This Time Was Different

This post is by Rose Jones, PhD, Medical Anthropologist

I was preparing a lecture on extreme heat, public health, and human rights for first-year medical students when Trump’s Executive Orders came crashing down in January 2025. It was a talk I had given many times, but this time was different.

The scale of what was unfolding was unprecedented. There was no historical roadmap, no institutional memory, or collective lived experience to draw from. The air felt heavy; the mood was somber, uncertainty loomed. In those early days only one thing was certain: a seismic shift had occurred. And yet, on the medical campus, it was business as usual. Lectures proceeded without acknowledgment of the crisis. Meetings followed pre-set agendas. Institutional review board applications were submitted on time. Black History Month celebrations were in full swing even as the very foundations of healthcare, science, and research were being dismantled around us.   

Social historians were quick to point out that this collective response was by design, the intended outcome of the “shock and awe” strategy deployed by the Trump administration. The goal was to overwhelm resistance, paralyze opposition, and rapidly restructure the federal government before meaningful dissent could take root. Although this explanation rang true, it did little to resolve my own conflict. Should I follow my colleagues’ lead and deliver the lecture unchanged? Or should I integrate the crisis into the lecture? And if so, to what extent? The lecture was already bleak.

Even before Trump’s assault on healthcare, the intersection of extreme heat, public health, and human rights was already on life support. Few healthcare educators, providers, researchers, scientists, or policymakers prioritized heat as a public health issue. Even fewer addressed the humanitarian crisis it engendered. Historically framed as an infrastructure and energy problem, the medical community was slow to respond to extreme heat. As a result, heat had been sidelined in public health, leaving countless communities without the resources, knowledge, or tools needed to navigate an increasingly hot planet.

Research has long shown that when temperatures spike so do rates of cardiovascular disease, respiratory conditions, pregnancy complications, depression, anxiety, substance abuse, crime, and domestic violence. Heat stresses every system in the human body and is the number one health and death threat from climate change. Nonetheless, heat is all too often an afterthought in medical training, patient care, epidemiological surveillance, and public health outreach. In 2021, the World Health Organization declared climate change to be the single greatest health threat facing humanity. Still fewer than 25% of medical schools have integrated climate health into their curricula. Those that do typically relegate it to electives rather than treating it as a core component of medical education.

Each summer, extreme heat results in more than $1 billion in healthcare costs across the United States, driven by increased emergency department visits and hospital admissions. Despite this significant financial burden, screening for heat exposure is not a standardized component of patient care, leaving vulnerable groups at heightened risk for heat-related illnesses and fatalities. Meanwhile, public health outreach efforts, ranging from cooling centers to financial assistance for utility bills and low-cost air conditioners, are available on a precarious and inconsistent basis. This is particularly troubling given the scientific consensus that heat will become more intense and more frequent for prolonged periods of time, with ambient temperatures on track to rise 3 to 6°F by 2050.

Public health campaigns on extreme heat are flawed and largely ineffective. Heat messaging tends to be generic with recycled content offering one-size-fits-all solutions. The directive to “stay hydrated” is neither culturally informed nor aligned with basic health literacy guidelines. Similarly, recommendations to “avoid outdoor activities” and “stay in an air-conditioned area” are unrealistic for many at-risk groups, including outdoor workers, unhoused populations, and those living in poverty. The complex ways in which diverse ethnomedical systems mediate extreme heat, combined with the socioeconomic dynamics of living in at-risk communities, remains largely unexamined in public health research. 

Evidence-based medicine has essentially failed to be applied to extreme heat. Heat-related mortality and morbidity data are scattered, fragmented, and often inaccurate, making it nearly impossible to measure or track the true toll of heat on human health.  There are no standardized criteria for documenting heat-related illnesses and deaths, and protocols for reporting and sharing data are inconsistently applied. Even ICD codes—the universal system for classifying medical diagnoses—fail to capture the complex and nuanced ways heat affects the human body.

When human rights enter the equation, the picture grows even bleaker. Extreme heat is no longer just an invisible public health crisis. Heat has been weaponized and transformed into a full-blown humanitarian crisis. From prisons to workplaces to the U.S.-Mexico border, heat is increasingly used as a tool of oppression. U.S. prisons are a case in point. Across multiple states, including Texas, Louisiana, and Arizona where summer temperatures regularly soar into the triple digits, incarcerated individuals are confined in spaces without air conditioning, proper ventilation, or in some cases adequate access to water. Under these conditions, the health, safety, and dignity of inmates, who are disproportionately Black, Indigenous, and poor, are unnecessarily and inhumanely put at risk.

American workers provide another stark example of how extreme heat, public health, and humanity have collided. Despite overwhelming empirical evidence of the dangers posed by extreme heat, there are still no federal workplace protections in place. As a result, millions of workers, particularly those in agriculture, construction, and manufacturing, are unnecessarily put at increased risk for heat-related illness, injury, and death. Even more troubling, some states have intentionally eliminated existing heat protection laws. Texas, which leads the nation in heat-related workplace deaths and is the deadliest state for Latino workers, recently eliminated critical life-saving protection for workers. In September 2023, House Bill 2127, known locally as the “Death Star Law,” struck down local ordinances in Austin and Dallas that required construction workers to receive 10-minute water breaks every four hours. Florida followed suit in 2024 with similar legislation. How this will play out under the Trump administration that openly prioritizes “profits over people” is deeply concerning.

Then there is the border. In July 2023, amid record-breaking temperatures, a medic stationed near Eagle Pass, Texas, reported that the Texas Department of Public Safety had instructed troopers to withhold water from migrants, including families with young children. In such extreme conditions, this is tantamount to a death sentence. Deeply disturbed, the medic went public, stating that the directive had crossed a moral line into inhumanity. He was right.  Heat is no longer just an invisible public health crisis; it is also now an invisible humanitarian crisis.

These were the issues I wrestled with as I pondered how to frame my lecture. As a medical anthropologist, I knew that a holistic, real-world perspective was essential for students to grasp the complex, nuanced and evolving intersections of extreme heat, public health, and human rights. But medical education is, by design, reductionist. Students are trained to synthesize vast amounts of biomedical research, clinical data, and patient histories into discrete categories of information that can be used to generate differential diagnoses. While this approach is effective for understanding the biophysical dimensions of disease, it often obscures the deeper sociocultural forces that shape patients’ lives, including the environmental determinants of health. I have found that patients’ lives rarely fit neatly into diagnostic boxes. The sociocultural dimensions of health require a different kind of lens, one that embraces holism and ambiguity. And when it comes to understanding the impact of heat on human health, that lens must also be grounded in empathy and humanity.

I ultimately chose to anchor the lecture in the crisis at hand, even though this made the narrative darker and more contentious. Climate scientists have long emphasized the importance of optimism in messaging, arguing that it sustains engagement, drives action, and prevents climate action paralysis. Over the years, this ethos has taken different forms ranging from “constructive hope” to “earth optimism” and more recently, “apocalyptic optimism.” The directive has, however, remained constant: create hope, no matter how dire the prognosis.

I had encountered this insistence on “hopeful messaging” before. Years earlier, while rounding at a public hospital with clinical teams, I watched attendings teach residents and interns how to deliver bad news to patients. The approach was rote and sterile: keep the information minimal, the tone reassuring, the message hopeful—even when survival is unlikely. I had always been skeptical of this Panglossian approach to patient care.

In the end, I found hope in my unhopeful lecture. The students’ reactions were measured and sober. But rather than ending in despair, the lecture evolved into something unexpected. Together, we discussed what it would take for the next generation of physicians,  namely them, to make extreme heat a public health priority. What would this rebuild look like in academic medicine? What new visions, curricula, preceptorships and collaborations would be needed to drive meaningful, enduring change?

This time was different.