Disparities in Access to Air Conditioning And Implications for Heat-Related Health Risks

Summary

June 2024 marked the 13th-consecutive month of record-breaking high temperatures. In early July 2024, the Eastern and Central regions of the U.S. experienced a record breaking heat wave, that exposed more than 200 million people to 90 degree Fahrenheit weather for more than seven days. As of mid-July, 37 people were suspected to have died from heat-related causes, however this is likely an undercount. As temperatures continue to rise and extreme heat events become more frequent in the U.S., people of color and other underserved communities are likely to be disproportionately affected due to increased exposure to heat and more limited access to air conditioning.

This brief examines disparities in access to air conditioning in the home by race and ethnicity and income and discusses the implications for heat-related health risks, including heat-related mortality. It is based on KFF analysis of data from the Residential Energy Consumption Survey, a nationally representative household survey. The survey asks respondents about how energy is utilized in their home, such as powering air conditioning units, while also collecting demographic and local weather information. Temperature in the respondent’s region is estimated from weighted temperatures of nearby weather stations.

Overall, this analysis shows that Asian-, Black-, and Hispanic-led households are more likely to report not having an air conditioning unit in their home compared to White households and keeping their homes at unsafe or unhealthy temperatures. Black- and Hispanic-led households are more likely than Asian- and White-led households to report being unable to use their air conditioning units due to financial challenges and to say they reduced or went without basic needs due to their home energy bills in the past year. Lower income households also are more likely than higher-income households to report these challenges.

More limited access to air conditioning contributes to disproportionate exposure to extreme heat and the development of heat-related illnesses, including death. As extreme heat worsens, strategies to increase access to residential air conditioning units and reduce exposure to extreme heat will be important for reducing the health risks associated with heat-related illnesses and mitigating disparities in these risks and negative health outcomes.

Access to and Use of Air Conditioning

People of color and those with lower household incomes are more likely to say they lack air conditioning than their White and higher income counterparts. In total, over 35 million people in the US report living in a household without an air conditioner, including almost 5 million people with a Black head of household, 6.2 million people with a Hispanic head of household, 3.6 million people with an Asian head of household, and 19.2 million people with a White head of household. One in five (21%) Asian-led households and about one in seven Black (15%) and Hispanic (14%) households do not have air conditioning equipment compared to one in ten (10%) White households. In addition, 17% of households with lower incomes (annual household income of less than $25,000) say they lack air conditioning compared to 8% of households with higher incomes (annual household income of $75,000 or more) (Figure 1). These disparities in access to air conditioning by race and ethnicity and by household income persist when limited to regions with above-average temperatures (see Appendix A), where 7% of households overall lack access.

Black and Hispanic households and those with lower incomes are more likely to report not using their air conditioners due to financial challenges compared to White and higher income households. Overall, 5% of households say they were unable to use air conditioning equipment in the past year because their equipment broke and they couldn’t afford to replace it, or their equipment was shut off because they were unable to pay their bills (Figure 2). This includes about one in ten Black (11%), Hispanic (9%), and lower income households (10%) compared to 4% of White households and 2% of higher income households. These disparities persist even in regions with above-average temperatures, where 7% of households say they were unable to use air conditioning equipment due to these reasons.

People of color and those with lower household incomes are more likely to say they keep their homes at temperatures they identified as unsafe or unhealthy than their White and higher income counterparts. Overall, one in ten households say they kept their homes at unhealthy temperatures at least once in the past year. This share was higher among Black (17%), Hispanic (17%), and Asian (12%) households compared to White households (7%) (Figure 3). One in five (21%) lower income households also say this compared to 4% of higher income households. These disparities persist even in regions with above-average temperatures.

Black, Hispanic, and lower income households also are more likely than White and higher income households to report reducing or foregoing basic needs due to their home energy bills in the past year (Figure 4). About four in ten Black (40%) and Hispanic (37%) households say they had to reduce or forego basic necessities such as medicine or food due to their energy bills in the past year compared to one in seven (14%) White households. Four in ten (40%) lower income households also report this compared to 6% of higher income households. These disparities persist even in regions with above-average temperatures, where almost a quarter (23%) of households say they had to reduce or forgo basic needs due to their energy bills.

Implications for Heat-Related Health Risks

Extreme heat is a serious threat to health and is the leading cause of weather-related deaths in the U.S. An analysis finds that 2023 set the record for the number of heat-related deaths in the U.S., with at least 2,300 death certificates citing the effects of excessive heat as a cause of death. Further, the Centers for Disease Control and Prevention reports that there were 119,605 emergency department visits for heat-related illness in 2023. In 2020, about 660,000 households reported that someone needed medical attention in the past year because their home was too hot.^1,2

While extreme heat has health implications for everyone in the U.S., some communities of color have higher risks of heat-related mortality than White people due to underlying inequities. Consistent with trends in earlier years, between 2018-2022, American Indian or Alaska Native people had the highest age-adjusted heat-related death rate, and Black people had a higher rate of heat-related deaths compared to White people. The rate for Hispanic people was more similar to that of White people, while Asian people had a lower age-adjusted rate of heat-related death (Table 1).[1] Data also show that noncitizens are more likely to die from heat exposure compared with U.S. citizens. These higher mortality risks reflect increased exposure to heat due to underlying inequities. Historical policies such as redlining have led to the residential segregation of communities of color who have a higher likelihood of living in a census tract with higher summer daytime surface urban heat island intensity compared to their White counterparts. Communities that live in these historically zoned areas are also more likely to have higher rates of asthma, cardiovascular illnesses, and other diseases that increase their risk of poor health outcomes associated with exposure to climate change-related extreme heat and air pollution. Low-income communities and communities of color also suffer from tree inequity, increasing the risk of exposure to extreme heat and subsequent heat-related illnesses.

As temperatures continue to rise, U.S. power grids may be unable to support the surges in energy use due to increases in air conditioning usage during heat wave events. Power outages that are considered medically relevant—lasting more than 8 hours and outlasting the lifespan of most medically necessary devices— tend to most frequently happen during the spring and summer months. They also tend to occur during severe weather or climate events, and during times of high electricity usage. These power outages can leave people without air conditioning or heating for extended periods of time, potentially increasing the risk of adverse health outcomes. In November 2023, the Biden-Harris administration announced up to $3.9 billion to strengthen the country’s electric grid’s resilience and reliability against climate change and extreme weather events.

As extreme heat worsens, strategies to increase access to residential air conditioning units and reduce exposure to extreme heat will be important for reducing the health risks associated with heat-related illnesses and mitigating disparities in these risks and negative health outcomes. There have been efforts to increase access to air conditioning units, which have played an important role in reducing heat-related deaths. In 2023, the Biden-Harris administration released about $3.7 billion in Low Income Home Energy Assistance Program (LIHEAP) funding that helps families sustain safe and healthy indoor temperatures. LIHEAP funds can also help households pay for energy bills and help them stay cool during the summer through the LIHEAP Cooling Assistance Program. In June 2024, the U.S. Department of Housing and Urban Development (HUD) announced new guidance on the use of HUD funding to reduce the impacts of extreme heat on residents of public housing. The guidance seeks to reduce the energy costs associated with cooling their homes during heat waves by increasing utility allowances and forgoing surcharges for the use of air conditioning for residents. HUD and the U.S. Department of Agriculture also announced the adoption of minimum energy standards for new single-family and multi-family unit homes that will reduce energy use and maximize energy cost-savings for residents. Continued efforts to address rising temperatures, reduce risks of heat exposure, and increase protections for those most at-risk for heat exposure will be important for reducing negative health impacts due to extreme heat, particularly for groups who already face disparities in exposure to heat and health risks.

Methods

This analysis was conducted using data from the Residential Energy Consumption Survey, conducted by the U.S. Energy Information Administration. It is administered to a nationally representative sample of housing units. Both web and mail forms were utilized in survey implementation. 18,500 households were surveyed from a survey population of 123.5 million primary residences. The survey respondent was identified as head of the household, and all demographic questions were asked only of that respondent. For example, in the instance of a household with people of different races, the recorded race and ethnicity is only the race or ethnicity of the respondent, not any other member of the household. Analysis was conducted in R using the survey package. Survey design was implemented based on analysis by Anthony Damico. Above average temperatures are defined as places with cooling degree days greater than or equal to the median (1143). Cooling degree days (CDD) are calculated by taking the 30-year average temperature (between 1981 and 2010) from the nearest weather station to the respondent and inoculating it with random errors. This measurement is defined as a summation of the difference between 65 degrees Fahrenheit and a day with a mean temperature above 65 degrees Fahrenheit for every day during a given year. For example, if the mean temperature is 80 degrees, then that day would have a cooling degree day value of 15. This measure identifies places that have both consistently high temperatures, and those with days much hotter than 65 degrees. Another explanation is if a region has the same number of cooling degree days as the median (1143), this could be equivalent to that area’s average daily temperature being 77 degrees Fahrenheit (12 degrees above 65) every day during the summer months. Population totals were scaled to the United States population in 2020 from the Decennial Census. Individuals in group quarters were subtracted from this population to represent individuals in households.

Appendix A

A majority of states (35 states) have households that are in the top 50 percent of hottest places in the U.S. In 2023, the West, South Central, and South Atlantic regions of the United States were identified as places with at least one household with above average heat.³ Some of the hottest states that frequently experience a higher number of Cooling Degree Days (CDDs) than the national average also have high shares of people of color, including Hawaii, which experiences +145% CDDs above the national average and about eight in ten (81%) of its population are people of color, Florida, which experiences +141% CDDs above the national average and about half (49%) of its population are people of color, and Texas, which experiences +92% CDDs above the national average and about six in ten (61%) of its population are people of color. Similar trends are seen in states with the highest shares of people who live below the Federal Poverty Line (FPL), including Louisiana, which experiences +86% CDDs above the national average and Mississippi, which experiences +51% CDDs above the national average and about one in five (both at 19%) of the population live below the FPL (Appendix Figure 1).