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.

 
 
 
 

Why exactly do Britain’s rail services to the cities of the South West keep getting cut off?

You see the problem? The line through Dawlish. Image: Geof Sheppard/Wikimedia Commons.

If you’ve ever looked at some picturesque photos of British railways, perhaps in a specialist railway magazine – we’re not judging – then you’ve probably seen images of the South West Railway sea wall, with trains running tantalisingly close to the sea, either framed by blue skies and blue water or being battered by dramatic waves, depending on the region’s notoriously changeable weather.

Designed by Isambard Kingdom Brunel and open since the 1840s, the line was placed so close to the water to avoid the ruinous cost of tunnelling through the South Devon hills. From Dawlish Warren to Teignmouth the line is, with the odd interruption, exposed to the sea, affording the striking images so beloved of rail photographers. Its exposed placement also inevitably leads to speed limitations, closure and damage to the infrastructure. This would be a matter of purely local interest were it not for the fact that the sea wall is an unavoidable link in rail routes to the South West.

Main line trains run from London Waterloo and Paddington down to the Devon hub of Exeter St Davids, before continuing on to Plymouth, Truro and other destinations on the peninsula. Trains leaving St Davids reach the bottleneck very quickly, following the river Exe and its estuary, before dipping behind the sand dunes and emerging on to the sea wall.

What happens to the track at the small seaside towns of Dawlish Warren and Dawlish therefore has an impact on the whole region. South Devon and Cornwall are inaccessible by rail when the sea wall is temporarily closed or, as happened in January 2014, when storms breached the sea wall altogether, damaging it so severely it took weeks to repair.

While it’s easy to understand the economic logic of building the sea wall in the first place, unsurprisingly the economics of maintaining the damn thing have proven less compelling. The sea wall is considered to be, per mile, the most expensive stretch of Network Rail’s network to maintain. It’s also baffling to modern eyes why the main line rail services for a whole region would flow through such a vulnerable bottle neck.

The Devon rail network. Image: Travel Devon.

As with so many oddities of the British rail system, these perversities emerged from the rapid change that came in the mid 20th century through war, nationalisation and Dr Beeching.

The need for a Dawlish Avoiding Line was identified as early the 1930s. This would have diverted from the existing route at Exminster, and rejoined the line between Teignmouth and Newton Abbot, passing through Dawlish inland. Tweaks to the plan were made, but by 1939 construction was under way, only to be suspended when war broke out. Work on the project did not resume after the war, and when the Great Western Railway became part of the nationalised British Railways it was not a priority. The land for the Dawlish Avoiding Line was later sold by British Rail and has subsequently been built on, so that was that.

In the 1960s, Dr Beeching’s axe fell on rail routes across Devon, including the lines through North Devon that had provided an alternative rail route through the county. Those closed lines have also been extensively built on or converted to other uses, leaving a single main line through Devon, and rendering the sea wall unavoidable.

In recent years the condition of the sea wall has become increasingly precari


ous. That’s not only due to storm damage to the wall itself, but also due to the potential for erosion of cliffs overlooking the rail line, resulting in falling rocks. While this has been an ongoing issue since... well, since the sea wall was opened over 150 years ago, the storm of 4 February 2014 brought the matter to national attention. The visual of twisted rails hanging out into empty space illustrated the problem in a way pages of reports on the precarious nature of the line never could.

An army of Network Rail workers descended on Dawlish to get the line re-opened within two months. But repairing the damage hasn’t resolved the base problem, and climate change increases the likelihood of further major storm damage. In October 2018 the line was hastily closed for weekend repairs when storms resulted in a six foot hole appearing under the tracks near Teignmouth.

Supportive noises of varying intensity and occasional oblique funding commitments have come from government in the last five years, and investigations and consultations have been conducted by both Network Rail and the Peninsula Rail Task Force, a group set up by local councils in the wake of February 2014. Proposals currently on the table include Network Rail’s plan to extend a section of the sea wall further out to sea, away from the crumbling cliffs, and reopening the Okehampton line across Dartmoor to provide an alternative rail route between Exeter and Plymouth. 

But in spite of talk about investment and grand plans, no major work is underway or funded, with Network Rail continuing their work maintaining and repairing the existing line, and the situation seems unlikely to change soon.

Massive spending on rail infrastructure in the South West is a hard Westminster sell, especially in the Brexit-addled political climate of the last few years. And with the parliamentary map of the region dominated by blue there’s been little political will to challenge the vague commitments of government. One of the South West’s few Labour MPs, Exeter’s Ben Bradshaw, is particularly damning of the failure of Tory MPs to put pressure on the government, using a recent column for Devon Live to describe them as “feeble”.

But regardless of the political will to solve the problems of rail in the South West, barring a string of unusually gentle winters, the issue isn’t going away soon. If the South West is to be an accessible and successful part of the UK, then it needs stable rail infrastructure that can survive whatever the weather throws at it.