Radu Sighetti/Reuters

Chapter 2 - summary
Heatwaves: the developed world's hidden disaster

During August 2003, between 22,000 and 35,000 people died due to a heatwave across Europe. Economic losses totalled over US$ 13 billion. Why were authorities and communities so poorly prepared? What can be done to support those most at risk?

Europe is not alone. Heatwaves kill more people in the United States than hurricanes, tornadoes, earthquakes and floods combined. Yet heatwaves are not a typical natural hazard, inflicting instantly recognisable damage. Few people are aware of the dangers. Heatwaves trigger silent disasters, which explains why most governments fail to raise the alarm in time. Those who suffer are the elderly and marginalized.

Heatwaves have been missing from disaster and public health policies, despite mounting death tolls. Why? Studies of human perceptions of risk reveal that sudden, high profile disasters such as earthquakes evoke greater dread than road accidents, despite evidence that more people die in road accidents than earthquakes. The higher the 'dread factor', the more people want action to reduce those risks. Yet this can divert limited resources towards reducing perceived, but infrequent, risks rather than addressing more urgent social problems. The challenge for health professionals and disaster specialists is to raise public awareness of the potential harm caused by extreme temperatures.

Summer 2003 was Europe's hottest for at least 500 years. The average temperature was 3.5°C above normal. Swiss scientists estimate that summer temperatures in Europe will be around 4.6 degrees higher by 2100. The World Meteorological Organization believes that, in the US alone, annual heat-related deaths could more than double by 2020.

However, projected increases in temperature variability may prove more damaging than a simple rise in average temperatures. Sudden variations can be more deadly than sustained heat, as the human body needs time to acclimatise. In extreme heat, the body cools itself by circulating blood to the skin and perspiring. The heart works harder, putting it and other vital organs at risk. The cooling-off period after sunset usually allows the body to recuperate. But at the height of Europe's heatwave, night temperatures didn't drop below 30 degrees - setting in motion the catastrophe.

Heatwaves are primarily an urban disaster - cities can be 5-6°C warmer than rural areas. In summer 2003, death rates in Paris were 130 per cent higher than in summer 2002, compared to a 20 per cent rise in rural regions. Planting grass roofs on industrial buildings is one idea. But deaths from heatwaves are more a function of social exclusion than of climate change or physical structures. During Chicago's 1995 heatwave, one poor neighbourhood, full of violence and abandoned buildings, had a death rate 10 times more than that of a similar area nearby with a more active street life, which drew people out of their homes and made them more visible.

The elderly in urban areas are worst affected. They may already suffer from cardio-vascular disease - which heatwaves exacerbate. They are often out of sight and less able to call for help. In France, 70 per cent of heatwave deaths last year were among the over-75s. The UN estimates that globally, the number of older persons (60 years or over) will triple to almost two billion by 2050. Europe - home to the world's largest aged population - is particularly threatened, as more, worse heatwaves are predicted. In France in 2003, two-thirds of heatwave victims died in hospitals, private health care institutions and retirement homes. In Chicago in 1995, most died alone, locked in their apartments, forgotten by family, friends and neighbours. Both disasters signified a catastrophic failure in the care and treatment of the elderly.

The 2003 death toll caused public uproar in France. Journalists criticised the national habit of taking holidays en masse during August, which left public services poorly equipped to deal with disaster. Health professionals argued that the problem was an underfunded, understaffed elderly care system in crisis, combined with a national habit of shutting senior citizens out of sight and mind. Less people died in southern European countries, mainly because the elderly there are more integrated into daily family life. The marginalization and poverty of the elderly are the root causes of disaster - extreme temperatures are simply the natural trigger.

Government officials rarely react well to heatwaves. Chicago's Mayor said that 1995's heatwave was blown out of proportion. France's health minister claimed the 2003 heatwave was "well managed by the health ministry". But a parliamentary commission concluded that poor political management had contributed to the disaster. Throughout central Europe, state welfare systems have traditionally provided social and medical protection. But as economies stagnate and the proportion of ageing non-taxpayers increases, these systems become increasingly unsustainable.

Specialists agree that preparedness plans should involve multiple partners, including city managers, public health and social services workers, and emergency medical officers. But practical preparedness must be complemented by a fundamental change in attitudes towards the elderly.

Individuals can take measures to protect themselves, such as arranging a time to phone a friend each day, wrapping up in cold wet towels, avoiding exercise and drinking enough liquids. However, where elderly people are too weak or poorly informed to prepare, the community (e.g. family, friends, public health authorities, elderly-care professionals) must intervene to ensure their safety.

Early warning is essential, and heatwaves can be predicted three days in advance. The US city of Philadelphia saved 117 people during heatwaves from 1995 to 1998, by:

• Using mass media to encourage friends and neighbours to visit elderly people daily;
• Activating a telephone hotline to provide information and counselling;
• Organising visits by health authorities to people requiring attention;
• Informing care homes of a high-risk heat situation;
• Increasing fire department and hospital emergency staffing; and
• Implementing daytime outreach services to homeless people.

When heatwaves become human-made disasters, it is time for the world's richest countries to reconsider their policies and values. As governments struggle to balance shrinking health budgets with rising costs for elderly care, the politics of ageing are becoming a global concern. The heatwave of 2003 highlighted what happens when the problem is ignored.

Jean Milligan, a freelance writer specializing in humanitarian and development issues, was the major contributor to this chapter. The box is contributed by Jonathan Walter, editor of the World Disasters Report.