France’s heatwave

by Chris Bertram on August 22, 2003

The latest figures from France suggest that there were up to 10,000 excess deaths in France’s recent heatwave. Chirac has called an emergency cabinet meeting and there will be an inquiry into the state of France’s medical services. As always, some kinds of people died more than others:

bq. Half the victims are believed to have died in old people’s homes, many operating with fewer staff during the August holidays. Many hospitals had closed complete wards for the month and were unable to offer sophisticated, or sometimes even basic, treatment to victims. About 2,000 people are thought to have died in their homes from the effects of dehydration and other heat- related problems while neighbours and relatives were away.

I’m a bit surprised that no-one covering this in the media has yet called on Eric Klinenberg whose analysis of the Chicago heatwave 1995 – in his book Heat Wave: A Social Autopsy of Disaster in Chicago – showed that what was at first thought of as a natural disaster had complex social causes. (UPDATE – thanks to Chris K for the link – big media in the form of today’s IHT have a piece by Klinenberg )

Here’s a snippet from an interview with Klinenberg:

bq. The death toll was the result of distinct dangers in Chicago’s social environment: an increased population of isolated seniors who live and die alone; the culture of fear that makes city dwellers reluctant to trust their neighbors or, sometimes, even leave their houses; the abandonment of neighborhoods by businesses, service providers, and most residents, leaving only the most precarious behind; and the isolation and insecurity of single room occupancy dwellings and other last-ditch low-income housing. None of these common urban conditions show up as causes of death in the medical autopsies or political reports that establish the official record for the heat disaster.

Klinenberg found that although, on the basis of the natural-environmental facts more women should have died than men, the opposite happened because old women have better social networks than old men. He also found very significant ethnic and racial differences in mortality, again attributing this largely to social networks. It would be very interesting to see the ethnic and gender breakdowns for France.

(See also an article in the Guardian by Klinenberg, from almost exactly a year ago.)



Chris K 08.22.03 at 9:41 am

One more article by Eric Klinenberg in the International Herald Tribune.

Eye catching quotes:

“In the United States, heat waves kill more people than hurricanes, tornadoes, earthquakes and floods combined.”

“Heat waves are slow, silent, and invisible killers of silent and invisible people.”

I am kind of upset by the widespread “those stupid frogs” kind of reports, posts and comments emanating from the US. There is a stench of macabre Schadenfreude in the air. Heartfelt thanks to crooked timber’s Chris for going beyond that.


eric 08.22.03 at 2:04 pm

It would indeed. It seems, that nobody planned for anything like this. (probably like in Chicago). It will be interesting to see if any real changes come about in France because of this. It is quite hot today in Philadelphia, and there are endless heat warnings; drink more water, go check on the elderly, don’t exert yourself outside, etc…


Doug 08.22.03 at 2:14 pm

Agree with Chris Bertram, it would be very interesting to find out more about who succumbed to the heat and where. More women than men, because they make up a greater proportion of the elderly? Or more men than women for the reasons Klinenberg asserts? French of European descent in neighborhoods whose ethnic makeups have changed, leaving them isolated? Elderly immigrants because they are generally poorer? Smaller localities because their facilities are less likely to be state-of-the art and more likely to be understaffed? Or larger cities because of a higher level of indifference?

I suspect that even the health authorities don’t know, as they appear to be getting things out of the aggregated data.


As for comments from the US side, schadenfreude is never edifying. On the other hand, European coverage (print and electronic) of America and American policy often seems to be nothing but schadenfreude. Iraq is only the most egregious example.

Furthermore, Europeans have been insisting for decades (at least) that their social model is caring and effective, almost infinitely better than the cold, uncaring, expensive, unjust (etc., etc.) straw-man version of US social relations that is presented for public discussion.

The Guardian articke that Chris K cites article fits the pattern: all about how terrible something is in America; neither author nor editor appears to have thought about asking whether something similar could happen in Britain or Europe. Now it has. But don’t look for the “can’t happen here” attitudes of the European press, public or governments to change.

Finally, in Europe it is a common view that life in America is cheap. But this summer in France, it looks like some people’s vacations were worth more than other people’s lives. And that’s just awful.


back40 08.22.03 at 4:37 pm

Kleinberg seems to have used data very selectively to make a point that otherwise can’t be supported. As John Wilhelm notes in the review at the link Chris provided Daley and the Chicago officals did precisely the right thing in 1995. They studied the event, made changes in policy, and averted a repeat when a 1999 heat wave posed a similar threat.

[Kleinberg] erroneously claims that … 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.

That Kleinberg continues to make false charges in 2003 is probably predictable, he has a book to sell and opportunities for columns, speaking engagements and consulting fees. But, city officials would be better off studying the reports and methods developed in Chicago to avert repeat events than continuing to reward Kleinberg and engage in witch hunts.


Chris 08.22.03 at 4:49 pm

Back 40, a quick google reveals that Klinenberg has replied to John Wilhelm, how convincingly, I cannot say.


Chris 08.22.03 at 4:58 pm

And a spot more googling reveals a longer and more aggressive response by Klinenberg to Wilhelm in the August 2003 Ideas for An Open Society. Sample quote:

bq. In fact, the only response from the city government came in a totally unexpected forum: The New England Journal of Medicine, which, in clear disregard for conflict of interest concerns,
invited John Wilhelm, Chicago’s current health commissioner and the deputy commissioner in charge of the city’s heat response in 1995, to write a scientific review of the book. Wilhelm made good use of the invitation, transforming the world’s leading health science journal into an outlet for continued denial….


Thomas Dent 08.22.03 at 5:32 pm

“…this summer in France, it looks like some people’s vacations were
worth more than other people’s lives.”

Yes, that’s awful: an awful sentence to write. Stand up in front of
someone who lost a relative in the heatwave and say that, you callous

It doesn’t lend much credibility if you decry a supposed European
tendency to make political capital out of disasters and then go on
and do it yourself.

Let’s try the game again: “Two years ago in America, it looked like
some people’s convenience at airports were worth more than other
people’s lives. And that’s awful.”

It still stinks.


back40 08.22.03 at 5:38 pm

It seems that Klineberg is in a snit because he was excluded from the commission and criticized in print for opportunism. This likely has financial and career consequences for him. Bear baiting is dangerous work.

As Eric noted earlier it is dead common now for public agencies to issue alerts to “drink more water, go check on the elderly, don’t exert yourself outside, etc…” The problem is in no way hidden. There are programs to provide cooling for those unable to pay. There are continuing efforts to reach those who have lost interest in caring for themselves or lost confidence in their ability to do so.

The social problems of poverty and isolation still exist. It is wasteful to engage in Klineberg style vindictiveness rather than making constructive efforts to identify and alleviate pressures. Using tragedy as a wedge issue for political and personal gain is unseemly, something we should reject.


Red HgS 08.23.03 at 2:30 am

I find it interesting that Klinenberg tries to portray the (supposed lack of) American reaction as another instance of our endless obsession with “individual responsibility rather than collective culpability” with a nice segue into a quote that blamed the victims. The underlying assumption of course being that this kind of individualistic thinking was backwards at best and if we would just assign blame to the collective and demand the resignation of the Minister of Such-and-Such, we would all be better off.

“Looking out for #1”, “every man is an island” is a fairly common straw man for individual responsibility — but it just doesn’t hold water in my book. We can each have a individual responsibility to look out for each other (and uphold other communitarian values) — there’s no conflict in that. The question is whether we’re going to offload the responsibility for this (and many other things) onto the state.

Yesterday I read a plausible, to me at least, explanation of the current crisis from a French woman (wish I could remember where I saw it) who blamed the thousands of deaths on people expecting the state to take care of everything — relieving them of responsibility for looking out for each other and loved ones.

Surely there’s a role for the state — in education, advance warning, accessibility of preventive measures, and treatment. But it’s foolish to pretend there’s no moral hazard in laying the blame on the state above all others as Klinenberg seems to advocate.


clew 08.23.03 at 7:49 pm

It might be proper to expect the state to take care of something (assuming one is ready to pull one’s share of the load, as a citizen of the state), but only after it’s been publicly agreed to, with details of what it will entail. That is, if one has been paying taxes for an eldercare system that’s supposed to check up on everyone, it’s much less reprehensible to leave for vacation. There’s still plenty of guilt to go around when you discover that it failed to do so, or wasn’t able to help when it found trouble.

If the French gov’t has expressed no such plan to take care of the weak, then even more personal guilt available.

The perpetual consciousness of who might be in trouble and what they might need is – in my family, certainly – traditionally women’s work. And it’s fscking tiring and thankless to run a constant background SCADA system for the people no-one else wants to take care of. Clergy do it, too, I hear. We’ve been told for a long generation that we’re going to be judged on the standards set by the people who have caretakers instead of the people who are caretakers. Of course we’re low on caretakers.


Doug 08.25.03 at 3:20 pm

From “Holocaust of the elderly: death toll in French heatwave rises to 10,000”

By John Lichfield in Paris

22 August 2003

“Half the victims are believed to have died in old people’s homes, many operating with fewer staff during the August holidays. Many hospitals had closed complete wards for the month and were unable to offer sophisticated, or sometimes even basic, treatment to victims.”

“Senior health officials have claimed ministers reacted slowly to warnings in early August that a calamity was in the making, while the Health Minister, Jean-François Mattei, has insisted he was not given adequate advice. By the time he and the Prime Minister, Jean-Pierre Raffarin, broke off holidays last week and ordered the emergency recall of hospital staff, the worst of the 10-day heatwave was over. Earlier this week, the director general of health, Lucien Abenhaim, resigned, complaining ministers had ignored his warnings, including a plea that military and Red Cross hospitals should be commandeered to ease the burden on state hospitals.”

“Dr Michel Dèsmaizieres, an emergency service doctor in Paris, told the newspaper Libération: ‘It is just not right to see [patients on] trolleys in the corridors, while whole wards were empty and locked up.'”

“Officials said 85 per cent of all public and private retirement homes in France were permanently understaffed. At holiday times, staffing levels fell even further.”

So there’s a system with little extra capacity to begin with, whose capabilities drop just as the crisis hits. The people who are supposed to give warnings gave them, but the people who are supposed to act based on the warnings didn’t.

Lichfield picks up the argument in the paper’s commentary section. The full article is pay-per-view, but the subhead makes the point:

“With so many medical staff on holiday it was impossible to prevent a catastrophe”

Why weren’t the staff called back from vacation? Why were wards locked?

There seems to have been callousness aplenty in French officialdom.

(Mark Steyn offers trenchant observations and a comparative perspective:

(Back on the 16th, CNN had lots of quotes from the political side, including one from Raffarin that has to be seen to be believed )


Robert Schwartz 08.26.03 at 6:11 am

Washington Post, August 25, 2003 “PARIS – Up to 400 unidentified or abandoned bodies awaited temporary burial Monday near Paris as authorities struggled with the fallout of France’s deadly heat wave, news reports said. . .

While many opposition leaders have criticized the center-right government for an allegedly slow response to the crisis, newspapers and editorial writers faulted French citizens in general.

“These forgotten dead,” wrote daily France-Soir in a front-page headline Monday.

Under the headline “French Barbarity,” Renaud Girard, an editorialist for Le Figaro newspaper, wrote: “It’s not up to the Father State to take care of our elderly. It’s up to us.” . . .”

So maybe it is not the lack of enough socialism?

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