In 2020, approximately 34 million households in the United States experienced some degree of energy insecurity. Energy insecurity is defined as the inability to meet basic household energy needs, such as reducing or forgoing basic necessities to pay energy bills. Others may maintain unsafe temperatures at home due to cost concerns, both of which are “chronic” forms of energy insecurity. Individuals may also experience “acute” energy insecurity, or a short-term disruption of energy sources for infrastructural or environmental reasons, much like power outages.
People who need electronic medical devices and who live in poor housing conditions tend to experience higher rates of energy insecurity. A recent Nature Communications study characterized power outages across the country from 2018 to 2020 and found there were nearly 17,500 power outages lasting more than eight hours. Outages of this duration are considered medically relevant due to the potential health risks to vulnerable groups, particularly those requiring durable medical equipment (DME) dependent on electricity such as oxygen concentrators and infusion pumps. Although some DMEs may have battery backup power, they only last a few hours.
“Understanding how power outages affect health motivated us to create the county-level power outages dataset,” says Joan Casey, assistant professor of environmental and occupational health sciences at the University of Washington, which participated in the study. “As our grid ages and climate change worsens, we need to understand who is affecting power outages.”
[Related: Fossil fuels are causing a buildup of human health problems.]
The authors used Local Spatial Association Indicators (LISA) to identify countries with high levels of social and medical vulnerability as well as frequent power outages. In particular, counties in Arkansas, Louisiana, and Michigan experience frequent medically relevant power outages and have a high prevalence of electricity-dependent EMR use. They “face a heavy burden and may have more difficulty responding effectively, which could lead to more adverse health outcomes,” Casey says.
The authors also determined the overlap between climatic events occurring on the same day as medically relevant blackouts. They reported that about 62% of these outages occurred at the same time as extreme weather events, such as heavy rainfall, abnormal heat and tropical cyclones. Additionally, medically relevant failures are 3.4 times more common on days with a single event and 10 times more common on days with multiple events. Weather and climate events can lead to large-scale outages, but increased energy demand from an aging power grid can play a role in county-level outages.
Upgrading the grid and relying more on distributed generation, such as renewable energy generation and storage, is necessary to avoid power outages and ensure large areas do not go offline, Casey says. The Department of Energy intends to upgrade the grid to increase resiliency, add clean energy capacity and optimize electricity delivery. The department is also investing in energy infrastructure such as micro-grids, which can disconnect from national infrastructure and continue to operate even when the main grid is down, and world-scale energy storage devices. grid, which store clean electricity to help provide power during load peaks.
“Some communities and individuals may experience increasingly severe power outages or have less ability to respond,” Casey says. “These groups may be consistently marginalized and lack access to generators, charging centers or health care.”
Communities of color have unequal access to power generation and battery storage, although they tend to be hardest hit in the event of power outages following extreme weather events. After Hurricane Maria in 2017, rural and black communities in Puerto Rico seemed to have the longest recovery times. Higher percentages of Hispanic/Latino populations were also associated with longer outages in Florida after Hurricane Irma in 2017. Meanwhile, counties with a higher proportion of Hispanic/Latino residents experienced outages. more severe currents during the 2021 winter storm in Texas. Black residents also reported more one-day outages.
“We need to work to understand who is most at risk during an outage and provide support to those populations,” Casey says. “This could involve preparing health systems to receive patients, community charging stations for those who rely on electricity-dependent medical equipment, or weatherproof homes to maintain indoor temperatures at more optimal levels.”
[Related: Heart disease-related deaths rise in extreme heat and extreme cold.]
Developing a registry of people medically dependent on electricity would help establish a national estimate of this vulnerable population and document their geographic location. This can help state, territory, and local health departments prioritize efforts and anticipate resources first responders need to deploy in an emergency. Currently, the Department of Health and Human Services only keeps records of more than 2.9 million Medicare beneficiaries who need an electric-dependent EMR. The number of EMR users covered by other insurance programs is not known.
Jurisdictions with a high prevalence of extended outages could also help vulnerable populations by installing temporary emergency power plants. Such a solution could make electricity more accessible and reduce avoidable visits to emergency departments, which could prevent congestion. Together, upgrading the grid, mitigating climate change, and providing alternative sources of electricity can all minimize the power supply impacts faced by vulnerable populations and communities of color.
