16:00

for a different set of mental health

16:02

related and wellbeing related outcomes that I

16:04

think are very much associated with this

16:06

question is an up and coming area

16:08

of research that I think deserves more

16:10

investigation as well. I totally

16:12

agree. And it's also interesting to think about

16:14

the relationship between wellbeing

16:17

and resilience and how that might

16:19

lead to Alzheimer's and related

16:21

dimensions, right? Like there's

16:24

a link between those two and there's

16:26

a link directly between heat and cognition.

16:28

And so I'm actually starting to do

16:30

some work looking at this and looking

16:32

at heat related impairments in cognition in

16:34

older adults and does that predict

16:38

neurocognitive decline? So

16:40

I agree. I think it's a really

16:42

interesting and kind of important step forward

16:44

in understanding kind of the scope of

16:47

some of these effects in

16:49

the more vulnerable populations, life older adults.

16:52

Maybe a little bit of an unfair question cause

16:54

you're not economists, but is

16:57

there a relationship between heat and productivity? I'm

16:59

just wondering because people who live in warmer

17:01

climates, we have the sense that, oh, well,

17:03

they're all basking on the beach all day

17:05

and the people who live in more temperate

17:07

places, well, they go to work because there's

17:09

no beach ticket. It's too cold to go

17:11

to the beach. Am I

17:13

just making this up or is there some correlation

17:15

here? I think there's definitely a

17:18

correlation here. And I think this is something that

17:20

we're starting to see more

17:22

and more particularly in highly

17:24

occupationally exposed environments where the

17:26

background exposure to extreme heat

17:28

is already quite high. Climate

17:30

change is exacerbating these risk

17:33

factors. The areas that

17:35

I think come to mind specifically

17:37

are outdoor workers, such as agricultural

17:40

workers, people in construction

17:42

industries. These are all areas where occupational

17:44

exposures are just going to be elevated

17:46

as a result of summertime extreme heat.

17:49

And it leads to a lot of

17:51

loss of productivity. And I think one

17:53

of the things that's really important is

17:56

to consider worker wellbeing

17:58

and worker health in the face of

18:00

it. of different summertime extreme temperatures. And

18:02

I don't know that there's any standard

18:05

related to extreme heat exposure in the

18:07

workplace, which I think can serve to

18:09

exacerbate people's vulnerability in these highly occupationally

18:11

exposed settings. Now, many

18:14

of us have heard about seasonal affective

18:16

disorder, which is a seasonal mood problem

18:18

that's mostly associated with winter

18:20

and light. But what about

18:22

heat and summer related mood

18:24

issues? Are there such things?

18:27

Summer sad is a thing and it's

18:29

so understudied. I'm not in this

18:31

space, so I won't speak much on it. But

18:33

I do know it's a it's very much a thing.

18:36

And our understanding of it appears to be pretty

18:39

poor at this point. I don't

18:41

know if Dr. Noorisarma knows more

18:43

about it than I do. Honestly,

18:46

I don't know that I know more

18:48

about the biological mechanism. But one thing

18:50

that I can say is that when

18:52

we look at year round mental illness

18:54

emergency department visits associated with mental health,

18:57

when we look at the year

18:59

round trends, we actually don't see

19:01

increases in the rates of emergency

19:03

department visits for mental health outcomes

19:05

among commercially insured individuals during

19:08

winter time periods. There's a pretty

19:10

straightforward increase as temperatures are increasing.

19:12

So maybe there's something subclinical that's

19:15

happening with seasonal affective disorder, whereas

19:17

the presentation during the summertime is

19:19

just more severe. So more people

19:21

are presenting to emergency departments in

19:23

the summer for their

19:26

summer sad, as Dr. Meidenbauer said. But

19:28

I think maybe there is something very

19:30

severe that's happening during the summertime periods

19:32

that we're just not seeing evidence of

19:34

the same effect in the winter. Dr.

19:38

Noorisarma, I know that because

19:40

of the work that you've done, you've talked about

19:42

how psychotropic medications

19:44

are affected, right? So is

19:47

it possible that, you

19:49

know, with your work on the emergency department

19:51

visits, you know, you're seeing kind of the

19:53

extreme cases, the subclinical sad, like stereotypical

19:56

winter sad, right? Does cold effects

19:58

like... medications and maybe that's or

20:01

not affects them and maybe that's

20:03

part of the puzzle here. I'm

20:06

curious what you think. I think that

20:08

the mechanism for psychotropic medications is really thermal

20:10

dysregulation that happens with extreme heat. So that's

20:12

why sometimes in the summertime when you see

20:14

patients who are mentally ill, they'll be bundling

20:16

up with more and more clothing. And

20:20

I think I haven't seen any

20:22

evidence of the linkage between psychotropic

20:24

drugs and extreme cold exposures. I

20:27

think it really is a lack of

20:29

ability to regulate your body's core temperature

20:31

during extreme heat periods. But

20:33

I think that likely what we're seeing in

20:35

the emergency department visits is that a

20:38

lot of the need for care or the

20:42

people's experience of their symptoms during the winter

20:44

is really just subclinical. So it's hard to

20:46

capture. There are going to be a lot

20:48

of people who will be interacting with the

20:51

healthcare system that we're not capturing in things

20:53

like emergency department visit claims. Or even

20:55

if we looked at preventative care, even

20:57

if we looked at visits

20:59

to your regular mental health professional,

21:01

I think those would still fail to

21:04

capture some of the subclinical outcomes that

21:06

we might be really concerned about as

21:08

a result of ongoing climate

21:10

anxiety or other types of regular

21:13

stressors from our environment. What

21:16

about the impact of heat on people

21:18

who are taking other kinds of medications?

21:20

For example, if you're on blood thinners

21:22

or you're on medication for

21:25

blood pressure, does heat affect

21:27

that? I don't know that

21:29

heat affects, I don't know

21:31

the effects by medication status, but I do

21:34

know that heat definitely has adverse impacts on

21:36

patients who have chronic illnesses. So we do

21:38

see a lot of evidence of increased

21:41

cardiovascular disease risk and

21:44

increases in another area

21:46

that I think has been really interesting is

21:49

cardiometabolic outcomes. So patients with

21:51

diabetes who need insulin

21:54

or require insulin have been particularly

21:56

distressed during periods of extreme heat.

22:00

think needs more research, but there

22:02

is evidence of increased

22:04

impacts on physical and mental health

22:07

among patients with chronic illnesses as

22:09

summertime temperatures are increasing. Dr. Darrell Bock

22:12

What about the other side of the

22:14

coin? Can he be beneficial to physical

22:16

and mental health? Dr. Mary

22:57

safely administered short-term

22:59

heat exposure to protect

23:02

against both later heat and just kind of some

23:05

other things like I've heard. So because

23:07

there's a relationship between like core temperature

23:09

and depression, I've heard some arguments for

23:11

like, if you use saunas, get people

23:13

to thermoregulate better, maybe this can actually

23:15

address some of the depressive symptoms, which

23:19

again, a little understudied, hard to know really what's

23:21

going on there biologically, but I

23:23

think it's a really interesting idea. And so

23:26

I think kind of like a cute heat exposure

23:28

through saunas or infrared light or something

23:30

like that. It's a really interesting idea.

23:33

I don't know about like exposure

23:35

to heat in summer in general, it seems

23:37

to be like some people like it more,

23:39

but I don't know if it's necessarily good

23:42

for them. Yeah,

23:44

I think that the important point that

23:47

Dr. Meidenbauer brings up, which I want

23:49

to underscore here is that I think

23:51

there's a meaningful difference between acute exposure

23:54

to very short periods of intense temperatures

23:56

versus a general change in your

23:58

chronic exposure to extreme heat. heat. And

24:01

a lot of evidence in places

24:03

of the world that are already

24:05

experiencing more extreme and longer lasting

24:07

and frequent heat waves has shown

24:10

that there are thresholds beyond which

24:12

our body just loses the capacity

24:14

to cope with extreme heat exposure.

24:16

So I think even if

24:18

we're thinking about it in terms of what

24:20

is the ideal temperature for humans to thrive,

24:23

there is a temperature beyond which we just

24:25

kind of start to lose that ability to

24:27

adapt and to cope and be resilient in

24:29

the face of these environmental stressors. And so

24:31

I think there's maybe potentially

24:34

two different discussions

24:36

to be had there. One is

24:38

acute heat as potentially restorative and

24:40

curative for mental health and well-being,

24:42

but then there's the separate conversation

24:44

of our more chronic exposure

24:46

to heat extremes, which I think is

24:48

a separate risk factor. Dr. Darrell Bock

24:50

So what's that level where we lose

24:53

it? I mean, we're seeing the ambient

24:55

temperature, the average temperature around the world

24:57

going up. Are we getting close in

24:59

some places where they're regularly hitting 120

25:02

degrees Fahrenheit during the

25:04

summer? Is that close to the threshold?

25:06

Dr. Julia

26:00

in a variety of different contexts globally. Well,

26:03

let's try for a moment to

26:05

talk about possible solutions. Do you

26:07

have thoughts about what policymakers, governments,

26:09

can do to kind of mitigate

26:11

the mental health and physical health

26:14

effects of extreme heat? Yeah,

26:16

I mean, I think it's a really

26:19

complex problem, and it's going to require approaching

26:22

it from a lot of different angles. I

26:24

mean, for me, again, as

26:26

someone who's done a lot of research before

26:28

on the benefits of nature exposure, the first

26:30

thing that comes to my mind is green

26:33

space infrastructure as something that can

26:35

both reduce the heat, especially in

26:37

urban heat island affected areas. But

26:42

also, exposure to

26:44

nature has its own mental health benefits, right?

26:46

We see that spending

26:48

time or even just having more tree

26:50

canopy in your neighborhood has mental

26:52

health effects and can reduce a lot

26:54

of other behaviors that we care about.

26:56

It can reduce aggression. It can improve

26:59

cognition. So I like

27:01

to think of green space infrastructure as kind of

27:03

like a one-two punch for

27:06

addressing some of these issues, reducing

27:09

temperatures, potentially mitigating against

27:11

global warming and climate

27:13

change effects, and then cleaning the

27:16

air and having these sort of mental health

27:19

benefits directly. But

27:21

at the same time, there's an argument that,

27:23

well, even if you planted all the trees

27:27

and the urban heat

27:29

island disappeared in an area, you're still going

27:31

to have really hot days. And if people

27:33

don't have ways to cool themselves, that's

27:36

still going to be a problem. So it's

27:38

tricky because I don't want to be like, we should

27:40

install air conditioning everywhere because that actually makes the call.

27:42

That also has negative effects on climate change. But

27:46

at the same time, for really vulnerable

27:48

populations, it's like, what do

27:50

you do? You don't want to

27:52

put people at risk on

27:54

really, really hot days. So

27:56

I don't know. It's complicated. It's hard.

27:59

Yeah, no. I think that the ones

28:01

that you've listed are really important. And

28:05

I think that hand in hand with

28:07

this conversation around nature-based solutions, I think

28:09

there's a conversation to be had around

28:11

accessibility of those solutions. I

28:14

think that one of the communities that

28:16

is very vulnerable that often gets left

28:18

out of the discussion is

28:20

the disability community, people with other

28:23

existing disabilities that may also intersect

28:25

with their vulnerability to extreme heat.

28:27

And so accessibility to nature-based

28:29

solutions is really important. And I think it's

28:31

important to keep in mind that different

28:34

communities may have differential access to those

28:36

solutions. So making it as equitable as

28:39

possible is really important. The other component

28:41

of that that I think plays into

28:43

vulnerability is that there's a new concept

28:46

of, so everyone has probably heard of

28:48

gentrification. There's a new concept of climate

28:50

gentrification, where greening neighborhoods and making built

28:53

environment more sustainable can often price the

28:55

most vulnerable communities out of their native

28:58

place or out of the place where they've been living

29:00

up until now. So I think making sure that in

29:03

the process of implementing these

29:05

solutions, we're also improving accessibility

29:07

and equity in the

29:09

implementation of these solutions so that the

29:11

most vulnerable folks still have access to

29:14

these more cool and safe environments and

29:17

better physical health, better mental health

29:19

in these urban communities and worldwide

29:22

as well as across the US. The

29:25

other thing that I think is really important that has

29:28

been a factor in a

29:30

lot of the different interventions that I've

29:33

seen around the US is access to

29:35

public spaces that have cooling. So instead

29:37

of implementing air conditioning within homes, providing

29:40

access to publicly available air conditioned spaces

29:42

in different communities. And for example, here

29:45

in Boston, the cooling centers in the

29:47

summer are also warming centers in the

29:49

winter. So providing access to a safe

29:52

and warm space in the wintertime storms

29:54

Boston is a cold city. So that's

29:57

really where those interventions started. And now they've

29:59

been implemented. also as cooling centers. And

30:01

so one of the things that I think is

30:04

another area of work is I don't know that

30:06

we have a good understanding of who's actually using

30:08

those solutions and how we can make sure that

30:10

those solutions are targeted towards the most vulnerable. So

30:13

I think that's also an area that needs to

30:15

be studied a little bit more, but potentially has really

30:18

big implications for the effectiveness of

30:21

interventions to reduce the

30:23

harmful effects of heat exposure and other types

30:25

of exposures. Yeah, totally. And

30:27

I might add on to that, that

30:29

like obviously then also SDS intersects with

30:31

whether or not you can easily get

30:33

to one of those cooling centers too,

30:36

right? So I mean, exactly what you

30:38

said about the green gentrification, right? And

30:40

kind of the role of affordability,

30:44

like that's huge. But then

30:46

I don't know, I'm thinking personally, we

30:48

had a heat wave here in Pullman, Washington

30:51

last summer at like the very start of

30:53

the school year. And

30:55

most places here do not have AC because

30:58

we've not usually had this as an issue.

31:01

And I saw, I like shared

31:03

with some of my students like, hey, the

31:05

library is one of those spaces that is,

31:08

it's always cool, it's open light. But

31:11

I was like, at the same time, not

31:13

everyone has a car getting to the library. Like,

31:15

do you wanna get on a hot bus? Do

31:17

you wanna walk in 110 degrees, right? Thinking

31:21

about just the accessibility of these cooling centers,

31:23

because I do think they have a huge

31:25

role in protecting vulnerable

31:27

populations, but also having

31:30

enough of them and having them close by

31:32

where people aren't exposing themselves further to get

31:34

to them, I think is

31:36

another kind of tricky piece

31:38

of the puzzle. Yeah, and

31:41

the puzzle gets even trickier as you

31:43

start to look more broadly, not just

31:45

limiting to the United States, but looking

31:47

at other populations in other countries worldwide.

31:50

So for example, this concept of a

31:52

cooling center is very

31:54

relevant in relatively

31:56

higher income country, like in the US

31:58

or in Europe, but... a

34:00

temperature increase for this to just show up. And

34:04

then also again, the effects of

34:06

just uncomfortable temperatures on cognition, again,

34:08

not dangerous. But if you're

34:10

focusing on how awful you feel because you're

34:12

like, oh, I hate the heat, it's so

34:14

hot, I'm so uncomfortable. That's like

34:17

a cognitive load in and of itself, it's a

34:19

distractor. And

34:21

so a lot of what I'm kind of

34:23

turning my research to is looking at this

34:26

sort of like less extreme change in

34:28

temperature, but noticeable and

34:30

potentially harmful nonetheless. And then

34:32

what might be solutions? So

34:35

like there's an increase in like personal cooling devices.

34:37

Do we need to just

34:39

like give people a little like the

34:42

fan in the water bottle in summer? Does everybody just

34:44

need to have one of those, right? If

34:46

you're vulnerable to like changes in temperature. But

34:50

even like if it's not, if you're at

34:52

a level that's not dangerous, can we be

34:54

teaching people a little bit better, have like

34:56

just a motion regulate, right? Is that actually

34:58

a viable solution when we're not talking about

35:00

dangerous heat? And so

35:02

that's kind of where I think my research

35:04

is headed. But I think there's too many

35:06

questions. It's

35:08

going to take a village of scientists

35:11

to really kind of understand how do

35:13

we cope with all the mental health

35:15

effects of a changing climate. Dr.

35:18

Nouri Sarma, what questions do you want to answer?

35:21

Yes. And I just want to say

35:23

that I couldn't agree more with the last part

35:25

of what Dr. Meidenbauer said, which is that there

35:27

are so many questions. All of them

35:29

are really vitally important in order to make

35:31

sure that communities are more resilient, more well

35:33

adapted, can cope with the summertime temperatures that

35:35

we're going to be facing. Because, you know,

35:38

even if we immediately address

35:40

the climatic changes that we're seeing in

35:43

terms of the different regulations that would be required

35:45

to do so to meet some of these lower

35:47

overall temperature change thresholds that we've been

35:49

talking about, we would still experience some

35:51

version of climate change for the next

35:53

few decades while things go

35:56

back to normal. So it's really crucial to

35:58

make sure that we have these resilient.