The stagnant atmospheric conditions of the heat wave trap pollutants in urban areas and add the stresses of severe pollution to the already dangerous affects of hot weather, creating a health problem of undiscovered dimensions. A map of heat related deaths in St. Louis during 1966, for example, shows a heavier concentration in the crowded alleys and towers of the inner city, where air quality would also be poor during a heat wave.

The high inner-city death rates also can be read as poor access to air-conditioned rooms. While air-conditioning may be a luxary in normal times, it can be a lifesaver during heat wave conditions.

The cost of cool air moves steadily higher, adding what appears to be a cruel economic side to heat wave fatalities. Indications from the 1978 Texas heat wave suggest that some elderly people on fixed incomes, many of them in buildings that could not be ventilated without air conditioning, found the cost too high, turned off their units, and ultimately succombed to the stresses of heat.