California has had heat standards on the books for outdoor workers , but the state announced Wednesday that a set of rules for indoor workers had been finalized following an expedited review. The state’s Occupational Safety and Health Standards Board approved the regulation last month, but it needed to be vetted for legal compliance.

“This regulation provides protections for workers across California and helps prepare employers to deal with the challenges of rising temperatures in indoor environments,” said Debra Lee, chief of California’s Division of Occupational Safety and Health.

California is among a responding to the growing impacts of climate change and extreme heat with worker safety standards. Earlier this month, the Biden administration to protect indoor and outdoor workers from heat exposure as extreme heat, already the No. 1 weather-related killer in the U.S., becomes even more dangerous.

California’s standards require indoor workplaces to be cooled below 87 degrees Fahrenheit when employees are present and below 82 degrees in places where workers wear protective clothing or are exposed to radiant heat, such as furnaces. Worksites that don’t have air conditioning may use fans, misters, and other methods to bring the room temperature down.

The rules allow workarounds for businesses if they can’t cool their workplaces sufficiently. In those cases, employers must provide workers with water, breaks, areas where they can cool down, cooling vests, or other means to keep them from overheating.

But even with workarounds, businesses are concerned about the cost of complying with the regulation, especially small businesses that don’t own their storefronts or are in old buildings, said Robert Moutrie, a senior policy advocate at the California Chamber of Commerce.

“The simplest answer to this regulation is AC, and that’s a costly investment,” Moutrie said. “If you’re a small business and you don’t own your structure, you can’t make changes like creating a new space to cool down.”

The rules have been in development since 2016 — delayed, in part, because of the covid pandemic. The worker safety board requested the regulations be expedited. A standard review would have delayed the regulation taking effect until the fall, leaving workers largely unprotected from the summer heat.

The regulation applies to most indoor workplaces, including classrooms and even delivery vehicles. But state regulators and local correctional facilities after Gov. Gavin Newsom’s administration projected it could cost the California Department of Corrections and Rehabilitation billions of dollars to implement.

The board intends to draft a separate regulation for the tens of thousands of workers at the state’s 33 state prisons, conservation camps, and local jails. That could take a year, if not longer.

In 2021, the Department of Health and Human Services reported, occurred nationally, which is likely an undercount because health care providers are not required to report them. In 2023, HHS reported, 2,302 heat-related deaths occurred. It’s not clear how many of these deaths are related to work, either indoors or outdoors.

Meanwhile, global temperatures in June were a record high for the 13th straight month.

“This is really one of the biggest safety issues we see workers experiencing across California in many different industries,” said Tim Shadix, legal director at the Warehouse Worker Resource Center, which lobbied for the protections. “And the problem is only getting worse with climate change and hotter summers.”

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California ha tenido estándares para proteger a los trabajadores al aire libre del calor , pero el estado anunció el miércoles 24 de julio que ya había acelerado la revisión de un conjunto de reglas para los trabajadores en interiores.

La Junta de Normas de Seguridad y Salud Ocupacional del estado aprobó la regulación en junio, pero necesitaba ser evaluada para su cumplimiento legal.

“Esta regulación proporciona protecciones para los trabajadores en todo California y ayuda a preparar a los empleadores para enfrentar los desafíos de las temperaturas en aumento en ambientes interiores”, dijo Debra Lee, jefa de la División de Seguridad y Salud Ocupacional estatal.

California es que están actuando frente a los crecientes impactos del cambio climático y el calor extremo con estándares de seguridad para los trabajadores.

A principios de este mes, la administración Biden propuso reglas federales para proteger a los trabajadores en interiores y exteriores, ya que el calor extremo, el asesino número 1 relacionado con el clima número en el país, se vuelve aún más peligroso.

Los estándares de California requieren que los lugares de trabajo en interiores se mantengan por debajo de los 87 grados Fahrenheit cuando hay empleados presentes, y por debajo de 82 grados en lugares donde los trabajadores usan ropa protectora o están expuestos al calor radiante, como hornos.

Los sitios de trabajo que no tienen aire acondicionado pueden usar ventiladores, nebulizadores y otros métodos para bajar la temperatura.

Las reglas permiten alternativas para los negocios si no pueden enfriar sus espacios lo suficiente. En esos casos, los empleadores deben proporcionar a los trabajadores agua, descansos, áreas donde puedan refrescarse, chalecos refrigerantes u otros medios para evitar el sobrecalentamiento.

Pero incluso con alternativas, las empresas están preocupadas por el costo de cumplir con la regulación, especialmente las pequeñas empresas que no son dueñas de sus locales o están en edificios antiguos, dijo Robert Moutrie, defensor de políticas senior en la Cámara de Comercio de California.

“La respuesta más simple a esta regulación es el aire acondicionado, y eso es una inversión costosa”, dijo Moutrie. “Si eres una pequeña empresa y no eres dueño de tu estructura, no puedes hacer cambios como crear un nuevo espacio para refrescarte”.

Las reglas se han estado desarrollando desde 2016, retrasadas, en parte, por la pandemia de covid. La Junta de Seguridad Laboral pidió que las regulaciones se aceleraran. Una revisión estándar habría retrasado la entrada en vigencia de la regulación hasta el otoño, dejando a los trabajadores en gran medida desprotegidos del calor del verano.

La regulación se aplica a la mayoría de los lugares de trabajo en interiores, incluidas aulas e incluso vehículos de reparto. Pero los reguladores estatales y las instalaciones correccionales locales después que la administración del gobernador Gavin Newsom proyectara que podría costar miles de millones de dólares al Departamento de Correcciones y Rehabilitación de California implementarlas.

La junta tiene la intención de redactar una regulación separada para los miles de trabajadores en las 33 prisiones estatales, campamentos de conservación y cárceles locales del estado. Eso podría llevar un año, si no más.

En 2021, el Departamento de Salud y Servicios Humanos (HHS) informó que ocurrieron relacionadas con el calor a nivel nacional, lo que probablemente sea un subregistro porque los proveedores de atención médica no están obligados a informarlas.

En 2023, el HHS informó 2,302 muertes relacionadas con el calor. No está claro cuántas de estas muertes estuvieron vinculadas al trabajo, ya sea en interiores o exteriores.

Mientras tanto, en junio, las temperaturas globales registraron récords históricos por decimotercer mes consecutivo.

“Este es realmente uno de los mayores problemas de seguridad que vemos que los trabajadores experimentan en California en muchas industrias”, dijo Tim Shadix, director legal del Warehouse Worker Resource Center, que abogó por las protecciones. “Y el problema solo está empeorando con el cambio climático y los veranos más calurosos”.

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The plan was ultimately blocked by Democrats who wanted the state to adopt a single-payer health care system instead. Yet the moment encapsulates classic Anthony Wright: independent-minded and willing to compromise if it could help Californians live healthier lives without going broke.

This summer, Wright will assume the helm of the health consumer group , taking his campaign for more affordable and accessible health care to the national level and a deeply divided Congress. In his 23 years in Sacramento, Wright has successfully lobbied to outlaw surprise medical billing, require companies to report drug price increases, and cap hospital bills for uninsured patients — policies that have spread nationwide.

“He pushed the envelope and gave people aspirational leadership,” said Jennifer Kent, who served as Schwarzenegger’s head of the Department of Health Care Services, which administers the state Medicaid program. The two were often on opposing sides on health policy issues. “There was always, like, one more thing, one more goal, one more thing to achieve.”

Recently, Wright co-led a to provide comprehensive Medicaid benefits to all eligible California residents regardless of immigration status. The state funds this coverage because the federal government doesn’t allow it.

His wins have come mostly under Democratic governors and legislatures and when Republican support hasn’t been needed. That will not be the case in Washington, D.C., where and the Senate , which has made it extremely difficult to pass substantive legislation. November’s elections are not expected to ease the partisan impasse.

Though both Health Access and Families USA are technically nonpartisan, they tend to align with Democrats and lobby for Democratic policies, including abortion rights. But “Anthony doesn’t just talk to his own people,” said David Panush, a veteran Sacramento health policy consultant. “He has an ability to connect with people who don’t agree with you on everything.”

Wright, who interned for Vice President Al Gore and worked as a consumer advocate at the Federal Communications Commission in his 20s, acknowledges his job will be tougher in the nation’s capital, and said he is “wide-eyed about the dysfunction” there. He said he also plans to work directly with state lawmakers, including encouraging those in the states that have not yet expanded Medicaid under the Affordable Care Act to do so.

In an interview with California Healthline senior correspondent Samantha Young, Wright, 53, discussed his accomplishments in Sacramento and the challenges he will face leading a national consumer advocacy group. His remarks have been edited for length and clarity.

Q: Is there something California has done that you’d like to see other states or the federal government adopt?

Just saying “We did this in California” is not going to get me very far in 49 other states. But stuff that has already gone national, like the additional assistance to buy health care coverage with state subsidies, that became something that was a model for what the federal government did in the American Rescue Plan [Act] and the Inflation Reduction Act. Those additional tax credits have had a huge impact. have coverage because of them. Yet, those additional tax credits expire in 2025. If those tax credits expire, the average premium will spike $400 a month.

Q: You said you will find yourself playing defense if former President Donald Trump is elected in November. What do you mean?

Our health is on the ballot. I worry about the Affordable Care Act and the protections for preexisting conditions, the help for people to afford coverage, and all the other consumer patient protections. I think reproductive health is obviously front and center, but that’s not the only thing that could be taken away. It could also be something like Medicare’s authority to negotiate prices on prescription drugs.

Q: But Trump has said he doesn’t want to repeal the ACA this time, rather “.”

We just need to look at the record of what was proposed during his first term, which would have left millions more people uninsured, which would have spiked premiums, which would have gotten rid of key patient protections.

Q: What’s on your agenda if President Joe Biden wins reelection?

It partially depends on the makeup of Congress and other elected officials. Do you extend this guarantee that nobody has to ? Are there benefits that we can actually improve in Medicare and Medicaid with regard to vision and dental? What are the cost drivers in our health system?

There is a lot we can do at both the state and the federal level to get people both access to health care and also financial security, so that their health emergency doesn’t become a financial emergency as well.

Q: Will it be harder to get things done in a polarized Washington?

The dysfunction of D.C. is a real thing. I don’t have delusions that I have any special powers, but we will try to do our best to make progress. There are still very stark differences, whether it’s about the Affordable Care Act or, more broadly, about the social safety net. But there’s always opportunities for advancing an agenda.

There could be a lot of common ground on areas like health care costs and having greater oversight and accountability for quality in cost and quality in value, for fixing market failures in our health system.

Q: What would happen in California if the ACA were repealed?

When there was the big threat to the ACA, a lot of people thought, “Can’t California just do its own thing?” Without the tens of billions of dollars that the Affordable Care Act provides, it would have been very hard to sustain. If you get rid of those subsidies, and 5 million Californians lose their coverage, it becomes a smaller and sicker risk pool. Then premiums spike up for everybody, and, basically, the market becomes a death spiral that will cover nobody, healthy or sick.

Q: California expanded Medicaid to qualified immigrants living in the state without authorization. Do you think that could happen at the federal level?

Not at the moment. I would probably be more focused on the states that are not providing Medicaid to American citizens [who] just happen to be low-income. They are turning away precious dollars that are available for them.

Q: What do you take away from your time at Health Access that will help you in Washington?

It’s very rare that anything of consequence is done in a year. In many cases, we’ve had to run a bill or pursue a policy for multiple years or sessions. So, the power of persistence is that if you never give up, you’re never defeated, only delayed. Prescription drug price transparency took three years, surprise medical bills took three years, the hospital fair-pricing act took five years.

Having a coalition of consumer voices is important. Patients and the public are not just another stakeholder. Patients and the public are the point of the health care system.

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Si este mes se aprueban las nuevas reglas de protección laboral contra el calor extremo, los empleadores del estado más poblado del país tendrán que buscar el modo de proporcionar alivio a las personas que trabajan en almacenes asfixiantes, cocinas llenas de vapor y otros espacios peligrosamente calurosos.

Estas mismas normas se extenderán a las escuelas, donde profesores, conserjes, quienes atienden las cafeterías y otros empleados suelen trabajar sin aire acondicionado, igual que sus alumnos.

“Nuestras condiciones de trabajo son las mismas que las de los estudiantes”, dijo Jeffery Freitas, presidente de la Federación de Maestros de California, que representa a más de 120.000 docentes y otros empleados de la educación. “Estamos asistiendo a un cambio sin precedentes en el medio ambiente y sabemos a ciencia cierta que cuando hace demasiado calor, los niños no pueden aprender”.

Está previsto que el 20 de junio una junta estatal de seguridad laboral vote las nuevas normas. Si así fuera, es probable que estén vigentes para el verano.

La medida, que muestra el último esfuerzo del gobernador demócrata Gavin Newsom por responder a los crecientes impactos del cambio climático y el calor extremo, pondría a California a la delantera del gobierno federal y de la mayoría del país en la creación de leyes sobre el calor excesivo.

Estas normas van a exigir que los lugares de trabajo en interiores se mantengan refrigerados por debajo de los 87 grados Fahrenheit cuando los empleados estén presentes. En aquellos lugares donde los trabajadores llevan ropa protectora o están expuestos al calor radiante, como ocurre con los hornos, la temperatura no debería superar los 82 grados.

Las escuelas y otros lugares de trabajo que no dispongan de equipos de aire acondicionado podrán utilizar ventiladores, rociadores y otros métodos que ayuden a reducir la temperatura ambiente.

Las normas permiten soluciones alternativas para las empresas que no pueden refrigerar suficientemente sus lugares de trabajo, incluidos los aproximadamente 1.000 distritos escolares del estado.

En esos casos, los empleadores deben proporcionar a los trabajadores agua, descansos, zonas donde puedan refrescarse, chalecos refrigerantes u otros medios para evitar que los empleados sufran de calor excesivo.

“El calor es un peligro mortal, independientemente del tipo de trabajo que se realice”, afirma Laura Stock, miembro del Consejo de Normas de Seguridad y Salud en el Trabajo. “Si tienes un espacio laboral interior poblado tanto por trabajadores como por el público, o en este caso por niños, ellos tendrían los mismos riesgos para su salud que los que tienen los trabajadores”.

Históricamente, las olas de calor golpeaban fuera del ciclo escolar. Pero el las está haciendo más largas, frecuentes e intensas.

El año pasado fue y las de todo Estados Unidos cerraron de forma intermitente durante la primavera y el verano, incapaces de mantener frescos a los alumnos.

Y los científicos dicen que este año .

En mayo, las autoridades escolares de Vicksburg, en Mississippi, dieron por antes de lo previsto por problemas con los aparatos de aire acondicionado. En California, la primera ola de calor de la temporada se está produciendo cuando algunas escuelas todavía están dando clases, con temperaturas que alcanzan los .

Varios estados, entre ellos y , exigen que las escuelas tengan aparatos de aire acondicionado en buenas condiciones, pero no que los hagan funcionar. Mississippi exige que , pero no especifica a qué temperatura debe ser colocado.

Las escuelas de Hawaii deben tener las aulas a una “temperatura aceptable para facilitar el aprendizaje de los alumnos”, pero no se especifica cuál es esa temperatura. Cuando el termómetro en el interior de las escuelas marca los 80 grados, deben intentar refrescar las aulas, por ejemplo, usando ventiladores, y deben proporcionar a los profesores y a otros empleados formas de refrescarse, como agua y períodos de descanso.

Cuando el sol recalienta la biblioteca en Bridges Academy en Melrose, una escuela pública en el este de Oakland que tiene poca sombra y pocos árboles, Christine Schooley cierra las cortinas y apaga las computadoras para enfriar su aula. Dejó de usar un ventilador después que el cabello largo de una niña quedó atrapado en él.

“Mi biblioteca es el lugar más caluroso del campus porque por aquí pasan 120 chicos al día”, explica Schooley. “Aquí hace calor. Y eso también me pone de mal humor e irritable”.

Un análisis realizado en 2021 por el Center for Climate Integrity sugiere que casi 14.000 escuelas públicas alrededor del país que no necesitaban aire acondicionado en 1970 ahora sí lo necesitan, porque experimentan anualmente 32 días de temperaturas superiores a los 80 grados. Adaptar el sistema costaría más de .

Los investigadores calcularon que instalar aire acondicionado en 678 escuelas de California obligaría a gastar unos .

No está claro cuántas escuelas de California podrían necesitar instalar aire acondicionados u otros equipos de refrigeración para cumplir las nuevas normas, porque el estado no hace un seguimiento de las que ya los tienen, dijo V. Kelly Turner, directora asociada del Centro Luskin para la Innovación de la Universidad de California-Los Ángeles.

Un distrito escolar del norte del estado no se enfrentaría a los mismos desafíos que otro situado en las ciudades desérticas de Needles o Palm Springs, dijo Naj Alikhan, vocero de la Asociación de Administradores Escolares de California, que no se ha pronunciado sobre las normas propuestas.

Un encargado por la junta estatal de seguridad laboral proporcionó estimaciones de costos para una serie de industrias, como almacenamiento, manufactura y construcción. Pero este estudio no tenía una estimación para los distritos escolares, que conforman uno de los sistemas de más grandes del estado y ya enfrentan un en las actualizaciones necesarias.

El Departamento de Educación estatal no se ha pronunciado sobre la propuesta y un portavoz, Scott Roark, declinó hacer comentarios sobre el posible costo para las escuelas.

Este año, el gobierno de Newsom se negó a aprobar las normas de calefacción interior después que las proyecciones mostraran que adecuar las prisiones estatales a las temperaturas extremas tendría un costo multimillonario. Desde entonces, para decenas de miles de empleados de prisiones y cárceles, así como para los reclusos.

Tampoco está claro si la normativa se aplicará a los autobuses escolares, muchos de los cuales no tienen aire acondicionado. El Departamento de Relaciones Industriales, que supervisa la junta de seguridad de los trabajadores, no ha respondido a las preguntas de los funcionarios escolares ni de Â鶹ŮÓÅ Health News.

Libia García está preocupada por su hijo de 15 años, que pasa al menos una hora al día viajando en un autobús escolar caluroso y mal ventilado desde su casa en la comunidad rural de Huron, en el Valle Central, hasta su instituto y viceversa. “Cuando mi hijo llega a casa, está agotado y deshidratado”, dijo García. “No tiene energía ni para hacer los deberes ni para nada”.

La está presionando a los legisladores estatales para que aprueben un proyecto de ley de . Esto le exigiría al estado que desarrolle un plan maestro para actualizar los sistemas de calefacción y aire acondicionado de las escuelas. El año pasado, Newsom similar, alegando su costo.

Las campañas para bajar la temperatura en las escuelas en otros estados han dado resultados desiguales. Este año, las leyes de y fracasaron. En tanto, en , la norma pasó a la Asamblea estatal.

El mes pasado, un sindicato docente de Nueva York llevó un sauna portátil al Capitolio del estado para demostrar cuánto calor puede hacer dentro de las aulas. “Sólo una cuarta parte tiene aire acondicionado”, explicó Melinda Person, presidenta de la Unión de Maestros del Estado de Nueva York.

“Existen límites de temperatura para los refugios de animales. ¿Cómo es que no los tenemos para las aulas?”, dijo Chris Eachus, miembro demócrata de la Asamblea de Nueva York, cuyo proyecto de ley obligaría a las escuelas a tomar medidas de alivio cuando las aulas y los edificios escolares alcancen los 82 grados. “Tenemos que proteger la salud y la seguridad de los niños”, declaró.

El calor extremo es la primera causa de muerte relacionada con el clima en Estados Unidos, más mortífera que los huracanes, las inundaciones y los tornados. El estrés térmico puede causar insolación, paro cardíaco e insuficiencia renal.

Los Centros para el Control y Prevención de Enfermedades (CDC) informaron que en 2021 relacionadas con el calor, lo que probablemente sea una cifra inferior a la real porque los profesionales de salud no están obligados a notificarlas. No está claro cuántas de estas muertes están relacionadas con el trabajo, ya sea en ámbitos laborales interiores o al aire libre.

En California, las normas de protección para los empleados que trabajan al aire libre ante temperaturas rigen . Las reglas para los que trabajan en lugares cerrados han estado en desarrollo desde 2016, aunque se han retrasado en parte por la pandemia de covid.

A nivel federal, la administración Biden ha tardado en publicar una normativa para proteger a los trabajadores de interior y exterior de la exposición a los calores extremos. Aunque un funcionario dijo que se espera un borrador este año, su futuro podría depender de las elecciones presidenciales de noviembre. Si gana el ex presidente Donald Trump, es poco probable que las normas que afectan a las empresas salgan adelante.

El gobierno federal celebró en abril una cumbre sobre . Allí, altos funcionarios animaron a los distritos escolares a aplicar una inyección de nuevos fondos federales para mejorar las infraestructuras educativas envejecidas. La administración también dio a conocer una para que los distritos escolares aprovechen los fondos federales.

“La forma en que invertimos en nuestros edificios y predios escolares marca la diferencia en la vida de nuestros alumnos”, declaró en la cumbre Roberto Rodríguez, subsecretario del Departamento de Educación de EE. UU. “Ellos son los primeros en sentir el impacto”.

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If the standards are approved this month, employers in the nation’s most populous state will have to provide relief to indoor workers in sweltering warehouses, steamy kitchens, and other dangerously hot job sites. The rules will extend to schools, where teachers, custodians, cafeteria workers, and other employees may work without air conditioning — like their students.

“Our working conditions are students’ learning conditions,” said Jeffery Freitas, president of the California Federation of Teachers, which represents more than 120,000 teachers and other educational employees. “We’re seeing an unprecedented change in the environment, and we know for a fact that when it’s too hot, kids can’t learn.”

A state worker safety board is scheduled to vote on the rules June 20, and they would likely take effect this summer. The move, which marks Democratic Gov. Gavin Newsom’s latest effort to respond to the growing impacts of climate change and extreme heat, would put California ahead of the federal government and much of the nation in setting heat standards.

The standards would require indoor workplaces to be cooled below 87 degrees Fahrenheit when employees are present and below 82 degrees in places where workers wear protective clothing or are exposed to radiant heat, such as furnaces. Schools and other worksites that don’t have air conditioning could use fans, misters, and other methods to bring the room temperature down.

The rules allow workarounds for businesses, including the roughly 1,000 school districts in the state, if they can’t cool their workplaces sufficiently. In those cases, employers must provide workers with water, breaks, areas where they can cool down, cooling vests, or other means to keep employees from overheating.

“Heat is a deadly hazard no matter what kind of work you do,” said Laura Stock, a member of the Occupational Safety and Health Standards Board. “If you have an indoor space that is both populated by workers and the public, or in this case by children, you would have the same risks to their health as to workers.”

Heat waves have historically struck outside of the school year, but is making them longer, more frequent, and more intense. Last year was the and closed sporadically during spring and summer, unable to keep students cool.

Scientists say this year . School officials in Vicksburg, Mississippi, last month when air conditioners had issues. And California’s first heat wave of the season is hitting while some schools are still in session, with temperatures in the Central Valley.

Several states, including and , require schools to have working air conditioners, but they aren’t required to run them. Mississippi but doesn’t say to what temperature. Hawaii schools must have classrooms at a “temperature acceptable for student learning,” without specifying the temperature. And Oregon schools must try to cool classrooms, such as with fans, and provide teachers and other employees ways to cool down, including water and rest breaks, when the heat index indoors .

When the sun bakes the library at Bridges Academy at Melrose, a public school in East Oakland with little shade and tree cover, Christine Schooley closes the curtains and turns off the computers to cool her room. She stopped using a fan after a girl’s long hair got caught in it.

“My library is the hottest place on campus because I have 120 kids through here a day,” Schooley said. “It stays warm in here. So yeah, it makes me grouchy and irritable as well.”

A 2021 analysis by the Center for Climate Integrity suggests nearly 14,000 public schools across the U.S. that did not need air conditioning in 1970 now do, because they annually experience 32 days of temperatures more than 80 degrees — upgrades that would cost more than . Researchers found that same comparison produces a cost of to install air conditioning in 678 California schools.

It’s not clear how many California schools might need to install air conditioners or other cooling equipment to comply with the new standards because the state doesn’t track which ones already have them, said V. Kelly Turner, associate director of the Luskin Center for Innovation at the University of California-Los Angeles.

And a school district in the northern reaches of the state would not face the same challenges as a district in the desert cities of Needles or Palm Springs, said Naj Alikhan, a spokesperson for the Association of California School Administrators, which has not taken a position on the proposed rules.

An commissioned for the board provided cost estimates for a host of industries — such as warehousing, manufacturing, and construction — but lacked an estimate for school districts, which make up one of the in the state and already face a of needed upgrades. The state Department of Education hasn’t taken a position on the proposal and a spokesperson, Scott Roark, declined to comment on the potential cost to schools.

Projections of a multibillion-dollar cost to state prisons were the reason the Newsom administration refused to sign off on the indoor heat rules this year. Since then, tens of thousands of prison and jail employees — and prisoners — .

It’s also unclear whether the regulation will apply to school buses, many of which don’t have air conditioning. The Department of Industrial Relations, which oversees the worker safety board, has not responded to queries from school officials or Â鶹ŮÓÅ Health News.

Libia Garcia worries about her 15-year-old son, who spends at least an hour each school day traveling on a hot, stuffy school bus from their home in the rural Central Valley community of Huron to his high school and back. “Once my kid arrives home, he is exhausted; he is dehydrated,” Garcia said in Spanish. “He has no energy to do homework or anything else.”

The is pushing state lawmakers to pass a that would require the state to develop a master plan to upgrade school heating and air conditioning systems. Newsom last year , citing the cost.

Campaigns to cool schools in other states have yielded mixed results. Legislation in and failed this year, while a bill in passed on June 7 and was headed to the governor for approval. A Ìýproposal was pending as of last week. Last month, a teachers union in New York brought a portable sauna to the state Capitol to demonstrate how hot it can get inside classrooms, only a quarter of which have air conditioning, said Melinda Person, president of New York State United Teachers.

“We have these temperature limits for animal shelters. How is it that we don’t have it for classrooms?” said Democratic New York Assembly member Chris Eachus, whose bill would require schools to take relief measures when classrooms and buildings reach 82 degrees. “We do have to protect the health and safety of the kids.”

Extreme heat is the No. 1 weather-related killer in the U.S. — deadlier than hurricanes, floods, and tornadoes. Heat stress can cause heatstroke, cardiac arrest, and kidney failure. The Centers for Disease Control and Prevention reported occurred in 2021, which is likely an undercount because health care providers are not required to report them. It’s not clear how many of these deaths are related to work, either indoors or outdoors.

California has had heat standards on the books for outdoor workers , and rules for indoor workplaces have been in development since 2016 — delayed, in part, because of the covid pandemic.

At the federal level, the Biden administration has been slow to release a to protect indoor and outdoor workers from heat exposure. Although an official said a draft is expected this year, its outlook could hinge on the November presidential election. If former President Donald Trump wins, it is unlikely that rules targeting businesses will move forward.

The Biden White House held a and climate change in April, at which top officials encouraged districts to apply an infusion of new federal dollars to upgrade their aging infrastructure. The administration also unveiled an for school districts to tap federal funds.

“How we invest in our school buildings and our school grounds, it makes a difference for our students’ lives,” Roberto Rodriguez, an assistant secretary at the U.S. Department of Education, said at the summit. “They are on the front line in terms of feeling those impacts.”

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About 160 health-care executives and officials have been invited to the White House today and Friday to promote public health solutions to the epidemic. A top priority, I’m told: The White House wants hospital emergency departments to collect more data about gunshot injuries their physicians treat, as well as routinely counsel patients about the safe use of firearms.

It’s part of the president’s strategy to build support for gun-safety measures outside the Capitol, where legislation to more strictly regulate firearms can’t overcome mainly Republican opposition. Biden’s already recruited educators to talk to parents about safe gun storage and community workers to help at-risk youth.

“The president has been clear: This is a public health crisis. So, to solve it, we need the leaders from the health-care sector,” Rob Wilcox, a deputy director of the White House Office of Gun Violence Prevention, told me in a phone interview. “Those are the leaders that run the health systems and hospitals that we go to for treatment, and it’s those doctors, nurses, practitioners on the front lines.”

Health experts have long described gun violence as a public health crisis, one that disproportionately affects Black and Hispanic residents in poor neighborhoods. Biden’s election opponent, former president Donald Trump, has assailed his gun policies and that “if the Biden regime gets four more years, they are coming for your guns.”

In 2022, more than in the United States, or about 132 people a day, according to the Centers for Disease Control and Prevention. An additional 200-plus Americans are injured each day,.

Surveys show most Americans — — support policies that could reduce violence.

Biden’s initiative isn’t just about messaging. It’s also about money. Unlike America’s other deadly health threats — such as cancer, HIV and automobile crashes — limited federal dollars fund gun violence research, in part because of politics.

In 1996, a Republican-controlled Congress cut federal funding for gun safety research at the CDC, essentially shifting the burden to the private sector and academia — with a fraction of the previous budget. In 2019, Congress reversed course and has since agreed every year to allocate $25 million to the CDC and the National Institutes of Health for gun research.

Health researchers say more timely and comprehensive data about gun injuries and deaths would give them a better understanding of trends behind gun violence — and what policies might prevent it.

The White House is asking state and local health departments, health systems and hospitals to increase timely data collection on emergency department visits for firearm-related injuries to “support state and local jurisdictions in identifying and responding to emerging public health problems,” Wilcox said.

The goal is “to inform prevention efforts,” he said.

The data will cover fatal and nonfatal injuries. Existing CDC data focuses on deaths, while its data on injuries is limited. For instance, one person was killed in the Feb. 14 shooting at the Kansas City Chiefs Super Bowl victory parade, but the CDC data probably will not count the roughly two dozen other people who were injured.

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Biden administration officials are hosting back-to-back events Thursday and Friday at the White House for about 160 health care officials, calling gun violence a “public health crisis” that requires them to act.

The strategy also reflects a stark political reality: Congress has been deadlocked on most gun-related legislation for years, with a deep divide between Republicans and Democrats. If Democratic President Joe Biden wants to get anything done quickly, he will need to look outside the Capitol. He has already enlisted educators to talk to parents about safe gun storage and community workers to help at-risk youth.

“The president has been clear: This is a public health crisis. So, to solve it, we need the leaders from the health care sector,” Rob Wilcox, a deputy director of the White House Office of Gun Violence Prevention, told Â鶹ŮÓÅ Health News. “Those are the leaders that run the health systems and hospitals that we go to for treatment, and it’s those doctors, nurses, practitioners on the front lines.”

Health experts have long described gun violence as a public health crisis, one that disproportionately affects Black and Hispanic residents in poor neighborhoods.

In 2022, more than 48,000 people in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to the Centers for Disease Control and Prevention. An additional 200-plus Americans are injured each day, from Johns Hopkins University research.

Guns are the leading cause of death for children and teens.

Gun violence prevention advocates applauded the Biden administration for attempting to depoliticize the issue by focusing on its health impacts. The health-centric message also resonates with the public, said Fatimah Loren Dreier, executive director of the Health Alliance for Violence Intervention, who planned to attend the June 6 event.

“The idea that there can be a bipartisan-driven, apolitical way to address the gun violence problem has created tremendous opportunity,” she said.

But the initiative isn’t just about messaging. It’s about numbers and statistics. Relative to America’s other deadly threats — such as cancer, HIV, and automobile crashes — fewer federal dollars fund gun violence research, mostly because of politics.

In 1996, Congress cut federal funding for gun control research by the CDC, essentially shifting the responsibility for funding and conducting the research to the private sector and academia — and with a fraction of the previous budget. In 2019, Congress reversed course and has since agreed every year to allocate $25 million to the CDC and the National Institutes of Health for gun research, but public health experts say it’s not nearly enough. By comparison, roughly three times that amount was on the prevention and treatment of underage drinking in fiscal year 2023, and 10 times as much to Parkinson’s disease research.

Slashing CDC research funding for firearms created decades-long gaps in data — and hamstrung efforts to respond to the crisis, researchers and health officials say. For instance, there’s little government data available to researchers on firearms, even basic statistics such as firearm ownership by city and which guns are used in shootings.

More timely and comprehensive data could give researchers a better understanding of the trends behind gun violence — and the steps to take to prevent it, said Bechara Choucair, an executive vice president and the chief health officer at Kaiser Permanente, who planned to attend the June 6 White House event.

“Anytime you want to address a problem with a public health lens, you have to understand the data,” he said. “You have to understand the data at a granular level so you can design interventions and test interventions and see if it works or if it doesn’t work.”

The White House is asking state and local health departments, health systems, and hospitals to boost timely data collection on emergency room visits for firearm-related injuries to “support state and local jurisdictions in identifying and responding to emerging public health problems,” Wilcox said.

The goal is “to inform prevention efforts,” he said.

The data will cover fatal and nonfatal injuries. Existing CDC data focuses on deaths, while its data on injuries is limited. For instance, one person was killed in the Feb. 14 shooting at the Kansas City Chiefs Super Bowl victory parade, but the CDC data likely will not count the roughly two dozen other people who were injured.

Collecting more detailed data could be costly for hospitals, whose ERs see most gunshot injuries, said Garen Wintemute, an ER physician and the head of a violence prevention program at the University of California-Davis. Right now, hospitals gather medical information about gunshot wounds and usually don’t get into other details, such as what type of gun or ammunition might have been used.

It’s not clear exactly what data hospitals will be asked to collect.

“It’s an intensive process,” Wintemute said. “The clinicians are going to gather the data that they need in order to treat the patient, and that may not include all the data that a researcher later would want to know about what happened.”

Some of this data is already being collected on a limited basis. The CDC collects of gunshot injuries from ERs in about a dozen states. The White House wants data from across the nation.

Wilcox added that federal grant dollars are available to health systems to conduct gun data collection through the , which Biden signed in 2022.

This year, Biden asked Congress to again boost funding for CDC firearm research in his proposed fiscal 2025 budget, but his previous efforts have failed in the GOP-controlled House of Representatives.

Lawmakers have yet to release a draft of their spending proposal for the Department of Health and Human Services.

“We should focus our CDC resources on infectious diseases, transmittable diseases, and certainly chronic diseases rather than controversial, political-charged activities,” of Biden’s 2024 funding proposal.

Surveys show most Americans — across political affiliations and regardless of gun ownership — that could reduce violence.

At this week’s meetings with health leaders, White House officials will also encourage doctors to talk with patients and the public about gun safety and securing guns.

When Wintemute talks with patients in the ER, he sits beside them and asks about their safety and the safety of others in their home, a practice he said many doctors already use to address an array of potential risks in a person’s life. The White House’s call for physicians to talk about gun violence legitimizes that, he said.

“A health professional can do what we do about tobacco and alcohol and other sorts of potentially risky behaviors, and talk with patients about how do we minimize the risk,” Wintemute said.

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“We lose loved ones all the time, but he was taken in a horrific way,” his mother, Janee Robinson, said from the family’s Inland Empire home, about 80 miles southeast of Los Angeles. “I would never want nobody to go through what I’m going through.”

The day her son died, Robinson, who teaches phys ed, kept her elementary school students inside, and she had hoped her children’s teachers would do the same.

The Riverside County Coroner’s Bureau ruled that Yahushua died on Aug. 29 of a heart defect, with heat and physical exertion as contributing factors. His death at Canyon Lake Middle School came on the second day of an excessive heat warning, when people were and limit their time outdoors.

Yahushua’s family is supporting in California that would require the state Department of Education to create guidelines that govern physical activity at public schools during extreme weather, including setting threshold temperatures for when it’s too hot or too cold for students to exercise or play sports outside. If the measure becomes law, the guidelines will have to be in place by Jan. 1, 2026.

Many states have adopted protocols to protect student athletes from extreme heat during practices. But the California bill is broader and would require educators to consider all students throughout the school day and in any extreme weather, whether they’re doing jumping jacks in fourth period or playing tag during recess. It’s unclear if the bill will clear a critical committee vote scheduled for May 16.

“Yahushua’s story, it’s very touching. It’s very moving. I think it could have been prevented had we had the right safeguards in place,” said state Sen. Melissa Hurtado (D-Bakersfield), one of the bill’s authors. “Climate change is impacting everyone, but it’s especially impacting vulnerable communities, especially our children.”

Last year marked the planet’s warmest on record, and extreme weather is becoming more frequent and severe, according to the National Oceanic and Atmospheric Administration. Even though most heat deaths and illnesses are preventable, about every year, according to the Centers for Disease Control and Prevention.

Young children are especially susceptible to heat illness because their bodies have more trouble regulating temperature, and they rely on adults to protect them from overheating. A person can go from feeling dizzy or experiencing a headache to passing out, having a seizure, or going into a coma, said , a physician and the division chief of general pediatrics at Loma Linda University Health.

“It can be a really dangerous thing,” Vercio said of heat illness. “It is something that we should take seriously and figure out what we can do to avoid that.”

It’s unclear how many children have died at school from heat exposure. Eric Robinson, 15, had been sitting in his sports medicine class learning about heatstroke when his sister arrived at his high school unexpectedly the day their brother died.

“They said, ‘OK, go home, Eric. Go home early.’ I walked to the car and my sister’s crying. I couldn’t believe it,” he said. “I can’t believe that my little brother’s gone. That I won’t be able to see him again. And he’d always bugged me, and I would say, ‘Leave me alone.’”

That morning, Eric had done Yahushua’s hair and loaned him his hat and chain necklace to wear to school.

As temperatures climbed into the 90s that morning, a physical education teacher instructed Yahushua to run on the blacktop. His friends told the family that the sixth grader had repeatedly asked the teacher for water but was denied, his parents said.

The school district has refused to release video footage to the family showing the moment Yahushua collapsed on the blacktop. He died later that day at the hospital.

Melissa Valdez, a Lake Elsinore Unified School District spokesperson, did not respond to calls seeking comment.

Schoolyards can reach on hot days, with asphalt sizzling up to 145 degrees, according to findings by researchers at the UCLA Luskin Center for Innovation. Some school districts, such as and , have hot weather plans or guidelines that call for limiting physical activity and providing water to kids. But there are no statewide standards that K-12 schools must implement to protect students from heat illness.

Under the bill, the California Department of Education must set temperature thresholds requiring schools to modify students’ physical activities during extreme weather, such as heat waves, wildfires, excessive rain, and flooding. Schools would also be required to come up with plans for alternative indoor activities, and staff must be trained to recognize and respond to weather-related distress.

California has had heat rules on the books for outdoor workers since 2005, but it was a latecomer to , according to the at the University of Connecticut, which is named after a Minnesota Vikings football player who died from heatstroke in 2001. By comparison, Florida, where Gov. Ron DeSantis, a Republican, this spring preventing cities and counties from creating their own heat protections for outdoor workers, has the best protections for student athletes, according to the institute.

Douglas Casa, a professor of kinesiology and the chief executive officer of the institute, said state regulations can establish consistency about how to respond to heat distress and save lives.

“The problem is that each high school doesn’t have a cardiologist and doesn’t have a thermal physiologist and doesn’t have a sickling expert,” Casa said of the medical specialties for heat illness.

In 2022, California released an that recommended state agencies “explore implementation of indoor and outdoor heat exposure rules for schools,” but neither the administration of Gov. Gavin Newsom, a Democrat, nor lawmakers have adopted standards.

Lawmakers last year failed to pass legislation that would have required schools to implement a heat plan and replace hot surfaces, such as cement and rubber, with lower-heat surfaces, such as grass and cool pavement. , which drew opposition from school administrators, stalled in committee, in part over cost concerns.

Naj Alikhan, a spokesperson for the Association of California School Administrators, said the new bill takes a different approach and would not require structural and physical changes to schools. The association has not taken a position on the measure, and no other organization has registered opposition.

The Robinson family said children’s lives ought to outweigh any costs that might come with preparing schools to deal with the growing threat of extreme weather. Yahushua‘s death, they say, could save others.

“I really miss him. I cry every day,” said Yahushua’s father, Eric Robinson. “There’s no one day that go by that I don’t cry about my boy.”

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It’s aÌýfirst-in-the-nation experimentÌýthat expands a Biden administration strategy to take Medicaid beyond traditional medical care and into the realm of social services.

“Climate change is a health-care issue,” Health and Human Services SecretaryÌýXavier BecerraÌýtold me, adding that states should be encouraged to experiment with ways to improve people’s health.

But Medicaid’s expansion into social services could lead to abuse, especially when government pays for equipment or services that everyone wants, saidÌýSherry Glied, dean ofÌýNew York University’s graduate school of public service.

“The challenge here is that air conditioners are something that both healthy people and people who have your really serious condition benefit from,” Glied said. “Most people have air conditioners for reasons that have nothing to do with their health.”

Many states are already spendingÌýÌýon services like helping homeless people get housing and preparing healthy meals for people with diabetes. But Oregon is the first to spend Medicaid money explicitly on climate-related equipment to help its most vulnerable residents — an estimatedÌý200,000Ìýenrollees.

Recipients must meet federal guidelines that categorize them as “facing certain life transitions,” a stringentÌýÌýthat disqualify most enrollees. For example, a person with an underlying medical condition that could worsen during a heat wave, and who is also at risk for homelessness or has been released from prison in the past year, could receive an air conditioner. But someone with stable housing might not qualify.

“Each person is going to be looked at as what they need for their particular circumstance,” saidÌýDave Baden, deputy director for programs and policy at theÌýOregon Health Authority, which administers the state’s Medicaid program, with aboutÌý. The program, part of a five-yearÌý$1.1 billionÌýeffort that includes housing and nutrition services, also pays for mini fridges to keep medications cold, portable power supplies to run ventilators and other medical devices during outages, space heaters for winter and air filters to improve air quality during wildfire season.

Scientists and public health officials say climate change poses a growing health risk. The federal government’sÌýÌýprojects that more frequent and intense floods, droughts, wildfires, extreme temperatures and storms will cause more deaths, cardiovascular disease from poor air quality and other problems.Ìý

The mounting health effects disproportionately hit low-income Americans and people of color, who are often covered by Medicaid, the state-federal health insurance program for low-income people.

Most of theÌý102ÌýOregonians who died during a deadly heat dome that settled over the Pacific Northwest in 2021 “were elderly, isolated and living with low incomes,” aÌýÌýfound.

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The equipment, which started going out in March, expands a Biden administration strategy to move Medicaid beyond traditional medical care and into the realm of social services.

At least 20 states, including California, , and Washington, already direct billions of Medicaid dollars into programs such as helping homeless people get housing and preparing healthy meals for people with diabetes, according to Â鶹ŮÓÅ. Oregon is the first to use Medicaid money explicitly for climate-related costs, part of its five-year, $1.1 billion effort to address social needs, which also includes housing and nutrition benefits.

State and federal health officials hope to show that taxpayer money and lives can be saved when investments are made before disaster strikes.

“Climate change is a health care issue,” so helping Oregon’s poorest and sickest residents prepare for potentially dangerous heat, drought, and other extreme weather makes sense, said Health and Human Services Secretary Xavier Becerra on a visit to Sacramento, California, in early April.

Becerra said the Biden administration wants states to experiment with how best to improve patient health, whether by keeping someone housed instead of homeless, or reducing their exposure to heat with an air conditioner.

But Medicaid’s expansion into social services may duplicate existing housing and nutrition programs offered by other federal agencies, while some needy Americans can’t get essential medical care, said , director of the Medicaid and Health Safety Net Reform Initiative at the Paragon Health Institute.

“There are intellectually disabled people in the United States waiting for Medicaid services. They’re on a waitlist,” said Alexander, who oversaw state health agencies in Pennsylvania and Rhode Island. “Meanwhile Medicaid has money for housing and food and air conditioners for recipients. Seems to me that we should serve the intellectually disabled first before we get into all of these new areas.”

Scientists and public health officials say climate change poses a growing health risk. More frequent and intense floods, droughts, wildfires, extreme temperatures, and storms cause more deaths, cardiovascular disease from poor air quality, and other problems, according to the federal government’s .

The mounting health effects disproportionately hit low-income Americans and people of color, who are often covered by Medicaid, the state-federal health insurance program for low-income people.

Most of the 102 Oregonians who died during the deadly heat dome that settled over the Pacific Northwest in 2021 “were elderly, isolated and living with low incomes,” according to a , which administers the state’s Medicaid program, with about . The OHA’s analysis of urgent care and emergency room use from May through September of 2021 and 2022 found that 60% of heat-related illness visits were from residents of areas with a median household income below $50,000.

“In the last 10-plus years, the amount of fires and smoke events and excessive heat events that we’ve had has shown the disproportionate impact of those events on those with lower incomes,” said Dave Baden, the OHA’s deputy director for programs and policy.

And, because dangerously high temperatures aren’t common in Oregon, many residents don’t have air conditioning in their homes.

Traditionally, states hit by natural disasters and public health emergencies have asked the federal government for on back-up power, air filters, and other equipment to help victims recover. But those requests came after the fact, following federal emergency declarations.

Oregon wants to be proactive and pay for equipment that will help an estimated 200,000 residents manage their health at home before extreme weather or climate-related disaster hits, Baden said. In addition to air conditioning units, the program will pay for mini fridges to keep medications cold, portable power supplies to run ventilators and other medical devices during outages, space heaters for winter, and air filters to improve air quality during wildfire season.

In March, the Oregon Health Plan, the state’s Medicaid program, began asking health insurers to who might need help coping with extreme weather. Recipients must meet federal guidelines that categorize them as “facing certain life transitions,” a stringent set of requirements that disqualify most enrollees. For example, a person with an underlying medical condition that could worsen during a heat wave, and who is also at risk for homelessness or has been released from prison in the past year, could receive an air conditioner. But someone with stable housing might not qualify.

“You could be in a housing complex, and your neighbor qualified for an air conditioner and you didn’t,” Baden said.

At the offices of insurer AllCare Health in Grants Pass, Oregon, air conditioners, air filters, and mini fridges were piled in three rooms in mid-April, ready to be handed over to Medicaid patients. The health plan provided equipment to 19 households in March. The idea is to get the supplies into people’s homes before the summer fire season engulfs the valley in smoke.

Health plans don’t want to find themselves “fighting the masses” at Home Depot when the skies are already smoky or the heat is unbearable, said Josh Balloch, AllCare’s vice president of health policy.

“We’re competing against everybody else, and you can’t find a fan on a hot day,” he said.

Oregon and some other states have already used Medicaid money to buy air conditioners, air purifiers, and other goods for enrollees, but not under the category of climate change. For example, to help asthma patients and New York to provide air conditioners to asthma patients.

Baden said Oregon health officials will evaluate whether sending air conditioners and other equipment to patients saves money by looking at their claim records in the coming years.

If Oregon can help enrollees avoid a costly trip to the doctor or the ER after extreme weather, other state Medicaid programs may ask the federal government if they can adopt the benefit. Many states haven’t yet used Medicaid money for climate change because it affects people and regions differently, said Paul Shattuck, a senior fellow at Mathematica, a research organization that has surveyed state Medicaid directors on the issue.

“The health risks of climate change are everywhere, but the nature of risk exposure is completely different in every state,” Shattuck said. “It’s been challenging for Medicaid to get momentum because each state is left to their own devices to figure out what to do.”

A California state lawmaker last year introduced legislation that would have required Medi-Cal, the state’s Medicaid program, to add a climate benefit under its existing social services expansion. The program would have been similar to Oregon’s, but , by Assembly member Lisa Calderon, died in the Assembly Appropriations Committee, which questioned in a whether “climate change remediation supports can be defined as cost-effective.”

The cost savings are clear to Kaiser Permanente. After the 2021 heat wave, it sent air conditioners to 81 patients in Oregon and southwest Washington whose health conditions might get worse in extreme heat, said Catherine Potter, community health consultant at the health system. The following year, Kaiser Permanente estimated it had prevented $42,000 in heat-related ER visits and $400,000 in hospital admissions, she said.

“We didn’t used to have extreme heat like this, and we do now,” said Potter, who has lived in the temperate Portland area for 30 years. “If we can prevent these adverse impacts, we should be preventing them especially for people that are going to be most affected.”

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