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One swallow does not make a summer

At the start of the winter, it might seem strange to write about swallows and summers, especially when we have just had the news that 21,700 older people died of cold related illness last year. That wasn’t 21,700 people. It was ten times that number because over the last 10 years, an average of over 26,000 have died each winter. You might be tempted to think that these deaths would have happened anyway and that they are ‘just brought forward’ by the cold of winter. But all the evidence tells us that this is not the case. Every single death is unnecessary, avoidable, preventable. For any other preventable cause of death this would be a national scandal. There would be outcry, protest, even outrage. And even more so when we know that this has been going on for over 150 years, since 1841 when the then registrar general, William Farr (who also happened to be Florence Nightingale’s statistician) first recorded an excess of winter deaths over the summer. A conservative estimate tells us that this amounts to an all-time, truly shocking total of over some 3 million deaths.

For the last 30 years there has been a debate about cause but the evidence shows that the over-riding reason for these deaths is the personal exposure of the individual to cold temperatures. This cause was first revealed by Curwen’s ‘regression model’ in 1997 when he showed that there were three factors most associated with excess winter deaths. These factors were secular trend (roughly equating to improvements in standard of living); influenza (only in epidemic years) and temperature. Of these three, the most strongly associated was temperature. Experts in physiology have now shown how exposure to cold contributes to the main causes of death, notably heart attack, strokes (caused by clotting) and respiratory illnesses. Interestingly, there is the paradox that although cold temperatures are the major cause, the colder countries of the world show much less winter mortality than in the British Isles. This is explainable in terms of our behaviour to cold. In Britain, there is little respect for its potential lethality. Even a casual comparison of the behaviour I have seen in Canada (where no-one ventures out from their superbly insulated homes without adequate clothing) with the UK (where it is common to see light clothing in the winter) reveals this to be the case. And in Yakutsk, the coldest city in the world, there is no excess winter mortality. It would be true to say that the Siberian body is kept at tropical temperatures inside the home and out.

But it is not all bad news. Over the last 50 years there has been a steady decline in the number of winter deaths. Partly this may be explained by the improvement in indoor temperatures and some would say outdoor ones too. So much so that it has been argued that all we have to do is wait and we shall see an end to winter deaths as an unlikely benefit of global warming. And that brings me to the swallow. A paper published in the American Journal of Epidemiology makes the case of the declining vulnerability of the population to cold in the UK. One paper, as we say in science, does not make a paradigm. My knowledge of climate, physiology and ageing leads me to believe that we cannot make the assumption that the phenomenon of winter deaths will just taper away. And there is a disturbing but almost hidden nuance in the latest figures which gives us cause for concern. Though there has been an 8% decline in all age winter deaths and a 3% decline in deaths over 65, there has been a 1% increase in deaths over 75 and a 7% increase in those over 85 – the fastest two segments of our ageing population. And this in a relatively mild winter.

That is why Age UK will continue to campaign for public health measures to address the cold and misery that many older people endure in the UK winter, at a time where fuel poverty is on the increase and the proportion of the oldest old, the most vulnerable in society, is rising.

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