Over the past two weeks, British Columbians have revisited the deadly heat wave that blanketed the province and much of western North America in 2021.
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Now that a “Super El Niño” weather pattern has developed in the Pacific Ocean, heralding the end of a hotter and drier-than-usual summer in the region, the question is whether we are prepared for similar extreme temperatures.
The answer is no, according to doctors, nurses and emergency workers who warn the state is putting people at risk of death or injury in the extreme heat.
Members of the Canadian Association of Environmental Physicians and the Canadian Environmental Nurses Association celebrated the fifth anniversary of the 2021 Heat Dome on June 29 and reflected on how the province remains at high risk for heat-related injuries and deaths.
Health experts have warned that not enough is being done to protect the province’s most vulnerable people, while B.C. continues to use and produce fossil fuels that will worsen climate change and future heatwaves.
Governments at all levels have been criticized for not divesting from fossil fuels, including the City of Vancouver’s recent decision to allow new homes to be built with gas heating.
“We know that higher emissions mean higher temperatures, and higher temperatures mean higher deaths,” CAPE member Tim Takaro, professor emeritus of health sciences at Simon Fraser University, said at the event.
As experts have warned, extreme weather continues in other temperate regions, giving British Columbians a stark reminder of what’s at stake.
This week, France was hit by its third heatwave of the year. The second began in mid-June, reaching unprecedented temperatures and causing at least 1,000 excess deaths. A heatwave in France in 2003 caused at least 15,000 excess deaths.
France and British Columbia are comparable because both have large numbers of low-income people who can’t afford to cool their homes, and governments continue to encourage emissions of climate-changing gases, Takaro said.
Looking at France this summer, B.C. needs to do more to ensure it’s prepared for the next heat event, Tacoro added.
Dr. Melissa Rehm, a Vancouver family physician and past president of CAPE, said “some progress” has been made in strengthening the province’s heat alert response system, identifying people at risk and setting up cooling centers, but those responses are limited to those with physical access.
“There’s really no real statewide mechanism to get people into cooling centers if they’re isolated, if they’re elderly, if they have mobility issues,” Lem says.
Dr. Jay Slater, a family physician and home care provider for frail seniors, added that hospitals are now better prepared for extreme heat and the public is better informed about the signs of burn injuries.
But it won’t help those most vulnerable to extreme heat, such as those living in Vancouver’s Downtown Eastside.
He fears people in the area will be “well-represented” as future casualties because of the high concentration of highly vulnerable people who are often plagued by drug use and mental illness, live in poor quality housing and streets that trap heat, and have limited access to shaded green spaces.
A 2024 study from the BC Center for Disease Control found that poverty and chronic conditions such as schizophrenia, chronic obstructive pulmonary disease, heart failure and substance use disorders significantly increase the risk of injury and death during heat.
During the 2021 Heat Dome, Slater said he made house calls to the buildings housing private rooms within the DTES. Fortunately, the patient was able to breathe again with a rehydration drink and survived.
“I’ll never forget the smell of that place and the stifling heat,” he said. “It was a terrible situation.”
Slater was limited to assisting with cooling procedures and helping people stay hydrated, but was unable to drive patients to the hospital or start IVs at home.
“As a health care provider, it’s really hard not being able to do anything,” he says.
At the 2021 Heat Dome, emergency workers felt similarly overwhelmed and helpless.
David Hollingworth, British Columbia’s director of environment and climate change and a paramedic and ambulance paramedic, said he has seen many deaths from cardiac arrest in the heat dome when elderly people lived alone in hot, cramped apartments.
If a patient cannot be resuscitated, paramedics are supposed to call the police, who then take over the call.
But he said there are so many emergency calls inside the Heat Dome that it could take hours for police to arrive, and emergency workers could be further tied up.
“These are times when emergency calls cannot be responded to, and this was just one of the situations where the system collapsed during this emergency,” he said, adding that paramedics in some of the state’s hottest regions responded to more than 11 cardiac arrest deaths in a single shift.
To better protect society’s most vulnerable, states need to keep people’s homes cool.
Emily Wang, a medical student at the University of British Columbia and president of CAPE, said health is shaped by the conditions people live in, including how isolated they are, what support they have access to, and how cool and safe their housing is.
If someone lives with a mental illness, cognitive impairment or social isolation, it can be much more difficult to recognize the dangers of extreme heat, seek help and move to a cooler location, she added.
“Our response cannot depend on telling individuals to be more prepared, because being prepared depends on whether a person has money, whether they have transportation, whether they have access to a car, whether they have a variety of living spaces, whether someone is checking in with them,” Wang said.
He added that governments at all levels need to ensure that people have access to safe indoor temperatures and practical cooling support, so that emergencies can connect people to active support before they reach crisis point.
New Westminster is the only municipality in the state with an updated ordinance requiring homeowners to keep at least one room at or below 26 degrees Celsius.
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The BC Building Code requires all new homes to be built to its standards, but excludes older buildings.
The new Westminster Bylaw applies to building owners and landlords, not tenants, and is not mandatory. That is, cooling may be provided by shade, air conditioning, or heat pumps.
“This directly meets a need that we have identified in that we know that it is older rental properties that experience deadly heat and that people inevitably die during heat events,” said Nadine Nakagawa, New Westminster City Council member and sponsor of the heat restriction ordinance.
Nakagawa said 33 people died in her city during the heat dome.
Most of these deaths occurred in the Brow of the Hill area, which has the lowest percentage of tree cover, the lowest incomes and the highest number of elderly and disabled people, she said.
Adding to that tragedy is how many people are following COVID-19 safety protocols, isolating at home and avoiding cooling facilities, she said.
Vancouver City Councilors Pete Fry and Sean Orr attended the event.
Vancouver could be a leader in addressing climate change, but it’s actually lagging behind, and that’s embarrassing, Orr told The Tyee.
The ABC City Council also had a majority and canceled $8 million in climate change grants. Voted against funding cooling kits for people in the Downtown Eastside. Eliminated the climate justice table. and eliminated the West End water park, he said.
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ABC’s recent austerity budget also means it’s unclear whether there will be enough money to restore tree canopies and create green space in areas like the Downtown Eastside that could help cool during the next heat wave.
On the positive side, Orr said ABC councilors Lisa Dominato and Peter Meisner are seeking the state’s authority to set maximum indoor temperatures. Or and Coun. Lucy Maloney imposed fines on landlords who banned air conditioning. And the city approved a grant to improve SRO cooling.
Orr said heatwaves are deadly in Vancouver because of inequality.
From 2023 to 2025, the number of Vancouver residents without housing increased by 12% to 2,715.
Orr said numbers like these don’t mean Vancouver is prepared for a heat wave. 
