Men who live alone are most likely to die during heatwaves

A New Yorker sunbathes by the East River during the 2012 heat wave. Image: Getty.

Cities around the globe felt record-breaking, red-hot temperatures this July: in the United States, Scotland, Ireland, Norway, Algeria, Georgia, Armenia, Russia, Oman and China, the thermometer reached all-time highs.

In the Canadian province of Quebec, a weeklong heatwave was linked to 74 deaths, making it the province’s second deadliest period of extreme heat since the summer of 2010.

At the peak of the heatwave, on Tuesday, 3 July 3, Montréal recorded its highest temperature in history (36.6 C) and posted its most extreme midnight combination of heat and humidity. The stifling temperatures continued for most of the week.

Quebecers felt the heat. By Wednesday of that week, Montréal ambulance services were so busy that people with mild symptoms of heat illness were asked to seek help elsewhere. By Saturday, the city morgue was so crowded they had no choice but to move bodies to funeral homes for storage.

We thought Montréal was prepared. The city pioneered an extreme heat plan in 1994, before any other Canadian city. The plan involves frequent visits to home-care patients, monitoring signs of heat illness, opening air-conditioned shelters, extending pool hours and conducting mass media communication campaigns to warn about the heat.

After 2010’s heatwave, the city ramped up efforts to contact individuals with underlying health conditions that make them particularly vulnerable to the heat. The city’s plan has worked until now, reducing mortality by 2.52 deaths per day during hot periods.

So what went wrong this summer?

Most were men, living alone

When Montréal cooled off on Sunday 7 July, journalists and commentators looked for answers. The media first drew comparisons with cities in other provinces, Toronto and Ottawa in particular, where no deaths were recorded in similar temperatures.

Public health officials noted that Ontario takes longer to attribute deaths to heat, so these deaths may be reported later. But, almost a month after the heatwave, the Ontario death toll has stayed at zero. Others suggested that ownership of air conditioning is part of the picture: 85 per cent of Toronto residents have access to it, compared to 42 per cent of Quebec households.

A new report from Quebec’s public health authority tells a different story.

Men living alone, especially those with underlying physical or mental health conditions and substance-abuse issues, counted for the majority of deaths. Almost all who died were over 60 years old. And the majority of deaths happened in densely built-up parts of the city — neighbourhoods where heat-trapping concrete and sparse vegetation elevated the temperatures by around 5C to 10C.

It’s true that most people who died had no air conditioning, but these social factors also crucially determined who lived and who died.


The fatal risk of isolation

Living alone in itself does not necessarily mean being disconnected, but older people are at a higher risk of becoming isolated if they live by themselves. This isolation can become fatal during a heatwave.

As sociologist Eric Klinenberg found in his analysis of the 1995 Chicago heatwave, older people living alone were at the highest risk of dying in the heat, especially if they had weak ties to their surrounding community, were distrustful of their neighbours or lived in neighbourhoods marked by disinvestment.

Montréal’s heat plan focuses on outreach: city staff getting in touch with people whose bodies are the most vulnerable to breaking down in the heat. Once they make contact, city staff take people to cool places or provide access to medical attention. But these strategies rely on social interaction and connection. Family, friends or even neighbours need to be available and willing to check up on the most vulnerable.

Even when firefighters comb neighbourhoods door-to-door, as they did in July, they cannot visit every single vulnerable person, and there’s no guarantee that older people alone in their apartments will answer the knocks. This is especially true for individuals with reduced mobility or lack of trust in their neighbours or city services.

The popularity of living alone and deadly heat

The province has more people living alone than ever before. It’s possible that in the face of this demographic shift, more Quebecers are at risk of losing the social ties that are vital in times of disaster.

The latest Canadian census uncovered that, for the first time in history, individuals living alone are the most common type of household — more than couples living together, or people living with roommates or with parents.

Single-person households are geographically concentrated. In the heatwave, we saw an overlap between where people are more likely to live alone and where people died from the heat. A total of 42 of the top 50 places in Canada where most people live alone are located in southern Quebec, where the heatwave killed 74 people.

It’s not possible to determine the exact role of Quebec’s demographic shift in explaining the high number of heat deaths. But this pattern points to the need for a close look into the social causes.

We also need new public health practices that target the growing number of people living alone, who we know to be the most vulnerable.

Dr. David Kaiser, senior doctor in Montréal’s health department, echoed the challenge: “Despite what we put in place in the last four, five days, some of the most vulnerable people are not being reached, and that is the central focus of the work we have to do.”

We need more effective ways to identify who is at risk, how to get in touch, and how to get them help.

The world is trending hotter

Editor and Montréal resident Fariha Naqvi-Mohamed wrote in the Montréal Gazette that resisting heatwaves is a community effort. The city must battle the heat together under city sprinklers, having fun in public pools and sharing popsicles.

The key question remains: how do we bring the people who feel socially isolated into the public spaces where we can look out for each other, and build the ties that people can rely upon in times of disaster?

While climate scientists are careful to not attribute single weather events to climate change, the world is trending hotter and the heatwaves are consistent with our expectations for more extreme temperatures more frequently.

The ConversationIn the face of mounting evidence of the severity of the impacts and the vulnerability of our communities, even in wealthy societies, it’s important that we now view climate change view as a serious public health threat and act accordingly.

Malcolm Araos, PhD Student, New York University

This article was originally published on The Conversation. Read the original article.

 
 
 
 

What’s killing northerners?

The Angel of the North. Image: Getty.

There is a stark disparity in wealth and health between people in the north and south of England, commonly referred to as England’s “north-south divide”. The causes of this inequality are complex; it’s influenced by the environment, jobs, migration and lifestyle factors – as well as the long-term political power imbalances, which have concentrated resources and investment in the south, especially in and around London.

Life expectancy is also lower in the north, mainly because the region is more deprived. But new analysis of national mortality data highlights a shockingly large mortality gap between young adults, aged 25 to 44, living in the north and south of England. This gap first emerged in the late 1990s, and seems to have been growing ever since.

In 1995, there were 2% more deaths among northerners aged 25 to 34 than southerners (in other words, 2% “excess mortality”). But by 2015, northerners in this age group were 29% more likely to die than their southern counterparts. Likewise, in the 35 to 44 age group, there was 3% difference in mortality between northerners and southerners in 1995. But by 2015, there were 49% more deaths among northerners than southerners in this age group.

Excess mortality in the north compared with south of England by age groups, from 1965 to 2015. Follow the lines to see that people born around 1980 are the ones most affected around 2015.

While mortality increased among northerners aged 25 to 34, and plateaued among 35 to 44-year-olds, southern mortality mainly declined across both age groups. Overall, between 2014 and 2016, northerners aged 25 to 44 were 41% more likely to die than southerners in the same age group. In real terms, this means that between 2014 and 2016, 1,881 more women and 3,530 more men aged between 25 and 44 years died in the north, than in the south.

What’s killing northerners?

To understand what’s driving this mortality gap among young adults, our team of researchers looked at the causes of death from 2014 to 2016, and sorted them into eight groups: accidents, alcohol related, cardiovascular related (heart conditions, diabetes, obesity and so on), suicide, drug related, breast cancer, other cancers and other causes.

Controlling for the age and sex of the population in the north and the south, we found that it was mostly the deaths of northern men contributing to the difference in mortality – and these deaths were caused mainly by cardiovascular conditions, alcohol and drug misuse. Accidents (for men) and cancer (for women) also played important roles.

From 2014 to 2016, northerners were 47% more likely to die for cardiovascular reasons, 109% for alcohol misuse and 60% for drug misuse, across both men and women aged 25 to 44 years old. Although the national rate of death from cardiovascular reasons has dropped since 1981, the longstanding gap between north and south remains.

Death and deprivation

The gap in life expectancy between north and south is usually put down to socioeconomic deprivation. We considered further data for 2016, to find out if this held true for deaths among young people. We found that, while two thirds of the gap were explained by the fact that people lived in deprived areas, the remaining one third could be caused by some unmeasured form of deprivation, or by differences in culture, infrastructure, migration or extreme weather.

Mortality for people aged 25 to 44 years in 2016, at small area geographical level for the whole of England.

Northern men faced a higher risk of dying young than northern women – partly because overall mortality rates are higher for men than for women, pretty much at every age, but also because men tend to be more susceptible to socioeconomic pressures. Although anachronistic, the expectation to have a job and be able to sustain a family weighs more on men. Accidents, alcohol misuse, drug misuse and suicide are all strongly associated with low socioeconomic status.

Suicide risk is twice as high among the most deprived men, compared to the most affluent. Suicide risk has also been associated with unemployment, and substantial increases in suicide have been observed during periods of recession – especially among men. Further evidence tells us that unskilled men between ages 25 and 39 are between ten and 20 times more likely to die from alcohol-related causes, compared to professionals.

Alcohol underpins the steep increase in liver cirrhosis deaths in Britain from the 1990s – which is when the north-south divide in mortality between people aged 25 to 44 also started to emerge. Previous research has shown that men in this age group, who live in the most deprived areas, are five times more likely to die from alcohol-related diseases than those in the most affluent areas. For women in deprived areas, the risk is four times greater.


It’s also widely known that mortality rates for cancer are higher in more deprived areas, and people have worse survival rates in places where smoking and alcohol abuse is more prevalent. Heroin and crack cocaine addiction and deaths from drug overdoses are also strongly associated with deprivation.

The greater number of deaths from accidents in the north should be considered in the context of transport infrastructure investment, which is heavily skewed towards the south – especially London, which enjoys the lowest mortality in the country. What’s more, if reliable and affordable public transport is not available, people will drive more and expose themselves to higher risk of an accident.

Deaths for young adults in the north of England have been increasing compared to those in the south since the late 1990s, creating new health divides between England’s regions. It seems that persistent social, economic and health inequalities are responsible for a growing trend of psychological distress, despair and risk taking among young northerners. Without major changes, the extreme concentration of power, wealth and opportunity in the south will continue to damage people’s health, and worsen the north-south divide.

The Conversation

Evangelos Kontopantelis, Professor in Data Science and Health Services Research, University of Manchester

This article is republished from The Conversation under a Creative Commons license. Read the original article.