On the hottest days of summer in New York City, the most dangerous place is often not the street—it is inside overheated apartments where residents have no air conditioning. Each year, extreme heat contributes to roughly 350 deaths in New York City, making it one of the city’s deadliest environmental hazards. As a public health graduate student studying environmental health risks in urban communities, I have come to see extreme heat not simply as a climate issue, but as a growing and preventable public health crisis. As climate change drives hotter summers and more frequent heat waves, the city must confront a difficult truth: access to safe indoor cooling has become a critical public health necessity.
Despite this growing risk, access to cooling remains deeply unequal across New York City. Without stronger policies to protect vulnerable residents, hundreds of preventable deaths will continue to occur each year.
Many people imagine heat-related deaths occurring outdoors during physical activity or prolonged sun exposure. Most heat-related deaths occur indoors. According to the New York City Department of Health and Mental Hygiene, nearly 90% percent of heat-stroke deaths occur in homes without air conditioning. Older adults, people with chronic health conditions, and individuals living alone are particularly vulnerable. For these residents, dangerously high indoor temperatures can quickly become life-threatening.
These deaths are preventable, yet they happen every summer.
Heat risk is strongly shaped by neighborhood conditions. Communities in the south Bronx, northern Manhattan, and central Brooklyn consistently experience higher temperatures due to the urban heat island effect, a phenomenon where asphalt, buildings, and limited vegetation trap heat in dense urban environments. Studies show that these neighborhoods can be 5–7 degrees hotter than wealthier areas with greater tree coverage and green space.
These same neighborhoods often face higher rates of poverty, aging housing infrastructure, and limited access to green space. Residents are also more likely to experience chronic health conditions such as cardiovascular disease, asthma, and diabetes—conditions that increase vulnerability to extreme heat. As a result, communities already facing health inequities are also disproportionately exposed to heat-related illness and death.
Air conditioning is the most effective protection against heat-related illness. Yet for many New Yorkers, it remains financially out of reach. Purchasing an air conditioner can cost several hundred dollars and running it regularly can significantly increase electricity bills. For seniors living on fixed incomes, low-income families, or residents already facing high housing costs, the fear of rising utility bills often discourages the use of air conditioning even when it is available.
New York State’s Home Energy Assistance Program offers limited cooling assistance for eligible households, including financial support for air conditioner purchases. However, strict eligibility requirements, limited funding, and administrative barriers mean that many vulnerable residents remain without adequate cooling. In a city where extreme heat already causes hundreds of deaths annually, these gaps represent a serious failure of public health protection.
To prevent avoidable deaths, New York City should expand targeted cooling assistance programs that provide free or heavily subsidized air conditioners to low-income households, particularly seniors, people with disabilities, and individuals with chronic health conditions. Public health data already identify the populations most vulnerable to heat-related illness. Targeting these groups for cooling interventions would be a practical and cost-effective strategy to save lives.
Cooling access alone, however, will not fully solve the problem. The city must also address the environmental conditions that make some neighborhoods far hotter than others. Urban planning strategies—such as expanding tree canopy, increasing green space, and implementing reflective “cool roof” technologies—can significantly reduce neighborhood temperatures. Research shows that increasing urban tree coverage can lower local temperatures while also improving air quality and community well-being.
These strategies represent more than climate adaptation efforts; they are essential public health interventions.
Critics may argue that expanding cooling assistance and urban heat mitigation programs would strain city budgets already under financial pressure. However, failing to act carries substantial costs as well. Heat-related emergency room visits, hospitalizations, and premature deaths place significant financial burdens on healthcare systems and public services. Preventive investments—such as cooling assistance and neighborhood greening—are often far less expensive than responding to preventable medical emergencies.
Others raise concerns about the environmental impact of increased air conditioner use, particularly in relation to energy consumption and greenhouse gas emissions. This concern deserves consideration, but it should not delay lifesaving interventions. Instead, policymakers can pursue a dual strategy: expanding access to cooling while promoting energy-efficient appliances, building efficiency improvements, and renewable energy investments. Modern air conditioning systems consume significantly less energy than older models, allowing cities to protect residents while still advancing climate goals.
Addressing heat risk therefore requires more than temporary emergency measures. It requires long-term investment in environmental justice and equitable urban planning.
Cooling centers can provide temporary relief during heat waves, but they cannot serve as the city’s primary solution. Many vulnerable residents, particularly older adults and individuals with mobility limitations—may find it difficult to travel during extreme heat events. For these residents, the safest place to remain during a heat wave is their own home, provided that the home can be adequately cooled.
Ensuring that residents have access to safe indoor cooling is therefore one of the most direct and effective ways to prevent heat-related illness and death.
In a city as wealthy and resourceful as New York, allowing hundreds of preventable heat-related deaths each year should no longer be acceptable. Extreme heat is a predictable and growing threat—and the tools to prevent these deaths already exist. What is needed now is the political will to act before the next heat wave arrives.
Mohammed Aldhuraibi, is an MPH candidate and an NIH Clinical Research Fellow at SUNY Downstate with a focus on clinical research, health equity, and underserved populations.
