Feast Bennemie,77, wipes his face in his home, which lacks central air conditioning, on a hot day in Houston in 2021. High indoor temperatures can exacerbate people's health conditions, especially for older people, health officials say.
Photo by Brett Coomer, courtesy The Houston Chronicle/Getty Images
Nearly one-third of U.S. households consider cost before turning on a heating system during winter or powering up a cooling system during summer, potentially endangering their health.
Each year, more than 12 million American households receive disconnection notices for failure to pay utilities, according to the Center on Global Energy Policy at Columbia University. Extreme cold or heat in a home can exacerbate people's existing health problems and sometimes cause death. In January, a 59-year-old Pennsylvania man died of hypothermia in his home after his utilities were cut off, with indoor temperatures averaging 18 degrees.
People without energy can also lose access to refrigeration for medication, power for medical devices and even their phone service.
People of color, older adults and those with low incomes are more likely to be energy insecure, Ranjani Prabhakar, MCRP-MSCE, legislative director of healthy communities at Earthjustice, an environmental law nonprofit, told The Nation's Health.
Meanwhile, extreme heat is accelerating. Over 170 Americans died in 2024 from high temperatures — more than from flash floods, tornado, winter storms or thunderstorms, according to the National Weather Service.
The urban heat island effect — in which concrete, metal and other human-made materials amplify heat — can raise temperatures by double-digits in metropolitan areas, making conditions particularly dangerous, especially for low-income people of color.
“These households are required to spend, on average, a disproportionate amount of their household income on energy,” Chris Dobens, director of communications at WE ACT for Environmental Justice, told The Nation's Health.
WE ACT has advocated for improvements to New York City's cooling center program and legislation requiring landlords to keep apartments at 78 degrees or below during summer.
In the past, low-income Americans have been able to rely on help through the Low Income Home Energy Assistance Program, a federal program that allocates $4 billion annually to states so they can help vulnerable people pay their energy bills. But this year, Trump administration officials eliminated all of the program's staff and proposed zeroing out its funding in the fiscal year 2026 budget.
Over 7 million households receive assistance each year through LIHEAP, part of the U.S. Department of Health and Human Services' Administration for Children and Families. In July, a Senate appropriations committee proposed increasing funding for the program in the next budget.
In the long run, cities and communities can subsidize smart surfaces, such as reflective and green roofs, which can lower indoor temperatures, Diana Hernandez, PhD, associate professor of sociomedical sciences at Columbia University's Mailman School of Public Health, said. And as utilities are stakeholders in energy security — it is in their interest that energy bills get paid — they can create discount programs and notify energy-insecure customers that discounts are available.
“Utilities are an important player, and I think that they need to be among the actors finding solutions,” Hernandez told The Nation's Health.
For more on energy security, see APHA and Columbia University's new “Understanding Energy Insecurity in the Field” toolkit at www.apha.org/extreme-heat.
- Copyright The Nation’s Health, American Public Health Association
