Medical Examiner

Dead Heat

Why don’t Americans sweat over heat-wave deaths?

It’s not easy to picture a heat wave. We all carry stock mental photos of more camera-ready extreme weather, such as hurricanes, tornadoes, earthquakes, and floods. These natural disasters are so visually spectacular that they make the front page or the TV news even when they occur in remote places. Extreme heat, on the other hand, is invisible.

But heat waves kill more people in the United States than all of the other so-called natural disasters combined. More than 400 Americans die from heat-related illnesses in a typical year. Annual mortality from tornadoes, earthquakes, and floods together is under 200. Since heat waves inflict damage on the nation’s major cities, well within the range of most media organizations, the lack of visibility or panic is all the more mysterious.

Heat-wave deaths aren’t the worst natural disasters only in quantitative terms, but also in qualitative ones because they’re slow and preventable. There’s no telling when an earthquake will strike. But dangerous heat always comes announced, and it’s fairly easy to prevent human damage. Victims of heat tend to wilt gradually, alone and at home, out of touch with family, friends, and social-service providers who could save their lives simply by treating them with water or bringing them to an air-conditioned place.

In the past three decades, New York City (1972, 1984), St. Louis (1980), Philadelphia (1993), Dallas (1998), and Milwaukee (1995) have experienced massively deadly heat waves. But in recent years, Chicago has become the national epicenter of heat mortality. This summer, Chicago had recorded 27 heat-related deaths by July 22. That’s small by current standards. In one week of July 1995, 739 Chicago residents—the majority of them home alone—died in one of the greatest and least-known American disasters in modern history.

To place the 1995 heat wave in context, think of the great Chicago fire of 1871. It killed less than half as many people. Other recent catastrophes, such as the Northridge, Calif. earthquake of 1994 or Hurricane Andrew of 1992, killed one-tenth and one-twentieth the number of people, respectively. Yet several lists of the most fatal American weather events of the 1990s fail to include the heat wave. In the words of the New England Journal of Medicine, the Chicago disaster “was forgotten as soon as the temperatures fell.”

That’s generous. From the moment the local medical examiner began to report heat-related mortality figures, political leaders, journalists, and in turn the Chicago public have actively denied the disaster’s significance and questioned whether the deaths were—to use the popular local phrase—”really real.” Although so many city residents died that the coroner had to call in nine refrigerated trucks to store the bodies, skepticism about the trauma continues today. In Chicago, people still debate whether the medical examiner exaggerated the numbers and wonder if the crisis was a “media event” that the press had “propped up somehow.” The American Journal of Public Health definitively established that the medical examiner’s numbers actually undercounted the mortality by about 250 since hundreds of bodies were buried before they could be autopsied. But how many people read the American Journal of Public Health?For now, the heat wave stands as a nonevent—perhaps a footnote—in the grand narrative of affluence and revitalization that dominates accounts of urban life in the 1990s.

The mass grave site of Chicago’s 1995 heat-wave victims

One reason so many people die in heat waves is that more Americans seem to be living and dying alone than ever before. In San Francisco, for example, officials report that they discovered almost as many cases of people who died alone, with no one to claim their bodies and estates, during the first six months of 2000 as they had in the previous decade. In Chicago, one month after the 1995 heat wave, county officials buried 68 people, most of them heat-wave victims, in a 160-foot-long trench.

Could it happen again? It already did. In 1999, over 110 Chicagoans perished in a late-July and early-August heat spell despite an exemplary response from city government that undoubtedly saved lives. Clearly, industrious local officials can only do so much.

There are a few simple and relatively inexpensive measures that could prevent future heat deaths. Cities can implement the heat-warning system designed by Laurence Kalkstein at the University of Delaware, a system that distinguishes dangerous air masses from ordinary summer heat. We can expand the supportive housing and social-service programs available to the people most likely to die in heat waves. And Congress can provide the poor with energy subsidies for summer cooling, just as it does for winter heat. (Rep. Danny Davis is now mobilizing support for such a bill.) Although it is cheap and effective, the Low Income Home Energy Assistance Program remains a favorite target of budget-cutters. In most cities LIHEAP funds run out long before the need ends. Just one week after the heat wave of 1995, with dozens of victims still unclaimed in Chicago, the House overwhelmingly approved a proposal to reduce LIHEAP funds. But compared to the cleanup costs and refunds the federal government routinely doles out to homeowners and corporations who suffer property damage in other disasters, the costs of preventing heat deaths are low. It’s just a question of whether we value the lives of poor city dwellers as much as the property of wealthy coastal developers.