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Heat dome hospitalizations tripled in this Vancouver neighbourhood

Vancouver Coastal Health's medical health officer reveals an unreleased report on the B.C. heat wave and how it hit some Vancouver neighbourhoods harder than others.
DTES ambulance
An ambulance rushes to attend to a call in Vancouver's Downtown Eastside during the city's third heat wave of 2021. During its first heat wave, the neighbourhood had more heat-related emergency room visits than anywhere else in the city.

Who died under British Columbia’s deadliest heat wave? What can be done to prevent so many deaths in the future? 

These are questions the BC Coroners Service and the BC Centre for Disease Control (BCCDC) are actively investigating. 

By the coroner's count, 569 people died in the week-long heat wave that scorched B.C. at the end of June. 

Dr. Sarah Henderson, scientific director for the BC Centre for Disease Control, environmental health section, says most deaths occurred in private homes where people did not have air conditioning. Of the rest, 35 per cent occurred in hospitals and 30 per cent in long-term care homes.

More people died in places where people had lower income and less access to trees. Many lived alone and most were over 55 years old. None were children.

Across the province, cities like Vancouver, Burnaby and New Westminster were hit hardest, accounting for the most deaths.

But understanding which neighbourhoods were hit hardest is still not clear. 

In an exclusive interview, Vancouver Coastal Health’s medical health officer Dr. Michael Schwandt tells Glacier Media how emergency room data is offering some early insights and what public health needs to do before the next heat wave hits.

This interview has been edited for clarity. 

What does the latest data tell you about how the June heat wave sent people to the hospital? 

By far, most of the increase was seen in urban areas.

Overall, we had over 200 heat-related emergency room visits. That's thought to be a conservative estimate of the number of visits due to heat because there may be some health conditions that could be exacerbated by heat that may not have been coded as being heat-specific.

I understand Vancouver Coastal Health has mapped out emergency room visits during the late June heat wave. Which communities saw the biggest spikes?

Some of the neighbourhoods that appear to have been hardest hit were both in the city centre, as well as these eastern and southern areas of the city. 

We saw areas like the West End, as well as the Downtown Eastside, having a large number of ER visits by people living in those areas. And then some areas in southeast Vancouver as well. 

The rate of heat-related emergency department visits was roughly triple the rate in Vancouver-Centre North compared to Vancouver Westside. That’s mostly driven by the Downtown Eastside. 

Vancouver South was more than double.

The whole trees/social advantage hypothesis seems to shine through. 

What do we know about who went to hospital?

In terms of the ER data that we have, unfortunately, we don't have data on people's living situations. I know the coroner’s office and the BCCDC are looking at some of those other risk factors. 

We know that age or pre-existing medical conditions can make people more vulnerable to extreme heat, but then also the places people live or spend their time. 

Even within that, the complications multiply, because there's issues like the urban heat island effect, neighbourhoods being hotter than others due to built-environment characteristics. And then even within a given neighbourhood, there's a wide variation between building types: so highrises versus freestanding wood-frame houses, the tree canopy that might be available in both spaces.

And even within a building, there are differences in heat between cooler basements and a relatively hot attic suite.

Do health authorities need to do more to change people’s built environment to protect against deadly heat?

I think so. I think that long-range adaptation to climate change involves the health sector and working with others to look at these important protective factors that relate to climate events.

I think that we have a growing role in working with governments, potentially with developers, with other sectors on these environments that can both place communities at risk and also protect communities from extreme weather events.

The amount of (tree) canopy that we have and the protection that that can give us from extreme heat, it's something that the health authority can help inform: where are the impacts of heat events that we've seen previously?… and making decisions related to the siting of trees.

Right now, we're working with the City of Vancouver to study building technologies of people who are affected by the heat wave.

What else has public health done since the June heat wave to protect people from extreme weather?

There is a new seasonal readiness steering committee that's been developed, so actually formalizing that work as part of week-to-week planning.

What's really critical is to help to develop seasonal readiness plans for the protection of our patients and communities.

Right now, those are being developed. And they're all being reviewed at the executive level within our health authority.

Some of the visits that made it to the emergency room, we want to make sure that the primary care system is equipped to handle those surges.

This summer’s heat dome made it clear that extreme climate events are already here. As public health teams plan for the next heat wave, what needs to happen to make those plans a reality?

This requires will and resources to execute many of these things — things like changes to building codes, for example, or programs to address tree canopy on a large scale — all of those things require the participation of multiple different parts of government.

Public health officials are trying to catalyze action on some of these things. 

Sometimes this can seem like an insurmountable task, but we can look to what are the things that we can get done in the very short term, and then a medium term, and in the longer term, as well.

So while things like addressing tree canopy, that’s a project we hope will take place over decades... today, we can look at the creation of cool and shady areas in neighbourhoods that may not have them; changing policies so that public spaces are more welcoming of people at all times, and in particular, during extreme weather events; and having programs to promote social connections so that neighbourhoods and community members are supported to check on one another.

These are things that can be changed in relatively short order.

My reporting found many front-line community groups who usually work to reduce harm in drug users stepped in to fill an important role as first responders during the heat wave. Do you see this as something other neighbourhoods could learn from?

Community-based organizations did tremendous work during the heat wave. We have reports from so many of our staff that were involved with patients and residents of our communities that benefited from that.

I think that learning those lessons and trying to replicate that in other areas will be very important.

Maintaining cool spaces for people to access overdose prevention services, for example, is absolutely crucial. Life-saving services are almost times two during a big heat event because we know there can be more risk of overdose during those events. 

B.C. faces a number of threats from climate change, from flooding to fallout from wildfires. What extreme weather event do you think will impact British Columbians the most in the coming years?

Heat is one of the greatest risks to public health.

I mean, we have other important health issues, of course — infectious diseases, including COVID-19 — that have probably resulted in more deaths in recent years.

But with climate change, I think extreme heat is one of the most immediate and impactful.

Events like this year’s really puts heat toward the top of the list. 

What are the limits to the way cities are adapting to extreme heat today?

In the longer run, I think that we can't 'cooling-centre' our way out of this problem.

We need to look at the housing that people have access to. So adequate and affordable housing needs to include the ability to cool off a space during a heat wave.

Historically in B.C., maybe that hasn't usually included air conditioning, heat pumps, and so forth. 

But I think in the future, we need to think more preventively: ways to cool off entire neighbourhoods like with tree canopy, looking at the amount of vehicular traffic, and looking at the nature (and also the affordability) of the housing that we're creating.


This story is part of a Glacier Media investigation into how the heat wave impacted neighbourhoods differently across Vancouver, and how the city is looking to fix the problem — with trees.

Stefan Labbé is a solutions journalist. That means he covers how people are responding to problems linked to climate change — from housing to energy and everything in between. Have a story idea? Get in touch. Email [email protected]