Things are Hotting Up: the fallacy of Loneliness Surveys

Nowhere is the need for resilient communities more apparent than in the face of natural disasters, and heat waves, more so than hurricanes, floods and freezing conditions punctuate this fact, and highlight the pressing need for community building at neighbourhood scale to ensure sufficient resilience to withstand new and increasing climatic challenges into the future. Heat waves as with other natural disasters also highlight the limits of health and social care systems to unilaterally intervene.

In 2005 Hurricane Katrina exacted a death toll of 1,836 as it wrecked havoc and devastation across New Orleans and the Gulf Coast, the world watched on in horror, city and federal systems were rendered helpless in the face of this tragedy, as real time images were piped into our living rooms. Two years prior, in August 2003 a heat wave struck Europe, killing an estimated 70,000 people, most were over 65years old, but the media, and the public for the most part were oblivious until well after the fact.

A high-pressure system produced the hottest summer weather since record keeping began in 1873 and when measured by mortality the worst natural disaster in contemporary France.

According to official estimates, 14,802 people died in France during the first half of August 2003 as a direct consequence of this heat wave. There were many factors at play in France and in particular in Paris, that did not play out in other European cities to the same extent, such as London for example where 600 people died. Nearly 6,000 died in Paris; August is a time when most professionals go on holidays in France; the first to realise the scale of what was happening were french undertakers, who were being overwhelmed by the body count.

While the number of doctors and other healthcare professionals on vacation was an important factor in that it reduced response time and capacity, there were a variety of other factors also at play. These included the density of population and quality of housing in any given area, but during the first two weeks of August in Paris, 2003, the people most likely to die were women over 65 living alone and in substandard urban housing.

Others contributory factors included the collective impact of air conditioning on the cumulative heat and cooling down time of a city particularly at night (most Older People, infants, and vulnerable people die at night, during heat waves. The heat island around the respective houses and apartment blocks were measured retrospectively, they proved that while ‘cities often function as the beating heart of the economy, they could also become the pressure cookers of a country’, as was the case in Paris for those two weeks. The extent of vegetation in the environs is also a critical issue and along with lower housing density explains why only 600 people died in London a little over 10% of the death toll in Paris, where green space abounds relative to Paris.

It is also important to remember that generally people are not attenuated to the effects of dehydration and so tend not to drink sufficient water, and further that some medications can amplify the effects of extreme heat. That combination in itself can be deadly. Reduced mobility was another critical factor. Yet according to Richard Keller the single biggest contributory factor for dying in a heat wave is: living alone. It may be more helpful to interpret that critical factor in terms of the extent to which one is connected to the wider community of place. In that frame, as against viewing the practice of living alone as the substantive issue, we see that it is the paucity of relationships with neighbours that kills within the context of a certain confluence of events. Put boldly, for the most vulnerable, in a prolonged and intense heat wave, community connections, not access to services are a matter of life and death.

Keller rightly points out that the heat wave of 2003 was as much a social as a health and epidemiological disaster. The interplay between quality of housing, economic insecurity, isolation and health equity are well rehearsed, but when set against global demographic shifts and climate change the immensity of the challenges facing public health and our neighbourhoods becomes clear.

Analysis
While seismic shifts are difficult if not impossible to spot ahead of time, in demographic terms we are experiencing more than our fair share. In 1950 the worlds population stood at 2.4 billion, in 1985 it had reached 5 billion and by 2020 it is projected to reach 8 billion. In a decade or so the world will be older and will be far more concentrated in urban areas; indeed in the next five years for the first time in human history, a majority of the world’s population will live in cities. (Ref) The speed at which the world grows older is mind boggling: in the year 2000, 420 million people were 65 or older (6.9% of the world’s population); by 2050 this cohort is projected to increase to approximately 1.5 billion, or 16.3 % of the total population of the world. The world is getting older at a rate unprecedented in human history.

Outside the Global South aging combined with large drops in fertility means fewer workers to support growing numbers of retirees, pushing inflation up, and tax take for public services down. Increased longevity sits side by side with other demographic “firsts” that are quickly exposing the financial limits of our medical systems and social services, and raising serious questions about their capacity to unilaterally improve health, social care and promote general well being.

The 2003 Heat wave provides a tragic reminder of the need to concern ourselves not alone with institutional and systems reform but also and more importantly with an effort toward building communities of place, with a view to supporting local people to identify, connect and mobilise their own and their neighbours assets in pursuit of a good life and enduring change. We will not achieve these objectives by conducting needs map or loneliness surveys.

Conclusion: The Fallacy of Loneliness Surveys
Public Sector workers in Paris in August 2003, like public sector workers at any other time, anywhere else in the world can’t unilaterally address loneliness, since there is no service or programme for loneliness, any more than they could provide service to single handedly counter the affects of the heatwave. To paraphrase Margaret Wheatley, if loneliness is the question, community is the answer, and that is why agencies conducting loneliness surveys, will not alone fail to achieve their ambition of reducing loneliness, but will more than likely create the opposite of what they intend.

Can you think of anything more lonely making than being a client of a bespoke service to de-programme your loneliness? Well imagine how redundant such programmes would be in a heatwave. Reduction of loneliness is a systems based ambition, because it is topical, measurable and controllable. It’s an ambition that creates the illusion of hitting the target, but in the end inevitably misses the point. The point being: finding ‘X’ number of lonely people in a disconnected community and placing them in ‘Y’ number of programmes is tantamount to allowing the remedy define the ailment. Loneliness is not the absence of programmes, but of a sense of belonging and having valued roles in community (non-professionalised) life and life in general (citizenship), the solution therefore is found in community building at neighbourhood level, not in loneliness surveys. Lets hope our systems and our citizens figure that out before the next extreme heat wave.

Cormac Russell

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