In North and South Carolina, sea-level rise is most noticeable in counties along the coast, where beaches shrink, dunes disappear and homes crumble, but the effects of climate change reach well inland. “Beyond the Beach” is a seven-part series examining the health toll that climate change is already taking on the people who live and work in the Carolinas.
The project is a partnership of The News & Observer in Raleigh, North Carolina, The State in Columbia, South Carolina, Columbia Journalism School and the Center for Public Integrity. Funding support for “Beyond the Beach” came from the Pulitzer Center on Crisis Reporting. Columbia Journalism Investigations, an investigative reporting unit at the Columbia Journalism School, also contributed to the project. Funding for CJI comes from the school’s Investigative Reporting Resource and the Energy Foundation.
When Charmain and Tony Hunt tried to turn on the air conditioning in their newly purchased Lumberton mobile home in May, hot air came out.
A few weeks, two technicians and $375 later, the air conditioning was working again. But in the meantime, the Hunts experienced what it is like to go without air conditioning in rural North Carolina.
“When you walked in the door, you could feel the heat,” Charmain Hunt said in an interview. “It was like you were literally walking into an outdoor experience on a hot summer day.”
The temperature inside frequently reached 85 degrees Fahrenheit without the air on. After spending 15 or 20 minutes inside the warm house, Charmain would develop a light headache that would eventually turn into a dull throb.
“We started just leaving the house and riding around, even if it was just riding to Walmart, walking around Walmart, where I could stay cool,” Charmain said.
While many people first associate heat illness with urban areas, state health officials believe high temperatures are also a major threat in rural parts of the state. The Sandhills region sees a higher rate of heat illness per capita than any other part of the state, even though the Piedmont and coastal regions have higher total numbers of heat illness cases.
When Lauren Thie, the N.C. Department of Health and Human Services’ heat prevention coordinator, was figuring out where to focus heat prevention efforts through a grant from the Centers for Disease Control and Prevention, she settled on counties in and adjacent to the Sandhills, specifically Bladen, Robeson, Sampson and Scotland.
Each county focuses its effort on a different group of people. In Bladen, outreach is geared toward farmworkers. In Robeson, it’s people living in mobile homes. Sampson focuses on older adults living at or near the poverty line, and Scotland on kids playing youth sports.
“For the population in these counties, it’s a really disproportionate number of people getting sick from heat,” Thie said, though heat danger does still exist in urban areas.
In a 2018 paper, Thie specifically pointed to living in a mobile home, being a non-citizen or working in agriculture as risk factors for heat illness in rural parts of the state.
“We think there’s some overlap between occupational exposure, and then, because people are earning low wages, that they don’t have access to housing or income that will allow them to pay for adequate cooling in their homes,” Thie said.
Global warming will likely require residents of North Carolina’s Coastal Plain to purchase more energy to keep their homes cool. According to the N.C. Climate Science Report, the region’s annual average temperature was above the long-term 61-degree Fahrenheit average in 16 of the first 18 years of the 21st century.
North Carolina climate scientists used two global greenhouse gas emissions scenarios to project forward. RCP 4.5 is forecasted to see global temperatures rise about 2.5 degrees Fahrenheit by midcentury, while RCP 8.0 would see an increase of about 3.6 degrees.
Among the ways scientists measure the impact of these scenarios is a metric called cooling degree days, which tries to capture how much energy it will take to cool homes and buildings. Cooling degree days counts the number of degrees a day’s average temperature is above 65 degrees Fahrenheit, so a day where the temperature averages 90 degrees Fahrenheit would count as 35.
According to the Climate Science Report, the number of annual cooling days statewide has steadily increased since 1970, with the 10-year moving average of annual “days” climbing from about 1,200 to nearly 1,600.
By the middle of this century, RCP 4.5 would mean at least 500 more “cooling days” each year for residents of Bladen, Robeson and part of Scotland counties, according to the N.C. Climate Science Report. RCP 8.0 would lead to an annual increase of 800 “cooling days.”
Heat Illness Can Happen To Anyone
Kathie Cox remembers a hot day in the summer of 2018 when she went to an exercise class, walked her dog for a least two miles and then decided to mow her lawn. She thought it was alright because the temperatures were in the upper 80s with a breeze.
By 8 p.m., Cox wrote in a column later published in the Laurinburg Exchange, she was suffering tell-tale signs of heat exhaustion and needed her daughter to come help.
“I know all too well it can happen to even the most informed person,” Cox said in an interview. She is a heat health educator and heat prevention specialist at the Scotland County Health Department. In that role, Cox is in charge of Scotland County’s involvement in DHHS’ Implementation and Monitoring Strategy for Heat-Related Illness program.
It was Cox, working with DHHS and other Sandhills-area health officials, who decided that the focus on heat health in Scotland County should be on kids playing sports and senior citizens in the county, two groups who are particularly vulnerable.
To help, Cox has provided high school and youth football coaches with information about heat illness and made sure that they know to keep players hydrated and get them shade if they’re beginning to feel heat exhaustion.
“I want to make sure (coaches) are aware and just reminding them to be on the lookout for it and be aware,” Cox said, “because a lot of times you can get sidetracked and kids don’t want to tell you they’re not feeling good in front of their peers.”
Outreach efforts began in 2017, Cox said, and while they have stalled during the COVID-19 pandemic, a pamphlet about heat illness is slipped into a promotional bag that some people receive after being tested at the health department. In more normal times, the health department visits churches that have older congregations and gives out hand fans with heat health information printed across them.
Thie said that Manos Unidas, a farmworker health program, has taken the lead for heat health education among the seasonal farmworkers in Bladen County, while Sampson gave its nutritional support staff training on heat illness.
The DHHS heat health staff have developed a training program that has been used in all four counties, Thie said. The program emphasizes that people should drink more fluids when it’s hot out, decrease activity in the afternoon, spend some time in a cool space and be aware of the impact medications could have on dehydration.
And while the program is focused on days when high temperatures reach 100 to 105 degrees Fahrenheit, Thie acknowledges that much of the state’s heat illness happens at lower temperatures.
“When I’m outside on a 105-degree day, it feels extraordinarily hot,” Thie said, “but we have a lot of days where the heat index is in the 90s and it can also be dangerous, especially if you’re a farmworker and exerting yourself outside.” The heat index measures the combined impact of temperature and humidity.
Climate Change as Threat Multiplier
Maggie Sugg’s 2015 doctoral dissertation focused on where and when North Carolina residents had to go to the emergency room because of heat illness.
The paper covers five full years of emergency room data, from January 2007 through December 2011. During that time, the 10 counties with the highest per capita rates of emergency department visits for heat-related illness were all rural, including Bladen and Robeson counties.
Each of the 10 counties had rates of at least 137 visits per 100,000 people over the five-year period.
“Heat-related illness is commonly found in rural areas,” Sugg, an Appalachian State medical geographer, said in an interview with The News & Observer. “It’s traditionally considered an urban problem due to the urban heat island effect, but due to underlying vulnerability and the makeup of the population, we’re seeing greater heat illness in the rural areas.”
Sugg also found that much of heat-related illness was happening around 95 degrees Fahrenheit, with fewer people getting sick when the thermometer reached 100.
“I think with those triple-digit numbers, people take that seriously and they stay indoors,” Sugg said.
Outdoor workers on three university campuses restructured their work days if the National Weather Service issued a heat advisory, according to a follow-up study conducted by Sugg and Jennifer Runkle. The NWS issues heat advisories when the heat index is expected to reach 100 degrees Fahrenheit.
“The risk of excess heat strain was occurring during those warm but not too warm temperatures,” Runkle, an environmental epidemiologist at the N.C. Institute for Climate Studies, said in an interview.
Both Runkle and Sugg said that climate amplifies existing vulnerabilities. For instance, in her dissertation, Sugg hypothesized that poorly insulated housing and mobile homes in rural areas could be contributing to increased heat-related illness in certain parts of the state.
Vulnerabilities that seem unrelated to climate change are, Runkle said, frequently heightened by the reality of living on a warming planet.
Calling climate change a “threat multiplier,” Runkle said, “If you you live in an under-resourced housing development that doesn’t have a lot of urban tree canopy and you don’t have the resources to perhaps use your (air conditioning) for the duration of the day that you need it, these increasing temperatures are going to exacerbate that social vulnerability that already exists.”
‘It Made Me Feel Sickened’
The three-bedroom, two-bath doublewide is the first home Charmain and Tony Hunt have purchased together. They bought it from Time Out Communities, which owns many of the mobile home parks around Lumberton. Time Out purchased the parks after Hurricane Florence, the Associated Press reported, ultimately buying more than 1,200 of the roughly 1,400 mobile homes in Robeson County.
Each month, the Hunts pay a $465 rental fee for their Abbott Park lot and a $233 mortgage payment for the trailer itself.
Charmain said that a company representative told the Hunts they would inspect the trailer before the sale, but a spokeswoman for Time Out disputes that. When selling homes, Time Out does not conduct inspections of used homes it is selling, the spokeswoman wrote in an email, and buyers are allowed to hire their own inspector to check the systems on a home. The Hunts did not hire an inspector.
A Time Out technician did service the air conditioning unit on May 2, the company spokeswoman wrote, adding freon and running it. Typically, Time Out would charge $110 for the service, but performed it as a “courtesy.” The company does not have any records indicating further contact about the air conditioning unit, the spokeswoman wrote.
But Charmain Hunt said that she called Time Out to ask about the faulty air conditioning unit in mid-May, hoping the company would waive the lot rental fee for a month to help offset the cost of repairs. She recalled a company representative saying Time Out could replace the unit, but the Hunts would have a third monthly bill until they paid off the cost of repairs.
“It made feel sickened,” Charmain said. “OK, you’re not getting headaches from being in a house that’s heated. After I’ve worked all day, I have to come home and deal with heat.”
If repairs need to be made within days of a buyer purchasing a used home from Time Out, the spokeswoman wrote, the company will “work with the owner to take care of it.” But, she added, the buyer will be responsible for repairs if something fails within weeks or months of purchase.
Had the home been a rental, Charmain said, she could ask a landlord to make repairs and at least have the option to leave. But because the home was purchased, they had no choice but to make the repairs.
“We felt very restricted,” Charmain said.
So Charmain, a medical technician who mostly works with patients with dementia, picked up some overtime. And Tony tacked some Saturday shifts onto his normal schedule on the deboning line at the nearby Sanderson Farms chicken plant.
While they built up the funds, the couple bought two tall oscillating fans, switching them on around bedtime and opening all of the windows in an effort to bring the temperature down at least a little bit. They also filled bags with ice and tried to use them to stay cool. They did not do any cooking, either eating takeout or making sandwiches at home.
“I did my best not to try to complain because I knew my husband and I were doing the best we could do,” Charmain said.
The faulty unit is repaired now, and the Hunts plan on staying in the mobile home and making it theirs.
“We’re just praying for no more little hiccups,” Charmain said.
This story is part of the Pulitzer Center’s nationwide Connected Coastlines reporting initiative. For more information, go to pulitzercenter.org/connected-coastlines.
This reporting was also financially supported by Report for America/GroundTruth Project, The North Carolina Local News Lab Fund of the North Carolina Community Foundation, Dogwood Health Trust, Solutions Journalism Network and more than 700 individual contributions. The News & Observer maintains full editorial control of the work. To support the future of this reporting, subscribe or donate.