San Antonio City Council: Vote YES on Tracking Heat Deaths

A Letter to the Governance Committee Members: Delivered Oct. 13, 2025

To:
Mayor Gina Ortiz Jones
Council Member District 2, Jalen McKee Rodriguez
Council Member District 3, Phyllis Viagran
Council Member District 4, Edward Mungia

Earlier this year, multiple community residents and organizations advocated for the City of San Antonio to begin accurately tracking heat-related deaths at both the city and county levels. In response, five council members filed a City Council Consideration Request (CCR) on this issue. However, this CCR remained stalled in governance and was not voted on before a major municipal election. It is now being reconsidered on October 15, and the new administration has recommended a “NO” vote, saying there are too few cases to prove heat deaths exist in our community and the informational websites are a sufficient precaution. 

This public meeting includes no opportunity for residents to provide comments, despite the fact that the impacts of extreme heat continue to grow more severe and more deadly.

Today is October 13, and the temperature is forecasted to reach 90°F. 

For outdoor workers, children, unhoused residents, and the 79,000 households currently at risk of utility disconnection, this is more than just a hot day, it is a public health emergency. Pregnant individuals, young children, and older adults are especially vulnerable to heat-related illness and death.

Our advocacy is grounded in real experiences from residents who live in homes where indoor temperatures can exceed 100°F for 12 hours or more each day. Many are afraid to run their window air conditioners due to high CPS Energy bills and fear of utility shutoffs. As a result, people are forced to sit outside in triple-digit heat, delay calling EMS, or avoid seeking medical care even with severe heat-related symptoms.

The absence of robust data does not mean heat deaths do not exist, it means we are failing to track them.
Data is not just a number, it is a life-saving tool. It allows the city to identify patterns, target resources, and develop policies that protect residents from preventable deaths.

The city has taken steps by posting heat safety information online, developing urban heat island programs, and publishing a Metro Health heat-related illness dashboard. But this is not enough. The city still lacks a consistent and comprehensive system for identifying and reporting heat-related deaths, especially those where heat is a contributing factor rather than the sole cause.

To make meaningful progress, the City of San Antonio must be a leader and work with Bexar County to adopt proven methods already used by other jurisdictions. 

Bexar County Medical Examiner’s Office

• Revise policy to document heat as a contributing cause of death when evidence supports it, even if it is not the primary cause.

• Standardize use of ICD-10 codes for heat-related illness and exposure.

• Ensure environmental factors are recorded on death certificates, such as ambient temperature, location, and housing status.

• Train medical examiners, coroners, EMS, and investigators to recognize, document, and report heat exposure appropriately

City of San Antonio

• Designate heat exposure as a reportable or special condition under state law.
  Require first responders and investigators to record weather and environmental conditions at the scene.

• Link multiple data sources, including EMS, hospitals, weather, and death certificates, to create a clearer picture of when and how heat contributes to death.

• Use “excess mortality” analysis during heatwaves to estimate underreported deaths by comparing observed deaths to historical averages.

• Publish heat-related death data regularly with demographic breakdowns on public dashboards.

• Protect vulnerable communities by identifying geographic and demographic patterns that signal greater risk.
  

San Antonio is not alone in facing extreme heat. Other cities have taken proactive steps to improve how they count and respond to heat-related deaths:

• Maricopa County, Arizona (Phoenix) provides weekly heat surveillance reports that distinguish between “heat-caused” and “heat-contributed” deaths, including those under investigation.

• Houston, Texas tracks both direct heat illness and heat-aggravated conditions such as kidney complications, pregnancy risks, and cardiovascular stress.

• New York City separates “heat-stress deaths” from “heat-exacerbation deaths” and uses death certificate and medical examiner data for more complete counts.

• California’s “Tracking California” project aggregates deaths using multiple cause-of-death records to give a broader picture of heat mortality.

• Cook County, Illinois includes heat and cold-related deaths alongside gun violence and opioid overdose data on a public Medical Examiner dashboard.

We urge the City Council to vote YES on this proposal.  Denying action because of little known cases and claiming informational websites as taking action is circular reasoning. If we do not track heat deaths, we will never have sufficient data, and people will continue to suffer and die invisibly.

Accurate, transparent tracking is the first step toward saving lives. We ask you to stand with your constituents, especially the most vulnerable, and protect public health in the face of extreme heat.