world. Thank you for joining us today, Ladd.
Ladd Keith: Yeah, thanks so much for having me on.
Juravich: So, tell me, what is extreme heat? How hot does it have to get to use the word extreme, I guess?
Keith: That's a perfect way to start off this episode, right? Extreme heat really varies across the world. And so I think depending on kind of your geographic location, your cultural norms, heat can mean a lot of different things to a lot different people in a lot of different places, right. So there's no one correct answer. I would say extreme heat probably should be best defined as heat that's above what's normal for your area at that time of year and causes impacts that are out of the norm.
Juravich: Okay, so above normal, impacts that are out of the norm. How has extreme heat in the US been different than what we're hearing about in Paris, for example? So I read very recently that France recorded maybe 5,700 more deaths than usual due to the historic heat wave they had in France in June. That seems very extreme to me, is it?
Keith: Yeah, that's a great question. I would say the underlying factors are actually exactly the same, no matter where you are in the world right now. Extreme heat is being fueled by human-caused climate change, which are causing kind of average temperatures to rise gradually over the years. But those gradual rises that might be a little bit harder for people to notice on a day-to-day basis lead to these extreme kind of tails of heat waves that we're seeing. And so, science has shown that heat waves are increasing in intensity, but they're longer in duration. They're happening longer outside of their seasons now too, and so kind of the same physics apply whether you're in Ohio or France, right? The heat waves that we're seeing are becoming more of your across the world.
Juravich: But six straight days of 90 plus temperatures in Paris and six straight days of ninety plus temperatures and Arizona probably are two different things you you're used to it right is that what is that the biggest difference is that in France they're not used to
Keith: Yeah, that's a good question. So I would say we do see a little bit of difference in the world between historically hot places and historically cooler places, right? And so places like Arizona have been historically hot and we have some adaptations built into what we work on, but we're seeing our temperatures rise too. And even just this year had a historic early heat wave that was in March and it was our earliest 100 degree temperature ever, which caught us a little off guard with kind of our preparations for protecting people. And so even in Arizona, where it's been historically hot, we're certainly being impacted by heat. How you address the heat certainly changes depending on whether you're a historically hot place or a cooler place. And so one of the things that Europe has been kind of grappling with is they do have a well-known kind of aversion to air conditioning. So part of it's just the building stock and the historically cooler temperatures that they have had in a lot of places like France. But that, and that differs from the United States where we obviously have the world's highest prevalence of indoor air conditioning, right? So those adaptations that we have built into our cities and our built environments are certainly changing how we're feeling the heat as it continues to rise. And so I think the main message there is that across the world, our cities have been built for a climate that no longer exists and places are kind of grappling with how to adapt very quickly to the heat that they're experiencing now due to climate change.
Juravich: That leads me to the term heat governance. What does heat governance mean?
Keith: Yeah, so I know heat governance is something that we defined in a Nature Comment paper back in 2021. So it sounds very wonky and academic, right? But basically heat governance is how does society as a whole address heat is how I would boil it down to the average non-academic person, right. And kind of an easy way to look at it would be heat is actually the number one weather related killer in the United States, but until the last five years or so governments really haven't been addressing it as seriously as we address other hazards like. Hurricanes, wildfires, droughts, floods, hazards that might be a little bit more visible with their impacts and things like that, right? And so we still spend billions of dollars more kind of across the world and in this nation addressing those more visible climate impacts than we do extreme heat. So the idea of heat governance is really how are we addressing extreme heat and in what ways could we better organize our society to do a better job of protecting people as these temperature rise.
Juravich: Yeah, I guess when you think about it, the government deals with natural disasters better than heat, because it seems like, I don't know, heat is just like day to day, it's hot outside, but a hurricane is like an event, right? So the government dealing with a hurricane or a wildfire, that seems more visible to me. Is that a part of the reason that hasn't been dealt with, I guess.
Keith: Yeah, so part of it is the visibility of the impacts and kind of what the media is able to report more easily. So when the heat wave kind of sweeps through an area and I believe Ohio just had a record breaking heat wave a couple of weeks ago, right? Yeah, we did.
Juravich: There's a lot of like, there's a lot of frying eggs on the sidewalk, but that's not as dramatic as like a hurricane coming to hit you. Yeah.
Keith: Yeah, absolutely. And then the heat waves over, unfortunately, although it does absolutely impact things like energy use, water use, our economies suffer due to extreme heat. But the biggest impact from extreme heat is unfortunately on human health. And so we do see people die during these heat waves, right? But a lot of times those are deaths that happen kind of quietly for people that are alone in apartment buildings or the unhoused. It could happen to But those deaths often go kind of under-reported versus when you have a hurricane or a wildfire sweep through an area, you see physical damage to the homes. And so I think, unfortunately, that's another reason why we haven't historically addressed extreme heat is that our nation tends to care a little bit more about the hazards that impact properties and kind of, you know, things that have capital damages versus the value of a human life. And so we're still trying to catch up to that. I would say things have changed, though, when I started working on this about 15 years ago, when I did interviews with government officials, the most common answer I would get is that heat is even something the government has, like is appropriate for the government to address. And I think that that has changed very quickly over the last five years, especially after the Pacific Northwest heat wave of 2021. We see a lot more governments taking up responsibility and saying they do have a responsibility to protect their people and their communities from extreme heat.
Juravich: This is All Sides on 89.7 NPR News. We're talking about extreme heat with Ladd Keith, director of the Heat Resilience Initiative at the University of Arizona. What about the people who will point out that decades ago, temperature soared and broke records? Some records still stand today. I can give you an example. In Toledo, here in Ohio, in 1936, a week in July, the week of July 8th, had six days of temperatures above 100 degrees. And that is still the record for the hottest week in Toledo, and it's 1936. So someone would say we've always had heat. It's not our problem with climate change now.
Keith: Yeah, and to that I would say, climate scientists understand this very well, right? We call it climate variability, and it's the idea that there's always gonna be hotter periods and cooler periods across the world no matter where you are, right. Even, I'm in Tucson, Arizona, and our record high temperature ever recorded was 117, and that's back in 1990. So we still haven't broken that record from over a couple of decades ago. The difference is we're breaking records more consistently now across every day of the year, And so we, you, know, people will still remember those hotter times in the past, but we're having more consistently hot times kind of as we move into the future, right? And so, you, know, with climate change, we don't expect to see every single temperature record. Every record of temperature broken immediately, but if you look at the trends, those averages are rising very quickly and we are getting record-breaking events like the heat waves that we're experiencing too. So it's kind of, if we were on a non-audio media, right, I would show a little graph that would show basically climate change is kind of amping up that climate variability, so the highs are higher and the lows that we experience will increasingly be a little bit less cool than they were in the past too.
Juravich: You're the director of the Arizona Institute for Resilience. So can you explain what your institute does? How does it work to mitigate heat damage in communities?
Keith: Yeah, so I'm the director for the Heat Resilience Initiative that's housed within the University of Arizona's Arizona Institute for Resilient. And it's really the university's initiative to kind of pull together a lot of programs that we had working on extreme heat. Like you said, Arizona is a historic place. We have a lot of faculty working on heat. So it's kind of become a center point for a lot of those projects and programs that run. And really our goal is to, you know, kind of advance this idea that heat resilience is something that we need more research on and we need to quickly get those lessons learned out to both Arizona communities because we're a state-serving institution, but we also want to improve kind of the global response to extreme heat. And so, you know, I work with everyone from Arizona communities, the federal government, all the way up to the United Nations. And so really the idea is kind of promoting this idea of heat resilience and how can we create practical lessons for communities and governments across the world to better address extreme heat? So- Can you give me-
Juravich: Can you give me some examples of best practices? Is it more shade structures? Give me an example of a community doing something.
Keith: Oh yeah, sure. So we have, I would say there's three kind of buckets of strategies that we found through our research. One is heat mitigation. And so those are actions that reduce the heat in the built environment through the things that people more commonly know as the urban heat island effect, right? And so urban greening, planting more trees, using stormwater infrastructure, you know, using cooler materials, we're testing out cool pavements here in Arizona to reflect the heat, cool roofs to reflect the Heat, and then also reducing waste heat from gasoline powered audible vehicles and air conditioning, that waste heat is often kind of not thought about as much as some of those other strategies to reduce heat, but in some places can be up to 50% of an area's urban heat island effect. Another bucket is heat management, and those are strategies that prepare and respond to the heat that we can't reduce in the built environment. So things kind of like public health measures, education awareness campaigns, heat safety labor laws, Opening up cooling centers for folks that don't have safe indoor cooling on their own. And then the last bucket is really heat governance, which we talked about, right? And that's the idea of appointing a point person for extreme heat, setting kind of goals and making sure that you're measuring the outcomes of that. So are you tracking the heat illnesses and deaths appropriately? And really coordinating across levels of government, which again, because heat is such a new hazard, and we don't have in many places, most places, right? There's actually only a couple that I can name. There's not like an office of heat in most governments. And so we need to come up with new ways for kind of coordinating around heat. And that's really one of the biggest things that we're grappling with right now as a society or as a human kind of species across the whole world is if you kind of look at it in the United States, we have tens of thousands of floodplain managers that protect our communities from flood damages. And we really only have a handful of folks that their full job is just looking at extreme heat. So we have a heat officer at the state of Arizona. That's the nation's only state level heat officer. And then the city of Phoenix, north of me, has an office of heat mitigation in response with a couple of employees. And so that's really the nation only example of a heat office in that way. So-
Juravich: Yeah, I can attest to that, because when we tried to book people for this show, there's only a few. We only found a few people to ask to come on, yeah.
Keith: Yeah, and it's a very small community, we all know each other, we text. Constantly when things like this happen, right? But yeah, but we need more than just five of us. We need a cadre of people to protect the nation from the nation's deadliest weather threats, right? And again, just think of the tens of thousands of people that work to protect us from floods, that work on drought and kind of water resources. When there's a wildfire, we have huge crews of like wild firefighters and scientists and professionals that kind of sound the direction it's going. And really we're not at the same place for extreme heat, so.
Juravich: So, you just mentioned something called waste heat, and you mentioned air conditioning. So my next question was, is having more air conditioning going to be the solution? But I'm guessing now that I heard the term waste heat you're going to say no. It's a part of the problem, yeah.
Keith: Yeah, so waste heat's really controversial. So in some ways, we're super fortunate in the United States because, again, we do have very high prevalence of air conditioning. So it's kind of conditioned us to be used to perfectly cooled indoor places in a lot of circumstances, right? Having said that, we obviously need cooling centers because we have large populations of unhoused individuals that don't have access to that air conditioning, and even in the United States, there are so many individuals that can't afford the energy because the energy costs are going up so high, right? And so we see a lot of research that shows that people will save money by not turning their air conditioners on even if they have it. So it's not perfect here, but we do have a lot more access to it. I think if you look around the world, places like Europe that haven't historically had air conditioning are having really kind of in-depth conversations right now about the future of air conditioning in their cities. And it's the conversations due to expect, right, the cost of retrofitting those buildings to even be able to put in the air conditioning, and then kind of cultural norms about not putting in air conditioning because of beliefs that it can actually cause illnesses. And then concerns, environmental concerns. So increasing the waste heat, which could make things unintentionally worse. And then kind what are the greenhouse gas impacts from air conditioning. And so if you kind of look across the whole world, it gets a little bit more concerning, right? Because you have huge places like in the global south like India with billions of people that don't have access to air conditioning right now and are at much higher heat risk than anyone else in the world. But kind of the ability of India to provide air conditioning to all of its people is not there. And so kind of what would be the impact if everyone on the planet had individual air conditioning? It would be for kind of like looking at a global systematic climate change. We would obviously increase greenhouse gas emissions by a huge amount, right? So I think. The answer really is kind of more nuanced, I believe, so it's providing air conditioning in public places where the most number of people currently can use it. And so some places in Europe are starting to look at providing air-conditioning in places that haven't had it, like libraries or transit stations or potentially community centers and places like that. So maybe it's not a matter of making sure that everyone has it in their own homes, but that at least communities have it at enough places when there's a heatwave that people can see seek refuge.
Juravich: I just wanted to end on that Ohio does offer emergency help in the summer. It's called the Summer Crisis Program, and it's helped to pay electric bills, buy air conditioners or fans, or to help pay for air conditioning repairs. To qualify, you have to be 175% below the federal poverty guidelines. But is this an example of a program that is like a heat resilience program, having this program, even though it's only available to people, you know, a certain number people.
Keith: Yeah, absolutely. I mean, I think. Probably, most communities in the United States are already doing things that protect their people from extreme heat. They might not call it heat resilience, and I'm perfectly fine with that, as long as we're doing some of those right things. I'd say cities do a lot of things that they don't take benefits for. When we see cities trying to plan for transit or walkability, those also can help reduce the amount of automobiles that are kind of emitting waste heat, but we often don't see cities connecting that with reducing the urban heat island effect. So I think, again, this idea of heat governance or heat resilience is kind of connecting the dots and making sure that we have clear goals and that we're. When we do those things that do have a positive impact on HEEB, we're certainly calling attention to it.
Juravich: We've been talking about keeping cool in extreme heat with Lad Keith, director of the Heat Resilience Initiative at the University of Arizona. Thank you so much for joining us today, Lad.
Keith: Yeah, thank you for having me on.
Juravich: Coming up, we're going to talk to a doctor to walk through how our bodies handle the heat. That's when All Sides continues on 89.7 NPR News.
You're listening to All Sides. I'm your host, Amy Juravich. It's summer. It's supposed to be hot, right? But when the temperature soars above 90 degrees for multiple days and the air is muggy and oppressive, it's not just hot. It's dangerous and maybe even deadly. For a better understanding of how our bodies handle the heat and when we're approaching that danger zone, it's time to talk to a doctor. Joining us now is family physician, Dr. Steve Auciello. He is the program director of the Ohio Health Riverside Methodist Hospital Family Medicine Residency Program. Welcome to all sides, Dr. Auciello.
Dr. Stephen Auciello: Thank you so much, Amy. I'm really pleased to be here.
Juravich: So, as a physician and an educator, I'm sure you see patients of all ages, both in hospital and clinical settings. Do you see an uptick in patients with heat-related ailments, like during the recent heat wave we had.
Auciello: Yeah, absolutely. This is something that has such a small margin for causing problems. And only small changes in heat, a little bit hotter than we're expecting, can really throw off our body's ability to handle what we're expecting. And regardless of the setting, whether you're trying to run a half marathon or whether you just trying to do your day-to-day activities, this can be something that can really sneak up on a lot of people and cause major problems.
Juravich: What are some common complaints? Like what does, you know, a heat ailment that would cause you to call your doctor? What are people saying?
Auciello: Yeah, there's a lot of terms out there. So from some terms that we might use, we will talk about things like heat illness, which is kind of a catch-all term. But for some of the things that your body can experience when you are experiencing problems related to heat. And those can be things like some cramps, increased sweating, maybe some light dizziness or light headedness, a little bit of nausea. Things that can throw you quickly all the way to some of the more severe complications like heat exhaustion or even heat stroke that can include mental status changes, confusion, lethargy. You might not even be able to be conversant with those around you or even things like seizures and those are certainly things that if we experience any of those types of things need urgent medical attention.
Juravich: We often see heat advisories when it's really hot that caution the very young and the very old. So let's start with the very Young. What is it about the bodies of the very young that can't handle heat? Cause I've seen some things that, you know, will tell you not to have like small babies out in the heat.
Auciello: Right, yes, for our littlest, particularly those in the first year or two of life, they're at increased risk to almost everything from an environmental standpoint. They have less surface area to be able to conduct the body's natural processes of heat. And really the main goal when we're talking about heat illness and avoiding heat illness is allowing the body to maintain its own core temperature. So a lot happens in terms of hydration, sweating, to really do what the body needs to do to try to maintain the same internal temperature. And the smaller we are the less of an ability our body really has to do that. There's less surface area, there's less developed skin to be able to do the sweating and the rehydration that needs to be done. So those kids also may not be able verbalize if they are experiencing some of the early symptoms of that. One of the earliest symptoms is thirst and they might not be telling you right away when they are thirsty. So it's maybe a little harder to stay caught up. They
Juravich: Yeah, I was talking to a mom recently who had a five month old baby out at like a picnic and it was hot and she was just like, she's like, I feel like my baby needs water, but I'm not supposed to give my like my baby doesn't drink water, you know, like it was, it was like a funny conversation because she was like, isn't that what we need when it's 90 degrees, right?
Auciello: That is exactly what we need.
Juravich: Yeah, but not for a five-month-old. Anyway, so what about those who are older, are seniors? Like, why do we have advisories that say the elderly should take care of themselves in extreme heat?
Auciello: Yeah, I think that's a very different conversation for some of us who are older or may have some chronic medical conditions that could put us at a higher risk. Many of the medications that people take can put us a higher of risk of heat-related illness. Many of our medications impair our ability to maintain adequate hydration. Things like diuretic medications, blood pressure medications, antihistamine or allergy medications, steroids. These are different medications that many people may be on, especially those that are older, that could impair the body's natural ability to regulate this heat. There is also just these systems may not work as well over time. And overall, as the aging process develops, this is one of those regulatory functions that just doesn't seem to work as well in our bodies over time, so maybe a little more prone to sensitivity to dehydration and heat-related illness.
Juravich: The Yale School of the Environment, in a recent issue, noted that heat-related deaths in the U.S. Have surged more than 50 percent since the year 2000. And the headline of the article said, Americans are underestimating the dangers of extreme heat. Would you agree with that? Do people underestimate extreme heat?
Auciello: Absolutely, I would agree with that. I think these are. These are symptoms that can sneak up on us very quickly, and most of us are just focused on when there's a beautiful day, go out and enjoy it. And oftentimes we may think about the dangers of heat a little too late, because by the time those symptoms have started to present, it may already be when you're experiencing some heat-related illness. We really need to be proactive to prevent heat- related illness, or once you're experience those symptoms, it may be already too late and you may already have to be looking at what do I need to do to address this? It's hard to prevent it once those symptoms have already started. So it's certainly something that can really sneak up on just about anyone, particularly those that are at a higher risk for heat-related illness.
Juravich: This is All Sides on 89.7 NPR News. We're talking about the health effects of extreme heat with Dr. Steve Osiello with the Ohio Health Riverside Methodist Hospital Family Medicine Program. So when do we call 911? Or when do just need a cold compress and some water and some shade? Yeah, tell me the differences here.
Auciello: Yeah, great question. I think the main goal is to not experience any symptoms. So if you are thirsty, it's already too late. So stay ahead with hydration. Water really is our mainstay for the most part. You can use electrolyte solutions to be a little more proactive with that if you're going to be outside for prolonged periods. But in general, as soon as you start to experience any type of symptoms, you're already into early stages of heat-related illness. So the first thing to look for is, are you thirsty? If you are a thirsty, you should be drinking something. Ideally, drinking something, carrying it with you. Before you start to feel that sensation. If you start experience things like some dizziness or lightheadedness, particularly with position changes, that can be an early sign. You may notice that your heart rate's going a little higher. When our body does experience dehydration, especially if you're not in extremes of physical exertion, if you notice, you've got a smart watch or something like that that tells you your heart rates a little high, that can an early signs. And if you are resting and you are not feeling well, for any of those reasons you're experiencing some nausea, maybe some early blurred vision, those are signs to really pause, take a break, get into a shaded area, get some hydration, sit down, and really try to catch up. Now, if you experience more extreme symptoms, you really want to seek help right away. If you are unable to stand, you are able to communicate with those around you. Those around you, you may notice that you seem confused or disoriented. You are vomiting and can't drink water. That would be a sign that you should stop everything you're doing. You should try to call 911 right away, and in those situations, we really want to rapidly cool the body, because as we move from heat illness to things like heat stroke, the body has lost its ability to regulate its own internal temperature. You can have extremes in body core temperature that can be life threatening, and that would constitute a medical emergency. Hmm
Juravich: So as these heat advisories that we hear become more frequent, do you think people are gonna become more accustomed to automatically taking precautions? I'm thinking like in the 70s and 80s, we didn't know about the dangers of sun exposure, but now many, many more people understand the importance of sunscreen, right? So do you we'll get there where it would like, people just understand it's too hot to do X activity?
Auciello: Yeah, I think we're continuing to learn more and more about these. We've come a long way in the sun protection and really, boy, the layers of sun protection. As someone who gets very annoyed by sunscreen, I love the layers you can put on and not have to reapply every couple hours. And I think that's become very normalized in a lot of communities of really getting everyone layered up with sun-protective clothing and complementing with sunscreen wherever we can. We may still be a little behind in heat-related illness because this is something that we don't necessarily notice until it's a problem or until near the end of activities. But I think being proactive with that hydration, really normalizing trying to take adequate hydration wherever you can. And then also those things of avoiding some of the things that can make dehydration worse, being mindful of if alcohol is being consumed, if excess caffeine is being consume. Those are things that can increase your risk of dehydration and make that even more risky. But I do think there is cultural shifts happening to become more aware of these things, and creating more public areas with better shaded access, trees, and things where you can escape some of the consistent dangers of the sun and the heat.
Juravich: And do you feel like, I mean, more and more people carry a water bottle with them all the time now, especially kids, I don't know how old you are, but in the 80s and 90s, we never had a water bottle with us, it was just like, you know, count to three at the water fountain once a day. So is that people adapting or is that just like I don't know if that's adapting to extreme heat or if we're just becoming a water-bottle society.
Auciello: Maybe a little bit of both, but yes, I've got three kids, and I don't think we can leave the house without having at least one, if not multiple, water bottles. We are always trying to be prepared and proactive with that. The last thing we want to hear is, I'm thirsty and I do not have a water bottle. So I think as we are a family that loves to do things in the outdoors, we always try to stay proactive with it, and that's one of the things that Sony people can do to avoid these things before they happen. Try to be proactive whenever you're thinking about going out. You'd rather have extra hydration than not have it. So even if you don't think it's that hot right now, I mean, I'm looking outside and it's in the 60s right now. But our UV index is still a little bit elevated, even on days where it's not of extreme heat, depending on your activity, depending on your risk level and if you're from one of those. From one of those backgrounds that might be higher risk, you could still experience some of the symptoms of heat-related illness if you're not being proactive with your hydration.
Juravich: In the in the past decades, though, were people having like heat stroke and heat exhaustion and having all of these things and maybe we just didn't hear about it as much within the days when we didn't carry a water bottle with us all the time.
Auciello: Yeah, I think we're better at describing it now. I think where we're more aware of it now, and it really is, and I assist some of my sports medicine colleagues in helping with some of the larger scale half marathons and things like that around town. And it's amazing how only a few degrees of temperature can be the difference in a race where almost no one experiences heat related illness and a lot of people experience that. So it can be really relative based on the time of year, what we're expecting, what the body's adapted to. So these subtle changes can really make such a difference.
Juravich: I wanted to pivot before we run out of time to the extreme heat in a country like France that's not as used to the high temperatures. They saw they had extreme heat and June and they released some numbers saying they saw something like 5,700 more deaths than usual during the historic June heat wave. The article said it's too early to tell exactly how many were heat related or if heat was just a factor in the death. But I think it's like a cautionary tale, because France is not known for having very much air conditioning. What do you, as a doctor here in Ohio, think about when you hear about that heat wave in Europe?
Auciello: Yeah, I think it reminds us how serious heat can be. I think, it's a great reminder to have a network that you're checking on. If you have those around you that are older, that are younger, that may be at higher risk of heat-related illness, check on them. I think we are lucky that so many people can have access to things like air conditioning, which can offset a lot of these, but if you are in a position where you don't have temperature-regulated environments during the day, you may be more prone to be leaving your house and not be at an adequate hydration place, too. So really having that network checking in on those that may be at a higher risk can be really important to be proactive with this. And hopefully, we can try to avoid these things because they sneak up so quickly. I think that's why heat-related illness is so dangerous, is you can go from feeling just fine to very sick very quickly. And the higher that heat index is, the quicker all of that can happen. I think the other thing to keep in mind is the humidity, too, is we talk a lot about the heat. I think the heat index is helpful because it encounters that. It considers the humidity in the air. And at times when it gets very hot and it's also very humid, that is particularly dangerous. Because high humidity, when there's more moisture in the Air, it impairs our body's natural ability to be able to regulate our own heat. So it means we're going to sweat more. We're going lose some of that fluid fast. So not just paying attention to the temperature, but particularly the heat and humidity humidity to really understand where a true dangerous heat wave may come from. Come from.
Juravich: And just to end on, would you say that doctors in central Ohio and elsewhere are learning more about educating people on extreme heat? I mean, is it a topic that would come up in medical school or is it kind of an aside?
Auciello: Yeah, I think it's certainly something that, in my realm of medicine and family medicine, which is very adjacent to the sports medicine world, it's talked about frequently. Certainly when we talk about the larger events where these types of problems happen at a higher concentration, it's... Paid very close attention to. I think where the opportunity are are the places that might sneak up. If you're someone who maybe is on multiple chronic medical medications that could increase your risk of heat-related illness and you're just going to a walk in the park on a hot day, are you aware of those things? Is your doctor counseling you on those things. Are we starting medications that may increase your risk if heat- related illness and are we including that in some of our counseling? I think that's where there's still some opportunity. I do think this is something that's being talked about more and more. And as we have days that are hotter and hotter, we really need to, as a medical community, make sure we're partnering with our patients to help them understand. What their individual risk level is, and what are some things they can do proactively to avoid these problems.
Juravich: We've been talking about what extreme heat does to the body with Ohio Health family physician, Dr. Steve Osiello. Thank you so much for your time today.
Auciello: It was a pleasure. Thank you so much.
Juravich: And coming up, we're gonna hear what does the law say when it comes to protecting workers who have to work in extreme heat. That is when All Sides continues on 89.7 NPR News.
You're listening to All Sides. I'm your host, Amy Juravich. Roofers, landscapers, and farm workers baking in the scolding sun. And they can't escape the elements while doing their job. What kind of protection exists for them as temperatures rise and the planet warms? We're talking this hour about extreme heat, how communities can prepare, what it does to the body. And now we're gonna talk about workplace safety and the law. Joining us now is Richard Bales. Professor of Law at Ohio Northern University, where he teaches labor and employment classes, also the subject of books he's authored and his research specialty. Welcome back to All Sides, Rick. Thank you. So, as we are all struggling, you know, with this recent heat dome that happened, you know, not too long ago, I had to wonder about all the outdoor workers up on a roof, putting a new roof on, working in fields. And surprisingly, there's no federal OSHA heat standards for outdoor workers. Are there heat standards for workers in Ohio?
Richard Bales: Well, you're right, Amy. There is no federal outdoor heat standard that is specific to heat. And although we have standards in Ohio, the standards in in Ohio basically track the federal law. So let me back up for just a minute and explain that under federal law, OSHA is the key law. There are two different ways that workers are protected. Just generally in the workplace, not just from heat but from everything. One is the general duty clause that says that employers have a general duty to provide a safe workplace. And the second is through much more specific standards. So a standard that says, for example, that if you go up more than two or three floors, you have to be tethered, or there have to the guard rails, or that if you're digging a really deep bitch... That the sides need to be supported so they don't cave in on you. There is no heat specific standard, specific standard. So for now we have to fall back on the general duty clause and that's the same thing at both the federal and the state level. So the OSHA, the federal OSHA standards covers exactly the workers that you just mentioned, like the roofers and other. Folks in the private sector workforce. For the folks who are working on the roads outside or working on our bridges or doing the public sector work that is incredibly important to us, they are covered by Ohio's Public Employment Risk Reduction Program, the acronym is PERP. But the standards are pretty much the same. There could be specific standards, but there aren't for heat. And so the fallback is the general duty clause.
Juravich: Okay, so if if I see construction workers working on the highway and it's above 90 outside and they're literally paving a road that like I it just it looks so hot, but the it is up to the supervisor on duty for those people to decide that is that what the general duty means the supervisor on duty decides if it's too hot to be working or something like that.
Bales: No, no, they don't. It's not like they have complete discretion, right? It's like a supervisor could say, well, it's a hundred degrees outside and a hundred percent humidity, but I don't think it's that hot. I suffered through it. So everyone else, that's not it. Okay. The every employer, just period. Every employer has a general duty to provide a safe workplace. And if it's really hot and really humid, and you're not giving your workers any breaks or any water. Or any shade or anything like that, then you're not providing a safe workplace. So it's a legal duty to provide a safe work place. The problem is that it's not specific, right? So there is a standard right now, a much more specific standard that is pending that OSHA, but it has not yet become law. And that would say that when the heat index gets to 80 degrees, employers have to do X, Y, Z. And when it gets to 90 degrees, employers have do A, B, C. Much more specific, and I think much more helpful. So, but we don't have it yet, and so for now we have to fall back on the general duty of employers to provide a safe workplace.
Juravich: So to implement something like you just explained with OSHA, you know, do ABC, do XYZ, is that something that's possible or are certain employers gonna push back on that because you know what one person deems is too hot to work is what another person deims is like a great sunny day, let's get a lot done. Yeah.
Bales: So it is very possible. In fact, it may be happening very, very soon. But just like any federal regulation, but certainly at OSHA, it takes a while. So this particular HEAT standard was proposed in 2024. In 2025, OSHA did a notice. They put out a notice, they received written comments, they hold hearings, all that sort of stuff. They've presumably written what will become the final rule. They just haven't officially promulgated it yet. So it's pending. It's probably coming. We don't know exactly what it will look like, but it will almost certainly be an improvement over the general duty clause. And it's still, you know, maybe an employer might say, yeah, I think it's just a warm sunny day, but my workers can work through it or they're used to it or whatever. But I think even many employers would prefer to know what the rules are, right? I mean, to have a set of guidelines to say, okay, when the temperature hits here or when the the temperature hit here, what is it that I need to do?
Juravich: Yeah, I understand that. Having a set of rules sometimes makes it just easier for everyone to follow the same rules. Because my next question was, can workers who have to work outside refuse to work if they feel it's unsafe because of the heat?
Bales: That's a difficult question to answer. And I think it is made much harder by the fact that the general duty clause is so general, right? It is so generalized that it's not really, it's very, it's necessarily obvious when it has been violated. So as a general rule, yes, an employee can refuse to work if the employee. As a good faith, reasonable belief that working would jeopardize his or her health or safety or the health or safetiness of someone else. That being said, it's really hard to show. It's even more difficult to prove. And employees tend to be very reluctant to do that because they're worried about getting fired. They're worried about retaliation, they're worried about their employer believing that they are slacking and docking them for performance or whatever else. So again, it's just much easier if you have a clear set of rules.
Juravich: Yeah, yeah. This is All Sides on 89.7 NPR News. We're talking about outdoor heat regulations for workers with Richard Bales, professor of law at Ohio Northern University. I noticed in your bio at Ohio northern that you also teach regularly in China where you're a visiting professor. So that made me wonder about other countries addressing the issue of extreme heat and working conditions. I mean, you don't have to necessarily use China as an example. It made me wonder about the whole world. Are other countries ahead of the US or behind the US when it comes to regulations like is there a role model for heat related rules?
Bales: Some countries are ahead, most countries are about where we are. At least a handful of countries you might say are behind. Most countries are about where are. You know, I know that there are at least a few countries out there that have much more specific regulations. I couldn't point to exactly which ones they are immediately. California has a heat regulation. That is fairly similar to the OSHA regulation that is pending, but is not yet final. So it might also serve as a model. Ohio doesn't necessarily have to wait for OSHA. We could implement the equivalent of the OSHSA standard at the state level immediately. But in any event, You know, as of right now, it's still the general duty clause. A more specific regulation may be coming. And beyond that, it's really like, if it's hot outside, if the supervisor sweating, that's probably a pretty good sign that it's time to start thinking about, whether the law requires it or not, let's make sure that workers are safe. As a worker that has passed out on the pavement is not a productive worker. And that's not good for any of us. Yeah. And so, I know I just kind of fall back on the basics of staying safe in the heat. Think about water, think about shade, think about rest and think about acclimating. Don't go out in the he and try to work a 10 hour really, really strenuous day if you haven't worked out for the last long while. Working in the Heat or doing anything in the He is much like exercise. A little bit at a time. Great build up to doing a lot of the time, but don't try to go from zero to a hundred in one day
Juravich: So you just mentioned California has standards, so that makes me wonder, you know, do states like Arizona, Texas, where it's much hotter, do they have different standards than a state like in Ohio, Pennsylvania, or Maine?
Bales: Yeah Most states do not have standards. California is an outlier. I believe Arizona may have a statute that looks like Arizona as well. But the handful of states, there are only a handful of states that have specific heat regulations. They tend to be in the desert southwest and California. A state like Maine, probably not surprisingly, doesn't have one. But, you know, on the other hand... There are a lot of states, like in Ohio 20 years ago, I'm not sure how badly we would have needed one. I don't remember summers here being as hot 20 years ago as they are today.
Juravich: Yeah, and you note that you use problem-based simulations in many of your courses. So your teaching style is rigorous, but participatory. That's what it says on your bio. So how would you teach extreme heat in the workplace and the law to your students?
Bales: I might have them do maybe a simulated OSHA hearing, and I think that this is a really good example illustrating how the general duty clause would work. Maybe I give the students a simulation in which a worker has passed out while working on a roof. And the question is, did the employer provide a a safe workplace to that worker under the general duty clause. And to make that showing, Bush would have to show that a heat hazard existed, the employer or the industry recognized it. Third, that the hazard could cause death or serious harm. And fourth, that feasible means existed to reduce the danger. So I could set up a hearing in which I signed the student's One side represents OSHA, and they make the argument that it was extremely hot, the employer knew about it, they didn't provide water, they didn't provide rest breaks, and it could have killed the worker who passed out on the roof, right? And the other side, another group of students might take the employer's side and make the arguments, well, it wasn't all that hot outside, this particular worker had a particular predisposition to heat and became plenty of water and rest breaks. So that's how I would try to teach it in the classroom.
Juravich: Yeah. Okay. And I mean, we only have just in a quick 30 seconds that we have left. I noticed in my neighborhood recently that roofers were working on the roofs at like eight and nine p.m. Because it was still light out. So is there any thing in the law where you're allowed to like shift hours, you know, so it's not as hot and have people work, you know, at eight o'clock at night?
Bales: As a general rule, I think that's a great idea, certainly during the summer. The only restriction on that is that workers, if you work more than 40 hours in a week, then you're generally are entitled to overtime. And so an employer can shift to early morning and late evening, so long as they're not working five 14 hour days.
Juravich: Well, we've been talking about outdoor heat regulations for workers with Richard Bales, professor of law at Ohio Northern University. Thank you so much for joining us today, Richard. Thanks, Amy. This has been All Sides on 89.7 NPR News. I want to say thank you to our staff, producers Marcus Charleston and Erin Esmont Rabinowitz. Student producer Iza Huck and Brianna Fortunet. Our student producer from Denison is Ellen Hansen. And video production by the Ohio Channel Board Operation by Chris Johnston and Trey Hayes. This is All Sides on 89.7 NPR News. Thanks for joining us.