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Maricopa County recorded a record-breaking 645 heat-related deaths in 2023, making exposure to heat the 10^th leading cause of death in Arizona during 2023. Persons experiencing homelessness in the urban Arizona summer have a 500x higher risk of perishing from over-exposure to heat. That’s a 50,000% increased risk!

Arizona has always been hot. Yes, last summer was exceptionally hot. But can that alone explain the staggering increase in heat related deaths?

Heat Deaths, Homelessness & Affordable Housing

I argue that the increase in heat related deaths in 2023 is due to a combination of last summer’s exceptional temperatures combined with the increase in homelessness, the decentralization of persons experiencing homelessness after ‘The Zone’ was cleared making it more difficult to provide hydration and other services, the bolus of evictions that occurred following the end of CDC’s eviction moratorium, and the difficulties getting persons experiencing homelessness into substance abuse treatment.

Persons experiencing homelessness bear an enormously disproportionate share of the heat-related deaths. According to the report, nearly half of the heat-related deaths were individuals experiencing homelessness. Imagine trying to survive relentless 110-degree days without access to air conditioning or even a consistent place to rest. This isn’t just a tragedy; it’s a policy failure.

Maricopa County Public Health 2023 Heat Deaths Report

In public health we often talk about how certain things put people at more risk for a bad outcome. For example, people who smoke one pack a day for 20 years have a lung cancer risk 20 times higher than non-smokers.

By comparison, persons experiencing homelessness in Maricopa County face a 500-fold increase in risk from dying from heat exposure. That translates into a 50,000% increased risk!

What’s driving this crisis? The shortage of affordable housing is a significant factor. Restrictive zoning laws have created an environment where affordable housing is scarce, forcing more people onto the streets. These policies not only limit where affordable housing can be built but also increase the cost of developing new housing projects. As a result, many low-income families and individuals find themselves without options, worsening homelessness and increasing vulnerability to extreme heat.

The Heat Crisis is a Housing Crisis – The New York Times

Furthermore, cities in Maricopa County have often prioritized luxury developments over affordable housing, a trend that needs urgent reversal. The need for more inclusive and flexible zoning laws has never been clearer. We desperately need to prioritize affordable housing developments and make it easier to zone them.

Local Initiatives Providing Some Relief

However, it’s not all bad news. In response to the deadly 2023 summer, Maricopa County and the Maricopa Association of Governments have significantly ramped up their heat relief efforts for 2024. They’ve expanded cooling and hydration stations across the county, increasing the number to over 200 locations. These stations provide critical respite from the sweltering heat and are now more accessible to underserved communities, a direct response to gaps found last year.

MAG | Heat Relief Network

A key change is the extended operational hours for these facilities, now open 24/7 during extreme heat advisories. Additionally, emergency transport services have been enhanced to ensure quick access to cooling centers for those unable to reach them. The county has also launched a new mobile cooling unit initiative, deploying air-conditioned buses to hotspots where homeless populations are most vulnerable.

In 2023 and 2024, the Maricopa County government implemented several key initiatives to combat homelessness. They significantly increased funding for emergency shelters and transitional housing, focusing on expanding bed capacity and improving access to supportive services. The county also launched comprehensive outreach programs to connect individuals experiencing homelessness with critical health, employment, and housing resources. Additionally, they partnered with local organizations to develop affordable housing projects and provide permanent supportive housing for the most vulnerable populations.

These measures reflect a proactive approach, prioritizing immediate heat relief but don’t get at the broader systemic issues that worsen vulnerability to extreme heat – the lack of affordable housing.

Arizona’s Housing Trust Fund Making Some Progress

Arizona has taken significant steps to address its affordable housing crisis through recent changes to the Housing Trust Fund. In FY2024, the state expanded the fund’s capacity, allocating $150M non-lapsing funds to the fund, helping to promote the development and maintenance of affordable housing units. This increase marks a notable shift from the previously limited funding, enabling more substantial investment in low-income housing projects.

Key changes include the prioritization of projects that serve the most vulnerable populations, including those experiencing homelessness and low-income families. The state also streamlined the application process for accessing these funds, making it easier for developers and non-profits to participate in creating affordable housing. Additionally, new regulations encourage the inclusion of green building practices, ensuring that the housing stock is not only affordable but also sustainable.

AHCCCS Enhances Supported Housing for Individuals with Serious Mental Illness

AHCCCS has also taken significant strides to improve supported housing for individuals with serious mental illness.

AHCCCS’s broader strategy focuses on increasing the availability of supported housing units, enhancing wrap-around services, and fostering community partnerships to ensure holistic care. By prioritizing stable housing, AHCCCS aims to reduce homelessness, hospitalizations and improve overall health outcomes for those with serious mental illness.

One of the program’s initiatives includes the development of a new shelter and treatment facility on the grounds of the Arizona State Hospital. This facility aims to provide comprehensive care by integrating housing with mental health treatment, addressing both immediate needs and long-term recovery goals. The innovative approach will offer a secure environment where individuals can receive continuous care, reducing the risks associated with homelessness and untreated mental health issues.

Summary

Public health interventions to provide lifesaving hydration and cooling relief are a welcome and badly needed resource to save lives. Recent increases in investments in affordable housing via the Housing Trust Fund are also helpful as are initiatives by AHCCCS to improve supported housing resources for persons at risk of homelessness as a result of their mental illness.

However, despite these interventions, if we continue on our current overly-restrictive affordable housing zoning path, we’re unlikely to make a significant impact reducing homelessness – and heat-related deaths among our most vulnerable populations.

The 2023 death toll is a clarion call for policy change, not just interventions like hydration and cooling centers, initiatives using the housing trust fund and AHCCCS’ efforts to help persons with a mental illness.

We also need policies that address one of the root causes of homelessness: overly restrictive local zoning requirements that make building multi-family affordable housing developments very difficult and, in many cases, impossible.

Perhaps the next legislative session will have a critical mass of legislators to implement statewide policy changes that compel cities with overly restrictive zoning to back off and take a more humane approach to zoning policy.