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Dying alone

Why killer heat waves are man-made catastrophes, not natural disasters

WITH A PROVISIONAL death toll of more than 11,000 in France and other European nations now reassessing their losses, the scale of this summer's heat catastrophe has surprised observers everywhere.

But the heartbreaking manner in which the victims perished also deserves attention. Thousands of elderly and isolated city dwellers died alone at home, slowly and painfully, while government officials, medical workers, and more affluent citizens left town to escape the heat. Their solitary deaths signal not only the danger of extreme summer weather, but also the challenge of caring for an emerging population of people living–and dying–alone.

The standard epidemiological language of risk factors and population statistics can obscure the human stories and social conditions that underlie heat waves, which kill more Americans than all other so-called natural disasters combined. According to the climatologist Laurence S. Kalkstein, in the 15 largest US cities more than 1,000 people die from heat-related causes each year. Heat waves are powerful social dramas, and we ignore their lessons at our own peril.

The relationship between aging, isolation, and heat deaths became apparent in the United States during the 1995 Chicago heat wave, when 739 city residents died during one broiling week in July. After epidemiologists acknowledged that their best climate models could not explain the death rate, I initiated my own ``social autopsy'' and spent five years investigating how and why the city's social and political structures broke down. My findings were disturbing.

In 1995, Chicagoans who lived alone and lacked air conditioning, local social contacts, and access to transportation were significantly more likely to die than their neighbors. Inhabitants of violent and depopulated neighborhoods, places without safe sidewalks and busy commercial streets, were also at greater risk. Men, who typically have more trouble than women maintaining family and social ties, were almost three times more likely to succumb in the heat. And nearly three-quarters of the victims were over 65. Although it is too soon to tell, early reports from France suggest that there may be similar patterns.

Following both the French and American disasters, many commentators made the point that the syndicated columnist William Pfaff articulated so sharply last week: ``The time had come for them to die, and the heat eased their way. We should all be so fortunate.'' But the reports authored by Chicago police officers who identified the dead in their homes and transported them to the morgue tell a very different story.

``Responding officer [R/O] learned that victim had been dead for quite awhile. Unable to contact any next of kin. Victim's room was uncomfortable, warm. Victim was diabetic, doctor unknown. Victim has daughter, last name unk. Victim hadn't seen her in years.''

``Upon arrival, R/Os noted there was a suspicious odor emanating from the house windows. R/Os observed the inside of the house to be extremely hot and the windows were shut. A small fan was running in the victim's bedroom. Victim was found in bed lying face up and partially decomposed.''

If it is a stretch to call these people ``fortunate,'' it is also inaccurate to say that their ``time had come.'' After the Chicago heat wave, public health officials measured whether there was a substantial drop in the death rates for subsequent months–in other words, whether the heat had merely claimed some victims who were already at death's door. It hadn't. The medical doctors I spoke with speculated that most of the victims would have survived at least several more years if they had had access to air conditioning or even the most rudimentary care during the heat wave.

Heat waves help make visible an emerging social issue that most Americans and Europeans experience only as a private struggle: the problem of supporting and caring for the elderly as they age on their own.

The surging population of people aging alone is one of the major demographic and social changes in contemporary America and Europe. In the United States, about 10 percent of the population over 65 lived alone in 1950; today roughly one-third does. In Western Europe, a greater overall proportion of the population is over 65; and in countries like France, they are less likely than Americans to live in retirement homes. In many ways these changes are a mark of success: Advances in medical care and relatively generous social welfare benefits mean that people live longer and can usually get by without moving out of their own homes.

But our cultural commitment to individualism and autonomy also inhibits us from confronting the underside of longevity. Although most seniors who live alone maintain healthy social networks, in too many cases the aged endure loneliness, depression, and poor care in order to remain independent. The problem is especially severe in the United States, where high rates of mobility mean that children and grandchildren are often far away.

Today, well-off families pay dearly to place their single parents in assisted-living homes, where residents maintain their cherished independence while still getting special attention from a full-time staff. Ordinary seniors can't afford such arrangements until they are frail enough to qualify for nursing home care, and even then many find the conditions in such homes unacceptable. Moving the elderly back in with their children is sometimes an option, but in most cases neither parent nor child wants to live together.

As a society, there are many signs that we do not take adequate steps to protect the elderly and isolated. In 1996, an article in the New England Journal of Medicine reported that during 12 weeks in San Francisco (population 770,000), 367 people who lived alone were found dead or incapacitated in their homes. And Chicago has not fully learned the lessons of the 1995 disaster. The number of residents who died alone and had no one claim the body or the estate increased substantially in the following years, even without another major heat wave. The county now investigates about four new cases per day.

There are a number of inexpensive measures that governments can take to prevent another heat-related disaster. First, they can issue public warnings and instruct the public about basic safety measures, such as drinking liquids, bathing in cold water, and getting to air-conditioned facilities. Second, they can remind the public about the importance of checking in on the elderly and isolated. Third, they can open cooling centers throughout the city and run special transportation programs to help people reach them. Fourth, they can monitor intake at emergency rooms and mortuaries, and call in backup staff at the initial signs of trouble. Finally, they can deploy community police officers and other city employees in poor neighborhoods and communities with high concentrations of elderly people.

Unfortunately, these measures cannot prevent heat deaths altogether. As advocates for the elderly argue, heat waves will remain lethal until we create more supportive housing environments for the aged, improve social services and health care for the homebound, and reach out to the socially isolated.

In the United States, though, the threat of future heat catastrophes has not motivated policy makers and the public to address the difficult issues of living and dying alone. What will?

Eric Klinenberg, an assistant professor of sociology at New York University, is the author of ``Heat Wave: A Social Autopsy of Disaster in Chicago.''

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