From The New England Journal of Medicine
Like motorists who slow down to stare at the aftermath of car crashes, most people are fascinated by meteorologic disasters. The perils of weathering a hurricane, a tsunami's destruction of property, and the human drama of a flood all make for riveting tales of struggle and survival. Yet one kind of weather-related catastrophe -- a deadly wave of heat and humidity -- seems not to get nearly the notice given the others, despite the fact that it kills more than all the other kinds combined. Why heat waves are such a quiet menace and how social conditions contributed to more than 700 deaths during a week-long wave of unprecedented heat and humidity in Chicago in 1995 are the focus of Heat Wave: A Social Autopsy of Disaster in Chicago, written by sociologist Eric Klinenberg. The term "social isolation" is usually applied to those living in remote locations, but Klinenberg demonstrates that this unfortunate condition also applies to thousands of people (primarily senior citizens) in our nation's largest cities. And so it was in 1995. Thousands of Chicago's elderly lived alone (many of them in or near poverty), isolated in many ways and by many factors. When the record-breaking heat and humidity arrived and stayed, these men and women started dying, one at a time and quietly, behind closed, locked doors. The immediate reasons were apparent. Many seniors did not have air conditioning in their houses or apartments. Of those who did have air conditioning, many chose not to use it, fearing utility bills that they could not afford to pay. Fear of crime kept others from leaving their homes to use free neighborhood "cooling centers." Still other elderly Chicagoans knew, from a physiological standpoint, that they were hot but were simply unaware that they were in danger. Klinenberg shows in detail how the tragedy was compounded by many factors and interests, including a public health and medical establishment that did not anticipate the magnitude of the looming danger and local news media that treated the severe heat and humidity as little more than a novel topic for lighthearted feature stories. The author also examines key sociological factors relating to the elderly, including the perils of "aging in place" while the surrounding environment changes; the idealization and valuing of personal independence among seniors; and differences between men and women in the establishment of friendships and other interpersonal connections. Heat Wave is a fascinating book, in part because the social conditions that led to Chicago's 1995 tragedy still exist, for the most part, throughout our nation and its aging population. People are still at risk. The book is not without its flaws. Klinenberg strays from sociological analysis and into a politicized attack when he examines the 1995 response of Mayor Richard M. Daley and his administration. He makes far too much of the mayor's brief questioning of exactly what constitutes a "heat-related death" -- a question, I might add, that most of us had at the time. The author erroneously claims that the response of the Daley administration was driven more by public-relations damage control than by a desire to understand the tragedy and prevent further deaths and that a report issued by the Mayor's Commission on Extreme Weather Conditions was little more than "spin," when it was in fact the product of careful deliberation by leading figures in public health, medicine, gerontology, meteorology, and other fields. Indeed, the report laid the groundwork for Chicago's successful response to extreme weather, which was credited with saving hundreds of lives in the summer of 1999. The report has been widely requested by and circulated to public health planners throughout the nation. Other descriptions of the mayoral response are similarly off-base. As a deputy commissioner of the Health Department in 1995, I was there for every step of the action, in front of the cameras and microphones and around the table at meetings about emergency response. Klinenberg and his sources were not there. Klinenberg also puts considerable emphasis on racial disparities in the 1995 heat deaths. (The raw death totals indicate a rough parity between mortality rates in the black and white populations, but age-adjusted rates supplied by the author claim otherwise.) In his biography posted on the Web site of Northwestern University, where he teaches, Klinenberg notes his interest in the exploration of "race as a principle of vision, division, and domination." His focus on race is therefore understandable, but many do not see race as the risk factor that he claims it is. Its flaws aside, Heat Wave is a thought-provoking examination that challenges everyone in medicine and public health to look beyond our training to consider sociological conditions as risk factors. It issues a call for all segments of the population to reestablish those familial and social connections that we once seemed to have but now, all too often, do not. John Wilhelm, M.D., M.P.H.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
A forceful account of what it means to be poor, sick and alone in the era of American entrepreneurial government -- Charles Taylor, Salon.com
A provocative, fascinating book, one that applies to much more than weather disasters -- Chicago Sun-Times
A trenchant, multilayered and well-written social autopsy of disaster. -- Micaela di Leonardo, The Nation
Klinenberg draws the lines of culpability in dozens of directions, drawing a dense and subtle portrait of exactly what happened. -- Malcom Gladwell, The New Yorker
Revealing and provocative. -- London Review of Books