2024 Summer Health Report

About this report

Health Effects of Summer Hazards

Higher summer temperatures without access to relief from the heat, and knowledge of precautions can lead to illness, hospitalization, and in severe cases death^[1] ^[2]. When a person’s body is no longer able to regulate internal temperature, they may experience heat-related illness that includes conditions such as heat cramps, heat exhaustion, heat stress, and heat strokes^[3]. Extended periods of extreme heat may also create conditions for other summer hazards that include poor air quality from wildfire smoke and extended allergy seasons, as well as injuries or drowning from recreational water activity while escaping the heat^[4].

Historically, Washington County’s communities had milder summer temperatures with few days over 90°F, and low temperatures that provided sufficient periods of relief without cooling systems. In recent years, however, average annual temperatures and number of days with temperatures over 90° F in the Pacific Northwest have increased. We present Washington County resident’s data on emergency department and urgent care visits for heat-related illness, asthma-like illness, fire and smoke inhalation, seasonal allergies, recreational water exposure, non-infectious respiratory illnesses, and drowning and submersion and non-fatal drowning. The goal of this summer hazards report is to better understand health effects of summer hazards, so we can better prepare, respond, and adapt.

Key Takeaways

The number of heat-related illness emergency department and urgent care (ED/UC) visits during summer months since 2021 has been greater than previous years.
Although Oregon, has historically had mild weather, in recent years there have been at least 12 days annually during summer months where communities faced moderate risk of heat exposure.
When compared with all-cause ED/UC visits, a larger percent of heat-related illness visits are by males, people 65 years and over, and people identifying as white alone.
In each of the past 4 summer seasons, we have lost at least one Washington County resident to drowning, and have had at least 12 ED/UC visits due to drowning and submersion. Most of these visits have been by children.

Methods

Quantitative

Summer Exposure

We report number of days based on categories of heat risk in Washington County, Oregon, from 2018 to 2024, during the summer months of May 1 to September 31).

We report the number of summer season days with different levels of the National Weather Service heat risk. This is a color-numeric-based index that provides a forecast for risk of heat-related impacts to occur over a 24-hour period. It considers:

How usual the heat is for the time of the year
The duration of the heat including both daytime and nighttime temperatures
If those temperatures pose an elevated risk of heat-related impacts based on data from the CDC

More information can be found on the NOAA’s “Understanding Heat Risk” document

We report the Air Quality Index (AQI). The U.S. Air Quality Index (AQI) is EPA’s tool for communicating about outdoor air quality and health. The AQI includes six color-coded categories, each corresponding to a range of index values. The higher the AQI value, the greater the level of air pollution and the greater the health concern.

Good: AQI between 0 and 50
Moderate: Between 51 and 100
Unhealthy for Sensitive Groups: Between 101 and 150
Very Unhealthy: Between 201 and 300
Hazardous: Between 301 and 500

More information can be found on the Air Now’s Air Quality Index (AQI) Basics page

Health Outcomes

We explain how summer hazard weather conditions are related to health emergencies like heat-related illness, asthma, smoke inhalation, non-infectious respiratory illness, seasonal allergies, recreational water exposure injury, and drowning and submersion in each tab.

We describe and analyze emergency department and urgent care (ED/UC) visits from the Oregon ESSENCE - Electronic Surveillance System for the Early Notification of Community-Based Epidemics) from 2018-2024 summer seasons (May 1- September 31) by Washington County residents. For each of the queries, we present:

Annual counts that include average count for the entire period as a reference
Rates of ED/UC query-specific visits among all-cause visits that are ranked by zip code during all 2018-2024 seasons
Comparison of demographic distributions (age, sex, and race/ethnicity) for ED/UC query-specific visits and all-cause visits during 2021-2024 summer seasons that include note of statistically significant differences (p < 0.05) based on chi-square and Fischer tests with a *, and sizeable differences with ^ (absolute difference of 5 percentage points).

This data was updated on July 10th, 2025.

We analyzed mortality data from Oregon Vital Statistics for deaths that happened in Washington County from 2018-2024 and report number of heat-related deaths, respiratory deaths, deaths from drowning, and all-cause deaths by summer season (May 1 to September 31).

Qualitative

A graduate student who is part of our community and has worked closely with groups focused on environmental justice interviewed three people: two community health workers and a director of a local organization.

They each had a 45-minute conversation about their experiences working with the community during extreme weather events. They discussed

Challenges people face
Community resilience in tough situations
Hopes for the future

They identified key experiences and perspectives from these talks. They worked with the county and community to summarize winter-related themes. This community voice spotlight was first presented in our winter report. For this report, we reviewed interview notes that mention summer and heat and summarize key themes and quotes from their lived experiences.

Data details

Daily data on heat risk for Washington County comes from the National Weather Services. The data on Air Quality Index (AQI) comes from the Environmental Protection Agency. Measures of AQI 24-hour averages were taken from all air monitor stations in Washington County, and results from the air monitor with the highest daily index were included in this report.

The number of emergency department and urgent care (ED/UC) visits for heat-related illness, seasonal allergies, asthma-like illness, fire and smoke inhalation, non-infectious respiratory illness, recreational water exposure, and submersion and non-fatal drowning, and all-cause visits came from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Oregon. All visits were by Washington County residents.

Data on deaths came from death certificates from Oregon Vital Statistics from 2018-2024 summer seasons. Deaths described in this report occurred in Washington County and may include non-Washington County residents.

Data in this report are for the months of May-September from 2018-2024 that are referred to as summer months or seasons. Queries used to define health outcomes in this report are detailed in the table below.

Heat-related health indicators and sources

Health Outcomes Surveillance Data
Health Outcome	Data Source	Query Text
Heat-related illness (ED/UC Visits) among county residents	Oregon ESSENCE (Electronic Surveillance System for the Early Notification of Community-Base Epidemics)	Keywords in patient records that suggest heat illness, such as: 'heat stroke', 'heat exhaustion', 'too hot', 'hyperthermia', 'sunstroke', 'heat cramps' and other variations like 'hot' with 'fatigue,' 'exposure,' or 'cramps.' ICD 9 and 10 Codes: T67, 992
Seasonal Allergies (ED/UC visit) among county residents	Oregon ESSENCE	Keywords in patient records that suggest seasonal illness, such as: Any mention of 'allergy' or 'allergies' This helps identify patients who might be reacting to pollen, dust, or seasonal environmental allergens (e.g., grasses, trees, weeds).
Asthma-like illness (ED/UC visit) among county residents	Oregon ESSENCE	Keywords in patient records include: 'asthma' (including misspellings like 'asma,' 'asthmae,' 'asthmia'), 'bronchospasm' (tightening of the muscles around the airways), 'reactive airway disease', 'airway disease'
Fire and Smoke Inhalation (ED/UC visit) among county residents	Oregon ESSENCE	Keywords in patient records include: wild fire or wildfire, the word 'smoke', but not when it's part of common phrases that don't indicate environmental exposure.
Non-Infectious Respiratory Illness (ED/UC visit) among county residents	Oregon ESSENCE	Keywords in patient records indicating chronic or acute lung conditions like: Asthma, COPD, Chronic bronchitis, Emphysema, Acute bronchitis (without infection), Bronchial asthma
Recreational Water Exposure (ED/UC visits) among county residents	Oregon ESSENCE	Keywords in patient records: Lake, River, Boat, swim
Submersion and non-fatal drowning (ED/UC visits) among county residents	Oregon ESSENCE	Keywords in patient records: Mentions of drowning, but not feelings of drowning: Includes the word 'DROWN', But excludes phrases like: 'FEEL DROWN', 'FELT DROWN'
Heat-Related Deaths that occurred in the County	Oregon Vital Records	ICD 10 Codes: X30, T67, and P810
Respiratory Deaths that occurred in the County	Oregon Vital Records	ICD 10 Codes: J20, J43, J44, J45, J80, R060, R0602, R0609, J96

Acknowledgments

Land Acknowledgement (as prepared by representatives of Confederate Tribes of Grand Ronde, Nez Perce, Siletz, and Yavapai)

We want to acknowledge the people on whose land we live—the Atfalati-Kalapuyans also known as the Tualatin Band of Kalapuyans—the first inhabitants of Washington County. We are grateful for the land we are on, Kalapuyan land.

Signers of the Willamette Valley Treaty of 1855 were removed from their homelands to the Grand Ronde Indian Reservation. Today their descendants are tribal members of Grand Ronde and Siletz tribes, carrying on the traditions and cultures of their ancestors.

We acknowledge and express gratitude for the ancestors of this place and recognize that we are here because of the sacrifices forced upon them. In remembering these communities, we honor their legacy, their lives, and their continuation in our community. Please reflect on the role government has played in the painful, colonial history and reflect as well on the resilience and healing of the Indigenous land and communities.

We would like to invite everyone to collaborate and work together with the tribes to take care of the land and water and the people who inhabit these spaces.

Community partners Acknowledgement

We would like to acknowledge G Lopez-Ixta for identifying community health worker voices as a critical part of this report and for reaching out to a community organization as a first step towards that in this report.

We would like to also acknowledge those interviewed for their dedication to their communities and willingness to share experiences and stories that give critical context to how we track and respond to impacts of climate on the community.

Resources

For more information on how to stay cool, go to the County’s Hot Weather page

Thank you again to our community who supported collection of information to identify heat islands in our community! This work has informed our County climate plan and is another reminder of the strength of working together as a community. View results from the heat mapping campaign

References

^[1] Voelkel J, Hellman D, Sakuma R, Shandas V. Assessing Vulnerability to Urban Heat: A Study of Disproportionate Heat Exposure and Access to Refuge by Socio-Demographic Status in Portland, Oregon. Int J Environ Res Public Health. 2018;15(4).↩︎

^[2] Mahsin MD, Cabaj J, Saini V. Respiratory and cardiovascular condition-related physician visits associated with wildfire smoke exposure in Calgary, Canada, in 2015: a population-based study. Int J Epidemiol. 2022; 51(2): 166-178.↩︎

^[3] CDC. National Institute For Occupational Safety and Health(NIOSH): Heat Stress Heat-related Illness. 2024; https://www.cdc.gov/niosh/heat-stress/about/illnesses.html. Accessed April 2025.↩︎

^[4] Sindall R, Mecrow T, Queiroga AC, Boyer C, Koon W, Peden AE. Drowning risk and climate change: a state-of-the-art review. Inj Prev. 2022; 28(2): 185-191.↩︎

Weather

Why we track this?

Exposure to extreme heat for longer periods is a more direct impact of climate change. As stated in the 2023 Report on Climate and Health in Oregon, the likelihood of visits to the emergency department for heat-related illness during summer is greater on days that reach temperatures over 80°F and periods of time where daily temperatures do not fall below 65°F^[5].

In Washington County, we have observed that heat-related illness emergency department visits begin to occur at lower temperatures in the earlier months of summer when people are less used to warmer temperatures. Because there are many factors at play, emergency preparedness and response teams will often base action off of the National Weather Service Heat Risk Index^[6].

In addition to heat, drought can increase risk of wildfires. Wildfire smoke in the region can linger and exacerbate asthma as well as other air-quality related illnesses^[7].

To better understand summer hazards in our community we present annual number of days during summer months with various levels of heat and air-quality.

What are you seeing

This section has two tabs that show the number of summer season days with different heat risk levels (CDC) and air quality index levels (EPA) that often informs response. Key takeaways are in the titles and description of information included are detailed below each tab’s image. Data are from May 1 to September 30 and referred as summer season.

Heat Risk
Air Quality

Since 2020, there have been at least 12 days per summer with moderate heat risk. There have been a few days with extreme heat risk since 2018.

Vertical bar graph with annual number of days with heat risk levels of extreme, major, moderate, minor, and little to no risk from 2018 to 2024 summer seasons in Washington County. — We report number of days to understand frequency of exposure, and report heat risk levels to understand severity.
Source: National Weather Service

Since 2020, at least two weeks of the summer season have had air quality indices of moderate air quality. During 2020 and 2023, both years with major wildfires, there were days where air quality indices were unhealthy for at least sensitive groups.

Vertical bar graph with annual number of summer days with air quality index levels of hazardous, very unhealthy, unhealthy for sensitive groups, moderate, good, and missing values from 2018 to 2024 summer seasons in Washington County. — We report number of days to understand frequency of exposure, and report air quality index levels to understand severity.
Source: Environmental Protection Agency (EPA)

References

^[5]Jesse E. Bell SCH, Lesley Jantarasami,Ch. 4: Impacts of Extreme Events on Human Health. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment.,Washington, DC: U.S. Global Change Research Program 2016. ↩︎

^[6] Center NWSWP. The Heat Index Equation. 2022. https://www.wpc.ncep.noaa.gov/html/heatindex_equation.shtml. 2025.↩︎

^[7] Wehner MF, J.R. Arnold, T. Knutson, K.E. Kunkel, and A.N. LeGrande. Droughts, floods, and wildfires. DC, USA 2017.↩︎

This page presents health impacts of environmental hazards.

Use the tabs below to explore specific topics:

Two community health workers and a director of a community based organization in Washington County were interviewed by a doctoral environmental health intern about their and their community’s experiences during extreme heat and extreme cold. Key themes are shared below. Methods are further described in the “About” tab.

Community Voices Spotlight

Key Interview Themes

Cost of rent and utilities: These are barriers to climate adaptation during extreme heat, especially for senior citizens and people with disability whose income has not grown proportionally with cost of living and utilities. Examples of direct impact include water shutoff and reluctance to use air conditioners because of electric bill.
Outdoor workers: During extreme heat, taking time may not be an option for workers.
Access to medical care, transport cool places, and shaded spaces: These are barriers of access to preventing and recognizing heat-related illness.
Community Empowerment: They described supporting community collaboration and communication as an effective way to identify and grow resilience to heat and climate change.

High cost of living and limited access to resources increase risk of heat-related illness

Community health workers described increased cost of living as major source of population needs during the summer. They described high water bills resulting in water being shutoff, and hesitation to use air conditioning due to energy costs, especially among seniors whose social security has not increased at the same rate as cost of living.

“When we look through our data. The majority of people that we are helping with financial assistance to pay their utility bills are senior citizens. So what we’re looking at is a whole population of people that were stable living on social security. But post pandemic rents have increased and so something has to give financially, and they’re every month looking at their bills and paying. They’re borrowing from Peter to pay Paul, and they’re not staying stable and it’s not sustainable.”

During extended periods of heat, people whose job and livelihood are outdoors are also at risk of heat related illness and injury.

“Talking about those who work in the fields and have to work, and suddenly they are working in very, very hot temperatures, so, well, they say, well, I have to go out, right? I have to go out to work. I can’t say today that I’m not going because it’s hot.”

Community health workers described limited access to medical care and transport that make people more vulnerable to heat injury on hot days.

“These are not temperatures we’re used to. So, if this happens, people who don’t have easy access to a doctor or transportation can’t go to places where they can cool off. They can’t go to see if they’re already experiencing a degree of dehydration, heatstroke, or extreme heat. These are the opportunities to get checked out to see if these symptoms I’m experiencing are normal.”

One community health worker described a need for shaded areas available to everyone near splash pads when asked about how we could create more resilience.

“There’s a little park here, near my house, with water fountains, right? You can go and cool off. But there’s no shade… And yes, you might last half an hour, but imagine being in the sun. It’s not going to do you any good to cool off there, like having the most accessible parks with shade, and where there’s shade, where there are roofs. Then they rent them out, so only the person who rented it can have access to that shade, right?”

Community Climate Solutions and Resilience

One community health worker described community members using existing resources and strategies to stay cool and that education can be helpful for staying cool.

“I visited a man this summer. No, no air was one of those really, really hot days. and he’s very disabled. And he was keeping bottles of water in his freezer and then taking them out in his walker and putting him on his body so he could stay cool. So people find hacks to deal with it. And I don’t, you know, really know how well they work, but it’s something to consider… how do hot climates survive really intense heat without central air and… there is an educational piece like that in the county.”

When reflecting on safety nets from loss of utilities. They described policies during COVID that helped people under extreme circumstances, like medical issues to prevent utility shutoff.

“It existed during Covid, but it doesn’t exist any longer. A financial safety net for people who are really dealing with some extreme issues, who have medical issues, and can’t. They’re struggling because the cost of all of our utilities has gone up significantly and we need to take care of those people.”

Community resilience and empowerment

They shared community health worker outreach that could be done in the field where people work and at church as spaces for community sharing and resilience to extreme heat. An idea for effective messaging was providing water and sun block, along with sharing signs of heat-related illness. There was an emphasis on community’s desire to help.

“I believe that communities. if we call upon them and support that village concept where people come together to solve problems that that can have a huge impact. When I say that I’m talking about situations like with that senior citizen where all it took was a group of community members to come together and talk about his situation and say, Oh, I can do this, I can do that. And it’s resolved without a huge investment of money. And that’s what we can do as a community. We need to be empowered to do that. And there needs to be some minimal funding to support that.”

About this report

Health Effects of Summer Hazards

Key Takeaways

Methods

Quantitative

Qualitative

Data details

Acknowledgments

Resources

Weather

Why we track this?

What are you seeing

Heat Related Illness

Why we track this?

What are you seeing

Seasonal Allergy

Why we track this?

What are you seeing

Asthma

Why we track this?

What are you seeing

Fire and Smoke Inhalation

Why we track this?

What are you seeing

Non-Infectious Respiratory Illness

Why we track this?

What are you seeing

Submersion and Non-fatal Drowning

Why we track this?

What are you seeing

Water Recreation

Why we track this?

What are you seeing

Mortality

Why we track this?

What are you seeing

Community Voices Spotlight

Key Interview Themes

High cost of living and limited access to resources increase risk of heat-related illness

Community Climate Solutions and Resilience

Community resilience and empowerment