As I write it’s baking hot, and seems to have been for days. The usual risks apply to writing about it though. By the time this is published the thunder storms we have been promised may have brought cooler wetter weather. But very possibly some numbers will have been crunched and you’ll be reading about the effects of the hottest June for decades – reduced productivity, transport delays and maybe mortality.
With that in mind, I’d like to recommend two ‘old but good’ books with something to say about how different societies manage public health in hot weather. I show how these appear to confirm other sociological work comparing people’s expectations of government in different locations. And I propose that such work can not only help us think about heatwaves but perhaps also add to our understanding of the aftermath of a manmade disaster, the fire in Grenfell Tower.
Back to books first. Heatwave (1999) by Eric Klinenberg promises a ‘social autopsy’ of the 1995 Chicago heatwave from a sociological perspective. Fatal Isolation (2015) – also published by University of Chicago Press and written by Richard Keller – does something similar for the hot weather experienced in Paris in 2003. Both events were associated with a significant increase in numbers of deaths, though precise numbers were uncertain. As the authors observe, formal reporting requirements reduced any chance that reference to heat would appear on the death certificate (in the US these included the need for people to record the temperature in a room where someone had died, in France the expectation that there would be a body temperature recorded at the time of death). Estimates of mortality from the heatwaves are instead often made in terms of excess deaths – that is the difference between reported mortality rates and typical rates for comparable time. Keller notes that the almost 15,000 excess deaths attributed to the 2003 Paris heatwave were derived from a comparison with deaths in the month of August between 2000 and 2002. This practice can generate further uncertainties around whether all excess deaths should be attributed to the incident. Are deaths by drowning a result of the heat? What about deaths from existing heart conditions where the heat has what epidemiologists call a ‘harvesting effect’ bringing forward an expected death?
In order to explain how such uncertainties were aired, the two authors amass a huge set of sources on the experience of the extreme weather. They explore how individual deaths occurred and how these, and collected mortality figures, became the subject of debate in the media. Both develop a sociological analysis which relates personal stories to public issues, including the social and environment conditions in which the victims were living and the practices of government. Yet there are important differences as well as similarities in their accounts of events in Chicago and Paris.
In both cities heatwave mortality was most often identified among older people, but in Chicago we are told deaths were concentrated in particular neighbourhoods that had been effectively ‘abandoned’ by government. This fits images of inner city America gleaned from The Wire or Lois Wacquant’s sociological work on advanced marginality where he directly compared Chicago and Paris. Yet in Paris heatwave deaths were not so much in the banlieues that he studied, but in apparently affluent neighbourhoods where there were pockets of poverty, for example older people living on the top floors of elegant fin de siècle blocks. Keller also points out that it was not just poverty that mattered. Infants might have been equally vulnerable to the heat but were more likely to be protected by ‘networks of care’. Older people who had dogs were more visible to neighbours, and had some kind of social protection.
Other interesting comparisons can be made with Wacquant’s work. In Chicago he describes racialised segregation over many decades as leading to a lack of confidence in the state and state withdrawal from many areas. Klinenberg points to a state presence in the heatwave as mainly through the police, which he describes along with the fire service as ‘paramilitary organisations’. There are obvious resonances with stories about the aftermath of Hurricane Katrina. In France both Wacqaunt and Keller point to the universal image of the French citizen. But where Wacquant suggests this reduces the scope to talk about racial inequalities, Keller argues it reduced the readiness of the state to respond to other ‘vulnerabilities’ – for example among the 3000 heatwave victims who had a disability or were drug users.
Klinenberg also talks about government’s image of its citizens as being grounded in a consumer model. Chicago residents were meant to be ‘smart shoppers’ for services, seeking information rather than being able to rely on help with things like energy costs, help which was essential for poorer residents to have a chance of air conditioning in summer. In Paris, Keller tells us that the government responded to the disaster by trying to get air conditioning into care homes, but this left people living in their own homes to access a telephone helpline in the event of more hot weather. Yet Wacquant argues that the French state still has a greater presence in people’s lives than in the inner cities of America. Citizenship still means something, but ironically perhaps this fuels greater criticism of government, as people have higher expectations.
If this all sounds familiar then perhaps I do not need to spell out the links to the Grenfell Tower disaster, beyond the ones already being made with Katrina. We have watched as local and central government failed to provide a coherent response. While we wait for a final figure on the number of people who have lost their lives – something which may never come – accusations fly around about the ways in which government effectively absented itself from responsibility for social housing and its safety. However, we are still more like France than America, thank goodness. The majority of people think the British state in some form should have been more directly involved in ensuring the safety of social housing, and an emergency response to the fire. The fire service was viewed as being there to help. Important questions must be answered about why older and disabled people were housed in high level flats, why safety issues with retrofits were ignored and responsibility passed on to organisations outside of government. We still have enough of a concept of citizenship to find the state wanting – to expect more – as witnessed in the public outcry and loud voices of local residents. But this week that’s cold comfort indeed.