How to Reduce Health Risks When September Temps Reach 100+

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Mark Masselli ( 00:04 ):
We are all living through a historic moment. NASA scientists say this July is likely to be earth's warmest
month on record in hundreds, if not thousands of years. How is this affecting our physical and mental
health? What solutions do local leaders have?
Marta Segura ( 00:20 ):
We are living in a much different summer. It's not your grandmother's summer. It's not even the
summer from 10 years ago. Because we know the heat waves are more frequent, they're longer in
duration, which means our bodies are less likely to recover if we don't have refuge from the heat.
Margaret Flinter ( 00:37 ):
Our guest today is the chief heat officer for the city of Los Angeles. Marta Segura is leading the nation's
second - largest city in a search for solutions while keeping equity at the forefront of their efforts.
Marta Segura ( 00:50 ):
And if you frame it, not so much about climate, but public health impacts on themselves, their family,
their community, I think that it becomes a much more personal issue and it becomes a much more
important issue when they recognize that it's impacting their community's health or their health.
Margaret Flinter ( 01:11 ):
And this is Conversations on Healthcare.
Mark Masselli ( 01:22 ):
Well, welcome Marta Segura to Conversations on Healthcare.
Marta Segura ( 01:27 ):
Thank you so much. Thanks for having me.
Mark Masselli ( 01:30 ):
You're joining us at a very important time as heat is really the leading weather - related killer in the
country. And according to the EPA, we heard you speak at Aspen Ideas: Health gathering, but let's start
by giving our audience understanding what does it mean to be the chief heat officer for LA? And just out
of curiosity, do you have enforcement powers?
Marta Segura ( 01:54 ):
Great. Okay. Yes. I'll start with what the role is. I have a dual role, actually. I'm the climate emergency
mobilization director, and that was my first role here at the city. But then of course, there was this
acknowledgement and discovery that extreme heat was LA's primary climate hazard, is LA's most
dangerous climate emergency. So the council, in their wisdom, decided to designate a chief heat officer.
So the question really is what does a chief heat officer do differently than a climate officer? And I would
say that we deal more in the realm of public health and public safety.
( 02:38 ):
I work much more closely with our emergency management department on disaster response and
emergency management, and then prioritizing extreme heat as one of the primary emergencies and

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disasters to prepare for, by being an advisor and steering committees and task forces that identify
resources like pooling centers, hydration stations, resilience hubs, shade structures, more tree canopy to
both have a better deployment of resources where they're most needed, but also to create mitigation
and adaptation for the long run. So it's a great fit for me personally because I have a master's degree in
public health. So for me, the main reason I got into environmental health, environmental policy was to
improve the health of communities. So it makes a lot of sense to me to integrate climate, equity, health
and disaster response.

Mark Masselli ( 03:49 ):
Well, it's such a good fit in terms of a clear and clean title for sure.

Marta Segura ( 03:56 ):
Mm - hmm.

Margaret Flinter ( 03:57 ):
Well, Marta, I know you've been in this role about a year or so and lots of projects underway. One of
them was titled Heat Relief 4 LA. I have a feeling many of the things you just talked about probably have
been incorporated into Heat Relief 4 LA, but tell us how it works and what other dimensions does it have
and how are you launching this or delivering it to the community?

Marta Segura ( 04:22 ):
Sure. We had a launch with the mayor's office, LA County and the state of California. And one part of it,
or aspect of it is a broad based social media campaign with over a hundred nonprofit partners, but we
have also included businesses on that. The other part is creating materials and curriculum and posters to
distribute to some of those same nonprofit partners, but more widely throughout the city, in addition to
our city departments sharing that information. The other aspect is we're collaborating with Metro, the
bus system, the train system. And very soon, they will have this information inside their buses, outside
the buses, at the bus shelters, on some bulletin boards.
( 05:09 ):
So we're trying to make this as ubiquitous as possible to put heat at the forefront of how people create
habits of care for themselves and for their community so that there's a recognition that we are living in a
much different summer. It's not your grandmother's summer, it's not even the summer, summer from
10 years ago because we know the heatwaves are more frequent, they're longer in duration, which
means our bodies are less likely to recover if we don't have refuge from the heat. So we're trying to
instill these better habits of care so people can know what to do, but also recognize the symptoms. So
all of this is a public awareness campaign, but also, we're compensating some nonprofit organizations
that already have community health educators to share this information with the more vulnerable
communities because as we know, vulnerable communities have greater rates of chronic illness. They
live in more polluted areas, they live in areas with less access to thermal comfort or air conditioning, and
that's why we see higher rates of emergency room visits and also premature deaths in those areas.
( 06:23 ):
So we are trying to make it as comprehensive as possible, and it's our first year that we've really
launched this, but we hope to learn a lot of lessons this year and continue to increase that
communication. And I also want to point out that it's part of any healthy early warning system to have
this kind of a campaign because you don't want to just notify people two days in advance that there's

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going to be a heat event. You want people to know the significance of that heat event by having this
kind of early communication and awareness building so people actually know what to do and how to
prevent heat injury.

Mark Masselli ( 06:59 ):
Marta, speaking of learning lessons, there are a few other chief heat officers across the country in cities
like Phoenix. I think Phoenix had 20 plus days of over 110 degrees. And Miami, another city that has a
chief heat officer, but you're the first Latina to serve in such a role. How are you using this really unique
platform to reach the vulnerable populations in LA?

Marta Segura ( 07:33 ):
Yes. No, that's a really good point. I think part of my drive and motivation is the fact that I come from a
family where my father was both a farm worker and a construction worker. My mother was a cannery
worker, so they would tell me about the fainting, the injuries, the deaths, the accidents that would
happen as a result of heat exposure. So it's a driver for me. And one way that I'm addressing that as a
public official is I'm bilingual, so I can do interviews in Spanish, I can write up narratives in Spanish. But
we have a multilingual campaign. So I'm sensitive to the fact that other vulnerable communities, maybe
not as large as the Latino community in Los Angeles, but Korean, Armenian, Tagalog, Chinese are all part
of our campaign.
( 08:27 ):
And we're also partnering with organizations that serve those communities so that we can get this
information out to them. And in fact, we're also partnering with indigenous communities from both
Mexico and Central America, because they have very different languages as well. But fortunately, there's
an organization here that has the expertise to translate this information into that language. So I think
that that experience has made me a lot more sensitive to how important it is to have this information
available in various languages and really careful about how we create strategies to reach these more
difficult to reach communities that aren't traditionally part of the broader civic engagement that we
have in Los Angeles.

Mark Masselli ( 09:15 ):
And Marta, are you working with these other chief heat officers? Do you have an association or is it
more informal right now?

Marta Segura ( 09:23 ):
Yeah, well, with the Miami and Sierra Leone, there's like eight women chief heat officers. We have a
cohort. And so we just had a meeting this morning, for example. Many of us are going to a retreat in
September. I won't be able to make it because it's our peak heat season, but we're all meeting in
Nairobi. Last year, we met in Washington DC. With regards to David Hondula in Arizona, we meet pretty
frequently, we're on a couple of cohorts ourselves and then in addition to that, we serve on panels for
one another. I invite him to be on panels with LA and I really respect the work that he's done there. And
in fact, I've learned a lot from Miami and Phoenix and other offices that have already implemented heat
planning into their city plans.

Margaret Flinter ( 10:23 ):

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As in so many health equity issues, poverty rears its head here. A study found that areas with higher
rates of poverty at temperature seven degrees warmer in the summer compared to wealthier
neighborhoods. And it may seem obvious to some folks what those contributing factors might be, but
we would love to hear from you what are the equity issues with heat climate change, and why do they
exist?

Marta Segura ( 10:48 ):
Great. Well, I think the easiest way to explain that is that in most cities, there was redlining and
therefore, subsequent historical disinvestment because those redlined areas, by legislation, were not
receiving the capital investments that other areas were receiving. And those areas were also where we
put the manufacturing, the polluters, the refineries, the oil drills. And so that's what made that real
estate less desirable and also less expensive to live near. So those are contributing factors to why there
is more chronic illness in those areas and why there's less tree canopy, why there is less public
infrastructure, green space, green streets, open space. We're trying to catch up. I think we're trying to
catch up in most cities, but there's a lot of catching up to do, over 60 years of catching up to do to
ensure that we have healthy, thriving communities everywhere.
( 11:51 ):
The other part that I want to mention is that heat exacerbates and stagnates pollution and smoke. So if
you have pollution in these areas and you have a wildfire nearby, those two are exacerbated. And what
that means is in our breathing zone, our near surface temperature, we're more exposed in those areas
to longer, greater rates of pollution. And if those bodies are compromised already by chronic illness,
whether it's diabetes, obesity, heart disease, kidney disease, it has an even greater impact on people
with those kinds of chronic illnesses because heat can denature our circulatory system. And once it
starts to do that and deoxygenates our system, then that's what puts us into the risk zone of exhaustion
and heat stroke. So we want to be able to tell these communities, "Look, you're even at greater risk,
even if it may not be as hot as it is in some parts of the desert because you have this pollution level,
because you don't have amenities like tree canopy and shade structures while you're walking from
school to home or from home to work," et cetera.
( 13:21 ):
And then there's food and diet. I also like to point out that caffeine, coffee, soda, alcohol, all dehydrate
our bodies. So if you're a construction worker that lives in one of these areas, or even just anywhere in
the city and you had a beer the night before, you drank three cups of coffee before your workday starts,
you're already starting at a disadvantage. So then there's that. I guess I brought that up because there's
an awareness and educational disadvantage because we have food deserts in these areas, and people
tend to rely on sodas to refresh themselves or iced coffees to refresh themselves or a beer. And those,
going back to the habits of care, if we really want to care for our bodies, we need to reduce the
consumption of those, particularly during heat season.

Mark Masselli ( 14:19 ):
We're speaking today with Marta Segura, chief heat officer for the Los Angeles. Marta, I'm wondering
about how you're able to address some of these issues that have a significant cost associated with them.
I'm wondering how Sacramento and Washington DC are helping out because some of these historic
problems really require investments by state and local as well as national governments. What are you
seeing that gives you some hope?

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Marta Segura ( 14:59 ):
Well, I'm seeing more resources in the state of California being allocated for climate adaptation, climate
mitigation, and in particular, extreme heat. And the state of California is taking a very proactive stance
on extreme heat and creating legislation around it and funding various departments like the Office of
Funding and Research, Cal OES, even their Department of Public Health, have all received resources to
not just redistribute to cities, but also participate in broader reaching campaigns across the state. I've
also seen FEMA change their guidelines to include climate hazards in our local hazard mitigation plans.
And in Los Angeles and in other cities, extreme heat is that primary climate hazard. And so we're
creating a special report in our local hazard mitigation plans to address the gaps, to address the
deficiencies that we still have. And those plans not only serve to guide LA on what to do, but they're
advocacy tools and we can use them to show the state and the federal government what still needs to
be funded.
( 16:16 ):
And so at the federal level, of course, you've heard of IIJA, the Infrastructure Investment Act, and we
want to make sure that in the city of LA, we receive our fair share. So we have a chief administrative
officer who is also our capital climate investment czar. So he's going to be tracking and monitoring all of
these federal investments and sharing them with various departments, whether it's Sanitation or Public
Works, Emergency Management Planning department. So each department can apply for these
available funds for the city of LA. And so for me, that's hopeful.
( 17:00 ):
And the other part that's hopeful to me is that the city of LA has an equity index. So we're trying to align
that equity index to monitor and track our investments, but also align it with Justice40, the Biden
administration initiative that basically tells cities to invest no less than 40% of these climate
infrastructure investments in communities that are vulnerable. And he calls them environmental justice
communities specifically. So all of this has to work in concert, and I think Los Angeles is at the forefront
of some of those needed changes to ensure that the money goes where it needs to go.

Mark Masselli ( 17:42 ):
Right.

Margaret Flinter ( 17:43 ):
Great. Well, certainly we want to keep an eye on what you're doing because the rest of the country isn't
far behind. This has been a summer where we saw a record - breaking heat spikes all over, even in the
east where we are. But I wanted to ask you sort of addressing both the equity issue and the health
impacts of heat, research also shows that there are greater mental health issues as the temperature
increases, some research showing that black and Hispanic people may experience greater mental health
issues secondary to the heat. That calls for a whole different response perhaps, or an additional
response, particularly I would think from your public health and law enforcement and civic employees.
What are you doing to address that issue?

Marta Segura ( 18:31 ):
Well, fortunately in LA, we have the county of Los Angeles and they have a department of public health,
but they also have a mental health division. And so we're going to be working much more closely with
them to ensure that this information gets out through their promotional materials. But we also want to
work more closely with hospitals and clinics to not just identify when people come in for heat stroke or

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heat injury, but if people are coming in because of increased anxiety or they're at the hospital because
there was an incident that involved mental health issues, that there is a correlation being made with the
possibility that it was caused by extreme heat.
( 19:20 ):
So we want to make sure to A, create the collaborations that we need to address that issue more
seriously, but also build the awareness so that people know that this could be the reason why they're
having more incidents during the summer. In these communities that you've mentioned, like the Latino
communities, the black communities, and in LA, they're one and the same. Latinos and black
communities live together. There could be an increase in violence and crime. And that's where we need
to work with law enforcement to have this recognition that during areas of extreme heat, maybe we
want to do more in advance to ensure people are safe and that they stay cool and they have areas of
refuge, and then monitor and track whether those kinds of investments are also having a positive impact
on that metric.

Mark Masselli ( 20:16 ):
Well, you mentioned clinics, and I know the federally qualified health centers across the country, this is
a very important issue for them and are working hard. Probably the rest of the country looks at LA and
says, "It's a very progressive community." But the reality is you're dealing with climate change deniers all
the time. I'm wondering how you manage the pushback that you're getting and any advice for others as
they're thinking about this conversation that needs to take place with every member of the community?

Marta Segura ( 20:46 ):
Yeah, I really think that engagement is a key part of it, having, not just conversations, but focus groups in
person so that you're not just asking people questions, but you're having a conversation with them
about what they think the solutions are. And if you frame it not so much about climate, but public
health impacts on themselves, their family, their community, I think that it becomes a much more
personal issue and it becomes a much more important issue when they recognize that it's impacting
their community's health or their health. So I think that that's another reason why framing it as extreme
heat, not just as a climate emergency, has been super helpful across the nation. I had a conversation the
other day with the climate director in Mobile, Alabama. Her name escapes me now, but you would think
that in Alabama, she wouldn't be having much success, but she's having quite a bit of success because of
her public engagement approach.
( 21:56 ):
And she's even tracked Latino, African - American and other ethnic groups in their responses on how they
feel about climate change and how they feel about extreme heat. So maybe the politics are still very
challenging and difficult in those areas, but when you talk to people, people are concerned. People do
want to remedy the challenges before them. And if they build that awareness and they build that muscle
to know that there's a correlation between extreme heat and public health, I think it becomes a lot
easier to deal with, and then the elected officials in those areas could get more pressure to make the
changes that are necessary. You haven't brought up Texas, but Texas is a good example of where I
believe people are very concerned about their health, want to do something about it. But the governor
obviously diminished the guidelines or breaks for construction workers, which is devastating because
you know that that will result in more death.

Margaret Flinter ( 23:04 ):

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Well, Marta, I know the CDC has estimated over 700 Americans die from heat each year. I have a feeling
that's probably under reported in terms of contributing factors, and I actually was just, over the last few
days, with lots of different groups from around the country that are engaged in training healthcare
professionals. And several of them were actually from the LA County Health Department. You were well
represented at the meeting, but I'm curious, as you do your master planning, are you working to try and
incorporate training around addressing the impact of heat on... Are you trying to impact the training of
health professionals to recognize it, to understand it, to counsel people? Is that working its way through
the curriculum as well?

Marta Segura ( 23:54 ):
Yes, it is for us. And we've already began to develop curriculum for all of our city partners. And I will say
that the Department of Health and Human Services has reached out to our office, the state, these
federally qualified healthcare providers, hospitals. And we're going to be having a meeting next week to
talk about not just the training that will be necessary, but the data that will be necessary and what data
gaps still exists, and how we could expedite the collection of that information to be much more
resourceful and efficient in how we're tracking the improvements from the investments that we're
making.
( 24:39 ):
And I'd like to point out that Dr. Eisenman at the UCLA School of Public Health created this heat map,
which is basically a heat risk map that points out excess deaths in hospitalizations across California. And
it demonstrates that in these areas of vulnerability, you obviously have far more emergency room visits.
I think he tracked that there's 1,177 on average more emergency room visits in these areas of
vulnerability per heatwave. And not all of those result in death, but it's just an indicator of how much
more we need this data and this collaboration with clinics and hospitals. So I'm glad to see the
Department of Health and Human Services taking this leadership role. So I want to thank Xavier Becerra
for that. I know he was a bit that you interviewed earlier, but they are taking that proactive role and
being more involved in how municipalities and states can accelerate those types of trainings and
solutions.

Mark Masselli ( 25:43 ):
Marta, you've got the opportunity here on Conversations on Healthcare to talk to leaders in all 50
states, the District of Columbia and the territories. I'm wondering what recommendations would you
have for cities and towns should they embrace the idea of a heat officer?

Marta Segura ( 26:02 ):
I would say yes, because when I was hired as designated chief heat officer, it gave me additional
responsibilities, but it also gave me additional authority to be an influencer, a policy influencer within
the city of LA in areas that I wasn't already a part of. So there is definitely an added value to having
somebody who is just dedicated to extreme heat as a climate emergency to ensure that it is not the
silent killer for their municipalities. And in my experience, the media has been much more interested in
discussing extreme heat as a public health issue more so than climate, right? There are experts in that
area there, but for some reason, extreme heat, I think, became a priority for our city because of the
public health threats.
( 27:06 ):

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So if your city wants to address this and wants to accelerate solutions, it does help to have one leader to
unsilo, collaborate and coordinate these different entities, agencies, and plans within your municipality
so that you can create a more comprehensive solution that affects those various areas that I've
mentioned, whether it's public health, public safety, emergency response, and climate adaptation and
climate mitigation. I've seen a big difference between these two roles.

Margaret Flinter ( 27:49 ):
Marta, some things seem so obvious, right? Increasing the tree canopies, having cooling stations, water
stations. Maybe talk in a moment a little more about protection for workers, which you raised, which I
think is very essential, but we also we're reading about some kind of high - tech ways that might help to
mitigate this. I've read about special white paint to reduce the sun's effect, shields to block the sun's
radiation. I would imagine all of these ideas cross over your desk. Are there ideas coming that are maybe
not so common sense basic, but they take advantage of new technologies or new products that you
think might be part of the armamentarium to try and fight this?

Marta Segura ( 28:33 ):
Yeah, I'm a big supporter of cool roofs, which uses this cool seal material that you're mentioning. I'm
also a big supporter of using AI to identify where we lack tree canopy, where our cool roofs are. Google
just came up and is going to be presenting a launching sometime this week, this analysis of cool roofs
throughout LA County. So now we're going to be able to use that in our building electrification strategy
because building electrification also means weatherization, energy efficiency, and reducing the urban
heat island effect overall.
( 29:13 ):
And it doesn't just come across my desk. In fact, it's an item or an investment that goes directly to the
Bureau of Street Services because the Bureau of Street Services then actually is the one implementing
the tree canopies, the bus shelters, the cool streets. We have seen more research that shows that cool
streets are more effective when surrounded by shade and shade structures, bus shelters, tree canopy,
because the radiant heat emitted by cool streets can affect the pedestrians walking by. So we want to
minimize that effect of that radiant energy on pedestrians, especially on hot days, right? So I just want
to point that out. And there's more research emerging on cool streets, but cool roofs, undeniably, is a
great way to reduce urban heat for buildings and for cities as a whole.

Mark Masselli ( 30:15 ):
Well, that's great. Well, thank you Marta Segura, chief heat officer for Los Angeles for your
environmental leadership, and we also advise everyone to stay cool and healthy right now. And thanks
to our audience. Be sure to go online at chcradio.com to sign up for our email updates. Marta, thank you
so much for being with us today.

Marta Segura ( 30:37 ):
I really appreciate you both. Thank you, Margaret, everyone.

Margaret Flinter ( 30:39 ):
Thank you, Marta, thank you for wonderful work.

Marta Segura ( 30:39 ):

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Thank you.
Mark Masselli ( 30:41 ):
Continued success. We'll follow your trajectory as you move forward on this really important area.
Margaret Flinter ( 30:49 ):
Absolutely.
Marta Segura ( 30:50 ):
I appreciate it. Thank you so much. Bye - bye.
Margaret Flinter ( 30:52 ):
Thank you. This copyrighted program is produced by Conversations on Healthcare and cannot be
reproduced or retransmitted in whole or in part without the expressed written consent from
Community Health Center Inc. The views expressed by guests are their own, and they do not necessarily
reflect the opinion of Conversations on Healthcare or its affiliated entities.

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