Disturbing voice in an overheated city

Marta Segura knows that in Los Angeles, it can be hard to consider heat an emergency — either because the air conditioning is on full blast and you have a cold drink in your hand or because you don’t have enough money for groceries, let alone the electric bill.

But it also knows that of all the natural disasters caused by global warming, heat – which it is tasked with combating – has claimed more lives than any other climate-related cause.

Half a million people worldwide die each year from heat-related illnesses. Yet while hurricanes and wildfires claim their victims almost immediately, heat is rarely blamed for their consequences. Sustained high temperatures can hasten deaths that are ultimately attributed to other causes: a heart attack, an uncontrollable asthma attack or an overdose.

Between 2010 and 2019, nearly 4,000 Californians died as a result of extreme temperatures. And summers are getting hotter.

As the city of Los Angeles’ chief heat officer, Segura’s job is to make sure we don’t look away – from those who have already fallen victim to the heat, or from the threat that lies ahead for the rest of us.

Jane Gilbert, heat officer for Miami-Dade County in Florida

Segura works almost like heat itself, taking up the available space and changing things in subtle ways.

Her position was created in June 2022 in response to a dramatic increase in extreme heat events. At the time, she served as director of the city’s Climate Emergency Mobilization Office, a position she still holds today.

The climate office has six employees and an annual budget of one million dollars – less than the city spends on Street sweeping accessoriesBut in Segura’s view, things don’t necessarily need her office’s approval to be considered a solution.

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People across city and county government — not to mention local nonprofits and universities — are working to make life more bearable in a hotter Los Angeles. Segura says her role as chief heat officer is to find those people and make sure their collective efforts are focused on getting services to the people and places that need them most.

Los Angeles is the third city in the U.S. to appoint a CHO, after Phoenix and Miami. What sets Segura’s approach to the job apart, her colleagues say, is her deep connection to the communities most affected by the heat.

“She has taken this to a new level,” said Jane Gilbert, chief heat officer for Miami-Dade County in Florida. “Her deep connection to the affected communities is something I admire.”

Segura, 60, recognizes her own family in the people she serves. She grew up in San Jose, the second of three daughters whose parents emigrated from Mexico.

Both of her parents suffered heat-related injuries on the job. Her mother once fainted at a cannery in Del Monte when she was denied water during a hot shift; her father suffered dehydration several times as a farm laborer in the Bracero program.

“My mother and father had a lot of work accidents together and they had stories of those who didn’t make it,” Segura said. “That had a profound impact on me.”

When Segura was 13, the family was evicted from a rental building surrounded by highways to make way for more construction. In their next home, they were sprayed with the pesticide malathion.

She took these experiences with her to UC Santa Barbara, where she planned to study biology. But an elective in environmental science changed everything. It tied everything together: her family’s displacement, her exposure to pollution and pesticides, the undeniable connection between an organism’s health and that of its environment.

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“It made sense to me. It made perfect sense,” she recalled. “This is what I want to do for the rest of my life because this is the problem I’m trying to solve.”

She graduated with a bachelor’s degree in environmental science and later earned a master’s degree in public health from UCLA. Her experiences in San Jose remain with her to this day.

The house near Park Mesa Heights that Segura now shares with her husband (and son, when he’s home from UC Berkeley) doesn’t have air conditioning, which she attributes to the frugality her pragmatic mother taught her.

When it gets hot, she opens the windows and closes the blinds. When it gets really hot, she leaves the house. She either goes to a cold storage facility in the city to see how people are doing, or to a shopping center, a café or the theater.

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Heat is a health issue, but it’s also an equity issue. Being able to afford the environment – perhaps with air conditioning or moving to a cooler coastal area – can mean the difference between life and death.

“It may be that two communities, literally adjacent zip codes, one of them has three times as many emergency room visits because of heat as the other,” said Dr. David Eisenman, director of the UCLA Center for Public Health and Disasters. “This is right under our noses.”

Our familiarity with heat is part of what makes it so deadly, Eisenman said.

People “think they can handle it,” he said. “They’re not really afraid of it. And it’s going to be a challenge for us to change the culture around it.”

Los Angeles has always had hot days. The sun is a selling point for many who choose to live here.

But heat waves – extreme heat that lasts for days and gives the body no chance to recover – are longer, hotter and more frequent than they were 50 or even 20 years ago, and are expected to become even more common by mid-century.

The hotter it gets, the harder your body has to work to maintain an internal temperature of 37 degrees Celsius.

As the temperature rises, your heart pumps harder. The capillaries beneath the surface of your skin dilate to accommodate the extra blood flowing through them, and your skin turns pinker and then redder as the blood rushes beneath the surface.

Then you start to sweat, the body trying to cool itself through evaporation. When you lose this water, your blood pressure drops, a change that can make you dizzy, nauseous and confused. If you lose too much water, you become dehydrated, which makes these symptoms even worse.

Meanwhile, your muscles cramp and tire easily due to the loss of water and electrolytes. This discomfort is a warning signal that you should drink fluids and seek shelter.

If you don’t voluntarily take a break – or can’t – your body will take one for you. Heat stroke begins at a body temperature of around 104 degrees Fahrenheit. As the blood and oxygen supply to the organs is cut off, they begin to fail. Even if you get help at that point – and someone will have to step in and take care of you, as you’re probably too disoriented to look for it yourself – the stress and inflammation may have already caused permanent damage to your cells.

“We talk a lot about prevention because once you get to that point, for some people there’s no turning back,” says Dr. Jan Shoenberger, professor of emergency medicine at the Keck School of Medicine of USC and chief of emergency medicine at Los Angeles General Medical Center.

At a body temperature of 41 degrees Celsius, the membranes around your cells break down. The mortality rate from heat stroke can be as high as 65%.

“When I teach it to medical students, I say, ‘Imagine the body melting from the inside,'” Shoenberger said.

In August, when a heat wave threatened, Segura packed paper fans in the trunk of a car with the city’s emergency number, 311, and tips for protecting against the heat.

She took them to organizations that help people who are particularly vulnerable to heat-related illnesses. During the trip, she wanted to see for herself what other supplies were needed.

Their first stop was the community ReFresh spot in Skid Row, a 24-hour recreation spot with cell phone chargers, showers, restrooms and cooling fans. Segura talked to the staff, then walked back and forth among people waiting to shower.

“We’re having a heat wave this weekend,” she said, handing a fan to a thin woman in striped leg warmers. She spoke to a man who was vocal about his concern about leaving his cat alone in the heat. (Stephany Campos of Homeless Health Care Los Angeles, one of the organizations that runs the site, said pets are welcome.)

Segura reminded people to drink water – it is available free of charge in the center – and that they can cool off in the city’s open libraries or community centers.

It was a beautiful late summer afternoon, when it’s hard to imagine too much sunshine. Many of the people she spoke to had other worries.

A tall, powerfully built man stood up as she approached. She offered him a fan, but he declined, saying he knew he couldn’t hold it and he didn’t want to leave any trash behind. He asked how hot it might get and nodded politely when she told him the weather forecast was for temperatures around 35 degrees.

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Many things worried him, he said, after Segura left: the apartment, his mental health, the harm that could be done to him on the street. But not the temperature.

“We’re in California,” he said, pointing to the cloudless sky. “What kind of weather will it be out here?”

Back in her car, Segura took a deep breath. It’s her habit to look for opportunities, for supports that can support the next step. The site already had a team of knowledgeable staff, she wondered aloud – maybe she could find a way to get them more training on heat illness or provide funding for a community health educator.

It would be too late for the coming heatwave. But the grim reality was that there would undoubtedly be another one.

“We must do more,” she said. “Not a single moment can be wasted.”

This story originally appeared in the Los Angeles Times.